Anesthesiology
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Randomized Controlled Trial Comparative Study
One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery.
Neither perioperative aspirin or clonidine show long-term benefit in terms of death, cardiovascular complication, cancer, or chronic pain at 1 year, except for a benefit of aspirin for patients with a history of PCI.
pearl -
Although cannabis is known to have cardiovascular and psychoactive effects, the implications of its use before surgery are currently unknown. The objective of the present study was to determine whether patients with an active cannabis use disorder have an elevated risk of postoperative complications. ⋯ An active cannabis use disorder is associated with an increased perioperative risk of myocardial infarction.
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Pneumoperitoneum for laparoscopic surgery is associated with a rise of driving pressure. The authors aimed to assess the effects of positive end-expiratory pressure (PEEP) on driving pressure at varying intraabdominal pressure levels. It was hypothesized that PEEP attenuates pneumoperitoneum-related rises in driving pressure. ⋯ Transpulmonary driving pressure rises with an increase in intraabdominal pressure, an effect that can be counterbalanced by targeted PEEP. Future studies have to elucidate which combination of PEEP and intraabdominal pressure is best in term of clinical outcomes.