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pearl
1
Peri-operative intravenous crystalloid probably reduces the risk of postoperative nausea and vomiting.
Jewer JK, Wong MJ, Bird SJ et al. Supplemental peri-operative intravenous crystalloids for postoperative nausea and vomiting: an abridged Cochrane systematic review. Anaesthesia. 2020 Feb 1; 75 (2): 254-265.
  Daniel Jolley
pearl
0
Sugammadex anaphylaxis risk is greater than for neostigmine.
Orihara M, Takazawa T, Horiuchi T et al. Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study. Br J Anaesth. 2020 Feb 1; 124 (2): 154-163.
  Daniel Jolley
pearl
1
Intraoperative and postoperative hypotension are both associated with postoperative delirium among patients admitted to ICU.
Maheshwari K, Ahuja S, Khanna AK et al. Association Between Perioperative Hypotension and Delirium in Postoperative Critically Ill Patients: A Retrospective Cohort Analysis. Anesth. Analg. 2020 Mar 1; 130 (3): 636-643.
  Daniel Jolley
pearl
1
Non-orthopaedic surgery is associated with a post-operative discontinuation of opioid use among chronic users.
Jivraj NK, Scales DC, Gomes T et al. Evaluation of opioid discontinuation after non-orthopaedic surgery among chronic opioid users: a population-based cohort study. Br J Anaesth. 2020 Mar 1; 124 (3): 281-291.
  Daniel Jolley
pearl
1
Up to 50% of contagious COVID-19 patients are asymptomatic or pre-symptomatic.
Gandhi M, Yokoe DS, Havlir DV. Asymptomatic Transmission, the Achilles' Heel of Current Strategies to Control Covid-19. N. Engl. J. Med. 2020 May 28; 382 (22): 2158-2160.
  Daniel Jolley
pearl
1
PPE doffing carries significant risk for self-contamination. Assisted doffing likely reduces this risk.
Chughtai AA, Chen X, Macintyre CR. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control. 2018 Dec 1; 46 (12): 1329-1334.
  Daniel Jolley
pearl
1
Personal protective equipment (PPE) may significantly reduce first-pass intubation success for trainees, primarily due to the visibility impact of protective hoods.
Scott R, Pitzer M, Goldman G et al. Comparison of intubation devices in level C personal protective equipment: A cadaveric study. Am J Emerg Med. 2018 Jun 1; 36 (6): 922-925.
  Daniel Jolley
summary
1
This relatively small study (N=19) randomised emergency resident trainees (14) and first responders (5) to cadaveric intubation with and without 'Level C PPE':
Level C PPE typically includes a full face mask with air respirator, a hooded chemical resistant clothing, inner and outer gloves and chemical resistant boots with covers.
First-pass intubation success was significant lower (58% vs 96%) while wearing PPE than without. Subjects identified the visibility impact of wearing protective hoods as the most common impediment to intubation.
Scott R, Pitzer M, Goldman G et al. Comparison of intubation devices in level C personal protective equipment: A cadaveric study. Am J Emerg Med. 2018 Jun 1; 36 (6): 922-925.
  Daniel Jolley
summary
1
This is the second update to Verbeek et al.'s 2016 Cochrane Review of personal protective equipment (PPE) for preventing infections in healthcare workers (HCW). The prior update was in July 2019.
What's worth knowing?
Overall most studies of PPE efficacy are of low quality and offer a low certainty of conclusions. Caveat emptor...
• Powered air-purifying respirator (PAPR) with coverall may be more protective than N95 masks and gown (RR 0.27), but create unique donning challenges.
• Long-gowns may be better than a coverall, but are also more difficult to doff. Gowns are better than aprons. Better sealing, fitting, and one-piece removal at gown-glove interfaces and closer fit around the neck may reduce exposure.
• Double-gloving may reduce exposure.
• Better training, computer simulation, video lectures, following CDC protocols, and spoken instruction may improve donning and doffing compliance.
Verbeek JH, Rajamaki B, Ijaz S et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Db Syst Rev. 2020 Apr 15; 4 (4): CD011621CD011621.
  Daniel Jolley
pearl
1
Transmission of SARS-CoV-2 should be conceptualised as a spectrum of risk where time exposed may be the dominant factor.
Wilson NM, Norton A, Young FP et al. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review. Anaesthesia. 2020 Aug 1; 75 (8): 1086-1095.
  Daniel Jolley