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summary
1
Pfizer and BioNTech reported that phase 3 trials of their mRNA SARS-COV-2 vaccine showed:
• Analysis of 927 confirmed symptomatic cases of COVID-19 demonstrates BNT162b2 is highly effective with 91.3% vaccine efficacy observed against COVID-19, measured seven days through up to six months after the second dose.
• Vaccine was 100% effective in preventing severe disease as defined by the U.S. Centers for Disease Control and Prevention and 95.3% effective in preventing severe disease as defined by the U.S. Food and Drug Administration.
• Vaccine was 100% effective in preventing COVID-19 cases in South Africa, where the B.1.351 lineage is prevalent.
• Vaccine safety now evaluated in more than 44,000 participants 16 years of age and older, with more than 12,000 vaccinated participants having at least six months follow-up after their second dose.
Liu Y, Liu J, Xia H et al. Neutralizing Activity of BNT162b2-Elicited Serum. N. Engl. J. Med. 2021 Apr 15; 384 (15): 146614681466-1468.
  Daniel Jolley
pearl
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Serum chloride level fluctuation in the first 72 h of ICU admission is independently associated with increased 30-day mortality.
Kim HJ, Oh TK, Song IA et al. Association between fluctuations in serum chloride levels and 30-day mortality among critically ill patients: a retrospective analysis. BMC Anesthesiol. 2019 May 17; 19 (1): 79.
  Daniel Jolley
pearl
1
Dexamethasone whether intravenous or perineural prolongs sensory & analgesic blocks more than perineural dexmedetomidine.
Sehmbi H, Brull R, Ceballos KR et al. Perineural and intravenous dexamethasone and dexmedetomidine: network meta-analysis of adjunctive effects on supraclavicular bracheal plexus block. Anaesthesia. 2021 Jul 1; 76 (7): 974-990.
  Daniel Jolley
pearl
1
Women experience a higher mortality from out-of-hospital cardiac arrest.
Parikh PB, Hassan L, Qadeer A et al. Association between sex and mortality in adults with in-hospital and out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2020 Oct 1; 155: 119-124.
  Daniel Jolley
pearl
1
Routine administration of sodium bicarbonate during pediatric cardiac arrest is not recommended, and may in fact worsen survival.
Chang CY, Wu PH, Hsiao CT et al. Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2021 May 1; 162: 188-197.
  Daniel Jolley
pearl
1
For women undergoing elective caesarean section, intrathecal hyperbaric prilocaine results in significantly shorter motor block than hyperbaric bupivacaine, with no difference in maternal hypotension, pain or satisfaction.
Chapron K, Sleth JC, Capdevila X et al. Hyperbaric prilocaine vs. hyperbaric bupivacaine for spinal anaesthesia in women undergoing elective caesarean section: a comparative randomised double-blind study. Anaesthesia. 2021 Jun 1; 76 (6): 777-784.
  Daniel Jolley
pearl
1
In patients having laparoscopic abdominal surgery, there was no difference in incidence of delayed neurocognitive recovery between propofol and sevoflurane-based anaesthesia.
Li Y, Chen D, Wang H et al. Intravenous versus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery. Anesthesiology. 2021 Mar 1; 134 (3): 381-394.
  Daniel Jolley
pearl
1
Use of quantitative neuromuscular monitoring significantly reduces the incidence of postoperative residual curarisation.
Carvalho H, Verdonck M, Cools W et al. Forty years of neuromuscular monitoring and postoperative residual curarisation: a meta-analysis and evaluation of confidence in network meta-analysis. Br J Anaesth. 2020 Oct 1; 125 (4): 466-482.
  Daniel Jolley
pearl
1
Sugammadex use is associated with lower incidence of postoperative residual curarisation.
Carvalho H, Verdonck M, Cools W et al. Forty years of neuromuscular monitoring and postoperative residual curarisation: a meta-analysis and evaluation of confidence in network meta-analysis. Br J Anaesth. 2020 Oct 1; 125 (4): 466-482.
  Daniel Jolley
summary
0
Following their important 2020 study of the risk of surgery for COVID patients, the COVIDSurg Collaborative reports on their prospective cohort study aiming to determine the optimal delay for planned surgery after COVID infection.
Once again this was an international (116 countries), multicentre, prospective cohort study including all surgery types, over 140,000 patients, and 3,127 post-COVID. Once again the 30-day postoperative mortality was sobering: even in the 5-6 week post-COVID group, 30-day mortality was dramatically higher (OR 3.6, 2.0-5.2) compared to those without a COVID diagnosis. Worryingly the risk was consistent among both low-risk and high-risk surgical groups.
Although after the 7-week mark postoperative mortality was similar to non-post-COVID patients (OR 1.5, 0.9–2.1), those with persisting COVID symptoms still suffered a 6.0% 30-day mortality (3.2–8.7). (30-day mortality among non-COVID patients was 1.5% (1.4-1.5).
Post-COVID surgical timing takeaway:
Surgery should be delayed for at least 7 weeks after COVID, although those with persistent COVID symptoms will still have more than twice the 30-day mortality than those without.
COVIDSurg Collaborative GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2021 Jun 1; 76 (6): 748758748-758.
  Daniel Jolley