ANZCA Final Exam Resources
Day 2

Landmark Trials

Book - Landmark Papers in Anaesthesia

Anaesthesia and Neurodevelopment

Jevtovic-Todorovic et al (2003) - significantly impaired learning in young rats exposed to six hour anaesthetic of midazolam, isoflurane and nitrous oxide - evidence of widespread neurodegeneration
GAS trial (2016)
Multicentre trial
< 60 weeks PGA
Randomised to awake regional vs GA
No significant difference in neurocognitive or behavioural domains at 2 and 5 years

Anaesthesia and Cardiovascular Risk

POISE-II (2014)
2x2 factorial design looking at
aspirin for prevention of major vascular complications (inhibition of thrombus formation)
clonidine for the prevention of (type 2) MI
No change in primary outcomes for aspirin except for slight increase in major bleeding
No change in primary outcomes for clonidine but significantly increased rates of bradycardia and hypotension
2x2 factorial design looking at
Hypotension vs hypertension avoidance strategies
Hypotension avoidance: MAP > 80, ACEi ceased
Hypertension-avoidance: MAP > 60, continue all antihypertensives
Significantly decreased risk of bleeding in patients taking TXA
No difference in outcomes with hypotension- or hypertension-avoidance

Dexamethasone in the Perioperative Period

PADDI trial (2021)
dexamethasone 8 mg vs placebo for patients undergoing non-cardiac surgery
Looking at risk of postoperative surgical site infection
dexamethasone established as non-inferior - in fact slight trend towards decreased rate of infection

Anaesthesia and COVID-19


Videolaryngoscopy vs Direct

JAMA study (2021)
Significantly higher first pass intubation rate with videolaryngoscope (98 vs 92%)

Surgical Site Infection

Slightly higher rate of surgical site infection in patients receiving both vancomycin and cephazolin vs cephazolin alone for major orthopaedic surgery

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