Usha Gurunathan - Academia.edu (original) (raw)

Papers by Usha Gurunathan

Anaesthesia and Intensive Care, Jul 28, 2022

Anaesthesia and Intensive Care, 2016

A voluntary, anonymous, cross-sectional online survey was conducted among 997 Fellows of the Aust... more A voluntary, anonymous, cross-sectional online survey was conducted among 997 Fellows of the Australian and New Zealand College of Anaesthetists, using an electronic questionnaire. Details about their demographics, employment, research experience and barriers they had encountered, their perception about research and their future intentions to participate in research, were collected. The survey response rate was 24.6%. At the time of the survey, 29% of the survey respondents were involved in research. Respondents currently involved in research were more likely to be practising at a tertiary hospital, to have previously presented at conferences, to believe in the importance of research and to intend to undertake further research training (P <0.05). Time constraints were the most commonly cited reason for not currently performing research. Those who were involved in research spent about 6.3 more hours per week in public practice than those who were not (P=0.012) and had about 4.4 more hours per week of non-clinical time (P <0.001). In terms of barriers encountered during previous projects, 91% of the respondents cited methodological issues, which included complicated ethics approval processes, difficulty in coordinating teams or recruiting participants, non-compliant patients and difficulty in publishing. Sixty-three percent of those surveyed believed more exposure to research activities during training would increase the number of anaesthetists involved in research and scholarly activities. Through this survey, we have identified several areas that, if satisfactorily addressed, could enhance interest and participation in research amongst anaesthetists in Australia and New Zealand.

Anaesthesia and Intensive Care, Oct 1, 2006

Heart Lung and Circulation, 2021

World Journal of Gastrointestinal Oncology, Jul 15, 2022

BACKGROUNDColorectal cancer (CRC) resection is currently being undertaken in an increasing number... more BACKGROUNDColorectal cancer (CRC) resection is currently being undertaken in an increasing number of obese patients. Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.AIMTo evaluate the post-operative outcomes of obese patients following CRC resection, as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.METHODSSix-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index (BMI): Obese [BMI ≥ 30, n = 182 (29.6%)] and non-obese [BMI < 30, n = 433 (70.4%)]. Demographics, comorbidities, surgical features, and post-operative outcomes were compared between both groups. Post-operative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery [n = 472: BMI ≥ 30, n = 136 (28.8%); BMI < 30, n = 336 (71.2%)].RESULTSObese patients had a higher burden of cardiac (73.1% vs 56.8%; P < 0.001) and respiratory comorbidities (37.4% vs 26.8%; P = 0.01). Obese patients were also more likely to undergo conversion to an open procedure (12.8% vs 5.1%; P = 0.002), but did not experience more post-operative complications (51.6% vs 44.1%; P = 0.06) or high-grade complications (19.2% vs 14.1%; P = 0.11). In the laparoscopic subgroup, however, obesity was associated with a higher prevalence of post-operative complications (47.8% vs 39.3%; P = 0.05) but not high-grade complications (17.6% vs 11.0%; P = 0.07).CONCLUSIONSurgical resection of CRC in obese individuals is safe. A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.

Anaesthesia and Intensive Care

There are few data on current trends in pain management for thoracic surgery in Australia and New... more There are few data on current trends in pain management for thoracic surgery in Australia and New Zealand. Several new regional analgesia techniques have been introduced for these operations in the past few years. Our survey aimed to assess current practice and perceptions towards various modalities of pain management for thoracic surgery among anaesthetists in Australia and New Zealand. A 22-question electronic survey was developed and distributed in 2020 with the assistance of the Australian and New Zealand College of Anaesthetists Cardiac Thoracic Vascular and Perfusion Special Interest Group. The survey focused on four key domains—demographics, general pain management, operative technique, and postoperative approach. Of the 696 invitations, 165 complete responses were obtained, for a response rate of 24%. Most respondents reported a trend away from the historical standard of thoracic epidural analgesia, with a preference towards non-neuraxial regional analgesia techniques. If re...

