Anaesthesia related complications - a single centre data analysis at a tertiary hospital in central Switzerland.

AIMS: Anaesthesia safety has improved over time with severe anaesthesia-related complications and death becoming rare events. We investigated anaesthesia-related complications over a period of 17 years in this single centre retrospective observational cohort study. The main aims were to assess the temporal trends of anaesthesia-related complications, their distribution among clinics and their relation to emergency versus non-emergency interventions. METHODS: In this retrospective, observational cohort study, anaesthesia and event protocols of patients who suffered from an anaesthesia-related complication were collected in the period from 1 January 2003 to 31 December 2019. These data sets were anonymised and grouped into demographic information, ASA physical status, information about dental status and hospital department. Out of the total of 257 cases that were reported to the department of anaesthesia at the Luzerner Kantonsspital, 110 were excluded as they were not anaesthesia-related and 14 because of incomplete reporting forms. The different complications were categorised by the severity injury scale score. The total number of anaesthetics during the study period amounted to 399,583. RESULTS: 133 patients with complications were included. Six patients died owing to a partially anaesthesia-related complication, two suffered from permanent damage, 62 had temporary symptoms and in 63 patients dental damage occurred. The temporal trend showed a major decrease in severe anaesthesia complications and deaths, whiledental injuries were the main complications after 2010. Most of the complications were reported in the orthopaedic department, whereas dental injuries were predominantly reported in the otorhinolaryngology department. The majority of complications occurred during elective surgery although this was not significant (p = 0.53). CONCLUSIONS: Severe anaesthesia-related complications and death decreased dramatically during the study period. Anaesthesia complications are not more frequent in emergency surgeries. Overall, complications occurred more frequently in orthopaedics, and dental injuries predominated in otorhinolaryngology.

How current transfusion practices in geriatric patients with hip fracture still differ from current guidelines and the effects on outcome: A retrospective observational study.

BACKGROUND: Transfusion guidelines have become increasingly restrictive. We investigated actual transfusion practices in geriatric hip fracture patients, why they differ from current guidelines and how this affects outcome. OBJECTIVES: The primary aim was to examine transfusion timing, evaluate how many red blood cell (RBC) transfusions are in keeping with guidelines and how this affects morbidity (infection, cardiac events and delirium), mortality and length of stay (LOS). Our secondary aim was to test the hypothesis that guidelines were more likely to be deviated from shortly before discharge and with consecutive transfusions. DESIGN: A retrospective observational study. SETTING: The Luzerner Kantonsspital, a major trauma centre, over a 12-month period from 1 February 2015 to 31 January 2016. PATIENTS: All patients over 70 years of age admitted to the Luzerner Kantonsspital with hip fractures over a 12-month period in 2015 to 2016 were included. RESULTS: 156 patients were included, to which 141 units of RBCs were transfused. All pre and intra-operative transfusions were according to guidelines; 110 transfusions were postoperative and 37 of these were not according to guidelines. Patients who were transfused had longer LOS in hospital (P = 0.002) and an odds ratio (OR) of 2.7 of contracting an infection (P = 0.04) in comparison with patients who were not transfused. No significant differences in mortality, LOS or morbidity were found between patients transfused according to guidelines and more liberal thresholds. Guidelines were more likely to be deviated from within the last 2 days before discharge than prior to this (58 vs. 24%, P = 0.03). Furthermore, 24 stable patients received two consecutive RBC units resulting in posttransfusion haemoglobin values of between 83 and 124 g l. CONCLUSION: Most RBC transfusions occur postoperatively, many still according to liberal transfusion thresholds, in particular shortly before discharge and as part of consecutive transfusions. Transfused patients had longer LOS and more infections than patients not transfused, but there was no difference in mortality, LOS or morbidity between patients transfused according to current guidelines and those where guidelines were deviated from.

Long-acting local anesthetics attenuate FMLP-induced acute lung injury in rats.

BACKGROUND: Endothelin-1 (ET-1) is a mediator of lung diseases and a potent pulmonary vasoconstrictor. In addition to thromboxane A2, it participates in the formation of lung edema. Both lidocaine and mepivacaine attenuate the increase of pulmonary arterial pressure (PAP) and lung edema development. We examined the effects of procaine, bupivacaine, and ropivacaine on experimentally evoked PAP increase and ET-1 release. METHODS: PAP and lung weight were measured in isolated rat lungs during perfusion with Krebs-Henseleit hydroxyethyl starch buffer. Bupivacaine, ropivacaine, or procaine was added to the solution at concentrations of 10(-2)-10(-7) mg/kg. ET-1 levels were measured in the perfusate by enzyme-immunoassay, and thromboxane A2 levels were assayed by radioimmunoassay. N-formyl-L-leucine-methionyl-L-phenylalanine was used to activate human polymorphonuclear neutrophils. RESULTS: Bupivacaine, ropivacaine, and procaine significantly attenuated increases of PAP (P < 0.05) and resulted in a reduction of lung weight in these treatment groups compared with the sham group (P < 0.05). The long-acting anesthetics bupivacaine and ropivacaine (P < 0.05), but not procaine, reduced ET-1 levels, produced low inflammation rates, and did not affect lung structures at doses from 10(-3) to 10(-6) mg/kg. CONCLUSION: Bupivacaine and ropivacaine attenuated N-formyl-L-leucine-methionyl-L-phenylalanine-induced PAP, reduced lung edema, and diminished ET-1 release. Lidocaine and mepivacaine are more effective in reducing PAP and edema formation, but long-acting local anesthetics also inhibit ET-1 depletion and therefore have increased anti-inflammatory properties.

