Performing perioperative optimization of the high-risk surgical patient.


:Perioperative risk of death after general surgery is quoted as overall less than 1%. However, each individual's risk varies widely according to many identified factors with some having a significantly increased risk of a worse outcome. The observation that manipulating and targeting certain physiological parameters in selected patients can influence this risk has been reported in numerous studies. Yet it is still not widely practised to assist the process, despite the availability of various invasive and non-invasive monitors. This may be in part because of a lack of experience with the practicalities of perioperative optimization, and lack of knowledge in applying currently available tools. This article aims to try and address this deficit and increase awareness of how and when to utilize monitoring equipment to achieve optimal results for the patients we treat.


Br J Anaesth


Tote SP,Grounds RM




Has Abstract


2006-07-01 00:00:00














  • Beta-adrenergic blockade and the metabolic response to surgery.

    abstract::The effect of the administration of propranolol 0.15 mg per kg body weight i.v. on the metabolic response to pelvic surgery was compared with results in similar patients who had not received propranolol. The only significant difference between the two groups was a lower plasma insulin concentration in the beta-blockad...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Cooper GM,Paterson JL,Mashiter K,Hall GM

    更新日期:1980-12-01 00:00:00

  • Double burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block.

    abstract::We present a new pattern of nerve stimulation--double burst stimulation (DBS)--to detect residual neuromuscular block manually. The DBS consists of two short lasting, 50-Hz tetanic stimuli or bursts separated by a 750-ms interval. The response to this pattern of stimulation is two single separated muscle contractions ...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Engbaek J,Ostergaard D,Viby-Mogensen J

    更新日期:1989-03-01 00:00:00

  • Pharmacokinetics and pulmonary extraction of clevidipine, a new vasodilating ultrashort-acting dihydropyridine, during cardiopulmonary bypass.

    abstract::Clevidipine is a new vascular-selective, calcium channel antagonist of the dihydropyridine type with an ester side chain susceptible to esterase metabolism. In healthy volunteers, it has high clearance (0.069 litres min-1 kg-1) with a small volume of distribution at steady state (0.19 litres kg-1). The half-lives of t...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Vuylsteke A,Milner Q,Ericsson H,Mur D,Dunning J,Jolin-Mellgård A,Nordlander M,Latimer R

    更新日期:2000-11-01 00:00:00

  • Effects of hepatic uptake of vecuronium bromide and its putative metabolites on their neuromuscular blocking actions in the cat.

    abstract::The neuromuscular blocking effects of equipotent doses of the three putative metabolites of vecuronium (3-hydroxy vecuronium, 17-hydroxy vecuronium and 3,17-dihydroxy vecuronium) were compared with those of an equipotent dose of vecuronium. Results obtained with the liver excluded from the circulation and after intrap...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Bencini AF,Houwertjes MC,Agoston S

    更新日期:1985-08-01 00:00:00

  • Effect of oral doxapram on morphine-induced changes in the ventilatory response to carbon dioxide.

    abstract::A double-blind crossover volunteer trial has been carried out to determine if oral doxapram reduces the respiratory depression caused by morphine 0.12 mg kg-1 i.m. Doxapram was given to the subjects 90 min before the morphine and significantly reduced the displacement of the ventilatory response to carbon dioxide caus...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Randall NP,Pleuvry BJ,Fazackerley EJ,Modla CY,Prescott LF,Healy TE

    更新日期:1989-02-01 00:00:00

  • Chronic pain epidemiology and its clinical relevance.

    abstract::Chronic pain affects ∼20% of the European population and is commoner in women, older people, and with relative deprivation. Its management in the community remains generally unsatisfactory, partly because of lack of evidence for effective interventions. Epidemiological study of chronic pain, through an understanding o...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审


    authors: van Hecke O,Torrance N,Smith BH

    更新日期:2013-07-01 00:00:00

  • Role of the massive transfusion protocol in the management of haemorrhagic shock.

