SummaryWe investigated whether the type of anaesthesia affects mortality and length of stay after non-traumatic major lower extremity amputations. A total of 1365 eligible patients who were operated on between 2002 and 2010 were included in the final analysis. Propensity score matching was used to produce 475 matched pairs of patients undergoing operation with either general or regional anaesthesia. We found that 30-day mortality was significantly greater in the general anaesthesia group compared with the regional anaesthesia group, with an odds ratio (95% CI) of 1.5 (1.0-2.3) in the total matched population and 4.2 (1.3-13.4) in a high-risk subgroup. The median (IQR [range]) length of postoperative hospital stay was significantly less in the patients of the high-risk subgroup who had general anaesthesia at 15 (7-21 [1-101]) days compared with 25 days (10-37 [0-78]) for those who had regional anaesthesia (p = 0.027). The results of our study suggest that 30-day mortality is significantly higher in patients undergoing major lower extremity amputations under general anaesthesia compared with regional anaesthesia. The choice of an appropriate anaesthetic technique is usually made by the anaesthesiologist after taking into account the patient's medical condition, operative factors, surgical requirements, skills of the anaesthesiologist and the preferences of the patient. Many of these decisions are based on previous experience and expert opinion. The fact that the anaesthetic technique can have repercussions beyond the traditional peri-operative period is only now being realised [1]. This new realisation has made intra-operative anaesthetic choice even more complex, requiring a more robust level of evidence to guide decision making than just expert opinion alone.The effect of anaesthetic technique on postoperative mortality has been studied in the past in various types of surgery [2,3], but the heterogeneity of the surgical population makes generalisations about the effect of anaesthesia on mortality inappropriate.Patients undergoing non-traumatic major lower extremity amputation (MLEA) are known to have a large number of comorbidities and an associated 30-day mortality ranging between 8% and 32% [4][5][6][7][8]. Cardiovascular complications make up the most common cause of postoperative mortality among these patients [7,9]. Although there is some evidence indicating that 612 Anaesthesia

VSD was the most common congenital heart defect seen in trisomy 21 in our study. A high proportion (25.0%) of trisomy 21 patients with tetralogy of Fallot also had AVSDs.

PTI allows users to visualize veins invisible to the naked eye. Thrombosed/tortuous veins, branch points and valves, are easily identified and avoided. It has comparable efficacy to Veinlite and is cheaper (Veinlite-USD 227 vs. Penlite-LP212-USD 7.00) and more easily available. PTI improves patient care, especially in developing regions where costs are a concern.

Tuberculosis (TB) is a major health issue in the Philippines. In 2010, it was the sixth leading cause of death, accounting for 5.1% of total deaths in the country. (1) The prevalence of TB among the urban poor in the Metro Manila area is twice that of the prevalence among the general population. (1) A significant population of the urban poor live in Payatas, Quezon City, the Philippines, where one of the largest waste disposal facilities in Manila is located.The TB-Care programme was introduced in 2011 by a group of medical students from Yong Loo

Background Perioperative smoking is associated with an increased incidence of general postoperative morbidity and mortality. The perioperative period is recognized as an important “teachable moment” that can motivate patients to adopt health changing behaviors. Objective In this study, we aimed to determine the prevalence of smokers among elective surgical patients in an Asian tertiary hospital. We also investigated their smoking characteristics, previous quitting attempts, readiness-to-quit status as well as knowledge of smoking-related postoperative complications. Methods We conducted a single-center prospective cohort study among all patients who attended a preoperative assessment clinic within a 2-month period (August to September 2020) using a preoperative smoking questionnaire. Results A total of 3362 patients participated in the study, of which 348 (10.4%) were current smokers. More than half (65.6%) of the smokers had previously attempted to quit smoking, with most (78%) having made more than one attempt. Forty-nine percent of current smokers were in the pre-contemplation stage of quitting and thirty-one percent were in the contemplation stage. Only twenty-one percent were in the preparation stage of quitting. Thirty-eight percent of patients recognized the importance of smoking cessation perioperatively but only twenty-eight percent were confident of quitting perioperatively. Less than sixty percent of smokers were aware of at least one type of smoking-related postoperative complication. Less than half of the patients (45%) had ever received advice on perioperative smoking cessation from the surgeons. Conclusion A thorough understanding of smokers’ smoking characteristics, barriers to quit and readiness-to-quit status are crucial to establishing a successful multidisciplinary perioperative smoking cessation program. Counselling should address knowledge deficits and be tailored to a patient’s stage-of-change in order to seize this precious perioperative “teachable moment”.