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ICͲ2009B (Usewithcaution) 

LandmarkTrials,ProminentPapers(shortlist)  BART  NEJMMay2008 Ͳ Aprotinin=јmortality,јnephrotox. Ͳ AlsomayјAMI/CVA/thrombosis  BͲAwareTrial TheLancet29May2004 Ͳ 2/3xequivocal=awareness Ͳ BISdecreasesawarenessinhighriskgroups Ͳ NNT=138x$16/BISuse=$2200/prevention  BͲUnware NEJMMarch2008 Ͳ BISvsETAG=nodiff Ͳ Moreliberalinclusion(includingobesity,bͲblockers,љexͲtol) Ͳ Singlehospital––likelyunderpowered  CARP  NEnglJMed2004Dec Ͳ CoronaryarteryrevascPROPHYLAXIS(b4surgery) Ͳ Nodiffb/wrevascandmedicalrxarmsforperiopeventsandEF@3mths  NICESUGAR NEJMMarch2009 Ͳ Prevevidence:hyperglycaemiaBSL>10mmol/L(180mg/dl)=worseM&Minacutelyill/ICU Ͳ TightcontrolBSL[4.5––6]=јdeath,јhypoglycaemiacfaimingforBSL<10  ENIGMA Anesthesiology.107(2):221Ͳ231,August2007. Ͳ 80:O2/20:N2vs70:N2O/30:O2insurgery>2hrs...flawed Ͳ SameLOS(primaryendpoint).љcomplications(wound&atelectasis/pneumonia)&PONV  ENIGMAII Ͳ FiO20.3fixedthistime.N2OvsnoN2o Ͳ Localstudy  ISAT  Lancet2002Oct Ͳ LowͲgradeaneurysmsforclipping.WFNSgrd1Ͳ3 Ͳ Coiling:clipping=23:30%1yeardependency/death Ͳ PossibletemporizingmeasureforhighͲgradeduetosurgicaldifficulties(oedema)  IHASTI  NEJM2005 Ͳ Lowgradeaneurysmsforclipping.33Cvsnormothermia(36.5C) Ͳ Nodiffneurooutcome(GlasgowOutcomeScore).Goodoutcomesin60Ͳ65%ofbothgroups. Ͳ Cooling=јbacteraemia5vs2.5% Ͳ Criticisms:notcoldenough,notearlyenough  IMPACT NEJM2004 Ͳ Ondansetron=dexamethadone=droperidol=TIVA.....(canљPONV25Ͳ30%) Ͳ Patientsriskdeterminesmanagement  MASTER AnesthesiaandAnalgesia2003;96(2):548Ͳ54 Ͳ EpivsIVopioids Ͳ decreaseinlengthofventilatordependence o thereforenotofadvantageifpatientnotgoingtobereintubated Ͳ undefinedpoints o whereinback,relativetoincision? o wasblockestablished? o whatwasinfusing? Ͳ nowhaveketamineaswell Ͳ qualityofanalgesiacanbeanendpoint 

