Anesthesiology (all articles)

Identifying perioperative anaphylaxis in Japan: epidemiology, allergens, and diagnostic tools

17 Apr, 2023 | 13:10h | UTC

The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: allergen exposure, epidemiology, and diagnosis of anaphylaxis during general anaesthesia – British Journal of Anaesthesia

Propofol and survival: an updated meta-analysis of randomized clinical trials

17 Apr, 2023 | 13:09h | UTC

Propofol 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 | UTC

Assessing 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 | UTC

Outcomes 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

Review | The failed peripheral nerve block

31 Mar, 2023 | 13:28h | UTC

The failed peripheral nerve block – BJA Education

Brief Review | Admission to intensive care unit after major surgery

28 Mar, 2023 | 14:39h | UTC

Admission 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 | UTC

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 | UTC

Summary: 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.

Article: Adherence to Antimicrobial Prophylaxis Guidelines for Elective Surgeries Across 825 US Hospitals, 2019–2020 – Clinical Infectious Diseases

RCT | 4F-PCC fails to reduce blood product consumption and raises thromboembolic events in trauma patients

22 Mar, 2023 | 13:41h | UTC

Summary: 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 | UTC

Summary: 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.

Article: Serum B-type natriuretic peptide levels (BNP) can be used as a predictor of complications in patients undergoing non-cardiac surgery: a prospective observational study – Open Heart

Preoperative N-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study – Annals of Internal Medicine

The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis – Journal of the American College of Cardiology

RCT | Short-term indwelling foley catheters do not reduce the risk of postoperative urinary retention in THA and TKA

22 Mar, 2023 | 13:14h | UTC

Short-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)

Review | Enhanced recovery after surgery and chest tube management

21 Mar, 2023 | 13:26h | UTC

Enhanced recovery after surgery and chest tube management – Journal of Thoracic Disease

Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS^®) Society and the European Society of Thoracic Surgeons (ESTS) – European Journal of Cardio-Thoracic Surgery

Enhanced recovery programs in lung cancer surgery: systematic review and meta-analysis of randomized controlled trials – Cancer Management and Research

Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery – Translational Lung Cancer Research

Systematic Review and Meta-Analysis of Randomized, Controlled Trials on Preoperative Physical Exercise Interventions in Patients with Non-Small-Cell Lung Cancer – Cancers

Pro-con debate | Should videolaryngoscopy be standard of care for tracheal intubation?

21 Mar, 2023 | 13:19h | UTC

Pro-Con Debate: Videolaryngoscopy Should Be Standard of Care for Tracheal Intubation – Anesthesia & Analgesia (free for a limited period)

RCT | Videolaryngoscopy improves first-pass tracheal intubation success compared with direct laryngoscopy

21 Mar, 2023 | 13:21h | UTC

A multicentre randomised controlled trial of the McGrath Mac videolaryngoscope versus conventional laryngoscopy – Anaesthesia

Perspective | Perioperative medicine: what the future can hold for anesthesiology

21 Mar, 2023 | 13:18h | UTC

Perioperative Medicine: What the Future Can Hold for Anesthesiology – Anesthesia & Analgesia (free for a limited period)

Review | Understanding outcomes after major surgery

21 Mar, 2023 | 13:17h | UTC

Understanding Outcomes After Major Surgery – Anesthesia & Analgesia

Review | Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery

21 Mar, 2023 | 13:09h | UTC

Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery – Current Opinion in Anesthesiology (free for a limited period)

M-A | Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy

21 Mar, 2023 | 13:06h | UTC

Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials – BMC Anesthesiology

RCT | Intermittent IV ibuprofen reduces morphine consumption and provides pain relief after surgery

20 Mar, 2023 | 13:39h | UTC

Summary: The article describes a randomized, placebo-controlled, double-blind clinical trial to evaluate the efficacy and safety of different doses of intravenous ibuprofen (IVIB) in treating acute postoperative pain. The trial involved patients who underwent abdominal or orthopedic surgery and were randomized to placebo, IVIB 400 mg, or IVIB 800 mg. The first dose was given intravenously 30 minutes before surgery ended, followed by IV administration every 6 hours for a total of 8 doses.

The study found that IV administration of ibuprofen 400 mg or 800 mg significantly reduced morphine consumption and relieved pain without increasing the incidence of adverse events.

The study’s strengths were its multicenter, randomized, controlled, and prospective design. However, the extensive list of exclusion criteria suggests that the study was made in a relatively healthy population, making it difficult to extrapolate the safety results for more fragile patients.

Article: Analgesic Efficacy of Intravenous Ibuprofen in the Treatment of Postoperative Acute Pain: A Phase III Multicenter Randomized Placebo-Controlled, Double-Blind Clinical Trial – Pain Research and Management

AHA Scientific Statement | Evaluation and management of pulmonary hypertension in noncardiac surgery

17 Mar, 2023 | 13:12h | UTC

Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association – Circulation

Top Things to Know: Evaluation and Management of Pulmonary HTN in Non-Cardiac Surgery – American Heart Association

Commentary: Pulmonary Hypertension in Non-Cardiac Surgery – a mandate for the multidisciplinary team! – American Heart Association