Incidence Of Immediate Complications Research Articles

Visual rigid laryngoscopy versus video laryngoscopy for endotracheal intubation in elderly patients: A randomized controlled trial.

To assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients. In 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints. The intubation times were 35.0 (30.0-41.5) s and 42.5 (38.0-51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05). Compared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups. ChiCTR2100054174.

Use and Outcomes of Amplatz Renal Dilator for Treatment of Urethral Strictures

Background: Urethral strictures pose a significant challenge in urological practice, with traditional treatments often associated with considerable morbidity. The quest for less invasive yet effective interventions has led to innovative approaches, among which the Amplatz Renal Dilator has emerged as a promising tool. Objective: This study aimed to evaluate the efficacy and safety of the Amplatz Renal Dilator in the treatment of urethral strictures, focusing on urinary flow rates, stricture severity, patient symptom relief, and the incidence of complications. Methods: A prospective, observational cohort study was conducted at multiple centers including Gajju Khan Medical College Swabi Naseer Teaching Hospital Peshawar in the duration from January, 2023 to June, 2023. Total Thirty-five participants diagnosed with urethral strictures were enrolled and treated with the Amplatz Renal Dilator. The study spanned two years, with an initial six-month recruitment phase followed by an eighteen-month follow-up. Efficacy was assessed through improvements in urinary flow rates and stricture severity, while safety was evaluated by monitoring procedural complications and recurrences. Quality of life and patient satisfaction were also measured using validated questionnaires. Results: Post-treatment, urinary flow rates significantly improved from a mean of 10 mL/s (SD ± 2) to 15 mL/s (SD ± 3) (p&lt;0.001). Stricture severity decreased from Grade 3 (SD ± 1) to Grade 1 (SD ± 1) (p&lt;0.001). International Prostate Symptom Score (IPSS) from 22 (SD ± 4) to 10 (SD ± 3) (p&lt;0.001). The incidence of immediate complications was 5%, with no significant long-term complications reported. The recurrence rate of strictures was observed at 10%. Conclusion: The Amplatz Renal Dilator demonstrates significant efficacy in improving urinary flow rates and reducing stricture severity, with minimal complications and a low recurrence rate. These findings suggest that the Amplatz Renal Dilator is a safe and effective option for the treatment of urethral strictures, warranting further investigation in larger, randomized controlled trials.

PERCUTANEOUS TRACHEOTOMY IN ICU: OUR EXPERIENCE IN 2020-2021 (COVID-19 PANDEMIC).

<h3>INTRODUCTION</h3> Percutaneous tracheostomy (PT) is a surgical procedure for the placement of a tracheal tube through the anterior wall of the trachea. It is performed using a modified Seldinger technique between the second and third tracheal rings and guided under direct vision by the fiberoptic bronchoscope. It is a minimally invasive procedure with a low number of complications by experienced physicians. It is considered a safe alternative to surgical tracheostomies (ST), a more aggressive procedure. According to the internal protocols of the Anesthesia Intensive Care Unit (ICU) of the Valencia University General Hospital (CHGUV), PT are performed by anaesthesiologists, while ST are performed by otorhinolaryngologists. This study aims to confirm that PT is just as safe as ST, as well as that it presents the same or fewer immediate complications, understanding these as bleeding, loss of the airway due to the exit of the endotracheal tube, creation of a false pathway, injury to the posterior wall, injury to one or more tracheal rings, the appearance of subcutaneous emphysema and damage to the fiberoptic bronchoscope with the puncture needle. Due to the Covid-19 pandemic, patients with Covid-19 have been included. The modified protocol for this type of patient has been followed, following the consensus document of the Spanish Societies of Intensive Medicine (SEMICYUV), Otorhinolaryngology (SEORL-CCC), and Anesthesia (SEDAR). <h3>OBJECTIVE</h3> Review the total number of tracheotomies performed by anesthesiologists and otolaryngologists in the CHGUV ICU in 2020-2021, including patients with SARS-COV2 infection, as well as the total of immediate complications that occurred concerning the procedure. Confirm that PT is the technique of choice in critically ill patients due to its lower number and less severity of complications. <h3>MATERIAL AND METHODS</h3> Descriptive, observational, and retrospective study, in which each one of the tracheotomies performed in the CHGUV anesthesia ICU in 2020-2021, as well as their immediate complications, were collected. Patients with Covid-19 were included too. <h3>RESULTS</h3> A total of 294 tracheostomies were performed (20 were patients with SARS-COV2 infection). 294 were TP (12 with SARS-COV2) and 11 TQ (8 with SARS-COV2). Among the complications recorded, the most frequent was mild bleeding appearing in a total of 35 patients. Of these patients, only 30% belonged to the PD group. No cases required a surgical revision. In addition, within the ST, there was one case of accidental decannulation with loss of the airway. <h3>CONCLUSIONS</h3> Our study shows in general a low rate of early complications in tracheostomies, however, ST caused a higher incidence of immediate complications. Furthermore, PT has shown not only a lower incidence of complications but a lower severity of these too. The data from this study support the PT performed by experimented anesthesiologists as the technique of choice in critical patients compared to CT.

