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  • ISSN: 2333-6641
    Volume 1, Issue 3
    November/December 2013
    Review Article
    David Canty1,2,3* and Colin F Royse2
    Abstract: Despite advances in medical care, hip fracture surgery remains one of the commonest and highest risk surgical procedures (10% in-hospital mortality and 25% at one year), representing a major economic cost to our community and a World health care burden. Hip fracture patients are usually elderly and chronic cardiovascular disease is common. Due to urgency of surgery, frequent patient cognitive impairment and limitations in health care resources, cardiac disease is often inadequately treated and remains the leading cause of mortality. Preoperative transthoracic echocardiography (TTE) performed in the echocardiography laboratory non-invasively alerts treating physicians to cardiac disease but may result in a delay which is associated with worse outcome and hence is usually restricted to selected patients. Anesthesiologists have been increasingly performing their own ‘goal-focused TTE’, an abbreviated examination which really forms an extension of clinical examination, which also alerts the anesthesiologist to abnormal hemodynamic states such as hypovolemia, ventricular failure and vasodilation, thus guiding appropriate hemodynamic treatment and monitoring before, during and after surgery. Recent published data showed a major influence of goal-focused TTE on management of patients requiring hip fracture and other non-cardiac surgery. Further proof of concept data has revealed that mortality may be reduced in hip fracture surgery patients who receive a preoperative focused transthoracic echocardiography by the anesthesiologist. This technology has the potential to drastically improve the medical care of patients at high risk of cardiac disease requiring non-cardiac surgery. Recently, several guidelines from learned societies of echocardiography have been published on recommendations for training and practice of focused TTE by non-cardiologists for ultrasound assisted examination. Focused TTE requires significant training and funding and to justify this important and rapid shift in medical practice, there is a need for high quality outcome studies to be performed. Equally important are efficient teaching methods and a robust mechanism to ensure minimum standards of proficiency to minimise the recognised potential harm from erroneous conclusions drawn from misinterpretation of data.
    Frank Schuster1*, Stephan Johannsen2, Susanne Moegele3 and Norbert Roewer4
    Abstract:
    Introduction: The gold-standard to diagnose malignant hyperthermia (MH) susceptibility is the in-vitro-contracture test (IVCT) requiring an open muscle biopsy. The aim of the presented investigation was to evaluate intra- and postoperative patients’ satisfaction and the incidence of serious complications following muscle biopsy for MH diagnostics.
    Subjects and methods: In a retrospective study anonymous standardized questionnaires were sent out to 149 patients who underwent muscle biopsy and IVCT according to the diagnostic guidelines of the European MH-Group at the department of Anesthesia and Critical Care of the University of Wuerzburg between 2006 and 2012. Questions concerning general conditions and postoperative recovery were included.
    Results: 96 patients returned the questionnaires. 29 individuals were classified MH susceptible and 67 MH non-susceptible. Patients felt well informed about the procedure, were content with the anesthetic procedure and appreciated the friendliness of the staff. Complications of wound healing were uncommon. However, postoperative pain and dysesthesia of the scar appeared more problematic. The duration of pain varied between 0 and 35 days. After the test 81% of the patients indicated feeling safer for future operative procedures.
    Conclusions: Muscle biopsy for IVCT is generally well accepted by the patients and serious complications are rare. However, main problems still consist in postoperative pain and in some cases long lasting physical restrictions.
    Research Article
    Kabore RA1*, Ki KB2, Traore AI3, Compaore S4, Bougouma CT5, Damba J6, Bonkoungou PZ6, Sanou J6 and Ouedraogo N6
    Abstract:
    Introduction: Pain is a frequent reason for patients visit in trauma centers, but it care remains insufficient for many reasons. The goal of this study was to assess the care of pain at the trauma center of the Yalgado Ouedraogo University hospital in Ouagadougou.
    Methods: Observational study concerning the care of pain for patients admitted in the trauma center during the study timeframe.
    Results: In total, pain was evaluated in 174 patients during the study timeframe. The patients’ sex ratio was 2 with a mean age of 31.3 +/-11 years. The mean time before the first clinical exam was 9 minutes. The main traumatic injuries were cutaneous wounds (39.1%), bone fractures (33.3%), and muscular contusions (11.5%). The pain was assessed for 54% of patients. The assessment involved non systematic questioning in 91.1% of cases. An analgesic treatment was administered to 80.5% of patients. This treatment was exclusively made of medications containing an association of acetaminophen and nefopam for 36.2% of patients. Morphine and peripheral nerves blockers have never used. The pain was relieved in 67.4% of patients after the treatment and 58.6% of the patients were entirely satisfied with the care at the discharge time from the trauma center.
    Conclusion: Pain management at the trauma center remains insufficient. The training of the staff and the use of validated therapeutic protocols would improve patients comfort and the quality of care.
    Jennifer Lucas1* and David J Canty2,3
    Abstract:
    Background:Patients with end stage renal disease (ESRD) have a high incidence of postoperative cardiac morbidity and mortality. The frequent presence of cardiac disease, extreme states of hydration and reduced capacity to excrete a fluid load pose challenges to anesthetic management. Routine preoperative focused transthoracic echocardiography (TTE) may assist in improved cardiac and hemodynamic state assessment directing more rational anesthetic care in these high-risk patients.
    Methods: An audit was performed on focused TTE performed by an anesthesiologist immediately before renovascular surgery in 18 sequential patients with ESRD. Data recorded included the quality and time to acquire echocardiography images and their influence on anesthetic management.
    Results: Interpretable images were obtained in 15 of 18 patients during the study period (83%). Hypovolemia was revealed in 33%, which lead to an intravascular fluid bolus immediately before surgery.
    Conclusion: Routine anesthesiologist-performed preoperative focused TTE detected hypovolemia and facilitated anesthetic management in one third of patients with ESRD presenting for renovascular surgery.
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