Article Notes

Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments.

  Daniel Jolley

The pectoralis-II myofascial block for breast cancer surgery is a safe and effective alternative to the paravertebral block, demonstrating non-inferiority for 24 hour pain and analgesia need.

  Daniel Jolley

When using supraglottic airways for laparoscopic surgery, the Ambu AuraGain® offers the highest oropharyngeal leak pressure before pneumoperitoneum, and the i-gel® the highest after pneumonperitoneum.

  Daniel Jolley

The combined spinal-epidural offers faster-onset and superior labour analgesia.

  Daniel Jolley

Perioperative use of statins in at-risk patients may significantly reduce perioperative stroke and major cardiac events.

  Daniel Jolley

Why is this interesting?

Digital radiology systems (PACS) allow point-of-care enhancement and adjustment of x-ray images. 'Inverted grayscale' viewing has been advocated as a way to improve the ability to detect small pneumothoraces on posterior-anterior chest x-rays (CXR).

This case-control cross-over study challenges this practice.

What did they do?

The researchers used CXRs of 106 adult patients with a known spontaneous pneumothorax and 162 matched-controls without pneumothorax, but who had presented with pneumothorax-consistent symptoms.

Using a senior radiologist as the gold standard diagnostician, two groups of five emergency physicians were then allocated to identify the presence of a pneumothorax in all 268 CXRs – one group using inverted grayscale and the other the conventional digital view.

To ensure the groups were comparable, the researchers also had each review a random selection of both inverted and conventional images, and compared how the group diagnostic sensitivities correlated.

Bottom-line:

Surprisingly, the sensitivity of pneumothorax detection was higher for conventional imaging than when using inverted grayscale (91.7% vs 84.5%). Specificity was comparable.

Be smart…

Although the researchers showed the inferiority of isolated inverted-grayscale imaging compared to conventional, it is a technique almost always used alongside first viewing a CXR with conventional contrast. Thus even if inferior, it is unlikely to undermine the diagnostic sensitivity of standard CXR reporting.

  Daniel Jolley

Inverted grayscale viewing of a PA chest x-ray is less sensitive for pneumothorax detection than conventional digital CXR viewing.

  Daniel Jolley

High-frequency heart rate variability (HRV) may be a useful intraoperative indicator of the balance between nociception and analgesia.

  Daniel Jolley

Spinal ultrasound improves first-pass success for patients with abnormal spinal anatomy undergoing spinal block, although there was no difference in total procedure time.

  Daniel Jolley

Volatile anaesthesia is associated with both lower long-term mortality and less myocardial infarction compared to propofol anaesthesia for cardiac surgery under cardiopulmonary bypass.

  Daniel Jolley