Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant – JAMA Internal Medicine (free for a limited period)

Commentary: Study Sheds Light on Stopping and Resuming DOACs in Afib Patients Undergoing Surgery – NEJM Journal Watch (free)

“The DOAC regimens were omitted for 1 day before a low–bleeding-risk procedure and 2 days before a high–bleeding-risk procedure. The DOAC regimens were resumed 1 day after a low–bleeding-risk procedure and 2 to 3 days after a high–bleeding-risk procedure.”


Related Commentary on Twitter


International consensus statement on the use of uterotonic agents during caesarean section – Anaesthesia (free)


Related Commentary on Twitter


Survey: Suicide Amongst Anesthetists

4 Jul, 2019 | 10:47h | UTC

Suicide amongst anaesthetists – an Association of Anaesthetists survey – Anaesthesia (free)

News Release: Survey highlights need for improved mental health guidance & support for anaesthetists – Association of Anaesthetists (free)


Related Commentary on Twitter


Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries – JAMA Internal Medicine (free for a limited period)

Commentary: Cascades Of Care – American Council on Science and Health (free)

Related: Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery (link to abstract and commentary) AND Systematic Review: Routine Preoperative Medical Testing for Cataract Surgery (free)


Related Commentary on Twitter (thread – click for more)


Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Setting Positive End-Expiratory Pressure in Mechanically Ventilated Patients Undergoing Surgery (free)


Related Commentary on Twitter


Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial – The Lancet (free)

Invited Commentary: Antibiotics for operative vaginal delivery: practice-changing data – The Lancet (free)


Related Commentary on Twitter


Neuroanesthesiology Update

11 May, 2019 | 15:51h | UTC

Recent advances in diabetes treatments and their perioperative implications – Current Opinion in Anesthesiology (free)

Source: Critical Care Reviews Newsletter

“Sulfonylureas and SGLT2i should be ceased before moderate or major surgery. Other oral antihyperglycemic therapies may be continued or ceased.


Canadian Pediatric Anesthesia Society statement on clear fluid fasting for elective pediatric anesthesia – Canadian Journal of Anesthesia (free)

Related: Position Statement: Clear Fluids Fasting for Elective Pediatric Anesthesia (free guidelines and reviews on the subject)

“Pediatric patients should be encouraged and allowed to ingest clear fluids up to one hour before elective anesthesia or sedation.”


Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations – JAMA Surgery (free for a limited period)

Invited Commentary: The Enhanced Recovery After Surgery in Cardiac Surgery Revolution – JAMA Surgery (free)

Related: Enhanced Recovery After Surgery (ERAS) Society Guidelines (free articles)


Related Commentary on Twitter


Guidelines for Day‐Case Surgery 2019

11 Apr, 2019 | 00:46h | UTC

Effect of an Incentive Spirometer Patient Reminder After Coronary Artery Bypass Grafting: A Randomized Clinical Trial – JAMA Surgery (free for a limited period)

Invited Commentary: Benefits of Incentive Spirometry: Still More Work to Do – JAMA Surgery (free)

Simple intervention leading to improved outcomes, but confirmatory studies are required (see invited commentary).


The Difficult Airway Trolley: A Narrative Review and Practical Guide – Anesthesiology Research and Practice (free)

Related Guidelines: Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults – British Journal of Anaesthesia (free) AND Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway – Anesthesiology (free)

“Despite several national guidelines on management of the anticipated and unanticipated difficult airway, with separate guidelines for pediatric, obstetric, and intensive care settings, only limited effort has been directed towards developing specific suggestions regarding the contents of a Difficult Airway Trolley”


Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial – The Lancet (link to abstract – $ for full-text)

Commentary: Having Anesthesia Once as a Baby Does Not Cause Learning Disabilities, New Research Shows – The New York Times (10 articles per month are free)


Related Commentary on Twitter


Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force – Intensive Care Medicine (free for a limited period)

Note: if the above link is paywalled, try this one


Related Commentary on Twitter


Guidelines for the safe provision of anaesthesia in magnetic resonance units 2019 – Anaesthesia (free)

Guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland.


Podcast: Perioperative Medicine

15 Jan, 2019 | 00:35h | UTC

Perioperative alcohol cessation intervention for postoperative complications – Cochrane Library (free)

Summary: Effects of perioperative alcohol cessation interventions on postoperative complications following surgery – Cochrane Library (free)

“Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications.”


Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications – Cochrane Library (free)

Summary: The effect of having nutrition within the first 24 hours after bowel surgery on length of hospital stay and postoperative complications – Cochrane Library (free)

This review suggests that early enteral feeding is associated with a shorter length of hospital stay. For all other outcomes (postoperative complications, mortality, adverse events, and QoL) the findings are inconclusive.


Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery – New England Journal of Medicine (free for a limited period)

“In moderate-to-high-risk patients undergoing cardiac surgery, six-month outcomes show that a restrictive red-cell transfusion strategy is noninferior to a liberal strategy” (via @NEJM see Tweet with Visual Abstract)


Colloids versus crystalloids for fluid resuscitation in critically ill people – Cochrane Library (link to abstract – $ for full-text)

Summary: Colloids or crystalloids for fluid replacement in critically people – Cochrane Library (free)

“Using starches, dextrans, albumin or FFP (moderate-certainty evidence), or gelatins (low-certainty evidence), versus crystalloids probably makes little or no difference to mortality. Starches probably slightly increase the need for blood transfusion and RRT (moderate-certainty evidence), and albumin or FFP may make little or no difference to the need for renal replacement therapy (low-certainty evidence)”.


To continue taking or to stop taking antiplatelet drugs for a few days before non-cardiac surgery in adults – Cochrane Library (link to abstract – $ for full-text)

Summary: To continue taking or to stop taking antiplatelet drugs for a few days before non-cardiac surgery in adults – Cochrane Library (free)

“We found low-certainty evidence that either continuation or discontinuation of antiplatelet therapy before non-cardiac surgery may make little or no difference to mortality, bleeding requiring surgical intervention, or ischaemic events”.


Rapid Recommendations: Atraumatic (pencil-point) versus conventional needles for lumbar puncture: a clinical practice guideline – The BMJ (free)

We issue a strong recommendation for use of atraumatic needles in all patients (adults and children) undergoing lumbar puncture because they decrease complications and are no less likely to work than conventional needles”


NAP6 Report: Anaesthesia, Surgery and Life-Threatening Allergic Reactions: Report and findings of the Royal College of Anaesthetists’ 6th National Audit Project (free PDF)

News Release: RCoA undertakes largest ever study of anaphylaxis in anaesthesia and surgery (free)

Infographic: Anaesthesia, Surgery and Life-Threatening Allergic Reactions (free PDF)

“The study found teicoplanin is 17-fold more likely to cause anaphylaxis than penicillin and similar drugs. As 90 per cent of patients who report penicillin allergy are in fact not allergic, better identification of true allergy would reduce risk”. (from News Release)


Review: Management of Drowned Airway

9 May, 2018 | 16:22h | UTC