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Anesthesiology (all articles)

RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock

1 Oct, 2023 | 15:19h | UTC

Study Design & Population: The research was a two-center, prospective, controlled parallel-group, double-blind trial involving 209 septic shock patients who had new-onset supraventricular arrhythmia and a left ventricular ejection fraction above 35%. Patients were randomized to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h).

Main Findings: The primary outcomes focused on the proportion of patients in sinus rhythm 24 hours post-infusion, time to the first sinus rhythm restoration, and arrhythmia recurrence rates. No significant difference was observed in 24-hour sinus rhythm rates between the propafenone (72.8%) and amiodarone (67.3%) groups (p=0.4). Time to the first rhythm restoration was significantly shorter for the propafenone group (median 3.7 hours) compared to the amiodarone group (median 7.3 hours, p=0.02). Recurrence of arrhythmia was notably lower in the propafenone group (52%) than in the amiodarone group (76%, p<0.001). In the subgroup of patients with a dilated left atrium, amiodarone appeared to be more effective.

Implications & Limitations: The study suggests that while propafenone doesn’t offer better rhythm control at 24 hours compared to amiodarone, it does provide faster cardioversion and fewer arrhythmia recurrences, especially in patients with a non-dilated left atrium. No significant differences were observed in clinical outcomes, such as ICU or long-term mortality, between propafenone and amiodarone in the trial. Limitations include potential underpowering of the study and the inability to fully account for the impact of multiple covariates involved in the complex therapy of septic shock.

Article: Balik, M., Maly, M., Brozek, T. et al. Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial. Intensive Care Med (2023)

 

Commentary on Twitter:

 


RCT | Restrictive vs. liberal red blood cell transfusion strategy for critically injured patients

11 Aug, 2023 | 15:08h | UTC

The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma – Journal of Intensive Care

 


Review | Regional anesthesia in the emergency department outside the operating theatre

8 Aug, 2023 | 13:17h | UTC

Regional anesthesia in the emergency department outside the operating theatre – Current Opinion in Anaesthesiology

 


Review | Local anesthetic adjuncts for peripheral nerve blockade

8 Aug, 2023 | 13:16h | UTC

Local anaesthetic adjuncts for peripheral nerve blockade – Current Opinion in Anaesthesiology

 


M-A | Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterization

7 Aug, 2023 | 14:49h | UTC

Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials – Indian Journal of Anaesthesia

 


M-A | Supine vs. nonsupine endotracheal intubation

4 Aug, 2023 | 11:45h | UTC

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Supine vs. Nonsupine Endotracheal Intubation – Critical Care Research and Practice

 


RCT | Ferric derisomaltose plus tranexamic acid may reduce blood transfusion risk by 50% in hip surgery

3 Aug, 2023 | 13:18h | UTC

Ferric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the HiFIT trial): a multicentre, 2 × 2 factorial, randomised, double-blind, controlled trial – The Lancet Haematology (link to abstract – $ for full-text)

 


International Study | Postoperative acute kidney injury affects one in five patients after major surgery

1 Aug, 2023 | 14:23h | UTC

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study – Intensive Care Medicine

 

Commentary on Twitter

 


Review | Regional analgesia for acute pain relief after open thoracotomy and video-assisted thoracoscopic surgery

31 Jul, 2023 | 14:03h | UTC

Regional analgesia for acute pain relief after open thoracotomy and video-assisted thoracoscopic surgery – BJA Education

 


Review | Perioperative iron deficiency anemia

31 Jul, 2023 | 14:02h | UTC

Perioperative iron deficiency anaemia – BJA Education

 


RCT | Combined pre-operative olanzapine regimen lowers postoperative nausea in high-risk cancer patients

24 Jul, 2023 | 12:49h | UTC

Olanzapine as an add-on, pre-operative anti-emetic drug for postoperative nausea or vomiting: a randomised controlled trial – Anaesthesia

 


