Search

Your search keyword '"Brull, R"' showing total 448 results
Start Over Author "Brull, R"
448 results on '"Brull, R"'

2. A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Author

Wallace, S., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Ismail, H., Riedel, B., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Au, S., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, J.K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., S James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., R Lifford, R., Melo, M., Mamdani, M., Hillis, G., Wijeysundera, H.C., Riedel, Bernhard, Li, Michael H-G., Lee, C.H. Angus, Ismail, Hilmy, Cuthbertson, Brian H., Wijeysundera, Duminda N., and Ho, Kwok M.

Published
2021
Full Text
View/download PDF

3. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Author

Cuthbertson, B.H., Wijeysundera, D.N., Pearse, R.M., Myles, P.S., Abbott, T.E.F., Shulman, M.A., Torres, E., Ambosta, A., Melo, M., Mamdani, M., Thorpe, K.E., Wallace, S., Farrington, C., Croal, B.L., Grocott, M.P.W., Granton, J.T., Oh, P., Thompson, B., Levett, D., Hillis, G., Beattie, W.S., Wijeysundera, H.C., Wijeysundera, Duminda N., Beattie, W. Scott, Hillis, Graham S., Abbott, Tom E.F., Shulman, Mark A., Ackland, Gareth L., Mazer, C. David, Myles, Paul S., Pearse, Rupert M., Cuthbertson, Brian H., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Ismail, H., Riedel, B., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., and Lifford, R.

Published
2020
Full Text
View/download PDF

4. Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study

Author

Myles, P.S., Shulman, M.A., Wallace, S., Farrington, C., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Ismail, H., Riedel, B., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Wijeysundera, D.N., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Granton, J.T., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Croal, B.L., Lum, M., Martin, D., James, S., Filipe, H., Pinto, M., Kynaston, S., Pearse, R.M., Abbott, T.E.F., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., Lifford, R., Cuthbertson, B.H., Torres, E., Ambosta, A., Melo, M., Mamdani, M., Thorpe, K.E., Grocott, M.P.W., Hillis, G., Wijeysundera, H.C., Bartoszko, J., and Laupacis, A.

Published
2019
Full Text
View/download PDF

5. Association of peri‐operative prescription of non‐steroidal anti‐inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims‐based cohort study.

Author

Hussain, N., Brull, R., Gilron, I., Weaver, T. E., Shahzad, H., D'Souza, R. S., Abdel‐Rasoul, M., Clarke, H., McCartney, C. J. L., and Abdallah, F. W.

Subjects
*TOTAL knee replacement, *ANTI-inflammatory agents, *DRUGS, *POSTOPERATIVE pain treatment, *KNEE pain, *OPIOIDS
Abstract

Summary: Non‐steroidal anti‐inflammatory drugs (NSAIDs) are one of the mainstays of multimodal pain management. While effective for acute pain control, recent pre‐clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. Our objective was to explore the association between peri‐operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90–180 days in previously opioid‐naïve patients undergoing total knee arthroplasty. A database of health claims in the USA was used to identify all opioid‐naïve adult patients who underwent primary knee arthroplasty between January 2010 and October 2021. We evaluated the magnitude of association between peri‐operative prescription NSAID claims and claims for opioids at 90 days postoperatively using multivariable logistic regression models. Secondary outcomes included: the magnitude of association between peri‐operative NSAID prescription and claims for opioids at 180 days postoperatively; and identifying other potential factors associated with opioid claims at 90 days postoperatively. After risk adjustment using multivariable logistic regression models in the 789,736‐patient cohort, the adjusted odds ratio (95%CI) for a continuous claim of opioids at 90 and 180 days postoperatively among patients with a peri‐operative NSAID prescription within 30 days was 1.32 (1.30–1.35), p < 0.001; and 1.12 (1.10–1.15), p < 0.001, respectively. This estimate of effect remained robust at 90 days after accounting for known potential confounders, including pre‐existing knee pain and acute postoperative pain severity. Similar analysis of other pain medications (e.g. paracetamol) did not detect such an association. This population‐based cohort study suggests that peri‐operative prescription NSAID use may be associated with continued opioid prescription claims at 90 and 180 days after knee arthroplasty, even after adjusting for other observed covariates for continuous opioid claims. These novel findings can inform clinical decision‐making for post‐surgical pain management, risk–benefit discussions with patients and future research. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

17. Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction.

Author

Hussain, N., Brull, R., Vannabouathong, C., Speer, J., Lagnese, C., McCartney, C. J. L., and Abdallah, F. W.

