Best evidence in anesthetic practice

Question  

In postoperative non-ventilated patients, what is the efficacy and harm of pharmacological interventions in treating postoperative shivering?     

Best evidence in anesthetic practice

Question  

In patients undergoing major non-cardiac surgery, what is the efficacy and harm of pharmacological interventions in preventing perioperative myocardial ischemia, nonfatal myocardial infarction (MI), or cardiac mortality?     

Best evidence in anesthetic practice

Objective  

How accurate is a 14-item index [postoperative pneumonia risk index (PPRI)] for estimating the 30-day risk of developing pneumonia in patients undergoing non-cardiac surgery?     

Best evidence in anesthetic practice Prevention: supplemental oxygen reduces the incidence of surgical-wound infection

Question

Can supplemental administration of oxygen during the perioperative period decrease the incidence of postoperative wound infections in patients undergoing colorectal resection?

Design

Multicenter, randomized, double-blind, controlled trial.

Setting

Three hospitals in Europe (Austria and Germany).

Patients

Five hundred patients between 18 to 80 yr of age (mean age 57 yr, 44% women) undergoing elective open colorectal resection. Exclusion criteria were minor colon surgery, recent history of fever or infection, serious malnutrition, and bowel obstruction.

Intervention

Two hundred fifty patients were allocated to 30% oxygen / 70% nitrogen (30% O₂ group); 250 patients were allocated to 80% oxygen / 20% nitrogen (80% O₂ group). Both received the assigned concentrations during anesthesia until immediately before extubation when oxygen was increased to 100%. After extubation, as soon as deemed safe by the anesthesiologist, the oxygen concentration was returned to the allocated levels for the first two hours of recovery.

Main outcomes

Fifteen-day incidence of surgicalwound infection was the primary outcome. ASEPSIS score, white-cell counts, time to first solid food, time to staples removal, duration of postoperative hospitalization, proportion of ICU admission, and 15-day mortality were secondary outcomes. Amounts of collagen and protein deposition were measured in a subgroup of patients (32 receiving 30% O₂; 22 receiving 80% O₂).

Main results

Analysis was intention-to-treat. Clinical characteristics, diagnoses, surgical procedures and duration, hemodynamic values, use of anesthetics, and types and duration of prophylactic antibiotic adminstration were similar between both groups. Overall incidence of surgical wound infections was 8%. The 80% O₂ group had fewer wound infections (5.2%) compared to the 30% O₂ group (11.2%) [absolute risk reduction 6.0%; 95% confidence interval 1.2–10.8%; number-needed-to-treat 17; P=0.01]. Similarly, the mean ASEPSIS score was lower in the 80% O₂ group (3 ±7) compared to the 30% O₂ group (5 ±9; P=0.01). There were no statistically significant differences between groups for the other outcomes.

Conclusion

Administration of 80% supplemental oxygen during colorectal resection and for two hours afterwards halved the 15-day incidence of surgicalwound infection.

Funding

U.S. National Institutes of Health, Fonds zur Förderung der wissenschafflichen Forschung, Joseph Drown Foundation, Anesthesia Patient Safety Foundation, Max Kade Foundation, Erwin-Schrödinger Foundation, Bürgermeister Fond der Stadt Wien, Austrian National Bank Fund.     

Best evidence in anesthetic practice Prevention: Intraoperative neuraxial blockade reduces some postoperative complications

Question  

What are the effects of neuraxial blockade with epidural or spinal anesthesia on postoperative morbidity and mortality?     

Best evidence in anesthetic practice prevention: planned Cesarean delivery reduces early perinatal and neonatal complications for term breech presentations

Question  

For the fetus that presents as breech at term, does a planned Cesarean birth reduce perinatal or neonatal mortality or serious neonatal morbidity compared to vaginal planned birth?     

Best evidence in anesthetic practice Prevention: recombinant human activated protein C reduces mortality in severe sepsis

Question  

Does recombinant human activated protein C (drotrecogin alfa activated, DAA) reduce the 28-day allcause mortality rate in patients with severe sepsis?     

Best evidence in anesthetic practice Prevention: Dimenhydrinate prevents postoperative nausea and vomiting

Question  

In patients undergoing surgery, does prophylactic dimenhydrinate reduce the frequency of postoperative nausea and vomiting (PONV) compared to placebo?     

Best evidence in anesthetic practice prognosis: the Apgar score predicts 28-day neonatal mortality

Question  

In infants born before term (26–36 weeks of gestation) and infants born at term (≥37 weeks of gestation), does the Apgar score, at five minutes of age, predict 28-day neonatal death?     

Best evidence in anesthetic practice Prevention: Fondaparinux is better than enoxaparin for prevention of major venous thromboembolism after orthopedic surgery

Question  

Compared to perioperative enoxaparin, does postoperative fondaparinux decrease the incidence of postoperative venous thromboembolism (VTE)?     

Best evidence in anesthetic practice Treatment: Vasopressin neither improves nor worsens survival from cardiac arrest

Question  

Does vasopressin, as the initial vasopressor, improve one-hour survival compared to epinephrine in inpatients with cardiac arrest?     

Best evidence in anesthetic practice Goal-directed therapy with the pulmonary artery catheter is not better than standard therapy

Question  

In high-risk elderly patients undergoing surgery followed by a stay in the intensive care unit (ICU), is there a difference in perioperative outcomes when treatment is guided by a pulmonary artery catheter (PAC) compared to treatment without a PAC?     

The anesthetic contribution of magnesium sulfate and ritodrine hydrochloride in rats

The anesthetic effects of the tocolytic agents, magnesium sulfate and ritodrine hydrochloride, were investigated by determining their effect on the minimal alveolar anesthetic concentration (MAC) of halothane in male and in pregnant and nonpregnant female rats. Magnesium and ritodrine were administered by continuous intravenous infusion to mechanically ventilated rats anesthetized with halothane. The tail-clamp technique was used to establish the MAC of halothane before and then again during the infusion of either magnesium or ritodrine. Ritodrine produced no change in halothane MAC. Increasing magnesium dosages and magnesium plasma levels were associated with nonlinear reductions in halothane MAC that were unrelated to sex or pregnancy. The alveolar halothane MAC concentration in pregnant rats (0.85 +/- 0.02) was not significantly different from the halothane MAC in nonpregnant female or male rats. At the highest plasma magnesium concentrations (15.8 +/- 1.57 mg/dl) achieved in the pregnant rats, the alveolar halothane MAC was 0.36 +/- 0.13, a 61.6% reduction in MAC. The anesthetic effects of magnesium were not attributable to cardiovascular, respiratory, or neuromuscular depression. Major decreases in blood pressure occurred only in the pregnant rats with the highest magnesium concentrations.