The pressure to practice truly patient-focused, evidence-based medicine weighs on every anaesthetist and anaesthesiologist. Yet as the volume of evidence has grown, so has the expectation to always provide the highest quality care.
There is a trap of unknown knowns: evidence known in the greater medical-knowledge body but that we are naively ignorant of.
Bastardising William Gibson (1993), we risk that the evidence:
“…is already here – it's just not very evenly distributed.”
The greatest challenge for evidence-based anaesthesia continues to be the translation of research findings into actual practice change. The key to this is the intersection between quality, personal relevance, general significance, and credibility. But how can we achieve this?
50% of retracted anesthesiology papers are retracted because of fraud, and 30% because of inadequate ethics approval.
90% of fraudulent papers in perioperative medicine retracted over the last 30 years were authored by only six researchers.
Carlisle investigated the distribution of independent variables between study groups in Fujii's fraudulent research:
"The published distributions of 28/33 variables (85%) were inconsistent with the expected distributions, such that the likelihood of their occurring ranged from 1 in 25 to less than 1 in 1 000 000 000 000 000 000 000 000 000 000 000 (1 in 1033), equivalent to p values of 0.04 to < 1 × 10-33 , respectively."
"It usually comes as a surprise to students to learn that some (perhaps most) published articles belong in the bin, and should certainly not be used to inform practice." – Greenhalgh.
Videolaryngoscopy is associated with improved glottic view, less failed attempts and fewer complications.
A lower processed-EEG based measure of anaesthetic resistance is associated with greater post-operative delirium risk.
Unsuccessful epidural blood patch is associated with higher lumbar levels, shorter time between puncture & patch, and with patients with migraine history.
Other than acute kidney injury, there appears no outcome difference between spinal and general anaesthesia in hip fracture surgery.
Ultrasound-guided parasternal block may be an effective regional technique to reduce pain, ventilation & ICU stay after cardiac surgery.