Search

Background: Many elderly patients are receiving antithrombotics, which may increase intra-operative blood loss. We aimed to assess whether chronic antithrombotic therapy was associated with intra-operative transfusion of packed red blood cells in patients at least 80 years of age undergoing elective procedures. Methods: We performed a secondary analysis of the prospective, observational European multicentre study entitled POSE (peri-interventional outcome study in the elderly) including 9497 surgical patients aged 80 years and older in 177 centres from October 2017 to December 2018. In this secondary analysis we included POSE patients who underwent elective procedures and with available data on chronic antithrombotic therapy. The primary outcome was intra-operative transfusion of packed red blood cells and results were analysed using multiple logistic regression model. We adjusted for the following predetermined explanatory variables: Age, sex, body mass index, American Society of Anaesthesiologists Physical Status Classification System, baseline haemoglobin concentration, disseminated cancer, and type and severity of surgery. Results: A total of 7174 patients were included of whom 4073 (56.8%) were on antithrombotic therapy. Among patients on antithrombotic therapy 191 (4.7%) received intra-operative blood transfusion compared with 98 (3.2%) of patients not on chronic antithrombotic therapy (crude odds ratio: 1.51, 95% CI 1.18–1.94). Following multiple logistic regression analysis, the adjusted odds ratio was 0.98; 0.73–1.32. We found that chronic antithrombotic therapy was associated with intra-operative transfusion of packed red blood cells in elderly patients undergoing elective procedures in an unadjusted analysis, but not in a multivariate adjusted model.

Background: Procedural pain in burn patients continues to be a major problem. Frequently used analgesics, such as opioids, may have various side effects, including respiratory depression, nausea, and vomiting. Inhaled methoxyflurane has been used in the pre-hospital setting for trauma-related pain. This pilot study aimed to investigate the feasibility of using methoxyflurane for pain relief during dressings changes for burns in the hospital setting. Methods: In this investigator-initiated pilot study, we included burn patients undergoing dressing changes in the burn ward. The primary outcome was the maximal pain level experienced by the patient during the procedure on a verbal rating scale of 0 to 100. Furthermore, patient satisfaction and the nurse’s assessment of the patient’s pain were reported. We also reported the presence of nausea, vomiting, coughing, and headache, along with changes in the pulse rate, oxygen saturation, and arterial blood pressure. Results: We included 12 patients in the period of June 2021 to July 2022. The median patient-reported maximal procedural pain was 60 (interquartile range (IQR), 37–80), which corresponded well with the nurse’s rating of a median of 57 (IQR 28–67). The patients were satisfied with methoxyflurane as an analgesic, with a median score of 96 (IQR 96–100). One patient reported coughing after the procedure, and another patient experienced nausea one week after the procedure. No clinically important haemodynamic changes during administration were detected. Conclusions: Methoxyflurane was found to be feasible for pain relief in burn patients undergoing dressing changes in the burn ward.