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Anesthesia & Analgesia
Journal Prestige (SJR): 1.472
Citation Impact (citeScore): 3
Number of Followers: 168  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-2999 - ISSN (Online) 1526-7598
Published by LWW Wolters Kluwer Homepage  [307 journals]
  • Balancing Act: Multimodal General Anesthesia
    • Authors: Nathan; Naveen
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Protecting the Beans: Perioperative Acute Kidney injury
    • Authors: Wanderer; Jonathan P.; Nathan, Naveen
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • “Randomization at the Expense of Relevance.” L. J. Cronbach and
           Intravenous Acetaminophen as an Opioid-Sparing Adjuvant
    • Authors: Nelson; Ariana M.; Wu, Christopher L.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Preoperative Intravenous Iron to Enhance a Blood Management Program: Is It
           All in “Vein”'
    • Authors: Simmons; Jeffrey W.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Multimodal General Anesthesia: A Principled Approach to Producing the
           Drug-Induced, Reversible Coma of Anesthesia
    • Authors: Egan; Talmage D.; Svensen, Christer H.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Why Cost-Effectiveness'
    • Authors: Bartha; Erzsebet
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Intraoperative Oliguria: Physiological or Beginning Acute Kidney
           Injury'
    • Authors: Küllmar; Mira; Meersch, Melanie
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Surveying the Literature: Synopsis of Recent Key Publications
    • Authors: Hessel; Eugene A. II; Martin, Timothy W.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Implication of Major Adverse Postoperative Events and Myocardial Injury on
           Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial
    • Authors: Beattie; W. Scott; Wijeysundera, Duminda N.; Chan, Matthew T. V.; Peyton, Philip J.; Leslie, Kate; Paech, Michael J.; Sessler, Daniel I.; Wallace, Sophie; Myles, Paul S.; Galagher, W.; Farrington, C.; Ditoro, A.; Baulch, S.; Sidiropoulos, S.; Bulach, R.; Bryant, D.; O’Loughlin, E.; Mitteregger, V.; Bolsin, S.; Osborne, C.; McRae, R.; Backstrom, M.; Cotter, R.; March, S.; Silbert, B.; Said, S.; Halliwell, R.; Cope, J.; Fahlbusch, D.; Crump, D.; Thompson, G.; Jefferies, A.; Reeves, M.; Buckley, N.; Tidy, T.; Schricker, T.; Lattermann, R.; Iannuzzi, D.; Carroll, J.; Jacka, M.; Bryden, C.; Badner, N.; Tsang, M. W. Y.; Cheng, B. C. P.; Fong, A. C. M.; Chu, L. C. Y.; Koo, E. G. Y.; Mohd, N.; Ming, L. E.; Campbell, D.; McAllister, D.; Walker, S.; Olliff, S.; Kennedy, R.; Eldawlatly, A.; Alzahrani, T.; Chua, N.; Sneyd, R.; McMillan, H.; Parkinson, I.; Brennan, A.; Balaji, P.; Nightingale, J.; Kunst, G.; Dickinson, M.; Subramaniam, B.; Banner-Godspeed, V.; Liu, J.; Kurz, A.; Hesler, B.; Fu, A. Y.; Egan, C.; Fiffick, A. N.; Hutcherson, M. T.; Turan, A.; Naylor, A.; Obal, D.; Cooke, E.; on behalf of the ANZCA Clinical Trials Network for the ENIGMA-II Investigators
      Abstract: imageBACKGROUND: Globally,>300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery.METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs).RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55–4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26–3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89–6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival.CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Postoperative Hypotension and Surgical Site Infections After Colorectal
           Surgery: A Retrospective Cohort Study
    • Authors: Yilmaz; Huseyin O.; Babazade, Rovnat; Leung, Steve; Zimmerman, Nicole M.; Makarova, Natalya; Saasouh, Wael; Stocchi, Luca; Gorgun, Emre; Sessler, Daniel I.; Turan, Alparslan
      Abstract: imageBACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure.METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables.RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001).CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Opening the Black Box: Understanding the Science Behind Big Data and
           Predictive Analytics
    • Authors: Hofer; Ira S.; Halperin, Eran; Cannesson, Maxime
