(Abstracted from Anesth Analg, 124(1):44–51, 2017) The purpose of this review was to examine the literature published over the period January 1980 to January 2016 regarding the use of tramadol for treatment of moderate to moderately severe chronic pain. Tramadol is a synthetic opioid medication with monoaminergic actions and a mechanism similar to serotonin-norepinephrine reuptake inhibitors.
Coagulopathy and severe bleeding are associated with high mortality. We evaluated haemostatic treatment guided by the functional viscoelastic haemostatic assays, thromboelastography or rotational thromboelastometry in bleeding patients. We searched for randomised, controlled trials irrespective of publication status, publication date, blinding status, outcomes published or language from date of inception to 5 January 2016 in six bibliographic databases. We included 17 trials (1493 participants), most involving cardiac surgery. Thromboelastography or rotational thromboelastometry seemed to reduce overall mortality compared to any of our comparisons (3.9% vs. 7.4%, RR (95% CI) 0.52 (0.28-0.95); I2 = 0%, 8 trials, 717 participants). However, the quality of evidence is graded as low due to the high risk of bias, heterogeneity, imprecision and low event rate. Thromboelastography or rotational thromboelastometry significantly reduced the proportion of patients transfused with red blood cells (RR (95% CI) 0.86 (0.79-0.94); I2 = 0%, 10 trials, 832 participants), fresh frozen plasma (RR (95% CI) 0.57 (0.33-0.96); I2 = 86%, 10 trials, 832 participants) and platelets (RR (95% CI) 0.73 (0.60-0.88); I2 = 0%, 10 studies, 832 participants). There was no difference in proportion needing surgical re-interventions (RR (95% CI) 0.75 (0.50-1.10); I2 = 0%, 9 trials, 887 participants). Trial sequential analysis of mortality suggests that only 54% of the required information size has been reached so far. Transfusion strategies guided by thromboelastography or rotational thromboelastometry may reduce the need for blood products in patients with bleeding, but the results are mainly based on trials of elective cardiac surgery involving cardiopulmonary bypass, with low-quality evidence.
(Abstracted from Anesthesiology, 125:445–448, 2016) Postoperative visual loss (POVL) after spinal surgery began to become a concern in the 1990s and led to the American Society of Anesthesiologists POVL Registry in 1999. Most of these result from ischemic optic neuropathy (ION).
(Abstracted from Anaesthesia, 71(11):1259–1264, 2016) This editorial accompanied and provides commentary on the article by Lindkær-Jensen et al. It recommends potential solutions related to the conclusions of their research.
(Abstracted from Anaesthesia, 71:1210–122, 12016) Critical care physicians as well as anesthetists are increasingly turning to transthoracic and transesophageal echocardiography to evaluate cardiac patients and determine management of clinically significant heart diseases. The main aim of the article is to assess the viability and effect of focused transthoracic and transesophageal echocardiography on the diagnosis and management of cardiac disease following cardiac surgery weighed against conventional clinical assessment.
(Abstracted from Can J Anaesth, 2016;63(10):1184–1196) In order to evaluate the increasing amount of literature on the use of various transversus abdominis plane (TAP) block techniques in postoperative pain management, a meta-analysis and review of randomized controlled trials (RCTs) was done. The US National Library of Medicine, the Excerpta Medica, and the Cochrane Central Register of Controlled Clinical Studies databases were examined for the period January 1, 2004, to August 31, 2014, and 51 RCTs that satisfied the inclusion criteria of the meta-analysis were identified.
All patients admitted for elective surgery should be encouraged to drink clear fluids (water, squash, tea/coffee or fortijuice) freely up to 2 hours preoperatively. It is the responsibility of staff on the ward or admissions lounge to ensure that patients remain adequately hydrated before surgery. Tea or coffee may contain a small amount of milk (up to one fifth volume) and be considered a clear fluid under this guideline. Chewing gum should not be used less than 2 hours pre-operatively
(Abstracted from Anesthesiology, 125:611–614, 2016) Residual neuromuscular blocks after operations have increased morbidity and mortality in surgical patients. Postoperative residual neuromuscular block (PRNB) has been linked to respiratory issues and postoperative pneumonia (POP), both in the immediate and long term.
(Abstracted from Eur J Anaesthesiol, 33(10):731–742, 2016) Effective pain relief and management are crucial after cesarean delivery. Inadequate pain relief hinders mother-child bonding, early ambulation, and hospital discharge and can cause chronic pain and postpartum depression.
(Abstracted from Can J Anesth, 63:1277–1290, 2016) The purpose of this narrative review was to examine anesthetic regimens for hip arthroscopy after an overview of the indications for the procedure and preoperative assessment with emphasis on anesthetic technique, analgesic adjuncts, and potential complications. The findings and conclusions were arrived at after reading of text chapters and analyzing 45 of 63 peer-reviewed articles discussing anesthetic techniques in patients undergoing hip arthroscopy.
(Abstracted from Anesthesiology, 125(5):846–849, 2016) This special review article addressed the current state of acute and chronic pain research and treatment. A recent survey suggested that more than 60% of patients experience moderate to extreme levels of pain postoperatively and 25% of the US population suffers from chronic pain, a problem costing the economy hundreds of billions of dollars annually.
Recent technological advances in thoracic and tracheal surgery make the anaesthesiologist use different respiratory techniques during the operation. Apneic oxygenation is a one of alternative techniques. This method is relatively easy in use, does not require special expensive equipment and is the only possible technique in several clinical situations when other respiratory methods are undesirable or cannot be used. However there is no enough information about apneic oxygenation in Russian. This article reviews publications about apneic oxygenation. The review deals with experiments on diffusion respiration in animals, physiological changes during apneic oxygenation in man and defines clinical cases when apneic oxygenation can be used.
(Abstracted from Anaesthesia, 71(9):1091–1100, 2016) This systematic review’s goal is to evaluate the influence of focused echocardiography on diagnosis and clinical management. Focused echocardiography, a potentially lifesaving diagnostic tool in anesthesia and critical care, is being used widely by both anesthetists and critical care physicians.
(Abstracted from Anesthesiology, 126(1):6–8, 2017) Preclinical animal studies have resulted in retrospective and prospective studies in humans regarding the safety of pediatric anesthesia. The possibility of adverse neurocognitive outcomes associated with repeated or prolonged pediatric anesthesia is worrisome.
(Abstracted from J Cardiothorac Vasc Anesth, 31:516–21, 2017) Using a fixed protamine-heparin dose (1:1) is the most commonly used method of protamine dosing in cardiopulmonary bypass patients to reverse the effects of heparin. The hemostasis management system (HMS Plus; Medtronic, Minneapolis, Minn) is an accepted alternate point-of-care device to calculate protamine dosing.
(Abstracted from Anesthesiolog, 125(6):1121–1129, 2016) Venous thromboembolism (VTE) occurs in 1% to 5% of noncardiac surgery patients in the 30 days following surgery without the use of routine thromboprophylaxis, thereby emphasizing the importance of postoperative VTE prevention. Aspirin is generally preferred over other anticoagulants because of its low cost and because it is already being taken by many patients preoperatively.
(Abstracted from Can J Anaesth, 63(10):1122–1127, 2016) The most common and potentially devastating conditions in patients undergoing cardiac surgery are pulmonary hypertension (PH) and right ventricular (RV) dysfunction. Development of perioperative RV failure is related to PH and has greater than 30% mortality.
