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Archive for March, 2013

Perioperative risk stratification for a patient with severe obstructive sleep apnoea undergoing laparoscopic banding surgery

13 Mar, 13 | by Emma

Surgery on patients with OSA can be problematic, and a preoperative assessment is useful as a predictor of complications and as a means of planning best clinical practice. This proposed assessment takes into account the 3 major areas of concern, namely the severity of OSA, the planned procedure, and the need for perioperative sedation and analgesia.

I would encourage others to have such an approach to preoperative assessment and management of surgical patients with OSA.

Reviewer
Dr David Barnes
Associate Professor
Royal Prince Alfred Hospital

Perioperative risk stratification for a patient with severe obstructive sleep apnoea undergoing laparoscopic banding surgery

A not very NICE case of endocarditis

6 Mar, 13 | by Emma

The recommendations of the American Heart Association and European Society for Cardiology on the use of antibiotic prophylaxis for patients considered to be high risk is very relevant in dental practice. The NICE guidelines as described by the author, at times need not be too nice for a high risk patient.

Reviewer
Dr Peter George MD
Associate Professor
Father Muller Medical College

A not very NICE case of endocarditis

Primary prophylaxis of pulmonary embolus with retrievable IVC filter

4 Mar, 13 | by Dr Dean Jenkins

Announced in the news today was the case of Doreen Carter who had an inferior vena cava filter inserted as an alternative for prophylaxis against thromboembolism.

http://www.bbc.co.uk/news/uk-england-berkshire-21655038

She was due to have bowel surgery and, presumably, was deemed too high risk for anticoagulation. The titanium device was also designed to be easily removed.

“Dr Carl Waldmann, a consultant at the hospital, said giving post-operative patients anti-clotting drugs can be risky, and existing measures to catch clots also carry risks because they are difficult to insert and remove.”

As the IVC filter devices and deployment skills have improved, especially of retrievable devices [1], there has been debate over when they should be used. [2]

 

1. Johnson MS, Nemcek AA Jr, Benenati JF, Baumann DS, Dolmatch BL, Kaufman JA, Garcia MJ, Stecker MS, Venbrux AC, Haskal ZJ, Avelar RL. The safety and effectiveness of the retrievable option inferior vena cava filter: a United States prospective multicenter clinical study. J Vasc Interv Radiol 2010 Aug;21(8):1173–1184.Available from: http://www.ncbi.nlm.nih.gov/pubmed/20598570

2. Wehrenberg-Klee E, Stavropoulos SW. Inferior vena cava filters for primary prophylaxis: when are they indicated? Semin Intervent Radiol 2012 Mar;29(1):29–35.Available from: http://www.ncbi.nlm.nih.gov/pubmed/23450194

 

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