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  Peri-operative beta blockade

  Cardiovascular Perioperative medicine

   
  • Randomized Controlled Trial

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

    Lancet. 2008 May 31;371(9627):1839-47.

    Perioperative metoprolol in at-risk patients undergoing non-cardiac surgery reduced major cardiovascular adverse events but increased mortality.

    pearl

  • Randomized Controlled Trial

    Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery.

    Eur. Heart J.. 2001 Aug 1;22(15):1353-8.

  • Randomized Controlled Trial

    Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV).

    Ann. Surg.. 2009 Jun 1;249(6):921-6.

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  Advanced age and anesthesia

  Anesthesia Frailty Perioperative medicine

   
  • Observational Study

    Mortality, Geriatric, and Nongeriatric Surgical Risk Factors Among the Eldest Old: A Prospective Observational Study.

    Anesth. Analg. 2017 Oct 1; 125 (4): 1329-1336.

  • Observational Study

    The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

    Anesth. Analg. 2017 May 1; 124 (5): 1653-1661.

  • Observational Study

    Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults.

    BMC Geriatr. 2014 Jan 1;14:129.

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  Perioperative stroke

  Cerebrovascular Perioperative medicine Postoperative complications

   
  • Review

    Perioperative stroke.

    Can J Anaesth. 2016 Feb 1; 63 (2): 193-204.

  • Article

    Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery.

    JAMA. 2014 Jul 16;312(3):269-77.

    Elective surgery should be delayed at least 9 months after stroke or cerebrovascular event, although there is a persisting increased risk of perioperative stroke in these patients.

    pearl

  • Multicenter Study

    Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study.

    Lancet. 2019 Sep 21; 394 (10203): 1022-1029.

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  Anesthesia & Perioperative Contribution to the Opioid Epidemic

  Addiction Opioid Perioperative medicine

   
  • Article

    Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan.

    JAMA Surg. 2019 Jan 1; 154 (1): e184234.

    The single greatest predictor of the amount of opioid used after surgical discharge is the amount of postoperative opioid prescribed.

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  • Article

    Association of Lowering Default Pill Counts in Electronic Medical Record Systems With Postoperative Opioid Prescribing.

    JAMA Surg. 2018 Nov 1; 153 (11): 1012-1019.

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  Postoperative mortality and intraoperative anesthetic depth

  Anesthesia Perioperative medicine Postoperative complications

   

  There has been some observational evidence that a greater depth of anesthesia, as measured by BIS, may be associated with an increase in post-operative mortality. In particular the association of the "triple low state" (low BIS, low volatile-ET, low MAP) with post-operative mortality is worrying.

  Completion of the Balanced Anaesthesia Study Group’s large RCT looking at this issue however brings us as close to a final word as we may expect. Short et al. (2019) showed no difference in 1-year mortality for older patients undergoing major surgery, whether they received a deep (BIS target 35) or light (BIS target 50) general anaesthetic.

  It is likely that earlier observational studies were showing the consequences of intraoperative hypotension resulting from anaesthetic depth, rather than anaesthetic depth itself.

  summary

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  • Randomized Controlled Trial

    Association between intraoperative electroencephalographic suppression and postoperative mortality.

    Br J Anaesth. 2014 Dec 1;113(6):1001-8.

  • Randomized Controlled Trial

    Concurrence of Intraoperative Hypotension, Low Minimum Alveolar Concentration, and Low Bispectral Index Is Associated with Postoperative Death.

    Anesthesiology. 2015 Oct 1;123(4):775-85.

  • Randomized Controlled Trial

    A pilot study for a prospective, randomized, double-blind trial of the influence of anesthetic depth on long-term outcome.

    Anesth. Analg.. 2014 May 1;118(5):981-6.

    Greater depth of anaesthesia may be associated with a higher incidence of wound infection, mortality and composite risk of complications.

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