Prevention of the cardiovascular responses to laryngoscopy and tracheal intubation: A comparative study with verapamil, diltiazem, esmolol, labetalol and alfentalil

The aim of this study was to investigate the effect of verapamil, diltiazem, esmolol, labetalol and alfentanil on the prevention of the cardiovascular responses to laryngoscopy and tracheal intubation. We studied 120 female patients, ASA grade I and II, scheduled to undergo elective abdominal hysterectomy. They were randomly allocated to six groups of 20 patients each. Patients in group A received 5ml of NaCI 0.9%, in Β 20 mg/kg alfentanil, in C 0.1 mg/kg verapamil, in D 0.3 mg/kg diltiazem, in E 3 mg/kg esmolol and F 0.5 mg/kg labetalol. The under study agents were given in such a way so that their peak effect to coincide with the time of laryngoscopy and tracheal intubation. We may say in conclusion, that the under study agents did not have any beneficial effect on cardiovascular responses to laryngoscopy and tracheal intubation, except alfentanil. Alfentanil, in a dose of 20mg/kg was effective in alleviating the increase in SBP, DBP, HR and RPP while any adverse reactions were not noted.Στην παρούσα μελέτη εξετάσαμε την αποτελεσματικότητα της βεραπαμίλης, διλτιαζέμης, εσμολόλης, λαβεταλόλης και αλφεντανύλης στην πρόληψη των αιμοδυναμικών διαταραχών κατά τη λαρυγγοσκόπηση και ενδοτραχειακή διασωλήνωση. Το υλικό της μελέτης μας αποτέλεσαν 120 θήλεις ασθενείς ASA Ι και II που προγραμματίστηκαν να υποβληθούν σε κοιλιακή υστερεκτομία. Οι ασθενείς χωρίστηκαν τυχαία σε 6 ομάδες των 20 ατόμων η κάθε μία. Στην ομάδα Α' χορηγήθηκαν 5ml φυσιολογικού ορού, στη Β' 20mg/kg αλφεντανύλης, στη Γ 0,1mg/kg βεραπαμίλης, στη Δ' 0,3mg/kg διλτιαζέμης, στη Ε' 3mg/kg εσμολόλης και στη ΣΤ' 0,5mg/kg λαβεταλόλης. Οι υπό μελέτη παράγοντες χορηγούντο κατά τέτοιο τρόπο ώστε η μέγιστη δράση τους να συμπίπτει με το χρόνο της λαρυγγοσκόπησης. Συμπερασματικά, από τους παράγοντες που μελετήσαμε για την άμβλυνση της καρδιαγγειακής απάντησης κατά τη λαρυγγοσκόπηση και ενδοτραχειακή διασωλήνωση σε ασθενείς ASA Ι και II, η αλφεντανύλη σε δόση 20 mg/kg φαίνεται να είναι ο μόνος αποτελεσματικός παράγοντας στην πρόληψη της ταχυκαρδίας, της αύξησης της συστολικής και διαστολικής αρτηριακής πίεσης και του έργου του μυοκαρδίου. Η χορήγηση της δεν συνοδεύεται, επίσης, από ανεπιθύμητες ενέργειες, όπως υπόταση, βραδυκαρδία ή παρατεταμένη αναπνευστική καταστολή

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London