Anesthesiology (all articles)
Review | Rapid sequence induction in pediatric anesthesia
4 May, 2023 | 13:26h | UTC
ISHLT Guidelines for the care of heart transplant recipients
3 May, 2023 | 15:09h | UTC
M-A | Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery
3 May, 2023 | 15:05h | UTC
Commentary on Twitter
Our new #metaanalysis by @wannabehawkeye et al. found that Myocardial injury (asympt Trop↗️) after non❤️surg (MINS) is associated with a 25%✝️ and 21% of major ❤️events at 1 year!! However, MINS defintions across studies show high variation! https://t.co/PQdG1eWuwC #SoMe4Surgery
— BJS Open (@BjsOpen) May 1, 2023
RCT | Hypotension-avoidance and hypertension-avoidance strategies resulted in similar outcomes in noncardiac surgery
2 May, 2023 | 13:54h | UTCHypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery: An International Randomized Controlled Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary: Hypotension-Avoidance No Better than Hypertension-Avoidance for Reducing Post-Op Adverse Events – HCP Live
Commentary on Twitter
Finally published-POISE-3 showed no diff in effects on major vasc complic between 2 alternative BP mgmt strategies. Probably easiest to continue current regimen.
Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery https://t.co/GIR4jAL07H— Steven Cohn, MD (@preopconsult) April 24, 2023
RCT | Ventilation approaches in one-lung ventilation and pulmonary complications after major lung resection surgery
2 May, 2023 | 13:23h | UTC
Commentary on Twitter
One of the largest #RCTs on the management of one lung ventilation in #thoracicanesthesia (880 pts). https://t.co/ZVhTP5sv4o pic.twitter.com/KyLu4BE2yd
— Journal of Cardiothoracic and Vascular Anesthesia (@JCVAonline) April 30, 2023
M-A | Non-opioid analgesics for the prevention of chronic postsurgical pain
26 Apr, 2023 | 14:17h | UTC
M-A | Efficacy of erector spinae plane block for postoperative analgesia lumbar surgery
26 Apr, 2023 | 13:53h | UTC
Pro-Con Debate | Peripheral nerve blockade should be provided routinely in extremity trauma
25 Apr, 2023 | 14:31h | UTCPro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome – Anesthesia & Analgesia (free for a limited period)
Perioperative opioids: a narrative review contextualizing new avenues to improve prescribing
24 Apr, 2023 | 13:26h | UTC
RCT | Peri-intubation hypoxia after delayed vs. rapid sequence intubation in critically injured patients on arrival to trauma triage
24 Apr, 2023 | 13:04h | UTCPeri-Intubation Hypoxia After Delayed Versus Rapid Sequence Intubation in Critically Injured Patients on Arrival to Trauma Triage: A Randomized Controlled Trial – Anesthesia & Analgesia (link to abstract – $ for full-text)
Review | The management of pregnant trauma patients
24 Apr, 2023 | 13:01h | UTCThe Management of Pregnant Trauma Patients: A Narrative Review – Anesthesia & Analgesia (free for a limited period)
See also: Infographic (free for a limited period)
Review | Current practice in the perioperative management of patients with diabetes mellitus
18 Apr, 2023 | 13:19h | UTCRelated:
Guideline Summary: New guidance on the perioperative management of diabetes.
Perioperative Evaluation and Management of Endocrine Disorders – Mayo Clinic Proceedings
M-A | Positive end-expiratory pressure and postoperative complications in patients with obesity
18 Apr, 2023 | 13:11h | UTC
M-A | Postoperative analgesic effects of serratus anterior plane block for thoracic and breast surgery
18 Apr, 2023 | 13:01h | UTC
Identifying perioperative anaphylaxis in Japan: epidemiology, allergens, and diagnostic tools
17 Apr, 2023 | 13:10h | UTC
Propofol and survival: an updated meta-analysis of randomized clinical trials
17 Apr, 2023 | 13:09h | UTCPropofol and survival: an updated meta-analysis of randomized clinical trials – Critical Care
Commentary on Twitter (thread – click for more)
Big headline: 252 RCTs looking at more than 30,000 patients show propofol increases mortality compared to ‘other’ (RR 1.10, 95% CI 1.01-1.20, p = 0.03). This translates to an NNH of 235.