Subjects
*ANTERIOR cruciate ligament surgery, *NERVE block, *CONDUCTION anesthesia, *ANESTHESIA, *FEMORAL nerve, *SCIATIC nerve, ANALGESIC effectiveness
Abstract

Summary: Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta‐analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid‐related adverse effects and functional recovery. Network meta‐analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft‐donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single‐injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respectively). Continuous femoral nerve block had the highest probability (87%) of reducing opioid‐related adverse effects, while local infiltration analgesia had the highest probability (88%) of optimising functional recovery. In contrast, systemic analgesia, local infiltration analgesia and adductor canal block were each poor performers across all analgesic outcomes. Regional anaesthesia techniques that target both the femoral and sciatic nerve distributions, namely a combination of single‐injection nerve blocks, provide the most consistent analgesic benefits for anterior cruciate ligament reconstruction compared with all other techniques but will most likely impair postoperative function. Importantly, adductor canal block, local infiltration analgesia and systemic analgesia alone each perform poorly for acute pain management following anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

Published
2023
Full Text
View/download PDF

19. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Author

Wijeysundera, DN, Beattie, WS, Hillis, GS, Abbott, TEF, Shulman, MA, Ackland, GL, Mazer, CD, Myles, PS, Pearse, RM, Cuthbertson, BH, Measurement of Exercise Tolerance before Surgery Study Investiga, Wallace, S, Farrington, C, Thompson, B, Ellis, M, Borg, B, Kerridge, RK, Douglas, J, Brannan, J, Pretto, J, Godsall, MG, Beauchamp, N, Allen, S, Kennedy, A, Wright, E, Malherbe, J, Ismail, H, Riedel, B, Melville, A, Sivakumar, H, Murmane, A, Kenchington, K, Kirabiyik, Y, Gurunathan, U, Stonell, C, Brunello, K, Steele, K, Tronstad, O, Masel, P, Dent, A, Smith, E, Bodger, A, Abolfathi, M, Sivalingam, P, Hall, A, Painter, TW, Macklin, S, Elliott, A, Carrera, AM, Terblanche, NCS, Pitt, S, Samuels, J, Wilde, C, Leslie, K, MacCormick, A, Bramley, D, Southcott, AM, Grant, J, Taylor, H, Bates, S, Towns, M, Tippett, A, Marshall, F, Kunasingam, J, Yagnik, A, Crescini, C, Yagnik, S, McCartney, CJL, Choi, S, Somascanthan, P, Flores, K, Karkouti, K, Clarke, HA, Jerath, A, McCluskey, SA, Wasowicz, M, Granton, JT, Day, L, Pazmino-Canizares, J, Oh, P, Belliard, R, Lee, L, Dobson, K, Chan, V, Brull, R, Ami, N, Stanbrook, M, Hagen, K, Campbell, D, Short, T, Van Der Westhuizen, J, Higgie, K, Lindsay, H, Jang, R, Wong, C, Mcallister, D, Ali, M, Kumar, J, Waymouth, E, Kim, C, Dimech, J, Lorimer, M, Tai, J, Miller, R, Sara, R, Collingwood, A, Olliff, S, Gabriel, S, Houston, H, Dalley, P, Hurford, S, Hunt, A, Andrews, L, Navarra, L, Jason-Smith, A, Thompson, H, McMillan, N, Back, G, Croal, BL, Lum, M, Martin, D, James, S, Filipe, H, Pinto, M, Kynaston, S, Phull, M, Beilstein, C, Bodger, P, Everingham, K, Hu, Y, Niebrzegowska, E, Corriea, C, Creary, T, Januszewska, M, Ahmad, T, Whalley, J, Haslop, R, McNeil, J, Brown, A, MacDonald, N, Pakats, M, Greaves, K, Jhanji, S, Raobaikady, R, Black, E, Rooms, M, Lawrence, H, Koutra, M, Pirie, K, Gertsman, M, Jack, S, Celinski, M, Levett, D, Edwards, M, Salmon, K, Bolger, C, Loughney, L, Seaward, L, Collins, H, Tyrell, B, Tantony, N, Golder, K, Stephens, RCM, Gallego-Paredes, L, Reyes, A, Gutierrez Del Arroyo, A, Raj, A, Lifford, R, International and National Coordinators, Central Project Office Operations Committee, CPET Methods Committee, Outcome Adjudication Committee, and International Steering Committee

Abstract

BACKGROUND: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. METHODS: The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. RESULTS: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96-0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92-0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00-1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01-1.05). CONCLUSIONS: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.

Published
2020

20. MRS of the Breast

Author

Allouche-Arnon, H., primary, Arazi-Kleinman, T., additional, Fraifeld, S., additional, Uziely, B., additional, and Katz-Brull, R., additional

Published
2014
Full Text
View/download PDF

26. A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Author

Riedel, Bernhard, primary, Li, Michael H-G., additional, Lee, C.H. Angus, additional, Ismail, Hilmy, additional, Cuthbertson, Brian H., additional, Wijeysundera, Duminda N., additional, Ho, Kwok M., additional, Wallace, S., additional, Thompson, B., additional, Ellis, M., additional, Borg, B., additional, Kerridge, R.K., additional, Douglas, J., additional, Brannan, J., additional, Pretto, J., additional, Godsall, M.G., additional, Beauchamp, N., additional, Allen, S., additional, Kennedy, A., additional, Wright, E., additional, Malherbe, J., additional, Ismail, H., additional, Riedel, B., additional, Melville, A., additional, Sivakumar, H., additional, Murmane, A., additional, Kenchington, K., additional, Kirabiyik, Y., additional, Gurunathan, U., additional, Stonell, C., additional, Brunello, K., additional, Steele, K., additional, Tronstad, O., additional, Masel, P., additional, Dent, A., additional, Smith, E., additional, Bodger, A., additional, Abolfathi, M., additional, Sivalingam, P., additional, Hall, A., additional, Painter, T.W., additional, Macklin, S., additional, Elliott, A., additional, Carrera, A.M., additional, Terblanche, N.C.S., additional, Pitt, S., additional, Samuels, J., additional, Wilde, C., additional, Leslie, K., additional, MacCormick, A., additional, Bramley, D., additional, Southcott, A.M., additional, Grant, J., additional, Taylor, H., additional, Bates, S., additional, Towns, M., additional, Tippett, A., additional, Marshall, F., additional, Mazer, C.D., additional, Kunasingam, J., additional, Yagnik, A., additional, Crescini, C., additional, Yagnik, S., additional, McCartney, C.J.L., additional, Choi, S., additional, Somascanthan, P., additional, Flores, K., additional, Au, S., additional, Beattie, W.S., additional, Karkouti, K., additional, Clarke, H.A., additional, Jerath, A., additional, McCluskey, S.A., additional, Wasowicz, M., additional, Day, L., additional, Pazmino-Canizares, J., additional, Oh, P., additional, Belliard, R., additional, Lee, L., additional, Dobson, K., additional, Chan, V., additional, Brull, R., additional, Ami, N., additional, Stanbrook, M., additional, Hagen, K., additional, Campbell, D., additional, Short, T., additional, Van Der Westhuizen, J., additional, Higgie, J.K., additional, Lindsay, H., additional, Jang, R., additional, Wong, C., additional, Mcallister, D., additional, Ali, M., additional, Kumar, J., additional, Waymouth, E., additional, Kim, C., additional, Dimech, J., additional, Lorimer, M., additional, Tai, J., additional, Miller, R., additional, Sara, R., additional, Collingwood, A., additional, Olliff, S., additional, Gabriel, S., additional, Houston, H., additional, Dalley, P., additional, Hurford, S., additional, Hunt, A., additional, Andrews, L., additional, Navarra, L., additional, Jason-Smith, A., additional, Thompson, H., additional, McMillan, N., additional, Back, G., additional, Lum, M., additional, Martin, D., additional, S James, S., additional, Filipe, H., additional, Pinto, M., additional, Kynaston, S., additional, Phull, M., additional, Beilstein, C., additional, Bodger, P., additional, Everingham, K., additional, Hu, Y., additional, Niebrzegowska, E., additional, Corriea, C., additional, Creary, T., additional, Januszewska, M., additional, Ahmad, T., additional, Whalley, J., additional, Haslop, R., additional, McNeil, J., additional, Brown, A., additional, MacDonald, N., additional, Pakats, M., additional, Greaves, K., additional, Jhanji, S., additional, Raobaikady, R., additional, Black, E., additional, Rooms, M., additional, Lawrence, H., additional, Koutra, M., additional, Pirie, K., additional, Gertsman, M., additional, Jack, S., additional, Celinski, M., additional, Levett, D., additional, Edwards, M., additional, Salmon, K., additional, Bolger, C., additional, Loughney, L., additional, Seaward, L., additional, Collins, H., additional, Tyrell, B., additional, Tantony, N., additional, Golder, K., additional, Ackland, G.L., additional, Stephens, R.C.M., additional, Gallego-Paredes, L., additional, Reyes, A., additional, Gutierrez del Arroyo, A., additional, Raj, A., additional, R Lifford, R., additional, Melo, M., additional, Mamdani, M., additional, Hillis, G., additional, and Wijeysundera, H.C., additional