Painful and nonpainful phantom and stump sensations in acute traumatic amputees.

BACKGROUND: The formation, prevalence, intensity, course, and predisposing factors of phantom limb pain were investigated to determine possible mechanisms of the origin of phantom limb pain in traumatic upper limb amputees. METHODS: Ninety-six upper limb amputees participated in the study. A questionnaire assessed the following question: side, date, extension, and cause of amputation; preamputation pain; and presence or absence of phantom pain, phantom and stump sensations or stump pain or both. RESULTS: The response rate was 84%. Sixty-five (81%) participants returned the questionnaire. In 64 (98.5%) participants a traumatic injury led to amputation; the amputation was necessary because of infection in one patient (1.5%). The median follow-up time (from amputation to evaluation) was 3.2 years (range, 0.9-3.8 years) The prevalence of phantom pain was 44.6%, phantom sensation 53.8%, stump pain 61.5%, and stump sensation 78.5%. After its first appearance, phantom pain had a decreasing course in 14 (48.2%) of 29 amputees, was stable in 11 (37.9%) amputees, and worsened in 2 (6.9%) of 29 amputees. Stump pain had a decreasing course in 19 (47.5%) of 40 amputees but was stable in 12 (30%) amputees. Phantom pain occurred immediately after amputation in 8 (28%) of 29 amputees between 1 month and 12 months in 3 (10%) amputees and after 12 or more months in 12 (41%) amputees. CONCLUSION: Stump pain and stump sensation predominate traumatic amputees' somatosensory experience immediately after amputation; phantom pain and phantom sensations are often long-term consequences of amputation. Amputees experience phantom sensations and phantom pain within 1 month after amputation, a second peak occurs 12 months after amputation. Revised diagnostic criteria for phantom pain are proposed on the basis of these data.

Reduction of pulmonary edema by short-acting local anesthetics.

BACKGROUND AND OBJECTIVES: Local anesthetics (LAs) possess a variety of effects that cannot be explained by the typical block of neuronal sodium channels. Antithrombotic effects of LAs are well known, but LAs also act as bactericides. Therefore, an investigation of the influence of LAs on the inflammatory response of the isolated rat lung (n = 78) to an N-formyl-l-leucin-methionyl-l-phenylalanine (FMLP) stimulus was performed. METHODS: The experiments were performed on isolated and ventilated rat lungs perfused with cell-free and plasma-free buffer. LAs (lidocaine and mepivacaine) were injected in various concentrations before application and activation of human granulocytes by FMLP. Pulmonary arterial pressure (PAP) and lung weight gain were monitored continuously. LAs in final dosages from 10(-2) to 10(-7) mg/kg body weight (n = 6 each) were injected into the pulmonary artery before treatment with FMLP (10(-6) M) to induce pulmonary arterial hypertension. Perfusate samples were taken intermittently to determine thromboxane A(2) (TX A(2)) and endothelin-1 concentrations. Microscopic analyses were performed to assess the degree of lung injury. RESULTS: Pretreatment with LAs significantly reduced the FMLP-induced PAP increase (treatment group v sham group: 0.5 to 5 mm Hg v 8 mm Hg; P < .05) and the release of endothelin-1 (2.4 v 5 fmol/mL). Histologic damage seen as acute granulocytic alveolitis was reduced by lidocaine and mepivacaine, even below clinically relevant concentrations. CONCLUSION: LA pretreatment reduces inflammatory reactions after FMLP stimulus.

Duration of effects of aspirin on platelet function in healthy volunteers: an analysis using the PFA-100.

STUDY OBJECTIVE: The aim of the study was to determine the duration and effects of aspirin on platelet function. STUDY DESIGN: Prospective investigation. SETTING: Blood samples from volunteers. PATIENTS AND MONITORING: Ten healthy male volunteers took part in this investigation. After having measured baseline hemostatic parameters, 2000-mg aspirin was taken orally. Subsequently, the hemostatic profile had been compiled daily for a duration of 4 days after ingestion. MEASUREMENTS AND MAIN RESULTS: Platelet function was analyzed (1) after 3 hours and (2) daily for 4 days by the platelet function analyzer (PFA-100, Dade Co, Miami, Fla), which represents a sensitive investigation method for measuring platelet function and dysfunction. Routine hemostatic parameters were investigated. Three hours after ingestion of aspirin, abnormal PFA-100 values could be detected. Further detectable elevated values were found during the following 3 days. CONCLUSION: Effects of single-dose aspirin 2000 mg on platelet function were detected after 3 hours and had been lasting for the following 3 days. This result shows that PFA-100 may help by evaluating hemostasis during the preoperative period.