      Abstract: imageBig data, smart data, predictive analytics, and other similar terms are ubiquitous in the lay and scientific literature. However, despite the frequency of usage, these terms are often poorly understood, and evidence of their disruption to clinical care is hard to find. This article aims to address these issues by first defining and elucidating the term big data, exploring the ways in which modern medical data, both inside and outside the electronic medical record, meet the established definitions of big data. We then define the term smart data and discuss the transformations necessary to make big data into smart data. Finally, we examine the ways in which this transition from big to smart data will affect what we do in research, retrospective work, and ultimately patient care.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural
           Sedation, Part 2 Safety: Sedation Consortium on Endpoints and Procedures
           for Treatment, Education, and Research Recommendations
    • Authors: Ward; Denham S.; Williams, Mark R.; Berkenbosch, John W.; Bhatt, Maala; Carlson, Douglas; Chappell, Phillip; Clark, Randall M.; Constant, Isabelle; Conway, Aaron; Cravero, Joseph; Dahan, Albert; Dexter, Franklin; Dionne, Raymond; Dworkin, Robert H.; Gan, Tong J.; Gozal, David; Green, Steven; Irwin, Michael G.; Karan, Suzanne; Kochman, Michael; Lerman, Jerrold; Lightdale, Jenifer R.; Litman, Ronald S.; Mason, Keira P.; Miner, James; O’Connor, Robert E.; Pandharipande, Pratik; Riker, Richard R.; Roback, Mark G.; Sessler, Daniel I.; Sexton, Anne; Tobin, Joseph R.; Turk, Dennis C.; Twersky, Rebecca S.; Urman, Richard D.; Weiss, Mark; Wunsch, Hannah; Zhao-Wong, Anna
      Abstract: imageThe Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research, established by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, a public–private partnership with the US Food and Drug Administration, convened a second meeting of sedation experts from a variety of clinical specialties and research backgrounds to develop recommendations for procedural sedation research. The previous meeting addressed efficacy and patient- and/or family-centered outcomes. This meeting addressed issues of safety, which was defined as “the avoidance of physical or psychological harm.” A literature review identified 133 articles addressing safety measures in procedural sedation clinical trials. After basic reporting of vital signs, the most commonly measured safety parameter was oxygen saturation. Adverse events were inconsistently defined throughout the studies. Only 6 of the 133 studies used a previously validated measure of safety. The meeting identified methodological problems associated with measuring infrequent adverse events. With a consensus discussion, a set of core and supplemental measures were recommended to code for safety in future procedural clinical trials. When adopted, these measures should improve the integration of safety data across studies and facilitate comparisons in systematic reviews and meta-analyses.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid
           Responsiveness in Mechanically Ventilated Patients' A Systematic
           Review and Meta-analysis
    • Authors: Si; Xiang; Xu, Hailin; Liu, Zimeng; Wu, Jianfeng; Cao, Daiyin; Chen, Juan; Chen, Minying; Liu, Yongjun; Guan, Xiangdong
      Abstract: imageBACKGROUND: We performed a systematic review and meta-analysis of studies investigating the diagnostic accuracy of respiratory variation in inferior vena cava diameter (ΔIVC) for predicting fluid responsiveness in patients receiving mechanical ventilation.METHODS: MEDLINE, EMBASE, the Cochrane Library, and Web of Science were screened from inception to February 2017. The meta-analysis assessed the pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve. In addition, heterogeneity and subgroup analyses were performed.RESULTS: A total of 12 studies involving 753 patients were included. Significant heterogeneity existed among the studies, and meta-regression indicated that ventilator settings were the main sources of heterogeneity. Subgroup analysis indicated that ΔIVC exhibited better diagnostic performance in the group of patients ventilated with tidal volume (TV) ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O than in the group ventilated with TV 5 cm H2O, as demonstrated by higher sensitivity (0.80 vs 0.66; P = .02), specificity (0.94 vs 0.68; P < .001), diagnostic odds ratio (68 vs 4; P < .001), and area under the receiver operating characteristic curve (0.88 vs 0.70; P < .001). The best ΔIVC threshold for predicting fluid responsiveness was 16% ± 2% in the group of TV ≥8 mL/kg and PEEP ≤5 cm H2O, whereas in the group of TV 5 cm H2O, this threshold was 14% ± 5%.CONCLUSIONS: ΔIVC shows limited ability for predicting fluid responsiveness in distinct ventilator settings. In patients with TV ≥8 mL/kg and PEEP ≤5 cm H2O, ΔIVC was an accurate predictor of fluid responsiveness, while in patients with TV 5 cm H2O, ΔIVC was a poor predictor. Thus, intensivists must be cautious when using ΔIVC.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes
