Curated medical journal articles

Guidelines for the peri-operative management of people with cardiac implantable electronic devices: Guidelines from the British Heart Rhythm Society. PubMed

Hyperoxia and Antioxidants for Myocardial Injury in Noncardiac Surgery: A 2 × 2 Factorial, Blinded, Randomized Clinical Trial. PubMed

Neither hyperoxia nor antioxidants (vitamin C/N-acetylcysteine) reduced perioperative myocardial injury in noncardiac surgery.

Tranexamic Acid in Patients Undergoing Noncardiac Surgery. PubMed

Less composite bleeding outcome (9.1% vs 11.7%). Not non-inferior for composite CV outcome.

Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists. PubMed

Surgery within 36 hours. Routine use of nerve blocks to supplement GA and spinal. Careful delivery of anaesthesia probably more important than type (GA/Spinal). Single shot nerve block may be repeated after 6 hours. "Do not attempt resuscitation decisions" = ? Use risk assessment tools and scores. Bone cement implantation syndrome. Complications in 20%, severe complications 2%, cardiorespiratory arrest in 0.5%. Participate in audit and regional review networks.

Dexamethasone and Surgical-Site Infection. PubMed

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study. PubMed

M-DASI should not be considered as a replacement for CPET, but rather as a triage tool for those who would benefit from further assessment (field walking tests / CPET)

Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. PubMed

1000 mg ferric carboxymaltose (Ferinject) before major elective abdominal surgery. No difference in 30-day mortality or need for transfusions.

Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial. PubMed

MAP 60-65 vs usual care in patients aged 65 years and older with vasodilatory hypotension. No difference in 90-day mortality (41% vs 43.8%).

Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. PubMed

Threshold = DASI 34 (7 METS) for increased perioperative risk. 12 questions. Max 58.2 = 9.89 METS. VO2 peak (mL/kg/min) = 0.43 x DASI + 9.6 METs (metabolic equivalents) = VO2 peak / 3.5

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. PubMed

1st-line inotrope = DOB, 1st-line vasopressor = NA

Paravertebral block with propofol anaesthesia does not improve survival compared with sevoflurane anaesthesia for breast cancer surgery: independent discussion of a randomised controlled trial. PubMed

Good commentary on anaesthesia and cancer.

Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. PubMed

Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. PubMed

Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. PubMed

TXA in CABG, trend towards less complications (14.3% vs 16.4%, p=0.053)

Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. PubMed

7% perioperative covert stroke. Increased risk of cognitive decline with covert stroke (42% vs 29%).

Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. PubMed

Paravertebral block + propofol vs GA (sevoflurane) + opioids. No difference in mortality, neuropathic pain, incisional pain.

Days at Home after Surgery: An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance. PubMed

Days at home 30 days after surgery is a valid and easy to measure patient-centred outcome metric.

Aspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial. PubMed

Single dose preop ASA 100 mg did not reduce 1-year mortality or morbidity

Anaesthetic depth and complications after major surgery: an international, randomised controlled trial. PubMed

Light GA (BIS 35) vs deep GA (BIS 50). No 1-year mortality difference.

Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. PubMed

TAVI superior to SAVR in STS low-risk patients

Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery. PubMed

Ongoing. GDT vs usual care in major GIT surgery.

Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. PubMed

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Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). PubMed

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. PubMed

Hydrocortisone vs placebo in ventilated patients with septic shock. No difference 90-day mortality. Hydrocortisone with faster resolution of shock (3 vs 4 days) and shorter duration ventilation.

Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. PubMed

Hydrocortisone + fludrocortisone, drotrecogin alfa, combination vs respective placebos, in septic shock. Hydrocortisone + fludrocortisone with lower 180-day mortality (46.6% vs 52.5%)

Organisational factors and mortality after an emergency laparotomy: multilevel analysis of 39 903 National Emergency Laparotomy Audit patients. PubMed

Standardised periop care has better 30-day and 90-day survival

Procedure-Specific Pain Management (PROSPECT) - An update. PubMed

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: renal endpoints. PubMed

1. AKI, 2. AKD Cr 30, 3. Death or RRT, 4. MAKE

Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS: A Randomized Clinical Trial. PubMed

Target lower (6-8 mL/kg) tidal volumes in NON-ARDS patients too

2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. PubMed

Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study. PubMed

Unexposed, single exposure, multiple exposure. Exposure before 3 yo. Testing at ages 8 to 12 or 15 to 20 yr. No difference in IQ. Parents of multiple exposure reported increased problems related to executive function, behavior, and reading.

Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial). PubMed

GDT (IVF + vasopressors) vs control. Less complications and LOS in GDT. No difference 6-month mortality.

An international consensus statement on the management of postoperative anaemia after major surgical procedures. PubMed

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A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. PubMed

PPC (atelectasis, pneumonia, ARDS, aspiration), postop pneumonia, postop respiratory failure.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary. PubMed

Choice of fluid type: physiological concepts and perioperative indications. PubMed

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Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. PubMed

ETT vs FM, and recent URTI < 2 weeks = high risk for respiratory critical events

Trial of decompressive craniectomy for traumatic intracranial hypertension. PubMed

Decompressive craniectomy in severe TBI. Mortality benefit but worse functional outcome.

A randomised double-blind trial of phenylephrine and metaraminol infusions for prevention of hypotension during spinal and combined spinal-epidural anaesthesia for elective caesarean section. PubMed

Metaraminol vs Phenylephrine. Metaraminol lower lactate and high UA pH, non-inferior to phenylephrine.

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. PubMed

Reduction in mortality from PPH (1.9% to 1.4%), RR 0·81, 95% CI 0·65-1·00; p=0·045). No difference all-cause mortality / transfusion / hysterectomy. Also issues with fragility index.

Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. PubMed

TXA in CABG. TXA had less bleeding. TXA had more seizures. No difference mortality or thrombotic complications.

International consensus statement on the peri-operative management of anaemia and iron deficiency. PubMed

Risk of perioperative bleeding related to highly selective cyclooxygenase-2 inhibitors: A systematic review and meta-analysis. PubMed

COX-2 inhibitors do not inhibit platelets, with no increased risk of bleeding. Can be continued perioperatively. Caution in 1) renal risk 2) thrombotic risk

Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. PubMed

BP management 10% vs 80 SBP / 40%. Less organ dysfunction in individualised group (46% vs 63%). No difference in 30-day mortality.

Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. PubMed

Hb 75 vs Hb 95 ICU (or Hb 85 on ward) post cardiac surgery. RS non-inferior. Growing evidence that restrictive protocols are not harmful to critically ill patients.

Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. PubMed

Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial. PubMed

EVAR vs no intervention for patients not suitable for open repair. No difference overall mortality. Lower aneurysm-related mortality.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. PubMed

Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. PubMed

Postop troponin rise associated with higher complications and mortality

Long-term outcomes in patients with septic shock transfused at a lower versus a higher haemoglobin threshold: the TRISS randomised, multicentre clinical trial. PubMed

Hb 70 vs Hb 90 in ICU septic shock. No difference 1-year mortality and HRQoL

AAGBI guidelines: the use of blood components and their alternatives 2016. PubMed

Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. PubMed

Exposure to GA for inguinal hernia repair before 36 months. Sibling matched (sibling within 3 years without exposure) Currently 8-15 years old 105 sibling pairs = 210 patients. No difference in IQ scores.

Acute pain management: scientific evidence, fourth edition, 2015. PubMed

Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids? PubMed

50% of HD unstable patients remain fluid responsive after initial resuscitation. Pulse pressure variation (with respiration, in intubated and ventilated patients) is useful predictor of fluid responsiveness. The change in CO after passive leg raising is most accurate predictor of fluid responsiveness, and is independent of ventilation mode.

Cervical spinal clearance: A prospective Western Trauma Association Multi-institutional Trial. PubMed

CT is effective in excluding significant injury (sensitivity 98.5%), further imaging with MRI may be warranted.

Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. PubMed

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). PubMed

Septic shock = vasopressors required for MAP > 65 + lactate > 2. Removal of severe sepsis definition. Use of qSOFA score.

Trial of early, goal-directed resuscitation for septic shock. PubMed

EGDT (including CVC with ScvO2) vs usual care. EGDT had no mortality benefit, with longer LOS, transfusion, and lower cost-effectiveness.

Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. PubMed

In severe trauma and major haemorrhage, plasma, platelets, RBC in 1:1:1 ratio vs 1:1:2 ratio. No signfiicant difference in 24-hour or 30-day mortality, but less 24-hour mortality from haemorrhage with 1:1:1 (9.2% vs 14.6%).

BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. PubMed

The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only. PubMed

Additional physician care vs paramedic-only care. Additional physician care assocaited with lower 30-day mortality (29% vs 45%) – as-treated analysis.

Liberal or restrictive transfusion after cardiac surgery. PubMed

Hb 75 vs Hb 90 post cardiac surgery. Higher mortality in RS (4.2% vs 2.6%, p=0.045, HR=1.64)

Safety guideline: reducing the risk from cemented hemiarthroplasty for hip fracture 2015: Association of Anaesthetists of Great Britain and Ireland British Orthopaedic Association British Geriatric Society. PubMed

Vigilance during cement application. IABP or stat NIBP. Beware sudden drop ETCO2. Maintain BP within 20%. Prepare vasopressors.

Risk of new or recurrent cancer after a high perioperative inspiratory oxygen fraction during abdominal surgery. PubMed

FiO2 0.8 vs FiO2 0.3 (intraop and 2 hours postop). Reduced cancer-free survival with 80% O2 (during and 2h postop), HR 1.19

Clonidine in patients undergoing noncardiac surgery. PubMed

Clonidine 200 mcg vs placebo. Clonidine blunts central ENS outflow. did not reduce mortality or MI in non-cardiac surgery. Increased risk of hypotension and cardiac arrest.

Aspirin in patients undergoing noncardiac surgery. PubMed

Aspirin (new) vs placebo. 2-by-2 factorial trial design. Perioperative aspirin increases major bleeding with no effect on mortality or MI

Consensus guidelines for the management of postoperative nausea and vomiting. PubMed

Goal-directed resuscitation for patients with early septic shock. PubMed

EGDT vs usual care. EGDT with no difference at 90-day mortality

Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. PubMed

Cardiac output monitoring reduces complications but not mortality

Albumin replacement in patients with severe sepsis or septic shock. PubMed

20% albumin + crystalloid to target serum albumin 30 g/L vs crystalloid alone. No difference in mortality or secondary outcomes.

Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. PubMed

UK National Hip Fracture Database, audit of 65,535 patients. GA vs spinal: no significant difference in 5-day or 30-day mortality. Cemented vs uncemented: higher mortality with cemented (1.6% vs 1.2%).

A randomized trial of protocol-based care for early septic shock. PubMed

Protocol-based EGDT (based on Rivers study) vs protocol-based standard therapy (based on published expert opinion) vs usual care. No difference in mortality or organ support. Significant mortality for sepsis ~ 20% 60-day mortality.

Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. PubMed

Updated international guidelines, including: antibiotics within 1 hour of cognition of septic shock, initial fluid resuscitation of 30 mL/kg crystalloid, NAd as 1st line vasopressor to MAP > 65, Ad as 2nd line

A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. PubMed

Lung-protective vs non-protective ventilation intraoperatively. Less acute respiratory failure (17% vs 5%), shorter LOS (-2.45 days).

Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. PubMed

Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. PubMed

CABG for complex lesions, PCI acceptable alternative for less complex disease (low SYNTAX scores)

Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review. PubMed

8 tools validated in multiple studies. P-POSSUM and Surgical Risk Scale are the most consistently accurate.

Evidence-based postoperative pain management after laparoscopic colorectal surgery. PubMed

Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. PubMed

No evidence that CVP predicts or should be used to guide fluid therapy.

