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pearl
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The Pfizer–BioNTech COVID-19 vaccine was 91% effective in preventing infection with SARS-CoV-2 in phase 3 trials.
Liu Y, Liu J, Xia H et al. Neutralizing Activity of BNT162b2-Elicited Serum. N. Engl. J. Med. 2021 Apr 15; 384 (15): 146614681466-1468.
  Daniel Jolley
summary
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Pfizer and BioNTech reported that phase 3 trials of their mRNA SARS-COV-2 vaccine showed:
• Analysis of 927 confirmed symptomatic cases of COVID-19 demonstrates BNT162b2 is highly effective with 91.3% vaccine efficacy observed against COVID-19, measured seven days through up to six months after the second dose.
• Vaccine was 100% effective in preventing severe disease as defined by the U.S. Centers for Disease Control and Prevention and 95.3% effective in preventing severe disease as defined by the U.S. Food and Drug Administration.
• Vaccine was 100% effective in preventing COVID-19 cases in South Africa, where the B.1.351 lineage is prevalent.
• Vaccine safety now evaluated in more than 44,000 participants 16 years of age and older, with more than 12,000 vaccinated participants having at least six months follow-up after their second dose.
Liu Y, Liu J, Xia H et al. Neutralizing Activity of BNT162b2-Elicited Serum. N. Engl. J. Med. 2021 Apr 15; 384 (15): 146614681466-1468.
  Daniel Jolley
pearl
1
Serum chloride level fluctuation in the first 72 h of ICU admission is independently associated with increased 30-day mortality.
Kim HJ, Oh TK, Song IA et al. Association between fluctuations in serum chloride levels and 30-day mortality among critically ill patients: a retrospective analysis. BMC Anesthesiol. 2019 May 17; 19 (1): 79.
  Daniel Jolley
pearl
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Dexamethasone whether intravenous or perineural prolongs sensory & analgesic blocks more than perineural dexmedetomidine.
Sehmbi H, Brull R, Ceballos KR et al. Perineural and intravenous dexamethasone and dexmedetomidine: network meta-analysis of adjunctive effects on supraclavicular bracheal plexus block. Anaesthesia. 2021 Jul 1; 76 (7): 974-990.
  Daniel Jolley
pearl
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Women experience a higher mortality from out-of-hospital cardiac arrest.
Parikh PB, Hassan L, Qadeer A et al. Association between sex and mortality in adults with in-hospital and out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2020 Oct 1; 155: 119-124.
  Daniel Jolley
pearl
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Routine administration of sodium bicarbonate during pediatric cardiac arrest is not recommended, and may in fact worsen survival.
Chang CY, Wu PH, Hsiao CT et al. Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2021 May 1; 162: 188-197.
  Daniel Jolley
comment
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Although interesting and perhaps relevant to settings which require motor block resolution before discharge from PACU (or when there are bupivacaine shortages), the practical relevance of this study is questionable.
Notable in this French study is the extended duration of PACU stay after caesarean section: more than 2 hours in the prilocaine group, and 3 hours in the bupivcaine group! It is unclear whether this is routine post-CS care, or specific to the study design to allow for motor block assessment.
Also of note, the caesarean sections were "...performed using Misgav-Ladach technique with externalisation of the uterus" which may again make this study less relevant in settings where it is routinely accepted that avoiding uterine externalisation makes for better patient experience.
Chapron K, Sleth JC, Capdevila X et al. Hyperbaric prilocaine vs. hyperbaric bupivacaine for spinal anaesthesia in women undergoing elective caesarean section: a comparative randomised double-blind study. Anaesthesia. 2021 Jun 1; 76 (6): 777-784.
  Daniel Jolley
pearl
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For women undergoing elective caesarean section, intrathecal hyperbaric prilocaine results in significantly shorter motor block than hyperbaric bupivacaine, with no difference in maternal hypotension, pain or satisfaction.
Chapron K, Sleth JC, Capdevila X et al. Hyperbaric prilocaine vs. hyperbaric bupivacaine for spinal anaesthesia in women undergoing elective caesarean section: a comparative randomised double-blind study. Anaesthesia. 2021 Jun 1; 76 (6): 777-784.
  Daniel Jolley
pearl
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In patients having laparoscopic abdominal surgery, there was no difference in incidence of delayed neurocognitive recovery between propofol and sevoflurane-based anaesthesia.
Li Y, Chen D, Wang H et al. Intravenous versus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery. Anesthesiology. 2021 Mar 1; 134 (3): 381-394.
  Daniel Jolley
pearl
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Use of quantitative neuromuscular monitoring significantly reduces the incidence of postoperative residual curarisation.
Carvalho H, Verdonck M, Cools W et al. Forty years of neuromuscular monitoring and postoperative residual curarisation: a meta-analysis and evaluation of confidence in network meta-analysis. Br J Anaesth. 2020 Oct 1; 125 (4): 466-482.
  Daniel Jolley