Postoperative pulmonary complications and mortality after major abdominal surgery. An observational multicenter prospective study.

BACKGROUND: Postoperative pulmonary complications (PPCs) significantly contribute to postoperative morbidity and mortality. We conducted a study to determine the incidence of PPCs after major elective abdominal surgery and their association with early and 1-year mortality in patient without pre-existing respiratory disease. METHODS: We conducted a multicenter observational prospective clinical study in 40 Italian centers. 1542 patients undergoing elective major abdominal surgery were recruited in a time period of 14 days and clinically managed according to local protocol. The primary outcome was to determine the incidence of PPCs. Further, we aimed to identify independent predictors for PPCs and examine the association between PPCs and mortality. RESULTS: PPCs occurred in 12.6% (95% CI 11.1-14.4%) of patients with significant differences among general (18.3%, 95% CI 15.7-21.0%), gynecological (3.7%, 95% CI 2.1-6.0%) and urological surgery (9.0%, 95% CI 6.0-12.8%). PPCs development was associated with known pre- and intraoperative risk factors. Patients who developed PPCs had longer length of hospital stay, higher risk of 30-days hospital readmission, and increased in-hospital and one-year mortality (OR 3.078, 95% CI 1.825-5.191; P<0.001). CONCLUSIONS: The incidence of PPCs in patients without pre-existing respiratory disease undergoing elective abdominal surgery is high and associated with worse clinical outcome at one year after surgery. General surgery is associated with higher incidence of PPCs and mortality compared to gynecological and urological surgery.

A case of posterior reversible encephalopathy syndrome in a 52 year old woman after cardiac arrest.

A 52 year old woman who suffered a cardiac arrest was treated in a local hospital with cardiopulmonary resuscitation. Following transfer to our hospital, she developed renal failure, hypertension, impaired consciousness, headache, and visual disturbances. Magnetic resonance imaging (MRI) showed high signal intensity areas in the periventricular deep cerebral white matter and subcortical white matter (mainly in the parieto-temporo-occipital lobes), findings typical of posterior reversible encephalopathy syndrome. After the MRI findings, her nitroglycerin infusion was stopped, and antihypertensive therapy was initiated using beta blockers and alpha-agonists. She was also treated with continuous venovenous hemofiltration.

The ProSeal laryngeal mask airway: fibreoptic visualization of the glottic opening is associated with ease of insertion of the gastric tube.

PURPOSE: To verify if correct ProSeal laryngeal mask airway (PLMA) placement may condition blind insertion of a gastric tube via the PLMA. METHODS: The PLMA was studied in 150 anesthetized patients using a size #4 in (females) and #5 in (males). Its position was determined by inserting a fibrescope in the airway tube. A lubricated gastric tube was inserted through the PLMA drainage tube, recording the number of attempts at insertion. The relationship between fibreoptic glottic visualization score and attempts at gastric tube insertion using the PLMA was tested statistically. RESULTS: Insertion success rate of the PLMA and of the gastric tube was 93.3% and 99.3%, respectively. Ventilation was satisfactory in all patients, irrespective of fibreoptic score value. A significant correlation (Spearman's rank correlation, P = 0.0186) was present between attempts at gastric tube insertion and fibreoptic score. CONCLUSION: Partial or total visualization of the vocal cords makes the success of gastric tube insertion more probable. Considering that fibreoptic visualization of the glottic aperture is associated with ease of insertion of a gastric tube (P < 0.02), the authors recommend adjusting or reinserting the PLMA if difficulty during the initial positioning of the gastric tube is experienced.