D Campbell, L Boyle, M Soakell-Ho, P Hider, L Wilson, J Koea, A F Merry, C Frampton, T G Short
BACKGROUND: Many multivariable models to calculate mortality risk after surgery are limited by insufficient sample size at development or by application to cohorts distinct from derivation populations. The aims of this study were to validate the Surgical Outcome Risk Tool (SORT) for a New Zealand population and to develop an extended NZRISK model to calculate 1-month, 1-year and 2-year mortality after non-cardiac surgery. METHODS: Data from the New Zealand National Minimum Data Set for patients having surgery between January 2013 and December 2014 were used to validate SORT...
October 2019: British Journal of Surgery
(no author information available yet)
BACKGROUND: In non-surgical settings, covert stroke is more common than overt stroke and is associated with cognitive decline. Although overt stroke occurs in less than 1% of adults after non-cardiac surgery and is associated with substantial morbidity, we know little about perioperative covert stroke. Therefore, our primary aim was to investigate the relationship between perioperative covert stroke (ie, an acute brain infarct detected on an MRI after non-cardiac surgery in a patient with no clinical stroke symptoms) and cognitive decline 1 year after surgery...
September 21, 2019: Lancet
M A Shulman, B H Cuthbertson, D N Wijeysundera, R M Pearse, B Thompson, E Torres, A Ambosta, S Wallace, C Farrington, P S Myles
BACKGROUND: The 6-min walk test (6MWT) is a common means of functional assessment. Its relationship to disability-free survival (DFS) is uncertain. METHODS: This sub-study of the Measurement of Exercise Tolerance for Surgery study had co-primary outcome measures: correlation of the preoperative 6MWT distance with 30 day quality of recovery (15-item quality of recovery) and 12 month WHO Disability Assessment Schedule scores. The prognostic utility of the 6MWT and other risk assessment tools for 12 month DFS was assessed with logistic regression and receiver-operating-characteristic-curve analysis...
January 2019: British Journal of Anaesthesia
Sohail Bampoe, Tim Cook, Lee Fleisher, Michael P W Grocott, Mark Neuman, David Story, Paul Myles, Guy Haller
INTRODUCTION: Clinical indicators are used to measure and quantify the safety and quality of patient care. They are also often used as endpoints in clinical trials. Definitions of clinical indicators in common use are extremely heterogeneous, limiting their applicability. As part of the international Standardised Endpoints in Perioperative Medicine initiative, this study will identify clinical indicators by systematically reviewing the anaesthesia and perioperative medicine literature, and will provide consensus, clinically useful definitions for those indicators using a Delphi process...
December 2, 2018: BMJ Open
Paul S Myles, Julian A Smith, Jessica Kasza, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D James Cooper, Silvana Marasco, John McNeil, Jean S Bussières, Shay McGuinness, Kelly Byrne, Matthew T V Chan, Giovanni Landoni, Sophie Wallace, Andrew Forbes
BACKGROUND: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes. METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo...
February 2019: Journal of Thoracic and Cardiovascular Surgery
Timothy E Miller, Paul S Myles
No abstract text is available yet for this article.
May 2019: Anesthesiology
Donald S Likosky, Robert A Baker, Richard F Newland, Theron A Paugh, Timothy A Dickinson, David Fitzgerald, Joshua B Goldberg, Nicholas B Mellas, Alan F Merry, Paul S Myles, Gaetano Paone, Kenneth G Shann, Jane Ottens, Timothy W Willcox
Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as "conventional," inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015...
December 2018: Journal of Extra-corporeal Technology
Mary Ellen McCann, Jurgen C de Graaff, Liam Dorris, Nicola Disma, Davinia Withington, Graham Bell, Anneke Grobler, Robyn Stargatt, Rodney W Hunt, Suzette J Sheppard, Jacki Marmor, Gaia Giribaldi, David C Bellinger, Penelope L Hartmann, Pollyanna Hardy, Geoff Frawley, Francesca Izzo, Britta S von Ungern Sternberg, Anne Lynn, Niall Wilton, Martin Mueller, David M Polaner, Anthony R Absalom, Peter Szmuk, Neil Morton, Charles Berde, Sulpicio Soriano, Andrew J Davidson
BACKGROUND: In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes...
