“The purposes of these updated Guidelines are to improve the perioperative management of blood transfusion and adjuvant therapies and to reduce the risk of adverse outcomes associated with transfusions, bleeding or anemia. The updated ASA practice guidelines differ from those published by other organizations in that: they include greater use of pharmacologic therapies to minimize blood transfusions, such as erythropoietin for the anemic patient, prothrombin complex concentrates for urgent reversal of warfarin, and intraoperative antifibrinolytic therapy during selected cardiac and noncardiac procedures having a high risk for bleeding. They advocate the use of transfusion algorithms, especially those based on thromboelastographic testing, blood-ordering schedules, and restrictive transfusion strategies. Why does this statement differ from existing guidelines? These ASA guidelines differ from the existing guidelines because they provide new evidence obtained from recent scientific literature along with findings from new surveys of expert consultants and randomly selected ASA members. Click here to read full-text.
News You Can Use
“Diagnostic accuracy of digital screening mammography with and without computer-aided detection” and accompanying editorial, “Is it time to stop paying for computer-aided mammography?”by jmiller on November 12, 2015
Article concludes “Computer-aided detection does not improve diagnostic accuracy of mammography. These results suggest that insurers pay more for CAD with no established benefit to women.” (JAMA Intern Med, Nov) Click here to read full text.
“Redefining blood-pressure targets – SPRINT starts the marathon,” “A SPRINT to the finish” and original article “A randomized trial of intensive versus standard blood-pressure control”by jmiller on November 12, 2015
Article concludes “Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.” (NEJM, articles in press) Click here to read full text.
Society for ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgeryby jmiller on October 12, 2015
“Optimal evidence-based perioperative blood glucose control in patients undergoing ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing ambulatory surgery. It was revealed that there is insufficient evidence to provide strong evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. (Anesth Analg ) Click here to read full text.
Ginkgo biloba in the treatment of attention-deficit/hyperactivity disorder in children and adolescents.by jmiller on September 9, 2015
Article concludes: The ginkgo biloba is an effective and safe complementary tratment for ADHD. It resulted in significant increase in overall clinical treatment response. (Complementary Therapies in Clinical Pracitice, August) Click here to read full-text.
Article concludes: “The evidence for the viability of bone-targeted pharmacotherapy in preventing hip fracture and other clinical fragility fractures is mainly limited to women aged 65-80 years with osteoporosis, whereas the proof of hip fracture-preventing efficacy in women over 80 years of age and in men at all ages is meagre or absent. Further, the antihip fracture efficacy shown in clinical trials is absent in real-life studies. Many drugs for the treatment of osteoporosis have also been associated with increased risks of serious adverse events. There are also considerable uncertainties related to the efficacy of drug therapy in preventing clinical vertebral fractures, whereas the efficacy for preventing other fractures (relative risk reductions of 20-25%) remains moderate, particularly in terms of the low absolute risk reduction in fractures associated with this treatment. This “Key Symposium” appears in the August issue of Journal of Internal Medicine.Click here to read full-text.
An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in Intensive Care Unitsby jmiller on July 16, 2015
“The multisociety statement on responding to requests for potentially inappropriate treatments in intensive care units provides guidance for clinicians to prevent and manage disputes in patients with advanced critical illness.” (Am J Resp Crit Care Med, June 1) Click here to read full-text.
How slow is too slow? Correlation of operative time to complications? An analysis from the Tennessee Surgical Quality Collaborativeby jmiller on July 16, 2015
“Duration of operation correlates with complications and time longer than a statewide established standard carries higher risk. to reduce risk of complications, these data support expeditious surgical technique and preoperative pulmonary training, and offer accurate outcomes assessment for patient counseling based on case duratio. These data can be used directly to counsel individual surgeons to improve outcomes.” (Bull Am Coll Surg, July) Click here to read full-text.