ASA Consensus Guidance | Preoperative management of patients on GLP-1 agonists

5 Jul, 2023 | 01:17h | UTC

American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists – American Society of Anesthesiologists

Commentary: Anesthesiologists Say Ozempic, Wegovy Should Be Halted Prior to Surgery – HealthDay

 


M-A | Clinical tests for confirming tracheal intubation or excluding esophageal intubation

3 Jul, 2023 | 14:19h | UTC

Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta-analysis – Anaesthesia

 


Consensus Statement 2023 Update | Timing of elective surgery and risk assessment after SARS-CoV-2 infection

30 Jun, 2023 | 15:00h | UTC

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: 2023 update – Anaesthesia

 

Commentary on Twitter

 


Development and validation of an international preoperative risk assessment model for postoperative delirium

30 Jun, 2023 | 14:43h | UTC

Development and validation of an international preoperative risk assessment model for postoperative delirium – Age and Ageing

 


M-A | Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery

29 Jun, 2023 | 14:03h | UTC

Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery: a systematic review, meta-analysis and trial sequential analysis – Anaesthesia

 


Review | Update on the management of patients with HIV infection in anesthesia and critical care

26 Jun, 2023 | 00:36h | UTC

Update on the management of patients with HIV infection in anaesthesia and critical care – BJA Education

 


RCT | Dexmedetomidine administration shows promise in PTSD reduction for trauma surgery patients

23 Jun, 2023 | 13:30h | UTC

Effect of Dexmedetomidine on Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery: A Randomized Clinical Trial – JAMA Network Open

See also: Visual Abstract

 


Review | Nonsurgical management of major hemorrhage

22 Jun, 2023 | 15:16h | UTC

Nonsurgical management of major hemorrhage – Canadian Medical Association Journal

 


ERAS Guideline | Perioperative care for emergency laparotomy

22 Jun, 2023 | 15:14h | UTC

Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations – World Journal of Surgery

Part 1: Preoperative: Diagnosis, Rapid Assessment and Optimization

Part 2: Emergency Laparotomy: Intra- and Postoperative Care

Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient

 


Qualitative Study | International perspectives on modifications to the surgical safety checklist

21 Jun, 2023 | 13:36h | UTC

International Perspectives on Modifications to the Surgical Safety Checklist – JAMA Network Open

Invited Commentary: Modifications of the World Health Organization’s Surgical Safety Checklist—Ways Forward to Ensure Sustainable Implementation – JAMA Network Open

Related: Consensus Statement | Development of an Enhanced Recovery After Surgery (ERAS) surgical safety checklist

 

Commentary on Twitter

 


Review | Traumatic hemorrhage and chain of survival

21 Jun, 2023 | 13:17h | UTC

Traumatic hemorrhage and chain of survival – Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

 


SR | Automated mandatory bolus vs. basal infusion for maintenance of epidural analgesia in labor

20 Jun, 2023 | 12:24h | UTC

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour – Cochrane Library

Summary: Do automated mandatory boluses of epidural medications provide superior labour pain relief than basal infusion? – Cochrane Library

 


RCT | Video laryngoscopy improves first-attempt intubation, severe complications unchanged

19 Jun, 2023 | 14:15h | UTC

Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Study shows video laryngoscope increases successful intubation on first attempt – Vanderbilt University Medical Center

 


Practice advisory for preoperative and intraoperative pain management of thoracic surgical patients

19 Jun, 2023 | 14:05h | UTC

Part 1: Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients – Anesthesia and Analgesia (free for a limited period)

Part 2: Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients – Anesthesia and Analgesia (free for a limited period)

See also: Prevalence and Characteristics of Persistent Postoperative Pain After Thoracic Surgery: A Systematic Review and Meta-Analysis – Anesthesia and Analgesia (free for a limited period)

Infographic: Persistent Pain After Thoracic Surgery—What Works, What Doesn’t – Anesthesia and Analgesia (free for a limited period)

 


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