Perioperatiivne maosisu aspiratsioon Tartu Ülikooli Kliinikumis

Taust. Aspiratsioonipneumoniit on haruldane anesteesiaga seotud tüsistus, mille põhjustab operatsiooniaegne maosisu regurgitatsioon ja aspiratsioon. Meie uuringu eesmärk oli retrospektiivselt hinnata perioperatiivse aspiratsioonipneumoniidi esinemissagedust, käsitlust ja riskitegureid Tartu Ülikooli Kliinikumis aastatel 2011–2014.Meetodid. Uurisime retrospektiivselt 80 133 täiskasvanute ja laste anesteesiajuhtu Tartu Ülikooli Kliinikumis aastatel 2011–2014, neist anesteesiatest 17 387 (21,7%) olid erakorralised. Kasutades anesteesia probleemjuhtude registrit ja elektroonilist haiguslugu, leidsime 44 juhtu, kus esines maosisu regurgitatsioon. Eristasime perioperatiivset aspiratsiooni regurgitatsioonist maosisu olemasolu järgi trahheobronhiaalpuus ja/või radioloogilise leiu järgi. Juhtusid hindas üks uurija, et määrata esinenud diagnoos, riskitegurid ja hinnata juhu käsitlust.Tulemused. 44 patsiendil uuringurühmas toimus maosisu regurgitatsioon ja 20 juhul leidis kinnitust perioperatiivne maosisu aspiratsioon. 33 patsiendil olid riskitegurid regurgitatsiooni toimumiseks ning 24 patsiendil mitu riskitegurit; sagedamad riskitegurid olid erakorraline operatsioon ja gastroenteraalne haigus anesteesia põhjusena. Anesteetiline käsitlus ei mõjutanud aspiratsiooni sagedust ega tulemit. 4 patsienti, kel kinnitati maosisu aspiratsiooni diagnoos, surid pulmonoloogiliste tüsistuste tõttu. Maosisu perioperatiivse regurgitatsiooni esinemissagedus oli 1 : 1821, aspiratsioonipneumoniidi esinemissagedus 1 : 4007 ja suremus 1 : 20 033.Järeldused. Anesteesiaaegse regurgitatsiooni ja maosisu aspiratsioonist tingitud kopsukahjustuse esinemissagedus ja suremus on Tartu Ülikooli Kliinikumis suurem, kui varasemates rahvusvahelistes uuringutes on näidatud. Põhjuste täpsemaks analüüsimiseks oleks vaja korraldada prospektiivne uuring.Eesti Arst 2017; 96(10):589–59

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold