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SummaryWe conducted a postal survey of cardiac anaesthetists in the UK, to determine the extent of magnesium sulphate (MgSO 4 ) use and the main indications for its administration. Questionnaires were sent to anaesthetists at 35 UK hospitals undertaking adult cardiac surgery. Responses were received from 24 hospitals (69%) totalling 124 individual responses. Twenty-five (20%) of the anaesthetists responding to the questionnaire routinely gave magnesium other than in cardioplegia. The most common indications for administration were arrhythmia prophylaxis and treatment, myocardial protection and the treatment of hypomagnesaemia.Keywords Anaesthesia; cardiovascular. Heart; arrhythmia, prevention. Ions; magnesium. Magnesium deficiency is common in hospitalised patients [1]. It may be related to diuretic and beta-blocker therapy, and is more common in the cardiac surgical population [2, 3]. Hypomagnesaemia is common following cardiopulmonary bypass (CPB), and persists into the postoperative period [4]. It is associated with a higher incidence of arrhythmias and a low cardiac index [2]. However, the routine administration of magnesium sulphate during cardiac surgery remains controversial. Several studies support its routine administration for arrhythmia prophylaxis [5][6][7][8], whereas others oppose this view [9, 10] and even suggest a detrimental effect from magnesium administration [11]. This survey was conducted to investigate the attitudes and current practice of cardiac anaesthetists in the UK to the routine administration of magnesium sulphate. MethodsFollowing approval from the Association of Cardiothoracic Anaesthetists (ACTA), postal questionnaires (Appendix) were sent to the ACTA contact in 35 adult cardiac surgery centres for distribution to consultant anaesthetists. The questionnaire was designed to examine the incidence of routine magnesium sulphate use, the dose and timing of its administration, the indications for its use, the frequency of serum magnesium measurements and the reasons for avoiding its routine use. ResultsReplies were received from 24 (69%) hospitals. A total of 124 individual questionnaires were completed. Of these, 25 (20%) of anaesthetists routinely administered magnesium sulphate.Of those who gave magnesium routinely, 76% administered it during CPB. The most common dose used was a 2-4 g (8-16 mmol) bolus. The main indications were arrhythmia prophylaxis, myocardial protection and suspected hypomagnesaemia associated with hypokalaemia and diuretic therapy. Several respondents commented on its usefulness in patients with poor left ventricular function and a reduction in inotropic support requirements post CPB.Thirty-six per cent of anaesthetists administer magnesium post CPB (24% during and post CPB), mainly as a bolus of 2-4 g. Indications given are arrhythmia prophylaxis and treatment, and measured hypomagnesaemia.Thirty-two per cent of anaesthetists administer it pre-CPB. A larger bolus dose of 5 g is most frequently given. The numerous indications stated include arrhythmia Anaesth...

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Background Laparoscopic appendectomy (LA) has become the standard of care for the management of acute appendicitis in adult patients. Despite the increasing experience in laparoscopy, conversion to open surgery might still occur. We aimed to identify preoperative and intraoperative risk factors for conversion and determine surgical outcomes in this population. Methods We performed a retrospective analysis of a consecutive series of patients undergoing LA during the period 2006–2020. The cohort was divided into two groups: patients who underwent a fully laparoscopic appendectomy (FLA) and patients who were converted to open appendectomy (CA). Demographics, perioperative variables and postoperative outcomes were compared between both groups. Independent risk factors for conversion were determined by logistic regression analysis. Results A total of 2193 patients were included for analysis; 2141 (98%) underwent FLA and 52 (2%) CA. Conversion rates decreased significantly over time ( p = 0.006). Patients with CA had significantly higher overall postoperative morbidity rates (FLA 14.9% vs. CA 48.0%, p < 0.0001) and longer mean length of hospital stay (FLA 1.7 vs. CA 5 days). In the multivariate analysis, obesity ( p < 0.001), previous abdominal operations ( p = 0.013), peritonitis ( p = 0.003) and complicated appendicitis ( p < 0.001) were independent risk factor for conversion. Conclusions Although conversion from laparoscopic to open appendectomy is infrequent and has decreased over time, it is associated with significantly higher postoperative morbidity. Patients with previous abdominal operations, obesity and complicated appendicitis should be thoroughly advised about the higher risk of conversion.

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