Anaesthesia and cognitive disturbance in the elderly

The first 150 words of the full text of this article appear below. Key points Perioperative delirium and longer term cognitivedisturbance are common and disabling consequences of anaesthesiaand surgery in the elderly. Evidence is emerging that the riskof postoperative delirium can be predicted by preoperative screeningof otherwise asymptomatic patients. The risk of prolonged postoperativecognitive dysfunction (POCD) is

Atrial fibrillation

The first 150 words of the full text of this article appear below. Key points

• Atrial fibrillation (AF) is the commonest cardiacarrhythmia; its incidence increases with age.
• Diabetes mellitus,hypertension and ventricular hypertrophy are commonly associatedwith non-valvular atrial fibrillation.
• Primary aims of managementof AF are conversion to sinus rhythm, maintenance of sinus rhythmand prevention of thromboembolic complications.
• In elderlypatients who are asymptomatic, adequate rate control of AF appearsto offer the same benefits as rhythm control.
• Chronic AF carriesa high risk of ischaemic stroke from thromboembolism; all patientsat risk must receive adequate anticoagulation.
• Anticoagulationshould be continued in patients with risk factors despite successfulconversion to sinus rhythm.

  Atrial fibrillation (AF) is the commonest cardiac arrhythmia.The incidence increases with age and affects 5% of UK populationabove the age of 65 yr and 10% above 75 yr.^{1 2} In the UnitedStates, AF accounts for more than 35% of all admissions forcardiac arrhythmias.³ Men are . . . [Full Text of this Article]

Anaesthesia for lower limb revascularization

The first 150 words of the full text of this article appear below. Key points Surgery for lower limb revascularization is associatedwith a high risk of cardiac morbidity and mortality. Preoperativecardiac risk assessment is important and risk-reducing measuresshould be started appropriately. Perioperative ß-blockadedecreases perioperative cardiac complications in the highestrisk patients. The quality of anaesthetic practice rather thanspecific technique per se has the most important influence onpatient outcome. Acute limb ischaemia is an emergency thatprecludes prolonged preoperative cardiac evaluation.  

Massive haemorrhage in pregnancy

The first 150 words of the full text of this article appear below. Key points Massive haemorrhage remains a significant causeof maternal mortality and morbidity. Clear and timely communicationbetween surgical, anaesthetic and haematology services is vitalto ensure optimal maternal and fetal outcome. Signs of hypovolaemiaoccur relatively late because of physiological changes in pregnancy. Theextent of intravascular volume deficit is not reflected by visualestimates of vaginal bleeding. The decision to perform a hysterectomyshould be made when other methods of haemostasis have failedand not delayed until control of maternal haemostasis and cardiovascularstability has been lost.   Massive haemorrhage is a major cause of maternal mortality.Life-threatening haemorrhage may occur as frequently as 6.7per 1000 deliveries.¹ This equates to 1400 cases yr ^–1in the UK or 33.5 yr ^–1 in an obstetric unit with 5000deliveries annually. Pregnancy-related conditions and complicationsaccount for 0.8% of intensive care admissions; 35% of thesearise from massive haemorrhage.^{1 2} Management of massive . . . [Full Text of this Article]

Pre-hospital trauma care: systems and delivery

The first 150 words of the full text of this article appear below. Key points Victims of trauma often spend a significant periodof time in the pre-hospital phase. There is wide variationin the practice of pre-hospital care internationally. The term‘paramedic’ covers a wide range of skills and abilities. Incountries other than the UK, physician-led pre-hospital careis well established. Where pre-hospital anaesthesia is performed,in-hospital standards should apply.   When the literature on pre-hospital trauma care is examined,it becomes apparent that a significant period of time is oftenspent between the time of accident and arrival in the emergencydepartment. Although the ‘Golden Hour’ is an arbitraryconcept, it is often applied to trauma care and emphasizes theimportance of life-saving interventions soon after injury. Inthe UK and elsewhere, the majority of the first hour has passedbefore the hospital-based physician has contact with the patient.Time at the scene can be much longer if the patient is . . . [Full Text of this Article]

Awareness during anaesthesia

The first 150 words of the full text of this article appear below. Key points Intraoperative awareness is associated with postoperativepsychological sequelae for the patient and medico-legal consequencesfor the anaesthetist. Awareness occurs after 1 in 3000 anaesthetics;it is twice as likely when neuromuscular block is used. Themost frequent cause of awareness is selection of an inadequatedose of anaesthetic agent. Assurance of >0.8 MAC end-tidalmakes awareness unlikely. The majority of the signs of awarenessinvolve sympathetic nervous system activation; these may bemasked by drugs or co-existing pathology. In high-risk situationsthe use of a monitor of depth of anaesthesia is justified.   Awareness during anaesthesia can be very distressing for a patient,particularly if accompanied by recall of the painful natureof surgery. This article explores the types, incidence, consequences,causes, management and avoidance of intraoperative awareness.

Complications of blood transfusion

The first 150 words of the full text of this article appear below. Key points

• Complications of blood transfusion are rare but canbe life-threatening.
• Since 2005, it has been a legal requirementthat all serious adverse reactions attributable to the safetyor quality of blood are reported.
• Most reported complicationsare because of transfusion of mismatched blood products andare avoidable through clinical vigilance.
• Massive blood transfusionsresult in abnormalities of coagulation status, serum biochemistry,acid–base balance and temperature homeostasis.
• Transfusion-relatedacute lung injury is the most common cause of major morbidityand death after transfusion.

  The serious hazards of transfusion (SHOT) scheme has collecteddata on significant adverse events resulting from transfusionof blood components from volunteer organizations since 1996.However, after the implementation of the European Union Directiveon Blood Safety and Quality in 2005, it is now a requirementthat all ‘Blood Establishments and Hospital Blood Banksreport to the Secretary of State for Health all serious adversereactions . . . [Full Text of this Article]