Dr. Caroline Andrew and Dr. David Nathan join the show to discuss the literature pertaining to intraoperative administration of dexamethasone.

Dr. Caroline Andrew is an anesthesia resident at the Massachusetts General Hospital. Dr. David Nathan is the Director of the Diabetes Center at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School.

This podcast was recorded as part of the Depth of Anesthesia podcast elective.

Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues.

—

Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates.

Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team.

Music by Stephen Campbell, MD.

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References

Tien M, Gan TJ, Dhakal I, White WD, Olufolabi AJ, Fink R, Mishriky BM, Lacassie HJ, Habib AS. The effect of anti-emetic doses of dexamethasone on postoperative blood glucose levels in non-diabetic and diabetic patients: a prospective randomised controlled study. Anaesthesia. 2016 Sep;71(9):1037-43. doi: 10.1111/anae.13544. PMID: 27523051.

Polderman JA, Farhang-Razi V, Van Dieren S, Kranke P, DeVries JH, Hollmann MW, Preckel B, Hermanides J. Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev. 2018 Nov 23;11(11):CD011940. doi: 10.1002/14651858.CD011940.pub3. PMID: 30480776; PMCID: PMC6426282.

Andrew J. Toner, Vyhunthan Ganeshanathan, Matthew T. Chan, Kwok M. Ho, Tomas B. Corcoran; Safety of Perioperative Glucocorticoids in Elective Noncardiac Surgery: A Systematic Review and Meta-analysis. Anesthesiology 2017; 126:234–248 doi: https://doi.org/10.1097/ALN.0000000000001466

Corcoran TB, O'Loughlin E, Chan MTV, Ho KM. Perioperative Administration of Dexamethasone And blood Glucose concentrations in patients undergoing elective non-cardiac surgery - the randomised controlled PADDAG trial. Eur J Anaesthesiol. 2021 Sep 1;38(9):932-942. doi: 10.1097/EJA.0000000000001294. PMID: 32833858.

Pang, QY., Wang, JY., Liang, XL. et al. The safety of perioperative dexamethasone with antiemetic dosage in surgical patients with diabetes mellitus: a systematic review and meta-analysis. Perioper Med 12, 4 (2023). https://doi.org/10.1186/s13741-023-00293-4

De Oliveira GS Jr, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013 Jan;116(1):58-74. doi: 10.1213/ANE.0b013e31826f0a0a. Epub 2012 Dec 7. PMID: 23223115.

Dr. Zach Cost and Dr. Tem Bendapudi join the show to discuss the literature pertaining to tranexamic acid and thromboembolic risk.

Dr. Zach Cost is an anesthesia resident at the Massachusetts General Hospital. Dr. Pavan (“Tem”) Bendapudi holds a joint faculty appointment in the Division of Hematology and Blood Transfusion Service and is assistant professor of medicine at Harvard Medical School.

This podcast was recorded as part of the Depth of Anesthesia podcast elective.

Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues.

—

Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates.

Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team.

Music by Stephen Campbell, MD.

—

References

CRASH-2 trial collaborators; Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010 Jul 3;376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5. Epub 2010 Jun 14. PMID: 20554319.

Henry DA, Carless PA, Moxey AJ, et al. Anti‐fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews. 2011;(1). doi:10.1002/14651858.CD001886.pub3

Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. doi:10.1136/bmj.e3054

Myles PS, Smith JA, Forbes A, et al. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. New England Journal of Medicine. 2017;376(2):136-148. doi:10.1056/NEJMoa1606424

Devereaux PJ, Marcucci M, Painter TW, et al. Tranexamic Acid in Patients Undergoing Noncardiac Surgery. New England Journal of Medicine. 2022;386(21):1986-1997. doi:10.1056/NEJMoa2201171 POISE 3 PeriOperative ISchemic Evaluation-3 (POISE-3) study

Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum hemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. The Lancet. 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4

Roberts I, Shakur-Still H, Afolabi A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. The Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5

Taeuber I, Weibel S, Herrmann E, et al. Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Surgery. 2021;156(6):e210884. doi:10.1001/jamasurg.2021.0884

Dr. Mark Neuman and Dr. Sam Falkson join the show to discuss the literature around risks of regional versus general anesthesia for postoperative delirium. Dr. Neuman is the founding Director of the Center for Perioperative Outcomes Research and Transformation and Professor of Anesthesiology at Penn Medicine. Dr. Sam Falkson is an anesthesia resident at the Massachusetts General Hospital.

This podcast was recorded as part of the Depth of Anesthesia podcast elective.

Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues.

—

Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates.

Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team.

Music by Stephen Campbell, MD.

—

References

Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;2(2):CD000521.

Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair. JAMA Netw Open. 2019;2(2):e190111.

Patel V, Champaneria R, Dretzke J, Yeung J. Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review. BMJ Open. 2018;8(12):e020757.

Zheng X, Tan Y, Gao Y, Liu Z. Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials. BMC Anesthesiol. 2020 Jun 30;20(1):162.

Neuman MD, Feng R, Carson JL, et al. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385(22):2025-2035.

Rathmell JP, Avidan MS. Patient-centered outcomes after general and spinal anesthesia. N Engl J Med. 2021 Nov 25;385(22):2088–9.

Stone AB, Poeran J, Memtsoudis SG. There remains a role for neuraxial anesthesia for hip fracture surgery in the post-REGAIN era. Reg Anesth Pain Med. 2023 Aug;48(8):430-432. doi: 10.1136/rapm-2022-104071. Epub 2023 Mar 28. PMID: 36977527.

Li T, Li J, Yuan L, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the raga randomized trial. JAMA. 2022;327(1):50-58.