Saturday, May 17, 2014

Aspirin in Patients Undergoing Noncardiac Surgery

 P.J. Devereaux, M.D.et al

N Engl J Med 2014; 370:1494-1503

 Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding.

Clonidine in Patients Undergoing Noncardiac Surgery

 P.J. Devereaux, M.D et al

N Engl J Med 2014; 370:1504-1513April 17, 2014

Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac arrest. 

Thursday, May 15, 2014

Restrictive Deferred Hydration Combined with Preemptive Norepinephrine Infusion during Radical Cystectomy Reduces Postoperative Complications and Hospitalization Time: A Randomized Clinical Trial

Wuethrich, Patrick Y. M.D.; Burkhard, Fiona C. M.D.; Thalmann, George N. M.D.; Stueber, Frank M.D.; Studer, Urs E. M.D.
Anesthesiology:
 
The incidence of major complications was significantly reduced, with a relative risk of 0.7 (95% CI, 0.55–0.88). The duration of hospitalization was also significantly reduced from a median of 17 to 15 days. 

Pharyngeal Function and Breathing Pattern during Partial Neuromuscular Block in the Elderly: Effects on Airway Protection

Cedborg, Anna I. Hårdemark M.D.; Sundman, Eva M.D., Ph.D.; Bodén, Katarina M.D., Ph.D.; Hedström, Hanne Witt M.D., Ph.D.; Kuylenstierna, Richard M.D., Ph.D.; Ekberg, Olle M.D., Ph.D.; Eriksson, Lars I. M.D., Ph.D., F.R.C.A.
 
Anesthesiology:
Incidence of swallowing dysfunction increased more than double during partial neuromuscular block in healthy elderly individuals without impairment of coordination between swallowing and breathing. Reduced upper esophageal sphincter tone did not recover even at the train-of-four ratio of 0.9. 

Successful Cardiopulmonary Resuscitation in the Lateral Position during Intraoperative Cardiac Arrest

Bengali, Raheel M.D.; Janik, Luke S. M.D.; Kurtz, Michael M.D.; McGovern, Francis M.D.; Jiang, Yandong M.D., Ph.D.
Anesthesiology:
Chest compressions on a patient in the lateral position can provide CO that is adequate for tissue perfusion and gain time for more advanced treatments.
 

Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2): A Randomized Controlled Trial on Blood Salvage as Transfusion Alternative Using a Restrictive Transfusion Policy in Patients with a Preoperative Hemoglobin above 13 g/dl

So-Osman, Cynthia M.D., Ph.D., M.Sc.; Nelissen, Rob G. H. H. M.D., Ph.D.; Koopman-van Gemert, Ankie W. M. M. M.D., Ph.D.; Kluyver, Ewoud M.D.; Pöll, Ruud G. M.D., Ph.D.; Onstenk, Ron M.D.; Van Hilten, Joost A. Ph.D.; Jansen-Werkhoven, Thekla M. Ph.D.; van den Hout, Wilbert B. Ph.D.; Brand, Ronald Ph.D.; Brand, Anneke M.D., Ph.D.
Anesthesiology:
 In this prospective randomized controlled trial including 1,759 patients with a preoperative hemoglobin level greater than 13 g/dl (and therefore ineligible for erythropoietin) undergoing hip or knee arthroplasty, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives. The use of these devices did not reduce erythrocyte use and increased costs.

Pulmonary Function after Emergence on 100% Oxygen in Patients with Chronic Obstructive Pulmonary Disease: A Randomized, Controlled Trial

Kleinsasser, Axel T. M.D.; Pircher, Iris M.D.; Truebsbach, Suzan M.D.; Knotzer, Hans M.D.; Loeckinger, Alexander M.D.; Treml, Benedict M.D.
Anesthesiology:
In a case-controlled open-labeled study of 53 chronic obstructive pulmonary disease patients, patients breathing 100% oxygen during emergence had lower arterial oxygen levels after 60 min compared with patients breathing 30% oxygen balanced with nitrogen. 
 

Nitrous Oxide–related Postoperative Nausea and Vomiting Depends on Duration of Exposure


Peyton, Philip J. M.D., Ph.D., M.B.B.S., F.A.N.Z.C.A.; Wu, Christine Yx M.B.B.S.
Anesthesiology:
Duration of exposure to nitrous oxide less than 1 h has little effect on the rate of postoperative nausea and vomiting. The risk ratio for postoperative nausea and vomiting increases approximately 20% per hour after the first 45 min of exposure to nitrous oxide 

Etomidate – a review of robust evidence for its use in various clinical scenarios   G. ERDOES et al

Acta Anaesthesiologica Scandinavica

Volume 58, Issue 4, pages 380–389, April 2014

Etomidate-induced transient adrenocortical suppression is well documented and has been associated with increased mortality in sepsis. In surgical patients at risk of hypotensive complications, however, a review of current literature provides no robust evidence to contraindicate a single-bolus etomidate induction

Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock
M. NÉMETH,K. TÁNCZOS,G. DEMETER,D. ÉRCES,J. KASZAKI,A. MIKOR,Z. MOLNÁR

 Acta Anaesthesiologica Scandinavica Volume 58, Issue 5, pages 611–619, May 2014

 In this SV-guided bleeding and fluid resuscitation model, both ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2( venous-to-arterial carbon dioxide gap ) may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.


The Effectiveness of Cricoid Pressure for Occluding the Esophageal Entrance in Anesthetized and Paralyzed Patients: An Experimental and Observational Glidescope Study

Zeidan, Ahed M. MD; Salem, M. Ramez MD; Mazoit, Jean-Xavier MD, PhD; Abdullah, Mohamad Ali MD; Ghattas, Tharwat MD; Crystal, George J. PhD
Anesthesia & Analgesia:

The current study provides additional visual and mechanical evidence supporting a success rate of at least 95% by using a cricoid force of 30 N to occlude the esophageal entrance in anesthetized and paralyzed normal adult patients.


Sedation Depth During Spinal Anesthesia and Survival in Elderly Patients Undergoing Hip Fracture Repair   Brown, Charles H. IV MD MHS; Azman, Andrew S. MS; Gottschalk, Allan MD, PhD Mears, Simon C. MD, PhD; Sieber, Frederick E. MD


Anesthesia & Analgesia:

Low intraoperative Bispectral Index (BIS) values may be associated with increased mortality. Among all patients, mortality was equivalent across sedation groups. However, among patients with serious comorbidities (Charlson score >4), 1-year mortality was reduced in the light (22.2%) vs deep (43.6%) sedation group (hazard ratio [HR], 0.43; 95% confidence interval, 0.19–0.97; P = 0.04) during spinal anesthesia. Similarly, among patients with Charlson score >6, 1-year mortality was reduced in the light (28.6%) vs deep (52.6%) sedation group (HR 0.33; 95% confidence interval, 0.12–0.94; P = 0.04) during spinal anesthesia. 

The Risk of Hypertension after Preoperative
Discontinuation of Angiotensin-Converting Enzyme
Inhibitors or Angiotensin Receptor Antagonists
in Ambulatory and Same-Day Admission Patients
Rebecca S. Twersky, MD, MPH, Vasudha Goel, MD, Preeti Narayan, MD,
and Jeremy Weedon, PhD, MA, BS
Anesth Analg 2014;118:938–44


Discontinuing ACEIs and ARBs in patients on the day of surgery did not result
in a substantively increased incidence of pre- or postoperative HTN compared with patients who
continued these medications on the day of surgery. The results provide an evidentiary basis for
the safety of discontinuing ACEIs and ARBs on the day of surgery without increasing adverse
hemodynamic outcomes.