Anaesthesia
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Randomized Controlled Trial
The effect of anaesthetic technique during primary breast cancer surgery on neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and return to intended oncological therapy.
Inflammation and immunosuppression contribute to the pathogenesis of cancer. An increased neutrophil-lymphocyte ratio reflects these processes and is associated with adverse cancer outcomes. Whether anaesthetic technique for breast cancer surgery influences these factors, and potentially cancer recurrence, remains unknown. ⋯ Pre-operative neutrophil-lymphocyte ratio was similar in the propofol-paravertebral 2.3 (95%CI 1.8-2.8) and inhalational agent-opioid anaesthesia 2.2 (1.9-3.2) groups, p = 0.72. Postoperative neutrophil-lymphocyte ratio was lower (3.0 (2.4-4.2) vs. 4.0 (2.9-5.4), p = 0.001) in the propofol-paravertebral group. Propofol-paravertebral anaesthesia attenuated the postoperative increase in the neutrophil-lymphocyte ratio.
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The Cook staged extubation set (Cook Medical) has been developed to facilitate management of the difficult airway. A guidewire inserted before tracheal extubation provides access to the subglottic airway should re-intubation be required. This prospective cohort study examines patients' tolerance of the guidewire and its impact on clinical status around tracheal extubation in the intensive care unit. ⋯ Nasendoscopy was performed in 11 of these patients and revealed one wire was in the oesophagus. The most common symptom was a mild intermittent cough in 13 patients. There was no impact of the guidewire on nursing care in 16 patients, tolerable impact in five and severe impact necessitating removal of the wire in one patient.
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The International Committee of Medical Journal Editors recommends the prospective registration of interventional clinical trials. We aimed to assess the compliance with these guidelines for manuscripts submitted to and published by a single anaesthetic journal. We examined the rates of prospective trial registration, the incidence of discrepancies in primary outcome measure(s) and sample sizes, and the citation metrics of all randomised controlled trials published in Anaesthesia over a 3-year period (2014-2016). ⋯ There was no difference in the median (IQR [range]) number of citations per month since publication between prospectively (0.27 (0.15-0.46 [0.00-1.59]), and retrospectively (0.39 (0.15-0.62 [0.10-0.67]); p = 0.502) or unregistered (0.33 (0.10-0.52 [0.00-0.67]); p = 0.867) studies. Our results suggest that prospective clinical trial registration has no influence on acceptance for publication by Anaesthesia or subsequent citation metrics. The international recommendation for prospective trial registration appears to have not been universally incorporated into anaesthetic-related research practice.