           and an Approach to Management
    • Authors: Dominguez; Jennifer E.; Krystal, Andrew D.; Habib, Ashraf S.
      Abstract: imageAmong obese pregnant women, 15%–20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman’s risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Incidence and Epidemiology of Perioperative Transfusion-Related Pulmonary
           Complications in Pediatric Noncardiac Surgical Patients: A Single-Center,
           5-Year Experience
    • Authors: Thalji; Leanne; Thum, Daniel; Weister, Timothy J.; Weber, Wayne V.; Stubbs, James R.; Kor, Daryl J.; Nemergut, Michael E.
      Abstract: imageBACKGROUND: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related fatalities. While these transfusion-related pulmonary complications (TRPCs) have been well detailed in adults, their burden in pediatric subsets remains poorly defined. We sought to delineate the incidence and epidemiology of pediatric TRPCs after intraoperative blood product transfusion.METHODS: In this retrospective cohort study, we evaluated all consecutive pediatric patients receiving intraoperative blood product transfusions during noncardiac surgeries between January 2010 and December 2014. Exclusion criteria were cyanotic heart disease, preoperative respiratory insufficiency, extracorporeal membrane oxygenation, and American Society of Anesthesiologists physical status VI. Medical records were electronically screened to identify those with evidence of hypoxemia, and in whom a chest x-ray was obtained within 24 hours of surgery. Records were then manually reviewed by 2 physicians to determine whether they met diagnostic criteria for TACO or TRALI. Disagreements were adjudicated by a third senior physician.RESULTS: Of 19,288 unique pediatric surgical patients, 411 were eligible for inclusion. The incidence of TRPCs was 3.6% (95% confidence interval [CI], 2.2–5.9). TACO occurred in 3.4% (95% CI, 2.0–5.6) of patients, TRALI was identified in 1.2% (95% CI, 0.5–2.8), and 1.0% (95% CI, 0.4–2.5) had evidence for both TRALI and TACO. Incidence was not different between males (3.4%) and females (3.8%; P = .815). Although a trend toward an increased incidence of TRPCs was observed in younger patients, this did not reach statistical significance (P = .109). Incidence was comparable across subsets of transfusion volume (P = .184) and surgical specialties (P = .088). Among the 15 patients experiencing TRPCs, red blood cells were administered to 13 subjects, plasma to 3, platelets to 3, cryoprecipitate to 2, and autologous blood to 3. Three patients with TRCPs were transfused mixed blood components.CONCLUSIONS: TRPCs occurred in 3.6% of transfused pediatric surgical patients, with the majority of cases attributable to TACO, congruent with adult literature. The frequency of TRPCs was comparable between genders and across surgical procedures and transfusion volumes. The observed trend toward increased TRPCs in younger children warrants further consideration in future investigations. Red blood cell administration was the associated component for the majority of TRPCs, although platelets demonstrated the highest risk per component transfused. Mitigation of perioperative risk associated with TRPCs in pediatric patients is reliant on further multiinstitutional studies powered to examine patterns and predictors of this highly morbid entity.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Recommendations for the Nomenclature of Cognitive Change Associated With
           Anaesthesia and Surgery—2018
    • Authors: Evered; L.; Silbert, B.; Knopman, D. S.; Scott, D. A.; DeKosky, S. T.; Rasmussen, L. S.; Oh, E. S.; Crosby, G.; Berger, M.; Eckenhoff, R. G.; The Nomenclature Consensus Working Group
      Abstract: imageCognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions.Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that ‘perioperative neurocognitive disorders’ be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Cost-Effectiveness Research in Anesthesiology
    • Authors: Teja; Bijan J.; Sutherland, Tori N.; Barnett, Sheila R.; Talmor, Daniel S.