    abstract::The concept of rapid delivery of multiple blood products to the bedside of a massively haemorrhaging patient seems to be a logical approach to the management of the massively bleeding patient. However, controversy exists in the use of fixed blood component ratios. Assessing the extent of the coagulopathy through point...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审


    authors: Waters JH

    更新日期:2014-12-01 00:00:00

  • Different effects of dopamine and dopexamine on the isolated perfused rat kidney.

    abstract::We have investigated the effect of dopamine and dopexamine on the isolated perfused rat kidney. After an equilibration period of 20 min and two control periods of 10 min, dopexamine 1.0, 2.5 or 4.0 micrograms kg-1 min-1 or dopamine 2.0 micrograms kg-1 min-1 were perfused for a further 40 min in random order. Renal blo...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Kirchhoff K,Leuwer M,Thum P,Bornscheuer A,Piepenbrock S

    更新日期:1999-12-01 00:00:00

  • Hypoxaemia during anaesthesia--an observer study.

    abstract::We have investigated 296 inpatients in a single-blind observer study to determine the incidence, degree and duration of hypoxaemia during anaesthesia. The clinical recognition of hypoxaemia, period of time until recognition and risk factors were studied. Oxygen saturation (Spo2) was monitored continuously with a pulse...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Moller JT,Johannessen NW,Berg H,Espersen K,Larsen LE

    更新日期:1991-04-01 00:00:00

  • Collaborative study of the frequency of the fluoride-resistant cholinesterase variant in patients with malignant hyperpyrexia.

    abstract::Cholinesterase phenotyping studies have been carried out in two laboratories on blood specimens from 28 patients shown to be susceptible to malignant hyperpyrexia. In contrast to previously published reports, no evidence could be found for an increase in the frequency of the E1u E1f genotype above that known to occur ...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Evans RT,Iqbal J,Ellis FR,Halsall PJ,Dietz AA,Lubrano T,Rubinstein HM

    更新日期:1981-03-01 00:00:00

  • Comparison of the laryngoscopy views with the size 1 Miller and Macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children

    abstract:BACKGROUND:Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was desi...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,随机对照试验


    authors: Passi Y,Sathyamoorthy M,Lerman J,Heard C,Marino M

    更新日期:2014-11-01 00:00:00

  • Utility of clinical risk predictors for preoperative cardiovascular risk prediction.

    abstract::Cardiovascular risk prediction using clinical risk factors is integral to both the European and the American algorithms for preoperative cardiac risk assessment and perioperative management for non-cardiac surgery. We have reviewed these risk factors and their ability to guide clinical decision making. We examine thei...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审


    authors: Biccard BM,Rodseth RN

    更新日期:2011-08-01 00:00:00

  • Zomepirac, dihydrocodeine and placebo compared in postoperative pain after day-case surgery. The relationship between the effects of single and multiple doses.

    abstract::Zomepirac 100 mg and dihydrocodeine 30 mg were compared with placebo in a controlled randomized, double-blind, single-dose postoperative study. Patients continued to receive either zomepirac or dihydrocodeine for pain relief for 5 days at home in a double-blind study, being allowed to titrate the consumption of tablet...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: McQuay HJ,Bullingham RE,Moore RA,Carroll D,Evans PJ,O'Sullivan G,Collin J,Lloyd JW

    更新日期:1985-04-01 00:00:00

  • Normal saline i.v. fluid load decreases uterine activity in active labour.

    abstract::This study was designed to observe the effects of i.v. fluid infusion on uterine activity during normal labour in women receiving an extradural block. Thirty-four women in spontaneous labour at term gestation were allocated randomly and prospectively to one of three i.v. pre-extradural fluid load groups: group A, no f...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Cheek TG,Samuels P,Miller F,Tobin M,Gutsche BB

    更新日期:1996-11-01 00:00:00

  • Measurement of lung volume by multiple indicator dilution. Testing a modelled hypothesis with on-line computation.

    abstract::Respiratory mass spectrometry and on-line computation were used to estimate lung volume in normal subjects by a rebreathing technique, using oxygen, nitrogen and argon as indicators. The computation had previously been tested in a numerical model. In real normal lungs, it performed well enough for practical purposes, ...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Black AM,Scott IL,Hahn CE,Maynard P,Baker AB

