Anesthesia
The following recommendations in recent guidelines have been based on weak evidence. There are more evidence gaps in the guidelines, but it is quite hard to design an OHDSI study to tackle these gaps. CPS stands for clinical practice statements.
R5.3: We suggest that patients admitted for hospital care with a previous clinical–radiological diagnosis of SARS-CoV-2 infection that required intensive care unit, or high-dependency unit admission should go through more extensive cardiorespiratory preoperative evaluation (echocardiography, chest CT, cardio-pulmonary exercise testing (CPET). (CPS)
Background and existing evidence: click
Twenty-two prospective and retrospective cohort studies were included in evaluating preoperative assessment of patients with previous moderate-to-severe COVID-19 infection. Unfortunately, there were no randomised controlled studies, and there is a need for more trials, as the large variation in study designs significantly affects the quality of any recommendations. Moreover, specific recommendations in the first waves of COVID-19 infection are not applicable in the post-COVID era.
R12.8: SGLT2 inhibitors (SGLT2i) drugs should be withheld for 3 to 4 days before elective procedures to reduce the risk of euglycemic diabetic ketoacidosis. (CPS)
Background and existing evidence: click
However, alongside their benefits, SGLT2i also pose risks such as genitourinary tract infections, AKI and skeletal fractures. Additionally, they can predispose patients to ketoacidosis, often with blood glucose levels remaining relatively normal, hence the name eDKA. There have been numerous documented instances of eDKA occurring in perioperative patients, highlighting the importance of recognising this as a potential risk factor for individuals undergoing surgical procedures.
Guidelines: Preoperative assessment of adults undergoing elective noncardiac surgery
The role of pre- and postoperative B-type natriuretic peptides (BNP/NT-proBNP) measurement as a prognostic factor is still unclear.
The questions are typically formulated the following way:
Should preoperative B-type natriuretic peptides (BNP/NT-proBNP) be assessed as a prognostic factor before non-cardiac surgery?
Should preoperative B-type natriuretic peptides (BNP/NT-proBNP) be added to clinical scores for the prediction ofpostoperative events?
Should preoperative B-type natriuretic peptide (BNP/NT-proBNP)-enhanced management be implemented in non-cardiac surgery patients to improve outcome?
Guidelines: ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation
R3.1: In patients undergoing surgery, we do not suggest the use of any drug as a prophylactic measure to reduce the incidence of POD.
No drugs known reduce the incidence rate of the delivery in the postoperative period, but the quality of evidence is low.
Guidelines: Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients