Dose-Dependent Protective Effect of Inhalational Anesthetics Against Postoperative Respiratory Complications: A Prospective Analysis of Data on File From Three Hospitals in New England

Grabitz, Stephanie D.; Farhan, Hassan; Ruscic, Katarina J.; Timm, Fanny P.; Shin, Christina H.; Thevathasan, Tharusan; Staehr‐Rye, A. K.; Kurth, Tobias; Eikermann, Matthias

doi:10.1097/ccm.0000000000002015

Cited by 42 publications

(26 citation statements)

References 64 publications

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“…We used patient data from all sources to form one de-identified database, as previously reported by our group. [23][24][25] Patient involvement No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for recruitment, design, or implementation of the study. No patients were asked advice on interpretation or writing up of results.…”

Section: Methods Study Populationmentioning

confidence: 99%

Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study

Timm

Houle

Grabitz

et al. 2017

BMJ

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Objective To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate.Design Prospective hospital registry study.Setting Massachusetts General Hospital and two satellite campuses between January 2007 and August 2014.Participants 124 558 surgical patients (mean age 52.6 years; 54.5% women).Main outcome measures The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location.Results 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.6%) perioperative ischemic strokes occurred within 30 days of surgery. Patients with migraine were at increased risk of perioperative ischemic stroke (adjusted odds ratio 1.75, 95% confidence interval 1.39 to 2.21) compared with patients without migraine. The risk was higher in patients with migraine with aura (adjusted odds ratio 2.61, 1.59 to 4.29) than in those with migraine without aura (1.62, 1.26 to 2.09). The predicted absolute risk is 2.4 (2.1 to 2.8) perioperative ischemic strokes for every 1000 surgical patients. This increases to 4.3 (3.2 to 5.3) for every 1000 patients with any migraine diagnosis, 3.9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura.Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41).Conclusions Surgical patients with a history of migraine are at increased risk of perioperative ischemic stroke and have an increased 30 day hospital readmission rate. Migraine should be considered in the risk assessment for perioperative ischemic stroke.

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Section: Methods Study Populationmentioning

confidence: 99%

Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study

Timm

Houle

Grabitz

et al. 2017

BMJ

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“…Indeed, we found in our study that titration of IAs to blood pressure is key, as hypotension for greater than 11 minutes obliterated the protective effects (1).…”

Section: Areas For Future Researchmentioning

confidence: 84%

Proper selection of sedative drugs improves outcomes: volatile anesthetics are surgeons’ best friends

et al. 2017

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“…This finding was robust to sensitivity analysis of multiple subgroups, but interestingly, was not found to be present in patients with the longest periods of hypotension (≥11 min with mean arterial pressure <55 mmHg) [29 ▪▪ ].…”

Section: Introductionmentioning

confidence: 92%

Prevention of respiratory complications of the surgical patient

Ruscic

Grabitz

Rudolph

et al. 2017

Current Opinion in Anaesthesiology

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Purpose of reviewPostoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common.Recent findingsResults of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders.SummaryPreoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.

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Dose-Dependent Protective Effect of Inhalational Anesthetics Against Postoperative Respiratory Complications: A Prospective Analysis of Data on File From Three Hospitals in New England

Cited by 42 publications

References 64 publications

Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study

Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study

Proper selection of sedative drugs improves outcomes: volatile anesthetics are surgeons’ best friends

Prevention of respiratory complications of the surgical patient

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