Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial.

CONTEXT: Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined. OBJECTIVE: To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery. DESIGN, SETTING, AND PATIENTS: The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006 and October 2008 among 1400 patients undergoing acute or elective laparotomy. INTERVENTIONS: Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery. MAIN OUTCOME MEASURES: Surgical site infection within 14 days, defined according to the Centers for Disease Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS: Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory failure in 38 (5.5%) vs 31 (4.4%) (OR, 1.27; 95% CI, 0.78-2.07; P = .34), and mortality within 30 days in 30 (4.4%) vs 20 (2.9%) (OR, 1.56; 95% CI, 0.88-2.77; P = .13). CONCLUSION: Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00364741.

[Knotted femoral catheter]. / Knudedannelse på femoraliskateter.

An 89-year-old woman was admitted with a fractured hip. For pain relief a femoral catheter was placed. Later, it was not possible to remove the catheter by traction. After X-ray visualisation, the catheter was removed surgically. The catheter was knotted around connective tissue 4 cm below skin level. Knotting of catheters for regional anaesthesia is a rare, but known complication which should be suspected when resistance is met during catheter removal. If necessary, the catheter should be removed surgically. The entire catheter should be removed, since any remains may increase the risk of infection.

[Complications of unnecessary arterial puncture]. / Komplikation til unødig arteriepunktur.

This case describes the complications of an arterial puncture in an 83-year-old female with a femoral neck fracture. Two arterial punctures were performed in the perioperative period. Ten days after surgery the patient was re-admitted with a pseudo aneurysm in the radial artery above the wrist. The artery was ligated and no signs of infection were found. Arterial puncture is an important source of information, but it is essential to use the correct aseptic technique and to apply compression to the artery afterwards. The indication should always be considered, as a venous blood sample can often provide the information needed.