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

对同时存在重大医疗问题的患者进行麻醉和大手术，对卫生专业人员提出了重大挑战，以避免和尽量减少这类手术危及生命的并发症。准确预测哪些患者可能会出现严重的情况，因此需要更严格的围手术期护理和监督，以及确切地了解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至关重要的问题。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，尽量减少系统和随机误差。在这方面，来自精心设计和监督的临床试验的数据库是一种宝贵的资源，因为它们是在记录、编码和输入信息的过程中通过严格应用明确的定义和协议编制的。通过汇集主试验组的资源和专业知识以及区域麻醉随机试验协作概述（CORTRA），这两个都是由澳大利亚地区领导的主要国际项目，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有力的答案。两个大型国际数据库的联合研究将提供更精确的定量分析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，以及硬膜外麻醉和脊髓麻醉通过减少这些并发症的频率来最大限度地降低风险的可能作用。

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.