A big PONV meta-analysis
Interesting Cochrane meta-analysis looking at PONV prophylaxis from German (Weibel et al. 2021) that included almost 100,000 study participants across 585 trials. Interesting not so much because it confirms much of what we already new (or assumed, based on our common PONV prophylaxis drug choices), but because it reassures us that side-effects from commonly used PONV drugs are low to non-existent.
Granisetron is probably the best single-agent or in combination with other agents because of it's efficacy (better than ondansetron), low-cost, long duration, and absent side-effects.
A cognitive aid to better manage perioperative bleeding
Although the benefits of cognitive aids to many areas of anaesthesia are well established, our resistance to using decision support tools persists. Whether due to misplaced perceptions of losing autonomy or Dunning Kruger-adjacent inflated belief in our ability to perform under pressure, is unclear.
In Anaesthesia, Kataife et al. (2021) describe a cognitive aid for better managing perioperative haemorrhage, the Haemostasis Traffic Light algorithm. Using a simulation-based RCT across two centres (University Hospital Zurich & The Italian Hospital of Buenos Aires, N=84), they showed that using the HTL improved case solutions (OR 7.23, 3.82-13.68), quickened therapeutic decisions, (HR 1.97, 1.18-3.29), improved therapeutic confidence, (OR 4.31, 1.67-11.11) and reduced workload perception.
The aim of the HTL is to improve both situational awareness and decision making, by integrating clinical judgement and point-of-care testing (ROTEM) within an accessible, structured algorithm.
Haemostasis Traffic Light takeaway:
Kataife's study again shows the benefit of cognitive aids, particularly in critical, time-sensitive situations. The anaesthesia and critical care community's historical resistance to decision-support tools requires challenge.