    更新日期:1984-05-01 00:00:00

  • Preoperative abnormalities in serum sodium concentrations are associated with higher in-hospital mortality in patients undergoing major surgery.

    abstract:BACKGROUND:Abnormal serum sodium concentrations are common in patients presenting for surgery. It remains unclear whether these abnormalities are independent risk factors for postoperative mortality. METHODS:This is a secondary analysis of the European Surgical Outcome Study (EuSOS) that provided data describing 46 53...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Cecconi M,Hochrieser H,Chew M,Grocott M,Hoeft A,Hoste A,Jammer I,Posch M,Metnitz P,Pelosi P,Moreno R,Pearse RM,Vincent JL,Rhodes A,European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society o

    更新日期:2016-01-01 00:00:00

  • Impact of phenylephrine administration on cerebral tissue oxygen saturation and blood volume is modulated by carbon dioxide in anaesthetized patients.

    abstract:BACKGROUND:Multiple studies have shown that cerebral tissue oxygen saturation (Sct(O(2))) is decreased after phenylephrine treatment. We hypothesized that the negative impact of phenylephrine administration on Sct(O(2)) is affected by arterial blood carbon dioxide partial pressure (Pa(CO(2))) because CO(2) is a powerfu...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章


    authors: Meng L,Gelb AW,Alexander BS,Cerussi AE,Tromberg BJ,Yu Z,Mantulin WW

    更新日期:2012-05-01 00:00:00

  • Diazepam: routes of administration and rate of absorption. A study of women with pre-eclampsia.

    abstract::Plasma diazepam concentrations were determined following oral, i.m. and i.v. administration to a group of pregnant women with pre-eclampsia and a group of normal pregnant women. Diazepam concentrations were greater following oral as compared with i.m. administration in the control group, who received a single 5-mg dos...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Sturdee DW

    更新日期:1976-11-01 00:00:00

  • Sedation following cardiac surgery: evaluation of alfentanil and morphine in the presence of a computerized closed loop arterial pressure controller.

    abstract::Forty patients who had undergone coronary artery graft surgery and who required vasodilator therapy for postoperative hypertension were given infusions of either alfentanil or morphine together with bolus doses of midazolam for sedation and analgesia while ventilation was controlled artificially. Sodium nitroprusside ...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: McMenemin IM,Church JA,Kenny GN

    更新日期:1988-12-01 00:00:00

  • Molecular weight of hydroxyethyl starch: is there an effect on blood coagulation and pharmacokinetics?

    abstract:BACKGROUND:The development of hydroxyethyl starches (HES) with low impact on blood coagulation but higher volume effect compared with the currently used HES solutions is of clinical interest. We hypothesized that high molecular weight, low-substituted HES might possess these properties. METHODS:Thirty pigs were infuse...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Madjdpour C,Dettori N,Frascarolo P,Burki M,Boll M,Fisch A,Bombeli T,Spahn DR

    更新日期:2005-05-01 00:00:00

  • Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration.

    abstract:BACKGROUND:Single preoperative gabapentinoid (gabapentin and pregabalin) administration has been associated with respiratory depression during Phase I anaesthesia recovery. In this study, we assess for associations between chronic (home) use and perioperative administration (preoperative and postoperative) of gabapenti...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Deljou A,Hedrick SJ,Portner ER,Schroeder DR,Hooten WM,Sprung J,Weingarten TN

    更新日期:2018-04-01 00:00:00

  • Abnormal pupillary activity in a brainstem-dead patient.

    abstract::The pupils in brainstem-dead patients are classically fixed and dilated. We present a case of a brainstem-dead patient whose pupils displayed persistent asynchronous pupillary constriction and dilatation independent of external physical stimuli. Central causes for the phenomenon were excluded leaving an unexplained pe...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Shlugman D,Parulekar M,Elston JS,Farmery A

    更新日期:2001-05-01 00:00:00

  • Postoperative analgesia with Duromorph.

