Author ’s reply to Grocott: Risk of cardiac ischaemia in patients without α-receptor blockade for phaeochromocytoma surgery
Editor —We thank Prof Grocott for his comments.1 The author questions whether the incidence of perioperative myocardial infarction in patients with phaeochromocytoma without perioperative α-receptor blockade is truly zero, without taking serial troponin measurements. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Safety assessments in the avoidance of preoperative α-receptor blockade in phaeochromocytoma surgery: the pitfalls of a zero numerator
Editor —The recent observational case series reported by Groeben and colleagues1 addressing the avoidance of preoperative α-receptor blockade in patients undergoing phaeochromocytoma surgery clearly challenges conventional thought. Their study showed that the maximal intraoperative blood pressure in non-α-blocked patients was no different than in those having received preoperative phenoxybenzamine or doxazosin therap y (185 mm Hgvs 178 mm Hg, respectively;P=0.25). In addition, there were no major complications reported – notably an absence of myocardial infarction (MI) – making this practice, at least accordin...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Optimal patient blood management in cardiac surgery using viscoelastic point-of-care testing Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis
Editor —We read with interest the study of Serraino and Murphy1 on routine use of point-of-care (POC) testing for diagnosis and treatment of coagulopathy in cardiac surgery patients. During cardiac surgery major blood loss is common. There is general agreement that less bleeding and optimal patient blood management are essential determinants of postoperative outcome.2 The conclusion of Serraino and Murphy that POC viscoelastic testing lacks clinical effectiveness is an important negative finding, but should not disparage the significance of efficiently reducing the rate of unnecessary transfusions. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis
Editor —With great interest we read the systematic review and meta-analysis on the routine use of viscoelastic haemostatic assays (VHA) for diagnosis and treatment of coagulopathic bleeding in cardiac surgery published by Serraino and Murphy.1 Significant reductions in red blood cell transfusion requirements by the use of VHA have been confirmed by previous Cochrane reviews.23 Reducing the exposure to allogeneic blood products is a clear perioperative management goal improving patient outcome and recommended by evidence-based bleeding guidelines.4 Moreover, Serraino and Murphy report significant reductions in platelet tr...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome
Editor —The conclusions of the very recent meta-analysis by Michard and colleagues1 in the British Journal of Anaesthesia is that the use of perioperative goal-directed therapy (GDT) with uncalibrated pulse contour (uPC) techniques is associated with a decrease in postoperative morbidity, but not associated with an increase in total fluid administration. An accompanying editorial has analysed in detail some methodological issues related to this and other systematic reviews, but has not challenged its conclusions.2 In fact, the editorial expanded these conclusions claiming that this systematic review provides us with the ...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Anaesthesia-induced developmental neurotoxicity: reality or fiction?
As animal evidence continues to mount, we face a real dilemma regarding the clinical relevance of anaesthesia-induced developmental neurotoxicity. In December 2016, the US Food and Drug Administration (FDA) issued an announcement stating that commonly used general anaesthetics could potentially be detrimental to very young and rapidly developing brains. This announcement was based on an extensive body of animal research.1 –24 Now we must grapple with the FDA ’s official recommendation that potential risks should be balanced with the benefits of appropriate anaesthesia in young children. More importantly, as we deal wit...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Theseus, the Labyrinth, and the Minotaur of anaesthetic-induced developmental neurotoxicity
When Theseus set sail to slay the mighty Minotaur, he likely spared a thought for the difficulty in navigating the Labyrinth that surrounded his foe. The search for therapies for anaesthetic-induced developmental neurotoxicity shares a similar mythical context. In our version of these events, Prince Theseus is the cure (potentially played by dexmedetomidine), the Minotaur is sevoflurane-induced neurotoxicity and the Labyrinth (a maze of confounding factors) is represented by physiological aberrations. In this issue of theBritish Journal of Anaesthesia, two reports12 appear to arrive at contradictory conclusions regarding t...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Viscoelastometric testing, fibrinogen and transfusion during post-partum haemorrhage
Editor —Many readers will recognize the pleasure of a new pair of glasses (Fig. 1). They are perfectly tailored to our own visual defect, and wearing them gives one a feeling of clarity and brightness that is comparable with opening the curtains after a good night ’s sleep. In an era of evidence-based medicine, should we question the evidence base for eyeglasses? Might this be unnecessary when there is a palpable association between a specific intervention and an intended outcome such that we are easily convinced of the causal nature of that association? Th ere will certainly be an effect of using viscoelastometric tes...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Can predicting transfusion in cardiac surgery help patients?
