In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland: Vascular Anaesthesia Society audit.

BACKGROUND: The mortality rate associated with elective aortic aneurysm repair is widely assumed to be in the region of 5 per cent. This figure does not take into consideration the effect of pre-existing risk factors. The Vascular Anaesthesia Society of Great Britain and Ireland conducted a large audit to estimate the in-hospital mortality rate associated with non-emergency infrarenal aortic surgery throughout the British Isles, and to determine the influence of risk factors on mortality rate. METHODS: This was a multicentre, prospective audit of 177 hospitals throughout the UK and Ireland. Data were collected by questionnaire to include all patients undergoing elective or urgent surgery for infrarenal abdominal aortic aneurysm or aortoiliac occlusive disease over 4 months. RESULTS: Nine hundred and thirty-three patients were recruited into the audit. The overall mortality rate was 7.3 per cent. Factors increasing the risk of death by up to fivefold included age over 74 years, urgent surgery, operation for occlusive disease, limited exercise capacity, a history of severe angina or cardiac failure, the presence of ventricular ectopics and abnormalities suggesting ischaemic heart disease on electrocardiography. CONCLUSION: Although the in-hospital mortality rate was similar to previously published figures, the rate increased considerably when commonly encountered risk factors were present.

Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoraco-abdominal aneurysm.

A 63-year-old male patient collapsed and died from a major subdural haemorrhage 5 days after elective repair of a Type III thoraco-abdominal aortic aneurysm. The anaesthetic technique had included the use of a lumbar cerebrospinal fluid drain. The management of the patient is described, and the association between subdural haemorrhage and cerebrospinal fluid drainage is discussed.

A prospective two-month audit of the lack of provision of a high-dependency unit and its impact on intensive care.

All admissions into a six-bedded intensive care unit were audited prospectively over a 2-month period. Data were collected daily and classified according to criteria for intensive care or high-dependency admission. There were 30 planned admissions (72 bed days) following elective major surgery, seven admissions following semi-elective surgery (41 bed days) and 47 emergency admissions (185 bed days). Overall bed occupancy was 89%. Of 366 possible intensive care days, 66 (23%) were occupied by high-dependency patients. Of the planned admissions all but five were discharged within 2 days. There were 39 major complications during the study period requiring life-saving interventions and 16 lesser but significant complications. In 12% of patients discharge was delayed because of the absence of a high-dependency unit. Four patients were transferred to an intensive care unit in another hospital and four patients were discharged prematurely because other patients required urgent admission. Seven patients were refused admission and three patients scheduled for elective operations had their surgery deferred. We estimate that over the study period 22 additional patients could have been cared for if a high-dependency unit existed.

Reversal of post-reperfusion coagulopathy by protamine sulphate in orthotopic liver transplantation.

We report details of two liver transplant procedures in which post-reperfusion coagulopathy was reversed by administration of protamine sulphate. Both procedures were uncomplicated until about 30 min after reperfusion of the graft, when the cut surfaces began to ooze blood. Failure of coagulation was confirmed by thrombelastography and in both cases routine coagulation tests revealed a prolonged kaolin cephalin clotting time (KCT). A heparin-like effect was suspected. Protamine sulphate 50 mg was given i.v., resulting in cessation of bleeding and normalization of the thrombelastogram and KCT.