British journal of anaesthesia
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Randomized Controlled Trial
Continuous intra-arterial versus intermittent oscillometric arterial pressure monitoring and hypotension during induction of anaesthesia: the AWAKE randomised trial.
Hypotension during induction of anaesthesia is associated with organ injury. Continuous arterial pressure monitoring might help reduce hypotension. We tested the hypothesis that continuous intra-arterial compared with intermittent oscillometric arterial pressure monitoring reduces hypotension during induction of anaesthesia in noncardiac surgery patients. ⋯ NCT04894019.
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Studies of intraoperative hypotension typically specify a blood pressure threshold associated with adverse outcomes. Such thresholds are likely to be study-biased, investigator-biased, or both. We hypothesised that a newly developed modelling method without a threshold, which is biologically more plausible than a threshold-based approach, would reveal a continuous association between exposure to intraoperative hypotension and adverse outcomes. ⋯ Intraoperative hypotension appears to have a graded association with postoperative myocardial injury and mortality, with depth appearing to contribute more than duration.
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Editorial
End the confusion: general anaesthesia improves patient outcomes in endovascular thrombectomy.
Expert physiological and pharmacological care by anaesthetists is required in all stroke endovascular thrombectomy cases. RCTs show clinical benefits in recanalisation rates and functional recovery after endovascular thrombectomy with general anaesthesia compared with sedation. Many stroke centres will require wholesale reorganisation of stroke pathways to ensure anaesthesia services are available for all cases. Anaesthetists have an integral role in improving clinical outcomes in large vessel occlusion stroke.
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Editorial Comment
The 'long shadow' of perioperative complications: association with increased risk of death up to 1 year after surgery.
Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the validity of this metric has recently been questioned. In this issue of the British Journal of Anaesthesia, Fowler and colleagues quantify, update, and put into perspective the looming suspicion that perioperative adverse events cast a 'long shadow' of increased mortality, far beyond the 30-day time frame. Their work not only raises important questions on how we should think about, analyse, and report 'perioperative' complications and mortality, but also stresses anaesthesiologist and surgeon roles as key stakeholders in patient long-term survival.