• Collection

    Landmark articles in Anesthesia


    Daniel Jolley, Brendan Little, and Abraham Hulst.

    14 articles.

    Created June 3, 2015, last updated 13 days ago.

    Collection: 25, Score: 5158, Trend score: 0, Read count: 5150, Articles count: 14, Created: 2015-06-03 03:28:53 UTC. Updated: 2018-10-18 20:04:13 UTC.



    A growing collection of landmark papers relevant to anaesthesia and anesthesiology.

    These papers are practice changing and hold current, ongoing significance beyond their historical importance.

    This is a dynamic and changing document that will be updated, pruned and added to as appropriate. Many of these papers have free full-text provided by the publisher because of their significance.

    Daniel Jolley  Daniel Jolley
    Do you have a pearl, summary or comment to save or share?
    250 characters remaining
    You can also include formatting and links in your notes
    • Simple formatting can be added to notes, such as _italic_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)

    Collected Articles

    • N. Engl. J. Med. · May 1996

      Randomized Controlled Trial Clinical Trial

      Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group.

      Mild perioperative hypothermia, which is common during major surgery, may promote surgical-wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen. Hypothermia also directly impairs immune function. We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization. ⋯ Hypothermia itself may delay healing and predispose patients to wound infections. Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations.

      explore further… or not…

    • Lancet · Apr 2002

      Randomized Controlled Trial Multicenter Study Clinical Trial

      Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial.

      Epidural block is widely used to manage major abdominal surgery and postoperative analgesia, but its risks and benefits are uncertain. We compared adverse outcomes in high-risk patients managed for major surgery with epidural block or alternative analgesic regimens with general anaesthesia in a multicentre randomised trial. ⋯ Most adverse morbid outcomes in high-risk patients undergoing major abdominal surgery are not reduced by use of combined epidural and general anaesthesia and postoperative epidural analgesia. However, the improvement in analgesia, reduction in respiratory failure, and the low risk of serious adverse consequences suggest that many high-risk patients undergoing major intra-abdominal surgery will receive substantial benefit from combined general and epidural anaesthesia intraoperatively with continuing postoperative epidural analgesia.

      expand abstract… or just mark as read…

    • Anesthesia and analgesia · Sep 2004

      Multicenter Study

      The incidence of awareness during anesthesia: a multicenter United States study.

      Awareness with recall after general anesthesia is an infrequent, but well described, phenomenon that may result in posttraumatic stress disorder. There are no recent data on the incidence of this complication in the United States. We, therefore, undertook a prospective study to determine the incidence of awareness with recall during general anesthesia in the United States. ⋯ There were 46 additional cases (0.24%) of possible awareness and 1183 cases (6.04%) of possible intraoperative dreaming. The incidence of awareness during general anesthesia with recall in the United States is comparable to that described in other countries. Assuming that approximately 20 million anesthetics are administered in the United States annually, we can expect approximately 26,000 cases to occur each year.

      read on… or not…

    • Lancet · May 2004

      Randomized Controlled Trial Multicenter Study Clinical Trial

      Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial.

      BIS monitoring significantly reduces the risk of awareness under general anesthesia in high-risk adult surgical patients.


      read more… or just mark as read…

    • N. Engl. J. Med. · Mar 2008

      Randomized Controlled Trial Comparative Study

      Anesthesia awareness and the bispectral index.

      Awareness during anesthesia is a serious complication with potential long-term psychological consequences. Use of the bispectral index (BIS), developed from a processed electroencephalogram, has been reported to decrease the incidence of anesthesia awareness when the BIS value is maintained below 60. In this trial, we sought to determine whether a BIS-based protocol is better than a protocol based on a measurement of end-tidal anesthetic gas (ETAG) for decreasing anesthesia awareness in patients at high risk for this complication. ⋯ We did not reproduce the results of previous studies that reported a lower incidence of anesthesia awareness with BIS monitoring, and the use of the BIS protocol was not associated with reduced administration of volatile anesthetic gases. Anesthesia awareness occurred even when BIS values and ETAG concentrations were within the target ranges. Our findings do not support routine BIS monitoring as part of standard practice. (ClinicalTrials.gov number, NCT00281489 [ClinicalTrials.gov].).

      read more… or just mark as read…

    • N. Engl. J. Med. · Jun 2004

      Randomized Controlled Trial Multicenter Study Clinical Trial

      A factorial trial of six interventions for the prevention of postoperative nausea and vomiting.

      Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown. ⋯ Because antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.

      keep reading… or not…

    • Anesthesiology · Dec 2002

      Randomized Controlled Trial Comparative Study Clinical Trial

      Randomized controlled trial comparing traditional with two "mobile" epidural techniques: anesthetic and analgesic efficacy.

      This follow-up paper to the original COMET study describes in detail the high and low-dose epidural techniques and the subsequent anesthetic characteristics.

      The low-dose techniques used infusions of 0.1% bupivacaine with 2 mcg/mL fentanyl, compared with 10mL boluses of 0.25% bupivacaine. Maternal analgesia experience was similar between the groups, all the CSE group experienced better analgesia in the first hour.


      keep reading… or not…

    • Lancet · Jun 2002

      Randomized Controlled Trial Multicenter Study Clinical Trial

      Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial.

      Magnesium sulphate halves the risk of eclampsia in pre-eclamptic pregnant women without significant adverse effect.


      read more… or not…

    • Lancet · May 2008

      Randomized Controlled Trial Multicenter Study

      Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial.

      POISE showed that for every 1000 patients receiving metoprolol, 15 were prevented from suffering a myocardial infract, 3 from requiring cardiac revascularization along with 7 new cases of atrial fibrillation, but at a cost of causing an excess 8 deaths, 5 strokes, 53 hypotensive events and 42 episodes of bradycardia.

      The harm associated with perioperative beta-blockade, at least in the form of non-titrated extended-release metoprolol, is greater than the demonstrated benefit. For every two cases of myocardial infract avoided there is one excess death.


      keep reading… mark as read…

    • N. Engl. J. Med. · Feb 2005

      Randomized Controlled Trial Comparative Study Clinical Trial

      The risk of cesarean delivery with neuraxial analgesia given early versus late in labor.

      Neuraxial analgesia early in labor does not increase the risk of cesarean delivery or increase the duration of labor compared with analgesia later in labor.


      keep reading… mark as read…

    • Anesthesiology · Aug 2007

      Randomized Controlled Trial Multicenter Study

      Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial.

      Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear. ⋯ Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned.

      read on… or not…

    • Lancet · Oct 2014

      Randomized Controlled Trial Multicenter Study

      The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial.

      Nitrous oxide use in non-cardiac surgery does not increase the risk of death, cardiovascular complications or wound infection.


      read more… mark as read…

    • N. Engl. J. Med. · Apr 2014

      Randomized Controlled Trial Multicenter Study

      Aspirin in patients undergoing noncardiac surgery.

      There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. ⋯ Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).

      expand abstract… or not…

    • N. Engl. J. Med. · Apr 2014

      Randomized Controlled Trial Multicenter Study Comparative Study

      Clonidine in patients undergoing noncardiac surgery.

      Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. ⋯ Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac arrest. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).

      keep reading… or not…

    collapse collection…