Venous thromboembolism in adult elective spinal surgery

Aims

To evaluate the incidence of primary venous thromboembolism (VTE), epidural haematoma, surgical site infection (SSI), and 90-day mortality after elective spinal surgery, and the effect of two protocols for prophylaxis.

Patients and Methods

A total of 2181 adults underwent 2366 elective spinal procedures between January 2007 and January 2012. All patients wore anti-embolic stockings, mobilised early and were kept adequately hydrated. In addition, 29% (689) of these were given low molecular weight heparin (LMWH) while in hospital. SSI surveillance was undertaken using the Centers for Disease Control and Prevention criteria.

Results

In patients who only received mechanical prophylaxis, the incidence of VTE was 0.59% and that of SSI 2.1%. In patients who were additionally given LMWH, the incidence of VTE was 0% and that of SSI 0.7%. The unadjusted p-value was 0.04 for VTE and 0.01 for SSI. There were no cases of epidural haematoma or 90-day mortality in either group. When adjusted for case-mix, LMWH remained a significant factor (p = 0.006) for VTE, but not for SSI.

Conclusion

A peri-operative protocol involving mechanical anti-embolism stockings, adequate hydration, and early post-operative mobilisation is effective in significantly reducing the incidence of VTE. The addition of LMWH is safe in patients at higher risk of developing VTE. Cite this article: Bone Joint J 2017;99-B:1204–9.

Gas chromatographic determination of volatile anaesthetic agents in blood. Part 2. Clinical studies

A method is described for the direct determination of the volatile anaesthetics halothane and isoflurane in blood by gas chromatography with flame-ionisation detection. The method is accurate and precise and allows rapid measurements of blood levels of anaesthetic agents. Headspace concentrations of anaesthetic agents in the concentration range 0-3% V/V are determined with an accuracy of +/- 0.01% V/V. The relative standard deviation of these results is less than 4.0%. A relatively small volume of blood is required for each determination, a factor of great significance in the treatment of children. The need for separate blood calibration graphs for each patient is discussed, further emphasising the need for a rapid calibration procedure. The results from the clinical application of this method show conclusively its suitability for the management of anaesthetised subjects.