Perioperative use of beta-blockers in vascular and endovascular surgery
Editor —Thank you for the opportunity to respond to the letter from Bolsin and Conroy1 in reference to our systematic review and meta-analysis of randomized clinical trials and observational studies investigating the effect of perioperative use of beta-blockers in vascular and endovascular surgery.2 They express their concerns regarding the inclusion of two observational studies34 and a randomized clinical trial,5 and suggest that these studies should be excluded from the meta-analysis because of allegations of scientific misconduct of the senior (or first) author, D. Poldermans, of these studies. Of note, the randomized...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Perioperative use of beta-blockers in vascular and endovascular surgery
Editor —I thank Drs Bolsin and Conroy1 for raising their concerns regarding a recent publication by Hajibandeh and colleagues2 in theBritish Journal of Anaesthesia. There is no doubt that the role of perioperative beta-blockade has come under close scrutiny since the 1990s,34 but it is misleading to describe the conclusions of the trial by Mangano and colleagues5 as ‘baseless’ despite there being some legitimate criticisms of its design and interpretation. The Mangano data have been used by others in other systematic reviews.67 We agree that data derived from the DECREASE trials are unreliable. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Perioperative use of beta-blockers in vascular and endovascular surgery
Editor —We were disappointed to read the content of the recent article by Hajibandeh and colleagues1 in theBritish Journal of Anaesthesia. Since the early, implausible reports of long-term benefit attributable to short-term perioperative beta-blockade, there has been increasing scepticism of this treatment among both anaesthetists and cardiologists.2 –8 Following the early criticisms of publications by Mangano and colleagues and Poldermans ’ group, the specialty of anaesthesia has discovered that the conclusions of these workers were baseless.9 This is because of a flawed analysis on the basis of ‘intention to trea...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
The great fluid debate: time for Flexit?
‘Insanity is doing the same thing over and over again and expecting different results’—attributed to A. Einstein (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
More or less? The Goldilocks Principle as it applies to red cell transfusions
The quest for the optimal haemoglobin threshold (previously referred to as ‘trigger’) for red blood cell transfusion seems a never-ending journey. As if we are chasing a mirage, the closer we seem to think we get to the ‘just right’ haemoglobin level, the further it seems to move away. Applying the ‘Goldilocks Principle’ to transfusion of red cells, regardless of the population queried, appears to yield results that satisfy some investigators but leave many practitioners still wondering what is best for the patient. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Bank blood shortage, transfusion containment and viscoelastic point-of-care coagulation testing in cardiac surgery
In January 2017, many Italian hospitals (including my own institution) were forced to reduce the number of major surgical operations because of a severe shortage of packed red blood cells (RBCs). Blood banks warned that donors with blood group O (both O+ and O–) were scarce, and imposed that units of RBCs of this group were to be reserved for non-postponable major surgeries. Subsequently, other blood groups were affected by the shortage. On January 12, 2017 the National Blood Center warned that about 2600 RBC units were lacking in nine Italian regions. This emergency, resulting from the combination of Christmas holida...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Visual recognition memory is impaired in rhesus monkeys repeatedly exposed to sevoflurane in infancy
Conclusions. Repeated exposure of infant rhesus monkeys to sevoflurane results in visual recognition memory impairment that emerges after the first yr of life. This is consistent with epidemiological studies that show increased risk of learning disability after repeated exposure to anaesthesia in infancy/early childhood. Moreover, these deficits may emerge at later developmental stages, even when memory performance is unaffected earlier in development. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 31, 2017 Category: Anesthesiology Source Type: research
Triple low, double low: it ’s time to deal Achilles heel a single deadly blow
Since the report by Monk and colleagues1 of an association between a cumulative duration of the bispectral index (BIS)<45 and postoperative mortality there has been debate regarding the plausibility that relatively excessive anaesthetic depth is deadly. It is not surprising that this premise has ignited a scientific controversy and that anaesthetists are both intellectually and emotionally vested in its resolution. If this hypothesis were indeed true, the concentration of (volatile) anaesthetic promoting death would be within what is currently considered the therapeutic window. Furthermore, if a minor increase in anaest...
Source: British Journal of Anaesthesia - May 31, 2017 Category: Anesthesiology Source Type: research
Randomized equivalence trial of the King Vision aBlade videolaryngoscope with the Miller direct laryngoscope for routine tracheal intubation in children & lt;2 yr of age
Conclusions. In children<2 yr of age, the KVL was associated with equivalent times for routine tracheal intubation when compared with the Miller blade.Clinical trial registration NCT02590237. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 26, 2017 Category: Anesthesiology Source Type: research
Pharmacokinetics and pharmacodynamics of propofol: changes in patients with frontal brain tumours
Conclusions: Brain tumours might alter the pharmacokinetics of propofol. Caution should be exerted when using propofol TCI in patients with frontal brain tumours due to higher clearance.Trial registry number: NCT01060631. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 26, 2017 Category: Anesthesiology Source Type: research
Predictive performance of the modified Marsh and Schnider models for propofol in underweight patients undergoing general anaesthesia using target-controlled infusion
Conclusions: The pooled biases and inaccuracies of both models were clinically acceptable. However, the M-Marsh and Schnider models consistently produced negatively and positively biased predictions, respectively, in underweight patients. In particular, the M-Marsh model showed greater inaccuracy at target Ce ≤ 3 μg ml−1 and the Schnider model showed greater inaccuracy at target Ce ≥ 4 μg ml−1. Therefore, it is necessary to develop a new pharmacokinetic model for propofol in underweight patients.Clinical trial registration: KCT0001502. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 24, 2017 Category: Anesthesiology Source Type: research
Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: a prospective observational study
British Journal of Anaesthesia, 2016; 117(3): 309 –15, DOI10.1093/bja/aew189 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 23, 2017 Category: Anesthesiology Source Type: research
Modern hydroxyethyl starch and acute kidney injury after cardiac surgery: a prospective multicentre cohort
British Journal of Anaesthesia, 2016; 117(4): 458 –63, DOI10.1093/bja/aew258 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 23, 2017 Category: Anesthesiology Source Type: research
Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial
British Journal of Anaesthesia, 2016; 117(6): 801 –11, DOI10.1093/bja/aew338 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 23, 2017 Category: Anesthesiology Source Type: research
Dexmedetomidine: a valuable sedative currently not widely available in the UK
British Journal of Anaesthesia, 2016; 117(2): 263 –264, DOI10.1093/bja/aew202 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - May 22, 2017 Category: Anesthesiology Source Type: research
