British journal of anaesthesia
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Preoperative frailty is associated with increased risk of postoperative mortality and complications. Routine preoperative frailty assessment is underperformed. Automation of preoperative frailty assessment using electronic health data could improve adherence to guideline-based care if an accurate instrument is identified. ⋯ All four frailty instruments significantly improved discrimination and risk reclassification when added to typically assessed preoperative risk factors. Accurate identification of the presence or absence of preoperative frailty using electronic frailty instruments may improve perioperative risk stratification. Future research should evaluate the impact of automated frailty assessment in guiding surgical planning and patient-centred optimisation amongst older surgical patients.
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Tranexamic acid reduces surgical bleeding. Consistent with previous research, the POISE-3 (Peri-Operative Ischemic Evaluation-3) trial found that tranexamic acid reduces major bleeding by 25% and with a low probability of any increase in thromboembolic events. Wider tranexamic acid use will improve surgical safety, avoid unnecessary blood use, reduce the risk of transfusion transmitted infections, and save healthcare funds. 'Consideration of tranexamic acid use' should be included in the safe surgery checklist. We have the evidence, and we need to act on it.
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Tobacco smoking is a leading preventable cause of death and increases perioperative risk. Determinants of smoking abstinence after noncardiac surgery and the association between smoking and 1-yr vascular outcomes are not fully elucidated. ⋯ Long-term tobacco abstinence is more likely after major surgery in those with serious medical comorbidities. Interventions to prevent smoking resumption after surgery remain a priority. Clinical trial registration NCT00512109.
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Randomized Controlled Trial
Comparison of two sizes of GlideScope® blades in tracheal intubation of infants: a randomised clinicaltrial☆.
The appropriate size of GlideScope® blade for tracheal intubation in neonates and premature infants has not been established. We evaluated the impact of the size of the GlideScope® blade on the time taken for intubation in infants weighing 2.5-3.6 kg. ⋯ KCT 0003867.
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Editorial Comment
'If you don't take a temperature, you can't find a fever': relevance to continuous arterial pressure monitoring.
Intraoperative hypotension is common and is associated with adverse postoperative outcomes. A substantial fraction of all perioperative hypotension occurs shortly after induction of anaesthesia and before the procedure begins. ⋯ Continuous blood pressure monitoring might help reduce hypotension. There are now strong arguments that if an arterial line is indicated, it should be placed before induction of anaesthesia to obtain maximal benefit.