      Abstract: imagePerioperative interventions aimed at decreasing costs and improving outcomes have become increasingly popular in recent years. Anesthesiologists are often faced with a choice among different treatment strategies with little data available on the comparative cost-effectiveness. We performed a systematic review of the English language literature between 1980 and 2014 to identify cost-effectiveness analyses of anesthesiology and perioperative medicine interventions. We excluded interventions related to critical care or pediatric anesthesiology, and articles on interventions not normally ordered or performed by anesthesiologists. Of the>5000 cost-effectiveness analyses published to date, only 28 were applicable to anesthesiology and perioperative medicine and met inclusion criteria. Multidisciplinary interventions were the most cost-effective overall; 8 of 8 interventions were “dominant” (improved outcomes, reduced cost) or cost-effective, including accelerated, standardized perioperative recovery pathways, and perioperative delirium prevention bundles. Intraoperative measures were dominant in 3 of 5 cases, including spinal anesthesia for benign abdominal hysterectomy. With regard to prevention of perioperative infection, methicillin-resistant Staphylococcus aureus (MRSA) decolonization was dominant or cost-effective in 2 of 2 studies. Three studies assessing various antibiotic prophylaxis regimens had mixed results. Autologous blood donation was not found to be cost-effective in 5 of 7 studies, and intraoperative cell salvage therapy was also not cost-effective in 2 of 2 reports. Overall, there remains a paucity of cost-effectiveness literature in anesthesiology, particularly relating to intraoperative interventions and multidisciplinary perioperative interventions. Based on the available studies, multidisciplinary perioperative optimization interventions such as accelerated, standardized perioperative recovery pathways, and perioperative delirium prevention bundles tended to be most cost-effective. Our review demonstrates that there is a need for more rigorous cost-effective analyses in many areas of anesthesiology and that anesthesiologists should continue to lead collaborative, multidisciplinary efforts in perioperative medicine.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Treating Anemia in the Preanesthesia Assessment Clinic: Results of a
           Retrospective Evaluation
    • Authors: Ellermann; Ines; Bueckmann, Andreas; Eveslage, Maria; Buddendick, Hubert; Latal, Tobias; Niehoff, Dennys; Geissler, R. Georg; Hempel, Georg; Kerkhoff, Andrea; Berdel, Wolfgang E.; Roeder, Norbert; Van Aken, Hugo K.; Zarbock, Alexander; Steinbicker, Andrea U.
