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pearl
1
Initiating therapeutic hypothermia for out-of-hospital cardiac arrest pre-hospital does not improve survival or neurological outcome.
Hunter BR, O'Donnell DP, Allgood KL et al. No Benefit to Prehospital Initiation of Therapeutic Hypothermia in Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis. Acad Emerg Med. 2014 Apr 1;21(4):355-64.
  Daniel Jolley
summary
1
For emergency medical services with low VF survival rates (<20%), early rhythm analysis improves survival, whereas in services where VF survival rates are high (>20%) delayed rhythm analysis with focus on immediate CPR instead improves survival.
Rea T, Prince D, Morrison L et al. Association Between Survival and Early Versus Later Rhythm Analysis in Out-of-Hospital Cardiac Arrest: Do Agency-Level Factors Influence Outcomes? Ann Emerg Med. 2014 Jul 1; 64 (1): 1-8.
  Daniel Jolley
summary
1
Modelling implementation of a clinical decision rule to identify children at very low risk of significant intra-abdominal injury after blunt trauma:
• Saved on average US$55 per child.
• Avoided a CT scan in 1 in 10 children.
• Missed 1 in 2,000 intra-abdominal injuries requiring acute intervention.
Nishijima DK, Yang Z, Clark JA et al. A Cost-effectiveness Analysis Comparing a Clinical Decision Rule Versus Usual Care to Risk Stratify Children for Intraabdominal Injury After Blunt Torso Trauma. Acad Emerg Med. 2013 Nov 1; 20 (11): 1131-8.
  Daniel Jolley
summary
1
After reviewing available evidence the Neuropathic Pain Special Interest Group could only recommend:
1. Epidural injections for herpes zoster neuropathic pain.
2. Steroid injections for radiculopathy.
3. Spinal cord stimulator for failed back surgery syndrome or Complex Regional Pain Syndrome type 1
Dworkin RH, O'Connor AB, Kent J et al. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain. 2013 Nov 1; 154 (11): 224922612249-2261.
  Daniel Jolley
pearl
1
The NICOM non-invasive cardiac output monitor is non-inferior to oesophageal doppler monitoring for guiding fluid therapy in colorectal surgery.
Waldron NH, Miller TE, Thacker JK et al. A Prospective Comparison of a Noninvasive Cardiac Output Monitor Versus Esophageal Doppler Monitor for Goal-Directed Fluid Therapy in Colorectal Surgery Patients. Anesth. Analg. 2014 May 1;118(5):966-75.
  Daniel Jolley
pearl
1
Epidural fentanyl has direct neuraxial analgesic effects distinct from systemic analgesic effects.
Sadurní M, Beltrán S, Dürsteler C et al. Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design. Acta Anaesthesiol Scand. 2013 Oct 1;57(9):1103-10.
  Daniel Jolley
comment
0
I like that POISE is another example in anaesthesia and peri-operative medicine of where surgery and anaesthesia themselves are not sufficient indications for intervening in a way (ie. starting peri-operative beta-blockers) that is not otherwise medically indicated (ie. as Allan notes, 'requiring beta blockade for cardiac reasons'). Screening coronary angiograms and revascularisation before major surgery are other examples.
There is a bit of "when will we learn?" to the beta-blockade story.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Daniel Jolley
summary
1
If a patient requires beta blockade for cardiac reasons they should have it.
If they do not then they should not.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Allan Palmer
pearl
1
Use of 6% HES solutions in surgical patients is not associated with either harm or benefit in terms of mortality, renal replacement or kidney injury.
Gillies MA, Habicher M, Jhanji S et al. Incidence of postoperative death and acute kidney injury associated with i.v. 6% hydroxyethyl starch use: systematic review and meta-analysis. Br J Anaesth. 2014 Jan 1; 112 (1): 25-34.
  Daniel Jolley
pearl
1
Goal directed fluid and vasoactive therapy using a non-invasive cardiac output monitor does not reduce complications after major abdominal surgery.
Pestaña D, Espinosa E, Eden A et al. Perioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic Trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery). Anesth. Analg. 2014 Sep 1;119(3):579-87.
  Daniel Jolley