Canadian journal of anaesthesia = Journal canadien d'anesthésie
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In the article entitled: "Carfentanil: a narrative review of its pharmacology and public health concerns" published online and in the April 2019 issue of the Journal, Can J Anesth 2019; DOI: https://doi.org/10.1007/s12630-019-01294-y , the Figure showed the wrong structures for remifentanil and carfentanil. This is now corrected in the accompanying revised figure and legend.
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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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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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Acute kidney injury (AKI) is defined as an abrupt decrease in kidney function, with the most severe form requiring some method of renal replacement therapy (RRT). The use of RRT is required in 5-10% of critically ill patients who develop severe AKI. ⋯ Continuous renal replacement therapy may be run in different modes of increasing complexity depending on a given patient's clinical needs. Regional citrate anticoagulation is recommended as the therapy of choice for the majority of critically ill patients requiring CRRT.