Heart, Lung and Circulation, 2021

Heart Lung and Circulation, 2019

Journal of Cancer Research and Clinical Oncology

British Journal of Anaesthesia, 2019

Background: The Duke Activity Status Index (DASI) questionnaire might help incorporate selfreport... more Background: The Duke Activity Status Index (DASI) questionnaire might help incorporate selfreported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. Methods: The analysis included 1546 participants (≥40 years) at elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. Secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-or-severe complications, and one-year death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. Results: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio 0.97 per one-point increase above 34; 95% CI, 0.96 to 0.99) and one-year death or new disability (odds ratio 0.96 per one-point increase above 34; CI, 0.92 to 0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio 1.05 per one-point decrease below 34; CI, 1.00 to 1.09), and moderate-or-severe complications (odds ratio 1.03 per one-point decrease below 34; CI, 1.01 to 1.05). Conclusions: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-or-severe complications and new disability.

British Journal of Anaesthesia, 2019

Background: Preoperative anaemia is associated with elevated risks of postoperative complications... more Background: Preoperative anaemia is associated with elevated risks of postoperative complications. This association may be explained by confounding related to poor cardiopulmonary fitness. We conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study to examine the associations of preoperative haemoglobin concentration with preoperative cardiopulmonary exercise testing performance (peak oxygen consumption, anaerobic threshold) and postoperative complications. Methods: The substudy included a nested cross-sectional analysis and nested cohort analysis. In the cross-sectional study (1279 participants), multivariate linear regression modelling was used to determine the adjusted association of haemoglobin concentration with peak oxygen consumption and anaerobic threshold. In the nested cohort study (1256 participants), multivariable logistic regression modelling was used to determine the adjusted association of haemoglobin concentration, peak oxygen consumption, and anaerobic threshold with the primary endpoint (composite outcome of death, cardiovascular complications, acute kidney injury, or surgical site infection) and secondary endpoint (moderate or severe complications). Results: Haemoglobin concentration explained 3.8% of the variation in peak oxygen consumption and anaerobic threshold (P<0.001). Although not associated with the primary endpoint, haemoglobin concentration was associated with moderate or severe complications after adjustment for peak oxygen consumption (odds ratio¼0.86 per 10 g L À1 increase; 95% confidence interval, 0.77e0.96) or anaerobic threshold (odds ratio¼0.86; 95% confidence interval, 0.77e0.97). Lower peak oxygen consumption was associated with moderate or severe complications without effect modification by haemoglobin concentration (P¼0.12). Conclusion: Haemoglobin concentration explains a small proportion of variation in exercise capacity. Both anaemia and poor functional capacity are associated with postoperative complications and may therefore be modifiable targets for preoperative optimisation.

Anaesthesia and Intensive Care, 2016

British Journal of Anaesthesia, 2016

Sasaki C. Preoperative endoscopic airway examination (PEAE) provides superior airway information ... more Sasaki C. Preoperative endoscopic airway examination (PEAE) provides superior airway information and may reduce the use of unnecessary awake intubation. Anesth Analg 2011; 112: 602-7 17. Tachibana N, Niiyama Y, Yamakage M. Incidence of cannot intubate-cannot ventilate (CICV): results of a 3-year retrospective multicenter clinical study in a network of university hospitals.

British Journal of Anaesthesia, 2017

Finally, we agree completely with Crapelli and Jaggar that there is a need for adequately powered... more Finally, we agree completely with Crapelli and Jaggar that there is a need for adequately powered randomized studies, preferably in patients with lower fibrinogen concentrations and a higher risk of bleeding than in the present study. Declaration of interest A.J. has received honoraria from CSL Behring for lectures and advisory work, and research support. M.K. has received an honorarium from CSL Behring for a lecture.

