Journal Club 2010-2011

Faculty: I Rampil, U Landman
Updated: 06-17-11


Date &

Topic, Papers, Comments
Intro to Reading Papers
HOW TO READ A PAPER - The basics of evidence based medicine, T Greenhalgh, 2001
Chapter 3: Getting your bearings (what is this paper about?)
Chapter 4: Assessing methodological quality
Cosyntropin for prophylaxis against postdural puncture headache after accidental dural puncture. Hakim SM. Anesthesiology. 2010 Aug;113(2):413 <PubMed
Types of Studies
We reviewed the article and discussed the anesthesia history as to why the use of CO2 disappeared. We made a comprehensive review of the types of studies.
Accelerated recovery from sevoflurane anesthesia with isocapnic hyperpnoea. Katznelson R, Minkovich L, Friedman Z, Fedorko L, Beattie WS, Fisher JA. Anesth Analg. 2008 Feb;106(2):486-91 <PubMed
Data and Descriptive Statistics
This article is of topical interest, although it will not change our practice. We reviewed the concepts of descriptive statistics.
Association between Epidural Analgesia and Cancer Recurrence after Colorectal Cancer Surgery. Gottschalk A, Ford JG, Regelin CC, You J, Mascha EJ, Sessler DI, Durieux ME, Nemergut EC. Anesthesiology. 2010 Jul;113(1):27-34 <PubMed
Comparing Groups
Disposable surgical face masks for preventing surgical wound infection in clean surgery. Lipp A, Edwards P. Cochrane Database of Systematic Reviews 2002, Issue 1. <Cochrane Reviews>
A comparison of 3% hypertonic saline and mannitol for brain relaxation during elective supratentorial brain tumor surgery. Wu CT, Chen LC, Kuo CP, Ju DT, Borel CO, Cherng CH, Wong CS. Anesth Analg. 2010 Mar 1;110(3):903-7 [PubMed]
Intracranial hypertension during surgery for supratentorial tumor: correlation with preoperative computed tomography scans. Bedford RF, Morris L, Jane JA. Anesth Analg. 1982 May;61(5):430-3 [PubMed]
Dr. Mervin Maze
An overview of the research of Dr. Mervin Maze. Dr. Maze will be the guest speaker at the Departmental Academic Research Evening on May 10.
Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Newman S, Stygall J, Hirani S, Shaefi S, Maze M. Anesthesiology. 2007 Mar;106(3):572-90. [PubMed]
Attentional effects of noradrenaline vary with arousal level: selective activation of thalamic pulvinar in humans. Coull JT, Jones ME, Egan TD, Frith CD, Maze M. Neuroimage. 2004 May;22(1):315-22 [PubMed]
The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. Anesthesiology. 2003 Feb;98(2):428-36 [PubMed]
Clinical uses of alpha2 -adrenergic agonists. Kamibayashi T, Maze M. Anesthesiology. 2000 Nov;93(5):1345-9 [PubMed]
Molecular mechanisms transducing the anesthetic, analgesic, and organ-protective actions of xenon. Preckel B, Weber NC, Sanders RD, Maze M, Schlack W. Anesthesiology. 2006 Jul;105(1):187-97 [PubMed]
We discussed some standard limitations of a retrospective study such as the Welch et al 2009 paper. One limitation is that the data is imcomplete. Here, weight was not included; this information would have been interesting to see. A retrospective study can only make associations and cannot address mechanisms. It was noted that it is very important to do a physical exam as part of your preop assessment and postop assessment. We discussed the role of "advisories". It was also noted that there is no real evidence behind much of the advisory information on preoperative nerve injuries. The 2011 paper does show that there is very little info on the subject yet we have OR personnel who are very attuned to padding/ positioning the patient. An advisory is noted to be mostly opinion. The final aspect of the JC involved a review of meta analysis.
Nerve injury associated with anesthesia: a closed claims analysis. Cheney FW, Domino KB, Caplan RA, Posner KL. Anesthesiology. 1999 Apr;90(4):1062-9. [PubMed]
Practice advisory for the prevention of perioperative peripheral neuropathies: an updated report by the American Society of Anesthesiologists task force on prevention of perioperative peripheral neuropathies. Anesthesiology. 2011 Apr;114(4):741-54. [PubMed]
Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. Welch MB, Brummett CM, Welch TD, Tremper KK, Shanks AM, Guglani P, Mashour GA. Anesthesiology. 2009 Sep;111(3):490-7. [PubMed]
Here are some questions to ponder:
  Is the study large enough?
  How do you define optimal?
  Are the results generalizable to our practice?
  What is the role of iv agents (ketamine, gabapentin, etc.)?
Dr. Zeqo gave a nice concise review of the article. We saw that it was important to identify the primary outcome is in a study and at what time point. The researchers looked at VAS score and another pain score. This article looked at 5 different groups: this requires a correction factor for multiple measurements. If the analysis of variance shows a significant difference among the groups, then a posthoc test must be done to determine which groups are significantly different.
We also reviewed the editorial "Do we have the Tools to Prevent Phantom Limb pain?". Dr. Milloul gave us a very complete historical review of Ethics in Research: from the Nuremberg code of 1948 through the violations seen recently in anesthesia research. It is important to remember that we should always be ethical in our life choices. Dr. Glass also informed us that the department will have a computer program to check all article submissions for originality.
Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial. Karanikolas M, Aretha D, Tsolakis I, Monantera G, Kiekkas P, Papadoulas S, Swarm RA, Filos KS. Anesthesiology. 2011 May;114(5):1144-54. [PubMed]

Drs Siddiqui, Florence and Rampil reviewed the article on Inspiratory Oxygen Fraction and Postoperative Complications in Obese patients. They discussed the relevance of BMI. In opting to study obese patients, the researchers had a greater chance of a detecting a difference in outcome. They also noted that some risks of BMI were not specifically addressed in the study: obese patients have an increased duration of surgery and a larger incision wound. Interestingly, it was noted that obese patients had a larger average rate of infection of 30%. This study did not detect any significant differences. However, the study appeared to be underpowered and probably should not have been published. It was published, however, probably because the study design involved a large consortium.
Dr. Foster gave a terrific and concise talk about giving oral presentations. She made many good points. For example, "tell them what you are going to say, tell them, and then tell them what you said."  One should also beware of using small fonts and poor color choices on slides. This information will definitely be useful to us no matter which side of the lecture podium we are standing.

Survey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests. Katz RI, Dexter F, Rosenfeld K, Wolfe L, Redmond V, Agarwal D, Salik I, Goldsteen K, Goodman M, Glass PS. Anesth Analg. 2011 Jan;112(1):207-12 [PubMed]
Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients: A Subgroup Analysis of the PROXI Trial. Stæhr AK, Meyhoff CS, Rasmussen LS; the PROXI Trial Group. Anesthesiology. 2011 Jun;114(6):1313-1319. [PubMed]

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