European journal of anaesthesiology
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This meta-analysis (unsurprisingly) confirms that pre-operative troponin levels are post-operatively associated with both major adverse cardiac events and mortality risk.
This sounds obvious, why should we care?
First, there's a difference between evidence and that vague feeling we call common-sense that a disproportionate number of our clinical decisions are based upon.
Surgical patients are getting older and sicker. We need better tools for risk stratifying patients before surgery to improve perioperative planning. Most importantly (though not exclusively) reliably identifying biomarkers for risk allows closer postoperative surveillance and monitoring – which may alter outcomes.
Why troponin?
We already know that troponin I and T are markers of cardiac damage, and unlike brain natriuretic peptide (BNP), troponin assays are readily available in most healthcare settings.
Ok, you convinced me... what did they find?
Analysing 10 studies totally 10,371 patients, they found an association between preoperative troponin elevation and MACE (OR 6.9), and short-term & long-term mortality (OR 4.2 & 2.5). Note though that the confidence intervals were quite wide.
There's always a but... the included studies were all observational in nature, used a variety of troponin assays, and the results were quite heterogenous across the 10. Most importantly, even assuming troponin is an accurate preop risk marker, we don't yet know whether that knowledge will allow us to alter outcomes for these patients.
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The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear. ⋯ CRD 42017068028.
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Randomized Controlled Trial
End-tidal carbon dioxide monitoring improves patient safety during propofol-based sedation for breast lumpectomy: A randomised controlled trial.
The use of sedation is becoming more commonplace. Although pulse oximetry is a standard monitoring procedure during sedation, it cannot accurately detect early hypoventilation. End-tidal carbon dioxide (EtCO2) monitoring can be an earlier indicator of airway compromise; however, the existing literature is limited to a few studies with varying outcomes. ⋯ The addition of EtCO2 monitoring to standard monitoring during propofol-based sedation can improve patient safety by decreasing the incidence of CO2 retention, and therefore the risk of hypoxaemia through early recognition of apnoea, and can also shorten recovery time.
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The concentration range of dexamethasone that inhibits neuromuscular blockade (NMB) and sugammadex reversal remains unclear. ⋯ Acute bolus administration of dexamethasone at clinical concentrations had no effect on NMB or on sugammadex reversal.
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Randomized Controlled Trial Comparative Study
Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study.
Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions. ⋯ Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia.