Survey of Anesthesiology最新文献

{"title":"Intrauterine Anaesthetic After Hysteroscopy to Reduce Post-operative Pain—A Double Blind Randomised Controlled Trial","authors":"K. Mahomed, J. McLean, Muhtashim Ahmed, B. Zolotarev, N. Shaddock","doi":"10.1097/sa.0000000000000304","DOIUrl":"https://doi.org/10.1097/sa.0000000000000304","url":null,"abstract":"This single-center, double-blind randomized controlled trial sought to assess whether intrauterine levobupivacaine reduced post hysteroscopy pain and need for analgesics and allowed earlier return to normal activity. During January 2013 to December 2015, 438 women were recruited into this study, with 224 in the intervention group and 214 in the control group. Levobupivacaine was chosen as the intrauterine anesthetic in the intervention group because of its safety profile. The control group received intrauterine normal saline","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87025800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypocapnia Measured by End-Tidal Carbon Dioxide Tension During Anesthesia Is Associated With Increased 30-Day Mortality Rate","authors":"P. Dony, M. Dramaix, J. Boogaerts","doi":"10.1097/SA.0000000000000307","DOIUrl":"https://doi.org/10.1097/SA.0000000000000307","url":null,"abstract":"The negative effects of hypocapnia are well documented, including a decrease in cerebral blood and cognitive function, an increase in airway resistance and pulmonary cellular dysfunction, vasoconstriction and an increase in myocardial oxygen demand, hypercoagulopathy, and dysrhythmias. However, there has been no study documenting an association between hypocapnia during anesthesia and postoperative mortality. The aim of this 8-month retrospective, observational study was to determine the impact of hypocapnia on inand out-of-hospital mortality in a diverse population of surgical patients within 30 days of surgery. The study’s secondary outcome was hospital length of stay (LOS), with particular attention to the proportion of patients with an LOS of more than 6 days. Complete case report forms of 5317 adult patients who underwent noncardiac surgery with general anesthesia were included in this study. Data collected included operation date, discharge date, and death date if appropriate.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80253169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Regurgitation in Patients Undergoing Gynecological Laparoscopy With a Laryngeal Mask Airway: A Prospective Observational Study","authors":"José Lemos, G. Oliveira, H. E. D. P. Cardoso, L. Lemos, L. R. Carvalho, N. S. Módolo","doi":"10.1097/01.sa.0000521855.52019.b9","DOIUrl":"https://doi.org/10.1097/01.sa.0000521855.52019.b9","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73863764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Ejection Fraction on Infectious, Renal, and Respiratory Morbidity for Patients Undergoing Noncardiac Surgery","authors":"Michael D. Maile, W. Armstrong, E. Jewell, M. Engoren","doi":"10.1097/01.sa.0000521853.07171.c1","DOIUrl":"https://doi.org/10.1097/01.sa.0000521853.07171.c1","url":null,"abstract":"The purpose of this single-center retrospective cohort study is to assess whether there is an increased risk of postoperative infection, respiratory, or kidney complications in patients undergoing noncardiac surgery who have decreased left ventricular systolic function. Participants were adults who underwent noncardiac surgery during the period January 1, 2005, to December 31, 2010, at the University of Michigan. Respiratory complication was defined as needing postoperative mechanical ventilation for over 48 hours or the occurrence of unplanned intubation. Kidney-related complications were defined as renal insufficiency with a postoperative increase in serum creatinine levels of more than 2 mg/dL or postoperative acute renal failure requiring dialysis. Infectious complications included pneumonia, urinary tract infections, sepsis, and wound infections. An independent association between decreased left ventricular ejection fraction (LVEF, a measure of systolic function) and renal and infectious complications were observed. A decreased LVEF correlated with a 69% increase in the odds of renal complications and a 33% increase in the odds of infectious