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The results of the trial should only be considered 'hypothesis forming' rather than practice changing, due to the:
• Small number of subjects in each arm.
• Non-randomised, observational nature of the trial.
• Difficulty generalising these findings to those from different cultural backgrounds.
Ding T, Wang DX, Qu Y et al. Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study. Anesth. Analg. 2014 Aug 1;119(2):383-92.
  Daniel Jolley
summary
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Women who received epidural analgesia during labour had a lower risk of post-natal depression at 6 weeks (OR 0.30), similar to the lowered risk in those who attended childbirth classes (OR 0.30).
Ding T, Wang DX, Qu Y et al. Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study. Anesth. Analg. 2014 Aug 1;119(2):383-92.
  Daniel Jolley
summary
1
Although improving, 'harms reporting' in analgesic clinical trials is generally poor. On average the 101 studied analgesic trials met only 60% of harms reporting recommendations.
Smith SM, Daniel R, Pereira A et al. Adherence to CONSORT harms-reporting recommendations in publications of recent analgesic clinical trials: an ACTTION systematic review. Pain. 2012 Dec 1;153(12):2415-21.
  Daniel Jolley
summary
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Sedation with TCI remifentanil targeting effect site concentration of 3 ng/mL resulted in detectable aspiration in almost 50% of the study participants after 1 hour.
Savilampi J, Ahlstrand R, Magnuson A et al. Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers. Anesthesiology. 2014 Jul 1;121(1):52-8.
  Daniel Jolley
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Interesting to note that not only did the pudendal nerve block group experience better analgesia than the caudal block group, they were also exposed to a much smaller absolute dose of bupivacaine (0.75 mg/kg vs 2.5 mg/kg). This is important not only because of the safety implications, but also because allows extra LA for top-up if the block is inadequate or fails.
Naja ZM, Ziade FM, Kamel R et al. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth. Analg. 2013 Dec 1;117(6):1401-7.
  Daniel Jolley
summary
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Despite increasing the likelihood of a Cormack-Lehane grade 1 view, pooled results from the studies showed no difference between the Pentax Airway Scope and standard Macintosh laryngoscope for:
• Rate of intubation on first attempt.
• Time for intubation.
• Incidence of oral or pharyngeal injury.
Hoshijima H, Kuratani N, Hirabayashi Y et al. Pentax Airway Scope(®) vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis. Anaesthesia. 2014 Aug 1;69(8):911-8.
  Daniel Jolley
summary
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Real-time ultrasound guidance of central line insertion dramatically reduces the incidence of procedural failure (RR 0.18), arterial puncture (RR 0.25), haematoma (RR 0.30), pneumothorax (RR 0.21), and haemothorax (RR 0.10). Studies specifically investigating children and infants were however too small to make significant conclusions.
Wu SY, Ling Q, Cao LH et al. Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology. 2013 Feb 1;118(2):361-75.
  Daniel Jolley
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Although this Cochrane review supports the belief that epidural and paravertebral blocks may reduce persistent-surgical pain after thoracotomy or breast cancer surgery respectively, the authors highlight the low total number of subjects (only 339 patients) in the five trials analysed. This is enough evidence to consider the PSP-benefits of regional anesthesia, but far from enough to be conclusive or change practice.
Andreae MH Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013 Nov 1; 111 (5): 711-20.
  Daniel Jolley
summary
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Tatsioni found that earlier disproven observational studies were still positively cited in 50% or more of peer reviewed publications, despite the existence of well-established contrary evidence.
Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007 Dec 5;298(21):2517-26.
  Daniel Jolley
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To explore the future contradiction of highly-cited research Ioannidis investigated just under 50 of the most significant and highly regarded medical research findings from 1990 to 2003. Of 45 that concluded their interventions were effective, 34 had had their hypothesis retested. Of these 34, over 40% (14) were subsequently shown to be incorrect or exaggerated. Forty percent of some of the most highly regarded, practice-changing medical evidence from the 20th century subsequently disproven!
Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005 Jul 13;294(2):218-28.
  Daniel Jolley