Published
2021
Full Text
View/download PDF

29. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Author

Wijeysundera, Duminda N., primary, Beattie, W. Scott, additional, Hillis, Graham S., additional, Abbott, Tom E.F., additional, Shulman, Mark A., additional, Ackland, Gareth L., additional, Mazer, C. David, additional, Myles, Paul S., additional, Pearse, Rupert M., additional, Cuthbertson, Brian H., additional, Myles, P.S., additional, Shulman, M.A., additional, Wallace, S., additional, Farrington, C., additional, Thompson, B., additional, Ellis, M., additional, Borg, B., additional, Kerridge, R.K., additional, Douglas, J., additional, Brannan, J., additional, Pretto, J., additional, Godsall, M.G., additional, Beauchamp, N., additional, Allen, S., additional, Kennedy, A., additional, Wright, E., additional, Malherbe, J., additional, Ismail, H., additional, Riedel, B., additional, Melville, A., additional, Sivakumar, H., additional, Murmane, A., additional, Kenchington, K., additional, Kirabiyik, Y., additional, Gurunathan, U., additional, Stonell, C., additional, Brunello, K., additional, Steele, K., additional, Tronstad, O., additional, Masel, P., additional, Dent, A., additional, Smith, E., additional, Bodger, A., additional, Abolfathi, M., additional, Sivalingam, P., additional, Hall, A., additional, Painter, T.W., additional, Macklin, S., additional, Elliott, A., additional, Carrera, A.M., additional, Terblanche, N.C.S., additional, Pitt, S., additional, Samuels, J., additional, Wilde, C., additional, Leslie, K., additional, MacCormick, A., additional, Bramley, D., additional, Southcott, A.M., additional, Grant, J., additional, Taylor, H., additional, Bates, S., additional, Towns, M., additional, Tippett, A., additional, Marshall, F., additional, Mazer, C.D., additional, Kunasingam, J., additional, Yagnik, A., additional, Crescini, C., additional, Yagnik, S., additional, McCartney, C.J.L., additional, Choi, S., additional, Somascanthan, P., additional, Flores, K., additional, Wijeysundera, D.N., additional, Beattie, W.S., additional, Karkouti, K., additional, Clarke, H.A., additional, Jerath, A., additional, McCluskey, S.A., additional, Wasowicz, M., additional, Granton, J.T., additional, Day, L., additional, Pazmino-Canizares, J., additional, Oh, P., additional, Belliard, R., additional, Lee, L., additional, Dobson, K., additional, Chan, V., additional, Brull, R., additional, Ami, N., additional, Stanbrook, M., additional, Hagen, K., additional, Campbell, D., additional, Short, T., additional, Van Der Westhuizen, J., additional, Higgie, K., additional, Lindsay, H., additional, Jang, R., additional, Wong, C., additional, Mcallister, D., additional, Ali, M., additional, Kumar, J., additional, Waymouth, E., additional, Kim, C., additional, Dimech, J., additional, Lorimer, M., additional, Tai, J., additional, Miller, R., additional, Sara, R., additional, Collingwood, A., additional, Olliff, S., additional, Gabriel, S., additional, Houston, H., additional, Dalley, P., additional, Hurford, S., additional, Hunt, A., additional, Andrews, L., additional, Navarra, L., additional, Jason-Smith, A., additional, Thompson, H., additional, McMillan, N., additional, Back, G., additional, Croal, B.L., additional, Lum, M., additional, Martin, D., additional, James, S., additional, Filipe, H., additional, Pinto, M., additional, Kynaston, S., additional, Pearse, R.M., additional, Abbott, T.E.F., additional, Phull, M., additional, Beilstein, C., additional, Bodger, P., additional, Everingham, K., additional, Hu, Y., additional, Niebrzegowska, E., additional, Corriea, C., additional, Creary, T., additional, Januszewska, M., additional, Ahmad, T., additional, Whalley, J., additional, Haslop, R., additional, McNeil, J., additional, Brown, A., additional, MacDonald, N., additional, Pakats, M., additional, Greaves, K., additional, Jhanji, S., additional, Raobaikady, R., additional, Black, E., additional, Rooms, M., additional, Lawrence, H., additional, Koutra, M., additional, Pirie, K., additional, Gertsman, M., additional, Jack, S., additional, Celinski, M., additional, Levett, D., additional, Edwards, M., additional, Salmon, K., additional, Bolger, C., additional, Loughney, L., additional, Seaward, L., additional, Collins, H., additional, Tyrell, B., additional, Tantony, N., additional, Golder, K., additional, Ackland, G.L., additional, Stephens, R.C.M., additional, Gallego-Paredes, L., additional, Reyes, A., additional, Gutierrez del Arroyo, A., additional, Raj, A., additional, Lifford, R., additional, Cuthbertson, B.H., additional, Torres, E., additional, Ambosta, A., additional, Melo, M., additional, Mamdani, M., additional, Thorpe, K.E., additional, Grocott, M.P.W., additional, Hillis, G., additional, and Wijeysundera, H.C., additional

Published
2020
Full Text
View/download PDF

37. A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: A secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Author

Riedel, B., Li, M.H-G, Lee, C.H.A., Ismail, H., Cuthbertson, B.H., Wijeysundera, D.N., Ho, K.M., Wallace, S., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Au, S., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, J.K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., S James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., Lifford, R., Melo, M., Mamdani, M., Hillis, G., Wijeysundera, H.C., Riedel, B., Li, M.H-G, Lee, C.H.A., Ismail, H., Cuthbertson, B.H., Wijeysundera, D.N., Ho, K.M., Wallace, S., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Au, S., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, J.K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., S James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., Lifford, R., Melo, M., Mamdani, M., Hillis, G., and Wijeysundera, H.C.

