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EA20 Newsletter: Session 01L3 – Hot topics in general anaesthesiology – last 12 months’ top publications

 

Presented Sunday 29 November, 1130-1215H, Channel 2

A review of some of the most important studies in the field of general anaesthesiology was presented on the middle day of Euroanaesthesia by Prof Mark Coburn, University Hospital Bonn, Germany. He divided his talk into three general areas: preoperative evaluation, intraoperative management, and curiosities and oddities.

Beginning with frailty, Professor Coburn discussed how this indicator has a substantial effect on outcomes and can be described by many indices, including the Clinical Frail Scale. The first paper Prof Coburn presented was from Anesthesia & Analgesia, “Prospective Comparison of Preoperative Predictive Performance Between 3 Leading Frailty Instruments”

This multicentre prospective cohort study looked at 645 elective non-cardiac surgery patients aged 65 years and over, with frailty compared to traditional risk factors. The Clinical Frailty Scale, the Fried phenotype frailty criteria, the Frailty Index, and traditional risk factors like age, sex, ASA stage and type of surgery were all included in the analysis. The primary outcome was death or new disability within 90 days. The study found that all types of assessment performed well in assessing death or new disability, however, in predicting adverse discharge, only the Clinical Frailty Scale performed satisfactorily.

To view this study, click here

Continuing with Frailty, Prof Coburn assessed a systematic review from Anesthesiology: “Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery: A Systematic Review and Meta-analysis”. This found that the Clinical Frailty Scale has the strongest association with mortality and non-favourable discharge, while for complications, it is the Edmonton Frail Scale, and for delirium, the Frailty Phenotype rated the highest. For the feasibility of use, overall the Clinical Frailty Scale again came out on top. Prof Coburn also gave a brief pictorial description of the nine categories of the Clinical Frailty Scale, from very fit to terminally ill.

To view this study, click here

Among the papers discussed in intraoperative management were some related to COVID-19, including a study in Ananesthesia: “Risks to healthcare workers following tracheal intubation of patients with COVID‐19: a prospective international multicentre cohort study”.

This study of 1,718 healthcare workers from 503 hospitals in 17 countries shows that overall, 1 in 10 (10.7%) healthcare workers involved in intubating seriously ill patients with novel coronavirus disease 2019 (COVID-19) later reports symptoms (8.4%) or lab-confirmed COVID-19 (3.1%) themselves. Promisingly, most participants were found to be using WHO minimum standard personal protective equipment.

To view this study, click here

Another included study was from The Lancet: “Anaesthetic depth and complications after major surgery: an international, randomised controlled trial”. This study included 18,000 patients aged 60 years and over from 7 countries, assessing light (BIS 50) versus deep (BIS 35) anaesthesia for surgery lasting at least 2 hours. The study concluded among other results that among patients at increased risk of complications after major surgery, light general anaesthesia was not associated with lower 1-year mortality than deep general anaesthesia.

To view this study, click here

These are just a handful of the studies discussed by Prof Coburn in his talk, with others including several on the environmental sustainability of anaesthesia and the emissions the speciality causes, and in the ‘oddity’ section a paper on soft drink consumption and mortality. To view the whole talk, please go to the On-Demand section of the Euroanaesthesia virtual platform.

 

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1 reply

Siphiwe Mthembu
Its a good study will like to get more
10 months ago

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