Anestesiologia

Diretriz de consenso sobre tratamento hemostático, anticoagulação e terapia antiplaquetária no transplante hepático.

20 Jan, 2022 | 22:44h

Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation – Transplantation

Estudo randomizado | Em adultos com doença crítica, o uso de solução balanceada de multieletrólitos não reduziu o risco de morte ou lesão renal aguda em comparação à solução salina padrão.

20 Jan, 2022 | 22:05h

Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults – New England Journal of Medicine (link para o resumo – $ para o texto completo)

Comentário: Australian study set to guide the treatment of critically ill patients worldwide – George Institute for Global Health

Conteúdos relacionados:

BaSICS RCT: Among critically ill patients requiring fluid therapy, treatment with a balanced solution did not lead to reduced mortality compared to a 0.9% saline solution.

BaSICS RCT: Among critically ill patients requiring fluid therapy, there was no difference in mortality with slower (333 mL/h) vs. faster (999 mL/h) intravenous fluid bolus rates.

Cochrane Review: Buffered Solutions Do Not Improve Mortality in Critically Ill Adults and Children Compared to 0,9% Saline

Comentário no Twitter

Trial of critically ill patients compared balanced multielectrolyte solution (BMES) with saline as fluid therapy in the ICU. There was no evidence that the risk of death or acute kidney injury was lower with the use of BMES than with saline. https://t.co/bmlg4BYaw8 pic.twitter.com/OlKGOM0Dmm

— NEJM (@NEJM) January 18, 2022

Debate Pró-Con | Medida de troponina cardíaca como parte do seguimento rotineiro de dano miocárdico após cirurgia não cardíaca.

20 Jan, 2022 | 21:07h

Pro-Con Debate: Cardiac Troponin Measurement as Part of Routine Follow-up of Myocardial Damage Following Noncardiac Surgery – Anesthesia & Analgesia

Diretrizes ERAS para atenção perioperatória na cirurgia bariátrica.

20 Jan, 2022 | 20:02h

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update – World Journal of Surgery

Conteúdo relacionado: Complete List of Enhanced Recovery After Surgery (ERAS) Society Guidelines

Comentário no Twitter

#VisualAbstract ➡️ Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update@Jasosamd @iss_sic
🆓🔗https://t.co/HknWwLUjCZ pic.twitter.com/amhszadwup

— WJS (@WorldJSurg) January 5, 2022

Estudo randomizado | Em pacientes submetidos a entubação endotraqueal, a sobrevida de 7 dias foi significativamente menor com etomidato vs. cetamina (77,3% vs. 85,1%), mas as taxas de sobrevida em 28 dias não foram significativamente diferentes (etomidato 64,1% vs. cetamina 66,8%, p = 0,294).

20 Jan, 2022 | 19:44h

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial – Intensive Care Medicine

Comentário: SGEM#356: Drugs are gonna knock you out – etomidate vs. ketamine for emergency endotracheal intubation – The Skeptics’ Guide to EM

Comentário no Twitter

Etomidate vs ketamine for emergency endotracheal intubation, RCT
💉801 critically ill pts assigned to receive etomidate (0.2–0.3 mg/kg) or ketamine (1–2 mg/kg)
💉day 7 survival significantly lower with etomidate
💉no significantly different day 28 survivalhttps://t.co/CkxufORC8A pic.twitter.com/xQ4AtCifc7

— Intensive Care Medicine (@yourICM) December 17, 2021

Considerações cardiovasculares perioperatórias antes de cirurgia não cardíaca eletiva em pacientes com histórico de Covid-19.

17 Jan, 2022 | 13:16h

Perioperative Cardiovascular Considerations Prior to Elective Noncardiac Surgery in Patients With a History of COVID-19 – JAMA Surgery

Conteúdos relacionados:

Guideline: SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery

Study from 116 countries suggests surgery should be delayed for at least seven weeks following a COVID-19 diagnosis to reduce mortality risk

BJS commission on surgery and perioperative care post-COVID-19.

The risk of postoperative complications following major elective surgery in active or resolved COVID-19 in the United States – Major, elective surgery 0–4 weeks after Covid-19 is associated with greatly increased risk of postoperative complications; surgery performed 4–8 weeks after infection is still associated with an increased risk of pneumonia.

ASA Guidance: Preoperative testing for COVID-19 is essential, regardless of vaccination.

Position statement: Perioperative management of post-COVID-19 surgical patients.

Cohort study: Postoperative in-hospital mortality of patients with COVID-19 infection was more than double that in patients without COVID-19

Revisão sistemática | Limiares restritivos de transfusão podem reduzir as transfusões de forma segura em até 41% em uma ampla variedade de contextos clínicos.

17 Jan, 2022 | 13:01h

Transfusion thresholds for guiding red blood cell transfusion – Cochrane Library

Resumo: Is it safe to use lower blood counts (haemoglobin levels) as a trigger for blood transfusion in order to give fewer blood transfusions? – Cochrane Library

Conteúdos relacionados:

RCT: Among patients with acute MI and anemia, a restrictive transfusion strategy resulted in a noninferior rate of major cardiovascular events compared to a liberal transfusion strategy

Randomized trial: Liberal vs. restrictive transfusion thresholds in extremely low-birth-weight infants

Meta-Analysis: Effects of Restrictive vs. Liberal Transfusion Strategies on Longer-term Outcomes After Cardiac Surgery

Randomized Trial: In Patients Undergoing Cardiac Surgery, A Restrictive Transfusion Approach Does Not Increase the Risk of Acute Kidney Injury

Effects of restrictive red blood cell transfusion on the prognoses of adult patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials – Critical Care

Research: Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery

Transfusion Requirements After Cardiac Surgery: The TRACS Randomized Controlled Trial – JAMA

Comentário no Twitter

Less can be more: updated Cochrane review strengthens conclusions on safety of restrictive transfusion thresholds https://t.co/uKkvX5UJrS @EUBloodAlliance @WHO @AABB @NIHRresearch @CochraneLibrary @NICEComms @NHSBT @RutgersU @LSHTM @RDMOxford #transfusionmedicine pic.twitter.com/2QXQNqzvPK

— Cochrane Injuries (@cochraneINJ) December 22, 2021