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comment
1
Withdrawn by the authors because of their inability to confirm validity of data from Surgisphere used as the basis for this study.
Mehra MR, Desai SS, Ruschitzka F et al. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020 May 22.
  Daniel Jolley
comment
0
Although the findings are broadly consistent with existing low-quality observational and randomised trials, once again there are trial issues that cast uncertainty:
• Small study size; note the wide confidence interval in absolute difference of percentage COVID infection, ranging from 50% relative decrease to 15% increase in infection rate.
• Self-reporting by subjects.
• Poor-compliance with hydroxychloroquine; around 1 in 5 did not complete course.
It is unfortunate that, perhaps in their haste, the researchers did not design a more robust trial.
Boulware DR, Pullen MF, Bangdiwala AS et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N. Engl. J. Med. 2020 Aug 6; 383 (6): 517525517-525.
  Daniel Jolley
pearl
1
Hydroxychloroquine probably provides no post-exposure benefit when taken within 4 days of COVID exposure.
Boulware DR, Pullen MF, Bangdiwala AS et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N. Engl. J. Med. 2020 Aug 6; 383 (6): 517525517-525.
  Daniel Jolley
pearl
1
Intrathecal ropivacaine is roughly dose equivalent to bupivacaine at a ratio of 1.5:1 ropivacaine:bupivacaine.
Gautier P, De M, Huberty L et al. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003 Nov 1; 91 (5): 684-9.
  Daniel Jolley
pearl
1
Intrathecal hyperbaric bupivacaine results in faster block onset but shorter duration when compared to isobaric bupivacaine.
Uppal V, Retter S, Shanthanna H et al. Hyperbaric Versus Isobaric Bupivacaine for Spinal Anesthesia: Systematic Review and Meta-analysis for Adult Patients Undergoing Noncesarean Delivery Surgery. Anesth. Analg. 2017 Nov 1; 125 (5): 1627-1637.
  Daniel Jolley
pearl
1
When used for Caesarean section, intrathecal ropivacaine results in faster recovery of motor block but no difference in onset, sensory duration or GA conversion when compared to bupivacaine.
Malhotra R, Johnstone C, Halpern S et al. Duration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section: a meta-analysis. Int J Obstet Anesth. 2016 Aug 1; 27: 9-16.
  Daniel Jolley
pearl
1
No intervention has yet been shown to completely avoid maternal hypotension due to spinal anaesthesia for Caesarean section.
Chooi C, Cox JJ, Lumb RS et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Db Syst Rev. 2017 Aug 4; 8 (8): CD002251CD002251.
  Daniel Jolley
comment
0
This Cochrane review was updated in 2017: Chooi C, Cox JJ, Lumb RS et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section.
Cyna AM, Andrew M, Emmett RS et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Db Syst Rev. 2006 Oct 18 (4): CD002251CD002251.
  Daniel Jolley
pearl
1
No intervention has yet been shown to completely avoid maternal hypotension due to spinal anaesthesia for Caesarean section.
Cyna AM, Andrew M, Emmett RS et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Db Syst Rev. 2006 Oct 18 (4): CD002251CD002251.
  Daniel Jolley
pearl
1
Metaraminol is likely superior to ephedrine for managing hypotension due to spinal anaesthesia for Caesarean section, and non-inferior to phenylephrine.
Chao E, Sun HL, Huang SW et al. Metaraminol use during spinal anaesthesia for caesarean section: a meta-analysis of randomised controlled trials. Int J Obstet Anesth. 2019 Aug 1; 39: 42-50.
  Daniel Jolley