      Abstract: imageBACKGROUND: Perioperative anemia is challenging during hospital stay because anemia and red blood cell (RBC) transfusions are associated with an increased morbidity and mortality. With the implementation of patient blood management (PBM), a preanesthesia assessment clinic to screen and treat anemia before elective surgery was institutionalized at Muenster University Hospital, Germany. The main objective of this study was to evaluate the association between treating preoperative anemic patients with intravenous iron (IVI) and (primarily) presurgical hemoglobin levels and (secondarily) use of RBCs and mortality.METHODS: Between April 1, 2014, and July 4, 2016, patients scheduled for elective surgery with a risk for RBC transfusions>10% in 2013 were screened for preoperative anemia and, if indicated, treated with IVI. Patients’ data, time span between visit in the anesthesia/PBM clinic and surgery, demographic data, type of surgery, the difference of hemoglobin levels between visit and surgery, RBC transfusion, infectious-related International Classification of Disease codes during hospital stay, and 1-year survival were determined retrospectively by screening electronic data files. In addition, patients were interviewed about adverse events, health-related events, and infections via telephone 30, 90, and 365 days after visiting the anesthesia/PBM clinic.RESULTS: A total of 1101 patients were seen in the anesthesia/PBM clinic between days −28 and −1 (median [Q1–Q3], −3 days [−1, −9 days]) before elective surgery. Approximately 29% of patients presented with anemia, 46.8% of these anemic patients were treated with ferric carboxymaltose (500–1000 mg).In the primary analysis, hemoglobin levels at median were associated with a reduction between the visit in the anesthesia/PBM clinic and the surgery in all nonanemic patients on beginning of medical treatment (nonanemic patients at median −2.8 g/dL [−4, −0.9 g/dL], while anemic patients without IVI presented with median differences of −0.8 g/dL [−2, 0 g/dL] and anemic patients with IVI of 0 g/dL [−1.0, 0.5 g/dL]). Hemoglobin levels raised best at substitution 22–28 days before surgery (0.95 g/dL [−0.35, 1.18 g/dL]). Due to the selection criteria, transfusion rates were high in the cohort. Overall, there was no association between IVI treatment and the use of RBC transfusions (odds ratio for use of RBCs in anemic patients, no IVI versus IVI: 1.14; 95% confidence interval, 0.72–1.82). Patients treated with or without IVI presented a comparable range of International Classification of Disease codes related to infections. Telephone interviews indicated similar adverse events, health-related events, and infections. Cox regression analysis showed an association between anemia and reduced survival, regardless of IVI.CONCLUSIONS: An anemia clinic within the preanesthesia assessment clinic is a feasible and effective approach to treat preoperative anemia. The IVI supplementation was safe but was associated with decreased RBC transfusions in gynecology/obstetric patients only. The conclusions from this retrospective analysis have to be tested in prospective, controlled trials.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Perioperative Patient Blood Management to Improve Outcomes
    • Authors: Desai; Neel; Schofield, Nick; Richards, Toby
      Abstract: imageAnemia is common in elective surgery and is an independent risk factor for morbidity and mortality. Historical management of anemia has focused on the use of allogeneic blood transfusion but this in itself is not without risk. It too has been independently associated with morbidity and mortality, let alone the costs and relative shortage of this resource. In recognition of this, patient blood management (PBM) shifts the focus from the product to the patient and views the patient’s own blood as a resource that should be conserved and managed appropriately as a standard of care. It consists of 3 pillars: the optimization of red blood cell mass; reduction of blood loss and bleeding; and optimization of the patient’s physiological tolerance toward anemia. Integration of these 3 pillars in the form of multimodal care bundles and strategies into perioperative pathways should improve care processes and patient outcome. Preoperative anemia is most commonly caused by functional iron deficiency and should be treated with oral iron, intravenous iron, and/or recombinant erythropoietin. An individualized assessment of the thrombotic risk of discontinuing anticoagulant and antiplatelet medication should be balanced against the risk of perioperative bleeding. Neuraxial anesthetic techniques should be considered and minimally invasive surgery undertaken where appropriate. Cell salvage should be used if significant blood loss is anticipated and pharmacological treatments such as tranexamic acid and fibrin sealants have been shown to reduce blood loss. Point of care tests can guide the perioperative management of dynamic coagulopathy. Blood testing sampling should be performed only when indicated and when taken, sample volume and waste should be minimized. Restrictive blood transfusion thresholds and reassessment after single unit transfusion should be incorporated into clinical practice where appropriate. For PBM to become standard practice in routine surgical care, national health care quality change initiatives must set the agenda for change but the patient-centered approach to PBM should be delivered in a way that is also hospital centered. Characterization of the current practice of PBM at each hospital is crucial to facilitate the benchmarking of performance. Barriers to effective implementation such as lack of knowledge should be identified and acted on. Continuous audit of practice with a focus on transfusion rates and patient outcomes can identify areas in need of improvement and provide iterative feedback to motivate and inspire the main stakeholders.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Intravenous Acetaminophen Does Not Reduce Inpatient Opioid Prescription or
           Opioid-Related Adverse Events Among Patients Undergoing Spine Surgery
    • Authors: Mörwald; Eva E.; Poeran, Jashvant; Zubizarreta, Nicole; Cozowicz, Crispiana; Mazumdar, Madhu; Memtsoudis, Stavros G.
