Professional news and highlights of January 2012 by Konstantin Lebedinskiy (Website Editor)
1/16/2012 12:00:00 AM
Professional news and highlights of January 2012
ISCHAEMIC OPHTHALMIC NEUROPATHY: OPENING THE DOOR?
Rare diseases and syndromes in any branch of medicine are unlucky – to be more precise, those patients who drop into this casuistic “small parts of percent” have unenviable fate. Doctors are usually unfamiliar with conditions they could see only once a whole life, pharmaceutical companies are more interested in wide market segments, and even as a topic of study such a curiosity is a hard task. One of such cases is ischaemic optic neuropathy (ION), known to be more frequent in patients operated in prone position, but never systematically evaluated for exact risk factors.
Members of The Postoperative Visual Loss Study Group headed by Lorri A. Lee from Seattle (Washington, USA) recently published the article “Risk Factors Associated with Ischemic Optic Neuropathy after Spinal Fusion Surgery” (Anesthesiology 2012; 116(1): 15–24) presenting the results of carefully performed multiinstitutional case control study, in which preexisting conditions and perioperative factors of patients with ION after spinal fusion from the ASA Postoperative Visual Loss Registry (n = 80) were compared with control subjects who did not develop ION (n = 315).
Obesity, Wilson frame use, longer anesthetic duration, male sex, greater estimated blood loss and decreased percent colloid administration were significantly and independently associated with ION after spinal fusion surgery. At least first half of these factors support authors’ suggestion about acute venous congestion of the optic canal as a potential etiology of ION in this setting. Unfortunately, the format of the study did not allow the authors to evaluate preventive measured – for example, head tilt or anti-inflammatory therapy, but… Certainly, a lot of further investigations have to be done, but the first door is “cracked”, as Mark A. Warner joked in the study’s accompanying editorial!
See also comment by J. Lance Lichtor at “Page 2” Anesthesiology’s blog…
BE ATTENTIVE WITH DABIGATRAN!
Dabigatran (Pradaxa) – oral anticoagulant, acting via direct thrombin inhibition – is widely used for treatment and prophylaxis of various thromboembolic events, including perioperative settings. RE-LY study (N Engl J Med. 2010; 363(19): 1875-6) was the first to suggest a small increased risk of myocardial infarction (MI) with the use of dabigatran etexilate vs warfarin in patients with atrial fibrillation.
Recently Ken Uchino and Adrian V. Hernandez from Cleveland (Ohio, USA) examined outcomes in nearly 30,000 patients from seven randomized trials of dabigatran use for stroke prophylaxis and postsurgical prophylaxis of deep venous thrombosis (Arch Intern Med. Published online January 9, 2012). The drug was associated with significantly higher risks for MI and acute coronary syndrome (ACS) than control medications or placebo; the risks remained elevated even when short-term studies were excluded. The increase in relative risk reaches 33%, but the increase in absolute risk was only 0.27%.
Invited commentators of the original article call the results "robust" and "alarming", while editorial note says the findings "deserve serious consideration" when deciding whether to use dabigatran. Both commentaries say the study emphasizes the importance of continuing scrutiny after a drug's approval. Anyway, remember risks and be attentive while using Dabigatran…
SIMPLE DOUBLING OR STILL USEFUL SUPPLEMENT?
“Bedside Procedures in the ICU” edited by Florian Falter (Papworth Hospital, Cambridge, UK) and written by authors mainly from Germany, UK and USA is available since the beginning of last December via the website of Springer Science+Business Media. The most interesting thing is that the same publishing house has printed recently another book on the exactly same topic– aimed for the same audience, of similar volume, and even of the same price… I mean almost completely US-written “Bedside Procedures for the Intensivist” (2010) edited by Heidi L. Frankel and Bennett P.
deBoisblanc, covering a lot of relevant issues – from common airway management to billing for bedside procedures. However, attentive learning outlines the difference between the two similar books: the previous one is truly “technique-oriented” while the new one seems to be more “problem-oriented”. Therefore, new “Bedside Procedures in the ICU” offers really step-by-step guidance for the most common physical interventions – from the “simplest” (DC cardioversion) to the most complex ones (ultrasound guided procedures, renal replacement therapy, etc.), including chapters on abdominal compartment syndrome and advanced non-invasive hemodynamic monitoring. It’s not only “textbook for the beginners” – but for this role the new book is a good choice. Preview example pages available at Amazon E-bookstore may give impression about this highly structured and detailed approach.
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