Update in perioperative medicine: practice changing evidence published in 2016

Abstract

This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change. We integrated the new evidence into the existing body of medical knowledge and identified practical implications for real world patient care. The articles address issues related to anticoagulation, transfusion threshold, immunosuppressive medications, postoperative delirium, myocardial injury after noncardiac surgery, postoperative pain management, perioperative management of antihypertensives, perioperative fasting, and perioperative diabetic control.

Incidence of Myocardial Infarction After High-Risk Vascular Operations in Adults

“…4,32 With continually changing guidelines on management of chronic conditions, such as atrial fibrillation and anti-platelet therapy for stable ischemic heart disease, the incidence of perioperative MI or CAR is likely to remain in flux. 33 Finally, the definition of MI continues to evolve, and many investigators have advocated lower thresholds of troponin and early intervention upon detection of postoperative MIs. 25 To our knowledge, this study is the first to report the influence of hospital volume on cost and duration of stay after MI or CAR for major abdominal operations.…”

Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines

“…Some studies have shown an increased risk of bleeding and thromboembolic events in patients undergoing bridging therapy. [50][51][52][53][54][55] This decision must be discussed with the physician prescribing the warfarin.…”

Rational Use of Nonsteroidal Anti-Inflammatory Drugs. Clinical Guidelines

“…Их использование позволяет существенно повысить уровень обезболивания, улучшить качество жизни пациентов, а также снизить потребность в опиоидных анальгетиках. «Опиоид-сберегающее» действие НПВП позволяет уменьшить частоту НЯ, связанных с наркотическими препаратами: тошноты, рвоты, избыточной седации и нарушения перистальтики кишечника [55][56][57].…”