Patients with suspected or symptomatic cardiac disease, associated with increased peri-operative risk, are often seen by anaesthetists in the pre-assessment clinic. The use of transthoracic echocardiography in this setting has not been reported. This prospective observational study investigated the effect of echocardiography on the anaesthetic management plan in 100 patients who were older than 65 years or had suspected cardiac disease. Echocardiography was performed by an anaesthetist, and was validated by a cardiologist. Overall, the anaesthetic plan was changed in 54 patients. Haemodynamically significant cardiac disease was revealed in 31 patients, resulting in a step-up of treatment in 20 patients, including: cardiology referral (four patients); altered surgical (two) and anaesthetic (four) technique; use of invasive monitoring (13); planned use of vasopressor infusion ; and postoperative high dependency care (five). Reassuring negative findings in 69 patients led to a step-down in treatment in 34 patients: altered anaesthetic technique (six); procedure not cancelled ; cardiology referral not made ; use of invasive monitoring not required (seven); and high dependency care not booked (11). We conclude that focused transthoracic echocardiography in the pre-operative clinic is feasible and frequently alters management in patients with suspected cardiac disease.
Ultrasound applications in peri-operative medicine have become common place in modern anaesthesia practice. Anaesthetists have performed transoesophageal echocardiography in cardiac and selected non-cardiac surgery for over two decades. We aimed to assess the indications, impact on clinical manag...
This prospective observational study investigated the effect of focused transthoracic echocardiography in 99 patients who had suspected cardiac disease or were ≥ 65 years old, and were scheduled for emergency non-cardiac surgery. The treating anaesthetist completed a diagnosis and management ...
Valve replacement in patients with aortic stenosis is usually followed by regression of left ventricular hypertrophy. More complete resolution of left ventricular hypertrophy is suggested to be associated with superior clinical outcomes; however, its translational impact on long-term survival aft...
Focused transthoracic echocardiography by anaesthetists in the peri-operative period has recently been described; the data suggest that the specific skills required can be obtained by non cardiology physicians with limited training. Aortic stenosis is known to increase significantly the peri-oper...
Multi-detector computed tomography (MDCT) has been used to provide diagnostic information after heart valve replacements such as prosthetic valve dysfunction. However, only few data are available about aortic paraprosthetic regurgitation (APR). The aim of this study is to assess the feasibility, ...
This contribution is an in-depth review of chemical and technological aspects of the alkylation of isobutane with light alkenes, focused on the mechanisms operative with both liquid and solid acid catalysts. The differences in importance of the individual mechanistic steps are discussed in terms ...
Trans-oesophageal echocardiography (TOE) has profoundly changed cardiac surgery and the role of the cardiac anaesthesiologist. It has been the driving force for a real-time diagnostic and decision-making partnership between cardiac anaesthesiologists and cardiac surgeons that has significantly ad...
The number of people in immediate need of anti-retroviral treatment (ART) in the southern African region continues to significantly exceed the capacity of health systems there to provide it. Approaches to this complex rationing dilemma have evolved in different directions. The ethical concepts of...
To assess cardiac structural and functional changes induced by competitive amateur cycling. Fifty-one young competitive amateur male cyclists and 47 age- and gender-matched control subjects underwent complex transthoracic echocardiographic examination focused on the detailed assessment of cardiac...
Bilateral caudate infarct is a very rare neurological situation, usually caused by small-artery disease resulting from a cardiac embolism. The most prominent clinical features of caudate vascular lesions are behavioral and cognitive abnormalities. We report here a case of bilateral infarction of ...