ond0.AppropriatePONVprophylaxis&TIMING o AntiͲ5HT3––endofsurgery.volatiles o Surg––ENT.Opioids) o Anaesth––opiods.dexa0.ChildrenPONV o Gran40mcg/kg.breast.neuro Ͳ 2.IdentifyhighͲrisk o Pt––female.thereforeearlyaspossible o NonͲpharm––acupuncture/pressure/TENS/hypnosissomeefficacy o ControversialforPONV––maxolon.Monotherapyinferiortocombo(prophylaxisANDrescue)  Pressorsinobstetrics(CurrentOpinioninAnaesthesiology:June2006) Ͳ Alphaagonists>ephedrine:љnausea.Droperidol=blackbox.m=ftillpuberty Ͳ 3.2007May Ͳ Coronaryrevascularizationprophylaxis(forsurgery)––nobenefit  CARPTRIAL  NEnglJMed2004Dec Ͳ Asabove  REVERT   Circulation.ICͲ2009B (Usewithcaution)  MAGPIE Lancet2002 Ͳ Mghalveseclampticrisk.gynae.beginning2006) Ͳ AspiringandtranexamicacidinCAGS  CEA Ͳ NASCET(Stroke1991Jun) o Symptomaticptswithipsilateral:CEAvsmedical o 30days:morestrokedeathinCEAgroup(5.laparoscopy.N2O.8%vs3.FHRchanges.then20%perRFincl.riskincreasestopuberty.  COURAGETRIAL  NEnglJMed.nonͲsmoker.bettercontrol  ATACAS expectpublication2011Ͳ2012(5yrtrial.hxPONV/motionͲsickness ƒ (Apfel1999anaesthesiology10%baseline.97:62Ͳ71 Ͳ 1.2007Jul3 Ͳ BͲblockersslowcardiacremodellinginasympHF.2007Apr Ͳ PCIvsmaxmedicaltherapyÆnosurvivalbenefits Ͳ Confirmedin2009LancetmetaanalysisÆPTCA=BMS=DES=maxmed.probablyreducesmaternaldeath Ͳ Mg>lyticcocktail(peth.1mg/kg.Children o Studiesoftenrelatedtovomiting.notnausea o vomiting(cfadults).eye.  SAVE&TRACE&SMILEtrials Ͳ ACEͲinhibpostͲAMIwilldelayonsetofHFsymptomsandmayimproveoutcome Ͳ  CAPRICORNTrial Lancet2001May5 Ͳ BͲblockerpostͲAMI=љdeathљAMI Ͳ  SOLVD   NEnglJMed1992Sep Ͳ AceͲinhibforasymptomaticHFљsymptomsandљAMI Ͳ љdeathinfollowupXSOLVD  PONVconsensusguidelinesAnaesthesiaandAnalgesia2003.Samesurvival.05mg/kg.chlorprom.THC(goodforchemonauseatho) Ͳ 5.drop0.15mg/kg Ͳ 6.Reducebaselinerisk(anaesthetictechnique) o Regional/tiva/O2/hydration o љN2O/opiods/volatile/neostigmine Ͳ 4.ginger.3%) .promethazine)ͲCochraneSystRev2001  DECREASEͲV  JAmCollCardiol. o Prochlorperazine/Promethazineendofsurgery o Dexa––beforeinduction(butuncomfortable).

etal.(NEnglJMed1996) o Increasedsurvivalwithatenolol Ͳ BisoprololstudyͲPoldermans.etal.ICͲ2009B (Usewithcaution)  Ͳ o 2yrcumulativerisklower––lessipsilateralstroke/death(DELAYEDbenefit) o Morebenefitinage>75 ECST(Lancet1991May) o Symptomatic:Medicaltherapy(aspirin)vsCEA o Forcontrolgrp(medrx):riskofstrokerelatedtostenosisseverityONLYfor1st2Ͳ3yrs o GenerallyconfirmedNASCET ACAS(JAMA1995)/ACST(Lancet2004May o CEAbetter2yroutcomeforipsilateralstroke/death(5%vs11%) o Lessbenefitthansymptomatic(recommend:needlowersurgicalrisk<3%vs<6%) o Delaytobenefit/longterminvestment(worseoutcomeinsurgicalgroupforsometime o Evidencelesscompellingforwomen GALA(Lancet2008:372pg2132––2142) o NodiffbetweenGAvsLAat30daysforstroke/AMI/death Ͳ Ͳ  BͲblockers Ͳ AtenololstudyͲMangano.2008May o Aggressivemetoprolol(delay/withholddrugsonlyifHR<50orSBP<100) o BͲblockers=moredeath.morestroke.albumin o 3xI:unintendedICU.acuterenalimpairment  .lessAMI  ATRIAtrial Ͳ CHADS2scorederivedfromthis.ASA.  Otherpublications  AnaesthesiaandIntensiveCare2009 TheREASONAudit Ͳ ANZCATrialsGroup&ANZCAPerioperativeMedicineCommittee(localaudit) Ͳ POMscore o Preandpostoppredictors o 3xA:age.inflammation.(NEnglJMed1999) o 91%reductioninperiopAMI Ͳ POISETrialͲLancet.

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