Elective open operations Emergency open operations Membership of the Vascular Anaesthesia Society of Great Britain and Ireland (VASGBI) Volume of cases done by anaesthetists Use of epidural anaesthesia Blood loss in open operations Temperature Monitoring and vasoactive drugs Destination after surgery Mechanical ventilation after surgery

The anaesthetist >> Mechanical ventilation after surgery

42% of elective patients were ventilated after surgery.

Table 25 shows the numbers of open operation patients who left theatre whose lungs were mechanically ventilated after open surgery.

Table 25. Mechanical ventilation of lungs postoperatively
Ventilation postoperatively	Elective	%	Emergency	%	Not answered	Total
Not ventilated	215	58	42	22	25	282
< 4 hours	49	13	9	5	4	62
4 – 24 hours	78	21	81	42	11	170
> 24 and < 72 hrs	15	4	29	15	3	47
> 72 hours	13	4	32	17	7	52
Sub-total	370		193		50	613
Unknown	4		6		0	10
Not answered	60		65		4	129
Total	434		264		54	752

Is there scope for the anaesthetists of the 127 (34%) of elective patients whose lungs were ventilated for less than 24 hours to review their management of elective open aortic aneurysm repair? It might have been possible for most of these patients to breathe spontaneously at the end of surgery and to be sent to an HDU for postoperative care. Analysis shows that 51 of the 127 patients lost less than five litres of blood and had a temperature greater than 36º C, and a further 53 had a blood loss of less than five litres and a temperature between 34º C and 36º C.

54 of the 215 elective patients who did not receive mechanical ventilation after surgery were admitted to Intensive Care Units. This would appear to be another misuse of Level 3 beds. Is it historical practice that causes clinicians to continue to mechanically ventilate the lungs and to send patients to Level 3 beds after elective aortic surgery?