Scoping review of mode of anaesthesia in emergency surgery

Abstract

Background Emergency surgery encompasses more than 50 per cent of the surgical workload; however, research efforts are disproportionally low. The mode of anaesthesia used during emergency surgery may affect outcomes, but the extent of research and the impact of the different modes of anaesthesia used are unclear. Methods MEDLINE and Embase were searched using scoping review methodology with a rapid systematic search strategy, identifying any study comparing locoregional (local, nerve block, subarachnoid, epidural) anaesthesia with general anaesthesia. All studies describing outcomes of emergency surgery with differing modes of anaesthesia were identified. Excluded were: studies published before 2003, studies enrolling patients aged less than 18 years and studies using sedation only. Results Forty‐two studies were identified, describing 11 surgical procedures. Most publications were retrospective cohort studies (32). A very broad range of clinical and patient‐reported outcomes were described, with wide variation in the outcomes reported in different studies. Conclusion Reporting of mode of anaesthesia is inconsistent across different procedures and is often absent. There is a need for directed research efforts to improve the reporting standards of anaesthesia interventions, to understand the role of different modes of anaesthesia in specific emergency surgical procedures, and to standardize outcome reporting using core outcome sets.

Mapping multicenter randomized controlled trials in anesthesiology: a scoping review

“…This finding is similar to a previous scoping review on anesthesia-related interventions that specifically analyzed mortality, including both single and multicenter trials [ 20 ]. Unlike the previous review, however, we did not limit our work to a specific type of surgery (e.g., emergency only [ 25 ]) and included a wide range of clinical patient outcomes beyond mortality. It is surprising that studies frequently investigated functional status and patient experience outcomes but tended to focus on provider-centric interventions (e.g., pharmacotherapy).…”

“…It is surprising that studies frequently investigated functional status and patient experience outcomes but tended to focus on provider-centric interventions (e.g., pharmacotherapy). Other scoping reviews have also focused on provider-centric interventions such as mode of anesthesia [ 25 ], with limited discussion of interventions that may provide patients with a greater sense of control over their care and outcomes. With both surgical patients [ 26 , 27 ] and anesthesia providers [ 28 , 29 ] increasingly interested in alternative therapies, perhaps more investigation is needed regarding non-pharmacotherapy interventions.…”

A systematic review of reporting quality for anaesthetic interventions in randomised controlled trials

“…An important aspect of complex interventions is how their delivery is standardised and how adherence to protocol is assessed. The lack of consensus definitions and standardised regimens might contribute to poor reporting [8,9]. The subsequent development of the CONSORT-NPT guideline should facilitate the replication of interventions and promote their reliable clinical implementation, in keeping with the Medical Research Council's framework [10].…”

Perioperative care and collaboration between surgeons and anaesthetists – it's about time

“…There is no doubt that the mode of anaesthesia can affect surgical outcomes, and Morley and colleagues describe the emerging evidence. Likewise, effective postoperative pain relief improves both outcomes and patient experience.…”