Perioperative medicine is rapidly emerging as a key discipline to address the specific needs of h... more Perioperative medicine is rapidly emerging as a key discipline to address the specific needs of high-risk surgical groups, such as those on chronic dialysis. Crude hospital separations rates for chronic dialysis patients are considerably higher than patients with normal renal function, with up to 15% of admission being related to surgical intervention. Dialysis dependency carries substantial mortality and morbidity risk compared to patients with normal renal function. This group of patients has a high co-morbid burden and complex medical need making accurate perioperative planning essential. Existing perioperative risk assessment tools are unvalidated in chronic dialysis patients. Furthermore, they fail to incorporate important dialysis treatment-related characteristics that could potentially influence perioperative outcomes. There is a dearth of information on perioperative outcomes of Australasian dialysis patients. Current perioperative outcome estimates stem predominantly from North American literature, however the generalizability of these findings is limited, as the survival of North American dialysis patients is significantly inferior to their Australasian counterparts and potentially confounds reported perioperative outcomes; let alone regional variation in surgical indication and technique. We propose that data-linkage between high-quality national registries will provide more complete data with more detailed patient and procedural information to allow for more informative analyses to develop and validate dialysis specific risk assessment tools.
Functional capacity is an important component of risk assessment for major surgery. Doctors' ... more Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed...
Plectranthus is a genus which belongs to the family of Lamiaceae. Even though numerous studies ha... more Plectranthus is a genus which belongs to the family of Lamiaceae. Even though numerous studies have been carried out on plants belonging to this family, Plectranthus remains a genus in which a lot of incongruity exists. Even though Plectranthus hadiensis is used as a medicinal herb, the information regarding it is scanty and not well documented. Our study focuses on the pharmacognostic studies and the phytochemical screening of Plectranthus hadiensis, previously known as Plectranthus zeylanicus or Coleus zeylanicus. The study includes macroscopy and microscopy, anatomy and phytochemistry of the stem of Plectranthus hadiensis. Phytochemical screening of the plant revealed the presence of phenolics, flavonoids, tannins, alkaloids, proteins and carbohydrates. The detailed pharmacognostic account of P. hadiensis which includes macroscopic and microscopic characters will be helpful for the correct botanical identification of the plant. The study scientifically validates the use of the pl...
Antiphospholipid antibodies (aPL) have been reported not only in autoimmune disorders but also in... more Antiphospholipid antibodies (aPL) have been reported not only in autoimmune disorders but also in various infectious diseases. Accumulating evidence indicates that b2 glycoprotein I (b2GPI) and prothrombin are the main proteins to which autoimmune aPL bind. The aim of this study was to evaluate the prevalence of different aPL in patients with leprosy. We included 51 outpatients (42 lepromatous and 9 borderline leprosy) without any clinical feature of the antiphospholipid syndrome (APS). 35 had lupus anticoagulant and 31 had anticardiolipin antibodies (aCL). Anti-β2GPI antibodies were highly positive in 29=51 and anti-prothrombin antibodies (anti-II) were detected in 23=51. Almost all aCL and anti-b2GPI were of IgM isotype, while IgG isotype was more frequent among anti-II. No statistical difference was found when aPL were evaluated in patients grouped according to their bacteriological status. Furthermore, patients under treatment (n ‘ 33) had a similar frequency of positive aPL com...
Three situations in which an anaesthetic assistant might be able to detect accidental oesophageal... more Three situations in which an anaesthetic assistant might be able to detect accidental oesophageal intubation during or immediately after intubation were assessed. These were: firstly, whilst applying cricoid pressure, secondly, whilst applying gentle palpation over the trachea just above the suprasternal notch and, thirdly, after intubation by means of a 'roll test'. During cricoid pressure, tracheal intubation was correctly diagnosed in all of 10 cases. However, deliberate oesophageal intubation was only detected in six out of 10 cases. During suprasternal palpation, three cases out of 10 oesophageal and three cases out of 10 tracheal intubation were misdiagnosed. In the 'roll test', two out of 10 tracheal and five out of 10 oesophageal intubations were misdiagnosed. In conclusion, no method could be relied on entirely and may indeed give false reassurance. Nonetheless, any doubt expressed about the tracheal tube position by the assistant should be taken seriously and a careful check made.
We report three cases of anaphylaxis during anaesthesia confirmed on intradermal testing to be re... more We report three cases of anaphylaxis during anaesthesia confirmed on intradermal testing to be related to patent blue V dye (Guerbet – Chemical Service 3536-49-0). All three cases were associated with moderate to severe hypotension. Two cases had delayed onset, and two were associated with a rash. None of the cases were associated with bronchospasm. In all three patients the interference with pulse oximetry readings contributed to difficulties in management. We recommend the use of a test dose of blue dye prior to surgery, as suggested in the manufacturer's product information. We also recommend high vigilance for possible allergic reactions when patent blue dyes are used for sentinel lymph node mapping, because the presentations may be atypical and the reduced pulse oximetry readings may be a distraction.
