Critical Care & Anaesthesia- November 2012



Critical Care & Anaesthesia – Update  



November 2012

Welcome to the November bulletin of 2012 highlighting new evidence published on selected topics relating to Critical Care, Anaesthesia, Pain and Resuscitation. This bulletin will continue in its current format following a positive evaluation by staff. Full text articles can be accessed via your HEFT Athens ID.


The following sub-topics are covered:

  • Cell salvage in surgery (including obstetric surgery)
  • Anaesthesia and surgical outcomes (including epidurals, regional anaesthesia)
  • Anaesthesia and Immunomodulation
  • Anaesthesia and post operative confusion


Title: Use of intraoperative cell salvage in neurosurgery

Citation: Transfusion Alternatives in Transfusion Medicine, December 2012, vol./is. 12/3-4(59-65), 1295-9022;1778-428X (December 2012) Author(s): Roberts H., Carroll C.

Abstract: Intraoperative cell salvage (ICS) is widely used in many surgical specialties, but uptake in neurosurgery has been slow. Little direct evidence exists to support the use of ICS in neurosurgical procedures; however, studies suggest that ICS may be safe and cost-effective in intracranial surgery and spinal fusion.


Title: Unwashed blood: Is widespread use justified? A review of current knowledge

Citation: Transfusion Alternatives in Transfusion Medicine, December 2012, vol./is. 12/3-4(72-77), 1295-9022;1778-428X (December 2012) Author(s): Munoz M., Slappendel R.

Title: Washing and filtering of cell-salvaged blood - does it make autotransfusion safer?

Citation: Transfusion Alternatives in Transfusion Medicine, December 2012, vol./is. 12/3-4(78-87), 1295-9022;1778-428X (December 2012) Author(s): Konig G., Waters J.H.

Abstract: Autologous transfusion was first performed in the late 1800s, but it was not until the 1970s that devices were developed that enabled widespread adoption of the practice. Unwashed salvaged blood contains thrombogenic products, cell breakdown products and plasma proteins, and gross chemical, cellular and physical contaminants. Washing and filtering of salvaged blood is routinely performed to remove or reduce these elements. In this paper we review the clinical data supporting the need for washing and filtering of salvaged blood.


Title: Residual blood processing by centrifugation, cell salvage or ultrafiltration in cardiac surgery: Effects on clinical hemostatic and ex-vivo rheological parameters

Citation: Blood Coagulation and Fibrinolysis, October 2012, vol./is. 23/7(622-628), 0957-5235;1473-5733 (October 2012) Author(s): Vonk A.B., Muntajit W., Bhagirath P., Van Barneveld L.J., Romijn J.W., De Vroege R., Boer C.

Abstract: The study compared the effects of three blood concentration techniques after cardiopulmonary bypass on clinical hemostatic and ex-vivo rheological parameters.


Title: Blood conservation in adult scoliosis surgery: A report of the first 15 months of the new Scottish National Adult Spine Deformity Correction Service

Citation: British Journal of Anaesthesia, September 2012, vol./is. 109/3(478P-479P), 0007-0912 (September 2012) Author(s): Carey K., Paul A., MacLaughlin S., Garrido E.

Full Text: Available from EBSCOhost EJS in BJA: British Journal of Anaesthesia


Title: Red cell utilization in revision hip surgery and attempting to reduce utilization using a standardized dose of tranexamic acid and appropriate cell salvage

Citation: British Journal of Anaesthesia, September 2012, vol./is. 109/3(475P-476P), 0007-0912 (September 2012) Author(s): Yoxall P.F., Mayhew D.

Abstract: The aim was to introduce a protocol of standardized dosage of tranexamic acid while encouraging greater utilization of intraoperative cell salvage to reduce transfusion requirements.

Full Text: Available from EBSCOhost EJS in BJA: British Journal of Anaesthesia



Cardiac arrests/cardiopulmonary resuscitation (CPR)

The following sub-topics are covered:

  • Quality of CPR
  • Use of feedback devices
  • Leadership and team factors


Title: Auditing resuscitation performance: Innovating to improve practice

Citation: Resuscitation, October 2012, vol./is. 83/10(1179-1180), 0300-9572;1873-1570 (October 2012) Author(s): Couper K., Abella B.S.

Full Text: Available from Elsevier in Resuscitation; Note: You will need to register (free of charge) with Science Direct the first time you use it.


Title: A new method of investigating the ergonomics of visual cardiopulmonary resuscitation (CPR) feedback delivery

Citation: Resuscitation, September 2012, vol./is. 83/9(e191-e192), 0300-9572;1873-1570 (September 2012) Author(s): Kovic I., Lulic I., Lulic D.

Full Text: Available from Elsevier in Resuscitation; Note: You will need to register (free of charge) with Science Direct the first time you use it.


Title: Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation

Citation: Critical Care Medicine, September 2012, vol./is. 40/9(2617-2621), 0090-3493;1530-0293 (September 2012) Author(s): Yeung J.H.Y., Ong G.J., Davies R.P., Gao F., Perkins G.D.

Abstract: Objective: This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed.

