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Background:Cardiac surgery is one of the most frequently performed major surgical procedures. Following surgery, haemodynamic instability and prevention of organ dysfunction may be treated in the intensive care unit (ICU) with intravenous fluid, inotropes and vasopressors. In other surgical groups, liberal intravenous fluid administration and a positive fluid balance have been associated with adverse outcomes and increased risk of morbidity and mortality. There is a paucity of evidence to guide intravenous fluid administration in cardiac surgery patients. We have previously shown that a protocol-guided strategy avoiding unnecessary fluid administration significantly reduces fluid loading.

This retrospective audit set out to identify referral rates, swallowing characteristics, and risk factors for dysphagia and silent aspiration in at-risk patients after cardiac surgery. Dysphagia and silent aspiration are associated with poorer outcomes post cardiac surgery.

A bronchopleural fistula (BPF) is a life-threatening complication of cardiothoracic surgery and acute illness. There is no consensus on how best to treat a BPF. Recently, endobronchial one-way valves, designed for bronchoscopic lung volume reduction in emphysema, have been used to treat BPFs. We describe the use of an endobronchial oneway valve, placed at the bedside via flexible bronchoscopy, to treat a BPF in a patient with hypoxic respiratory failure, supported by extracorporeal membrane oxygenation (ECMO), secondary to pneumonia. We believe that this is the first published description of this technique being used in a patient needing ECMO support.

Objective: To determine the accuracy of multidetector computed tomography (MDCT) in the diagnosis of nonocclusive mesenteric ischaemia (NOMI) among patients after cardiovascular surgery.

We undertook a prospective, randomised, double-blind clinical trial of 50 ASA I and II patients undergoing total abdominal hysterectomy to compare the effect of intraoperative ketamine (0.3 mg kg−1 i.v.) and ketamine 1 mg ml−1 plus morphine 1 mg ml−1 patient controlled analgesia (PCA) (group MK) — with morphine 1 mg ml−1 PCA (group M) for postoperative analgesia. There was no significant difference in pain scores at rest or after compulsory cough at 24 hours. The mean total dose of morphine used at 24 hours was 33 mg in the control group vs 34.5 mg in the ketamine group (ns). Patient reporting of adverse effects was similar in both groups, although the ketamine group reported significantly less sleepiness. No patients reported hallucinations, confirming that low-dose ketamine is well tolerated. Overall satisfaction with the quality of analgesia was significantly better in the control group.

Providing an assistive navigation system that augments rather than usurps user control of a powered wheelchair represents a significant technical challenge. This paper evaluates an assistive collision avoidance method for a powered wheelchair that allows the user to navigate safely whilst maintaining their overall governance of the platform motion. The paper shows that by shaping, switching and adjusting localized potential fields we are able to negotiate different obstacles by generating a more intuitively natural trajectory, one that does not deviate significantly from the operator in the loop desired-trajectory. It can also be seen that this method does not suffer from the local minima problem, or narrow corridor and proximity oscillation, which are common problems that occur when using potential fields. Furthermore this localized method enables the robotic platform to pass very close to obstacles, such as when negotiating a narrow passage or doorway.