Interesting one. Where does the effect stem from? 1/8https://t.co/8z8Z1OE0I3
— Jan Hansel (@VirtueOfNothing) April 14, 2023
Review | Assessing the risk of surgery in patients with cirrhosis
10 Apr, 2023 | 13:20h | UTCAssessing the risk of surgery in patients with cirrhosis – Hepatology Communications
RCT | Comparable results in endovascular therapy using general anesthesia vs. procedural sedation for stroke treatment
4 Apr, 2023 | 13:45h | UTCOutcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke: The AMETIS Randomized Clinical Trial – JAMA Neurology (free for a limited period)
See also: Visual Abstract
Related: M-A | General Anesthesia vs. to Non-GA in endovascular thrombectomy for ischemic stroke
Review | The failed peripheral nerve block
31 Mar, 2023 | 13:28h | UTCThe failed peripheral nerve block – BJA Education
Brief Review | Admission to intensive care unit after major surgery
28 Mar, 2023 | 14:39h | UTCAdmission to intensive care unit after major surgery – Intensive Care Medicine
Commentary on Twitter
? Major surgeries common reason for #ICU admission (expected/scheduled or unplanned), with varying practices & mortality. 4 major determinants driving decision
1️⃣ intrinsic procedure risk
2️⃣ patient risk
3️⃣ crashing risk
4️⃣ support outside ICU#FOAMcc
?️ https://t.co/CluprKlYM9 pic.twitter.com/PZC4zmymOp— Intensive Care Medicine (@yourICM) March 23, 2023
Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management
24 Mar, 2023 | 13:07h | UTCEpidural-related maternal fever: incidence, pathophysiology, outcomes, and management – American Journal of Obstetrics & Gynecology (free for a limited period)
Commentary on Twitter
AJOG Expert Review in Labor: Epidural-related maternal fever: incidence, pathophysiology, outcomes and management – Proposed mechanisms of sterile inflammation resulting in epidural-related maternal fever https://t.co/iTaQTKBlc3 pic.twitter.com/z0yrxzoMlh
— AJOG (@AJOG_thegray) March 19, 2023
Study reveals high rates of nonadherence to antimicrobial prophylaxis guidelines, often due to unnecessary vancomycin use
23 Mar, 2023 | 13:13h | UTCSummary: The study evaluated adherence to surgical antimicrobial prophylaxis guidelines in 825 US hospitals for elective surgeries from 2019-2020. The study found that 41% of surgical prophylaxis regimens were nonadherent to the American Society of Health-System Pharmacists guidelines.
Unnecessary vancomycin use was the most common reason for nonadherence to surgical antimicrobial prophylaxis guidelines, accounting for 77% of nonadherent regimens and occurring in 31% of all surgeries. It’s noteworthy that when vancomycin was used, it was often unnecessarily combined with cefazolin, and patients who received this combination had a 19% higher risk of acute kidney injury compared to those who received cefazolin alone.
The authors suggest that quality-improvement efforts aimed at reducing unnecessary vancomycin use and potential guideline revisions may offer impactful strategies for improving the risk-benefit profile of antimicrobial prophylaxis.
RCT | 4F-PCC fails to reduce blood product consumption and raises thromboembolic events in trauma patients
22 Mar, 2023 | 13:41h | UTCSummary: The PROCOAG Randomized Clinical Trial aimed to investigate the efficacy and safety of 4-factor prothrombin complex concentrate (4F-PCC) in trauma patients at risk of massive transfusion. Conducted in 12 French trauma centers, this double-blind, randomized, placebo-controlled superiority trial involved 324 patients. All patients were treated according to European traumatic hemorrhage guidelines and received early ratio-based transfusion (packed red blood cells:fresh frozen plasma ratio of 1:1 to 2:1). The primary outcome measured was 24-hour blood product consumption (efficacy), while arterial or venous thromboembolic events were assessed as a secondary outcome (safety).
The trial revealed no significant difference in 24-hour blood product consumption between the 4F-PCC and placebo groups, with median consumption of 12 units and 11 units, respectively. However, the study identified a statistically significant higher risk of thromboembolic events in the 4F-PCC group, with 35% of patients experiencing at least one event compared to 24% in the placebo group.
In conclusion, the study found no beneficial effect of incorporating 4F-PCC into a ratio-based transfusion strategy for patients with severe trauma at risk of massive transfusion. Furthermore, the higher rate of thromboembolic events in the 4F-PCC group indicated potential harm. The findings do not support the routine use of 4F-PCC in patients experiencing trauma who are at risk for extensive transfusion.
Article: Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial – JAMA (free for a limited period)
See also: Visual Abstract
Elevated pre- & postoperative BNP tied to complications in hypertensive & diabetic patients undergoing surgery
22 Mar, 2023 | 13:28h | UTCSummary: This study aimed to assess if preoperative and postoperative serum B-type natriuretic peptide levels (BNP) could predict postoperative complications in hypertensive and diabetic patients after non-cardiac surgery. The study involved 260 adult participants and measured BNP levels before and after surgery. The primary outcome was the change in BNP levels and the development of postoperative complications within 30 days of surgery.
Results showed that patients who developed postoperative complications had significantly higher serum BNP levels both before and after surgery. The preoperative BNP levels (baseline BNP) in patients with complications were 152.02 pg/mL ± 106.56 compared to 44.90 pg/mL ± 44.22 in patients without complications. Similarly, postoperative BNP levels in patients with complications were 313.99 pg/mL ± 121.29, while in patients without complications, they were 83.95 pg/mL ± 70.19.
Although the study does not provide specific cutoff values, higher BNP levels both preoperatively and postoperatively are associated with an increased risk of complications in hypertensive and diabetic patients undergoing non-cardiac surgery. Further multicenter prospective studies with a larger population are needed to confirm the role of BNP in predicting surgical prognosis.
Related:
RCT | Short-term indwelling foley catheters do not reduce the risk of postoperative urinary retention in THA and TKA
22 Mar, 2023 | 13:14h | UTCShort-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA: A Randomized Controlled Trial – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)