SummaryDexmedetomidine, a highly selective and potent a 2 -adrenergic agonist, has a potentially useful role as a sedative agent in patients requiring intensive care. As part of a larger European multicentre trial, a total of 119 postoperative cardiac and general surgical patients requiring ventilation and sedation in an intensive care unit were enrolled in four centres in the United Kingdom. One hundred and five patients were randomly allocated to receive either dexmedetomidine or placebo with rescue sedation and analgesia provided by midazolam and morphine, respectively. Compared with the control group, intubated patients receiving dexmedetomidine required 80% less midazolam [mean 4.9 (5.8) mg.kg ¹1.h ¹1 vs. 23.7 (27.5) mg.kg ¹1.h ¹1 , p < 0.0001], and 50% less morphine [11.2 (13.4) mg.kg. Cardiovascular effects and adverse events could be predicted from the known properties of alpha-2 agonists. In conclusion, dexmedetomidine is a useful agent for the provision of postoperative analgesia and sedation.

In patients undergoing coronary artery bypass grafting surgery, the cyclooxygenase 2 inhibitor combination, parecoxib/valdecoxib, was effective for postoperative analgesia. However, the 14-day treatment regimen also was associated with an increased incidence of serious adverse events overall and sternal wound infections in particular. Therefore our study raises important concerns requiring their comprehensive evaluation in a large-scale trial before these cyclooxygenase 2 inhibitors are used in patients undergoing coronary artery bypass grafting surgery.

Transoesophageal echocardiography (TOE) is a standard and indispensable technique in clinical practice. The present recommendations represent an update and extension of the recommendations published in 2001 by the Working Group on Echocardiography of the European Society of Cardiology. New developments covered include technical advances such as 3D transoesophageal echo as well as developing applications such as transoesophageal echo in aortic valve repair and in valvular interventions, as well as a full section on perioperative TOE.

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Treatment with recombinant human antithrombin III in a dose of 75 U/kg is effective in restoring heparin responsiveness and promoting therapeutic anticoagulation for cardiopulmonary bypass in the majority of heparin-resistant patients. Two units of fresh frozen plasma were insufficient to restore heparin responsiveness. There was no apparent increase in bleeding associated with recombinant human antithrombin III.

I.v. anaesthetic agents, including propofol, have not been shown to inhibit hypoxic pulmonary vasoconstriction (HPV). This may encourage the use of propofol in thoracic surgery where one lung ventilation (OLV) is required. We have compared the effects of maintaining anaesthesia with either isoflurane or propofol infusion on right ventricular function and shunt fraction. We studied 10 patients who received isoflurane and 12 who received propofol. When OLV commenced there was a greater reduction in both mean cardiac index (3.2 (SEM 0.2) to 2.4 (0.1) litre min-1 m-2 for propofol, and 3.4 (0.2) to 3.3 (0.4) litre min-1 m-2 for isoflurane) and right ventricular ejection fraction (0.45 (0.03) to 0.37 (0.02) for propofol, and 0.48 (0.02) to 0.42 (0.02) for isoflurane) in patients who received propofol. Furthermore, these reductions were sustained for longer in the propofol group. However, propofol was not associated with a significant increase in shunt fraction during OLV, which increased threefold in patients who received isoflurane.

SummaryWe undertook this survey to identify the trend in the published output of original research in anaesthesia emanating from the United Kingdom (UK) in a 10-year period from 1997 to 2006, inclusive. We examined seven major anaesthetic journals for each of the 10 years, and four other specialist journals for the years 1997, 2000, 2003 and 2006. We included papers on experimental research, randomised controlled clinical trials, large observational studies and case series, formal equipment and apparatus assessments, but we excluded editorials, comments, reviews including systematic reviews, special articles, small case series and case reports, questionnaire surveys of clinical practice and correspondence. We found a highly significant reduction in published research output from the UK in the period under study (% change per year; )5.7 (95% CI )7.4 to )4.0), a trend which was significantly different (p < 0.001) from the trend of changes in research publications worldwide ()1.0% change per year; 95% CI )1.7 to 0.0). We discuss the implications of these findings for UK anaesthesia research strategy.

An increasing number of patients aged>or=70 years are presenting for elective non-cardiac surgery. We undertook this study to: (i) compare the nature and distribution of cardiovascular disease (CVD) risk factors in an at risk population of patients aged>or=70 years undergoing elective surgery compared with a younger at risk cohort; and (ii) identify the impact of age and other risk factors on 6-month survival. We conducted a prospective observational study of patients undergoing elective non-cardiac surgery. A total of 1622 patients aged>or=40 years with recognised surgical or patient-specific risk factors for CVD were identified. The patients were divided into two groups; group 1 (aged: 40-69 years) and group 2 (aged>or=70 years). Logistic regression was used to identify the factors associated with 6-month mortality. Odds ratios (OR) and 95% confidence interval (CI) are presented. In hospital, mortality was similar in both groups. However, 6-month mortality in those aged>or=70 years was significantly higher (p=0.001). Cardiovascular symptoms were significantly more common in group 2 (p<0.001) as were cardiovascular-related deaths (p=0.04) at 6 months follow-up. Preoperative cardiovascular preventative therapy was under prescribed in the elderly cohort. Factors independently associated with 6-month mortality were aged>or=70 (OR=3.57, 95% CI: 2.22-5.73), angina (OR=2.0, 95% CI: 1.26-3.20), renal impairment (OR=2.39, 95% CI: 1.17-4.89) also operation type and duration. Despite similar in-hospital mortality, those aged>or=70 years had significantly higher 6-month mortality than the younger surgical cohort. Cardiovascular deaths were significantly higher in patients aged>or=70 years. Effective identification and the management of cardiovascular risk factors may improve 6-month survival.