Thrombosis and Haemostasis

The risk of venous thromboembolism following total joint arthroplasty is significantly greater th... more The risk of venous thromboembolism following total joint arthroplasty is significantly greater than those of other types of elective orthopaedic procedures. This risk is increased in obesity due to the associated prothrombotic physiological and hematological changes that predispose to embolic events. The prevalence of obesity is increasing in the aging population, which contributes to a further increase in the risk of postoperative thrombosis in the older patients. There is a lack of clear evidence regarding dosing information for thromboprophylaxis medications in patients with obesity. As a result, the currently available thromboprophylaxis guidelines do not provide specific recommendations for this group. Suboptimal dosing regimens for these medications can place these patients at a risk of bleeding or clotting complications postsurgery. Hence any increase in dosage may require intensive surveillance for the residual anticoagulant effects and careful balancing of risks and benefit...

Journal of Anaesthesiology Clinical Pharmacology, 2022

Journal of Cardiothoracic and Vascular Anesthesia, 2022

Kounis syndrome commonly is described as a complex multisystem phenomenon mainly affecting corona... more Kounis syndrome commonly is described as a complex multisystem phenomenon mainly affecting coronary arteries, resulting in coronary vasospasm in the context of an allergic manifestation. This article reviews the literature regarding perioperative presentations of the syndrome. A systematic search in MEDLINE and Embase databases was performed for case reports through June 16, 2021, on Kounis syndrome triggered by medications administered in the perioperative setting. The authors' search resulted in 35 perioperative reports of Kounis syndrome, with the majority of the cases occurring in men between 40 and 80 years of age, manifesting within 20 minutes following the administration of the suspected trigger. Chest pain and ischemic changes on the electrocardiograph were the most frequent presentations, while intravenous antibiotics and neuromuscular blocking agents were the most common triggers. In most instances, the patients had a good recovery following the event. Coronary vasospasm is often less frequently recognized as a form of allergic manifestation in the perioperative setting. Many potential triggers, such as antibiotics and neuromuscular blocking agents, are routinely administered during surgery. Awareness of this condition, early diagnosis, and effective management of this condition can lead to good outcomes.

Annals of Diagnostic Pathology, 2011

A 41-year-old man with history of recurrent airways infection since his childhood, with chronic c... more A 41-year-old man with history of recurrent airways infection since his childhood, with chronic coughing and voice hoarseness for seven years. The patient was referred to undergo laryngotracheobronchoscopy that revealed the presence of whitish nodular lesions on the anterolateral walls of the trachea and at the most proximal portion of the main bronchi, whose material was sent for histopathological analysis (Figures 1A and 1B). Computed tomography (CT) showed tiny, subcentimeter, submucosal, sessile nodules, some of them calcified, at the different levels of the trachea, with predominance in the two lower thirds of the trachea, and also in the right main bronchus. No significant luminal narrowing was observed and, typically, the posterior membranous wall of the trachea was spared (Figures 1C and 1D). The patient remains under clinical follow-up with management of symptoms. Tracheobronchopathia osteochondroplastica is a rare chronic benign disease, with male prevalence (male:female = 3:1), and predominantly manifesting between the fifth and seventh decades of life (1,2). Association with several factors has been reported, as follows: chronic infections; chemical or medicamentous agents; degenerative tissue alterations; calcium and phosphorus metabolism disorders; and amyloidosis (3,4). The disease is generally asymptomatic (1,2,5,6) , and therefore, in most cases, the diagnosis is based on incidental findings at

British Journal of Anaesthesia, 2020

Background: Accurate assessment of functional capacity, a predictor of postoperative morbidity an... more Background: Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods: In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg À1 min À1 and peak oxygen consumption (VO 2 peak) >16 ml kg À1 min À1 , cut-points that represent a reduced risk of postoperative complications. Results: Five questions were identified to have dominance in predicting AT>11 ml kg À1 min À1 and VO 2 peak>16 ml.kg À1 min À1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg À1 .min À1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q¼0.67 vs original 12-question DASI¼0.66) and VO 2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO 2 peak>16 ml.kg À1 .min À1 and VO 2 peak<16 ml.kg À1 .min À1. Conclusions: The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.

