SummaryA postal survey was sent to members of the Association of Cardiothoracic Anaesthetists to ascertain current practice in the use of pharmacological agents as cerebral protectants during deep hypothermic circulatory arrest. The response rate was 60%. Eighty-three per cent of respondents used some form of pharmacological agent specifically for cerebral protection. Fifty-nine per cent of respondents used thiopental, 29% used propofol and 48% used a variety of other agents, the most common of these being a steroid. There were variations in the dose and timing of administration of drugs. Few respondents believed that there was a body of evidence to support this use of pharmacological agents. Only 35% of respondents believed there to be sufficient evidence to support the use of thiopental. Similarly, only 11% of respondents believe that there is evidence supporting the use of propofol, and 16% the use of steroids. The above findings demonstrate that it would not be possible to create a 'best practice' set of guidelines at present. A national database of all cases of adult thoracic surgery involving deep hypothermic cardiac arrest, with methodology and outcome, could probably establish such guidelines, evidence based.

A postal questionnaire survey was sent to Royal College of Anaesthetists' tutors in Great Britain and Northern Ireland to gain insight into current practice with regard to information and consent for anaesthesia. Details of consent practice in three specific areas were requested: anaesthesia in general, teaching medical students during anaesthesia and obstetric anaesthesia. Replies were received from 218 tutors (77%). Of these, 72% of departments had a policy on consent for anaesthesia that was in accordance with The Association of Anaesthetists of Great Britain and Ireland guidelines oǹ Information and Consent for Anaesthesia'. We identified three areas of concern. Firstly, almost a third of departments (27%) had no policy on consent for anaesthesia. Second, only 18% of relevant departments obtain specific consent for the teaching of medical students on anaesthetised patients. Third, 1 year after publication of the guidelines, 17% of obstetric anaesthetic units, despite stating an intention to alter their departmental policy based on the Association's recommendations, had not yet implemented any changes.

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Introduction: Brain natriuretic peptide (BNP) is released from stretched ventricular wall. BNP particularly the N-terminal portion of proBNP (NTproBNP) is a sensitive marker of congestive heart failure and predictor of outcome [1]. Variations in NTproBNP in cardiac surgical patients are not well described [2]. We investigated changes in NTproBNP in relation to clinical progress in open heart surgery patients. Methods: We measured serum concentrations of NTproBNP in 15 perioperative cardiac surgical patients in a pilot observational study using an electrochemiluminescent sandwich immunoassay (Elecsys 2010, Roche Diagnostics: interassay c.v. 5.0% at 380 ng/l, 4.4% at 8700 ng/l, 5.0% at 13 000 ng/l, detection limit 20 ng/l, upper measuring limit 25,000 ng/l). We collected samples on induction of anaesthesia, at the end of the surgery, 12 hourly for 3 days, then daily for 3 days. Results: Two patients of 15 died. One had preoperative right ventricular failure and a baseline NTproBNP of > 25,000 ng/l falling to 18 613 ng/l postoperatively but rising to > 25,000 ng/l until death. The other with left ventricular failure and NTproBNP of 3720 ng/l had sustained postoperative levels of > 25,000 ng/l until death. Two patients were hemofiltered and NTproBNP rose to > 25,000 ng/l postoperatively. Eight patients with a baseline NTproBNP < 700 ng/l had uncomplicated recoveries. Of five patients with a baseline NTproBNP > 1000 ng/l two died and two had prolonged ICU stays. Baseline NTproBNP was missing for two patients, one of whom died (Fig. 1). Conclusions: Changes in serum NTproBNP in cardiac surgical patients may predict clinical course.

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