Scribd Logo
Upload

Welcome to Scribd!

    • 256 views

    Landmark Trials To Know

    Uploaded by

    yoshiuda
    This document provides a summary of landmark trials and prominent papers in anesthesia and medicine. It lists several major trials that studied topics like aprotinin use, anesthetic awareness, tight glycemic control, nitrous oxide use, endovascular coiling vs clipping for aneurysms, therapeutic hypothermia, magnesium for preeclampsia, and coronary revascularization. It also summarizes guidelines for PONV prophylaxis and treatment as well as trials on carotid endarterectomy and beta-blocker use in the perioperative period.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Landmark Trials To Know

    Uploaded by

    yoshiuda
    256 views3 pages
    This document provides a summary of landmark trials and prominent papers in anesthesia and medicine. It lists several major trials that studied topics like aprotinin use, anesthetic awareness, tight glycemic control, nitrous oxide use, endovascular coiling vs clipping for aneurysms, therapeutic hypothermia, magnesium for preeclampsia, and coronary revascularization. It also summarizes guidelines for PONV prophylaxis and treatment as well as trials on carotid endarterectomy and beta-blocker use in the perioperative period.

    Original Description:

    anaesthesia landmark trial

    Original Title

    Landmark Trials to Know

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides a summary of landmark trials and prominent papers in anesthesia and medicine. It lists several major trials that studied topics like aprotinin use, anesthetic awareness, tight glycemic control, nitrous oxide use, endovascular coiling vs clipping for aneurysms, therapeutic hypothermia, magnesium for preeclampsia, and coronary revascularization. It also summarizes guidelines for PONV prophylaxis and treatment as well as trials on carotid endarterectomy and beta-blocker use in the perioperative period.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    256 views3 pages

    Landmark Trials To Know

    Uploaded by

    yoshiuda
    This document provides a summary of landmark trials and prominent papers in anesthesia and medicine. It lists several major trials that studied topics like aprotinin use, anesthetic awareness, tight glycemic control, nitrous oxide use, endovascular coiling vs clipping for aneurysms, therapeutic hypothermia, magnesium for preeclampsia, and coronary revascularization. It also summarizes guidelines for PONV prophylaxis and treatment as well as trials on carotid endarterectomy and beta-blocker use in the perioperative period.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    IC2009B (Usewithcaution)

    LandmarkTrials,ProminentPapers(shortlist) BART NEJMMay2008 Aprotinin=mortality,nephrotox. AlsomayAMI/CVA/thrombosis BAwareTrial TheLancet29May2004 2/3xequivocal=awareness BISdecreasesawarenessinhighriskgroups NNT=138x$16/BISuse=$2200/prevention BUnware NEJMMarch2008 BISvsETAG=nodiff Moreliberalinclusion(includingobesity,bblockers,extol) Singlehospitallikelyunderpowered CARP NEnglJMed2004Dec CoronaryarteryrevascPROPHYLAXIS(b4surgery) Nodiffb/wrevascandmedicalrxarmsforperiopeventsandEF@3mths NICESUGAR NEJMMarch2009 Prevevidence:hyperglycaemiaBSL>10mmol/L(180mg/dl)=worseM&Minacutelyill/ICU TightcontrolBSL[4.56]=death,hypoglycaemiacfaimingforBSL<10 ENIGMA Anesthesiology.107(2):221231,August2007. 80:O2/20:N2vs70:N2O/30:O2insurgery>2hrs...flawed SameLOS(primaryendpoint).complications(wound&atelectasis/pneumonia)&PONV ENIGMAII FiO20.3fixedthistime.N2OvsnoN2o Localstudy ISAT Lancet2002Oct Lowgradeaneurysmsforclipping.WFNSgrd13 Coiling:clipping=23:30%1yeardependency/death Possibletemporizingmeasureforhighgradeduetosurgicaldifficulties(oedema) IHASTI NEJM2005 Lowgradeaneurysmsforclipping.33Cvsnormothermia(36.5C) Nodiffneurooutcome(GlasgowOutcomeScore).Goodoutcomesin6065%ofbothgroups. Cooling=bacteraemia5vs2.5% Criticisms:notcoldenough,notearlyenough IMPACT NEJM2004 Ondansetron=dexamethadone=droperidol=TIVA.....(canPONV2530%) Patientsriskdeterminesmanagement MASTER AnesthesiaandAnalgesia2003;96(2):54854 EpivsIVopioids decreaseinlengthofventilatordependence o thereforenotofadvantageifpatientnotgoingtobereintubated undefinedpoints o whereinback,relativetoincision? o wasblockestablished? o whatwasinfusing? nowhaveketamineaswell qualityofanalgesiacanbeanendpoint

