26/3/09 NEJM. The NICE SUGAR study of glucose control in ICU patients shows that very tight normogylcaemia (4.5 to 6 mmmol/l) had a worse outcome than looser control of blood glucose (8 to 10 mmol/l). 90 day mortality was 27.5% versus 24.9% respectively. This is in contrast to previous studies from Belgium that showed a marked improvement in survival with normoglycaemia in critically ill patients. The accompanying editorial backgrounds the whole issue well.
It is known that Methadone can cause QTc prolongation on the ECG which can lead to Torsades de Pointes. This is due to blockade of the curiously named 'human ether-a-go-go related gene' channels (hERG). This study published in the British Journal of Clinical Pharmacology in Feburary 2009 showed for the first time that oxycodone causes the same effect in a dose related manner. Morphine and tramadol do not have this problem. This has implications for patients on high doses of oxycodone especially when taken chronically
BMJ 9th March. Dr Scott Reuben from Baystate Medical center in Massachusetts has admitted to fabricating data in 21 of his clinical studies. Some of these studies have been influential especially on use of celecoxib, Pregabalin and multimodal analgesia. One study described the outcome of 1200 patients having multimodal analgesia after knee surgery. Editorials about the problems caused by these highly cited studies and their effect on clinical practice have been published in Anesthesiology and Anesthesia and Analgesia.
This website from Toronto General has an excellent 3D model of the heart and allows an interactive view to facilitate understanding of the sonoanatomy of the heart. It would be useful for anyone who is learning how to use transoesphageal echocardiography.
The July 2008 issue of the BJA has a good theme issue about pain. It covers the latest in basic sciences as well as clinical topics. Recommended.
The BART study has been published in today's NEJM.
The POISE study, (metoprolol versus placebo in high risk surgical patients) has just been published. The key findings were fewer MIs but more deaths. The publication was fast tracked, and it is on the Lancet website only. Should be in a print issue soon. The responses will be interesting to read, especially from cardiologists. This is the largest ever RCT in perioperative patients.
When writing papers, academics use Endnote or similar to manage their references. Recently there has been the emergence of online services that not only manage references, but also add in the function of social bookmarking. Social bookmarking is when anyone online can bookmark an interesting webpage and also see what everyone else is marking (eg Del.icio.us and Flickr). This helps to see what other colleagues in the field are reading and leads to discovery of new papers (as well having your references available from any computer anywhere).
NEJM March 13. This study reports a comparison of BIS monitoring compared with end-tidal volatile agent monitoring. It found no difference in the incidence of awareness. There is an associated editorial. This finding is in contrast with the B-Aware study that found a 75% reduction in awareness when using BIS monitoring in high risk patients. The study included 1900 patients and was an RCT.
A recent issue of the BMJ has highlighted the strong relationship between depression in RMOs and their six times increase in prescribing errors. This is a new finding, as previously there has been emphasis on system errors. Depression was common in the RMOs in the study (20%). There is also an editorial about the article.
While this research does not specifically deal with anaesthesia, it is likely it applies to impairment of cognitive tasks performed by any doctor that is depressed.
The full article can be viewed at this link.
The January issue of Anesthesiology has a special article that presents twelve of the best papers from 2007. Topics include: wound infiltration with diclofenac, a novel local anaesthetic without toxicity, the site of action of general anaesthesia, the causes of maternal death during anaesthesia, the ENIGMA study and others.
This comprehensive review published in Circulation gives a good insight into the problem of cardiovascular risk and the use of COX 2 inhibitors or conventional NSAIDs. I covers the basic pharmacology as well as the clinical use of this important group of drugs. Importantly it looks at the different CVS risk of the conventional NSAIDs. Diclofenac has a high risk (> 2) while naproxen is low risk. More food for thought when prescribing NSAIDs/COX 2 inhibitors for post-op analgesia
In recent years there has been much interest about the survival benefit from tight glucose control in critically ill patients. This large RCT, published in the NEJM, evaluated the effect of intensive insulin therapy and pentastarch 10% for fluid resusciation (v Ringers lactate solution) in patients with severe sepsis. The study was halted early due to safety. Overall there was no survival benefit. The rate of severe hypoglycaemia was 17% in the insulin group. Pentastach was associated with renal failure compared with Ringers lactate solution.
December 2007. The Australian and New Zealand College of Anaesthetists (ANZCA) have released an update to the 2nd edition (2005). It is evidenced based and well written. Highly recommended. It is available online by clicking on the title above.
The NEJM reports that the US Supreme court is to rule whether death by lethal injection is unconstitutional because it is 'cruel and unusual'. The journal states that it is the policy the American ASA and AMA that physicians do not participate or advise in capital punishment. The standard three-drug regimen (thiopentone, pancuronium and potassium) has been shown previously to be unreliable in producing unconsciousness. A report from an execution in 2006 said the prisoner called out "It don't work". A video discussion is also available on the NEJM site from the link above.
Posts
All Comments
