Cross-Sectional Study of Knee Bone Mineral Density and Fragility Fractures in Patients with Neurological Injuries and Neuromuscular Disorders.

Background: Patients with neurological injury and neuromuscular disorders are at increased risk for osteoporosis and fragility fracture. This cross-sectional study investigated whether knee bone mineral density (BMD) correlates with fragility fracture in patients with neurological injury and neuromuscular injuries.

Methodology: In this retrospective chart review, 435 participants underwent dual-energy X-ray absorptiometry (DXA) for BMD analysis.

Factors determining the duration of tracheal intubation in cardiac surgery: a single-centre sequential patient audit.

Background And Objective: The study was designed to identify those factors associated with early tracheal extubation following cardiac surgery. Previous studies have tended to concentrate on surgery for coronary artery bypass or on other selected cohorts.

Methods: Sequential cohort analysis of 296 unselected adult cardiac surgery patients was performed over 3 months.

Critical care for the surgical patient.

Dr Chris Aps has been involved, since the early 1980s, with the impact of the surgical patient on critical care provision. At that time, he established clinical techniques to lower patient dependency after cardiac surgery. This allowed for the postoperative management of such patients in a general recovery facility rather than in the formal Intensive Care Unit (ICU).

Operating theatres. Cutting edge.

An enhanced postoperative theatre recovery unit can provide overnight intensive care for surgical patients. Most recovery units could be adapted for this purpose. Set-up capital costs are lower than for developing separate stand-alone facilities.

Fast-tracking in cardiac surgery.

Fast-tracking in cardiac surgery evolved as the pressure on bed space in intensive therapy units (ITU) grew and clinical management improved. It relies on achieving a patient condition that allows for earlier extubation and postoperative management in alternative facilities to the ITU.

Adult respiratory distress syndrome following closure of a chronic ventricular septal defect: possible relationship to the use of intracardiac gelatin-resorcin-formaldehyde glue.

Gelatin-resorcin-formaldehyde glue is now widely used in cardiac surgery, particularly in Europe. A case is reported where its use may have contributed to the pulmonary dysfunction seen postoperatively after elective closure of a postinfarct ventricular septal defect. It is believed that this is a result of a relatively high exposure of the pulmonary circulation to the glue, in particular to formalin.

Postoperative cardiac surgical care: an alternative approach .

Combined appropriate anaesthetic and surgical techniques have allowed increasing numbers of patients to be successfully managed in a general surgical recovery ward after cardiac surgery rather than in an intensive care unit. From 1983 to 1989, 933 of 1542 patients undergoing open heart surgery were transferred to the general surgical recovery ward in the immediate postoperative period. Of these, 718 (77%) had undergone coronary artery bypass grafts, sometimes combined with other procedures and 168 (18%) had had cardiac valve replacements with or without other procedures.

Tension pneumothorax and pulse oximetry.

A case is described of spontaneous tension pneumothorax occurring during preparation for thoracic surgery. The earliest indication of this was unexplained haemoglobin desaturation as detected by pulse oximetry. This case report provides another example of the early warning potential of pulse oximetry.

The management of cardiac surgical patients in a general surgical recovery ward.

A suitable combination of anaesthetic and surgical techniques has allowed the safe management of post-operative cardiac surgical patients to be conducted in a surgical recovery area rather than in the intensive care ward. The results of the first 103 patients so managed (aged 49 +/- 10.7 years) are presented.

Magnesium and coronary revascularization.

Twenty patients, who underwent coronary revascularization without cardioplegic arrest, were given (during cardiopulmonary bypass) either magnesium chloride 16 mmol in 10 ml of water (magnesium group) or 10 ml of water alone (control group). Plasma and urinary magnesium concentrations were measured for 24 h after operation. ECG was recorded continuously during this period.

Myasthenia gravis and cardiac surgery. A case report.

This paper describes the successful management of a diabetic patient with bulbar myasthenia who underwent mitral valve replacement and coronary revascularization.

Protamine sulphate and heparin rebound following open-heart surgery.

The efficacy of heparin reversal was investigated in 35 patients undergoing open-heart surgery. A total protamine sulphate dose of 3.0 mgs/kg was administered in divided doses and given as a continuous infusion.

Extracorporeal circuit sequestration of fentanyl and alfentanil.

Fentanyl or alfentanil, in doses approximating to those used in clinical practice, was added to the priming fluid of an extracorporeal circuit before the institution of cardiopulmonary bypass (CPB). The concentrations of both drugs in the priming fluid were measured over a 20-min period. The concentration of fentanyl decreased at neutral or high pH values, suggesting drug adsorption to the circuit.

Anaesthetic management and postoperative care of cardiac surgical patients in a general recovery ward.

The postoperative care of 143 cardiac surgical patients has been successfully conducted in a general surgical recovery ward. Admission was limited to overnight stay only and all but two patients were returned to the general ward the following day. There were no deaths.

The role of anaesthetic management in enhancing peripheral blood flow in patients undergoing free flap transfer.

An anaesthetic protocol is described that is designed to promote peripheral blood flow and prevent vascular spasm in patients undergoing free flap transfer. The technique has been used successfully over a period of 3 years at St Thomas' Hospital, London, and since its introduction vascular spasm has ceased to be a major intraoperative problem.

Hypotension following cimetidine administration during cardiopulmonary bypass.

Intravenous administration of cimetidine may occasionally cause profound hypotension. Cimetidine 200 mg was administered as a bolus injection to patients whilst on cardiopulmonary bypass and subsequent changes in systemic arterial pressure were recorded. A statistically significant fall in arterial pressure was observed (p less than 0.