title: Perioperative morbidity:  lessons from recent clinical trials.
abstract: OBJECTIVE
  To identify the recent literature supporting the ability of anesthesiologists to impact morbidity and mortality outside of the immediate intraoperative period.
  
  
  RESULTS
  Hemodynamic management designed to optimize cardiac output and stroke volume can significantly lower the risk of perioperative morbidity, and, in some cases, mortality. The implications of the POISE trial, which upended the previously accumulating data in support of indiscriminate perioperative β-blockade by demonstrating worsened outcomes, were supported by high-quality, propensity-matched, prospectively collected data. Data supporting the safety of colloid use has been threatened by the retraction of 88 publications of a single author, as well as prospective, nonrandomized data, suggesting increased renal morbidity in critically ill patients receiving synthetic colloids. Large datasets continue to suggest an association between red blood cell transfusion and mortality. Analysis of the operating room strongly implicates anesthesia providers as a potential mechanism for bacterial contamination.
  
  
  CONCLUSIONS
  Anesthesiologists should consider implication of goal-directed therapy in high-risk surgical patients, adhere to the American College of Cardiology/American Heart Association guidelines with regard to perioperative β-blockade, critically assess the data to support their choice of synthetic colloids over crystalloids, explore all possible strategies for avoiding perioperative transfusion, and be cognizant of their potential contribution to perioperative infectious morbidity.
authors.affiliation: Department of Anesthesiology, Duke University, Durham, North Carolina, USA. robert.thiele@duke.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Thiele
authors.forename: Julie L
authors.initials: JL
authors.lastname: Huffmyer
authors.forename: Jacob
authors.initials: J
authors.lastname: Raphael
mesh_terms: D058186:Acute Kidney Injury; D000758:Anesthesia / Q000009:adverse effects*; D001786:Blood Glucose; D001803:Blood Transfusion; D002986:Clinical Trials as Topic; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D019317:Evidence-Based Medicine / Q000379:methods; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy / Q000517:prevention & control*; D007552:Isotonic Solutions / Q000627:therapeutic use; D010347:Patient Care Planning; D019990:Perioperative Care / Q000379:methods*; D013318:Stroke Volume
chemical_list: D001786:Blood Glucose; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions