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  1. Artikel ; Online: Clonidine in pediatric anesthesia: the new panacea or a drug still looking for an indication?

    Afshari, Arash

    Current opinion in anaesthesiology

    2019  Band 32, Heft 3, Seite(n) 327–333

    Abstract: Purpose of review: Clonidine, an α2-receptor agonist is a widely used drug in pediatrics with a large scope of indications ranging from prevention of postoperative emergence agitation, analgesia, anxiolysis, sedation, weaning to shivering. In the era of ...

    Abstract Purpose of review: Clonidine, an α2-receptor agonist is a widely used drug in pediatrics with a large scope of indications ranging from prevention of postoperative emergence agitation, analgesia, anxiolysis, sedation, weaning to shivering. In the era of 'opioid-free' medicine with much attention be directed toward increasing problems with opioid use, clonidine due to its global availability, low cost and safety profile has become an even more interesting option.
    Recent findings: Increasing evidence from randomised clinical trials support the use of clonidine in healthy children in the perioperative setting. Clonidine appears to significantly reduce postoperative emergence agitation, opioid consumption, shivering, nausea and vomiting. In addition, emerging evidence support the use of clonidine for sedation of critically ill children in ICUs. In this review, the current evidence for clonidine in pediatrics is described and analyzed including a meta-analysis for prevention of emergence agitation.
    Summary: Clonidine appears a safe and beneficial drug with moderate to high-quality evidence supporting its use in pediatric anesthesia. However, for some indications and populations such as children younger than 12 months old and those with hemodynamic instability, there is an urgent need for high-quality trials.
    Mesh-Begriff(e) Adrenergic alpha-2 Receptor Agonists/administration & dosage ; Adrenergic alpha-2 Receptor Agonists/adverse effects ; Age Factors ; Anesthesia/adverse effects ; Anesthesia/methods ; Child ; Clonidine/administration & dosage ; Clonidine/adverse effects ; Emergence Delirium/etiology ; Emergence Delirium/prevention & control ; Humans ; Patient Selection ; Postoperative Nausea and Vomiting/etiology ; Postoperative Nausea and Vomiting/prevention & control ; Randomized Controlled Trials as Topic ; Shivering/drug effects
    Chemische Substanzen Adrenergic alpha-2 Receptor Agonists ; Clonidine (MN3L5RMN02)
    Sprache Englisch
    Erscheinungsdatum 2019-05-02
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Review
    ZDB-ID 645203-6
    ISSN 1473-6500 ; 0952-7907
    ISSN (online) 1473-6500
    ISSN 0952-7907
    DOI 10.1097/ACO.0000000000000724
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Is clinical heterogeneity the foremost prominent threat to the validity of meta-analyses?

    Fabritius, Maria Louise / Afshari, Arash

    Acta anaesthesiologica Scandinavica

    2021  Band 65, Heft 7, Seite(n) 863–864

    Sprache Englisch
    Erscheinungsdatum 2021-06-16
    Erscheinungsland England
    Dokumenttyp Editorial ; Comment
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.13852
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: Effects of avoidance versus use of neuromuscular blocking agents for facilitation of tracheal intubation in children and infants.

    Christensen, Michelle Icka / Vested, Matias / Creutzburg, Andreas / Nørskov, Anders Kehlet / Lundstrøm, Lars Hyldborg / Afshari, Arash

    Acta anaesthesiologica Scandinavica

    2024  

    Abstract: Background: The European Society of Anesthesiology and Intensive Care recommends the use of neuromuscular blocking agents (NMBA) in adults, to facilitate tracheal intubation and reduce its associated complications. Children who undergo tracheal ... ...

