Month: August 2018

Weekly Medical & Health News

Even more need to be on cholesterol medications? LDL-C and non–HDL-C ≥160 mg/dL (4.15mmol/l) were independently associated with a 50% to 80% increased relative risk of CVD mortality  link

A higher cardiovascular health score was associated with a lower risk of dementia and lower rates of cognitive decline  link

Omega oil fails again: in diabetics without cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n−3 fatty acid supplementation  and placebo link

But in diabetics aspirin reduces cardiovascular events but at the price of increased bleeding, mostly gastrointestinal  link

Aspirin not clearly great at primary prevention in low risk non-diabetic patients either  link

EpiPen shortage continues  link

Lorcaserin facilitated sustained weight loss without a higher rate of major cardiovascular events than that with placebo, but ongoing surveillance appropriate due to non-significant greater valvulopathy  link

Warning on potential dangers of cannabis in pregnancy and breastfeeding – concerns regarding both short-term growth and long-term neurodevelopmental and behavioral consequences  link

Pollution associated with cognitive performance  link

STDs sharply increasing- nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States in 2017  link

 

Gastric Volume in Term Pregnancy

The risk of gastric aspiration in pregnancy often alters anesthetic techniques before Cesarean. In this study fasted non-labouring term pregnant patients scheduled for elective Caesarean delivery underwent gastric ultrasound and results showed that baseline gastric volume of non-labouring pregnant patients at term is not significantly different from that of non-pregnant females.

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Central venous line failure and complications

A systematic search on this issue revealed: Central venous access device failure was 5% with the highest rates in hemodialysis catheters. Overall central line-associated bloodstream infection rate was 4.59 per 1,000 catheter days with the highest rate in nontunneled central venous access devices. Removal of central venous access device due to suspected infection was high at 17% (20.4 per 1,000 catheter day).

The authors note the disconnect between reported infection rate and removal rate and suggest better practice recommendations for removal of central lines.

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Laryngeal Tube and Cardiac Arrest Outcome

A strategy of initial laryngeal tube insertion, compared with endotracheal intubation, was associated with greater likelihood of 72-hour survival after out of hospital cardiac arrest.

There were small differences in secondary outcomes like favourable neurological status. Airway success rates were far higher in the laryngeal tube group and this makes it difficult to compare directly as intubation successes were so low here, about 50%, quite concerning

At least once again, supraglottic airways seem appropriate as a choice of initial airway management.

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Midazolam and Dexmedetomidine in Cancer

This is a preclinical study whose clinical significance remains to be determined but illustrates the potential wide ranging effects of medications in the cancer patient.

The study in Anesthesiology found “Midazolam possesses antitumorigenic properties partly mediated by the peripheral benzodiazepine receptor, whereas dexmedetomidine promotes cancer cell survival through signaling via the α2-adrenoceptor in lung carcinoma and neuroglioma cells”.

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Neostigmine-Induced Muscle Weakness

While an immense amount of literature on inadequate neuromuscular block reversal exists, this study shows that Neostigmine in the absence of any neuromuscular block can cause weakness itself, resembling a Phase 1 depolarizing block that may not be readily apparent by train-of-four stimulation.

The clinical scenario may be slightly different in the presence of some residual muscle paralysis but the study speaks to the need for universal (and better) neuromuscular monitors as always, especially if hours have elapsed since a muscle relaxant was given. It will be seized upon by Sugammadex enthusiasts who see this latter agent as a better and quicker reversing agent.

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Manual or Mechanical Resuscitation

A meta-analysis studied the performance of two mechanical CPR devices, LUCAS and AutoPulse, compared to manual compression  resuscitation. Manual resuscitation was associated with better survival at 30 days, hospital discharge and better neurological outcomes, as well as less risk of pneumothorax or hematoma.

Manual CPR compression remains the standard of care, but mechanical devices may have a role in special or difficult circumstances  as well as during transport.

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Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness

Extended prophylaxis for thromboembolism after orthopedic surgery is sometimes used, up to 35 days. In contrast, this study focussed on medical patients given Rivaroxaban (Xarelto) for 45 days after discharge. It was not associated with a significantly lower risk of symptomatic venous thromboembolism and death due to venous thromboembolism than placebo. Major bleeding was uncommon. Overall occurrence rates were low and the possibility of benefit in higher risk patients cannot be ruled out.

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Death after Non-Cardiac Surgery

Conference news highlights the risks of death after non-cardiac surgery. The top three complications, which contributed to nearly three-quarters of all deaths, were myocardial injury after noncardiac surgery (MINS; 29%), major bleeding (25%), and sepsis (20%).

“One in 56 patients died within 30 days of noncardiac surgery and nearly all deaths occurred after leaving the operating room, with more than a quarter occurring after hospital discharge.”

Strategies to identify and optimize such patients to help reduce risk are the important implications of ongoing discussion.

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