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.
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.
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.
The combined spinal-epidural offers faster-onset and superior labour analgesia.
Perioperative use of statins in at-risk patients may significantly reduce perioperative stroke and major cardiac events.
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.
Surprisingly, the sensitivity of pneumothorax detection was higher for conventional imaging than when using inverted grayscale (91.7% vs 84.5%). Specificity was comparable.
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.
Inverted grayscale viewing of a PA chest x-ray is less sensitive for pneumothorax detection than conventional digital CXR viewing.
High-frequency heart rate variability (HRV) may be a useful intraoperative indicator of the balance between nociception and analgesia.
Spinal ultrasound improves first-pass success for patients with abnormal spinal anatomy undergoing spinal block, although there was no difference in total procedure time.
Volatile anaesthesia is associated with both lower long-term mortality and less myocardial infarction compared to propofol anaesthesia for cardiac surgery under cardiopulmonary bypass.