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Early 2021 update of the 2020 Cochrane Review: Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection.
Better data is now available on correlation between PCR cycle threshold and likely infectivity.
Dinnes J, Deeks JJ, Berhane S et al. Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection. Cochrane Db Syst Rev. 2021 Mar 24; 3 (3): CD013705CD013705.
  Daniel Jolley
summary
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Although labelled as 'false' negative, negative RATs associated with positive PCR results, were in this study all in low viral-concentration patients, determined by a high PCR cycle threshold (ie. number of thermal cycles of RNA replication required before fluorescence is detected).
High PCR CT / calculated low-viral-concentration, correlates well with low/non-infectivity of the individual. This does not mean that they may not become infectious in the future, but rather means that at that point in time they are unlikely to be infectious.
Möckel M, Corman VM, Stegemann MS et al. SARS-CoV-2 antigen rapid immunoassay for diagnosis of COVID-19 in the emergency department. Biomarkers. 2021 May 1; 26 (3): 213-220.
  Daniel Jolley
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Early 2020 studies of COVID rapid antigen tests were of low quality and of variable applicability to COVID diagnostic decisions. This situation improved dramatically in 2021 and 2022, and many RATs are now continually validated in existing and emerging variants.
This Cochrane Review was updated in 2021.
Dinnes J, Deeks JJ, Adriano A et al. Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection. Cochrane Db Syst Rev. 2020 Aug 26; 8 (8): CD013705CD013705.
  Daniel Jolley
pearl
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Lateral Flow Devices / RATs show good correlation with low cycle threshold PCR results, and subsequent viral culture, indicating excellent sensitivity for identifying contagious individuals.
Pickering S, Batra R, Merrick B et al. Comparative performance of SARS-CoV-2 lateral flow antigen tests and association with detection of infectious virus in clinical specimens: a single-centre laboratory evaluation study. Lancet Microbe. 2021 Sep 1; 2 (9): e461-e471.
  Daniel Jolley
pearl
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A negative SARS-CoV-2 RAT result with a Roche Cobas RAT indicates a non-contagious individual, even if PCR positive.
Kessler HH, Prüller F, Hardt M et al. Identification of contagious SARS-CoV-2 infected individuals by Roche's Rapid Antigen Test. Clin Chem Lab Med. 2022 Apr 26; 60 (5): 778-785.
  Daniel Jolley
pearl
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The nuance of differences, strengths & indications between direct Macintosh laryngoscopy and various videolaryngoscopes is not easily definable and continues to be open to debate.
de CC, da DM, Lemos VM et al. Videolaryngoscopy vs. direct Macintosh laryngoscopy in tracheal intubation in adults: a ranking systematic review and network meta-analysis. Anaesthesia. 2022 Mar 1; 77 (3): 326-338.
  Daniel Jolley
pearl
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Paravertebral block for breast surgery reduces acute postoperative pain, but not the incidence of chronic pain.
Albi-Feldzer A, Dureau S, Ghimouz A et al. Preoperative Paravertebral Block and Chronic Pain after Breast Cancer Surgery: A Double-blind Randomized Trial. Anesthesiology. 2021 Dec 1; 135 (6): 1091-1103.
  Daniel Jolley
pearl
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Perioperative vitamin C in patients undergoing non-cardiac surgery likely does not offer significant outcome benefit.
Suter M, Bollen PintoBernardoBDivision of Anaesthesiology, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland., Belletti A et al. Efficacy and safety of perioperative vitamin C in patients undergoing noncardiac surgery: a systematic review and meta-analysis of randomised trials. Br J Anaesth. 2022 Apr 1; 128 (4): 664-678.
  Daniel Jolley
pearl
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Goal-directed haemodynamic therapy might decrease mortality, hospital stay & postoperative complications, yet only infectious complications & anastomotic leak show moderate evidence certainty.
Jessen MK, Vallentin MF, Holmberg MJ et al. Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2022 Mar 1; 128 (3): 416433416-433.
  Daniel Jolley
pearl
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Intrathecal 2-chloropocaine 3% is an acceptable alternative to intrathecal hyperbaric bupivacaine for cervical cerclage placement, providing a shorter time to sensory resolution and PACU discharge.
Lee A, Shatil B, Landau R et al. Intrathecal 2-Chloroprocaine 3% Versus Hyperbaric Bupivacaine 0.75% for Cervical Cerclage: A Double-Blind Randomized Controlled Trial. Anesth. Analg. 2022 Mar 1; 134 (3): 624632624-632.
  Daniel Jolley