Immediate and delayed complications of inferior vena cava filters

ObjectiveInferior vena cava (IVC) filter placement has increased dramatically in the past two decades. However, literature supporting the efficacy of these devices has been limited and controversial. In the present study, we have evaluated the predictors and rates of technical complications after IVC filter insertion in a large national database. MethodsThe Vascular Quality Initiative registry was explored (January 2013 to December 2020). Immediate complications were defined as venous injury requiring treatment, filter misplacement (failure to open, deployed >20 mm from intended site or in wrong vein, embolized to the heart), angulation >20°, and insertion site complications. Delayed complications were defined as migration, angulation >15°, fracture, caval and/or iliac thrombosis, filter thrombus, fragment embolization, and perforation. The Pearson χ2 test was used to compare the baseline characteristics between the patients who had developed immediate and/or delayed complications and those who had not. The predictors of these complications were evaluated using multivariable logistic regression, Cox proportional hazard regression, and Kaplan-Meier survival analysis. ResultsA total of 14,784 patients were included in the present analysis, with a median follow-up of 11 months (interquartile range, 4-16 months). The rate of immediate and delayed complications was 1.8% and 3.1%, respectively. Angulation (1.2%) was the most common immediate complication, and filter thrombosis (1.6%) was the most common delayed complication. Compared with the patients with no immediate complications, those with immediate complications were more likely to have had abnormal anatomy (6.0% vs 1.7%; P < .001) and a landing zone other than infrarenal (7.0% vs 4.2%; P = .02). Compared with their counterparts, those with delayed complications were less likely to have received statins (21.0% vs 29.5%; P = .006) and were more likely to have a family history of venous thromboembolism (8.0% vs 5.1%; P = .047). Logistic regression analysis revealed that renal vein visualization was associated a 50% reduction (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.27-0.92; P = .027) in the odds of immediate complications and female sex and abnormal anatomy were associated with a 41% (aOR, 1.41; 95% CI, 1.08-1.85; P = .013) and 244% (aOR, 3.44; 95% CI, 1.66-7.16; P < .001) increase in the odds of immediate complications, respectively. Immediate (P = .21) and delayed (P = .51) complications did not result in increased mortality. ConclusionsThe immediate and delayed IVC filter complication rates were 1.8% and 3.1%, respectively, but the occurrence of complications was not associated with increased mortality. Female sex was associated with an increase in the development of immediate complications. The incidence of immediate complications might be mitigated if advanced imaging were used for renal vein visualization before IVC filter deployment. Delayed complications might be avoided if IVC filter retrieval were performed in a timely fashion and institutional retrieval protocols were optimized.

Safety and tolerability of regadenoson in comparison with adenosine stress cardiovascular magnetic resonance: Data from a multicentre prospective registry.

