Respiratory cycle-related variations in intra-abdominal pressure were specifically investigated, quantified and shown as linearly increasing with end-expiratory intra-abdominal pressure; this phenomenon could be explained by patients' abdominal compliance status. Supine posture should be an important consideration in specific patients affected by intra-abdominal hypertension.

No abstract

SummaryRegional anaesthesia has been shown to have several advantages over general anaesthesia in reducing the need for, and hence cost of, unscheduled outpatient visits or readmission to hospital. However, the benefit has not been evaluated in a direct comparison between day-care patients and inpatients. We randomly allocated 120 patients undergoing unilateral foot surgery to either inpatient (two-day postoperative stay) or day-care management under continuous regional anaesthesia, and compared the impact on unscheduled postoperative outpatient visits, readmissions to hospital and the associated costs. The operations were performed under popliteal sciatic nerve block. A perineural catheter was inserted before surgery and removed from all patients on the third postoperative day. We found no significant difference in the incidence of outpatient visits (3.3% day-care vs 5.0% inpatient, p = 0.640), readmissions (6.7% day-care vs 3.3% inpatient, p = 0.395) or complications between the two groups. Costs were also significantly lower in the day-care group (net difference €8011 (£6684; $10 986) per patient, p < 0.001). We conclude that continuous regional anaesthesia allows foot surgery to be performed as a day-care procedure more cheaply than in inpatients, without an increase in clinical complications.

In this study early postoperative delirium was found to be a very common complication after major surgery, even in a population without known risk factors. Thiopentone was independently associated with an increase in its relative risk.