    Abstract Background: The European Society of Anesthesiology and Intensive Care recommends the use of neuromuscular blocking agents (NMBA) in adults, to facilitate tracheal intubation and reduce its associated complications. Children who undergo tracheal intubation may suffer some of the same complications, however, no consensus exists regarding the use of NMBA for tracheal intubation in the pediatric population. We will explore the existing evidence assessing the effects of avoidance versus the use of NMBA for the facilitation of tracheal intubation in children and infants.
    Methods: This protocol follows the preferred reporting items for systematic reviews and meta-analyses protocols recommendations. We will include all randomized controlled clinical trials assessing the effects of avoidance versus the use of NMBA for facilitation of tracheal intubation (oral or nasal) using direct laryngoscopy or video laryngoscopy in pediatric participants (<18 years). Our primary outcome is incidence of difficult tracheal intubation. Secondary outcomes include incidence of serious adverse events, failed intubation, events of upper airway discomfort or injury, and difficult laryngoscopy. We will conduct a thorough database search to identify relevant trials, including CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science, CINAHL, and trial registries. Two review authors will independently handle the screening of literature and data extraction. Each trial will be evaluated for major sources of bias with the "classic risk of bias tool" used in the Cochrane Collaboration tool from 2011. We will use Review manager (RevMan) or R with the meta package to perform the meta-analysis. We will perform a trial sequential analysis on the meta-analysis of our primary outcome, providing an estimate of statistical reliability. Two review authors will independently assess the quality of the body of evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. We will use GRADEpro software to conduct the GRADE assessments and to create "Summary of the findings" tables.
    Sprache Englisch
    Erscheinungsdatum 2024-04-30
    Erscheinungsland England
    Dokumenttyp Journal Article ; Review
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14429
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: A new era for troponins in clinical practice guidelines.

    Foex, Pierre / Afshari, Arash / Kranke, Peter / Romero, Carolina S

    European journal of anaesthesiology

    2023  Band 40, Heft 12, Seite(n) 879–883

    Mesh-Begriff(e) Humans ; Biomarkers ; Myocardial Infarction ; Myocardium ; Troponin ; Troponin T ; Practice Guidelines as Topic
    Chemische Substanzen Biomarkers ; Troponin ; Troponin T
    Sprache Englisch
    Erscheinungsdatum 2023-11-08
    Erscheinungsland England
    Dokumenttyp Editorial ; Comment
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001909
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  5. Artikel ; Online: The rationale for the recommendations of the European Paediatric Fasting Guideline: Improving paediatric anaesthesia and perioperative medicine.

    Frykholm, Peter / Disma, Nicola / Kranke, Peter / Afshari, Arash

    European journal of anaesthesiology

    2021  Band 39, Heft 1, Seite(n) 1–3

    Mesh-Begriff(e) Anesthesia/adverse effects ; Child ; Fasting ; Humans ; Perioperative Care ; Perioperative Medicine
    Sprache Englisch
    Erscheinungsdatum 2021-12-02
    Erscheinungsland England
    Dokumenttyp Journal Article ; Comment
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001587
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  6. Artikel ; Online: Adapt or perish: Introducing focused guidelines.

    Romero, Carolina S / Afshari, Arash / Kranke, Peter

    European journal of anaesthesiology

    2021  Band 38, Heft 8, Seite(n) 803–805

    Sprache Englisch
    Erscheinungsdatum 2021-07-02
    Erscheinungsland England
    Dokumenttyp Editorial
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001535
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  7. Artikel ; Online: Clinical guideline on reversal of direct oral anticoagulants in patients with life threatening bleeding.

    Grottke, Oliver / Afshari, Arash / Ahmed, Aamer / Arnaoutoglou, Eleni / Bolliger, Daniel / Fenger-Eriksen, Christian / von Heymann, Christian

    European journal of anaesthesiology

    2024  Band 41, Heft 5, Seite(n) 327–350

    Abstract: Background: Anticoagulation is essential for the treatment and prevention of thromboembolic events. Current guidelines recommend direct oral anticoagulants (DOACs) over vitamin K antagonists in DOAC-eligible patients. The major complication of ... ...