      Abstract: imageBACKGROUND: Having entered the US market relatively recently, the perioperative role of intravenous acetaminophen (ivAPAP) remains to be established for several surgeries. Using national data, we therefore assessed current utilization and whether it reduces inpatient opioid prescription and opioid-related side effects in a procedure with relatively high opioid utilization.METHODS: Patients undergoing a lumbar/lumbosacral spinal fusion (n = 117,269; 2011–2014) were retrospectively identified in a nationwide database and categorized by the amount and timing of ivAPAP administration (1 or>1 dose on postoperative day [POD] 0, 1, or 1+). Multivariable models measured associations between ivAPAP utilization categories and opioid prescription and perioperative complications; odds ratios (or % change) and 95% confidence intervals are reported.RESULTS: Overall, ivAPAP was used in 18.9% (n = 22,208) of cases of which 1 dose on POD 0 was the most common (73.6%; n = 16,335). After covariate adjustment, use of ivAPAP on POD 0 and 1 was associated with minimal changes in opioid prescription, length and cost of hospitalization particularly favoring>1 ivAPAP dose with a modestly (−5.2%, confidence interval, −7.2% to −3.1%; P < .0001) decreased length of stay. Use of ivAPAP did not coincide with a consistent pattern of significantly reduced odds for complications. In comparison, the most commonly used nonopioid analgesic, pregabalin/gabapentin, did demonstrate reduced opioid prescription combined with lower complication risk.CONCLUSIONS: We could not show that perioperative ivAPAP reduces inpatient opioid prescription with subsequent reduced odds for adverse outcomes. It remains to be determined if and under what circumstances ivAPAP has a meaningful clinical role in everyday practice.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Association Between Intraoperative Oliguria and Acute Kidney Injury After
           Major Noncardiac Surgery
    • Authors: Shiba; Ayako; Uchino, Shigehiko; Fujii, Tomoko; Takinami, Masanori; Uezono, Shoichi
      Abstract: imageBACKGROUND: Acute kidney injury (AKI) occurs in 6.1%–22.4% of patients undergoing major noncardiac surgery. Previous studies have shown no association between intraoperative urine output and postoperative acute renal failure. However, these studies used various definitions of acute renal failure. We therefore investigated the association between intraoperative oliguria and postoperative AKI defined by the serum creatinine criteria of the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification.METHODS: In this single-center, retrospective, observational study, we screened 26,984 patients undergoing elective or emergency surgery during the period September 1, 2008 to October 31, 2011 at a university hospital. Exclusion criteria were age
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Update on Perioperative Acute Kidney Injury
    • Authors: Zarbock; Alexander; Koyner, Jay L.; Hoste, Eric A. J.; Kellum, John A.
