Pre-operatory
RCT: Continuing Aspirin vs. Antiplatelet Cessation Before Surgery Did Not Reduce Ischemic Events in Patients With Coronary Stents Over 1 Year Post-Implantation
7 Sep, 2024 | 12:29h | UTCStudy Design and Population: This randomized controlled trial (ASSURE-DES) investigated the perioperative management of antiplatelet therapy in 926 patients with coronary drug-eluting stents (DES) undergoing low-to-intermediate-risk noncardiac surgery. The patients, at least one year post-stent implantation, were randomized to continue aspirin monotherapy or stop all antiplatelet therapy five days prior to surgery.
Main Findings: The study found no significant difference in the primary composite outcome (death, myocardial infarction, stent thrombosis, or stroke) between the aspirin monotherapy group (0.6%) and the no antiplatelet group (0.9%). However, minor bleeding was more frequent in the aspirin group (14.9% vs 10.1%, P=0.027), with no difference in major bleeding.
Implications for Practice: These results suggest that for stable patients with DES undergoing noncardiac surgery, temporarily discontinuing aspirin may be a safe option, as continuing aspirin did not reduce ischemic events but did increase minor bleeding risk. Further research is needed to assess outcomes in higher-risk surgical settings.
Review | Perioperative iron deficiency anemia
31 Jul, 2023 | 14:02h | UTCPerioperative iron deficiency anaemia – BJA Education
Consensus Statement 2023 Update | Timing of elective surgery and risk assessment after SARS-CoV-2 infection
30 Jun, 2023 | 15:00h | UTCTiming of elective surgery and risk assessment after SARS-CoV-2 infection: 2023 update – Anaesthesia
Commentary on Twitter
?"In most circumstances, surgery should proceed unless risk assessment indicates that the risk of proceeding exceeds the risk of delay."@Assoc_Anaes @RCoANews @UkFssa @RCSnews @elboghdadly @doctimcook @justin_kua @NigelMercer @rmoonesinghe
?https://t.co/gfjymze0oi pic.twitter.com/D8bEfAHBD7
— ??????????? (@Anaes_Journal) June 20, 2023
Review | Update on the management of patients with HIV infection in anesthesia and critical care
26 Jun, 2023 | 00:36h | UTC
Review | How to use cardiac troponin in non-cardiac surgery
13 Jun, 2023 | 13:50h | UTC
ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation
5 Jun, 2023 | 13:37h | UTC
Quality-improvement intervention | Impact of stopping preoperative screening for asymptomatic bacteriuria
2 Jun, 2023 | 12:29h | UTCCommentary: Hospital intervention reduces unnecessary screening, antibiotics for bacteriuria – CIDRAP
Review | Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery
11 May, 2023 | 11:54h | UTCRelated:
Guideline Summary: New guidance on the perioperative management of diabetes.
Perioperative Evaluation and Management of Endocrine Disorders – Mayo Clinic Proceedings
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
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
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
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
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:
Perspective | Perioperative medicine: what the future can hold for anesthesiology
21 Mar, 2023 | 13:18h | UTCPerioperative 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 | UTCUnderstanding Outcomes After Major Surgery – Anesthesia & Analgesia
AHA Scientific Statement | Evaluation and management of pulmonary hypertension in noncardiac surgery
17 Mar, 2023 | 13:12h | UTCTop Things to Know: Evaluation and Management of Pulmonary HTN in Non-Cardiac Surgery – American Heart Association
Review | Preoperative frailty screening, assessment and management
16 Feb, 2023 | 14:37h | UTCPreoperative frailty screening, assessment and management – Current Opinion in Anaesthesiology
SR | Perioperative clinical practice guidelines for care of older adults living with frailty
30 Jan, 2023 | 00:34h | UTC
M-A | Routine use of α1-antagonists in orthopedic surgery increases adverse events and does not reduce postoperative urinary retention
23 Jan, 2023 | 13:20h | UTC
Commentary on Twitter
#ICYMI
Do α1-antagonists prevent retention after #ortho #surgery?#systematicreview and meta-analysis says no, and high rates of α related complications seencaveat – few trials!https://t.co/kTaK5Oej85#some4surgery @asgbi @SEIQuirurgica pic.twitter.com/amMrVRGhbf
— BJS Open (@BjsOpen) January 19, 2023