Abstract

Background Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg −1 min −1 and peak oxygen consumption (VO 2 peak) >16 ml kg −1 min −1, cut-points that represent a reduced risk of postoperative complications. Results Five questions were identified to have dominance in predicting AT>11 ml kg −1 min −1 and VO 2 peak>16 ml.kg −1min −1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg −1.min −1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q=0.67 vs original 12-question DASI=0.66) and VO 2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO 2 peak>16 ml.kg −1.min −1 and VO 2 peak<16 ml.kg −1.min −1. Conclusions The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.

Published
2020

39. Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study

Author

Bartoszko, J., primary, Thorpe, K.E., additional, Laupacis, A., additional, Wijeysundera, D.N., additional, Myles, P.S., additional, Shulman, M.A., additional, Wallace, S., additional, Farrington, C., additional, Thompson, B., additional, Ellis, M., additional, Borg, B., additional, Kerridge, R.K., additional, Douglas, J., additional, Brannan, J., additional, Pretto, J., additional, Godsall, M.G., additional, Beauchamp, N., additional, Allen, S., additional, Kennedy, A., additional, Wright, E., additional, Malherbe, J., additional, Ismail, H., additional, Riedel, B., additional, Melville, A., additional, Sivakumar, H., additional, Murmane, A., additional, Kenchington, K., additional, Kirabiyik, Y., additional, Gurunathan, U., additional, Stonell, C., additional, Brunello, K., additional, Steele, K., additional, Tronstad, O., additional, Masel, P., additional, Dent, A., additional, Smith, E., additional, Bodger, A., additional, Abolfathi, M., additional, Sivalingam, P., additional, Hall, A., additional, Painter, T.W., additional, Macklin, S., additional, Elliott, A., additional, Carrera, A.M., additional, Terblanche, N.C.S., additional, Pitt, S., additional, Samuels, J., additional, Wilde, C., additional, Leslie, K., additional, MacCormick, A., additional, Bramley, D., additional, Southcott, A.M., additional, Grant, J., additional, Taylor, H., additional, Bates, S., additional, Towns, M., additional, Tippett, A., additional, Marshall, F., additional, Mazer, C.D., additional, Kunasingam, J., additional, Yagnik, A., additional, Crescini, C., additional, Yagnik, S., additional, McCartney, C.J.L., additional, Choi, S., additional, Somascanthan, P., additional, Flores, K., additional, Beattie, W.S., additional, Karkouti, K., additional, Clarke, H.A., additional, Jerath, A., additional, McCluskey, S.A., additional, Wasowicz, M., additional, Granton, J.T., additional, Day, L., additional, Pazmino-Canizares, J., additional, Oh, P., additional, Belliard, R., additional, Lee, L., additional, Dobson, K., additional, Chan, V., additional, Brull, R., additional, Ami, N., additional, Stanbrook, M., additional, Hagen, K., additional, Campbell, D., additional, Short, T., additional, Van Der Westhuizen, J., additional, Higgie, K., additional, Lindsay, H., additional, Jang, R., additional, Wong, C., additional, Mcallister, D., additional, Ali, M., additional, Kumar, J., additional, Waymouth, E., additional, Kim, C., additional, Dimech, J., additional, Lorimer, M., additional, Tai, J., additional, Miller, R., additional, Sara, R., additional, Collingwood, A., additional, Olliff, S., additional, Gabriel, S., additional, Houston, H., additional, Dalley, P., additional, Hurford, S., additional, Hunt, A., additional, Andrews, L., additional, Navarra, L., additional, Jason-Smith, A., additional, Thompson, H., additional, McMillan, N., additional, Back, G., additional, Croal, B.L., additional, Lum, M., additional, Martin, D., additional, James, S., additional, Filipe, H., additional, Pinto, M., additional, Kynaston, S., additional, Pearse, R.M., additional, Abbott, T.E.F., additional, Phull, M., additional, Beilstein, C., additional, Bodger, P., additional, Everingham, K., additional, Hu, Y., additional, Niebrzegowska, E., additional, Corriea, C., additional, Creary, T., additional, Januszewska, M., additional, Ahmad, T., additional, Whalley, J., additional, Haslop, R., additional, McNeil, J., additional, Brown, A., additional, MacDonald, N., additional, Pakats, M., additional, Greaves, K., additional, Jhanji, S., additional, Raobaikady, R., additional, Black, E., additional, Rooms, M., additional, Lawrence, H., additional, Koutra, M., additional, Pirie, K., additional, Gertsman, M., additional, Jack, S., additional, Celinski, M., additional, Levett, D., additional, Edwards, M., additional, Salmon, K., additional, Bolger, C., additional, Loughney, L., additional, Seaward, L., additional, Collins, H., additional, Tyrell, B., additional, Tantony, N., additional, Golder, K., additional, Ackland, G.L., additional, Gallego-Paredes, L., additional, Reyes, A., additional, Gutierrez del Arroyo, A., additional, Raj, A., additional, Lifford, R., additional, Cuthbertson, B.H., additional, Torres, E., additional, Ambosta, A., additional, Melo, M., additional, Mamdani, M., additional, Grocott, M.P.W., additional, Hillis, G., additional, and Wijeysundera, H.C., additional

