British journal of anaesthesia
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Randomized Controlled Trial
Phenylephrine impairs host defence mechanisms to infection: a combined laboratory study in mice and translational human study.
Immunosuppression after surgery is associated with postoperative complications, mediated in part by catecholamines that exert anti-inflammatory effects via the β-adrenergic receptor. Phenylephrine, generally regarded as a selective α-adrenergic agonist, is frequently used to treat perioperative hypotension. However, phenylephrine may impair host defence through β-adrenergic affinity. ⋯ NCT02675868 (Clinicaltrials.gov).
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We examined the association between emergent postoperative tracheal intubation and the use of supraglottic airway devices (SGAs) vs tracheal tubes. ⋯ In patients undergoing procedures under general anaesthesia that could be managed with either SGA or tracheal tube, use of an SGA was associated with lower risk of emergent postoperative intubation. The effect can partly be explained by use of NMBAs. Use of NMBAs in patients with an SGA appears to increase the risk of emergent postoperative intubation.
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Review Meta Analysis
Reducing the dose of neuromuscular blocking agents with adjuncts: a systematic review and meta-analysis.
Acute global shortages of neuromuscular blocking agents (NMBA) threaten to impact adversely on perioperative and critical care. The use of pharmacological adjuncts may reduce NMBA dose. However, the magnitude of any putative effects remains unclear. ⋯ PROSPERO: CRD42020183969.
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Randomized Controlled Trial
Propofol plus low dose dexmedetomidine infusion and postoperative delirium in older patients undergoing cardiac surgery.
Postoperative delirium (POD) is a frequent complication in older patients. Dexmedetomidine might be effective in decreasing the incidence of POD. We hypothesised that adding low-dose rate dexmedetomidine infusion to a propofol sedation regimen would have fewer side-effects and would counteract the possible delirium producing properties of propofol, resulting in a lower risk of POD than propofol with placebo. ⋯ NCT03388541.