      Abstract: imageAcute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Several specific considerations for AKI risk are important in surgical patients. The surgery, especially major and emergency procedures in critically ill patients, may cause AKI. In addition, certain comorbidities, such as chronic kidney disease and chronic heart failure, are important risk factors for AKI. Diuretics, contrast agents, and nephrotoxic drugs are commonly used in the perioperative period and may result in a significant amount of in-hospital AKI. Before and during surgery, anesthetists are supposed to optimize the patient, including preventing and treating a hypovolemia and correcting an anemia. Intraoperative episodes of hypotension have to be avoided because even short periods of hypotension are associated with an increased risk of AKI. During the intraoperative period, urine output might be reduced in the absence of kidney injury or the presence of kidney injury with or without fluid responsiveness. Therefore, fluids should be used carefully to avoid hypovolemia and hypervolemia. The Kidney Disease: Improving Global Outcomes guidelines suggest implementing preventive strategies in high-risk patients, which include optimization of hemodynamics, restoration of the circulating volume, institution of functional hemodynamic monitoring, and avoidance of nephrotoxic agents and hyperglycemia. Two recently published studies found that implementing this bundle in high-risk patients reduced the occurrence of AKI in the perioperative period. In addition, the application of remote ischemic preconditioning has been studied to potentially reduce the incidence of perioperative AKI. This review discusses the epidemiology and pathophysiology of surgery-associated AKI, highlights the importance of intraoperative oliguria, and emphasizes potential preventive strategies.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Multimodal General Anesthesia: Theory and Practice
    • Authors: Brown; Emery N.; Pavone, Kara J.; Naranjo, Marusa
      Abstract: imageBalanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids. While opioids are the most effective antinociceptive agents, they have undesirable side effects. Moreover, overreliance on opioids has contributed to the opioid epidemic in the United States. Spurred by concern of opioid overuse, balanced general anesthesia strategies are now using more agents to create the anesthetic state. Under these approaches, called “multimodal general anesthesia,” the additional drugs may include agents with specific central nervous system targets such as dexmedetomidine and ones with less specific targets, such as magnesium. It is postulated that use of more agents at smaller doses further maximizes desired effects while minimizing side effects. Although this approach appears to maximize the benefit-to-side effect ratio, no rational strategy has been provided for choosing the drug combinations. Nociception induced by surgery is the primary reason for placing a patient in a state of general anesthesia. Hence, any rational strategy should focus on nociception control intraoperatively and pain control postoperatively. In this Special Article, we review the anatomy and physiology of the nociceptive and arousal circuits, and the mechanisms through which commonly used anesthetics and anesthetic adjuncts act in these systems. We propose a rational strategy for multimodal general anesthesia predicated on choosing a combination of agents that act at different targets in the nociceptive system to control nociception intraoperatively and pain postoperatively. Because these agents also decrease arousal, the doses of hypnotics and/or inhaled ethers needed to control unconsciousness are reduced. Effective use of this strategy requires simultaneous monitoring of antinociception and level of unconsciousness. We illustrate the application of this strategy by summarizing anesthetic management for 4 representative surgeries.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Estimating the Risk of a Rare But Plausible Complication That Has Not
           Occurred After n Trials
    • Authors: Ho; Anthony M.-H.; Ho, Adrienne K.; Mizubuti, Glenio B.; Dion, Peter W.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Predicting Persistent Pain After Surgery: Can Predicting the Weather Serve
           as an Example'
    • Authors: van Helmond; Noud; Olesen, Søren S.; Wilder-Smith, Oliver H.; Drewes, Asbjørn M.; Steegers, Monique A.; Vissers, Kris C.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Pharmacological Basis of Anesthesia: How to Overcome Stagnation'
    • Authors: Kissin; Igor; Vlassakov, Kamen V.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Time for a Fresh Approach to Examining Factors Associated With Red Blood
           Cell Transfusion Outcome
    • Authors: Mazzeffi; Michael; Chriss, Evan; Tanaka, Kenichi
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Vertical and Horizontal Pathways: Intersection and Integration of Enhanced
