Thursday, 7 November 2013
Risk of Major Adverse Cardiac Events Following Noncardiac Surgery in Patients with Coronary Stents. JAMA October 2013
Posted by Pedram M at 19:27
Aortic stenosis is the most common form of valvular heart disease. So how should we approach the patient who presents to preadmission with severe aortic stenosis? If they are asymptomatic and have a normal left ventricular ejection fraction then it is unlikely they will require a valve replacement. An exercise test will be useful in those with uncertain symptomatology. This is an informative review on the subject.
Posted by Pedram M at 19:25
Tuesday, 5 November 2013
This post hoc analysis of the POISE trial has discovered an association between epidural combined with GA (versus GA alone) and increased risk of adverse cardiovascular outcomes in patients at high risk of cardiovascular morbidity. The most notable increased risk was shown with thoracic epidurals. Rather than change practice, this article highlights the need for more studies to help guide the patient population that will benefit most from a neuraxial block and those who we may actually harm. An accompanying editorial discusses the limitation of the methodology of propensity-score matching used in the analysis.
Posted by Pedram M at 22:05
Monday, 30 September 2013
Trauma and Tranexamic acid – Editorial . MJA Sept 2013
The CRASH-2 (Clinical Randomisation of an Antifibrinolytic Significant haemorrhage 2) is a landmark study that has changed our practice when dealing with trauma patients. This editorial discusses the gaps in our knowledge with regards to tranexamic acid and trauma patients . To address some unknowns about this topic, a new study PATCH- Trauma ( Pre-hospital Anti- fibrinolytics for traumatic coagulopathy and Haemorrhage study) funded by the NHMRC will start recruiting soon from trauma centres throughout Australia and New Zealand. Westmead will certainly be involved!
Posted by Pedram M at 11:51
This MA looked at 39 trials (RCTs, quasi-RCTs, and retrospective cohort studies) in which a bundled intervention was employed, or one of the two strategies was used alone.
Posted by Pedram M at 10:04
Safety and efficacy of Intravenous iron therapy in reducing requirement for allogenic blood transfusion : systematic review and meta-analysis of randomized clinical trials . BMJ August 2013
Posted by Pedram M at 09:59
Sunday, 25 August 2013
Our brains tend to process and manage information either "intuitively" or "analytically". Intuitive thinking is fast, is based on experience and common sense, and is usually right, while analytical thinking is slow, thorough and ensures that we use all our available deductive powers and resources and don't miss things. Analytical thinking (eg thorough use of algorithms, checklists etc) usually results in fewer mistakes or oversights, but is time consuming and simply not practical when dealing with the many decisions required in our daily activities. The problem in medicine is that intuitive thinking (something many experienced clinicians are often proud of) accounts for most of the major clinical mistakes. How then do we balance our use of both thought processes to deal efficiently with the many clinical problems we face every day without exposing patients to unnecessary risks by mentally "cutting corners"? This editorial looks at this question and has enough in it to give us all reason to think about it.
Posted by Jeremy Field at 16:28
The perioperative sleep apnoea epidemic has probably not been the "rude awakening" suggested in the title of this article for any anaesthetist working in Western Sydney any time this century. Just knowing about the problem, however, doesn't automatically mean we can fix it. This opinion piece highlights the increasingly common dilemma facing anaesthetists and surgeons and while it doesn't provide all the answers it does put out an important call for protocols that heighten awareness of the problem and make best use of the resources available to fix it. Westmead is looking at such protocols as well as contributing to the much needed research in this area. Worth a read.
Posted by Jeremy Field at 16:26
PICC lines are commonly used and often have advantages over central lines, but their thrombotic complications have perhaps been under appreciated until now. This metanalysis shows that they have a slightly higher incidence of DVT than central lines, and a subsection of observational work quantifies this risk and identifies the patient groups at highest risk. It comes with a useful editorial for those that don't want to read all the fine print, but it's worth thinking about the next time you're weighing up the pros and cons of a PICCline over a central line.
Posted by Jeremy Field at 16:24
What effect does the ventilator settings have on the postoperative course of our patients? How often do you change the settings from the standard of 500 by 10? This original article makes a compelling argument for lung protective ventilation in any patient with intermediate to high risk of pulmonary complication having major abdominal surgery. Benefits include an almost 70% reduction in ventilatory support in the postoperative period, reduced hospital stay and less risk of pneumonia.
Posted by Jeremy Field at 16:21