    Abstract Background: Anticoagulation is essential for the treatment and prevention of thromboembolic events. Current guidelines recommend direct oral anticoagulants (DOACs) over vitamin K antagonists in DOAC-eligible patients. The major complication of anticoagulation is serious or life-threatening haemorrhage, which may necessitate prompt haemostatic intervention. Reversal of DOACs may also be required for patients in need of urgent invasive procedures. This guideline from the European Society of Anaesthesiology and Intensive Care (ESAIC) aims to provide evidence-based recommendations and suggestions on how to manage patients on DOACs undergoing urgent or emergency procedures including the treatment of DOAC-induced bleeding.
    Design: A systematic literature search was performed, examining four drug comparators (dabigatran, rivaroxaban, apixaban, edoxaban) and clinical scenarios ranging from planned to emergency surgery with the outcomes of mortality, haematoma growth and thromboembolic complications. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to assess the methodological quality of the included studies. Consensus on the wording of the recommendations was achieved by a Delphi process.
    Results: So far, no results from prospective randomised trials comparing two active comparators (e.g. a direct reversal agent and an unspecific haemostatic agent such as prothrombin complex concentrate: PCC) have been published yet and the majority of publications were uncontrolled and observational studies. Thus, the certainty of evidence was assessed to be either low or very low (GRADE C). Thirty-five recommendations and clinical practice statements were developed. During the Delphi process, strong consensus (>90% agreement) was achieved in 97.1% of recommendations and consensus (75 to 90% agreement) in 2.9%.
    Discussion: DOAC-specific coagulation monitoring may help in patients at risk for elevated DOAC levels, whereas global coagulation tests are not recommended to exclude clinically relevant DOAC levels. In urgent clinical situations, haemostatic treatment using either the direct reversal or nonspecific haemostatic agents should be started without waiting for DOAC level monitoring. DOAC levels above 50 ng ml-1 may be considered clinically relevant necessitating haemostatic treatment before urgent or emergency procedures. Before cardiac surgery under activated factor Xa (FXa) inhibitors, the use of andexanet alfa is not recommended because of inhibition of unfractionated heparin, which is needed for extracorporeal circulation. In the situation of DOAC overdose without bleeding, no haemostatic intervention is suggested, instead measures to eliminate the DOACs should be taken. Due to the lack of published results from comparative prospective, randomised studies, the superiority of reversal treatment strategy vs. a nonspecific haemostatic treatment is unclear for most urgent and emergency procedures and bleeding. Due to the paucity of clinical data, no recommendations for the use of recombinant activated factor VII as a nonspecific haemostatic agent can be given.
    Conclusion: In the clinical scenarios of DOAC intake before urgent procedures and DOAC-induced bleeding, practitioners should evaluate the risk of bleeding of the procedure and the severity of the DOAC-induced bleeding before initiating treatment. Optimal reversal strategy remains to be determined in future trials for most clinical settings.
    Mesh-Begriff(e) Humans ; Heparin/therapeutic use ; Prospective Studies ; Hemorrhage/prevention & control ; Anticoagulants ; Hemostatics/therapeutic use ; Administration, Oral
    Chemische Substanzen Heparin (9005-49-6) ; Anticoagulants ; Hemostatics
    Sprache Englisch
    Erscheinungsdatum 2024-04-04
    Erscheinungsland England
    Dokumenttyp Journal Article
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001968
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  8. Artikel ; Online: Decoding the meaning of medical guidelines and their medicolegal implications.

    Kranke, Peter / Afshari, Arash / Meybohm, Patrick / Buhre, Wolfgang / Wiege, Stephanie / Romero, Carolina S

    European journal of anaesthesiology

    2023  Band 41, Heft 2, Seite(n) 109–114

    Abstract: Medical practice guidelines (MPGs) are important in medicine to ensure well tolerated and effective healthcare. They provide evidence-based recommendations for healthcare professionals in daily clinical settings. MPGs help patients and practitioners make ...

