Assessing cardiorespiratory fitness relative to sex improves surgical risk stratification.

Background: To what extent sex-related differences in cardiorespiratory fitness (CRF) impact postoperative patient mortality and corresponding implications for surgical risk stratification remains to be established.

Methods: To examine this, we recruited 640 patients (366 males vs. 274 females) who underwent cardiopulmonary exercise testing prior to elective colorectal surgery.

'Fit for surgery': the relationship between cardiorespiratory fitness and postoperative outcomes.

New Findings: What is the topic of this review? The relationships and physiological mechanisms underlying the clinical benefits of cardiorespiratory fitness (CRF) in patients undergoing major intra-abdominal surgery. What advances does it highlight? Elevated CRF reduces postoperative morbidity/mortality, thus highlighting the importance of CRF as an independent risk factor. The vascular protection afforded by exercise prehabilitation can further improve surgical risk stratification and postoperative outcomes.

Subjective assessment underestimates surgical risk: On the potential benefits of cardiopulmonary exercise testing for open thoracoabdominal repair.

Background: Initial clinical evaluation (ICE) is traditionally considered a useful screening tool to identify frail patients during the preoperative assessment. However, emerging evidence supports the more objective assessment of cardiorespiratory fitness (CRF) via cardiopulmonary exercise testing (CPET) to improve surgical risk stratification. Herein, we compared both subjective and objective assessment approaches to highlight the interpretive idiosyncrasies.

Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery.

Background: The extent to which physiological factors influence outcome following oesophageal cancer surgery is poorly understood. This study aimed to evaluate the extent to which cardiorespiratory fitness and selected metabolic factors predicted complications after surgery for carcinoma.

Methods: Two hundred and twenty-five consecutive patients underwent preoperative cardiopulmonary exercise testing to determine peak oxygen uptake ( o ), anaerobic threshold and the ventilatory equivalent for carbon dioxide ( e/ co ).

Cardiorespiratory fitness fails to predict short-term postoperative mortality in patients undergoing elective open surgery for abdominal aortic aneurysm.

Introduction: Preoperative cardiopulmonary exercise testing aids surgical risk stratification and is an established predictor of mid- to long-term survival in patients undergoing elective open abdominal aortic aneurysm repair. Whether cardiopulmonary exercise testing also predicts 30-day mortality in this population remains to be established.

Materials And Methods: Data for 109 patients (mean age 72 years) who underwent cardiopulmonary exercise testing to assess risk for surgical abdominal aortic aneurysm repair was analysed.

High-intensity exercise training improves perioperative risk stratification in the high-risk patient.

Exercise prehabilitation prior to major surgery can improve cardiorespiratory fitness (CRF) and clinical outcome. However, in patients deemed "high--risk" for surgery, the feasibility, optimum training modality and its intensity, duration, and frequency are yet to be defined. We assessed the cardiorespiratory fitness of a 70-year-old female patient requiring major thoraco-abdominal surgery for reconstruction of her esophagus.

Cardiopulmonary fitness predicts postoperative major morbidity after esophagectomy for patients with cancer.

Surgery for radical treatment of esophageal cancer (EC) carries significant inherent risk. The objective identification of patients who are at high risk of complications is of importance. In this study the prognostic value of cardiopulmonary fitness variables (CPF) derived from cardiopulmonary exercise testing (CPET) was assessed in patients undergoing potentially curative surgery for EC within an enhanced recovery program.

Cardiorespiratory fitness is impaired and predicts mid-term postoperative survival in patients with abdominal aortic aneurysm disease.

New Findings: What is the central question of this study? To what extent cardiorespiratory fitness is impaired in patients with abdominal aortic aneurysmal (AAA) disease and corresponding implications for postoperative survival requires further investigation. What is the main finding and its importance? Cardiorespiratory fitness is impaired in patients with AAA disease. Patients with peak oxygen uptake of <13.

The cardiopulmonary exercise test grey zone; optimising fitness stratification by application of critical difference.

Background: Cardiorespiratory fitness can inform patient care, although to what extent natural variation in CRF influences clinical practice remains to be established. We calculated natural variation for cardiopulmonary exercise test (CPET) metrics, which may have implications for fitness stratification.

Methods: In a two-armed experiment, critical difference comprising analytical imprecision and biological variation was calculated for cardiorespiratory fitness and thus defined the magnitude of change required to claim a clinically meaningful change.

Prognostic significance of age in the radical treatment of oesophageal cancer with surgery or chemoradiotherapy: a prospective observational cohort study.

Aims: To compare the outcomes of stage-directed surgical therapy and chemoradiotherapy (CRT) for oesophageal cancer and to determine if a significant age-treatment interaction exists to guide therapy.

Materials And Methods: Five hundred and eight consecutive patients with oesophageal cancer suitable for radical treatment based on radiological stage and performance status were studied (275 surgery; 93 surgery alone, 131 neoadjuvant chemotherapy, 51 neoadjuvant CRT and 233 definitive CRT). The primary measure of outcome was survival.

Laparoscopic cholecystectomy in the grossly obese: 4 years experience and review of literature.

Background: Conventional abdominal surgery in grossly obese patients is associated with an increased rate of postoperative complications; thus, laparoscopic surgery may be preferred in these patients.

Patients And Methods: A prospective analysis was performed of 20 grossly obese patients who underwent laparoscopic cholecystectomy between April 1996 and April 2000 for symptomatic non-complicated gallstone disease.

Results: Technical problems at operation included difficulty with induction of pneumoperitoneum and introduction of the most lateral subcostal port, retraction of the gallbladder fundus, the need for longer instruments and the closure of the fascia.

Anaphylaxis to vecuronium: the use of basophil CD63 expression as a possible screening tool to identify a safe alternative.

A 29-year-old woman with a history of anaphylaxis during anesthesia required diagnostic laparoscopic surgery for investigation of infertility. Previous laboratory investigations suggested that she had reacted to vecuronium, but she also had a specific IgE antibody to succinylcholine. The use of the basophil activation marker CD63 as a screening tool in selecting a safe muscle relaxant is presented.

Anions and the anaesthetist.

Anions are the negative components of most chemical structures and play many important physiological and pharmacological roles that are of interest to the anaesthetist. Their relevance is reviewed with a particular emphasis on the inorganic anions (halides, bicarbonate, phosphate and sulphate) and the significance and limitations of the anion gap. Organic anions (albumin, lactate) are also discussed, albeit briefly.

Laparoscopic cholecystectomy in the presence of a lumboperitoneal shunt.

Laparoscopic cholecystectomy was performed safely in a 70-year-old man with a lumboperitoneal shunt. Techniques for preventing retrograde flow of carbon dioxide are described.

Prophylactic amrinone for weaning from cardiopulmonary bypass.

This prospective, randomised, double-blind, controlled clinical study was performed at a single tertiary referral centre to test the hypothesis that the prophylactic administration of amrinone before separation of a patient from cardiopulmonary bypass decreases the incidence of failure to wean, and to identify those patients who could be predicted to benefit from such pre-emptive management. Two hundred and thirty-four patients, scheduled to undergo elective cardiac surgery, were randomly allocated to receive either a bolus dose of 1.5 mg x kg(-1) amrinone over 15 min, followed by an infusion of 10 microg x kg(-1) x min(-1), or a bolus of placebo of equal volume followed by an infusion of placebo.