Full Text: Available from Ovid in Critical Care Medicine


Title: Leadership and resuscitation: Attention must be paid!-with apologies to Arthur Miller

Citation: Critical Care Medicine, September 2012, vol./is. 40/9(2719-2720), 0090-3493;1530-0293 (September 2012) Author(s): Fein A.B.

Full Text: Available from Ovid in Critical Care Medicine



Critical Care

The following sub-topics are covered:

  • Sepsis – the use of statins, biomarker MMP9
  • Acute lung injury (ALI)/adult respiratory distress syndrome (ARDS)
  • Use of non invasive ventilation (NIV) in weaning
  • Ventilator associate pneumonia (including E.Coli)


Title: Statins and hemoperfusion improve 28-day survival in septic shock patients

Citation: Central European Journal of Medicine, August 2012, vol./is. 7/4(475-480), 1895-1058;1644-3640 (August 2012) Author(s): Nakamura T., Sato E., Fujiwara N., Kawagoe Y., Maeda S., Inoue H., Yamagishi S.-I.

Abstract: The study examined retrospectively whether pre-existing statin and hemoperfusion with PMX-F at the time of admission were separately and independently associated with decreased overall 28-day mortality in septic shock patients.


Title: Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk

Citation: Journal of Critical Care, October 2012, vol./is. 27/5(447-453), 0883-9441;1557-8615 (October 2012) Author(s): Karnatovskaia L.V., et al.

Abstract: This study aims to estimate whether prehospital amiodarone also increases the risk of ALI/ARDS.


Title: Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing  countries of four continents: Findings of the International Nosocomial Infection  Control Consortium.

Citation: Crit Care Med. 2012 Sep 12. [Epub ahead of print] Author(s): Rosenthal VD, Rodrigues C, Alvarez-Moreno C, Madani N, Mitrev Z, Ye G, Salomao R, Ulger F, Guanche-Garcell H, Kanj SS, Cuéllar LE, Higuera F, Mapp T,

Fernández-Hidalgo R; International Nosocomial Infection Control Consortium Investigators.

Abstract: The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units.


Title: Inflammasome-regulated cytokines are critical mediators of acute lung injury.

Citation: American Journal of Respiratory & Critical Care Medicine, June 2012, vol./is. 185/11(1225-34), 1073-449X;1535-4970 (2012 Jun 1) Author(s): Dolinay T, Kim YS, Howrylak J, Hunninghake GM, An CH, Fredenburgh L, Massaro AF, Rogers A, Gazourian L, Nakahira K, Haspel JA, Landazury R, Eppanapally S, Christie JD, Meyer NJ, Ware LB, Christiani DC, Ryter SW, Baron RM, Choi AM

Abstract: The study sought to determine the contribution of the inflammasome pathway in experimental acute lung injury and human ARDS.


Title: Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia

Citation: Acta Anaesthesiologica Scandinavica, October 2012, vol./is. 56/9(1139-1145), 0001-5172;1399-6576 (October 2012) Author(s): Lunn T.H., Kristensen B.B., Gaarn-Larsen L., Husted H., Kehlet H.

Abstract: Post-anaesthesia care unit (PACU) admission must be well founded and the stay as short as possible without compromising patient safety. However, within the concept of fast-track surgery, studies are limited in addressing the question: why are patients staying in the PACU? All patients operated with primary unilateral total hip or knee arthroplasty (THA or TKA) under spinal anaesthesia were included in this hypothesis-generating, prospective, observational cohort study during a 4-month period.


Title: Cardiovascular disease predicts complications following bilateral total knee arthroplasty under a single anesthetic

Citation: Knee, October 2012, vol./is. 19/5(580-584), 0968-0160;1873-5800 (October 2012)

Author(s): Peskun C., Mayne I., Malempati H., Kosashvili Y., Gross A., Backstein D.

Abstract: This study evaluated the rate of perioperative complications of single anesthetic bilateral total knee arthroplasties (TKA) compared with staged procedures.


Title: Functional outcome after major orthopedic surgery: The role of regional anesthesia redefined

Citation: Current Opinion in Anaesthesiology, October 2012, vol./is. 25/5(621-628), 0952-7907;1473-6500 (October 2012) Author(s): Bernucci F., Carli F.

Abstract: This article aims to establish the impact of regional anesthesia in facilitating the recovery process, measured by significant clinical outcomes.


Title: Ultrasound-guided (USG) selective nerve blocks for knee surgery

Citation: Regional Anesthesia and Pain Medicine, September 2012, vol./is. 37/5 SUPPL. 1(E23-E26), 1098-7339 (September-October 2012) Author(s): BLrglum J., Lenz K., Christensen A.F., Johansen K.K., Worm B.S., Danker J., Jensen K.

Abstract: The aim of this refresher course paper regarding the administration of ''Ultrasound-guided (USG) selective nerve blocks for knee surgery'' is to highlight some of the current possibilities to provide various USG blocks and block combinations for several types of knee surgery.


Title: Ultrasound-guided nerve block for inguinal hernia repair: A randomized, controlled, double-blind study

Citation: Regional Anesthesia and Pain Medicine, September 2012, vol./is. 37/5(502-507), 1098-7339;1532-8651 (September-October 2012) Author(s): Baerentzen F., Maschmann C., Jensen K., Belhage B., Hensler M., Borglum J.

