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Electronic Letters to:

Case Reports:
C. J. Leech, R. Baba, and M. Dhar
Spinal anaesthesia and non-invasive positive pressure ventilation for hip surgery in an obese patient with advanced chronic obstructive pulmonary disease
Br. J. Anaesth. 2007; 0: aem093v1-3 [Abstract] [Full text] [PDF]
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[Read E-letter] Spinal anaesthesia and non-invasive positive pressure ventilation- use in cardiac patients?
BALAMURUGAN RAMALINGAM   (29 June 2007)

Spinal anaesthesia and non-invasive positive pressure ventilation- use in cardiac patients? 29 June 2007
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BALAMURUGAN RAMALINGAM

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Re: Spinal anaesthesia and non-invasive positive pressure ventilation- use in cardiac patients?

Dear authors,

I read the interesting case report of anaesthetic management of an obese patient with advanced chronic obstructive pulmonary disease for a hip surgery. I would like to appreciate your effort to do a litterature search and share this interesting work. Most anaesthetists will agree that they would have come across a similar situation while doing a trauma list. The most common approach would be endotracheal intubation with controlled ventilation with the possiblity of post-operative ventilatory support and associated complications. Regional anaesthesia is normally precluded for the fact that patients cannot lie flat for the duration of operation. I would like to raise a point here. When this approach seems logical and work well, can we consider applying the same in two other similar situations. One, patients having hip fixing surgeries who are very old with very little cardiorespiratory reserve and therefore cannot lie flat. The other is cardiac failure patients with orthopnea. Here, I want to mention the well known fact that there are several evidences to support the successful use of noninvasive venilation for cardiogenic repiratory failure. I would appreciate further input from you on this, including additional supporting evidence if you have found any.

Dr B Ramalingam

Wolverhampton

Reference:

1. Joao C Winck et al. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema – a systematic review and meta-analysis. Critical Care 2006, 10:R69 doi:10.1186/cc4905

2. Masip et al. Heart failure: pulmonary oedema: non-invasive pressure support ventilation reduced treatment failure. Lancet 2000; 356: 2126-2132

Conflict of Interest:

None declared