Published
2019
Full Text
View/download PDF

40. Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block.

Author

Sehmbi, H., Brull, R., Ceballos, K. R., Shah, U. J., Martin, J., Tobias, A., Solo, K., and Abdallah, F. W.

Subjects
*BRACHIAL plexus block, *DEXMEDETOMIDINE, *DEXAMETHASONE, *NERVE block, *PERIPHERAL nervous system
Abstract

Summary: Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta‐analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long‐acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2‐h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One‐hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366–435) min, motor block duration of 369 (330–408) min and analgesic duration of 435 (386‐483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160–795) min], followed by perineural dexamethasone [411 (343–480) min] and perineural dexmedetomidine [284 (235–333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236–352) min], followed by intravenous dexamethasone [289 (129–448)min] and perineural dexmedetomidine [258 (212–304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448–589) min], followed by intravenous dexamethasone [478 (277–679) min] and perineural dexmedetomidine [318 (266–371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics. [ABSTRACT FROM AUTHOR]

Published
2021
Full Text
View/download PDF

41. Heart rate recovery and morbidity after noncardiac surgery: Planned secondary analysis of two prospective, multi-centre, blinded observational studies

Author

Bianchi, C, Ackland, GL, Abbott, TEF, Minto, G, Clark, M, Owen, T, Prabhu, P, May, SM, Reynolds, JA, Cuthbertson, BH, Wijesundera, D, Pearse, RM, Myles, PS, Shulman, MA, Wallace, S, Farrington, C, Thompson, B, Ellis, M, Borg, B, Kerridge, RK, Douglas, J, Brannan, J, Pretto, J, Godsall, MG, Beauchamp, N, Allen, S, Kennedy, A, Wright, E, Malherbe, J, Ismail, H, Riedel, B, Melville, A, Sivakumar, H, Murmane, A, Kenchington, K, Kirabiyik, Y, Gurunathan, U, Stonell, C, Brunello, K, Steele, K, Tronstad, O, Masel, P, Dent, A, Smith, E, Bodger, A, Abolfathi, M, Sivalingam, P, Hall, A, Painter, TW, Macklin, S, Elliott, A, Carrera, AM, Terblanche, NCS, Pitt, S, Samuels, J, Wilde, C, Leslie, K, MacCormick, A, Bramley, D, Southcott, AM, Grant, J, Taylor, H, Bates, S, Towns, M, Tippett, A, Marshall, F, Mazer, CD, Kunasingam, J, Yagnik, A, Crescini, C, Yagnik, S, McCartney, CJL, Choi, S, Somascanthan, P, Flores, K, Wijeysundera, DN, Beattie, WS, Karkouti, K, Clarke, HA, Jerath, A, McCluskey, SA, Wasowicz, M, Granton, JT, Day, L, Pazmino-Canizares, J, Oh, P, Belliard, R, Lee, L, Dobson, K, Chan, V, Brull, R, Ami, N, Stanbrook, M, Hagen, K, Campbell, D, Short, T, Van Der