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Objective: to assess the optimal cut-off values of toe blood pressure (TBP) and transcutaneous oxygen pressure (TcpO 2 ) in the supine and sitting positions, in order to accurately detect the presence of severe leg ischaemia requiring invasive treatment. Methods: in 49 consecutive patients (65 legs) with severe ischaemia according to clinical symptoms of Fontaine III or IV and a lowered ankle blood pressure, TBP and TcpO 2 were measured in the supine and sitting positions. Treatment within 6 weeks after the diagnosis was classified as either conservative or invasive (revascularisation or amputation). Results: of the 65 legs, 38 (58%) required invasive treatment. The mean ankle pressure for this group was 70 mmHg. The optimal cut-off value for TBP was 38 mmHg and for TcpO 2 35 mmHg. A TBP of ≤30 mmHg and a TcpO 2 ≤25 mmHg while supine, showed likelihood ratios (LR) of 7.0 and 3.3, respectively, and when combined an LR of 12.4. Measurements in the sitting position did not enhance diagnostic power. Conclusions: the need for invasive therapy in patients with severe leg ischaemia might be predicted by measuring TBP and TcpO 2 , using the above-mentioned cut-off values.

Background. Arterial cannulation is a common anaesthetic procedure that can be challenging and time-consuming in small children. By visualizing the position of the radial artery, near-infrared vascular imaging systems (NIRVISs) might be of assistance in arterial cannulation. The present study evaluates the effectiveness of an NIRVIS in arterial cannulation in infants. Methods. An observational study was conducted in patients up to 3 yr old, undergoing arterial cannulation before cardiothoracic surgery. Arterial cannulation was performed as usual in 38 patients, and subsequently with the NIRVIS in 39 patients. Results. The time to successful cannulation was 547 s (171-1183) without and 464 s (174-996) with the NIRVIS (P=0.76) and the time to first flashback of blood was 171 s (96-522) and 219 s (59-447), respectively (P=0.38). There was a tendency in favour of the NIRVIS in success at first attempt: 12/38 and 7/39, respectively (P=0.29) and in the number of punctures: 6 (2-12) and 3 (1-7), respectively (P=0.10). Conclusions. The present study did not show a significant clinical improvement when NIR light was used during arterial cannulation in small children. There is a large difference between time to first flashback of blood and time to successful cannulation, indicating that inserting the cannula, and not localizing the artery, is the main difficulty in arterial cannulation in children. © 2012 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

Background Research in postoperative mortality is scarce. Insight into mortality and cause of death might improve and innovate perioperative care. The objective for this study was to report the 24-hour and 30-day overall, and surgery and anaesthesia-related, in-hospital mortality at a tertiary paediatric hospital. Methods All patients

Objective: to determine the degree of interobserver variation of color-flow duplex scanning of infrainguinal arterial bypass grafts. Methods: two experienced vascular technologies randomly assessed bypass grafts in 32 consecutive patients, using a color-flow duplex scan. In pre-defined segments the highest peak systolic velocity (PSVmax) and end-diastolic velocity (EDV) were measured and a peak systolic velocity ratio (PSV ratio) was calculated. Results were analyzed as continuous variables (Bland and Altman plots and Intraclass Correlation Coefficient = ICC) and also as categorical data (weighted Kappa coefficient) for the PSV ratio 1-2.5, greater than or equal to2.5-4, greater than or equal to4.0. Results: the ICC for the PSVmax, PSV ratio and EDV indicated "almost perfect" agreement for all three parameters. However, the Bland and Altman plots showed impressive interobserver variation for the higher values of all three parameters. For the PSV ratio categories a weighted kappa of 0.31 was calculated, indicating only fair agreement. Substantial variation was found for the categories with PSV ratios >2.5-4.0 and greater than or equal to4.0. Conclusions: though performing accurately for the lower values of the assessed parameters, duplex scanning shows considerable interobserver variation for the clinically significant higher values. Particularly in the PSV ratio interval greater than or equal to2.5-4.0, most relevant for clinical decision-making, the interobserver variability is unacceptable