Knowledge

Collections of articles, notes and knowledge from the metajournal community.

Hydroxylethyl starches: harm and acute liver injury

Anesthesia Critical care Fluids Resuscitation
Hydroxyethyl starches, such as Hespan, Voluven, Volulyte, Tetrahes and Hestar, have been shown in several large trials to increase the risk of acute kidney injury (AKI) and/or the need for renal replacement therapies among critically ill patients, particulalry those suffering sepsis.

Evidence demonstrating harm among fit & healthy surgical patients is however lacking, notably Giles et al could find no increased risk of adverse event among surgical patients in their 2014 meta-analysis. Nonetheless, given the similar lack of demonstrable benefit of HES fluids for this group, avoidance of use in both the ICU and surgical population is prudent.
summary

...and 1 more note
- Comparative Study
  
  Hydroxyethyl Starch and Acute Kidney Injury in Orthotopic Liver Transplantation: A Single-Center Retrospective Review.
  
  Anesth. Analg. 2015 Mar 1; 120 (3): 619-626.
- Review
  
  Randomised trials of 6% tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis.
  
  Intensive Care Med. 2013 May 1; 39 (5): 811-22.
- Review
  
  Incidence of postoperative death and acute kidney injury associated with i.v. 6% hydroxyethyl starch use: systematic review and meta-analysis.
  
  Br J Anaesth. 2014 Jan 1; 112 (1): 25-34.
  
  Use of 6% HES solutions in surgical patients is not associated with either harm or benefit in terms of mortality, renal replacement or kidney injury.
  pearl
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Decision support tools in anesthesia

Cognitive aids Decision making
- Review
  
  The Use of Cognitive Aids During Emergencies in Anesthesia: A Review of the Literature.
  
  Anesth. Analg.. 2013 Nov 1;117(5):1162-71.
- Randomized Controlled Trial
  
  Adherence to guidelines for the management of local anesthetic systemic toxicity is improved by an electronic decision support tool and designated "reader".
  
  Reg Anesth Pain Med. 2014 Jul 1; 39 (4): 299-305.
- Article
  
  Generation of dynamically configured check lists for intra-operative problems using a set of covering algorithms.
  
  Proc AMIA Symp. 2001 Jan 1:593-7.
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The wonderful world of perioperative magnesium

Magnesium
- Review
  
  Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials.
  
  Anesthesiology. 2013 Jul 1;119(1):178-90.
  
  Peri-operative systemic magnesium reduces postoperative pain and opioid consumption, although it is of uncertain clinical significance.
  pearl
- Randomized Controlled Trial
  
  Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial.
  
  Lancet. 2002 Jun 1;359(9321):1877-90.
  
  Magnesium sulphate halves the risk of eclampsia in pre-eclamptic pregnant women without significant adverse effect.
  pearl
- Randomized Controlled Trial
  
  The effect of magnesium sulphate infusion on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia.
  
  Anaesthesia. 2013 Oct 1;68(10):1045-52.
expand collection
Professionalism in anesthesia and medicine

Anesthesia Decision making Professionalism
- Review
  
  Physician professional behaviour affects outcomes: a framework for teaching professionalism during anesthesia residency.
  
  Can J Anaesth. 2011 Nov 1;58(11):1039-50.
- Article
  
  Priorities for professionalism: what do surgeons think?
  
  Med. J. Aust.. 2015 May 4;202(8):433-7.
- Article
  
  The role of maintenance of certification programs in governance and professionalism.
  
  JAMA. 2015 May 12;313(18):1809-10.
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Hyperalgaesia

Pain
- Review
  
  Review of the Performance of Quatitative Sensory Testing Methods to Detect Hyperalgesia in Chronic Pain Patients on Long-term Opioids.
  
  Anesthesiology. 2015 Mar 1;122(3):677-85.
- Randomized Controlled Trial
  
  Preoperative pregabalin administration significantly reduces postoperative opioid consumption and mechanical hyperalgesia after transperitoneal nephrectomy.
  
  Br J Anaesth. 2012 May 1;108(5):845-9.
- Article
  
  Opioid-Induced Hyperalgesia in Community-Dwelling Adults with Chronic Pain.
  
  Pain. 2015 Jun 1; 156 (6): 1145-1152.
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