To assess the feasibility and incidence of immediate complications of stress cardiovascular magnetic resonance (CMR) with regadenoson in comparison with adenosine in a large referral population. This is a large, multicenter, prospective registry of vasodilator stress-CMR in a referral population. We recorded the clinical and demographic data, quality of test, CMR findings, hemodynamic data, and complications. Between January 2016 and July 2019, 2908 patients underwent stress-CMR, 2253 with regadenoson and 655 with adenosine. 25.1% of patients had previously known coronary artery disease (CAD). In 305 patients regadenoson was used due to presence of chronic obstructive pulmonary disease (COPD) or asthma, while in 1948 subjects regadenoson was used as first-line vasodilator. Quality was optimal in 90.0%, suboptimal in 9.5%, and poor in 0.5%. Images were diagnostic in 98.9%. After stress with regadenoson, aminophylline 200mg was administered intravenously in all patients. No patient died or had severe immediate complications with regadenoson as opposed to 2 severe bronchospasm with adenosine (p = 0.05). 11 patients (0.5%) had non-severe complications with regadenoson and five patients (0.8%) with adenosine (p = n.s.). Only two patients (0.088%) had non-severe bronchospasm after regadenoson administration. All complications were solved in the CMR unit, with no need for further specific care. Factors significantly associated with presence of complications were history of COPD or asthma and detection of inducible ischaemia. Patients had significantly more minor symptoms when adenosine was used (66.0% vs. 18.4%, p < 0.0001). Stress-CMR with regadenoson is feasible, providing diagnostic information in a referral population. Regadenoson had an excellent safety profile and better tolerability than adenosine, with no serious immediate complications and low incidence of non-severe complications. Only inducible ischaemia and previous history of COPD or asthma were associated with complications after regadenoson-CMR. The incidence of minor symptoms was low.

Vasodilatation stress cardiovascular magnetic resonance: feasibility and safety in a monocentric prospective study

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Cardiovascular magnetic resonance imaging (CMR) has emerged as an accurate technique that can assess ventricular function, stress myocardial perfusion, and viability, without radiation. Recent studies have shown that stress CMR would be the best test to predict obstructive coronary artery disease (CAD) with a good safety. PURPOSE The aim of our study was to assess the feasibility and incidence of immediate complications of stress CMR in a tertiary Cardiovascular Center with CMR Laboratory dedicated. METHODS Prospective registry of vasodilator stress CMR in a French center with CMR expertise included all consecutive patients referred for vasodilator stress perfusion CMR to detect an obstructive CAD between 2008 and 2020. Stress CMR was performed at 1.5 T using dipyridamole. The clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications were prospectively recorded. RESULTS Stress CMR was performed in 35,157 patients (98.2% of requested). The study could not be performed due to claustrophobia in 0.3%. Quality was optimal in 93.1%, suboptimal in 6.4%, and poor in 0.5% of studies. Images were diagnostic in 97.9% of patients. No patient died or had acute myocardial infarction during the test. Moreover, 56 patients (0.16%) had severe immediate complications, and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia (p &amp;lt; 0.001). Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (35.5%). CONCLUSION Performance of stress CMR is safe with very high image rate of satisfactory quality to perform the diagnosis in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications. Abstract Table. Final results after stress CMR

Vasodilator perfusion stress cardiovascular magnetic resonance: Feasibility and safety in a French monocentric prospective study

Cardiovascular magnetic resonance imaging (CMR) has emerged as an accurate technique that can assess ventricular function, stress myocardial perfusion, and viability, without radiation. Recent studies have shown that stress CMR would be the best test to predict obstructive coronary artery disease (CAD) with a good safety. The aim of our study was to assess the feasibility and incidence of immediate complications of stress CMR in a tertiary Cardiovascular Centre with CMR Laboratory dedicated. Prospective registry of vasodilator stress CMR in a French centre with CMR expertise included all consecutive patients referred for vasodilator stress perfusion CMR to detect an obstructive CAD between 2008 and 2020. Stress CMR was performed at 1.5 T using dipyridamole. The clinical and demographic data, quality of test, CMR findings, hemodynamic data, and complications were prospectively recorded. Stress CMR was performed in 35,157 patients (98.2% of requested). The study could not be performed due to claustrophobia in 0.3%. Quality was optimal in 93.1%, suboptimal in 6.4%, and poor in 0.5% of studies. Images were diagnostic in 97.9% of patients. No patient died or had acute myocardial infarction during the test. Moreover, 56 patients (0.16%) had severe immediate complications, and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia ( P < 0.001). Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (35.5%) ( Fig. 1 ). Performance of stress CMR is safe with very high image rate of satisfactory quality to perform the diagnosis in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications.