The GENESIS project (GENeralized Early Sepsis Intervention Strategies): a multicenter quality improvement collaborative. PubMed

Resuscitation bundle in severe sepsis / septic shock reduced in-hospital mortality by 15% (43% to 29%), poor outcomes observed with low adherence to RB

Percutaneous coronary intervention vs. coronary artery bypass graft surgery for unprotected left main coronary artery disease in the drug-eluting stents era--an aggregate data meta-analysis of 11,148 patients. PubMed

PCI with DES for LMCA non-inferior to CABG

Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. PubMed

Both CABG and PCI reasonable. CABG for DM, ULMD, TVD, LVD

Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. PubMed

TXA group had lower mortality, greatest benefit in patients requiring massive transfusion

Perioperative fluid management strategies in major surgery: a stratified meta-analysis. PubMed

Goal-directed therapy group with better outcomes than liberal fluid therapy

Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. PubMed

30-day mortality was 1.9%, troponin T levels associated with 30-day mortality

Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. PubMed

HES vs Ringer's acetate. HES had higher 90-day mortality (51% vs 43%), 90-day RRT (22% vs 16%)

2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. PubMed

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Mortality after surgery in Europe: a 7 day cohort study. PubMed

7 day cohort, 4% mortality (1.2% to 21.5%)

Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. PubMed

Decompressive craniectomy in diffuse traumatic brain injury. PubMed

Decompressive craniectomy and extended GCS in severe TBI. DC decreased ICP and ICU LOS but associated with more unfavourable outcomes. Adjustment for pre-specified covariates showed no difference in mortality / outcomes / LOS.

The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. PubMed

Treatment with TXA after 3 hours associated with mortality from bleeding (4.4% vs 3.1%). Give TXA as early as possible to bleeding trauma patients. TXA may be harmful if given late.

ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). PubMed

Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy. PubMed

Neuraxial block in patients on anti-thrombotic therapy

Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). PubMed

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Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage. PubMed

FVIIa in trauma. No mortality difference. Less blood product wastage.

Endovascular versus open repair of abdominal aortic aneurysm. PubMed

EVAR vs open AAA. No difference all-cause mortality. EVAR = less intraop mortality but more later fatal endograft ruptures, more graft-related complications and higher cost.

Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). PubMed

Regional anaesthesia in patients on anti-thrombotic therapy

Comparison of dopamine and norepinephrine in the treatment of shock. PubMed

DA vs NAd in shock. No difference 28-day mortality. DA with more arrythmias (24% vs 12%), and higher mortality in cardiogenic shock.

Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. PubMed

ScvO2 70% vs lactate clearance > 10%. No inpatient mortality difference. This paper allowed development of non-invasive protocols.

Perioperative mortality risk score using pre- and postoperative risk factors in older patients. PubMed

Preop: "three A's" (age + ASA + albumin < 30) Postop: "three I's" (unplanned ICU + systemic inflammation + AKI)

Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. PubMed

FiO2 0.8 vs 0.3 intraop to 2-hours postop. No difference in wound infection

A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. PubMed

BSL 7.8-10.0 vs 4.4-6.1. Stopped early due to high rate of protocol violations. Lower BSL with lack of clinical benefit.

Intensive versus conventional glucose control in critically ill patients. PubMed

Intensive-control (4.5-6 mM) vs conventional (< 10 mM). Intensive-control had increased mortality (27.5% vs 24.9%)

General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. PubMed

GA vs LA for carotid surgery. No difference in composite primary outcome (stroke, MI, death). No difference in secondary outcomes QOL, LOS). No difference in subgroups (age, contralateral occlusion, baseline surgical risk)

Vasopressin versus norepinephrine infusion in patients with septic shock. PubMed

Vasopressin vs NA in septic shock. No difference in 28-day or 90-day mortality rate.

A comparison of epinephrine and norepinephrine in critically ill patients. PubMed

AD vs NA in shock. No difference in 28-day or 90-day mortality – for either septic shock or acute circulatory failure.

The Parkland formula under fire: is the criticism justified? PubMed

Urine output is the important parameter. The Parkland formula is only a resuscitation starting point.

Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. PubMed

Metoprolol (extended-release, pre-op and for 30-days post-op) vs placebo. Metoprolol group had more deaths and stroke, but less MI.

Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. PubMed

Bedside Lung Ultrasound in Emergency. Ultrasound on consecutive patients with respiratory failure.

Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. PubMed

NA + DOB vs AD for septic shock. No difference in mortality.

Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial. PubMed

FiO2 0.8 vs N2O:O2 70:30: less complications and PONV, but no difference LOS

Transfusion trigger trial for functional outcomes in cardiovascular patients undergoing surgical hip fracture repair (FOCUS). PubMed

Hb 80 vs Hb 100 in NOF patients. LS not superior

Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. PubMed

PAC in ICU. No difference 28-day mortality. No harm or benefit with PAC. Low powered study

Association between compensation status and outcome after surgery: a meta-analysis. PubMed

Compensation associated with poorer outcomes. OR 3.79 for unsatisfactory outcome.

Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. PubMed

Bedside screening tests for predicting difficult intubation have limited clinical value. Most useful = Mallampati + thyromental distance.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. PubMed

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ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery. PubMed

Hyperbaric bupivacaine. ED50 7.6 mg (1.5 mL), ED 95 11.2 mg (2.2 mL)

Coronary-artery revascularization before elective major vascular surgery. PubMed

Coronary revascularisation before elective surgery. No mortality benefit in STABLE CAD. Beneficial if clinical indicators, eg. 3VD + LVEF < 50%, 2VD + LAD, LMS, ACS

Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. PubMed

Methylprednisolone vs placebo in head trauma. Increased mortality 1052 [21.1%] vs 893 [17.9%] deaths. LD 2 g then 400 mg/hr for 48 hours. 2 g = 1000x basal, 400 mg = 200x basal

A comparison of albumin and saline for fluid resuscitation in the intensive care unit. PubMed

4% albumin vs NS in ICU for fluid resuscitation. No difference in 28-day mortality or complications.

Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. PubMed

TEA in major abdominal surgery: no major difference in morbidity or mortality

International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. PubMed

International Subarachnoid Aneurysm Trial. Open clipping vs endovascular coiling. Lower mortality (23.7% vs 30.6%) and dependency with endovascular treatment at 1 year. Sample = younger, WFNS 1-2, aneurysms < 10 mm

The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. PubMed

Multicentre Aneurysm Screening Study for AAA. Screening reduced mortality (65 vs 113 deaths). Elective surgery when AAA 5.5 cm

The Canadian C-spine rule for radiography in alert and stable trauma patients. PubMed

The CCR is described here. 3 questions: high-risk factor, safe assessment, active rotation 45 degrees, 100% sensitivity, 42% specficity

Intensive insulin therapy in critically ill patients. PubMed

BSL 4.4-6.1 vs <11.9. Lower BSL with lower 12-month mortality (4.6% vs 8.0%).

Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. PubMed

CHADS2 stroke risk index is described here, better than existing AFI and SPAF indices

Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. PubMed

Low-dose epidural infusion (0.1% bupivacaine with fentanyl 2 mcg/mL 10 mL) vs low-dose CSE vs traditional epidural (0.25% bupivacaine 10 mL + 10 mL boluses) for labour analgesia. Low-dose ED had higher rates of NVD (42% vs 35%), lower instrumental delivery, but more low APGAR scores (7 or less) and high-level resuscitation.

A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. PubMed

Restrictive strategy (Hb < 70) vs liberal strategy (Hb < 100) in ICU patients. No difference in 30-day mortality (RS as effective, except in patients with AMI and UA)

Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. PubMed

Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). PubMed

European Carotid Surgery Trial. Symptomatic and 70% stenosis = mortality benefit if early surgery. Asymptomatic and 70% stenosis = halve 5-year stroke risk. Weaker evidence as stenosis smaller. No mortality benefit if 0-30% or 100%. NICE Guidelines within 48 hours, max 2 weeks.

A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). PubMed