October 2016 Highlights from Acta Anaesthesiologica Scandinavica
In the October 2016 issue of Acta Anaesthesiologica Scandinavica, some highlights include the following articles, though I believe that readers can find interesting and useful study results throughout the whole issue.
Well performed systematic reviews and analyses of reliable clinical trials assessing the same research question are probably the strongest form of evidence available today to provide guidance for clinical treatments. It is upon these that trustworther treatment recommendation guidelines are based. When there is only low quality evidence, no strong recommendations concerning the treatment of interest can be made. One should always also look for indications that the treatment may have caused harm for some subjects, even if it was unexpected.
In this well performed systematic review (Gabapentin for post-operative pain management – a systematic review with meta-analyses and trial sequential analyses (pages 1188–1208), by M. L. Fabritius, A. Geisler, P. L. Petersen, L. Nikolajsen, M. S. Hansen, V. Kontinen, K. Hamunen, J. B. Dahl, J. Wetterslev, and O. Mathiesen.), use of gabapentin for post-operative pain management was scrutinized in many clinical trials. One can summarize the results: the quality of evidence for a clinically relevant beneﬁt of gabapentin is low, and, importantly, harm may be present.
Serious adverse events are something that clinical trials need to try to identify, as part of their study design. Sometimes, retrospective examination of well collected patient data in a registry can be used to identify risk for harm or rates for harm events related to a type of intervention. This study did just that (Post-operative serious adverse events in a mixed surgical population – a retrospective register study (pages 1209–1221) by M. S. Hansen, E. E. Petersen, J. B. Dahl and J. Wetterslev). Based on the national Danish Anaesthesia Database, this analysis reports the rates of serious adverse events, including re-operations and mortality after different major surgical procedures. The ﬁndings conﬁrm that age, abdominal, and emergency surgery strongly increase the risk. This knowledge is needed for planning future and more detailed studies on serious adverse perioperative events.
Living at extreme latitude, as many do in subarctic regions of Scandinavia, may have health consequences. This might be unexpected in high income nations. In this report from Iceland, vitamin D was in focus. It is unclear which patient groups might benefit from vitamin D supplementation. A critically ill cohort in Iceland was examined for potential vitamin D deficiency (Severe vitamin D deficiency is common in critically ill patients at a high northern latitude (pages 1289–1296). R. B. Kvaran, M. I. Sigurdsson, S. J. Skarphedinsdottir and G. H. Sigurdsson). Most of the critically ill patients in this cohort had measured vitamin D levels below that which is associated with good general health. Food for thought.
Finally, read about and consider safety in emergency and prehospital airway management in an editorial treatment of this subject (Emergency airway management – by whom and how? (pages 1185–1187) by S. J. M. Sollid, J. Mellin-Olsen and T. Wisborg). Good training and experience are necessary for best outcomes in this challenging area. Anesthesia/Intensive care medicine specialists have an important role in this area.