Anaesthetic depth and complications after major surgery: an international, randomised controlled trial
Publication date: Available online 20 October 2019Source: The LancetAuthor(s): Timothy G Short, Douglas Campbell, Christopher Frampton, Matthew T V Chan, Paul S Myles, Tomás B Corcoran, Daniel I Sessler, Gary H Mills, Juan P Cata, Thomas Painter, Kelly Byrne, Ruquan Han, Mandy H M Chu, Davina J McAllister, Kate Leslie, Australian and New Zealand College of Anaesthetists Clinical Trials Network, M Shulman, S Wallace, C Farrington, W Gallagher, A DitoroSummaryBackgroundAn association between increasing anaesthetic depth and decreased postoperative survival has been shown in observational studies; however, evidence from randomised controlled trials is lacking. Our aim was to compare all-cause 1-year mortality in older patients having major surgery and randomly assigned to light or deep general anaesthesia.MethodsIn an international trial, we recruited patients from 73 centres in seven countries who were aged 60 years and older, with significant comorbidity, having surgery with expected duration of more than 2 h, and an anticipated hospital stay of at least 2 days. We randomly assigned patients who had increased risk of complications after major surgery to receive light general anaesthesia (bispectral index [BIS] target 50) or deep general anaesthesia (BIS target 35). Anaesthetists also nominated an appropriate range for mean arterial pressure for each patient during surgery. Patients were randomly assigned in permuted blocks by region immediately before surgery, with the ...
Authors: Pandit A, Gupta N, Madan K, Bharti SJ, Kumar V Abstract Pulmonary alveolar proteinosis (PAP) is an uncommon lung disease characterized by excessive accumulation of pulmonary surfactant that usually requires treatment with whole-lung lavage. A 47-year-old female presented with history of dry cough and breathlessness for past 6months. Chest radiograph demonstrated bilateral alveolar shadows and high resolution computerized tomography thorax showed crazy paving pattern. Broncho-alveolar lavage (BAL) and transbronchial lung biopsy confirmed a diagnosis of PAP. Due to worsening hypoxemia and respiratory failure...
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