    abstract::The analgesic effects and bioavailability of a slow-release preparation of morphine (Duromorph) were studied in 12 patients with acute postoperative pain. Duromorph produced significant analgesia within 1-2 h of administration i.m., and there was a progressive decrease in the mean pain score for at least 8 h. None of ...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Charway CL,Calvey TN,Williams NE,Murray GR

    更新日期:1985-10-01 00:00:00

  • The pneuPAC hyperbaric variant HB: a ventilator suitable for use within a one-man hyperbaric chamber.

    abstract::We describe the performance of the pneuPAC hyperbaric variant HB, a ventilator designed for use in a one-man hyperbaric chamber. The ventilator delivered minute volumes of 11-23 litre at 1 atm abs to 7.6-16 litre at 2.5 atm abs. The delivered minute volume may be controlled easily from outside the chamber by manipulat...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Spittal MJ,Hunter SJ,Jones L

    更新日期:1991-10-01 00:00:00

  • Differential B and C fibre block by an amide- and an ester-linked local anaesthetic.

    abstract::The relative sensitivity of sympathetic preganglionic and postganglionic axons, B and C fibres, respectively, to two structurally dissimilar local anaesthetics was examined. The concentration of amethocaine (ester-linked tertiary amine) or prilocaine (amide-linked secondary amine) required to reduce the B fibre compou...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Scurlock JE,Heavner JE,de Jong RH

    更新日期:1975-11-01 00:00:00

  • Propofol metabolism is enhanced after repetitive ketamine administration in rats: the role of cytochrome P-450 2B induction.

    abstract:BACKGROUND:In a series of ex vivo and in vivo studies we investigated the ability of repetitive ketamine administration to alter the metabolism and anaesthetic effect of propofol and the role of ketamine-mediated P-450 2B induction in rats. METHODS:Male Wistar rats were pretreated with 80 mg kg(-1) ketamine i.p. twice...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Chan WH,Chen TL,Chen RM,Sun WZ,Ueng TH

    更新日期:2006-09-01 00:00:00

  • Cardiovascular and electroencephalographic effects of laudanosine in "nephrectomized" cats.

    abstract::We studied a cat model simulating laudanosine accumulation in the "anephric" patient. Cardiovascular effects were seen only with the bolus doses of laudanosine 2 mg kg-1, and at plasma laudanosine concentrations unlikely to be achieved clinically. Similarly, EEG and power spectra analysis showed no evidence of epilept...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Ingram MD,Sclabassi RJ,Cook DR,Stiller RL,Bennett MH

    更新日期:1986-01-01 00:00:00

  • Incidence of lower thoracic ligamentum flavum midline gaps.

    abstract:BACKGROUND:Lower thoracic epidural anaesthesia and analgesia (EDA) has gained increasing importance in perioperative pain therapy. The loss-of-resistance technique used to identify the epidural space is thought to rely on the penetration of the ligamentum flavum. Investigations at the cervical and lumbar regions have d...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审


    authors: Lirk P,Colvin J,Steger B,Colvin HP,Keller C,Rieder J,Kolbitsch C,Moriggl B

    更新日期:2005-06-01 00:00:00

  • Investigation of malignant hyperthermia in Denmark and Sweden.

    abstract::Units for the investigation of susceptibility to malignant hyperthermia (MH) were set up in Denmark in 1977 and in Sweden in 1981. Two hundred and ten patients from 76 families have been investigated. The diagnosis of MH susceptibility (MHS) was made by in vitro exposure of muscle from vastus medialis to halothane and...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章


    authors: Ording H,Ranklev E,Fletcher R

    更新日期:1984-11-01 00:00:00

  • Effect of tropisetron, a 5-HT3 receptor antagonist, on analgesia and nausea after intrathecal morphine.

    abstract::We have studied the effect of tropisetron, a 5-HT3-receptor antagonist, on postoperative nausea, vomiting and pain in 54 patients, aged 50-83 yr, after major hip or knee surgery. The patients were given subarachnoid injection of plain 0.5% bupivacaine, mixed with preservative-free morphine 0.3 mg, for surgical and pos...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Pitkänen MT,Niemi L,Tuominen MK,Rosenberg PH

    更新日期:1993-11-01 00:00:00