[Protocol for preoperative chest X-rays in elective surgery]. / Protocollo per l'esecuzione della radiografia preoperatoria del torace nella chirurgia d'elezione.

BACKGROUND: To evaluate the effects of a protocol designed to optimize the use of preoperative chest X-rays (CXRs) in the evaluation of patients undergoing anesthesia for elective surgery. DESIGN: Observational prospective study. SETTING: General 350 bedded hospital, with main surgical branches. METHODS: a) PROTOCOL: routine CXRs can be avoided in patients aged less than 60 years, nonsmokers, without acute-chronic respiratory, cardiovascular symptoms, free from neoplastic diseases, not candidates to major vascular, abdominal or thoracic surgery, not treated with immunosuppressive therapy, nor immigrants from areas of endemic TB. b) All out patient subjects admitted to anesthesiology service for evaluation prior to elective surgery. RESULTS: Out of 5198 patients, 3795 were enrolled in the protocol; in 152 cases, preoperative CXRs were performed, 3456 patients (57.2% ASA 1; 42% ASA 2; 0.8% ASA 3) underwent surgery without CXRs. Thirty-four percent of patients had general anesthesia, 54.5% regional anesthesia, 20.6% regional-peripheral anesthesia with/without MAC. No critical events nor major complications were observed in the perioperative period in these subjects. Preoperative CXRs (performed in 152 cases) yelded useful informations with effect on the clinical management in 20 instances. CONCLUSIONS: In a context of adequate preoperative anesthesiologic evaluation, this protocol proved to be effective in reducing the number of routine preoperative CXRs in patients undergoing elective surgery. This resulted in a substantial reduction of radiation exposure both to the subject and to the general population, and costs saving, without evident negative side-effects.

[Evaluation of cardiac risk in patients undergoing major vascular surgery. Usefulness and limitations of transesophageal atrial pacing]. / Valutazione del rischio cardiaco in pazienti da sottoporre a chirurgia vascolare maggiore. Utilità e limiti del pacing atriale transesofageo.

Patients undergoing vascular surgery are at high risk of developing cardiac events in the perioperative period. The aim of the study was the evaluation of the predictive accuracy of transesophageal atrial pacing (TAP) in identifying patients at higher risk of developing major cardiac events (cardiac death, acute myocardial infarction, unstable angina, heart failure and sustained ventricular tachyarrhythmias). We studied 96 consecutive patients, 80 males and 16 females, median age 63, requiring arterial surgery (aortofemoral or aortoiliac bypass and thromboendoarterectomy, abdominal aneurysm resection and extracranial carotid thromboendoaterectomy). TAP was performed without cardioactive drugs in all patients, but one. After surgery CK and CKMB serial assessment and ECG recording were performed daily until the seventh postoperative day. Preoperatively all patients were admitted to the Intensive Care Unit and submitted to haemodynamic monitoring with Swan-Ganz catheter at least for 72 hours. Three patients did not undergo surgery because of severe ST depression during TAP. Thus, 93 patients (96.8% of the series) were the subject of this report. In the postoperative period only two events (2.1% of the patients) were recorded, one relapsing acute myocardial infarction and one ventricular fibrillation, both in patients with negative TAP. No death occurred. Our study shows a very low prevalence of major cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac and circulatory response to the intravenous administration of urapidil during general anaesthesia.

The authors have assessed the hypotensive response to the intravenous administration of urapidil bolus, during intra-operative hypertensive crises, in 42 patients undergoing general anaesthesia for surgery. Twenty-two of these patients underwent major vascular surgery and were monitored through catheters introduced into the radial and pulmonary arteries, to study the haemodynamic changes induced by urapidil. A significant reduction was observed in these values: systolic and diastolic arterial pressure, systolic and diastolic pulmonary pressure, pulmonary wedge pressure and systemic vascular resistance. A non-significant reduction was observed in central venous pressure and pulmonary vascular resistance. Heart rate and cardiac output remained unchanged. Systolic arterial pressure decreased 12% from the baseline in 81% of patients. The transient action of urapidil bolus in some cases (55%) suggests the need for urapidil infusion.