complications. Amajor strength of this studywas the robustness of the comorbidities and outcomes collected as experienced cardiologists assessed LVEF, while trained experts collected patient and outcome data, unlike the hit-or-miss general administrative databases. Postoperative infections (n = 175 [10%]) were the most common postoperative complication in this study population of 1692 individuals, followed by respiratory complications, which manifested in 77 cases (5%), whereas renal complications occurred in 29 participants (2% of the study population). The time gap between the echocardiogram and surgery spanned from 7months (interquartile range, 1.8–15.7months) for thosewith severely reduced LVEF to 24 months (interquartile range, 2.5–38.6 months) for those with a normal LVEF (P = 0.038). A univariate statistical analysis supported a relationship between decreased preoperative LVEF and complications from infections and of the kidney but not respiratory complications. After adjusting for preoperative characteristics, decreased preoperative LVEF was associated with infectious complications (odds ratio, 1.33; 95% confidence interval, 1.03–1.68; P = 0.0265) and renal complications (odds ratio, 1.69; 95% confidence interval, 1.12–2.48; P = 0.0142). Thus, the findings of this study can help clinicians better balance the risks and benefits of various therapies as it emphasizes the noncardiac complications that can arise in patients with preexisting cardiac dysfunction undergoing noncardiac surgery. Published data exist on the association of increased major adverse cardiac events in patients with a known history of heart failure, but less is known on risk to other organ systems. The researchers from the University of Michigan have elucidated the effects of decreased LVEF in regard to infectious, renal, and res","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83223160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Continuous Paravertebral Dexmedetomidine Administration on Intraoperative Anesthetic Drug Requirement and Post-Thoracotomy Pain Syndrome After Thoracotomy: A Randomized Controlled Trial.","authors":"Vikas Dutta, B. Kumar, A. Jayant, A. Mishra","doi":"10.1097/01.sa.0000521732.87385.7f","DOIUrl":"https://doi.org/10.1097/01.sa.0000521732.87385.7f","url":null,"abstract":"OBJECTIVES\u0000To assess the effect of paravertebral administration of dexmedetomidine as an adjuvant to local anesthetic on the intraoperative anesthetic drug requirement and incidence of post-thoracotomy pain syndrome.\u0000\u0000\u0000DESIGN\u0000Prospective, randomized, controlled, double-blind trial.\u0000\u0000\u0000SETTING\u0000Single university hospital.\u0000\u0000\u0000PARTICIPANTS\u0000The study comprised 30 patients who underwent elective thoracotomy and were assigned randomly to either the Ropin or Dexem group (n = 15 each).\u0000\u0000\u0000INTERVENTIONS\u0000All patients received the study medications through paravertebral catheter. Patients in the Ropin group received a bolus of 15 mL of 0.75% ropivacaine over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine at 0.1 mL/kg/hour. Patients in the Dexem group received 15 mL of 0.75% ropivacaine plus dexmedetomidine, 1 µg/kg bolus over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine plus 0.2 µg/kg/hour of dexmedetomidine at 0.1 mL/kg/hour.\u0000\u0000\u0000MEASUREMENTS AND MAIN RESULTS\u0000The primary outcome of the study was intraoperative anesthetic drug requirement. The secondary outcome was the incidence of post-thoracotomy pain syndrome 2 months after surgery. The amount of propofol required for induction of anesthesia was significantly less in the Dexem group (Dexem 49.33±20.51 v 74.33±18.40 in the Ropin group, p = 0.002). End-tidal isoflurane needed to maintain target entropy was significantly less in the Dexem group at all time points. Intraoperative fentanyl requirement was lower in the Dexem group (Dexem 115.33±33.77 v 178.67±32.48 in the Ropin group, p = 0.002). Postoperative pain scores and morphine consumption were significantly less in the Dexem group (p<0.001). The incidence of post-thoracotomy pain syndrome was comparable between the 2 groups (69.23% v 50%, p = 0.496).