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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
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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
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The researchers found that in a cohort of 198 patients admitted to ICU after major abdominal cancer surgery, those subjected to a liberal blood transfusion threshold of < 9 g/dL experienced fewer major complications (NNT 6.2) than those subjected to a restrictive transfusion threshold (< 7 g/dL).
Pinheiro J, Vincent JL, Galas FR et al. Transfusion Requirements in Surgical Oncology Patients: A Prospective, Randomized Controlled Trial. Anesthesiology. 2015 Jan 1;122(1):29-38.
  Daniel Jolley
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This prospective matched-cohort study from Thailand found that children experiencing a perioperative respiratory event were subsequently hospitalized twice as long, incurred 30% higher hospital costs, along with 58% higher indirect costs.
Oofuvong M, Geater AF, Chongsuvivatwong V et al. Excess Costs and Length of Hospital Stay Attributable to Perioperative Respiratory Events in Children. Anesth. Analg. 2015 Feb 1;120(2):411-9.
  Daniel Jolley
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Small study of data collected more than 15 years ago suggests hemoglobin-based oxygen carrier HBOC-201 may reduce transfusion requirements in a non-cardiac surgery cohort. Although no significant difference in adverse events or mortality, a trend to higher incidence of both among the HBOC-201 group requires a much larger trial to be conducted before any conclusion regarding safety of such a novel therapy can be made.
Van J, Levien LJ, Veeckman L et al. A Safety and Efficacy Evaluation of Hemoglobin-Based Oxygen Carrier HBOC-201 in a Randomized, Multicenter Red Blood Cell-Controlled Trial in Noncardiac Surgery Patients. Anesth. Analg. 2014 Oct 1;119(4):766-76.
  Daniel Jolley
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I find the existence of this study perplexing. This meta-analysis appears to simply confirm basic neuromuscular pharmacology and age-related cardiovascular changes. The unanswered question is why are they so interested in using mivacurium anyway?
I conclude that good conditions for tracheal intubation are more likely when using a muscle relaxant other than mivacurium.
Vanlinthout LE, Mesfin SH, Hens N et al. A systematic review and meta-regression analysis of mivacurium for tracheal intubation. Anaesthesia. 2014 Dec 1;69(12):1377-87.
  Daniel Jolley