British journal of anaesthesia
-
Review Meta Analysis
Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis.
Low dose ketamine reduces pain and opioid requirements in the first 24 hours after major joint surgery.
pearl -
Review Meta Analysis
Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis.
Dexmedetomidine reduces perioperative stress and inflammation, while supporting surgical patients’ immune function.
pearl -
Why is this important?
Suspicions that anesthetic technique impacts survival after cancer surgery continues to be both unanswered and psychologically weighty: are anesthetic choices undermining patient survival?
What did they do?
This Taiwanese research group conducted a retrospective cohort-study in a single hospital covering 10 years of elective hepatectomy patients, comparing propofol to desflurane anesthesia. Notably, hepatocellular carcinoma is one of the leading causes of cancer death in Taiwan.
And they found...?
TIVA propofol was associated with a dramatically better survival (hazard ratio 0.57 (0.38-0.59)), even in subgroup analysis dependent on staging.
Reality check
Although this finding is consistent with other observational studies across a range of cancers, the apparent size of the benefit (50% mortality reduction!) should give us pause.
Given inconsistent findings from a range of similar observational studies, it is unlikely that there is a real treatment effect of this magnitude.
While we await results from well-powered RCTs, the jury is still out on whether anesthesia choices impact any specific cancer surgery...
summary -
Severe acute pain in orthopaedic trauma patients is more common among female patients and those having had previous injury-related surgery, and preoperative pain severity is associated with persistent pain at 3 months.
pearl -
Perioperative hypersensitivity reactions vary greatly between countries both in incidence and causative agents.
pearl