Anaesthesia and Intensive Care

Anaesthesia and Intensive Care, Jul 28, 2022

Anaesthesia and Intensive Care, 2016

A voluntary, anonymous, cross-sectional online survey was conducted among 997 Fellows of the Aust... more A voluntary, anonymous, cross-sectional online survey was conducted among 997 Fellows of the Australian and New Zealand College of Anaesthetists, using an electronic questionnaire. Details about their demographics, employment, research experience and barriers they had encountered, their perception about research and their future intentions to participate in research, were collected. The survey response rate was 24.6%. At the time of the survey, 29% of the survey respondents were involved in research. Respondents currently involved in research were more likely to be practising at a tertiary hospital, to have previously presented at conferences, to believe in the importance of research and to intend to undertake further research training (P <0.05). Time constraints were the most commonly cited reason for not currently performing research. Those who were involved in research spent about 6.3 more hours per week in public practice than those who were not (P=0.012) and had about 4.4 more hours per week of non-clinical time (P <0.001). In terms of barriers encountered during previous projects, 91% of the respondents cited methodological issues, which included complicated ethics approval processes, difficulty in coordinating teams or recruiting participants, non-compliant patients and difficulty in publishing. Sixty-three percent of those surveyed believed more exposure to research activities during training would increase the number of anaesthetists involved in research and scholarly activities. Through this survey, we have identified several areas that, if satisfactorily addressed, could enhance interest and participation in research amongst anaesthetists in Australia and New Zealand.

Anaesthesia and Intensive Care, Oct 1, 2006

Heart Lung and Circulation, 2021

World Journal of Gastrointestinal Oncology, Jul 15, 2022

BACKGROUNDColorectal cancer (CRC) resection is currently being undertaken in an increasing number... more BACKGROUNDColorectal cancer (CRC) resection is currently being undertaken in an increasing number of obese patients. Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.AIMTo evaluate the post-operative outcomes of obese patients following CRC resection, as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.METHODSSix-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index (BMI): Obese [BMI ≥ 30, n = 182 (29.6%)] and non-obese [BMI < 30, n = 433 (70.4%)]. Demographics, comorbidities, surgical features, and post-operative outcomes were compared between both groups. Post-operative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery [n = 472: BMI ≥ 30, n = 136 (28.8%); BMI < 30, n = 336 (71.2%)].RESULTSObese patients had a higher burden of cardiac (73.1% vs 56.8%; P < 0.001) and respiratory comorbidities (37.4% vs 26.8%; P = 0.01). Obese patients were also more likely to undergo conversion to an open procedure (12.8% vs 5.1%; P = 0.002), but did not experience more post-operative complications (51.6% vs 44.1%; P = 0.06) or high-grade complications (19.2% vs 14.1%; P = 0.11). In the laparoscopic subgroup, however, obesity was associated with a higher prevalence of post-operative complications (47.8% vs 39.3%; P = 0.05) but not high-grade complications (17.6% vs 11.0%; P = 0.07).CONCLUSIONSurgical resection of CRC in obese individuals is safe. A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.

Anaesthesia and Intensive Care

There are few data on current trends in pain management for thoracic surgery in Australia and New... more There are few data on current trends in pain management for thoracic surgery in Australia and New Zealand. Several new regional analgesia techniques have been introduced for these operations in the past few years. Our survey aimed to assess current practice and perceptions towards various modalities of pain management for thoracic surgery among anaesthetists in Australia and New Zealand. A 22-question electronic survey was developed and distributed in 2020 with the assistance of the Australian and New Zealand College of Anaesthetists Cardiac Thoracic Vascular and Perfusion Special Interest Group. The survey focused on four key domains—demographics, general pain management, operative technique, and postoperative approach. Of the 696 invitations, 165 complete responses were obtained, for a response rate of 24%. Most respondents reported a trend away from the historical standard of thoracic epidural analgesia, with a preference towards non-neuraxial regional analgesia techniques. If re...