The prophylactic anti-emetic efficacy and safety of pre-operative intravenous ondansetron was eva... more The prophylactic anti-emetic efficacy and safety of pre-operative intravenous ondansetron was evaluated in a randomised, double-blind, comparison with droperidol, metoclopramide and placebo in 160 ASA grade 1 and 2 patients undergoing laparoscopic cholecystectomy under total intravenous anaesthesia. The patients were randomly allocated to receive ondansetron (4 mg), droperidol (1.25 mg), metoclopramide (10 mg) or placebo given as a single intravenous dose immediately before induction of a standardised general anaesthetic. There were no significant differences between the four study groups with regard to the demographic and anaesthetic data, postoperative analgesia, postoperative sedation scores, duration of postoperative hospital stay and incidence of adverse events. The incidence of nausea and vomiting was significantly lower (p`0.05) between 1 h and 4 h after surgery in the ondansetron group compared with the droperidol, metoclopramide and placebo groups. The incidence of nausea was similar in the four groups in the other study periods: 0-1 h and 4-24 h. The incidence of vomiting was lower in the ondansetron, droperidol and metoclopramide groups than in the placebo group between 1 and 4 h but was the same between 4 and 24 h. As a result of the lower incidence of nausea and vomiting between 1 h and 4 h in the ondansetron group, the overall incidence of nausea and vomiting was lower during the first 24 h after surgery in this group than in the other three groups.
One patient (5%) of the AE group required an open procedure. Four patients of the OA group, who h... more One patient (5%) of the AE group required an open procedure. Four patients of the OA group, who had associated cardiac and respiratory risk, had surplus cost due to postoperative complications. Conclusions: We conclude that a careful selection of patients is necessary. Surcharge may be produced by both an excessive and a defective AE procedure selection. Patients should be selected on basis of surgery feasibility but also on the presence of coexisting disease.
Many surgical patients are anxious while waiting to go to the operating theatre in spite of the b... more Many surgical patients are anxious while waiting to go to the operating theatre in spite of the best preparation with drugs, information and reassurance. It is possible that patients could be more comfortable if allowed a choice of activities before operations. The objective of this study was to find out how pre-operative patients might prefer to occupy their time. We distributed 200 questionnaires to elective surgery patients and 184 (92%) were available for analysis. Of the respondents, 54.1% wanted to be slightly sleepy, 72.0% preferred not to be fast asleep and 57.2% preferred not to be wide awake. Reading (56.8%), listening to music (57.1%) and chatting with other patients (39.9%) were preferred activities. It might be appropriate to ask patients how sedated they would wish to be before their surgery and perhaps have alternatives to sedation available.
Perioperative medicine is rapidly emerging as a key discipline to address the specific needs of h... more Perioperative medicine is rapidly emerging as a key discipline to address the specific needs of high-risk surgical groups, such as those on chronic dialysis. Crude hospital separations rates for chronic dialysis patients are considerably higher than patients with normal renal function, with up to 15% of admission being related to surgical intervention. Dialysis dependency carries substantial mortality and morbidity risk compared to patients with normal renal function. This group of patients has a high co-morbid burden and complex medical need making accurate perioperative planning essential. Existing perioperative risk assessment tools are unvalidated in chronic dialysis patients. Furthermore, they fail to incorporate important dialysis treatment-related characteristics that could potentially influence perioperative outcomes. There is a dearth of information on perioperative outcomes of Australasian dialysis patients. Current perioperative outcome estimates stem predominantly from North American literature, however the generalizability of these findings is limited, as the survival of North American dialysis patients is significantly inferior to their Australasian counterparts and potentially confounds reported perioperative outcomes; let alone regional variation in surgical indication and technique. We propose that data-linkage between high-quality national registries will provide more complete data with more detailed patient and procedural information to allow for more informative analyses to develop and validate dialysis specific risk assessment tools.
Functional capacity is an important component of risk assessment for major surgery. Doctors' ... more Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed...
Plectranthus is a genus which belongs to the family of Lamiaceae. Even though numerous studies ha... more Plectranthus is a genus which belongs to the family of Lamiaceae. Even though numerous studies have been carried out on plants belonging to this family, Plectranthus remains a genus in which a lot of incongruity exists. Even though Plectranthus hadiensis is used as a medicinal herb, the information regarding it is scanty and not well documented. Our study focuses on the pharmacognostic studies and the phytochemical screening of Plectranthus hadiensis, previously known as Plectranthus zeylanicus or Coleus zeylanicus. The study includes macroscopy and microscopy, anatomy and phytochemistry of the stem of Plectranthus hadiensis. Phytochemical screening of the plant revealed the presence of phenolics, flavonoids, tannins, alkaloids, proteins and carbohydrates. The detailed pharmacognostic account of P. hadiensis which includes macroscopic and microscopic characters will be helpful for the correct botanical identification of the plant. The study scientifically validates the use of the pl...
