We studied 20 adult ASA I patients undergoing elective peripheral surgery allocated randomly to one of two groups. In the propofol group (n = 9) anaesthesia was induced with propofol and fentanyl followed by continuous infusion of propofol. In the control group (n = 11), after induction of anaesthesia with thiopentone and fentanyl, anaesthesia was maintained with isoflurane. Concentrations of lipid peroxides in both plasma and muscle tissue samples were measured as thiobarbituric acid-reacting substances (TBARS). Plasma TBARS concentrations increased significantly in the control group at 1, 5, 15, 30 and 45 min after release of the tourniquet to mean 1.83 (SD 0.13), 2.00 (0.12), 2.25 (0.14), 2.30 (0.12) and 2.41 (0.14) mumol litre-1, respectively, compared with pre-reperfusion values (1.64 (0.14) mumol litre-1). In the propofol group this was significant only at 30 min (1.85 (0.03) vs 1.74 (0.04) mumol litre-1). TBARS concentrations of reperfused muscle tissue were significantly higher than pre-reperfusion concentrations in the control group (70.30(10.06) vs 52.13 (5.73) nmol/g wet tissue). We conclude that propofol attenuated ischaemia-reperfusion-induced lipid peroxidation in the therapeutic doses used in anaesthesia.

Ann R Coll Surg Engl 2005; 87: 348-352 348Fractures with arterial injury requiring vascular repair are severe injuries. This type of fracture is often associated with severe soft-tissue compromise and damage of neurological structures.1-3 Amputation rates after these injuries vary widely depending in large part on the degree of skeletal and soft tissue destruction. Amputation rates as low as 4% have been reported with isolated arterial injuries, although rates as high as 61% have been seen when combined vascular, skeletal, and soft tissue injuries are present. [4][5][6] In this study, we have evaluated our experience with a subset of patients who had a combination of vascular injury and limb fracture. Patients and MethodsBetween 1985 and 2002, we treated 192 patients with limb fractures and concomitant vascular injury. The records from these 192 cases were retrospectively reviewed. Data including mechanism of injury, location and severity of vascular and orthopaedic injuries, methods of vascular and orthopaedic repair, and amputation rates were collected. Primary amputations are excluded in this study.There were 168 men and 24 women. The mean age was 26 years (range, 3-65 years).Upon arrival, an initial injury assessment was performed, life-threatening injuries treated, and fluid resuscitation was started. Following stabilisation, a focused extremity examination was performed. The presence of pulses in the extremities was determined by palpation. If pulses were absent, arterial Doppler signals were assessed in the emergency room using a hand-held Doppler instrument. Orthopaedic consultation was obtained for all patients. Bone injuries were classified as either open or closed and by the number of bones fractured based on physical examination and radiological studies. Open fractures were further classified according to the grading system of Gustilo et al. 5 All orthopaedic injures were stabilised in the emergency room with external splints.Pre-operative arteriograms were used in patients in whom an arterial injury was suspected by physical findings The goal of therapy in all patients with combined orthopaedic and vascular injuries of the extremities is salvage of a functional limb. In this study, we have evaluated our experience with a subset of patients who had a combination of vascular injury and limb fracture.

No abstract

Postoperative atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). The mean platelet volume (MPV) is an important marker of platelet activity and is associated with cardiovascular risk factors. We investigated whether the MPV is associated with the development of AF after CABG. This study included 208 patients undergoing elective isolated CABG. We evaluated the standard preoperative 12-lead electrocardiograph (ECG) recorded at a paper speed of 25 mm/s obtained for each patient from our hospital records before surgery. All study patients underwent standard CABG requiring cardiopulmonary bypass without concurrent valvular surgery. Forty-three patients were excluded. After CABG, all patients were monitored by telemetry and 12-lead ECGs. AF was defined using the established Society of Thoracic Surgeons definition. Postoperative AF occurred in 38 (22%) patients. The hemoglobin and platelet and leukocyte counts were similar in the groups with and without AF. However, the MPV and neutrophil/lymphocyte ratio were significantly higher in the AF group (8.9 [1.4] vs. 7.9 [1.2], p < 0.001 and 3.2 ± 1.9 vs. 2.6 ± 1.2, p = 0.005, respectively). In addition, the C-reactive protein (CRP) levels were significantly higher in the AF group (8.9 [19.6] vs. 5.3 [8.7], p = 0.025). Multivariate logistic regression analysis showed that MPV and CRP were independent predictors of postoperative AF (odds ratio [OR] 2.564, 95% confidence interval [CI] 1.326-4.958, p = 0.005; OR 1.055, 95% CI 1.000-1.114, p = 0.050, respectively). Our results show that increased platelet activity is associated with the development of AF after CABG.

In this study, LA maximum volume and PA-TDI duration were found to be the independent predictors of the development of POAF after CABG. Echocardiographic predictors of left atrial electromechanical dysfunction may be useful in risk stratifying of patients in terms of POAF development after CABG.