    IC2009B (Usewithcaution)
    MAGPIE Lancet2002 Mghalveseclampticrisk,probablyreducesmaternaldeath Mg>lyticcocktail(peth,chlorprom,promethazine)CochraneSystRev2001 DECREASEV JAmCollCardiol.2007May Coronaryrevascularizationprophylaxis(forsurgery)nobenefit CARPTRIAL NEnglJMed2004Dec Asabove REVERT Circulation.2007Jul3 BblockersslowcardiacremodellinginasympHF. COURAGETRIAL NEnglJMed.2007Apr PCIvsmaxmedicaltherapynosurvivalbenefits Confirmedin2009LancetmetaanalysisPTCA=BMS=DES=maxmed.Samesurvival. SAVE&TRACE&SMILEtrials ACEinhibpostAMIwilldelayonsetofHFsymptomsandmayimproveoutcome CAPRICORNTrial Lancet2001May5 BblockerpostAMI=deathAMI SOLVD NEnglJMed1992Sep AceinhibforasymptomaticHFsymptomsandAMI deathinfollowupXSOLVD PONVconsensusguidelinesAnaesthesiaandAnalgesia2003;97:6271 1.Identifyhighrisk o Ptfemale,nonsmoker,hxPONV/motionsickness (Apfel1999anaesthesiology10%baseline,then20%perRFincl.Opioids) o Anaesthopiods,N2O,volatiles o SurgENT,gynae,breast,eye,laparoscopy,neuro 2.Children o Studiesoftenrelatedtovomiting,notnausea o vomiting(cfadults),riskincreasestopuberty,m=ftillpuberty 3.Reducebaselinerisk(anaesthetictechnique) o Regional/tiva/O2/hydration o N2O/opiods/volatile/neostigmine 4.AppropriatePONVprophylaxis&TIMING o Anti5HT3endofsurgery.Droperidol=blackbox. o Prochlorperazine/Promethazineendofsurgery o Dexabeforeinduction(butuncomfortable),thereforeearlyaspossible o Nonpharmacupuncture/pressure/TENS/hypnosissomeefficacy o ControversialforPONVmaxolon,ginger,THC(goodforchemonauseatho) 5.ChildrenPONV o Gran40mcg/kg,ond0.1mg/kg,drop0.05mg/kg,dexa0.15mg/kg 6.Monotherapyinferiortocombo(prophylaxisANDrescue) Pressorsinobstetrics(CurrentOpinioninAnaesthesiology:June2006) Alphaagonists>ephedrine:nausea,FHRchanges,bettercontrol ATACAS expectpublication20112012(5yrtrial,beginning2006) AspiringandtranexamicacidinCAGS CEA NASCET(Stroke1991Jun) o Symptomaticptswithipsilateral:CEAvsmedical o 30days:morestrokedeathinCEAgroup(5.8%vs3.3%)

    IC2009B (Usewithcaution)
    o 2yrcumulativerisklowerlessipsilateralstroke/death(DELAYEDbenefit) o Morebenefitinage>75 ECST(Lancet1991May) o Symptomatic:Medicaltherapy(aspirin)vsCEA o Forcontrolgrp(medrx):riskofstrokerelatedtostenosisseverityONLYfor1st23yrs o GenerallyconfirmedNASCET ACAS(JAMA1995)/ACST(Lancet2004May o CEAbetter2yroutcomeforipsilateralstroke/death(5%vs11%) o Lessbenefitthansymptomatic(recommend:needlowersurgicalrisk<3%vs<6%) o Delaytobenefit/longterminvestment(worseoutcomeinsurgicalgroupforsometime o Evidencelesscompellingforwomen GALA(Lancet2008:372pg21322142) o NodiffbetweenGAvsLAat30daysforstroke/AMI/death

    Bblockers AtenololstudyMangano,etal.(NEnglJMed1996) o Increasedsurvivalwithatenolol BisoprololstudyPoldermans,etal.(NEnglJMed1999) o 91%reductioninperiopAMI POISETrialLancet.2008May o Aggressivemetoprolol(delay/withholddrugsonlyifHR<50orSBP<100) o Bblockers=moredeath,morestroke,lessAMI ATRIAtrial CHADS2scorederivedfromthis. Otherpublications AnaesthesiaandIntensiveCare2009 TheREASONAudit ANZCATrialsGroup&ANZCAPerioperativeMedicineCommittee(localaudit) POMscore o Preandpostoppredictors o 3xA:age,ASA,albumin o 3xI:unintendedICU,inflammation,acuterenalimpairment

    You might also like