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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
comment
1
Although interesting and perhaps relevant to settings which require motor block resolution before discharge from PACU (or when there are bupivacaine shortages), the practical relevance of this study is questionable.
Notable in this French study is the extended duration of PACU stay after caesarean section: more than 2 hours in the prilocaine group, and 3 hours in the bupivcaine group! It is unclear whether this is routine post-CS care, or specific to the study design to allow for motor block assessment.
Also of note, the caesarean sections were "...performed using Misgav-Ladach technique with externalisation of the uterus" which may again make this study less relevant in settings where it is routinely accepted that avoiding uterine externalisation makes for better patient experience.
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
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
comment
1
The most relevant takeaway from this meta-analysis is really just how poor a lot of the evidence around resuscitation and CPR is (not for lack of effort, but because of the obvious limitations of research around critical-event and end-of-life medicine). Not only was the analysed evidence of low certainty but notably all seven RCTs were manikin studies.
Manikins are designed for resuscitation education and training, not for physiological fidelity. Even if this study had shown an improvement in compression depth for different surfaces, it's relevance to CPR in flesh-and-blood humans would be no less questionable.
Holt J, Ward A, Mohamed TY et al. The optimal surface for delivery of CPR: a systematic review and meta-analysis. Resuscitation. 2020 Oct 1; 155: 159-164.
  Daniel Jolley