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pearl
1
For paediatric anaesthesia premedication comparing midazolam 0.5 mg/kg to clonidine 4 µg/kg, there is no clinical or statistical difference in negative behaviour changes in 2 to 8 year olds at 1 week. Midazolam did however show significantly lower pre-induction anxiety.
Zickerman C, Hult AC, Hedlund L et al. Clonidine Versus Midazolam Premedication and Postoperative Negative Behavioral Changes in Younger Children: A Randomized Controlled Trial. Anesth. Analg. 2022 Aug 1; 135 (2): 307-315.
  Daniel Jolley
pearl
1
Meta-analysis pooled data continues to suggest that processed-EEG guided general anaesthesia is associated with a slightly lower incidence of postoperative delirium compared to usual care or deeper-guided GA.
Sumner M, Deng C, Evered L et al. Processed electroencephalography-guided general anaesthesia to reduce postoperative delirium: a systematic review and meta-analysis. Br J Anaesth. 2023 Feb 1; 130 (2): e243e253e243-e253.
  Daniel Jolley
pearl
1
After Emergency Medical Services witnessed out-of-hospital cardiac arrest, pooled survival is approximately twice as high in Europe (26%) & Australasia (31%), than in North America (14%).
Gowens P, Smith K, Clegg G et al. Global variation in the incidence and outcome of emergency medical services witnessed out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2022 Jun 1; 175: 120-132.
  Daniel Jolley
pearl
1
Corticosteroid treatment is associated with a reduction in all-cause mortality in severe COVID.
Zeng Y, Zeng W, Yang B et al. Effectiveness of corticosteroids to treat coronavirus disease 2019 symptoms: A meta-analysis. Med Clin (Barc). 2022 Dec 23; 159 (12): 575583575-583.
  Daniel Jolley
pearl
1
Physical activity is associated with lower incidence of COVID-hospitalisation in a non-linear dose-dependent fashion.
Li D, Jin S, He Z et al. Association of physical activity and the risk of COVID-19 hospitalization: A dose-response meta-analysis. Medicine (Baltimore). 2023 Jan 27; 102 (4): e32814e32814.
  Daniel Jolley
pearl
1
Patients with persisting exercise limitation after COVID infection show reduction in peak VO2 from peripheral rather than central cardiovascular limitation.
Singh I, Joseph P, Heerdt PM et al. Persistent Exertional Intolerance after COVID-19: Insights from Invasive Cardiopulmonary Exercise Testing. Chest. 2022 Jan 1; 161 (1): 546354-63.
  Daniel Jolley
pearl
1
Long COVID shows evidence of immunological dysfunction persisting even 8 months after acute recovery.
Phetsouphanh C, Darley DR, Wilson DB et al. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nat. Immunol. 2022 Jan 13.
  Daniel Jolley
summary
0
Patient was IgE positive to both morphine & pholcodine...
Pedersen AF, Green S, Rose MA. Failure to investigate anaesthetic anaphylaxis resulting in a preventable second anaphylactic reaction. Anaesth Intensive Care. 2012 Nov 1; 40 (6): 105310551053-5.
  Daniel Jolley
comment
0
As of February 28th 2023, pholcodine has FINALLY been banned in Australia by the Therapeutic Goods Administration (TGA).
Press release here: TGA - Pholcodine
It's very sad that it took 14 years after Florvaag & Johansson's landmark 2009 paper describing the connection between pholcodine and NMBD anaphylaxis, for this problem to be addressed.
How many patients were exposed to avoidable harm?
Collection: What is the significance of Pholcodine for anesthesia?
  Daniel Jolley
summary
2
Collection: Drowning in the Sea of Evidence
The pressure to practice truly patient-focused, evidence-based medicine weighs on every anaesthetist and anaesthesiologist. Yet as the volume of evidence has grown, so has the expectation to always provide the highest quality care.
There is a trap of unknown knowns: evidence known in the greater medical-knowledge body but that we are naively ignorant of.
Bastardising William Gibson (1993), we risk that the evidence:
“…is already here – it's just not very evenly distributed.”
The greatest challenge for evidence-based anaesthesia continues to be the translation of research findings into actual practice change. The key to this is the intersection between quality, personal relevance, general significance, and credibility. But how can we achieve this?
  Daniel Jolley