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Top 20 Research Studies of 2022 for Primary Care Physicians
This article summarizes the top 20 research studies of 2022 identified as POEMs (patient-oriented evidence that matters), excluding COVID-19. Statins for primary prevention of cardiovascular disease produce only a small absolute reduction in a person's likelihood of dying (0.6%), having a myocardial infarction (0.7%), or having a stroke (0.3%) over three to six years. Supplemental vitamin D does not reduce the risk of a fragility fracture, even in people with low baseline vitamin D levels or a previous fracture. Selective serotonin reuptake inhibitors are preferred medical therapy for panic disorder, and patients who disco...
Source: Pain Physician - April 13, 2023 Category: Anesthesiology Authors: Roland Grad Mark H Ebell Source Type: research

Statins Losing Their Luster?
STATINS HAVE NUMEROUS intriguing and potentially desirable pleiotropic anti-inflammatory effects that may clinically benefit patients undergoing cardiac surgery with/without cardiopulmonary bypass.1,2 Suggested clinical benefits include decreased postoperative morbidity (renal dysfunction, atrial fibrillation, myocardial infarction, stroke, infection) as well as decreased in-hospital mortality. While suppressing perioperative inflammation in patients undergoing cardiac surgery appears to make sense, nothing is ever as simple as it seems.
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 19, 2017 Category: Anesthesiology Authors: Richa Dhawan, Mark A. Chaney Tags: Editorial Source Type: research

Interventions to reduce cognitive impairments following critical illness: a topical systematic review
ConclusionNone of the interventions had significant positive effects on cognitive impairments following critical illness. Quality was negatively affected by study limitations, imprecision and indirectness in evidence. Clinical research on cognition is feasible, but large, well designed trials with a specific aim at reducing cognitive impairments are needed.
Source: Acta Anaesthesiologica Scandinavica - October 31, 2016 Category: Anesthesiology Authors: H. K. Nedergaard, H. I. Jensen, P. Toft Tags: Review Article Source Type: research

Subarachnoid Hemorrhage
Publication date: September 2016 Source:Anesthesiology Clinics, Volume 34, Issue 3 Author(s): Jeremy S. Dority, Jeffrey S. OldhamTeaser Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cereb...
Source: Anesthesiology Clinics - August 9, 2016 Category: Anesthesiology Source Type: research

Pharmacological modification of the perioperative stress response in noncardiac surgery
Publication date: June 2016 Source:Best Practice & Research Clinical Anaesthesiology, Volume 30, Issue 2 Author(s): Hans-Joachim Priebe The perioperative period is associated with alterations in the neuroendocrine, metabolic, and immune systems, referred to as “stress response.” The resultant increased sympathetic activity and elevated serum concentrations of catecholamines may adversely affect the cardiovascular system, resulting in cardiovascular instability (hypertension, tachycardia, and arrhythmia), morbidity (myocardial ischemia, myocardial infarction, and stroke), and mortality (cardiac death and fata...
Source: Best Practice and Research Clinical Anaesthesiology - July 8, 2016 Category: Anesthesiology Source Type: research

From preoperative evaluation to stroke center: Management of postoperative acute ischemic stroke
This article reviews the perioperative management (covering diagnosis and treatment), prevention (covering surgery postponement, management with anticoagulant/antiplatelet and the growing interest in statins and beta-blockers) and intraoperative recommendations (covering anaesthetic techniques, ventilation strategies, transfusion and blood pressure management) specifically for the general surgical population. A summary of current treatments is enlightened by recently described evidence for the effectiveness of mechanical thrombectomy.
Source: Anaesthesia, Critical Care and Pain Medicine - May 31, 2016 Category: Anesthesiology Source Type: research

Pharmacological modification of the perioperative stress response in non-cardiac surgery
Publication date: Available online 7 April 2016 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Hans-Joachim Priebe The perioperative period is associated with alterations in the neuroendocrine, metabolic, and immune systems, referred to as 'stress response'. The resultant increased sympathetic activity and elevated serum concentrations of catecholamines may adversely affect the cardiovascular system resulting in cardiovascular instability (hypertension, tachycardia, arrhythmia), morbidity (myocardial ischemia, myocardial infarction, stroke) and mortality (cardiac death, fatal stroke), partic...
Source: Best Practice and Research Clinical Anaesthesiology - April 6, 2016 Category: Anesthesiology Source Type: research

Peri‐operative cardiac protection for non‐cardiac surgery
Summary Cardiovascular complications are an important cause of morbidity and mortality after non‐cardiac surgery. Pre‐operative identification of high‐risk individuals and appropriate peri‐operative management can reduce cardiovascular risk. It is important to continue chronic beta‐blocker and statin therapy. Statins are relatively safe and peri‐operative initiation may be beneficial in high‐risk patients and those scheduled for vascular surgery. The pre‐operative introduction of beta‐blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should o...
Source: Anaesthesia - December 1, 2015 Category: Anesthesiology Authors: S. S. C. Wong, M. G. Irwin Tags: Review Article Source Type: research

New therapy in cardioprotection
Purpose of review: An increasing number of patients are presenting for major surgery with cardiovascular comorbidities. Evidence of myocardial injury was found in 8% of all noncardiac surgery patients older than 45 years and was associated with adverse outcome. For this reason, there has been a lot of interest in finding and evaluating effective cardioprotective interventions. Recent findings: Current evidence suggests that statins, volatile anesthetic agents, and propofol are cardioprotective. Beta blockers reduce myocardial injury, but the resultant hypotension may contribute to the increased all-cause mortality and stro...
Source: Current Opinion in Anaesthesiology - July 3, 2015 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Tong J. Gan Source Type: research

Perioperative statin therapy in patients at high risk for cardiovascular morbidity undergoing surgery: a review
Statins feature documented benefits for primary and secondary prevention of cardiovascular disease and are thought to improve perioperative outcomes in patients undergoing surgery. To assess the clinical outcomes of perioperative statin treatment in statin-naive patients undergoing surgery, a systematic review was performed. Studies were included if they met the following criteria: randomized controlled trials, patients aged ≥18 yr undergoing surgery, patients not already on long-term statin treatment, reported outcomes including at least one of the following: mortality, myocardial infarction, atrial fibrillation, strok...
Source: British Journal of Anaesthesia - December 11, 2014 Category: Anesthesiology Authors: de Waal, B. A., Buise, M. P., van Zundert, A. A. J. Tags: Review Articles Source Type: research

Relationship between early postoperative C-reactive protein elevation and long-term postoperative major adverse cardiovascular and cerebral events in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study
Conclusions Postoperative CRP elevation was associated with long-term postoperative MACCE in OPCAB patients. This was mitigated by postoperative statin medication. Furthermore, postoperative CRP elevation was associated with intraoperative parameters reflecting hypoperfusion and inflammation.
Source: British Journal of Anaesthesia - August 18, 2014 Category: Anesthesiology Authors: Min, J. J., Nam, K., Kim, T. K., Kim, H. J., Seo, J. H., Hwang, H. Y., Kim, K. B., Murkin, J. M., Hong, D. M., Jeon, Y. Tags: Cardiovascular Source Type: research