Can we use the ankle non-invasive blood pressure during otolaryngologic surgery: an observational study

Introduction

In otolaryngologic surgery, ankle is frequently used for monitoring anesthesia in place of brachial when the patient doesn´t need invasive arterial cannulation. If there is a clinically useful and Predictable link between the two readings in hemodynamic normal patient, this difference during otolaryngologic surgery, was not evaluated. We aimed to investigate the reliability and the acceptability of non invasive blood pressure measurements at the ankle compared to those obtained concurrently at the arm during otolaryngologic surgery.

Methods

Eighty ASA grade I and II patients who had to be operated under general anesthesia were taken as subjects for our study. Blood pressures were measured simultaneously in the 2 limbs before induction and then every 10 minutes until the end of the surgical procedure. Readings were initiated concurrently. Statistical analysis was performed with PASW Statistics 13.

Results

There were 41 males (51.2 %) and 39 females (48.8 %). Bland-Altman analysis of mean difference between the ankle and arm (95 % limits of agreement) was -11.47 (- 23.77 to 0.82) mmHg for systolic blood pressure (SBP), -7.89 (-19.16 to 3.36) mmHg for diastolic blood pressure (DBP) and - 9.09 (18.19 to 0.00) mmHg for mean arterial pressure (MAP). Non-parametric analysis showed that 67.5 % of SBP, 46.2 % of DBP and 56.2 % of MAP measurements differed by > 10mmHg.

Conclusion

Ankle BP cannot be used routinely in otolaryngological surgery. Although, the ankle can be used as an alternative where the arm cannot be used taking into account a difference.

[Role of rocuronium-sugammadex algorithm in suspension direct laryngoscopy]

La laryngoscopie directe en suspension est un geste chirurgical diagnostique et/ou thérapeutique des lésions endo-laryngées. Sa gestion anesthésique est compliquée. Différentes techniques anesthésiques peuvent être proposées. Malgré les contraintes, les curares gardent tout leur intérêt. L’association rocuronium et sugammadex est envisageable, elle permet une inversion rapide du bloc neuromusculaire profond et par conséquent une réduction de la morbidité postopératoire. Nous rapportons un cas d’une laryngoscopie directe en suspension réalisée sous anesthésie générale dont l’utilisation de l’association rocuronium-sugammadex a permis une facilité du geste chirurgicale, une sécurité pour le patient et un confort pour l’anesthésiste.

Unplanned Intensive Care Unit Admission following Elective Surgical Adverse Events: Incidence, Patient Characteristics, Preventability, and Outcome

Context:

Adverse events (AEs) are a persistent and an important reason for Intensive Care Unit (ICU) admission. They lead to death, disability at the time of discharge, unplanned ICU admission (UIA), and prolonged hospital stay. They impose large financial costs on health-care systems.

Aims:

This study aimed to determine the incidence, patient characteristics, type, preventability, and outcome of UIA following elective surgical AE.

Settings and Design:

This is a single-center prospective study.

Methods:

Analysis of 15,372 elective surgical procedures was performed. We defined UIA as an ICU admission that was not anticipated preoperatively but was due to an AE occurring within 5 days after elective surgery.

Statistical Analysis:

Descriptive analysis using SPSS software version 18 was used for statistical analysis.

Results:

There were 75 UIA (0.48%) recorded during the 2-year study period. The average age of patients was 54.64 ± 18.02 years. There was no sex predominance, and the majority of our patients had an American Society of Anesthesiologist classes 1 and 2. Nearly 29% of the UIA occurred after abdominal surgery and 22% after a trauma surgery. Regarding the causes of UIA, we observed that 44 UIA (58.7%) were related to surgical AE, 24 (32%) to anesthetic AE, and 7 (9.3%) to postoperative AE caused by care defects. Twenty-three UIA were judged as potentially preventable (30.7%). UIA was associated with negative outcomes, including increased use of ICU-specific interventions and high mortality rate (20%).

Conclusions:

Our analysis of UIA is a quality control exercise that helps identify high-risk patient groups and patterns of anesthesia or surgical care requiring improvement.