           Recovery After Surgery and the Perioperative Surgical Home
    • Authors: Cannesson; Maxime; Mahajan, Aman
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Making the Case for Case Reports
    • Authors: Vu; Michelle H.; Weinberg, Guy
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Medical Catastrophe: Confessions of an Anesthesiologist
    • Authors: Sinha; Ashish C.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • 71st World Health Assembly, Geneva, Switzerland 2018
    • Authors: O’Brien; Niki; Gore-Booth, Julian; Gelb, Adrian W.; Mellin-Olsen, Jannicke
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Anesthesia in High-Risk Patients, 1st ed
    • Authors: Alli; Ahmad; Bolon, Stefan N.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Anesthesia: The Gift of Oblivion and the Mystery of Consciousness
    • Authors: Cassella; Carol W.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Advanced Procedures for Pain Management: A Step-by-Step Atlas
    • Authors: Forget; Patrice
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Perioperative Two-Dimensional Transesophageal Echocardiography: A
           Practical Handbook, 2nd ed
    • Authors: Andrews; David T.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Is Neuraxial Anesthesia Appropriate for Cesarean Delivery in All Cases of
           Morbidly Adherent Placenta'
    • Authors: Tawfik; Mohamed Mohamed; Tolba, Mohamed Ahmed; Moawad, Sarah Salah; Ismail, Khalid Samir; Taman, Mohamed Elsayed
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Markley; John C.; Farber, Michaela K.; Perlman, Nicola C.; Carusi, Daniela A.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • When Laryngeal Masks Fail
    • Authors: Nielsen; James
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Vannucci; Andrea; Kallogjeri, Dorina; Helsten, Daniel L.; Cavallone, Laura F.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Intrinsic Plan B Airway for Patients Undergoing Bronchial Thermoplasty
    • Authors: Sorbello; Massimiliano; Gaçonnet, Cory; Skinner, Marcus
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Saran; Jagroop S.; Kreso, Melissa; Karan, Suzanne
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Anesthetics and Trauma: A Complex Interaction
    • Authors: Matot; Idit
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Perouansky; Misha; Wassarman, David A.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Global Anesthesia
    • Authors: Coonan; Thomas J.; Perndt, Haydn; McQueen, Kelly A.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Enright; Angela; McDougall, Robert
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Obstructive Sleep Apnea and Risk of Postcardiac Surgery Atrial
           Fibrillation
    • Authors: Kaw; Roop; Mehra, Reena
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Kelava; Marta; Duncan, Andra E.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Teaching Medical Students Clinical Anesthesia: A View From the United
           Kingdom
    • Authors: Al-Dubbaisi; Halah; Roy, Roman; Patel, Vishal N.; Parekh, Kishan P.; Rizvi, Khaizer S. A.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Curry; Saundra E.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Traumatic Brain Injury in Flies
    • Authors: Morgan; Philip G.; Sedensky, Margaret M.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Nitrous Oxide Supply Systems
    • Authors: Kibelbek; Michael J.
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Of Flies and Men
    • Authors: Einav; Sharon; Zlotnik, Alexander
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Perouansky; Misha
      Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Improvement of the Elevated Tryptase Criterion to Discriminate IgE- From
           Non–IgE-Mediated Allergic Reactions: Erratum
    • Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • American Society for Enhanced Recovery and Perioperative Quality
           Initiative Joint Consensus Statement on Postoperative Gastrointestinal
           Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal
           Surgery: Erratum
    • Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • American Society for Enhanced Recovery and Perioperative Quality
           Initiative Joint Consensus Statement on Patient-Reported Outcomes in an
           Enhanced Recovery Pathway: Erratum
    • Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • American Society for Enhanced Recovery and Perioperative Quality
           Initiative Joint Consensus Statement on Nutrition Screening and Therapy
           Within a Surgical Enhanced Recovery Pathway: Erratum
    • Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
  • Safe Surgery Globally By 2030: The Essential Role Of Anesthesia, The View
           From Obstetrics Erratum
    • Abstract: No abstract available
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT-
       
 
 
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