Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study
Tracheostomy versus prolonged intubation in moderate to severe traumatic brain injury: a multicentre retrospective cohort study.
Tracheostomy is a surgical procedure that is commonly performed in patients admitted to the intensive care unit (ICU). It is frequently required in patients with moderate to severe traumatic brain injury (TBI), a subset of patients with prolonged altered state of consciousness that may require a long period of mechanical respiratory assistance. While many clinicians favour the use of early tracheostomy in TBI patients, the evidence in favour of this practice remains scarce. The aims of our study were to evaluate the potential clinical benefits of tracheostomy versus prolonged endotracheal intubation, as well as whether the timing of the procedure may influence outcome in patients with moderate to severe TBI. ⋯ In this multicentre cohort study, tracheostomy was associated with decreased mortality when compared with prolonged endotracheal intubation in patients with moderate to severe TBI. This effect does not appear to be modified by the timing of the procedure. Nevertheless, the generalization and application of these results remains limited by potential residual time-dependent indication bias.
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Abrupt hemodynamic changes or life-threatening arrhythmias are frequently observed in individuals receiving anesthesia for cardiac arrhythmia ablation. Remimazolam is a novel ultra-short-acting benzodiazepine that has been associated with better hemodynamic stability than conventional anesthetic agents do. This study aimed to investigate whether remimazolam reduces vasoactive agent use compared with desflurane in individuals undergoing ablation for atrial fibrillation under general anesthesia. ⋯ General anesthesia using remimazolam vs desflurane was associated with significantly reduced vasoactive agent requirement and better hemodynamic stability without increased postoperative complications in patients undergoing ablation for atrial fibrillation.
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The primary objective of our study was to determine how lowering a P value threshold from 0.05 to 0.005 would affect the statistical significance of previously published randomized controlled trials (RCTs) in major anesthesiology journals. ⋯ Lowering a P value threshold of 0.05 to 0.005 would have altered one third of significance interpretations of RCTs in the surveyed anesthesiology literature. Thus, it is important for readers to consider post hoc probabilities when evaluating clinical trial results. Although the present study focused on the anesthesiology literature, we suggest that our results warrant further research within other fields of medicine to help avoid clinical misinterpretation of RCT findings and improve quality of care.