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pearl
1
Duggan et al.'s MacGyver bias describes the inherent attraction of one's own personal improvised medical devices, even in the absence of evidence of benefit.
Duggan LV, Marshall SD, Scott J et al. The MacGyver bias and attraction of homemade devices in healthcare. Can J Anaesth. 2019 Jul 1; 66 (7): 757-761.
  Daniel Jolley
pearl
1
Leff & Finucane describe Gizmo idolatry as the implicit belief in the superiority of an unproven technological medical solution over one that is less technological.
Leff B Finucane TE. Gizmo idolatry. JAMA. 2008 Apr 16; 299 (15): 1830-2.
  Daniel Jolley
pearl
1
Under simulated conditions perspex aerosol intubating boxes increased intubation time, decreased first-pass intubation success, and increased PPE breaches. Their use during the COVID pandemic cannot be recommended.
Begley JL, Lavery KE, Nickson CP et al. The aerosol box for intubation in COVID-19 patients: an in-situ simulation crossover study. Anaesthesia. 2020 Aug 1; 75 (8): 1014-1021.
  Daniel Jolley
pearl
1
External cephalic version performed under neuraxial anaesthesia has higher odds of success (OR 1.88-3.57) although with higher incidence of hypotension.
Hao Q, Hu Y, Zhang L et al. A Systematic Review and Meta-analysis of Clinical Trials of Neuraxial, Intravenous, and Inhalational Anesthesia for External Cephalic Version. Anesth. Analg. 2020 Dec 1; 131 (6): 180018111800-1811.
  Daniel Jolley
pearl
1
Norepinephrine infusion is practical to use to reduce hypotension during caesarean section under spinal anaesthesia, and is non-inferior compared with phenylephrine.
Hasanin A, Amin S, Refaat S et al. Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial. Anaesth Crit Care Pain Med. 2019 Dec 1; 38 (6): 601-607.
  Daniel Jolley
pearl
1
Norepinephrine (noradrenaline) infusion at 0.08 μg/kg/min prevents spinal-associated hypotension during cesarean section in 90% of patients, although increasing dose increases reactive hypertension.
Fu F, Xiao F, Chen W et al. A randomised double-blind dose-response study of weight-adjusted infusions of norepinephrine for preventing hypotension during combined spinal-epidural anaesthesia for Caesarean delivery. Br J Anaesth. 2020 Mar 1; 124 (3): e108-e114.
  Daniel Jolley
pearl
1
Vasopressors are the most effective method for preventing maternal hypotension, nausea & vomiting after spinal anaesthesia, with metaraminol possibly the best.
Fitzgerald JP, Fedoruk KA, Jadin SM et al. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia. 2020 Jan 1; 75 (1): 109-121.
  Daniel Jolley
pearl
0
When supply-constrained, N95 respiratory masks should be prioritised for high-risk aerosol-generating procedures because they do not appear to offer general healthcare workers significantly greater protection from influenza or other respiratory illness than surgical masks.
Bartoszko JJ, MAM Farooqi, Alhazzani W et al. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respi Viruses. 2020 Jul 1; 14 (4): 365-373.
  Daniel Jolley
comment
0
When considering whether COVID could have significant airborne transmission, note that during the SARS pandemic at least one large Hong Kong outbreak (187 cases) was very likely due to airborne infection: Yu 2004 (NEJM).
Cook TM. Personal protective equipment during the COVID-19 pandemic - a narrative review. Anaesthesia. 2020 Jul 1; 75 (7): 920-927.
  Daniel Jolley
pearl
1
Airway procedures associated with an increased risk of SARS transmission to HCWs include tracheal intubation (OR 6.6), non-invasive ventilation (OR 3.1), tracheotomy (OR 4.2) and manual ventilation (OR 2.8).
Tran K, Cimon K, Severn M et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. Plos One. 2012 Jan 1; 7 (4): e35797.
  Daniel Jolley