Abstract 13467: Vasodilatation Stress Cardiovascular Magnetic Resonance: Feasibility and Safety in a Monocentric Prospective Study

Introduction: Cardiovascular magnetic resonance imaging (CMR) has emerged as an accurate technique that can assess ventricular function, stress myocardial perfusion, and viability, without radiation. Recent studies have shown that stress CMR would be the best test to predict obstructive coronary artery disease (CAD) with a good safety. Hypothesis: To assess the feasibility and incidence of immediate complications of stress CMR in a tertiary Cardiovascular Center with CMR Laboratory dedicated. Methods: Prospective registry of vasodilator stress CMR in a French center with CMR expertise included all consecutive patients referred for vasodilator stress perfusion CMR to detect an obstructive CAD between 2008 and 2020. Stress CMR was performed at 1.5 T using dipyridamole. The clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications were prospectively recorded. Results: Stress CMR was performed in 35,157 patients (98.2% of requested). The study could not be performed due to claustrophobia in 0.3%. Quality was optimal in 93.1%, suboptimal in 6.4%, and poor in 0.5% of studies. Images were diagnostic in 97.9% of patients. No patient died or had acute myocardial infarction during the test. Moreover, 56 patients (0.16%) had severe immediate complications, and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia (p&lt;0.001). Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (35.5%). Conclusions: Performance of stress CMR is safe with very high image rate of satisfactory quality to perform the diagnosis in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications.

P1368EVOLUTIVE PROFILE OF HEMODIALYSIS VASCULAR ACCESSES

Abstract Background and Aims Arterio-venous fistula (AVF) is considered to be the first choice vascular access for hemodialysis (HD). Hemodialysis catheter (KT) may be a temporary or permanent alternative. The aim of our work was the study of indications, and complications’ contributing factors of KT, and to identify complications and predictive factors of AVF survival. Method It’s a retrospective, descriptive, analytic, and multicentric study interesting AVF and KT created in patients with end stage renal disease and who have been treated with hemodialysis in the four hemodilysis centers of the KEF governorate in Tunisia over the period from 01/07/18 to 31/12/18. Results We have studied 288 AVF and 148 KT that were created in 205 patients averaging 58.14 ±15.56 years in age [25-93 years]. The sex ratio was 1.5. Diabetic nephropathy was the most common (25.9%). For the KT, the main indication was the wait of AVF creation (68.9%). The overall incidence of immediate complications was 11.5%. Dysfunction was reported in 23.6% of cases with obesity (p=0.035) and tunneled type of KT (p=0.045) as contributing factors. KT infection, occuring in 39.2% of cases, was promoted by prolonged duration of use (p=0.041) and hemoglobin level &amp;lt;8 g/dl (p=0.039). The use of an antiseptic lock reduces infections’ risk (p=0.011). For the AVF, the most common complications were thrombosis (36.2%), aneurysm (29.9%) and stenosis (22.6%). The survival rates were 60% at 2000 days. The AVF impairing factors were diabetes (p=0.05), obesity (p=0.05), the anterior AVF creation (p=0.011), AVF grafts (p=0.016) and the use of an anticoagulant therapy (p=0.0001). An antiplatelet therapy improved AVF patency (p=0.02). Conclusion Despite of concerted efforts, much remained to be done to reduce the incidence of catheterization, the creation of AVF on time and the prevention of its complications.

Clinical Study on the Minimally Invasive-Guided Genioplasty Using Piezosurgery and 3D Printed Surgical Guide.

