Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review Meta Analysis
Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis.
Why is this relevant?
Sore throat following endotracheal intubation is common (reported in up to 68%), and along with postoperative nausea & vomiting, negatively impacts postoperative well-being.
Small studies have previously suggested that IV dexamethasone reduces sore throat due to intubation. It is thought this occurs by reducing mucosal inflammation at the point of tracheal cuff contact, the presumed aetiology of the majority of post-ETT sore throat.
Kuriyama and Maeda conducted a systematic review and meta-analysis of 15 RCTs totalling 1,849 patients.
And they found?
Preoperative dexamethasone IV (~4-10 mg across the studies) reduced the incidence of sore throat by almost 40% (RR 95% CI 0.51-0.75) and mean severity by 1.1 (SMD 95% CI 1.8-0.3).
Take-home...
Given the established effectiveness of preoperative dexamethasone to safely reduce post-operative nausea and vomiting, this meta-analysis affirms another important indication for the routine use of dexamethasone in intubated patients who do not have contraindications to steroid use.
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Review Meta Analysis Comparative Study
Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia.
Cancer-related mortality, a leading cause of death worldwide, is often the result of metastatic disease recurrence. Anesthetic techniques have varying effects on innate and cellular immunity, activation of adrenergic-inflammatory pathways, and activation of cancer-promoting cellular signaling pathways; these effects may translate into an influence of anesthetic technique on long-term cancer outcomes. To further analyze the effects of propofol (intravenous) and volatile (inhalational gas) anesthesia on cancer recurrence and survival, we undertook a systematic review with meta-analysis. ⋯ This meta-analysis suggests that propofol-TIVA use may be associated with improved recurrence-free survival and overall survival in patients having cancer surgery. This is especially evident where major cancer surgery was undertaken. Nevertheless, given the inherent limitations of studies included in this meta-analysis these findings necessitate prospective randomized trials to guide clinical practice.
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Multicenter Study Observational Study
Predictors of transfusion outcomes in pediatric complex cranial vault reconstruction: a multicentre observational study from the Pediatric Craniofacial Collaborative Group.
Pediatric patients undergoing complex cranial vault reconstruction (CCVR) are at risk of significant perioperative blood loss requiring blood product transfusion. Minimizing allogeneic blood product transfusion is an important goal because of the associated risks and cost. The impact of patient and surgical variables on transfusion is unknown in this population. Our primary aim was to examine relationships between demographic and perioperative variables and blood product transfusion outcomes in CCVR. ⋯ Clinical factors associated with increased allogeneic blood product transfusion in pediatric CCVR include: age ≤ 24 months, ASA status ≥ III, preoperative anemia, prolonged surgical duration, lack of intraoperative antifibrinolytic use, lack of intraoperative cell saver use, and the lack of transfusion protocols.
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In a national cross-sectional survey, we aimed to i) characterize work profile, workload, and income, ii) evaluate work satisfaction, work-life integration, burnout, incivility, mentorship, and promotion, iii) gauge future physician resource requirements, and iv) assess for differences by gender and specialty (adult vs pediatric). ⋯ Although most intensivists were satisfied with their careers, many were dissatisfied with their workload, experienced work-life integration challenges, and acknowledged burnout symptoms. Women intensivists were significantly less satisfied with their careers, experienced greater work-life integration challenges, more frequent and severe burnout symptoms, and greater incivility.