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Collection: Hydroxylethyl starches: harm and acute liver injury
Hydroxyethyl starches, such as Hespan, Voluven, Volulyte, Tetrahes and Hestar, have been shown in several large trials to increase the risk of acute kidney injury (AKI) and/or the need for renal replacement therapies among critically ill patients, particulalry those suffering sepsis.
Evidence demonstrating harm among fit & healthy surgical patients is however lacking, notably Giles et al could find no increased risk of adverse event among surgical patients in their 2014 meta-analysis. Nonetheless, given the similar lack of demonstrable benefit of HES fluids for this group, avoidance of use in both the ICU and surgical population is prudent.
  Daniel Jolley
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Collection: Debunking anesthetic myths
Evidence challenging, debunking or correcting long-held anesthesia dogma.
  Daniel Jolley
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One of the early papers that lit the fire under the pro-periop beta-blocker camp. Note that the legitimacy of Poldermans' DECREASE trials has been called into question due to scientific misconduct (read more)
Results from more recent trials, such as POISE greatly undermine Poldermans' rather extraordinary findings in this paper.
"Extraordinary claims require extraordinary evidence" — Carl Sagan
Poldermans D, Boersma E, Bax JJ et al. Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery. Eur. Heart J. 2001 Aug 1;22(15):1353-8.
  Daniel Jolley
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The legitimacy of Poldermans' DECREASE trials, in particular DECREASE IV, has been called into question due to scientific misconduct.
Results from other trials, such as POISE greatly undermine the argument for both benefit and safety of starting perioperative beta-blockade, even in high-risk patients. Read more about Poldermans and scientific misconduct.
Dunkelgrun M, Boersma E, Schouten O et al. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann. Surg. 2009 Jun 1;249(6):921-6.
  Daniel Jolley
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Kinda interesting, but not too surprising given that their technique really just increases the catheterisation threshold (albeit individualized for each patient). Nonetheless the practicality and cost-effectiveness of patients pre-measuring their MBC is questionable. To avoid 27 unnecessary catheterizations they measured 931 pre-operative MBC's.
Brouwer TA, Rosier PF, Moons KG et al. Postoperative Bladder Catheterization Based on Individual Bladder Capacity: A Randomized Trial. Anesthesiology. 2015 Jan 1;122(1):46-54.
  Daniel Jolley
pearl
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Use of an individualised maximum bladder volume in post-op patients reduces the need for catheterization compared with arbitrary 500mL threshold.
Brouwer TA, Rosier PF, Moons KG et al. Postoperative Bladder Catheterization Based on Individual Bladder Capacity: A Randomized Trial. Anesthesiology. 2015 Jan 1;122(1):46-54.
  Daniel Jolley
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This review and case series examines this uncommon complication following airway management - most commonly after intubation, although not exclusively. Reassuringly hypoglossal nerve palsy resolves in 80% of cases within 4 months.
Shah AC, Barnes C, Spiekerman CF et al. Hypoglossal nerve palsy after airway management for general anesthesia: an analysis of 69 patients. Anesth. Analg. 2015 Jan 1; 120 (1): 105-120.
  Daniel Jolley
pearl
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Initial liberal fluid resuscitation strategies in trauma patients may be associated with higher mortality.
Wang CH, Hsieh WH, Chou HC et al. Liberal Versus Restricted Fluid Resuscitation Strategies in Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Crit. Care Med. 2014 Apr 1; 42 (4): 954-61.
  Daniel Jolley
pearl
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There is limited evidence supporting superiority between plain or hyperbaric spinal bupivacaine for spinal cesarean section.
Heng SiaAlex TiongATFrom the Duke-NUS Graduate Medical School, Singapore, Singapore; Medical Board, Obstetrics Gynaecology, Women's Anaesthesia, KK Women's Children's Hospital, Singapore, Singapore; Clinical Research Institute, Singapore, , Tan KH, Sng BL et al. Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery. Anesth. Analg. 2015 Jan 1; 120 (1): 132-140.
  Daniel Jolley
pearl
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Fentanyl-only epidural infusion shows no benefit over fentanyl/bupiv in respect to duration of labor, motor block, delivery, analgesia, or outcomes.
Craig MG, Grant EN, Tao W et al. A Randomized Control Trial of Bupivacaine and Fentanyl versus Fentanyl-only for Epidural Analgesia during the Second Stage of Labor. Anesthesiology. 2015 Jan 1; 122 (1): 172-7.
  Daniel Jolley