Faculty: I Rampil, U Landman
|08-27-09||The founding datum for our extensive OR checklist
A surgical safety checklist to reduce morbidity and mortality in a global population. Haynes AB, et al; Safe Surgery Saves Lives Study Group. N Engl J Med. 2009 Jan 29;360(5):491-9. <pdf>
The original WHO checklist from which our present four page system evolved <jpg>
Discussion: Not all outcomes were elaborated on after implementation of the checklist, eg. surgical site and side correctness, etc. There was no statistical significance after accounting for multiple comparisons. Ror this observational trial with historical controls, the surgeries in phase 2 were not the same surgeries as in phase 1. There is missing data:how many times x was caught by using the checklist, what type of cause of death was shown by doing this study, and finally where again was the other outcome data besides the 4 elaborated on.
|Drs. Rampil & DiGuglielmo|
|09-24-09||The effect of regional anesthesia on recurrence of prostate cancer
Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthesiology. 2008 Aug;109(2):180-7. <pdf>
Discussion: This article, a retrospective review, did have bias. There was no power analysis done. We also do not know how many subjects had surgery but were not included in the review. We also do not know how many subjects were dropped due to inadequate data. We briefly reviewed the concept of propensity score.
|Drs. Rampil & Makaryus|
|10-29-09||Rethinking preoperative Beta-blockers
Perioperative Strokes and beta-Blockade. Poldermans D, Schouten O, van Lier F, Hoeks SE, van de Ven L, Stolker RJ, Fleisher LA. Anesthesiology. 2009 Sep 25.
Discussion: We reviewed Beta blocker pharmacology and the data from the POISE study and the Podermans review. We saw where the push to use beta blockers perioperatively originated and how mandates were created for its use since the Mangano study (NEJM, 1996). Those of us who attended Lee Goldman's talk this week got to hear his persepctive on the studies too. POISE used a large high dose of metoprolol extended release. We now see that Beta blocker use does have risk.
We reviewed SB policy on Beta blockers and how it has changed over the years. We no longer give all patients a beta blocker immediately preop with no titration. If pts are on a beta blocker, we continue its use. If the patient has previous ischemia (positive stress stest or positive cath), a beta blocker is used. We do have exclusion criteria and this should be noted on the record: we have to document for SCIP why we are not giving a beta blocker.
|1-7-10||Intraoperative Hypothermia for Aneurysm Surgery Trial
No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Hindman BJ, Bayman EO, Pfisterer WK, Torner JC, Todd MM; IHAST Investigators. Anesthesiology. 2010 Jan;112(1):86
We reviewed the article by Hindman, et al. and the Cohrane database for hypothermia. We saw that duration, clip, age, preop neuro status, & ebl do effect neurological outcome. Introperative hypothermia, use of pentothal, use of etomidate are also not associated with immproved outcomes.
Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY; MAC Study Group. Anesth Analg. 2010 Jan;110(1):47-56. Epub 2009 Aug 27.
We reviewed the article. We also talked about the spectrum of monitored anesthesia care and how it varies among anesthesiologists. We looked at the OAAS scale and the closed claim ASA MAC analysis database. The patients who were excluded from the study are actually the pts we see clinically as likely to get monitored anesthesia care. Perhaps those cases should really have the study done on them.
|Drs. Sangster & Rampil|
Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study. Taenzer AH, Pyke JB, McGrath SP, Blike GT. Anesthesiology. 2010 Feb;112(2):282-7 <PubMed>
Pulse oximetry for perioperative monitoring. Pedersen T, Møller AM, Hovhannisyan K. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD002013. <PubMed>
Neither article found a difference in outcome when pulse oximetry was used.
|Dr. Rampil & Linda Rampil|
|4-29-10||Two small clinical studies with potential impact on practice from this month's Anesthesiology
Cognitive function after major noncardiac surgery, apolipoprotein E4 genotype, and biomarkers of brain injury. McDonagh DL, Mathew JP, White WD, Phillips-Bute B, Laskowitz DT, Podgoreanu MV, Newman MF; Neurologic Outcome Research Group. Anesthesiology. 2010 Apr;112(4):852-9 <PubMed>
Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG. Anesthesiology. 2010 Apr;112(4):860-71 <PubMed>
Scientific principles and clinical implications of perioperative glucose regulation and control. Akhtar S, Barash PG, Inzucchi SE. Anesth Analg. 2010 Feb;110(2):478-97. <PubMed>
Breathe deeply the sweet air: ruminations on glycemic control. Keegan MT, Coursin DB. Anesth Analg. 2010 Feb;110(2):296-8 <PubMed>
We Have Met the Enemy and He Is PowerPoint. Bumiller, E. April 26, 2010 NY Times
|Drs. Milloul & Rampil|
|5-27-10||Central Eicosanoids and Pain
Role of spinal cyclooxygenase in human postoperative and chronic pain. Eisenach JC, Curry R, Rauck R, Pan P, Yaksh TL. Anesthesiology. 2010 May;112(5):1225-33 <PubMed>
Intrathecal cyclooxygenase inhibitors in humans: don't throw in the towel! Angst MS. Anesthesiology. 2010 May;112(5):1082-3 <PubMed>
This paper is an example in which a therapy that was found to be effective in animals, did not have the expected outcome in a human trial. However, it is possible that a study with a different or better design may reveal a positive outcome.
We reviewed the analysis of variance and had a preview of the statistics we will cover next year.
|6-24-10||Clinical trial of Electroanesthesia
The Analgesic and Antihyperalgesic Effects of Transcranial Electrostimulation with Combined Direct and Alternating Current in Healthy Volunteers. Nekhendzy V, Lemmens HJ, Tingle M, Nekhendzy M, Angst MS. Anesth Analg. 2010 Jun 8. [Epub ahead of print] <PubMed>
TES DC/AC has a wide effect. The most prominent effect is on inflammatory pain. 60Hz has a larger effect that 100Hz. The effect is similar to NSAID analgesia. However, this study did not compare the TES group with a group receiving medical analgesia.
|Drs. Rampil and Emanuel|