In the August 2008 BJA...
Awareness and anaesthesia Awareness during anaesthesia is traumatic for the patient and is a complication anaesthetists strive to avoid happening to their patients. In a prospective study from Spain (Errando et al., pages 178–85), in which over 4000 patients were interviewed postoperatively, an overall incidence of around 1% (0.6% for elective surgery) was found. There is an interesting description and discussion of the causes. One striking aspect of this, and of previous studies, is that anaesthetists do not know what the incidence of awareness is in their own patients. A related explanation may well be the finding that patients do not tell medical or nursing staff about awareness they may have experienced unless specifically asked. This finding alone should prompt some self-assessment in all anaesthetists.Anaesthesia for laryngeal surgery Anaesthesia for laryngeal surgery, and in particular airway management, can be a challenge. In an national survey in the UK focusing on the use of high-pressure source ventilation in this setting, Cook and Alexander (pages 266–72) found a wide variation in practice. The use of high-frequency jet ventilation may be associated with fewer major problems but the authors recommend further examination of outcomes and the development of guidelines.
Cardiovascular monitoring and fluid balance There is considerable interest in the use of cardiovascular monitoring to improve the management of fluid replacement perioperatively. A number of studies in this month's BJA look at possible methods, new and old, of achieving this. The use of systolic pressure variation to guide treatment was associated with slightly more intraoperative fluid but organ perfusion and function was similar (Buettner et al., pages 194–9). Pleth variability index, an automatic and continuous monitor of change on plethysmographic waveform amplitude, was used to predict fluid responsiveness non-invasively in mechanically ventilated patients during general anaesthesia, and was found to have potential clinical applications (Cannesson et al., pages 200–6). In a study comparing external jugular venous pressure with the more commonly used central venous pressure, agreement was reasonable for estimates of trend but was influenced by patient positioning (Leonard et al., pages 166–70). In a more specialized setting, right ventricular ejection fraction pulmonary artery catheter (RVEF-PAC) was used to monitor the right ventricular function during propofol anaesthesia for orthotopic liver transplantation (OLT) and was well maintained (Gouvêa et al., pages 161–5).
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Related articles in BJA:
- Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients
- C. L. Errando, J. C. Sigl, M. Robles, E. Calabuig, J. García, F. Arocas, R. Higueras, E. del Rosario, D. López, C. M. Peiró, J. L. Soriano, S. Chaves, F. Gil, and R. García-Aguado
BJA 2008 101: 178-185.[Abstract] [Full Text] - Major complications during anaesthesia for elective laryngeal surgery in the UK: a national survey of the use of high-pressure source ventilation
- T. M. Cook and R. Alexander
BJA 2008 101: 266-272.[Abstract] [Full Text] - Influence of systolic-pressure-variation-guided intraoperative fluid management on organ function and oxygen transport
- M. Buettner, W. Schummer, E. Huettemann, S. Schenke, N. van Hout, and S. G. Sakka
BJA 2008 101: 194-199.[Abstract] [Full Text] - Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre
- M. Cannesson, O. Desebbe, P. Rosamel, B. Delannoy, J. Robin, O. Bastien, and J.-J. Lehot
BJA 2008 101: 200-206.[Abstract] [Full Text] - Comparison of central venous and external jugular venous pressures during repair of proximal femoral fracture
- A. D. Leonard, C. M. Allsager, J. L. Parker, A. Swami, and J. P. Thompson
BJA 2008 101: 166-170.[Abstract] [Full Text] - Evaluation of the right ventricular ejection fraction during orthotopic liver transplantation under propofol anaesthesia
- G. Gouvêa, R. Diaz, L. Auler, and J. M. Martinho
BJA 2008 101: 161-165.[Abstract] [Full Text]
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