The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis.

BACKGROUND: Current evidence on the effect of dexmedetomidine in early postoperative recovery is limited. We conducted a systematic review to evaluate the effect of dexmedetomidine on the length of stay (LOS) and recovery profile in postanesthesia care unit (PACU) patients. METHODS: The study protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42021240559). No specific funding or support was received. We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library to March 31, 2021 for peer-reviewed randomized controlled studies comparing adult patients who received intravenous dexmedetomidine and placebo undergoing noncardiac, nonneurosurgical procedures under general anesthesia. All studies reporting statistics relating to the duration of stay in the recovery ward or PACU, the primary outcome, were included. We performed individual random-effect meta-analysis on the primary and secondary outcomes (time to extubation, emergence agitation, cough, pain, postoperative nausea and vomiting, shivering, residual sedation, bradycardia, and hypotension) using Stata version 17.0. Evidence was synthesized as mean difference (MD) and risk ratio (RR) for continuous and dichotomous variables, respectively. The quality of evidence was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Thirty-three studies including 2676 patients were eligible for analysis. All studies had low risk or some concerns of overall bias and provided low-to-high certainty evidence for all studied outcomes. Dexmedetomidine was not associated with a significantly increased PACU LOS (MD, 0.69 minute; 95% confidence interval [CI], -1.42 to 2.81 minutes). It was associated with a statistically but not clinically significant prolonged time to extubation (MD, 1 minute; 95% CI, 0.32-1.68 minutes). Dexmedetomidine was associated with significantly reduced incidence of emergence agitation (RR, 0.38; 95% CI, 0.29-0.52), cough (RR, 0.69; 95% CI, 0.61-0.79), pain (RR, 0.50; 95% CI, 0.32-0.80), postoperative nausea and vomiting (RR, 0.54; 95% CI, 0.33-0.86), and shivering (RR, 0.24; 95% CI, 0.12-0.49) in PACU. There was an increased incidence of hypotension (RR, 5.39; 95% CI, 1.12-5.89) but not residual sedation (RR, 1.23; 95% CI, 0.20-7.56) or bradycardia (RR, 5.13; 95% CI, 0.96-27.47) in the dexmedetomidine group. CONCLUSIONS: The use of dexmedetomidine did not increase the duration of PACU LOS but was associated with reduced emergence agitation, cough, pain, postoperative nausea and vomiting, and shivering in PACU. There was an increased incidence of hypotension but not residual sedation or bradycardia in PACU.

Solution-phase decomposition of ferrocene into wüstite-iron oxide core-shell nanoparticles.

We report an improved method for the controlled solvent-phase decomposition of ferrocene into highly crystalline monodisperse iron oxide nanoparticles at relatively low temperatures. Solution-phase decomposition of ferrocene into nanoparticles has received little attention in the literature, due to the percieved stability of ferrocene. However, we synthesised wüstite FeO-iron oxide core-shell nanoparticles by thermally decomposing ferrocene in 1-octadecene solvent and in the presence of oleic acid and oleylamine, as surfactants. We report procedures that provide cubic and spherical core-shell iron oxide nanoparticles whose size (29.3 ± 2.3 nm for spheres, 38.6 ± 6.9 nm for distorted cubes and 23.5 ± 2.4 nm for distorted cubes with concave faces) and shape can be controlled through simple adjustments to reaction parameters. Transmission electron microscopy, scanning transmission electron microscopy, energy dispersive X-ray spectroscopy, electron energy-loss spectroscopy and powder X-ray diffraction analysis methods were used to characterise the nanoparticles.

The role of the PCA3 assay in predicting prostate biopsy outcome in a South African setting.

UNLABELLED: What's known on the subject? and What does the study add? The PCA3 assay has shown significant potential amongst the initial studies carried out in Western countries. This assay performed in line with previous studies. We have shown this marker to perform independent of prostatic volume and have identified potential indications for its use in our setting. However, we have not observed the PCA3 assay to outperform the PSA level across the risk spectrum. OBJECTIVES: • To evaluate the investigational role, ideal threshold and indications of the Prostate CAncer gene 3 (PCA3) assay in a South African context. • To better define the universality of the above marker since this is the pioneer study on the continent of Africa. PATIENTS AND METHODS: • We prospectively evaluated 105 consecutive South African men referred for a prostate biopsy at two tertiary centres in the capital city, Pretoria. • Sequentially, PSA levels and post DRE urine samples were taken within 24 h before prostate biopsy. • The urine specimen was tested using the PROGENSA™ PCA3 assay and a score was generated as (PCA3 mRNA/PSA mRNA) × 1000. • The performance of this assay in predicting biopsy outcome was assessed, and compared with that of serum PSA. RESULTS: • Median patient age was 67 years with a positive biopsy incidence of 42.9%. • The higher the PCA3 score the greater the probability of a positive biopsy (P = 0.003). • This score performed independently of prostatic volume (P = 0.3889) or the presence of a concurrent primary malignancy (P = 0.804). • A threshold of 60 revealed a positive predictive value of 60% with an odds ratio of 4, whereas setting a limit of 35 revealed a positive predictive value of 54% and odds ratio of 3.5. • Using receiver operating characteristics for overall performance comparison, the PSA level (area under the curve 0.844) performed better than the PCA3 score (area under the curve 0.705). CONCLUSION: • PCA3 assay has shown consistency and performed in line with previous studies but it did not surpass serum PSA in this population. • A PCA3 assay threshold of 60 performed better than the conventional limit of 35. • This assay may have a potential niche in a certain subset of South African men that includes patients with larger glands, previous negative biopsies and altered baseline PSA levels.