Heart, Lung and Circulation, 2021

Heart Lung and Circulation, 2019

Journal of Cancer Research and Clinical Oncology

British Journal of Anaesthesia, 2019

Background: The Duke Activity Status Index (DASI) questionnaire might help incorporate selfreport... more Background: The Duke Activity Status Index (DASI) questionnaire might help incorporate selfreported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. Methods: The analysis included 1546 participants (≥40 years) at elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. Secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-or-severe complications, and one-year death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. Results: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio 0.97 per one-point increase above 34; 95% CI, 0.96 to 0.99) and one-year death or new disability (odds ratio 0.96 per one-point increase above 34; CI, 0.92 to 0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio 1.05 per one-point decrease below 34; CI, 1.00 to 1.09), and moderate-or-severe complications (odds ratio 1.03 per one-point decrease below 34; CI, 1.01 to 1.05). Conclusions: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-or-severe complications and new disability.

British Journal of Anaesthesia, 2019

Background: Preoperative anaemia is associated with elevated risks of postoperative complications... more Background: Preoperative anaemia is associated with elevated risks of postoperative complications. This association may be explained by confounding related to poor cardiopulmonary fitness. We conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study to examine the associations of preoperative haemoglobin concentration with preoperative cardiopulmonary exercise testing performance (peak oxygen consumption, anaerobic threshold) and postoperative complications. Methods: The substudy included a nested cross-sectional analysis and nested cohort analysis. In the cross-sectional study (1279 participants), multivariate linear regression modelling was used to determine the adjusted association of haemoglobin concentration with peak oxygen consumption and anaerobic threshold. In the nested cohort study (1256 participants), multivariable logistic regression modelling was used to determine the adjusted association of haemoglobin concentration, peak oxygen consumption, and anaerobic threshold with the primary endpoint (composite outcome of death, cardiovascular complications, acute kidney injury, or surgical site infection) and secondary endpoint (moderate or severe complications). Results: Haemoglobin concentration explained 3.8% of the variation in peak oxygen consumption and anaerobic threshold (P<0.001). Although not associated with the primary endpoint, haemoglobin concentration was associated with moderate or severe complications after adjustment for peak oxygen consumption (odds ratio¼0.86 per 10 g L À1 increase; 95% confidence interval, 0.77e0.96) or anaerobic threshold (odds ratio¼0.86; 95% confidence interval, 0.77e0.97). Lower peak oxygen consumption was associated with moderate or severe complications without effect modification by haemoglobin concentration (P¼0.12). Conclusion: Haemoglobin concentration explains a small proportion of variation in exercise capacity. Both anaemia and poor functional capacity are associated with postoperative complications and may therefore be modifiable targets for preoperative optimisation.

Anaesthesia and Intensive Care, 2016

British Journal of Anaesthesia, 2016

Sasaki C. Preoperative endoscopic airway examination (PEAE) provides superior airway information ... more Sasaki C. Preoperative endoscopic airway examination (PEAE) provides superior airway information and may reduce the use of unnecessary awake intubation. Anesth Analg 2011; 112: 602-7 17. Tachibana N, Niiyama Y, Yamakage M. Incidence of cannot intubate-cannot ventilate (CICV): results of a 3-year retrospective multicenter clinical study in a network of university hospitals.

British Journal of Anaesthesia, 2017

Finally, we agree completely with Crapelli and Jaggar that there is a need for adequately powered... more Finally, we agree completely with Crapelli and Jaggar that there is a need for adequately powered randomized studies, preferably in patients with lower fibrinogen concentrations and a higher risk of bleeding than in the present study. Declaration of interest A.J. has received honoraria from CSL Behring for lectures and advisory work, and research support. M.K. has received an honorarium from CSL Behring for a lecture.