February 16, 2019: Lancet
Peter Szmuk, Dean Andropoulos, Francis McGowan, Ansgar Brambrink, Christopher Lee, Katherine J Lee, Mary Ellen McCann, Yang Liu, Rita Saynhalath, Choon Looi Bong, Brian J Anderson, Charles Berde, Jurgen C De Graaff, Nicola Disma, Dean Kurth, Andreas Loepke, Beverley Orser, Daniel I Sessler, Justin J Skowno, Britta S von Ungern-Sternberg, Laszlo Vutskits, Andrew Davidson
BACKGROUND: Concern over potential neurotoxicity of anesthetics has led to growing interest in prospective clinical trials using potentially less toxic anesthetic regimens, especially for prolonged anesthesia in infants. Preclinical studies suggest that dexmedetomidine may have a reduced neurotoxic profile compared to other conventional anesthetic regimens; however, coadministration with either anesthetic drugs (eg, remifentanil) and/or regional blockade is required to achieve adequate anesthesia for surgery...
January 2019: Paediatric Anaesthesia
Katherine R Gentry, Sarah J Arnup, Nicola Disma, Liam Dorris, Jurgen C de Graaff, Agnes Hunyady, Neil S Morton, Davinia E Withington, Mary Ellen McCann, Andrew J Davidson, Anne M Lynn
INTRODUCTION: Randomized trials are important for generating high-quality evidence, but are perceived as difficult to perform in the pediatric population. Thus far there has been poor characterization of the barriers to conducting trials involving children, and the variation in these barriers between countries remains undescribed. The General Anesthesia compared to Spinal anesthesia (GAS) trial, conducted in seven countries between 2007 and 2013, provides an opportunity to explore these issues...
January 2019: Paediatric Anaesthesia
D J Buggy, J Freeman, M Z Johnson, K Leslie, B Riedel, D I Sessler, A Kurz, V Gottumukkala, T Short, N Pace, P S Myles
BACKGROUND: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, given the current equipoise in the existing literature, prospective, randomised, controlled trials are necessary to test this hypothesis. As such, a cancer subgroup was formed to derive endpoints related to research in onco-anaesthesia based on a current evidence base, international consensus and expert guidance...
July 2018: British Journal of Anaesthesia
Ben Korman, Ranjan K Dash, Philip J Peyton
BACKGROUND: Recent clinical studies suggest that the magnitude of the second gas effect is considerably greater on arterial blood partial pressures of volatile agents than on end-expired partial pressures, and a significant second gas effect on blood partial pressures of oxygen and volatile agents occurs even at relatively low rates of nitrous oxide uptake. We set out to further investigate the mechanism of this phenomenon with the help of mathematical modeling. METHODS: Log-normal distributions of ventilation and blood flow were generated representing the range of ventilation-perfusion scatter seen in patients during general anesthesia...
June 2018: Anesthesiology
(no author information available yet)
BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital...
October 31, 2016: British Journal of Anaesthesia
Nicola Disma, James D O'Leary, Andreas W Loepke, Ansgar M Brambrink, Karin Becke, Nicola G Clausen, Jurgen C De Graaff, Fang Liu, Tom G Hansen, Mary E McCann, Cynthia F Salorio, Sulpicio Soriano, Lena S Sun, Peter Szmuk, David O Warner, Laszlo Vutskits, Andrew J Davidson
All commonly used general anesthetics have been shown to cause neurotoxicity in animal models, including nonhuman primates. Opinion, however, remains divided over how cumulative evidence from preclinical and human studies in this field should be interpreted and its translation to current practices in pediatric anesthesia and surgery. A group of international experts in laboratory and clinical sciences recently convened in Genoa, Italy, to evaluate the current state of both laboratory and clinical research and discuss future directions for basic, translational, and clinical studies in this field...
