Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis

BACKGROUND: Epidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems. METHODS: We performed an extensive systematic review to find published cohorts of use of epidural catheters during vascular, cardiac, and thoracic surgery, using electronic searching, hand searching, and reference lists of retrieved articles. RESULTS: Twelve studies included 14,105 patients, of whom 5,026 (36%) had vascular surgery, 4,971 (35%) cardiac surgery, and 4,108 (29%) thoracic surgery. There were no cases of epidural haematoma, giving maximum risks following epidural anaesthesia in cardiac, thoracic, and vascular surgery of 1 in 1,700, 1 in 1,400 and 1 in 1,700 respectively. In all these surgery types combined the maximum expected rate would be 1 in 4,700. In all these patients combined there were eight cases of transient neurological injury, a rate of 1 in 1,700 (95% confidence interval 1 in 3,300 to 1 in 850). There were no cases of persistent neurological injury (maximum expected rate 1 in 4,600). CONCLUSION: These estimates for cardiothoracic epidural anaesthesia should be the worst case. Limitations are inadequate denominators for different types of surgery in anticoagulated cardiothoracic or vascular patients more at risk of bleeding

A comparison of transoesophageal echocardiographic Doppler across the aortic valve and the thermodilution technique for estimating cardiac output.

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Life strategies, energetics and growth characteristics of Calanoides carinatus (Copepoda) in the Angola-Benguela frontal region

Rates of daily egg production, moulting and egg hatching success, as well as total lipid content and composition of Calanoides carinatus, were measured in the region of the southern Angola Current (SAC), the Angola-Benguela Front (ABF) and the coastal upwelling area of the northern Benguela Current (NBC) system during February–March 2002. There were distinct differences in the vertical distribution, growth characteristics, lipid content and composition of populations in the SAC/ABF and NBC regions, indicative of different physiological states. Whereas in the NBC, C. carinatus was actively growing in response to elevated chlorophyll a levels associated with coastal upwelling, it comprised deep-living C5 copepodids with very large wax ester reserves (c. 40–50% dry mass) and extremely low metabolism in the SAC/ABF, suggesting diapause. This study provides the first data on lipid composition (lipid classes, fatty acids and alcohols) of this copepod in the region; in particular, the diapausing C5s contained high levels of long-chain, mono-unsaturated fatty acids (23% of all fatty acids) and alcohols (69% of all fatty alcohols) in addition to trophic markers of diatoms, viz. 16:1(n-7) and 20:5(n-3). Based on total lipid content, the maximum survival time of the diapausal component of C. carinatus was estimated to be 149–192 days, whereas active surface-dwelling C5s and females could not survive for more than 10 days without feeding.Keywords: Angola-Benguela Front, Calanoides carinatus, diapause, growth rates, lipid content and composition, northern Benguela upwelling, oxygen minimum layer, vertical distribution African Journal of Marine Science 2005, 27(3): 641–65