\u0000\u0000\u0000CONCLUSIONS\u0000Paravertebral dexmedetomidine administration resulted in decreased intraoperative anesthetic drug requirement, less pain, and lower requirements of supplemental opioid in the postoperative period. However, it had no effect on the incidence of post-thoracotomy pain syndrome.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85576674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial.","authors":"Ying-jie Geng, Qingyi Wu, Rui-qin Zhang","doi":"10.1097/SA.0000000000000320","DOIUrl":"https://doi.org/10.1097/SA.0000000000000320","url":null,"abstract":"STUDY OBJECTIVE\u0000To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population.\u0000\u0000\u0000DESIGN\u0000Prospective, randomized, double-blind clinical trial.\u0000\u0000\u0000SETTING\u0000University-affiliated teaching hospital.\u0000\u0000\u0000PATIENTS\u0000One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy.\u0000\u0000\u0000INTERVENTIONS\u0000Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia.\u0000\u0000\u0000MEASUREMENTS\u0000Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1-40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively.\u0000\u0000\u0000MAIN RESULTS\u0000The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1-40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group.\u0000\u0000\u0000CONCLUSIONS\u0000Propofol anesthesia may be an option for elderly surgical patients.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72894951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrinogen Supplementation Ex Vivo Increases Clot Firmness Comparable to Platelet Transfusion in Thrombocytopenia","authors":"B. Schenk, A. K. Lindner, Benjamin Treichl, M. Bachler, M. Hermann, O. Larsen, C. Fenger-Eriksen, D. Wally, H. Tauber, C. Velik-Salchner, D. Fries","doi":"10.1097/SA.0000000000000301","DOIUrl":"https://doi.org/10.1097/SA.0000000000000301","url":null,"abstract":"This study investigates how the use of fibrinogen concentrate ex vivo compares to the use of in vivo platelet transfusion (PT) to improve clot firmness in patients with thrombocytopenia (platelet count <150 10 L−1). While PT is currently first-line treatment to prevent bleeding in patients with clinically significant thrombocytopenia, PT carries significant risks, including viral or bacterial infection, febrile and nonfebrile transfusion reactions, and transfusion-related lung injury. Furthermore, the effectiveness of PT varies. The use of fibrinogen concentrate might be a useful tool to reduce PT, given its role in platelets activation and clot formation. Experimental data in animal models have indicated that fibrinogen concentrate can improve clot firmness better than PT. For this investigation, 100 patients aged between 18 and 35 years in need of PT were enrolled. Of the patients included, 88% were thrombocytopenic, and 65% had received antiplatelet medication. Indications for PTwere variable, but the most common indication was diffuse (microvascular) bleeding tendency. The enrolled patients’ blood samples were collected immediately before PT and 1 and 24 hours after PT. Using ROTEM (rotational thromboelastometry), the blood samples citrated with fibrinogen concentrate were analyzed at concentrations of 50, 100, 200, and 400mg kg−1 for the maximum clot firmness (MCF). ROTEM is a tool to predict, manage, and correct coagulation parameters. It was found that fibrinogen supplementation increasedMCF significantly and dose-dependently before and after PT. The effect of equivalent doses of 100 and 200 mg kg−1of fibrinogen concentrate ex vivo was comparable to that of PT in vivo. It was also noted that MCF improved markedly with 400 mg kg−1 compared with PT (P < 0.001). This study suggests that fibrinogen concentrate ex vivo compensates clot firmness to a similar degree as PT in vivo and could serve as an alternative treatment in appropriate situation. These results need to be confirmed in clinical trials.