Westhuizen, J, Higgie, K, Lindsay, H, Jang, R, Wong, C, Mcallister, D, Ali, M, Kumar, J, Waymouth, E, Kim, C, Dimech, J, Lorimer, M, Tai, J, Miller, R, Sara, R, Collingwood, A, Olliff, S, Gabriel, S, Houston, H, Dalley, P, Hurford, S, Hunt, A, Andrews, L, Navarra, L, Jason-Smith, A, Thompson, H, McMillan, N, Back, G, Croal, BL, Lum, M, Martin, D, James, S, Filipe, H, Pinto, M, Kynaston, S, Phull, M, Beilstein, C, Bodger, P, Everingham, K, Hu, Y, Niebrzegowska, E, Corriea, C, Creary, T, Januszewska, M, Ahmad, T, Whalley, J, Haslop, R, McNeil, J, Brown, A, MacDonald, N, Pakats, M, Greaves, K, Jhanji, S, Raobaikady, R, Black, E, Rooms, M, Lawrence, H, Koutra, M, Pirie, K, Gertsman, M, Jack, S, Celinski, M, Levett, D, Edwards, M, Salmon, K, Bolger, C, Loughney, L, Seaward, L, Collins, H, Tyrell, B, Tantony, N, Golder, K, Stephens, RCM, Gallego-Paredes, L, Reyes, A, del Arroyo, AG, Raj, A, Lifford, R, King, A, Pollak, C, Williams, C, Patrick, A, West, C, Vickers, E, Green, R, Jones, A, Otto, J, Lach, A, Whittle, J, Paredes, LG, Toner, A, Williams, A, Pradhu, P, Hull, D, Montague, L, Bianchi, C, Ackland, GL, Abbott, TEF, Minto, G, Clark, M, Owen, T, Prabhu, P, May, SM, Reynolds, JA, Cuthbertson, BH, Wijesundera, D, Pearse, RM, Myles, PS, Shulman, MA, Wallace, S, Farrington, C, Thompson, B, Ellis, M, Borg, B, Kerridge, RK, Douglas, J, Brannan, J, Pretto, J, Godsall, MG, Beauchamp, N, Allen, S, Kennedy, A, Wright, E, Malherbe, J, Ismail, H, Riedel, B, Melville, A, Sivakumar, H, Murmane, A, Kenchington, K, Kirabiyik, Y, Gurunathan, U, Stonell, C, Brunello, K, Steele, K, Tronstad, O, Masel, P, Dent, A, Smith, E, Bodger, A, Abolfathi, M, Sivalingam, P, Hall, A, Painter, TW, Macklin, S, Elliott, A, Carrera, AM, Terblanche, NCS, Pitt, S, Samuels, J, Wilde, C, Leslie, K, MacCormick, A, Bramley, D, Southcott, AM, Grant, J, Taylor, H, Bates, S, Towns, M, Tippett, A, Marshall, F, Mazer, CD, Kunasingam, J, Yagnik, A, Crescini, C, Yagnik, S, McCartney, CJL, Choi, S, Somascanthan, P, Flores, K, Wijeysundera, DN, Beattie, WS, Karkouti, K, Clarke, HA, Jerath, A, McCluskey, SA, Wasowicz, M, Granton, JT, Day, L, Pazmino-Canizares, J, Oh, P, Belliard, R, Lee, L, Dobson, K, Chan, V, Brull, R, Ami, N, Stanbrook, M, Hagen, K, Campbell, D, Short, T, Van Der Westhuizen, J, Higgie, K, Lindsay, H, Jang, R, Wong, C, Mcallister, D, Ali, M, Kumar, J, Waymouth, E, Kim, C, Dimech, J, Lorimer, M, Tai, J, Miller, R, Sara, R, Collingwood, A, Olliff, S, Gabriel, S, Houston, H, Dalley, P, Hurford, S, Hunt, A, Andrews, L, Navarra, L, Jason-Smith, A, Thompson, H, McMillan, N, Back, G, Croal, BL, Lum, M, Martin, D, James, S, Filipe, H, Pinto, M, Kynaston, S, Phull, M, Beilstein, C, Bodger, P, Everingham, K, Hu, Y, Niebrzegowska, E, Corriea, C, Creary, T, Januszewska, M, Ahmad, T, Whalley, J, Haslop, R, McNeil, J, Brown, A, MacDonald, N, Pakats, M, Greaves, K, Jhanji, S, Raobaikady, R, Black, E, Rooms, M, Lawrence, H, Koutra, M, Pirie, K, Gertsman, M, Jack, S, Celinski, M, Levett, D, Edwards, M, Salmon, K, Bolger, C, Loughney, L, Seaward, L, Collins, H, Tyrell, B, Tantony, N, Golder, K, Stephens, RCM, Gallego-Paredes, L, Reyes, A, del Arroyo, AG, Raj, A, Lifford, R, King, A, Pollak, C, Williams, C, Patrick, A, West, C, Vickers, E, Green, R, Jones, A, Otto, J, Lach, A, Whittle, J, Paredes, LG, Toner, A, Williams, A, Pradhu, P, Hull, D, and Montague, L