Introduction:A retrospective clinical study was performed regarding the minimally invasive-guided genioplasty technique (MIGG technique) described in a previous clinical note. The aims of this clinical study were to study the incidence of immediate complications with this technique compared with a control group using a nonminimally genioplasty technique, to validate the accuracy of the three-dimensional (3D) printed cutting guide, and to evaluate the duration of the surgery and the satisfaction of the surgeons with this technique.Materials and Methods:One controlled group, including 56 patients, operated with a classical genioplasty and one group, including 24 patients operated with the MIGG technique. The inclusion criteria were patients from 18 years old benefiting from orthognathic surgery for dysmorphic maxillofacial disorders, sleep apneas, or posttraumatic malocclusion; operated by the three same surgeons. A database was retrospectively made, including the demographics parameters, the indication, the type and the duration of surgery, the incidence of complication, and the type of complication. The accuracy of the cutting guide was also studied by the comparison of two distances in the MIGG group on the preoperative surgical simulation and on the postoperative cephalometric radiography. A satisfaction survey for the surgeons of the department regarding the MIGG technique was also analyzed.Conclusion:No statistical difference was found in the incidence of complications between the MIGG group and the control group. Using a guide does not cause more surgical infection. The protection of the inferior alveolar nerve is obvious. The absence of statistical difference is due to the fact that the majority of patients also benefited from the bilateral sagittal split osteotomy during surgery. The 3D-cutting guide used is very accurate: There is indeed no significative difference in the measurements A and B before and after the genioplasty. The MIGG technique is thus a predictable, safe, and easy-to-use technique that should be used routinely by maxillofacial surgeons. It combines the latest technologies in piezosurgery and in 3D-guided surgery by the creation of a validated-accurate 3D-printed cutting guide. This technique is affordable by the use of open-source program and a desktop fused deposit Modeling 3D-printer. Finally, the comfort of the surgeon is improved, and the operating time is decreased.

Immediate Complications of Elective Newborn Circumcision.

To determine the incidence of immediate complications of elective newborn circumcision in 2 community teaching hospitals. We performed a retrospective chart review of all term neonates who had circumcision performed between August 2011 and December 2014 at 2 community hospitals in New York. Neonatal hospital records and subsequent inpatient and outpatient records were reviewed. We classified complications as minor, intermediate, and major. Out of a total of 1115 circumcisions, 1064 met inclusion criteria. There were 41 complications (3.9%), all involving hemorrhage. Sutures were used to control hemorrhage in 3 patients (0.3%). Local pressure or application of hemostatic chemical agents controlled bleeding in the remainder of patients. Bleeding was more common with the use of the Gomco clamp than with the Mogen clamp. Circumcisions performed with Gomco clamp represented 73.2% of the total complications compared with 26.8% with the Mogen clamp. There were no injuries to structures outside the prepuce or problems requiring medical treatment after discharge from the neonatal hospitalization. The most common immediate complication encountered during an elective neonatal circumcision was bleeding that required only pressure or topical thrombin to achieve hemostasis. Bleeding was more common with the use of the Gomco versus the Mogen clamp. To conclude, our data support the theory that elective infant circumcision can be performed safely in a hospital setting.

Indications and immediate outcomes of tracheostomy in Rwanda

Introduction: Tracheostomy is performed as an alternative to the natural breathing airways for upper airway obstruction, pulmonary toilet or for protecting the larynx. It is a common procedure in surgical departments.Objectives: The study aimed at evaluating the immediate outcomes of tracheostomy and the incidence of immediate complications associated with tracheostomy.Methods: Using a questionnaire, prospective data was collected from patients, who presented in Ear, Nose and Throat department at the Kigali University Teaching Hospital (KUTH).Results: 29 patients underwent a tracheostomy. The age rang was 4 to 77 years, mean of 37 years, 82.8% were aged above 18 years. Male to female ratio was 3.8:1. The incidence of tracheostomy was 9.5%. The most common indication was prolonged intubation accounting for 55.2% of cases. No intra -operative complications were noted. No tracheostomy related mortality occurred within 24 hours after the procedure. 86.2% patients were clinically stable after the procedure while 13.8% were unstable due to their primary medical conditions.Conclusion: Prolonged intubation is the most common indication for tracheostomy, most of the times performed as an elective procedure. The procedure is safe for all patients even in resource poor settings and post-operative complications are minimal.Keywords: Tracheostomy, Indications, Immediate outcome, Complications, Rwanda

Ultrasound versus anatomical landmarks: Immediate complications in the central venous catheterization in children under 18 years of age

