British journal of anaesthesia
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Review Meta Analysis
Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies.
The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue. ⋯ Moderate-quality evidence suggests that almost half of all women undergoing breast cancer surgery develop persistent post-surgical pain, and about one in four develop moderate-to-severe persistent post-surgical pain; the higher prevalence was associated with axillary lymph node dissection. Future studies should explore whether nerve sparing for axillary procedures reduces persistent post-surgical pain after breast cancer surgery.
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Cognitive dysfunction after surgery includes delirium and postoperative cognitive dysfunction. Important risk factors for these include increased age and pre-existing cognitive dysfunction. This study describes preoperative cognitive dysfunction and its associated factors in patients aged ≥60 yr awaiting elective noncardiac surgery in a developing country. ⋯ Undiagnosed pre-existing cognitive dysfunction was common in older patients awaiting surgery at a regional academic hospital in South Africa. Patients at risk for cognitive dysfunction should be identified through brief preoperative screening.
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Anaesthetic agents are likely to alter circulating cytokine concentrations. Because preceding studies have not been able to exclude the contribution of surgical trauma, perioperative stress, or both to circulating cytokine concentrations, the effects of anaesthesia remain unclear. The aim of this study was to quantify serum cytokines in healthy volunteers administered i.v. anaesthetic agents in the absence of surgical trauma and perioperative stress. ⋯ In healthy volunteers not undergoing surgery, different i.v. anaesthesia regimens were associated with differential effects on circulating cytokines.
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Review
Causal inference in perioperative medicine observational research: part 1, a graphical introduction.
Graphical models have emerged as a tool to map out the interplay between multiple measured and unmeasured variables, and can help strengthen the case for a causal association between exposures and outcomes in observational studies. In Part 1 of this methods series, we will introduce the reader to graphical models for causal inference in perioperative medicine, and set the framework for Part 2 of the series involving advanced methods for causal inference.