    Abstract Medical practice guidelines (MPGs) are important in medicine to ensure well tolerated and effective healthcare. They provide evidence-based recommendations for healthcare professionals in daily clinical settings. MPGs help patients and practitioners make informed decisions, ensure quality of care, allocate healthcare resources effectively and reduce legal liability. MPGs have medicolegal implications, as they influence clinical decision-making and patient outcomes, which can impact liability and malpractice cases. They define the standard of care within the healthcare industry and provide best practice recommendations. MPGs are a cornerstone of the informed consent process, as they facilitate a shared decision support system and they provide valuable evidence-based recommendations on various treatments or medical options. Finally, MPGs are also relevant in medical claims; thus, adherence to MPGs is highly encouraged in order to assure the best medical care. Nonetheless, MPGs have limitations and we advocate for wise usage of MPGs combined with the expertise of trained physicians that allows for individualisation and evidence-based recommendations. In this review, we describe the potential legal implications that MPGs may represent for healthcare providers and the role that MPGs have in daily practice at different stages in the doctor--patient relationship.
    Mesh-Begriff(e) Humans ; Malpractice ; Delivery of Health Care
    Sprache Englisch
    Erscheinungsdatum 2023-10-19
    Erscheinungsland England
    Dokumenttyp Review ; Journal Article
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001917
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  9. Artikel ; Online: Clonidine for preventing emergence agitation in infants (PREVENT AGITATION II): Protocol and statistical analysis plan.

    Garioud, Anne Louise de Barros / Nielsen, Bettina Nygaard / Falcon, Lars / Mondrup, Frederik / Afshari, Arash

    Acta anaesthesiologica Scandinavica

    2023  Band 67, Heft 5, Seite(n) 663–669

    Abstract: Background: Emergence agitation is a common clinical condition in children. Symptoms pertaining to the spectrum of early postoperative negative behavior typically occur upon emergence from anesthesia. Clonidine is an effective adjunctive agent for the ... ...

    Abstract Background: Emergence agitation is a common clinical condition in children. Symptoms pertaining to the spectrum of early postoperative negative behavior typically occur upon emergence from anesthesia. Clonidine is an effective adjunctive agent for the prevention of emergence agitation in children, but evidence in the smallest age groups is sparse We aim to investigate the efficacy and safety of an intraoperative bolus of intravenous clonidine for preventing emergence agitation in children 3-12 months of age.
    Methods: This is a randomized, placebo-controlled, double-blind trial. We will enroll 320 patients aged 3-12 months who have been scheduled for general anesthesia maintained with sevoflurane and opioid. The randomization is parallel and stratified by age group, sex, and site. The investigational medicinal product will be administered intravenously ~20 min before the anticipated end of the surgical procedure. The intervention is clonidine 3 μg/kg and placebo is isotonic saline in a corresponding volume.
    Results: The primary outcome is the incidence of emergence agitation as assessed on the Watcha scale, that is, any Watcha score >2 during participants' stay in the postanesthetic care unit. Secondary outcomes are the proportion of participants with postoperative pain, with postoperative nausea and vomiting, and a composite safety outcome. Statistical analysis will be conducted according to the Statistical Analysis Plan with the intention-to-treat population for our primary analyses.
    Conclusion: The PREVENT AGITATION II trial will contribute valuable knowledge on efficacy for the prevention of emergence agitation and safety in infants.
    Mesh-Begriff(e) Child ; Humans ; Infant ; Clonidine/therapeutic use ; Emergence Delirium/prevention & control ; Anesthetics, Inhalation ; Sevoflurane ; Anesthesia, General/adverse effects ; Psychomotor Agitation/prevention & control ; Psychomotor Agitation/epidemiology ; Double-Blind Method ; Anesthesia Recovery Period ; Methyl Ethers ; Randomized Controlled Trials as Topic
    Chemische Substanzen Clonidine (MN3L5RMN02) ; Anesthetics, Inhalation ; Sevoflurane (38LVP0K73A) ; Methyl Ethers
    Sprache Englisch
    Erscheinungsdatum 2023-02-27
    Erscheinungsland England
    Dokumenttyp Clinical Trial Protocol ; Journal Article
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14212
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  10. Artikel ; Online: Pitfalls of clinical practice guidelines in the era of broken science: Let's raise the standards.

    Afshari, Arash / De Hert, Stefan

    European journal of anaesthesiology

    2018  Band 35, Heft 12, Seite(n) 903–906

    Mesh-Begriff(e) Anesthesiology/standards ; Humans ; Practice Guidelines as Topic/standards ; Societies, Medical/standards
    Sprache Englisch
    Erscheinungsdatum 2018-10-29
    Erscheinungsland England
    Dokumenttyp Editorial
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000000892
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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