Abstract Introduction The insertion of a central venous line in children and adolescents is technically more difficult, due to the smaller size of the structures. This can lead to an increase in immediate complications, which can be reduced when using ultrasound. In our institution, the percentage of these complications and the use of ultrasound are unknown. Objective To describe the frequency of immediate complications of central venous catheterisation guided by the ultrasound in a general university hospital, compared to the anatomical landmarks technique in children less than 18 years of age. Materials and methods Observational, retrospective, and analytical study, comparing the frequency of complications with two central venous catheterisation techniques: anatomical landmarks and ultrasound, according to the clinical records of procedures performed from June to November 2016. Results A total of 201 procedural records were analysed, of which 71% were with landmarks, and 29% with ultrasound. The overall incidence of immediate complications was 18.4%, with 12% using ultrasound and 21% using landmarks (OR: 0.5; 95 CI: 0.2–1.2). Children under 5 years of age presented with 90% of the complications, the most frequent being the impossibility of passing the guide (29.7%) and multiple punctures (24.3%). There was no arterial puncture with use of ultrasound. Ultrasound was used by 13.4% of paediatric surgeons, by 32.4% of paediatricians, and 46.4% of anaesthetists, with complications of 25%, 19%, and 7%, respectively. The main indication for catheterisation was the need for vasoactive agents (74%), with the procedure being more complicated in patients with no peripheral venous accesses (46%). The success rate with anatomical landmarks was 77.6%, compared to 91.4% with ultrasound. Conclusion Central venous catheterisation with ultrasound guidance in children under 18 reduces immediate complications by 42.8% and improves the success rate by 13.8%.

Ultrasonido frente a referencias anatómicas: complicaciones inmediatas en la canalización de vía venosa central en menores de 18 años

IntroductionThe insertion of a central venous line in children and adolescents is technically more difficult, due to the smaller size of the structures. This can lead to an increase in immediate complications, which can be reduced when using ultrasound. In our institution, the percentage of these complications and the use of ultrasound are unknown. ObjectiveTo describe the frequency of immediate complications of central venous catheterisation guided by the ultrasound in a general university hospital, compared to the anatomical landmarks technique in children less than 18years of age. Materials and methodsObservational, retrospective, and analytical study, comparing the frequency of complications with two central venous catheterisation techniques: anatomical landmarks and ultrasound, according to the clinical records of procedures performed from June to November 2016. ResultsA total of 201 procedural records were analysed, of which 71% were with landmarks, and 29% with ultrasound. The overall incidence of immediate complications was 18.4%, with 12% using ultrasound and 21% using landmarks (OR: 0.5; 95%CI: 0.2-1.2). Children under 5years of age presented with 90% of the complications, the most frequent being the impossibility of passing the guide (29.7%) and multiple punctures (24.3%). There was no arterial puncture with use of ultrasound. Ultrasound was used by 13.4% of paediatric surgeons, by 32.4% of paediatricians, and 46.4% of anaesthetists, with complications of 25%, 19%, and 7%, respectively. The main indication for catheterisation was the need for vasoactive agents (74%), with the procedure being more complicated in patients with no peripheral venous accesses (46%). The success rate with anatomical landmarks was 77.6%, compared to 91.4% with ultrasound. ConclusionCentral venous catheterisation with ultrasound guidance in children under 18 reduces immediate complications by 42.8% and improves the success rate by 13.8%.

Clinical Practice and Risk Factors for Immediate Complications of Endotracheal Intubation by Intensive Care Unit Doctors in a Regional Hospital in Hong Kong

