BackgroundThe aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection.MethodsSerum lactate concentration was recorded at the end of liver resection in a consecutive series of 488 patients over a seven-year period. Liver function, coagulation and electrolyte tests were performed post-operatively. Renal dysfunction was defined as a creatinine rise of >1.5x the pre-operative value.ResultsThe median lactate was 2.8 mmol/L (0.6 to 16 mmol/L) and was elevated (≥2 mmol/L) in 72% of patients. The lactate concentration was associated with peak post-operative bilirubin, prothrombin time, renal dysfunction, length of hospital stay and 90-day mortality (P < 0.001). The 90-day mortality in patients with a post-operative lactate ≥6 mmol/L was 28% compared to 0.7% in those with lactate ≤2 mmol/L. Pre-operative diabetes, number of segments resected, the surgeon’s assessment of liver parenchyma, blood loss and transfusion were independently associated with lactate concentration.ConclusionsInitial post-operative lactate concentration is a useful predictor of outcome following hepatic resection. Patients with normal post-operative lactate are unlikely to suffer significant hepatic or renal dysfunction and may not require intensive monitoring or critical care.

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum) É valuation de la formation en habiletés techniques et de la performance en anesthésie au moyen de l'analyse des sommes cumulées (cusum) Abstract Purpose The current methods (work based assessments and logbooks) used to assess procedural competency and performance have well-documented deficiencies. Cumulative sum analysis (cusum), a statistical method that generates performance graphs over time, is an alternative tool that is not currently widely used. The purpose of this review is to investigate its current role in anesthetic procedural skills training and performance.Tim

ISRCTN21597243.