PREOPERATIVE RISK FACTORS, ADVERSE OUTCOMES AND EFFECTS OF EPIDURAL AND SPINAL ANAESTHESIA

麻醉和大手术的患者共存的重要的医疗问题提出了一个重大挑战，卫生专业人员，以避免和尽量减少危及生命的并发症，这种手术。准确预测哪些患者可能会出现严重的情况，因此需要更密集的围手术期护理和监督，并明确知道硬膜外技术是否真的能改善手术结果，这些都是麻醉实践中的核心重要问题。为这两个问题提供明确的答案需要对大量数据进行仔细分析，其中系统性和随机性误差已被最小化。精心设计和监督的临床试验数据库是这方面的宝贵资源，因为这些数据库是通过在记录、编码和输入信息的过程中严格应用明确的定义和协议汇编的。通过汇集MASTER试验组和区域麻醉随机试验协作概述（CORTRA）的资源和专业知识，这两个项目都是来自澳大利亚地区的主要国际项目，我们有一个独特的机会为麻醉中一些最具挑战性的问题提供非常强大的答案。两个大型国际数据库的联合研究将对术前风险的组成部分及其与危及生命的术后并发症的关系提供更精确的定量分析，以及硬膜外麻醉和脊髓麻醉在通过减少这些并发症的频率来最大限度地降低风险方面的可能作用。

Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. Providing clear answers to both questions requires careful analysis of large amounts of data in which systematic and random errors have been minimised. Databases from well-designed and supervised clinical trials represent an invaluable resource in this regard because they have been compiled through the rigorous application of unambiguous definitions and protocols during the process of recording, coding and entering the information. By bringing together the resources and expertise of the MASTER Trial group and the Collaborative Overview of Randomised of Trials of Regional Anaesthesia (CORTRA), both of which are major international projects led from the Australasian region, we have a unique opportunity to provide exceptionally robust answers to some of the most challenging issues in anaesthesia. The combined study of two large international databases will provide a more precise quantitative analysis of the components of preoperative risk and their relationship to life threatening post operative complications, and the possible role of epidural and spinal anaesthesia in minimising risk by reducing the frequency of these complications.