Journal of clinical anesthesia
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Review Meta Analysis
Validity of non-contact methods for diagnosis of Obstructive Sleep Apnea: a systematic review and meta-analysis.
Obstructive Sleep Apnea (OSA) is associated with increased perioperative cardiac, respiratory and neurological complications. Pre-operative OSA risk assessment is currently done through screening questionnaires with high sensitivity but poor specificity. The objective of this study was to evaluate the validity and diagnostic accuracy of portable, non-contact devices in the diagnosis of OSA as compared with polysomnography. ⋯ Available data indicate contactless methods have high pooled sensitivity and specificity for OSA diagnosis with moderate to high level of evidence. Future research is needed to evaluate these tools in the perioperative setting.
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Myocardial injury is a frequent complication of surgical patients after having non-cardiac surgery that is strongly associated with perioperative mortality. While intraoperative anesthesia-related deaths are exceedingly rare, about 1% of patients undergoing non-cardiac surgery die within the first 30 postoperative days. Given the number of surgeries performed annually, death following surgery is the second leading cause of death in the United States. ⋯ Preventive measures, systematic approaches to surveillance and treatment standards are still lacking, however many factors are modifiable and should be considered in clinical practice: the importance of hemodynamic control, adequate oxygen supply, metabolic homeostasis, the use of perioperative medications such as statins, anti-thrombotic agents, beta-blockers, or anti-inflammatory agents, as well as some evidence regarding the choice of sedative and analgesic for anesthesia are discussed. Also, as age and complexity in comorbidities of the surgical patient population increase, there is an urgent need to identify patients at risk for MINS and develop prevention and treatment strategies. In this review, we provide an overview of current screening standards and promising preventive options in the perioperative setting and address knowledge gaps requiring further investigation.
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Observational Study
Association between intraoperative body temperature and postoperative delirium: A retrospective observational study.
The effect of perioperative body temperature derangement on postoperative delirium remains unclear. This study aimed to evaluate the association between intraoperative body temperature and postoperative delirium in patients having noncardiac surgery. ⋯ Intraoperative hypothermia (even mild hypothermia) was significantly associated with an increased risk of postoperative delirium.
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Randomized Controlled Trial
Large volume acute normovolemic hemodilution in patients undergoing cardiac surgery with intermediate-high risk of transfusion: A randomized controlled trial.
To investigate whether large volume acute normovolemic hemodilution (L-ANH), compared with moderate acute normovolemic hemodilution (M-ANH), can reduce perioperative allogeneic blood transfusion in patients with intermediate-high risk of transfusion during cardiac surgery with cardiopulmonary bypass (CPB). ⋯ Compared with M-ANH, L-ANH during cardiac surgery inclined to be associated with reduced perioperative RBC transfusion and the volume of RBC transfusion was inversely proportional to the volume of ANH. In addition, LANH during cardiac surgery was associated with a lower incidence of postoperative excessive bleeding.
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Meta Analysis
Overall anesthesia department quality of clinical supervision of trainees over a year evaluated using mixed effects models.
Earlier studies of supervision in anesthesiology focused on how to evaluate the quality of individual anesthesiologist's clinical supervision of trainees. What is unknown is how to evaluate clinical supervision collectively, as provided by the department's faculty anesthesiologists. This information can be a metric that departments report annually or use to evaluate the effect of programs on the quality of clinical supervision over time. ⋯ Random effects meta-analysis of percentage incidences of maximum scores is a suitable statistical approach to analyze the daily supervision scores of individual anesthesiologists to evaluate the overall quality of clinical supervision provided to the trainees by the department over a year.