GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n¼5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]¼1.16; 95% confidence interval [CI], 1.04e1.28

Conclusions: Treatment of de novo superficial femoral artery (SFA) lesions with paclitaxel-eluting balloon (PEB) angioplasty, followed by stenting, is superior to balloon angioplasty (BA) and stenting or directional athererctomy (DA) regarding angiographic diameter stenosis at 6 months and target lesion restenosis (TLR) at 24 months.Summary: The many percutaneous avenues of treating the SFA include balloon angioplasty, stents, atherectomy, and various combinations. The ISAR-STATH (Intravascular Stenting and Angiographic Results: A randomized trial comparing paclitaxel-eluting balloon angioplasty plus stenting versus standard balloon angioplasty plus stenting versus directional atherectomy for symptomatic femoral artery disease) trial was a prospective, randomized, active-controlled, open-label trial at two German centers designed to assess the effects of stenting after PEB angioplasty compared with stenting after conventional BA or DA on SFA restenosis in patients with intermittent claudication. The angiographic inclusion was a de novo stenosis >70% to 100% occlusion of the SFA. Exclusion criteria were significant untreated inflow disease (>70% iliac artery stenosis), acute ischemia from SFA occlusion, previous SFA stenting, popliteal stenosis >70%, or renal insufficiency (estimated glomerular filtration rate <30 mL/min/1.73 m 2 ) as well as life expectancy <1 year and contraindication to required medications. Randomization was by sealed envelopes containing computer-generated sequence after the decision to intervene was made and was to a 1:1:1 ratio. In general, the lesion was crossed with a 0.014-inch guidewire and supporting 4F catheter with a small "dissection reentry" 0.035-inch guidewire if intraluminal passage was not possible. With the wire in the distal lumen, randomization took place. In both angioplasty cohorts, predilation to a vessel-to-balloon ratio of 1:1 was achieved with a standard balloon. In the PEB angioplasty group, an additional dilation of the entire lesion with a PEB for 2 minutes was preformed to a 1:1 diameter just before nitinol stent placement oversized by 1 mm (Smart Stent) and exceeding the lesion length by 5 mm on each side. The BA cohort was treated with stent placement in a similar fashion, and in both groups, poststent balloon angioplasty used standard balloons. In the DA cohort, a Spider filter was deployed in the popliteal artery for distal protection, and the SilverHawk plaque excision system was used to remove plaque. If residual stenosis was >50% or flow-limiting dissection was present, inflation with standard BA to a 1:1 diameter for 1 minute at low pressure was attempted with a nitinol stent placed for persistent residual stenosis of >50% or flow-limiting dissection. Technical success was defined as <30% residual stenosis. Peri-interventional medications were 500 mg of aspirin (12 hours before by mouth or intravenously at the time of the intervention) and 5000 units of intra-arterial heparin. Postintervention medications were aspirin (100 mg daily) indefinitely and clopido...

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO 2 <90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions:The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348.

Recurrent malignant pleural effusion (MPE) is a common concomitant phenomenon of malignant disease, which can worsen the patient's quality of life and lead to significant morbidity. Tunneled indwelling pleural catheters (TIPC) offer new modalities in patients with recurrent MPE and impaired dilatability of the lung. We report on our experience with 100 consecutive patients suffering from recurrent benign (n = 12) and malignant pleural effusion (n = 88) who were treated with TIPC. The catheter was placed during a VATS procedure or under local anesthesia in an open technique. The median residence time of the TIPC was 70 days; spontaneous pleurodesis was achieved in 29 patients. The rate of complications was low: pleura empyema (n = 4), accidental dislodgement (n = 2), malfunction of the drainage (n = 3). In conclusion, TIPC is a useful method for the palliative treatment of patients with recurrent malignant or nonmalignant pleural effusions and 3 groups of patients seem to benefit most: a) patients with the intraoperative finding of a trapped lung in diagnostic VATS procedure; b) patients after a history of repeated pleuracenteses or previously failed attempts at pleurodesis; c) patients in a reduced condition with a limited lifespan due to underlying disease.