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78456445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Neuroprotection? It's Complicated.","authors":"D. Warner, H. Sheng","doi":"10.1097/01.sa.0000527587.95213.27","DOIUrl":"https://doi.org/10.1097/01.sa.0000527587.95213.27","url":null,"abstract":"<zdoi;10.1097/ALN.0000000000001535> Anesthesiology, V 126 • No 4 579 April 2017 A NESTHETICS possess num erous pharmacologic properties that could increase tolerance of brain to an ischemic insult. Despite investigation for over half a century,1 and robust demonstration of such benefit in laboratory animals,2 there is no solid evidence that anesthetic neuroprotection is present in humans.3 The article by Archer et al.4 in this issue of A nesthesiology provides considerable insight into this apparent paradox. It once seemed so straight forward. The brain consumes adenosine triphosphate at an incredible rate and holds little stores of this critical metabolite. Hence, continuous delivery of oxygen and glucose is essential to maintain adenosine triphosphate synthesis, neural function, and cellular integrity. Most anesthetics can markedly suppress metabolic rate. Thus, the duration the brain can survive in low-flow or no-flow states should be increased substantially. Neuroprotection investigation was focused on the perioperative environment for several decades. Anesthesiologists and surgeons were at the forefront of therapeutic stroke research. In the late 1980s, problems arose for the metabolic suppression hypothesis. Nonanesthetic drugs that had little or no effect on metabolic rate were found highly neuroprotective in the laboratory. Evidence rapidly grew in support of protective benefits from mild hypothermia, which again induced little change in metabolic rate. It was becoming clear that other neuroprotective mechanisms were important. And later, it became evident that exposure of brain to a mild stressor stimulus, either before (preconditioning) or after (postconditioning) a severe ischemic insult, set in play a biomolecular cascade that improved ischemic outcome. It is now known that anesthetics can also serve as effective conditioning stimuli, again independent of effects on metabolic rate during the ischemic insult. At the same time, a series of failures in detecting anesthetic neuroprotection in clinical trials accumulated, dashing almost all hope for such intervention. This caused a pivot of investigation away from neuroprotection in the perioperative environment toward development of nonanesthetic drugs relevant to the large number of patients who sustain out-of-hospital stroke. While the above logic sequence seems reasonable, is it all correct? The fact remains that after trials of scores of drugs in human stroke, other than tissue plasminogen activator, there is no pharmacologic intervention proven efficacious for any form of stroke in humans. This body of failure has led to serious questions regarding the pathway from bench to bedside for stroke drugs. Most such criticism has focused on the preclinical side of efficacy analysis. While major flaws in clinical trial designs must also be considered, lessons from the preclinical stroke research community are highly relevant to the study of anesthetics in the perioperative environment. Our m","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90164843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative dysglycemia in elective non-diabetic surgical patients: a prospective observational study.","authors":"Michael Hang Yang, M. Jaeger, M. Baxter, E. Vandenkerkhof, J. V. van Vlymen","doi":"10.1097/01.sa.0000516022.94902.80","DOIUrl":"https://doi.org/10.1097/01.sa.0000516022.94902.80","url":null,"abstract":"PURPOSE\u0000Elevated glycosylated hemoglobin (HbA1c) is often found in surgical patients with no history of diabetes. The purpose of this prospective observational study was to determine if elevated preoperative HbA1c is associated with postoperative hyperglycemia in non-diabetic surgical patients and to identify predictors of elevated HbA1c.\u0000\u0000\u0000METHODS\u0000This study included 257 non-diabetic adults scheduled for inpatient surgery. Preoperatively, capillary blood glucose (CBG) and HbA1c were measured and patients completed the Canadian Diabetes Risk Questionnaire (CANRISK). Capillary blood glucose was measured for two days or until hospital discharge at the following time points: postoperatively, before all meals, and at 22:00 hr. The mean CBG and incidence of hyperglycemia were compared between HbA1c levels: Group I < 6.0%, Group II 6.0-6.4%, and Group III ≥ 6.5%.