Antiphospholipid antibodies (aPL) have been reported not only in autoimmune disorders but also in... more Antiphospholipid antibodies (aPL) have been reported not only in autoimmune disorders but also in various infectious diseases. Accumulating evidence indicates that b2 glycoprotein I (b2GPI) and prothrombin are the main proteins to which autoimmune aPL bind. The aim of this study was to evaluate the prevalence of different aPL in patients with leprosy. We included 51 outpatients (42 lepromatous and 9 borderline leprosy) without any clinical feature of the antiphospholipid syndrome (APS). 35 had lupus anticoagulant and 31 had anticardiolipin antibodies (aCL). Anti-β2GPI antibodies were highly positive in 29=51 and anti-prothrombin antibodies (anti-II) were detected in 23=51. Almost all aCL and anti-b2GPI were of IgM isotype, while IgG isotype was more frequent among anti-II. No statistical difference was found when aPL were evaluated in patients grouped according to their bacteriological status. Furthermore, patients under treatment (n ‘ 33) had a similar frequency of positive aPL com...
Three situations in which an anaesthetic assistant might be able to detect accidental oesophageal... more Three situations in which an anaesthetic assistant might be able to detect accidental oesophageal intubation during or immediately after intubation were assessed. These were: firstly, whilst applying cricoid pressure, secondly, whilst applying gentle palpation over the trachea just above the suprasternal notch and, thirdly, after intubation by means of a 'roll test'. During cricoid pressure, tracheal intubation was correctly diagnosed in all of 10 cases. However, deliberate oesophageal intubation was only detected in six out of 10 cases. During suprasternal palpation, three cases out of 10 oesophageal and three cases out of 10 tracheal intubation were misdiagnosed. In the 'roll test', two out of 10 tracheal and five out of 10 oesophageal intubations were misdiagnosed. In conclusion, no method could be relied on entirely and may indeed give false reassurance. Nonetheless, any doubt expressed about the tracheal tube position by the assistant should be taken seriously and a careful check made.
We report three cases of anaphylaxis during anaesthesia confirmed on intradermal testing to be re... more We report three cases of anaphylaxis during anaesthesia confirmed on intradermal testing to be related to patent blue V dye (Guerbet – Chemical Service 3536-49-0). All three cases were associated with moderate to severe hypotension. Two cases had delayed onset, and two were associated with a rash. None of the cases were associated with bronchospasm. In all three patients the interference with pulse oximetry readings contributed to difficulties in management. We recommend the use of a test dose of blue dye prior to surgery, as suggested in the manufacturer's product information. We also recommend high vigilance for possible allergic reactions when patent blue dyes are used for sentinel lymph node mapping, because the presentations may be atypical and the reduced pulse oximetry readings may be a distraction.
The prophylactic anti-emetic efficacy and safety of pre-operative intravenous ondansetron was eva... more The prophylactic anti-emetic efficacy and safety of pre-operative intravenous ondansetron was evaluated in a randomised, double-blind, comparison with droperidol, metoclopramide and placebo in 160 ASA grade 1 and 2 patients undergoing laparoscopic cholecystectomy under total intravenous anaesthesia. The patients were randomly allocated to receive ondansetron (4 mg), droperidol (1.25 mg), metoclopramide (10 mg) or placebo given as a single intravenous dose immediately before induction of a standardised general anaesthetic. There were no significant differences between the four study groups with regard to the demographic and anaesthetic data, postoperative analgesia, postoperative sedation scores, duration of postoperative hospital stay and incidence of adverse events. The incidence of nausea and vomiting was significantly lower (p`0.05) between 1 h and 4 h after surgery in the ondansetron group compared with the droperidol, metoclopramide and placebo groups. The incidence of nausea was similar in the four groups in the other study periods: 0-1 h and 4-24 h. The incidence of vomiting was lower in the ondansetron, droperidol and metoclopramide groups than in the placebo group between 1 and 4 h but was the same between 4 and 24 h. As a result of the lower incidence of nausea and vomiting between 1 h and 4 h in the ondansetron group, the overall incidence of nausea and vomiting was lower during the first 24 h after surgery in this group than in the other three groups.
One patient (5%) of the AE group required an open procedure. Four patients of the OA group, who h... more One patient (5%) of the AE group required an open procedure. Four patients of the OA group, who had associated cardiac and respiratory risk, had surplus cost due to postoperative complications. Conclusions: We conclude that a careful selection of patients is necessary. Surcharge may be produced by both an excessive and a defective AE procedure selection. Patients should be selected on basis of surgery feasibility but also on the presence of coexisting disease.
Many surgical patients are anxious while waiting to go to the operating theatre in spite of the b... more Many surgical patients are anxious while waiting to go to the operating theatre in spite of the best preparation with drugs, information and reassurance. It is possible that patients could be more comfortable if allowed a choice of activities before operations. The objective of this study was to find out how pre-operative patients might prefer to occupy their time. We distributed 200 questionnaires to elective surgery patients and 184 (92%) were available for analysis. Of the respondents, 54.1% wanted to be slightly sleepy, 72.0% preferred not to be fast asleep and 57.2% preferred not to be wide awake. Reading (56.8%), listening to music (57.1%) and chatting with other patients (39.9%) were preferred activities. It might be appropriate to ask patients how sedated they would wish to be before their surgery and perhaps have alternatives to sedation available.
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