Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation.

BACKGROUND There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1year outcome. METHODS Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%). RESULTS A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505). CONCLUSIONS Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.

Gynophobia and Anti-republicanism in Thomas Mann's Doctor Faustus

Why does Adrian Leverkühn choose a Shakespeare play for his major first and his first twelve-tone composition? Why in particular a Shakespeare comedy? And why, of all comedies, Love’s Labour’s Lost? Why does he start working on it in Munich? Why does his work there soon come to a halt? Why does it prosper only in Italy? And why does he eventually return to Upper Bavaria so as to complete it? Why is he said to have completed the opera exactly one hundred years ago? And why, finally, is it first performed only after the outbreak of the war and then, surprisingly, in a German adaptation? In order to answer these and similar questions, this paper sets out to re-contextualise Doktor Faustus with regard to discourse history and re-read the novel from a gender-theoretical perspective. The leading hypothesis is that Thomas Mann’s novel belongs to the proto-history of feminist Shakespeare reception, an assumption to be substantiated through an analysis of settings, locations and the constructions of space.