Abstract: We aimed to evaluate acute postoperative pain management in male adults randomized to receive an ultrasound-guided ilioinguinal and iliohypogastric nerve block administered before surgery, in addition to a standard analgesic regimen.


Title: Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery

Citation: HPB, September 2012, vol./is. 14/9(611-618), 1365-182X;1477-2574 (September 2012) Author(s): Revie E.J., McKeown D.W., Wilson J.A., Garden O.J., Wigmore S.J.

Abstract: Epidural analgesia is recommended for the provision of analgesia following major abdominal surgery. Continuous local anaesthetic wound infiltration may be an effective alternative. A prospective randomized trial was undertaken to compare these two methods following open liver resection. The primary outcome was length of time required to fulfil criteria for discharge from hospital.


Title: The effect of adding magnesium sulfate to lidocaine compared with paracetamol in prevention of acute pain in hand surgery patients under intravenous regional anesthesia (IVRA)

Citation: International Journal of Preventive Medicine, September 2012, vol./is. 3/9(616-621), 2008-7802;2008-8213 (September 2012) Author(s): Mirkheshti A., Aryani M.R., Shojaei P., Dabbagh A.

Abstract: This study was done to compare the analgesic effects of "magnesium plus lidocaine," "paracetamol plus lidocaine," and "placebo plus lidocaine" on block characteristics for intravenous regional anesthesia (IVRA) in patients undergoing upper extremity orthopedic surgery.

Full Text: Available from National Library of Medicine in International Journal of Preventive Medicine


Title: Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy?

Citation: Arthroscopy - Journal of Arthroscopic and Related Surgery, August 2012, vol./is. 28/8(1064-1069), 0749-8063;1526-3231 (August 2012) Author(s): Ward J.P., Albert D.B., Altman R., Goldstein R.Y., Cuff G., Youm T.

Abstract: To evaluate the utility of femoral nerve blocks in postoperative pain control after hip arthroscopy.


Title: Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: A prospective randomized study

Citation: Journal of Laparoendoscopic and Advanced Surgical Techniques, July 2012, vol./is. 22/6(550-555), 1092-6429;1557-9034 (01 Jul 2012) Author(s): Bessa S.S., Katri K.M., Abdel-Salam W.N., El-Kayal E.-S.A., Tawfik T.A.

Abstract: The aim of this study was to compare the surgical outcome of day-case laparoscopic cholecystectomy (DCLC) performed with the patient under spinal anesthesia with that performed with the patients under general anesthesia in the management of symptomatic uncomplicated gallstone disease.


Title: Impact of clinical severity index, infective pathogens, and initial empiric antibiotic use on hospital mortality in patients with ventilator-associated pneumonia

Citation: American Journal of Infection Control, September 2012, vol./is. 40/7(648-652), 0196-6553;1527-3296 (September 2012) Author(s): Tseng C.-C., Liu S.-F., Wang C.-C., Tu M.-L., Chung Y.-H., Lin M.-C., Fang W.-F.

Abstract: We investigated whether appropriate initial antibiotic therapy, infective pathogens, and the clinical severity index influence hospital mortality in patients with VAP and determined independent risk factors for the same.

Full Text: Available in American Journal of Infection Control at Heartlands Staff Library; Note: Available in print at Heartlands Library


Title: Ventilator-associated pneumonia: depends on your definition.

Citation: American Surgeon, August 2012, vol./is. 78/8(851-4), 0003-1348;1555-9823 (2012 Aug) Author(s): Novosel TJ, Hodge LA, Weireter LJ, Britt RC, Collins JN, Reed SF, Britt LD

Abstract: Reduction of hospital-acquired infections is a patient safety goal and regularly monitored by Performance Improvement committees. There is discordance between the ventilator-associated pneumonia (VAP) rate reported by the Infection Control Committee (ICC) and that observed by our Trauma Service. To investigate this difference, a retrospective evaluation of cases of VAP diagnosed on a single service was undertaken. Full Text: Available from ProQuest in American Surgeon, The


Title: Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis.

Citation: British Journal of Anaesthesia, September 2012, vol./is. 109/3(305-14), 0007-0912;1471-6771 (2012 Sep) Author(s): Glossop AJ, Shepherd N, Bryden DC, Mills GH

Abstract: A meta-analysis of the available evidence was performed on the use of NIV in three areas: weaning, reduction in reintubation rates post-extubation on ICU, and reduction in respiratory failure after major surgery.

Full Text: Available from EBSCOhost EJS in BJA: British Journal of Anaesthesia


New Books Added to the HEFT Libraries

            To reserve any of the above books, please go to and reserve them using your library ID and PIN number.


Further Information:

The following sources have been scanned for evidence published in the previous 8 weeks: Lancet, BMJ, JAMA, NEJM and American Journal of Critical Care Medicine; and articles from other journals as retrieved via searches on MEDLINE and EMBASE are also listed.

For a detailed list of sources that have been scanned, please contact [email protected]

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