\u0000\u0000\u0000RESULTS\u0000The mean postoperative glucose levels at all time points were significantly higher in Group III compared with Groups I and II (P < 0.01). At least one episode of hyperglycemia (CBG ≥ 10.0 mMol·L-1) occurred in 61% (11/18) of patients in Group III vs 11% (23/209) of patients in Group I (relative risk, 5.55; 95% confidence interval [CI], 3.26 to 9.47; P < 0.001). Elevated glycosylated hemoglobin ≥ 6.0% was found in 31% (33/107) of those with a high CANRISK score. The best predictors of postoperative hyperglycemia were preoperative CBG > 6.9 mMol·L-1 [diagnostic odds ratio (OR) (reference < 6.0 mMol·L-1), 4.16; 95% CI, 1.57 to 10.98; P = 0.004], HbA1c ≥ 6.0% [OR (reference < 6.0%), 3.00; 95% CI, 1.39 to 6.49; P = 0.005], and HbA1c ≥ 6.5% [OR (reference < 6.5%), 13.45; 95% CI, 4.78 to 37.84; P <0.001].\u0000\u0000\u0000CONCLUSIONS\u0000Elevated HbA1c is associated with higher mean postoperative glucose levels in patients with no diabetic history. The CANRISK score is a strong predictor of elevated HbA1c, while CBG and HbA1c are both predictors of postoperative hyperglycemia.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88645625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Medications Associated With Hemodynamically Significant Anaphylaxis","authors":"R. Freundlich, N. Duggal, Michelle T. Housey, Tyler T Tremper, M. Engoren, S. Kheterpal","doi":"10.1097/01.sa.0000515836.31290.fc","DOIUrl":"https://doi.org/10.1097/01.sa.0000515836.31290.fc","url":null,"abstract":"Despite variations in definitions used, significant numbers of surgical cases are known to be complicated by anaphylaxis. This may be due to drugs such as antibiotics and neuromuscularblocking drugs or even due to latex and disinfectants. Poorly defined patient risk factors and difficulty in accurate and early identification of anaphylaxis by anesthesiologists increase the intraoperative risks. Epinephrine is a widely accepted first line of treatment, and intravenous fluids, antihistamines, and glucocorticoids offer the second line of treatment for anaphylaxis. Intraoperative anaphylaxis mortality is estimated at 0% to 1.4%. The main objective of the study was to identify drugs and patient factors related to hemodynamically significant anaphylaxis in adult patients undergoing surgery. Possible instances of hemodynamically significant anaphylaxis were studied from the University of Michigan Anesthesia Information Management System database from 2004 to 2015. The primary outcome was hemodynamically significant anaphylaxis: grade III (shock and/or life-threatening smooth muscle spasm) and grade IV (cardiac and/or respiratory arrest). The screening process used physiologic and treatment-based screening algorithm for identifying hypotension followed by treatment suggestive of anaphylaxis in “hemodynamically significant” adult (≥18 years old) patients. Two clinicians manually reviewed all the cases using predefined criteria, and a third clinician adjudicated any disagreements. Confirmed cases of hemodynamically significant anaphylaxis were matched 3:1 with control cases and were further reviewed to create a list of medications administered postanesthesia but before the onset of suspected anaphylactic reaction. Intraoperative medications administered in hemodynamically significant anaphylaxis cases and patient risk factors were compared with control cases. A total of 461,986 were studied; of these, 635 met the initial screening criteria, and of these, 55 cases (1 in 8400) were identified for likely hemodynamically significant anaphylaxis. It was noted that 52 patients experienced hemodynamically significant anaphylaxis (1 patient with 3 instances and 1 patient with 2 instances). Protamine was the only drug associated with an increased risk of hemodynamically significant anaphylaxis (odds ratio, 11.78; 95% confidence interval, 1.40–99.26; P = 0.0233) and that no other category of drugs was associated with an increased risk. Only personal history of anaphylaxis was associated with an increased risk (odds ratio, 77.1; 95% confidence interval, 10.46–567.69; P ≤ 0.0001). Other noted results were as follows: low postoperative follow-up and evaluation of patients; serum tryptase level was sent in only 49% of cases (41% positive vs","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80764936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}