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This analysis is not practice-changing, but instead highlights our continued lack of understanding of the outcome benefit (or not) of neuraxial versus general anaesthesia in high risk patient groups.
Interestingly, it is also a meta-analysis of meta-analyses, demonstrating that there are limits to the answers that re-analysing existing data may provide.
Guay J, Choi PT, Suresh S et al. Neuraxial Anesthesia for the Prevention of Postoperative Mortality and Major Morbidity: An Overview of Cochrane Systematic Reviews. Anesth. Analg. 2014 Sep 1;119(3):716-25.
  Daniel Jolley
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This small trial found that pre-operative stellate ganglion block before upper-limb orthopaedic surgery significantly reduced both 24 h tramadol consumption and pain at rest for up to 6 hours, although the later was of borderline clinical significance.
Kumar N, Thapa D, Gombar S et al. Analgesic efficacy of pre-operative stellate ganglion block on postoperative pain relief: a randomised controlled trial. Anaesthesia. 2014 Sep 1;69(9):954-660.
  Daniel Jolley
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Important though not to rush to cause and effect – a higher PaCO₂ may simply reflect better systemic perfusion and thus the greater offloading of tissue PaCO₂ in those recovering better after their arrest, or similar reflection of systemic cellular metabolic function vs dysfunction.
Vaahersalo J, Bendel S, Reinikainen M et al. Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest: Associations With Long-Term Neurological Outcome. Crit. Care Med. 2014 Jun 1;42(6):1463-70.
  Daniel Jolley
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In patients resuscitated after out-of-hospital cardiac arrest, mean 24 hour PaCO₂ predicted good outcome, specifically time spent with PaCO₂ > 45 mmHg. No similar associations could be found between mean 24 h PaO₂ and outcome.
Vaahersalo J, Bendel S, Reinikainen M et al. Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest: Associations With Long-Term Neurological Outcome. Crit. Care Med. 2014 Jun 1;42(6):1463-70.
  Daniel Jolley
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Comparing PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury along with two modalities of physician judgement showed significant variation in the sensitivities and specificities of the five modalities. Only physician practice and PECARN identified all traumatic brain injuries at a cost of lower specificity compared with CHALICE.
Easter JS, Bakes K, Dhaliwal J et al. Comparison of PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury: A Prospective Cohort Study. Ann Emerg Med. 2014 Aug 1; 64 (2): 145152.e1525145-52, 152.e1-5.
  Daniel Jolley
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For emergency medical services with low VF survival rates (<20%), early rhythm analysis improves survival, whereas in services where VF survival rates are high (>20%) delayed rhythm analysis with focus on immediate CPR instead improves survival.
Rea T, Prince D, Morrison L et al. Association Between Survival and Early Versus Later Rhythm Analysis in Out-of-Hospital Cardiac Arrest: Do Agency-Level Factors Influence Outcomes? Ann Emerg Med. 2014 Jul 1; 64 (1): 1-8.
  Daniel Jolley
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Modelling implementation of a clinical decision rule to identify children at very low risk of significant intra-abdominal injury after blunt trauma:
• Saved on average US$55 per child.
• Avoided a CT scan in 1 in 10 children.
• Missed 1 in 2,000 intra-abdominal injuries requiring acute intervention.
Nishijima DK, Yang Z, Clark JA et al. A Cost-effectiveness Analysis Comparing a Clinical Decision Rule Versus Usual Care to Risk Stratify Children for Intraabdominal Injury After Blunt Torso Trauma. Acad Emerg Med. 2013 Nov 1; 20 (11): 1131-8.
  Daniel Jolley
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After reviewing available evidence the Neuropathic Pain Special Interest Group could only recommend:
1. Epidural injections for herpes zoster neuropathic pain.
2. Steroid injections for radiculopathy.
3. Spinal cord stimulator for failed back surgery syndrome or Complex Regional Pain Syndrome type 1
Dworkin RH, O'Connor AB, Kent J et al. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain. 2013 Nov 1; 154 (11): 224922612249-2261.
  Daniel Jolley
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I like that POISE is another example in anaesthesia and peri-operative medicine of where surgery and anaesthesia themselves are not sufficient indications for intervening in a way (ie. starting peri-operative beta-blockers) that is not otherwise medically indicated (ie. as Allan notes, 'requiring beta blockade for cardiac reasons'). Screening coronary angiograms and revascularisation before major surgery are other examples.
There is a bit of "when will we learn?" to the beta-blockade story.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Daniel Jolley
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If a patient requires beta blockade for cardiac reasons they should have it.
If they do not then they should not.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Allan Palmer