Background Endotracheal intubation in critically ill patients is often challenging and is associated with a high complication rate. Intensive Care Unit (ICU) doctors are often responsible for emergency intubation but local data about their experience is lacking. Objective To describe the ICU team's practice of endotracheal intubation in critically ill patients in a regional hospital; to evaluate the incidence of immediate complications; and to identify risk factors for complications and predictors for successful intubation. Design Retrospective, observational study Patients All patients who received endotracheal intubation by the ICU team of the study centre between the 1st July 2013 and 31st December 2013. Results Complete data from 325 endotracheal intubations were analyzed. The commonest diagnosis was pneumonia (41.5%) and the mostly frequently cited indication for endotracheal intubation was respiratory failure (50.8%). Complications occurred in 25.5% of all intubations including 4 cases of cardiac arrest after the procedure. Haemodynamic alterations (hypotension and hypertension occurred in 9.2% and 7.4% respectively) were the most common complications. Overall, 96.6% of intubations were successful on the first two attempts. Logistic regression analyses showed that reduced mouth opening was a significant risk factor for immediate complications (odds ratio [OR] 15.98, 95% confidence interval [CI]: 2.71 to 94.41, P=0.006). Cormack-Lehane laryngoscope grading below 2b (OR 0.2, 95% CI: 0.07-0.59, P=0.003) and operator with more than 6 months of formal anaesthetic training (OR 7.06, 95% CI: 1.63 to 30.62, P=0.009) were independent predictors for successful intubation. Conclusion The ICU team achieves a high successful rate of emergency endotracheal intubation. High rates of anticipated and unanticipated difficult airway are encountered. Reduced mouth opening is a significant risk factor for complications occurrence. Cormack-Lehane laryngoscopic grading below 2b and intubation performer with more than 6 months of formal anaesthetic training are significant independent predictors for successful intubation. (Hong Kong j.emerg.med. 2016;23:135-144)

Pharmacological stress cardiovascular magnetic resonance: feasibility and safety in a large multicentre prospective registry.

To assess the feasibility and incidence of immediate complications of stress cardiovascular magnetic resonance (CMR) and to determine associated factors. This was a large multicentre, prospective registry of pharmacologic stress CMR in a referral population. We used dipyridamole when no contraindication was present and dobutamine in the remaining patients. Stress CMR was performed at 1.5 T. We recorded the clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications. Stress CMR was performed in 11 984 patients (98.2% of requested), using dipyridamole in 95.4% and dobutamine in 4.6%. The study could not be performed due to claustrophobia in 0.2%. Quality was optimal in 93.4%, suboptimal in 6.2%, and poor in 0.4% of studies. Images were diagnostic in 97.6% of patients (98.7% with dipyridamole and 75.1% with dobutamine, P < 0.0001). No patient died or had acute myocardial infarction during the test. Ten patients (0.08%) had severe immediate complications, seven after dipyridamole and two after dobutamine (P = 0.062), and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia. Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (24.8%). Both were significantly more frequent when dobutamine was used. Performance of stress CMR is safe in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications. The incidence of non-severe complications and minor symptoms was greater with dobutamine.

Predictive factors for colonoscopy complications.

To determine factors predicting complications caused by colonoscopy. Prospective cohort study. A private hospital in Hong Kong. All patients undergoing colonoscopy in the Endoscopy Centre of the Hong Kong Sanatorium & Hospital from 1 June 2011 to 31 May 2012 were included. Immediate complications were those that were recorded by nurses during and up to the day after the examination, while delayed complications were gathered 30 days after the procedure by way of consented telephone interview by trained student nurses. Data were presented as frequency and percentage for categorical variables. Logistic regression was used to fit models for immediate and systemic complications with related factors. A total of 6196 patients (mean age, 53.7 years; standard deviation, 12.7 years; 3143 women) were enrolled and 3657 telephone interviews were completed. The incidence of immediate complications was 15.3 per 1000 procedures (95% confidence interval, 12.3-18.4); 50.5% were colonoscopy-related, including one perforation and other minor presentations. Being female (odds ratioadjusted=1.6), use of monitored anaesthetic care (odds ratioadjusted=1.8), inadequate bowel preparation (odds ratioadjusted=3.5), and incomplete colonoscopy (odds ratioadjusted=4.5) were predictors of risk for all immediate complications (all predictors had P<0.05 by logistic regression). The incidence of delayed complications was 1.6 per 1000 procedures (95% confidence interval, 0.3-3.0), which comprised five post-polypectomy bleeds and one post-polypectomy inflammation. The overall incidence of complications was 17.8 per 1000 procedures (95% confidence interval, 13.5-22.1). The incidences of complications were among the lower ranges across studies worldwide. Inadequate bowel preparation and incomplete colonoscopy were identified as factors that increased the risk for colonoscopy-related complications. Colonoscopy-related complications occurred as often as systemic complications, showing the importance of monitoring.

