Anaesthetic management of planned or emergency endovascular stent graft surgery for thoracic aneurysms and dissections.

We reviewed the intraoperative anaesthetic management and outcome of seven consecutive cases of endovascular stent graft surgery for thoracic aortic aneurysms or dissections over a period of 20 months in our institution. Seven males (median age 63) underwent endovascular stent graft surgery of the thoracic aorta under general anaesthesia. Four were emergency procedures for acute dissection or leaks of thoracic aneurysms. The duration of the procedures ranged from 120 to 300 minutes. Intraoperative stent migration occurred in one patient. Induced hypotension and immobilization were critical during stent deployment. Six out of the seven patients were discharged home between three to 20 days postoperatively. There was no 30-day mortality. One patient died sixty days postoperatively. Anaemia and respiratory complications were the most common postoperative problems encountered. None of the patients sustained spinal cord ischaemia, acute myocardial infarction or renal impairment. Endovascular stent graft surgery of the thoracic aorta is a relatively new alternative to conventional open surgery. Our experience suggests satisfactory short-term outcome even for patients with acute dissection. However, long-term survival and results require further evaluation.

The emerging role of sociological consultation in the field of community mental health.

One of the most innovative features of the community mental health movement is its expansion to include other than the traditional mental health personnel. It seems most appropriate now that the sociologist be among the new manpower resources put to use by the various agencies concerned with the community mental health movement. In this regard, it is necessary that both professionals and lay people working in mental health be made aware of what the sociologist can contribute to the mental health movement. Sociological services relative to the comprehensive community mental health centers, to other mental health agencies, and to lay and professional persons concerned with mental health are described. The emergence of this role will not be without problems, several of which are described here.