Issues

In an administrative database of over 10,000 adults with congenital heart disease undergoing major noncardiac surgery, in-hospital mortality was increased compared with a well-matched comparison cohort. Adult congenital heart disease is an independent predictor of increased perioperative mortality.

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Test samples of five surgical materials were ignited in three oxygen concentrations. At 21% oxygen, all materials tested met the Standard for Flammability of Clothing Textiles established by the Consumer Product Safety Commission. When exposed to 100% oxygen, all surgical materials tested would be categorized as unacceptable for consumer wear.

While the β-blockers metoprolol and atenolol reduce the risk of perioperative myocardial infarction, they also increase the risk of postoperative stroke. A retrospective cohort study was undertaken to determine whether the more β₁-selective agent bisoprolol would be associated with a lower risk of postoperative stroke in patients undergoing noncardiac, nonneurological surgery at the University Health Network in Toronto, Ontario, Canada. A matched cohort of 2,462 patients, half of whom received bisoprolol while the other half received either metoprolol or atenolol, was created using a propensity score estimating the probability of being exposed to bisoprolol. The primary outcome, a stroke within 7 days of surgery, occurred in 2 patients taking bisoprolol and 10 patients taking metoprolol or atenolol. These results, along with those of other studies, suggest the risk of stroke associated with less selective β₁-blockers results from inhibition of β₂-mediated cerebral vasodilation.

The number of claims related to gas delivery, their severity, and their fraction of the total decreased markedly. Provider error continues to contribute, as does failure to complete a full machine check.

In 747 consecutive all-payer patients seen at a preoperative assessment center, 5% were dead within 1 yr. Compared to survivors, decadents were more likely to undergo palliative or diagnostic rather than elective procedures.

No significant differences in troponin levels were observed between patients receiving volatile versus total intravenous anesthesia after elective abdominal aortic surgery. These prospective randomized data suggest that volatile anesthesia is no more protective than total intravenous anesthesia.

This prospective, double-blinded, randomized clinical trial demonstrated that patients with orthostatic intolerance had increased length of hospital stay after open prostatectomy but goal-directed therapy did not reduce the prevalence of orthostatic intolerance after surgery.

Early goal-directed therapy using stroke volume variation, cardiac index, and optimized global end-diastolic volume index reduces intensive care unit stay after cardiac surgery.

In this randomized open-labeled clinical trial enrolling 177 patients with obstructive sleep apnea, auto-titrated continuous positive airway pressure (CPAP) successfully reduced the apnea hypopnea index whereas it remained abnormally high without the treatment. Despite the effectiveness, only 26–48% of the patients used the CPAP for more than 4 h per night during the perioperative nights.

A closed-loop anesthesia delivery system using a computer-controlled infusion of propofol can achieve a reliable and accurate real-time control of burst suppression in rats.

Isoflurane, in contrast to propofol, during cardiopulmonary bypass is associated with a greater increase in fluid extravasation from the intravascular to the interstitial space, resulting in dilution of interstitial fluid and a decrease in interstitial colloid osmotic pressure.

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There was no association between unit size and standardized mortality. Factors other than size, such as having full-time intensivists, appear to be the major determinants of mortality.

Using computed tomography references for morphologic indexes in both a training and a validation group of patients, a Pplat >25 cm H₂O and a STRESS INDEX >1.05 were found to be the best thresholds for identifying injurious ventilation.

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In the early stage of inflammation after acid-induced acute lung injury, the pulmonary blood flow is distributed heterogeneously. Areas of aspiration damage are congruent with regions of higher blood flow 10 min after injury.

Exposing septic mice to volatile anesthetics, particularly sevoflurane, significantly improved survival.

This systematic review of the literature found that the few available trials directly comparing epidural nonsteroid to nonepidural injections showed no benefit. Indirect comparisons of the techniques from a larger number of trials suggested epidural nonsteroid injections may confer some benefit.

Lidocaine administration to patients undergoing complex spine operations reduced pain but not opioid requirements early in the postoperative period.

In 14 healthy volunteers, cyclosporine, an inhibitor of blood–brain barrier transporters, had minimal effects on circulating morphine concentrations, but increased the centrally mediated effect of morphine (miosis). These results suggest that transporter-mediated removal of morphine from the brain plays a role in morphine’s pharmacodynamics after systemic administration.

This article is a qualitative systematic review of risk stratification systems used in major noncardiac, nonneurological surgery, and which have been validated in heterogeneous surgical cohorts.