Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2014
Evaluation of differences in patient and physician perception of benefit and risks of aspirin and antifibrinolytic therapy in cardiac surgery.
It is unclear whether physicians and patients have similar concerns and preferences when considering benefit and risks of aspirin and antifibrinolytic therapy for cardiac surgery. We surveyed both groups to ascertain their perceptions and preferences for treatment in this setting. Both preoperative and postoperative cardiac surgical patients and the physician craft groups caring for them (cardiology, surgery, anaesthesia/critical care), were provided with estimates of benefits and risks of aspirin and antifibrinolytic therapy. ⋯ For antifibrinolytic therapy, the tolerated increased relative risk of stroke for physicians was 20% versus patients 10% (P=0.004), and for myocardial infarction, physicians 16.7% versus patients 4.2% (P <0.001). The three physician craft groups had comparable tolerances of thrombotic risk. Patient and physician preferences for perioperative aspirin and antifibrinolytic therapy sometimes differ based on risk benefit analysis.
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Anaesth Intensive Care · Sep 2014
An audit of the statistical validity of conclusions of clinical superiority in anaesthesia journals.
Making a statistically valid conclusion of the superiority of a clinical intervention in a clinical trial requires not only a statistically significant P value, but also adequate a priori power and an observed effect size larger than the clinically important value specified in the sample size calculation. We scrutinised the five most highly cited clinical trials reporting one or more conclusions of clinical superiority published in Anesthesiology, the British Journal of Anaesthesia, Anaesthesia, Anesthesia and Analgesia and Anaesthesia and Intensive Care in 2011 or 2012 to determine how many met all three requisite criteria. In the 25 articles, there were a total of 36 unconditional conclusions of the superiority of a clinical intervention. ⋯ The remainder included secondary outcomes without specific reference to their observational nature, and primary outcomes whose observed effect size was smaller than the clinically important value specified in the sample size calculation. These findings indicate that clinicians should closely scrutinise conclusions of clinical superiority in anaesthesia journals. Many will be 'hypothesis-generating observations' without adequate statistical support for a conclusion of clinical superiority in their own right.
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Anaesth Intensive Care · Sep 2014
Inter-rater reliability of the ASA physical status classification in a sample of anaesthetists in Western Australia.
The American Society of Anesthesiologists (ASA) scale is a widely used six-point ordinal scale that allows anaesthetists to assign a risk score to each patient scheduled for anaesthesia. Earlier studies of inter-rater reliability in assigning ASA physical status classifications to a standard set of patient descriptions have shown modest agreement. We surveyed 401 anaesthetists practising in Western Australia using descriptions of clinical history, physical examination and investigation results of ten hypothetical adult patients, pre-designed by other researchers, to have ASA class ranging 1 through 5. ⋯ Correctly identifying ASA class was not related to age, level of training, sex or training region. We found only fair agreement among anaesthetists in assigning ASA class to ten fictitious patients, which was no better than that observed in earlier studies. Further, the range of scores assigned to standard patients' histories by anaesthetists supports earlier concerns about the robustness of this classification.
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Anaesth Intensive Care · Sep 2014
Anaesthesia-related haemodynamic complications in Williams syndrome patients: A review of one institution's experience.
Williams syndrome is a genetic disorder associated with cardiac pathology, including supravalvular aortic stenosis and coronary artery stenosis. Sudden cardiac death has been reported in the perioperative period and attributed to cardiovascular pathology. In this retrospective audit, case note and anaesthetic records were reviewed for all confirmed Williams syndrome patients who had received an anaesthetic in our institution between July 1974 and November 2009. ⋯ Twelve of the anaesthetics (11.1%) were associated with cardiac complications including cardiac arrest in two cases (1.85%). Of the two cardiac arrests, one patient died within the first 24 hours postanaesthetic and the other patient survived, giving an overall mortality of 0.9% (3.4%). We conclude that Williams syndrome confers a significant anaesthetic risk, which should be recognised and considered by clinicians planning procedures requiring general anaesthesia.