In this issue of theBritish Journal of Anaesthesia, Klein and colleagues1 describe the ACTA-PORT, a new score for predicting the risk of one or more red blood cell transfusions in patients undergoing cardiac surgery. The authors ’ desire to provide a simple, accurate tool to help predict the risk of transfusion in patients undergoing cardiac surgery is commendable, but does it help our patients? (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Lack of benefit of near-infrared spectroscopy monitoring for improving patient outcomes. Case closed?
Near-infrared spectroscopy (NIRS) monitoring of regional cerebral oxygen saturation (rSco2) during cardiac surgery has been available to clinicians for more than three decades.12 This monitoring is attractive because it is non-invasive, requires minimal user technical expertise, provides an intuitively important end point (oxygenation of the superficial cerebral cortex), and has a continuous output. As a result of these features, NIRS monitoring overcomes many of the limitations of existing monitors for judging adequacy of cerebral perfusion during surgery [(particularly, throughout cardiopulmonary bypass (CPB)], such as e...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Difficult Airway Society 2016 Conference Abstracts
(Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Benefit and harm of pregabalin in acute pain treatment: a systematic review with meta-analyses and trial sequential analyses
Conclusions were based primarily on trials with low risk of bias. Ninety-seven randomized clinical trials with 7201 patients were included. The 24 h morphine i.v. consumption was reported in 11 trials with overall low risk of bias, finding a reduction of 5.8 mg (3.2, 8.5; TSA adjusted confidence interval: 3.2, 8.5). Incidence of SAEs was reported in 21 trials, with 55 SAEs reported in 12 of these trials, and 22 SAEs report ed in 10 trials with overall low risk of bias. In trials with overall low risk of bias, Peto’s odds ratio was 2.9 (1.2, 6.8; TSA adjusted confidence interval: 0.1, 97.1). Based on trials with low r...
Source: British Journal of Anaesthesia - September 6, 2017 Category: Anesthesiology Source Type: research
Analgesia nociception index for the assessment of pain in critically ill patients: a diagnostic accuracy study
ConclusionsDespite low sensitivity/specificity, ANIi ≥43 had a Negative-Predictive-Value of 90%. Hence ANIi may be of highest benefit for excluding significant pain. A randomized controlled trial should compare sedation-analgesia protocols based on ANIi to presently recommended behavioural-pain-tools. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 6, 2017 Category: Anesthesiology Source Type: research
Association between intraoperative non-depolarising neuromuscular blocking agent dose and 30-day readmission after abdominal surgery
ConclusionsIn a retrospective analysis, high doses of NMBAs given during abdominal surgery was associated with an increased risk of 30-day readmission, particularly in patients undergoing ambulatory surgery. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 6, 2017 Category: Anesthesiology Source Type: research
Neuropathic pain in cancer: systematic review, performance of screening tools and analysis of symptom profiles
ConclusionsWe identified concordance between the clinician diagnosis and screening tool outcomes for LANSS, DN4 and PDQ in patients with cancer pain. Shortcomings in relation to standardized clinician assessment are likely to account for variation in screening tool sensitivity, which should include the use of the neuropathic pain grading system. Further research is needed to standardize and improve clinical assessment in patients with cancer pain. Until the standardization of clinical diagnosis for neuropathic cancer pain has been validated, screening tools offer a practical approach to identify potential cases of neuropat...
Source: British Journal of Anaesthesia - September 4, 2017 Category: Anesthesiology Source Type: research
