Evidence-based medicine and anaesthesia: uneasy bedfellows?

Area of Science:

• Anesthesiology
• Medical Informatics
• Research Methodology

Background:

• Evidence-based medicine (EBM) emerged in 1992 and is now widely adopted.
• Its relevance and foundational principles in anaesthetic practice warrant examination.
• Anaesthesia differs from disease-treating specialties in its research endpoints.

Purpose of the Study:

• To assess the applicability and validity of evidence-based medicine principles within anaesthetic practice.
• To identify limitations of EBM when applied to anaesthesia.
• To critically evaluate research methodologies and evidence sources in anaesthesia.

Main Methods:

• Literature review and conceptual analysis of evidence-based medicine principles.
• Comparison of research outcome measures in anaesthesia versus disease-treating specialties.
• Critical appraisal of evidence synthesis techniques like meta-analysis and multicentre trials.

Main Results:

• Anaesthetic research predominantly uses surrogate or intermediate outcomes, not real-world clinical endpoints.
• The transferability of findings from skilled interventions to all practitioners is questionable.
• Sources of evidence outside peer-reviewed literature and the application of meta-analysis require cautious interpretation.

Conclusions:

• Evidence-based medicine offers less direct benefit to anaesthesia compared to disease-treating specialties.
• The reliance on surrogate outcomes and the nature of anaesthetic interventions limit EBM's direct applicability.
• Critical evaluation of evidence sources and methodologies is crucial for anaesthetic practice.