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Fulltext Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS)

Shander A, Corwin HL, Meier J, Auerbach M, Bisbe E, Blitz J, et al.

Ann Surg, 2023 Apr 01;277(4):581-590.
PMID: 36134567 DOI: 10.1097/SLA.0000000000005721

BACKGROUND: Perioperative anemia has been associated with increased risk of red blood cell transfusion and increased morbidity and mortality after surgery. The optimal approach to the diagnosis and management of perioperative anemia is not fully established.
OBJECTIVE: To develop consensus recommendations for anemia management in surgical patients.
METHODS: An international expert panel reviewed the current evidence and developed recommendations using modified RAND Delphi methodology.
RESULTS: The panel recommends that all patients except those undergoing minor procedures be screened for anemia before surgery. Appropriate therapy for anemia should be guided by an accurate diagnosis of the etiology. The need to proceed with surgery in some patients with anemia is expected to persist. However, early identification and effective treatment of anemia has the potential to reduce the risks associated with surgery and improve clinical outcomes. As with preoperative anemia, postoperative anemia should be treated in the perioperative period.
CONCLUSIONS: Early identification and effective treatment of anemia has the potential to improve clinical outcomes in surgical patients.

Matched MeSH terms: Perioperative Period
Fulltext Diagnosing Perioperative Cardiovascular Risks in Noncardiac Surgery Patients

Li P, Lei Y, Li Q, Lakshmipriya T, Gopinath SCB, Gong X

J Anal Methods Chem, 2019;2019:6097375.
PMID: 31534814 DOI: 10.1155/2019/6097375

Every year, over 200 million adults are undergoing noncardiac surgery. These noncardiac surgery patients may face the risk of cardiac mortality and morbidity during the perioperative and recovery periods. Around ten million patients who underwent noncardiac surgery experience cardiac complications within the first 30 days of the postoperative period; the complications are myocardial infarction, cardiac death, and cardiac arrest. This cardiovascular risk is mostly faced by the patients having cerebrovascular or cardiac disease and the patients with the age greater than 50 years. Monitoring and treating cardiac diseases with a suitable biomarker during the perioperative period is necessary for the early recovery of noncardiac surgery patients. This review discussed the risk factors and the key guidelines to avoid the cardiovascular risks during the perioperative period of noncardiac surgery patients. In addition, the biomarkers and identification strategies for cardiac diseases are discussed.

Matched MeSH terms: Perioperative Period
Fulltext Perioperative very late stent thrombosis treated with thrombosuction

Sikdar S, Kumar D, Basu S, Mohanty V, Naik J, Banerjee S

Med J Malaysia, 2012 Feb;67(1):129-30.
PMID: 22582568
Matched MeSH terms: Perioperative Period
Fulltext Robotic Surgery: Anaesthesiologist's Contemplation

Kapur A, Kapur V

Malays J Med Sci, 2020 May;27(3):143-149.
PMID: 32684815 DOI: 10.21315/mjms2020.27.3.15

Technological advances in the field of surgery and medicine have increased the demand for minimally invasive surgery manifold. Robot assisted surgery is gaining popularity, overcoming the flaws of laparoscopic techniques; with improved surgical precision. The conservative nature of anaesthesia care has to face the challenges with respect to patient positioning, bulkiness of the operating system and being positioned far and away from the patient. Anaesthesiologist's commitment to be the 'best man' for the patient during the perioperative period mandates him to familiarise with these challenges of robot assisted surgical system and provide best possible anaesthetic care and ensure patient safety. In this article, a systematic review of the development of surgical robots and the consideration of unique anaesthetic concerns thereof have been undertaken as any new technology is known to be accompanied by its risks and technical perplexity.

Matched MeSH terms: Perioperative Period
Fulltext Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: a prospective international cohort study

Mrkobrada M, Chan MTV, Cowan D, Spence J, Campbell D, Wang CY, et al.

BMJ Open, 2018 07 06;8(7):e021521.
PMID: 29982215 DOI: 10.1136/bmjopen-2018-021521

OBJECTIVES: Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function.
SETTING AND PARTICIPANTS: We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents.
PARTICIPANTS: We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia.
PRIMARY AND SECONDARY OUTCOME MEASURES: Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment (MoCA) instrument. After surgery, a brain MRI study is performed between postoperative days 2 and 9 to determine the presence of acute brain infarction. One year after surgery, the MoCA is used to assess postoperative cognitive function. Physicians and patients are blinded to the MRI study results until after the last patient follow-up visit to reduce outcome ascertainment bias.We will undertake a multivariable logistic regression analysis in which the dependent variable is the change in cognitive function 1 year after surgery, and the independent variables are acute perioperative covert stroke as well as other clinical variables that are associated with cognitive dysfunction.
CONCLUSIONS: The NeuroVISION study will characterise the epidemiology of covert stroke and its clinical consequences. This will be the largest and the most comprehensive study of perioperative stroke after non-cardiac surgery.
TRIAL REGISTRATION NUMBER: NCT01980511; Pre-results.

Matched MeSH terms: Perioperative Period
Association of ethnicity and acute kidney injury after cardiac surgery in a South East Asian population

Chew ST, Mar WM, Ti LK

Br J Anaesth, 2013 Mar;110(3):397-401.
PMID: 23171723 DOI: 10.1093/bja/aes415

BACKGROUND: Postoperative acute kidney injury (AKI) is a frequent and serious complication after cardiac surgery. Clinical factors alone have failed to accurately predict the incidence of AKI after cardiac surgery. Ethnicity has been shown to be a predictor of AKI in the Western population. We tested the hypothesis that ethnicity is an independent predictor of AKI in patients undergoing cardiac surgery in a South East Asian population.
METHODS: A total of 1756 consecutive patients undergoing cardiac surgery were prospectively recruited. Among them, data of 1639 patients met the criteria for analysis. There were 1182 Chinese, 195 Indian, and 262 Malay patients. The main outcome was postoperative AKI, defined as a 25% or greater increase in preoperative to a maximum postoperative serum creatinine level within 3 days after surgery.
RESULTS: Five hundred and seventy-nine patients (35.3%) developed AKI after cardiac surgery. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery with Indians and Malays having a higher risk of developing AKI when compared with Chinese patients (odds ratio: Indian vs Chinese 1.44, Malay vs Chinese 1.51).
CONCLUSIONS: Indians and Malays have a higher risk of developing AKI after cardiac surgery than Chinese in a South East Asian population. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery.

Matched MeSH terms: Perioperative Period