Perioperative clonidine administration does not reduce mortality or myocardial infraction, but does increase the risk of hypotension and non-fatal cardiac arrest.
Ondansetron, dexamethasone, droperidol and total intravenous anesthesia (TIVA) all have a roughly similar, productive effect to reduce postoperative nausea and vomiting (PONV) by about one third.
BIS monitoring may not reduce the incidence of awareness under general anesthesia.
The incidence of awareness-with-recall under general anesthesia in the United States is 1-2 cases per 1,000 patients.
Note that the reported ’reduction in respiratory failure’ was entirely due to a small difference in post-op ventilation duration in the ICU between the groups. Significant, but perhaps not clinically remarkable.
Perioperative epidural analgesia in high-risk patients undergoing major abdominal surgery improves analgesia but doesnot have other morbidity or mortality benefits.
Intraoperative warming of patients avoids hypothermia, reduces wound infection and shortens hospital stay after colorectal surgery.
Perioperative aspirin use does not reduce mortality or myocardial infraction, but does increase the risk of major bleeding.
This meta-analysis (unsurprisingly) confirms that pre-operative troponin levels are post-operatively associated with both major adverse cardiac events and mortality risk.
This sounds obvious, why should we care?
First, there's a difference between evidence and that vague feeling we call common-sense that a disproportionate number of our clinical decisions are based upon.
Surgical patients are getting older and sicker. We need better tools for risk stratifying patients before surgery to improve perioperative planning. Most importantly (though not exclusively) reliably identifying biomarkers for risk allows closer postoperative surveillance and monitoring – which may alter outcomes.
We already know that troponin I and T are markers of cardiac damage, and unlike brain natriuretic peptide (BNP), troponin assays are readily available in most healthcare settings.
Ok, you convinced me... what did they find?
Analysing 10 studies totally 10,371 patients, they found an association between preoperative troponin elevation and MACE (OR 6.9), and short-term & long-term mortality (OR 4.2 & 2.5). Note though that the confidence intervals were quite wide.
There's always a but... the included studies were all observational in nature, used a variety of troponin assays, and the results were quite heterogenous across the 10. Most importantly, even assuming troponin is an accurate preop risk marker, we don't yet know whether that knowledge will allow us to alter outcomes for these patients.
Plasma fibrinogen measurement is usually a more important target in post-partum hemorrhage than other coagulation lab results.