I’m not sure we can call India a developing world; the definition is controversial here. Nevertheless, in a country where private practice is most common, this is how people are perceiving new technologies … Very interesting reflection …
the Pain SoluTions In the Emergency Setting (PASTIES) RCT showed a significant patient satisfaction.
A META-ANALYSIS (BJS 2015) showed the following: (DOI: 10.1002/bjs.9861)
- Anaemia was associated with increased mortality (OR 2·90, 2·30 to 3·68; I2 = 97 per cent; P < 0·001), acute kidney injury (OR 3·75, 2·95 to 4·76; I2 = 60 per cent; P < 0·001) and infection (OR 1·93, 1·17 to 3·18; I2 = 99 per cent; P = 0·01).
- Among cardiac surgical patients, anaemia was associated with stroke (OR 1·28, 1·06 to 1·55; I2 = 0 per cent; P = 0·009) but not myocardial infarction (OR 1·11, 0·68 to 1·82; I2 = 13 per cent; P = 0·67).
- Anaemia was associated with an increased incidence of red cell transfusion (OR 5·04, 4·12 to 6·17; I2 = 96 per cent; P < 0·001). Similar findings were observed in the cardiac and non-cardiac subgroups.
THEREFORE, the following recommendations applies to anaemic patients undergoing an operation: (DOI: 10.1002/bjs.9898)
- Both anaemia and blood transfusion are independently associated with adverse outcomes.
- Functional iron deficiency (iron restriction due to increased levels of hepcidin) is the most common cause of preoperative anaemia, and should be treated with intravenous iron.
- Intraoperative blood loss can be reduced with antifibrinolytic drugs such as tranexamic acid, and cell salvage should be used.
- A restrictive transfusion practice should be the standard of care after surgery.
The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history.
This series is large enough to provide an excellent natural history analysis of the femoral artery aneurysm.
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