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Anesthesiology & Perioperative Care

Local nerve blocks can improve outcomes for people with hip fracture – NIHR Signal (free)

Original article: Peripheral nerve blocks for hip fractures – Cochrane Library (link to abstract – $ for full-text)

“One case of pneumonia prevented for every 7 hip fracture patients given pain relief with nerve block” (RT @NIHR_DC see Tweet)

 


Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)

“Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery” (RT @NIHR_DC see Tweet)

 


Benefits and harms of sugammadex versus neostigmine in reversing induced paralysis – Cochrane Library (free)

Full review: Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults – Cochrane Library (link to abstract – $ for full-text)

“sugammadex may work more rapidly than neostigmine to reverse neuromuscular block in adults” (RT @CochraneUK see Tweet)

 


American College of Surgeons (ACS) 2017 Quality and Patient Safety Conference: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free)

Related guideline: Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)

See other Enhanced Recovery After Surgery (ERAS) Guidelines and Reviews in our collection and in the ERAS Society Website.

“Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure”

 


2017 ACS Quality and Safety Conference: “Strong for Surgery” Shows Promise in Reducing Smoking Rates for Patients Facing Surgery – American College of Surgeons, via NewsWise (free)

“Study suggests big drop in smoking rates when surgeons help patients quit before their operations”.

 


Effectiveness of Lateral Decubitus Position for Preventing Post-Dural Puncture Headache: A Meta-Analysis – Pain Physician (free PDF)

Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)

Evidence suggests lateral decubitus position is associated with reduced incidence of post-dural puncture headache.

 


Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)

This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.

 


Implant Survival After Minimally Invasive Anterior or Anterolateral Vs. Conventional Posterior or Direct Lateral Approach: An Analysis of 21,860 Total Hip Arthroplasties from the Norwegian Arthroplasty Register (2008 to 2013) – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)

Commentary: Implant survival for minimally invasive vs. open hip surgery: 4 key notes – Spine Review (free)

Source: EvidenceAlerts (free resource to find articles of interest in all specialties)

“There were no significant differences among the surgical approaches with regard to the 2 and 5-year survival rates or RR of revision due to any cause”

 


Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis – Chest (free)

Source: Video Laryngoscopy Does Not Improve First-Pass Success in ICU Patients – Journal Watch ($)

“The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients”.

 


Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Comparative Effectiveness Review – Agency for Healthcare Research and Quality (free report and summary)

See also: Executive summary (free PDF)

Source: ACP Journal Wise ($ resource to find articles of interest)

Comprehensive review on the evidence regarding thromboembolism prophylaxis in major orthopedic surgery.

 


Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery – British Journal of Surgery (link to abstract – $ for full-text)

Source: ACP Journal Club ($ resource to find articles of interest)

In this RCT, a comprehensive preoperative geriatric assessment and optimization before vascular surgery was associated with shorter length of hospital stay, lower incidence of complications, and patients were less likely to be discharged to a higher level of dependency.

 


A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery – Annals of Surgery (link to abstract – $ for full-text)

Source: EvidenceAlerts (free resource to find articles of interest)

“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”

 


Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial – JAMA Surgery (free) (RT @PreetiNMalani see Tweet)

Commentary: Anti-delirium strategy reduces after-surgery confusion in elderly – Reuters Health (free)

Multicomponent nonpharmacologic interventions, including orienting communications, oral and nutritional assistance, and early mobilization reduced postoperative delirium by 56% and length of stay by 2 days.

 


After Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are free)

See also: Time to Rethink Inpatient Rehab After Knee Replacement? – The Rheumatologist (free)

Original article abstract ($ for full-text): Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial – JAMA (free)

The NYT commentary talks about the futility of some interventions currently used to postpone surgery and about the benefits of outpatient rehabilitation.

 


Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial) – The BMJ (free)

A single dose of 8 mg intravenous dexamethasone at induction of anesthesia reduced postoperative nausea and vomiting with no increase in adverse events.

 


European Association of Urology releases its 1st thromboprophylaxis guideline (free)

 

Procedure-specific Risks of Thrombosis and Bleeding in Urological Cancer Surgery: Systematic Review and Meta-analysis – European Urology (free)

“Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without pelvic lymph node dissection in low-risk patients)

 

Procedure-specific Risks of Thrombosis and Bleeding in Urological Non-cancer Surgery: Systematic Review and Meta-analysis – European Urology (free)

“Extended prophylaxis is warranted for some procedures (eg, kidney transplantation procedures in high-risk patients) but not others (transurethral resection of the prostate and reconstructive female pelvic surgery in low-risk patients)”

 


ACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)

Browse Appropriateness Criteria Topics (free)

Source: Newswise

This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.

 


Going Under the Knife, With Eyes and Ears Wide Open – New York Times (free access to 10 articles per month)

“More and more surgeries are being performed with the patient awake and looking on, for financial and medical reasons”.

 


Trial of Pregabalin for Acute and Chronic Sciatica – New England Journal of Medicine (link to abstract – $ required for full-text)

Pregabalin did not reduce pain and was associated with higher incidence of adverse events.

 


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