September 2018: Paediatric Anaesthesia
Stephan A Schug, Julie Bruce
Risk stratification for the development chronic postsurgical pain is an important tool, which may permit preventive measures or appropriate advice for patients at high risk.
November 2017: Pain Reports
Leon N Warne, Stephan A Schug, Thierry Beths, Juliana T Brondani, Jennifer E Carter, B Duncan X Lascelles, Anthea L Raisis, Sheilah A Robertson, Paulo V M Steagall, Polly M Taylor, Ted Whittem, Sébastien H Bauquier
Introduction: This article reports the content validation of a Critical Appraisal Tool designed to Review the quality of Analgesia Studies (CATRAS) involving subjects incapable of self-reporting pain and provide guidance as to the strengths and weakness of findings. The CATRAS quality items encompass 3 domains: level of evidence, methodological soundness, and grading of the pain assessment tool. Objectives: To validate a critical appraisal tool for reviewing analgesia studies involving subjects incapable of self-reporting pain...
July 2018: Pain Reports
Carol L Hodgson, Kimberley J Haines, Michael Bailey, Jonathan Barrett, Rinaldo Bellomo, Tracey Bucknall, Belinda J Gabbe, Alisa M Higgins, Theodore J Iwashyna, Julian Hunt-Smith, Lynne J Murray, Paul S Myles, Jennie Ponsford, David Pilcher, Andrew A Udy, Craig Walker, Meredith Young, D J Jamie Cooper
PURPOSE: To determine predictors of inability to return to work due to health six-months after intensive care admission; and compare functional recovery between patients who had not returned to work and employed patients. METHODS: Participants were working adults admitted to ICU who received >24 h of mechanical ventilation. Outcomes included inability to return to work due to health at six-months post-ICU admission, disability, health status, anxiety, depression and post-traumatic stress...
August 13, 2018: Journal of Critical Care
Duminda N Wijeysundera, Rupert M Pearse, Mark A Shulman, Tom E F Abbott, Elizabeth Torres, Althea Ambosta, Bernard L Croal, John T Granton, Kevin E Thorpe, Michael P W Grocott, Catherine Farrington, Paul S Myles, Brian H Cuthbertson
BACKGROUND: Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery...
June 30, 2018: Lancet
Paul S Myles, Jan M Dieleman, Andrew Forbes, Stephane Heritier, Julian A Smith
BACKGROUND: Numerous studies have investigated high-dose corticosteroids in cardiac surgery, but with mixed results leading to ongoing variations in practice around the world. DECS-II is a study comparing high-dose dexamethasone with placebo in patients undergoing cardiac surgery. METHODS: We discuss the rationale for conducting DECS-II, a 2800-patient, pragmatic, multicenter, assessor-blinded, randomized trial in cardiac surgery, and the features of the DECS-II study design (objectives, end points, target population, based on practice preference with post-randomization consent, treatments, patient follow-up and analysis)...
October 2018: American Heart Journal
Priscilla H Yong, Laurence Weinberg, Niloufar Torkamani, Leonid Churilov, Raymond J Robbins, Ronald Ma, Rinaldo Bellomo, Que T Lam, James D Burns, Graeme K Hart, Jeremy F Lew, Johan Mårtensson, David Story, Andrew N Motley, Douglas Johnson, Jeffrey D Zajac, Elif I Ekinci
OBJECTIVE: Limited studies have examined the association between diabetes and HbA1c with postoperative outcomes. We investigated the association of diabetes, defined categorically, and the association of HbA1c as a continuous measure, with postoperative outcomes. RESEARCH DESIGN AND METHODS: In this prospective, observational study, we measured the HbA1c of surgical inpatients age ≥54 years at a tertiary hospital between May 2013 and January 2016. Patients were diagnosed with diabetes if they had preexisting diabetes or an HbA1c ≥6...
June 2018: Diabetes Care
2018-06-28 22:48:19
Fetch more papers »
Fetching more papers... Fetching...
Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.