Thrombosis and Haemostasis

The risk of venous thromboembolism following total joint arthroplasty is significantly greater th... more The risk of venous thromboembolism following total joint arthroplasty is significantly greater than those of other types of elective orthopaedic procedures. This risk is increased in obesity due to the associated prothrombotic physiological and hematological changes that predispose to embolic events. The prevalence of obesity is increasing in the aging population, which contributes to a further increase in the risk of postoperative thrombosis in the older patients. There is a lack of clear evidence regarding dosing information for thromboprophylaxis medications in patients with obesity. As a result, the currently available thromboprophylaxis guidelines do not provide specific recommendations for this group. Suboptimal dosing regimens for these medications can place these patients at a risk of bleeding or clotting complications postsurgery. Hence any increase in dosage may require intensive surveillance for the residual anticoagulant effects and careful balancing of risks and benefit...

Journal of Anaesthesiology Clinical Pharmacology, 2022

Journal of Cardiothoracic and Vascular Anesthesia, 2022

Kounis syndrome commonly is described as a complex multisystem phenomenon mainly affecting corona... more Kounis syndrome commonly is described as a complex multisystem phenomenon mainly affecting coronary arteries, resulting in coronary vasospasm in the context of an allergic manifestation. This article reviews the literature regarding perioperative presentations of the syndrome. A systematic search in MEDLINE and Embase databases was performed for case reports through June 16, 2021, on Kounis syndrome triggered by medications administered in the perioperative setting. The authors' search resulted in 35 perioperative reports of Kounis syndrome, with the majority of the cases occurring in men between 40 and 80 years of age, manifesting within 20 minutes following the administration of the suspected trigger. Chest pain and ischemic changes on the electrocardiograph were the most frequent presentations, while intravenous antibiotics and neuromuscular blocking agents were the most common triggers. In most instances, the patients had a good recovery following the event. Coronary vasospasm is often less frequently recognized as a form of allergic manifestation in the perioperative setting. Many potential triggers, such as antibiotics and neuromuscular blocking agents, are routinely administered during surgery. Awareness of this condition, early diagnosis, and effective management of this condition can lead to good outcomes.

Annals of Diagnostic Pathology, 2011

A 41-year-old man with history of recurrent airways infection since his childhood, with chronic c... more A 41-year-old man with history of recurrent airways infection since his childhood, with chronic coughing and voice hoarseness for seven years. The patient was referred to undergo laryngotracheobronchoscopy that revealed the presence of whitish nodular lesions on the anterolateral walls of the trachea and at the most proximal portion of the main bronchi, whose material was sent for histopathological analysis (Figures 1A and 1B). Computed tomography (CT) showed tiny, subcentimeter, submucosal, sessile nodules, some of them calcified, at the different levels of the trachea, with predominance in the two lower thirds of the trachea, and also in the right main bronchus. No significant luminal narrowing was observed and, typically, the posterior membranous wall of the trachea was spared (Figures 1C and 1D). The patient remains under clinical follow-up with management of symptoms. Tracheobronchopathia osteochondroplastica is a rare chronic benign disease, with male prevalence (male:female = 3:1), and predominantly manifesting between the fifth and seventh decades of life (1,2). Association with several factors has been reported, as follows: chronic infections; chemical or medicamentous agents; degenerative tissue alterations; calcium and phosphorus metabolism disorders; and amyloidosis (3,4). The disease is generally asymptomatic (1,2,5,6) , and therefore, in most cases, the diagnosis is based on incidental findings at

British Journal of Anaesthesia, 2020

Background: Accurate assessment of functional capacity, a predictor of postoperative morbidity an... more Background: Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods: In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg À1 min À1 and peak oxygen consumption (VO 2 peak) >16 ml kg À1 min À1 , cut-points that represent a reduced risk of postoperative complications. Results: Five questions were identified to have dominance in predicting AT>11 ml kg À1 min À1 and VO 2 peak>16 ml.kg À1 min À1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg À1 .min À1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q¼0.67 vs original 12-question DASI¼0.66) and VO 2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO 2 peak>16 ml.kg À1 .min À1 and VO 2 peak<16 ml.kg À1 .min À1. Conclusions: The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.

Anaesthesia and Intensive Care