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Perioperative morbidity: lessons from recent clinical trials

Thiele, Robert H.a; Huffmyer, Julie L.b; Raphael, Jacobb

Current Opinion in Critical Care: August 2012 - Volume 18 - Issue 4 - p 358–365
doi: 10.1097/MCC.0b013e3283552af9
POSTOPERATIVE PROBLEMS: Edited by Andrew Shaw

Purpose of review: To identify the recent literature supporting the ability of anesthesiologists to impact morbidity and mortality outside of the immediate intraoperative period.

Recent findings: Hemodynamic management designed to optimize cardiac output and stroke volume can significantly lower the risk of perioperative morbidity, and, in some cases, mortality. The implications of the POISE trial, which upended the previously accumulating data in support of indiscriminate perioperative β-blockade by demonstrating worsened outcomes, were supported by high-quality, propensity-matched, prospectively collected data. Data supporting the safety of colloid use has been threatened by the retraction of 88 publications of a single author, as well as prospective, nonrandomized data, suggesting increased renal morbidity in critically ill patients receiving synthetic colloids. Large datasets continue to suggest an association between red blood cell transfusion and mortality. Analysis of the operating room strongly implicates anesthesia providers as a potential mechanism for bacterial contamination.

Summary: Anesthesiologists should consider implication of goal-directed therapy in high-risk surgical patients, adhere to the American College of Cardiology/American Heart Association guidelines with regard to perioperative β-blockade, critically assess the data to support their choice of synthetic colloids over crystalloids, explore all possible strategies for avoiding perioperative transfusion, and be cognizant of their potential contribution to perioperative infectious morbidity.

aDepartment of Anesthesiology, Duke University, Durham, North Carolina

bDepartment of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA

Correspondence to Robert H. Thiele, MD, Fellow, Critical Care Anesthesiology, Department of Anesthesiology, Duke University, Box 3094 Medical Center, Durham, NC 27710, USA. Tel: +1 434 249 3192; e-mail: robert.thiele@duke.edu

© 2012 Lippincott Williams & Wilkins, Inc.