Abstract

BACKGROUND: Impaired cardiac vagal function, quantified preoperatively as slower heart rate recovery (HRR) after exercise, is independently associated with perioperative myocardial injury. Parasympathetic (vagal) dysfunction may also promote (extra-cardiac) multi-organ dysfunction, although perioperative data are lacking. Assuming that cardiac vagal activity, and therefore heart rate recovery response, is a marker of brainstem parasympathetic dysfunction, we hypothesized that impaired HRR would be associated with a higher incidence of morbidity after noncardiac surgery. METHODS: In two prospective, blinded, observational cohort studies, we established the definition of impaired vagal function in terms of the HRR threshold that is associated with perioperative myocardial injury (HRR ≤ 12 beats min-1 (bpm), 60 seconds after cessation of cardiopulmonary exercise testing. The primary outcome of this secondary analysis was all-cause morbidity three and five days after surgery, defined using the Post-Operative Morbidity Survey. Secondary outcomes of this analysis were type of morbidity and time to become morbidity-free. Logistic regression and Cox regression tested for the association between HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR; (95% confidence intervals). RESULTS: 882/1941 (45.4%) patients had HRR≤12bpm. All-cause morbidity within 5 days of surgery was more common in 585/822 (71.2%) patients with HRR≤12bpm, compared to 718/1119 (64.2%) patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR≤12bpm was associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p = 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91 (1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p<0.001)), neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38 (1.14-1.68); p = 0.001) within 5 days of surgery. CONCLUSIONS: Multi-organ dysfunction is more common in surgical patients with cardiac vagal dys

Published
2019

42. Intra‐articular infiltration analgesia for arthroscopic shoulder surgery: a systematic review and meta‐analysis.

Author

Yung, E. M., Got, T. C., Patel, N., Brull, R., and Abdallah, F. W.

Subjects
BRACHIAL plexus block, ARTHROSCOPY, PATIENT satisfaction, ANALGESIA, RANDOMIZED controlled trials, OPERATIVE surgery
Abstract

Summary: Phrenic‐sparing analgesic techniques for shoulder surgery are desirable. Intra‐articular infiltration analgesia is one promising phrenic‐sparing modality, but its role remains unclear because of conflicting evidence of analgesic efficacy and theoretical concerns regarding chondrotoxicity. This systematic review and meta‐analysis evaluated the benefits and risks of intra‐articular infiltration in arthroscopic shoulder surgery compared with systemic analgesia or interscalene brachial plexus block. We sought randomised controlled trials comparing intra‐articular infiltration with interscalene brachial plexus block or systemic analgesia (control). Cumulative 24‐h postoperative oral morphine equivalent consumption was designated as the primary outcome. Secondary outcomes included visual analogue scale pain scores during the first 24 h postoperatively; time‐to‐first analgesic request; patient satisfaction; opioid‐related side‐effects; block‐related adverse events; and any indicators of chondrotoxicity. Fifteen trials (863 patients) were included. Compared with control, intra‐articular infiltration reduced 24‐h postoperative analgesic consumption by a weighted mean difference (95%CI) of −30.9 ([−38.9 to −22.9]; p < 0.001). Intra‐articular infiltration also reduced the weighted mean difference (95%CI) pain scores up to 12 h postoperatively, with the greatest reduction at 4 h (−2.2 cm [(−4.4 to −0.04]); p < 0.05). Compared with interscalene brachial plexus block, there was no difference in opioid consumption, but patients receiving interscalene brachial plexus block had better pain scores at 2, 4 and 24 h postoperatively. There was no difference in opioid‐ or block‐related adverse events, and none of the trials reported chondrotoxic effects. Compared with systemic analgesia, intra‐articular infiltration provides superior pain control, reduces opioid consumption and enhances patient satisfaction, but it may be inferior to interscalene brachial plexus block patients having arthroscopic shoulder surgery. [ABSTRACT FROM AUTHOR]

Published
2021
Full Text
View/download PDF

46. Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade.

Author

Barrington, MJ, Brull, R, Hadzic, A, Reina, MA, Barrington, MJ, Brull, R, Hadzic, A, and Reina, MA

Abstract

This review synthesizes anatomical, anesthetic, surgical, and patient factors that may contribute to neurologic complications associated with peripheral nerve blockade. Peripheral nerves have anatomical features unique to a given location that may influence risk of injury. Peripheral nerve blockade-related peripheral nerve injury (PNI) is most severe with intrafascicular injection. Surgery and its associated requirements such as positioning and tourniquet have specific risks. Patients with preexisting neuropathy may be at an increased risk of postoperative neurologic dysfunction. Distinguishing potential causes of PNI require clinical assessment and investigation; a definitive diagnosis, however, is not always possible. Fortunately, most postoperative neurologic dysfunction appears to resolve with time, and the incidence of serious long-term nerve injury directly attributable to peripheral nerve blockade is relatively uncommon. Nonetheless, despite the use of ultrasound guidance, the risk of block-related PNI remains unchanged.

Published
2015

Catalog

Books, media, physical & digital resources
See catalog results