Difficult Tracheal Intubation in Obese Gastric Bypass patients.

BACKGROUND: Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. METHODS: This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. RESULTS: The overall proportion of patients with DTI was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass index (BMI) <40, CLC >2, ASA scores >2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 % of the patients, respectively, and there were no association between BMI and difficult vascular access. CONCLUSIONS: We found no association between increasing BMI and DTI.

Aortic aneurysm disease vs. aortic occlusive disease: differences in outcome and intensive care resource utilisation after elective surgery: an observational study.

CONTEXT: Abdominal aortic surgery is a high-risk procedure, with aortic aneurysm and aortic occlusive diseases being the main indications. These groups are often regarded as having equal perioperative risk profiles. Previous reports suggest that the haemodynamic and inflammatory response to aortic clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES: The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN: Cohort observational study based on prospective registrations from national databases. SETTING: Eight Danish hospitals, including four university and four non-university centres, from 1 January 2007 to 1 March 2010. PATIENTS: One thousand two hundred and ninety-three patients scheduled for primary open elective, aortoiliac bypass or aortofemoral bypass procedures or abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES: Mechanical ventilation, acute dialysis, use of vasopressors or inotropes, ICU stay more than 24 h, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P < 0.001) and more often needed acute dialysis or ventilatory support (17 vs. 11%, P = 0.04). No difference was found in hospital length of stay, 30-day mortality or overall risk of death. Mortality after 1 year was higher in patients with aortic aneurysm disease (8 vs. 4.7%, P = 0.04). CONCLUSION: Patients with abdominal aortic aneurysms were at higher risk of developing postoperative organ dysfunction and required more ICU resources than patients with occlusive disease, despite no differences in hospital length of stay or 30-day mortality. Distinguishing between these two diseases may be useful in planning and distribution of ICU resources and for in future studies.

[Fascia iliaca block performed by emergency department physician trainees in hip fractures]. / Fascia iliaca-blokade anlagt af skadestuevagter ved hoftenaere frakturer.

INTRODUCTION: Patients with hip fractures (HF) may have severe pain on arrival to the emergency department (ED) and have traditionally been treated with systemic opioids. The aim of this study was to investigate the effect of fascia iliaca compartment block (FICB) performed by ED physician trainees in patients with HF. MATERIAL AND METHODS: This prospective study included 102 patients with femoral neck fractures. After arrival to the ED they received a FICB. The block was performed by ED physician trainees who injected a weight-adjusted amount of 5 mg/ml ropivacaine. Pain intensity at rest was registered immediately before the block (T0) and after one hour (T1) using a visual analogue scale (VAS). Adequate pain relief was defined as VAS

[Clinical database for intensive care patients]. / Kliniske databaser for kritisk syge patienter.

Intensive care contributes to a substantial part of health care expenses. Admission to intensive care units is associated with a high mortality rate and a high risk of long-term disability. Data from several studies suggest that suboptimal standards of intensive care are relatively common. Lack of knowledge regarding the use of intensive care and long-term outcome as well as the effectiveness and adverse effects of intensive care impede a systematic and evidence-based development and quality improvement. An initiative to establish a Danish national clinical database for intensive care has been launched.