Cognitive/ Memory Decline after Surgery / Anesthesia

A headline grabbing study in Anaesthesia suggests middle age memory decline after surgery and anesthesia. The effect was small and says anesthesia and surgery. As always it is unclear how much baseline condition was a marker for decline in this observational study but it joins the growing literature in adults and infants/children (link) on the potential link between anesthesia/surgery and the entire spectrum of delirium/post-op cognitive dysfunction/cognitive decline and even dementia.  link

 

ARDS Chest X-Ray Diagnosis

“The ability of clinicians from various backgrounds and years of experience to correctly identify ARDS according to CXRs is extremely poor, bringing the current ARDS definition into question. An educational intervention did not improve this. Better diagnostic tools for ARDS need to be developed, which may include biomarkers, ultrasound or CT imaging”.

Lke ASA physical status, something subjective is prone to variability and/or error.

Dr. Ferguson’s slide illustrates concisely the 2012 Berlin ARDS definition:

Acute Coronary Syndrome in Non-Cardiac Surgery

This study confirms our feeling that demand ischemia is the predominant etiology after noncardiac surgery rather than thrombotic obstruction or plaque rupture. So our focus should be to ensure prompt treatment of low MAP and volume status to maintain coronary perfusion, adequate oxygenation and anemia correction, sufficient analgesia and perhaps B-Blockers. (An interesting finding was a sizeable “stress-induced Takotsubo cardiomyopathy” incidence).  link

 

Weekly General Medical News

School intervention trial failed to curb childhood obesity. Doing all the right things but the problem goes deeper than schools alone  link bmj

Women with AFib have more symptoms, lower quality of life and higher stroke risk but lower overall and cardiovascular death risk  link

Netherlands to introduce presumed consent for organ donation in 2020 unless people opt out ink

Adolescent cannabis (and to a lesser degree, tobacco) use increase subsequent psychotic episodes  link

Curb your enthusiasm for Vitamin D mass screening and treatment for unproven indications link

New initiation of LABA or LAMAs in COPD increases severe cardiovascular risk  link

PE rule out criteria accurate for diagnosis – that is in extremely low risk patients  link

No benefit reported from Hydroxychloroquine in hand osteoarthritis  link

Measles immunization rates a concern as cases on the rise  link

Tdap and Influenza vaccines safe during pregnancy  link

Tooth decay is the most common chronic disease in US children  link

Managing cases of Tidepod ingestion  link

Canadian resident matching leaves many unmatched  link

Very preterm infants’ (<32 weeks) intelligence deficits largely associated with bronchopulmonary dysplasia have not improved   link

Alcohol use disorders a major risk factor for onset of all types of dementia, and especially early-onset dementia link

Low fat or low carb diets for weight loss no difference link

After 5 days Rivaroxaban in hip or knee arthroplasty, subsequent aspirin for 9(knee) or 30(hip)days was equivalent to continued Rivaroxaban for thromboembolism prevention  link

Carotid plaque volume correlated with symptoms of cerebral ischaemia, but not carotid stenosis. It could be a potential indicator for CEA. Plaque volume means more embolic potential  link

Oral contraceptives protect women against ovarian and endometrial cancer without raising risk for breast cancer.  link

Cranial electrical stimulation (not to be confused with transcranial magnetic stimulation) for various conditions not backed up by good quality evidence  link

WHO new guidelines on intrapartum care WHO   Or a quick summary here

Yes antidepressants do work  link

FDA warns of cardiac patient risks wth Clarithromycin (Biaxin)  fda

CABG has  mortality benefit over PCI only in multivessel or complex disease, especially in diabetes, and not in left main disease.  link

PPIs not linked to dementia link

 

Opioid Balance – Pain vs Misuse

“Opioid analgesics are an important part of our therapeutic armamentarium, but they have serious consequences when used improperly. As the pendulum swings from liberal opioid prescribing to a more rational, measured, and safer approach, we can strive to ensure that it doesn’t swing too far, leaving patients suffering as the result of injudicious policies”.

A reflection on controlling the current opioid pendulum swing from the New England Journal. Buprenorphine has a role in anslgesia   link

Hypertonic Saline for TBI and Intracranial Hypertension

While both mannitol and hypertonic saline are used for intracranial hypertension, a trend to better control has emerged with continuous hypertonic saline infusion as opposed to bolus dosing in adult traumatic brain injuries.

Sodium in the range of 145-155 or serum osmolality of 320 is the aim using 23.4% NaCl with 6 hourly Na monitoring and caution rapidly raising Na if hyponatremia exists to avoid central pontine myelinolysis.

link