To establish what is the prevalence of elevated HbA1c among diabetic patients scheduled for coronary surgery and whether this may influence their postoperative outcome. We performed a retrospective review of our departmental cardiac surgical database over a 3-year period (2006-2008). Among the 2665 patients, who underwent coronary revascularization, 782 (29.3%) patients had diabetes mellitus, with 735 (94.0%) patients having their HbA1c assessed preoperatively up to 3 days before the start of the procedure. Patients with preoperative normal or elevated HbA1c (>7%) were compared regarding their hospital mortality, morbidity (defined as any postoperative complication such as stroke, renal failure, wound infection, perioperative myocardial infarction (MI), and others) as well as mean intensive care unit (ICU) and hospital stay. Patients for comparisons were matched to achieve similar preoperative status with a use of a Greedy matching procedure. Chi-square test was performed to compare variables of interest; p<0.05 was considered significant. Elevated HbA1c levels were present in 38.4% of diabetic patients - 57.1% of patients among insulin-dependent diabetics, 27.3% of patients on oral medication, and in 7.7% of patients whose diabetes was treated with diet only. In a direct comparison and after matching for preoperative variables, elevated HbA1c levels increased only the frequency of perioperative MI (p=0.01). Other complications, length of ICU and hospital stay as well as early mortality were similar in both the groups. Elevated HbA1c levels are common among diabetic patients scheduled for coronary surgery, particularly in patients receiving insulin, and are associated with more frequent occurrence of perioperative MI.

The study investigated the effect of intravenous dexmedetomidine on brachial plexus block in patients with end-stage renal disease sedated with dexmedetomidine or midazolam for the formation of arteriovenous fistula. A supraclavicular brachial plexus block was performed in 68 patients scheduled for an arteriovenous fistula formation. A successful block was achieved in 64 patients (94%). Sixty-four patients received either dexmedetomidine (loading dose 1 microg kg 10 min followed by infusion of 0.2-0.7 microg kg h) or midazolam (bolus dose 0.04 mg kg followed by infusion of 0.04-0.08 mg kg h). Three patients were excluded during the study. Finally, 61 patients were analysed, 32 in the dexmedetomidine group and 29 in the midazolam group. Administration of the study drug was started after achievement of a complete block. The duration of the motor and sensory block was assessed. The motor and sensory block was longer in the dexmedetomidine group (11.9 +/- 3.8 vs. 9.4 +/- 3.4 h, P = 0.0085 and 9.4 +/- 3.4 vs. 7.3 +/- 2.8 h, P = 0.030, respectively). A systemic administration of dexmedetomidine prolongs the duration of brachial plexus block.

No clinical trials comparing the characteristics of sensory blockade caused by various local anaesthetics in thoracic paravertebral blockade have been published. The aim of this prospective study was a clinical assessment of sensory blockade after paravertebral injection of ropivacaine or bupivacaine in patients undergoing modified radical mastectomy. Seventy ASA I-II patients were randomized to receive a single injection of ropivacaine 0.5% (n = 35) or bupivacaine 0.5% (n = 35) at the T4 level. General anaesthesia with propofol and fentanyl was provided during the procedure and patients were not intubated. The following parameters were analysed: duration and dynamics of the sensory blockade and the patient's and surgeon's assessment. Both ropivacaine and bupivacaine provided a similar level of analgesia. Ropivacaine was characterized by more rapid onset - after only 5 min 53% of patients in this group had the extent of sensory blockade wide enough to perform modified radical mastectomy in comparison to only 20% after bupivacaine (P 9 segments blocked) was noted more often in the ropivacaine group (88% vs. 65%, P < 0.05), lasted longer and appeared to be wider than sensory blockade produced by bupivacaine. Regression of sensory blockade was initially similar, but after 24 h sensory blockade in the ropivacaine group still had a potential to provide analgesia for modified radical mastectomy in 81% of patients in comparison to only 50% of such patients in the bupivacaine group (P < 0.05). Degree of postoperative pain, performance of the cardiovascular system, consumption of medications and complications were all similar between the study groups. Both agents provide satisfactory conditions for mastectomy, but ropivacaine seems to be superior to bupivacaine for thoracic paravertebral blockade during breast cancer surgery.