New invasive therapies for management of resistant hypertension

The failure of pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments. New catheter systems using radiofrequency or ultrasound energy have been developed, allowing a percutaneous endovascular approach to renal denervation for patients with resistant hypertension. To date, this technique has been evaluated only in a few open-label trials including small numbers and the available evidence suggests a favorable blood pressure-lowering effect in the short-term and a low incidence of immediate complications. All studies published to date have several limitations due to their open-label design. Carotid baroreceptor stimulation requires surgical implantation of electrodes connected to a stimulator. Preliminary results show a positive effect on blood pressure with a complication rate similar to the implantation of a pacemaker. In this context, there are arguments against an uncontrolled use of these procedures in routine practice: an unknown benefit/risk ratio, a variable blood pressure response, absence of cost-effectiveness evaluation. The indications of these procedures should follow the 2013 European Society of Hypertension guidelines. A strict follow-up of patients remains necessary at best by including them in clinical trials or international registries.

Routine Chest X-ray is not Mandatory after Fluoroscopy-Guided Totally Implantable Venous Access Device Insertion

The aim of this study is to determine whether systematic postoperative chest X-ray is required after totally implantable venous access port device (TIVAD) placement under fluoroscopic control. A retrospective chart review of all consecutive patients with fluoroscopy-guided TIVAD insertion from July 10, 2009 to April 16, 2012 was conducted at the Geneva University Hospitals (n = 927). Patients with an available postoperative chest X-ray were included, regardless of approach (open or percutaneous) and venous access site (subclavian, cephalic, jugular, etc.). Exclusion criteria were incomplete data and preexisting pneumothorax or hemothorax. Eight hundred ninety-one patients were included. First-intention venous cutdown was performed in 878 patients (98.5%), with success rates of 79.4% and 88.2% when targeting the left and right cephalic veins, respectively. Percutaneous access was the chosen first-intention procedure for 12 patients (1.3%). Eight-hundred thirty-six (93.8%) insertions were performed only by the open approach and 53 (5.9%) implantations required at least one venous puncture. Two implantations were performed using previous central venous accesses. Immediate complications associated with TIVAD placement and detected on the postoperative chest X-ray consisted of 1 asymptomatic pneumothorax, 1 symptomatic hemothorax, and 2 malpositions of the catheter. One additional pneumothorax was discovered during the first night after TIVAD insertion in a patient who became symptomatic. The very low incidence of immediate complications detected by postprocedural chest X-ray suggests that such a control is not mandatory as a routine method after fluoroscopy-guided TIVAD insertion mainly performed by venous cutdown. X-ray should be performed only in cases of clinical suspicion.

Incidence and predictors of immediate complications following perioperative non-obstetric epidural punctures

BackgroundEpidural Anesthesia (EA) is a well-established procedure. The aim of the present study was to evaluate the incidence of immediate complications following epidural puncture, such as sanguineous puncture, accidental dural perforation, unsuccessful catheter placement or insufficient analgesia and to identify patient and maneuver related risk factors.MethodsA total of 7958 non-obstetrical EA were analyzed. The risk of each complication was calculated according to the preconditions and the level of puncture. For probabilistic evaluation we used a logistic regression model with forward selection.ResultsThe risk of sanguineous puncture (n = 247, 3.1%) increases with both the patient’s age (P = 0.013) and the more caudal the approach (P < 0.01). Dural perforation (n = 123, 1.6%) was found to be influenced only by advanced age (P = 0.019). Unsuccessful catheter placement (n = 68, 0.94%) occurred more often in smaller individuals (P < 0.001) and at lower lumbar sites (P < 0.01). Amongst all cases with successful catheter placement a (partial) insufficient analgesia was found in 692 cases (8.8%). This risk of insufficient analgesia decreased with patient’s age (P <0 .01), being least likely for punctures of the lower thoracic spine (P < 0.001).ConclusionsCompared to more cranial levels, EA of the lower spine is associated with an increased risk of sanguineous and unsuccessful puncture. Insufficient analgesia more often accompanies high thoracic and low lumbar approaches. The risk of a sanguineous puncture increases in elderly patients. Gender, weight and body mass index seem to have no influence on the investigated complications.