A simple procedure for the production of large ferromagnetic cobalt nanoparticles.

Epsilon cobalt (ε-Co) nanoparticles in a number of octahedral morphologies have been synthesised. The particles are polycrystalline, with sizes in the order of 30 nm. Magnetic studies reveal the particles are ferromagnetic, with a room temperature saturation magnetisation of 131 emu g(-1). Unlike other large cubic ε-Co syntheses, we have not added an additional co-surfactant. Instead, we have modified the heating regime and reaction agitation. This alternative method highlights the complex chemistry associated with the formation of cobalt nanoparticles by thermal decomposition.

Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices.

Until now, no information is available about the effect of the presence of a doctor-in-training on a patient's blood pressure. We tested the hypothesis that the presence of a last year medical student might increase the blood pressure of the patient, in addition to the possible pressor response to the doctor-trainer. Normotensive and hypertensive patients with a minimum age of 25 years, visiting for any reason, were recruited at 22 teaching general practices. Patients were randomised into a 'trainee' group (n=133) and a 'no trainee' (n=129) group. The blood pressure was measured at two subsequent contacts. In the 'trainee' group, a student was present at the first visit only. In the 'no trainee' group, both visits were without student. Both groups had similar anthropometric characteristics at entry. At the first visit, systolic pressure was higher in the 'trainee' group than in the control group (139.5 vs 133.1 mmHg, P=0.004), with a similar trend for diastolic pressure (80.2 vs 77.8 mmHg, P=0.07). From the first contact to the follow-up visit, blood pressure decreased in the trainee group by 4.8 mmHg systolic (P<0.001) and 1.7 mmHg diastolic (P=0.03), whereas the corresponding changes in the control group were -0.1 mmHg (P=0.90) and +1.5 mmHg (P=0.03). Thus, the between group differences in these trends averaging 4.7 mmHg (CI 1.5-7.9, P=0.005) systolic and 3.2 mmHg (CI 1.1-5.3, P=0.003) diastolic were statistically significant. We conclude that in teaching-practices, the presence of a doctor-in-training has a significant pressor effect when an experienced general practitioner measures a patient's blood pressure. If confirmed, our findings imply that doctors should be cautious to initiate or adjust antihypertensive treatment when blood pressure readings are obtained in the presence of a student.

Bladder hamartoma: a unique cause of urinary retention in a child with Goldenhar syndrome.

The bladder hamartoma is an extremely rare entity. We report on its presence in a 5-year-old boy with Goldenhar syndrome. Most probably, this is the first report of a bladder hamartoma presenting with obstruction of the bladder outlet resulting in urinary retention. The obstructive lesion was resected endoscopically. This proved to be curative for the lesion, since the follow-up voiding cysto-urethrogram revealed only a negligible post-void residual volume. Although urogenital anomalies have a well-known correlation with the Goldenhar syndrome, the existence of the bladder hamartoma found in association with this syndrome, according to the best of our knowledge, has not been previously reported in the world literature. With this report being only the 11 th described case of bladder hamartoma, we highlight on the management options for this exceptional histological finding. The incidence, screening, treatment decisions and important urogenital associations of the Goldenhar syndrome are also discussed.

Periapatite may not improve micromotion of knee prostheses in rheumatoid arthritis.

UNLABELLED: Prosthesis migration in bone inevitably occurs in cemented and uncemented total knee arthroplasty tibial components. Cemented designs as the gold standard give immediate fixation whereas cementless designs need a period of bone ingrowth onto the surface irregularities of the implants. The addition of bioactive coatings may enhance this process of ingrowth. A controlled randomized prospective RSA study was carried out on 26 Duracon implants in a rheumatoid arthritis patient group to evaluate the effect of a periapatite coating on the fixation of the tibial tray. The coated and the noncoated groups were matched for sex, age, body mass index, and HSS Knee Score. Stage of preoperative joint destruction and preoperative and postoperative mechanical leg axis showed no differences. We saw no differences in migration between the two groups, but a trend for lesser translations along and rotations about all three axes in the periapatite group. The periapatite-coated components showed a lower variance in subsidence than did the uncoated components. Both groups also showed a high variance in anterior tilting of the components. The cementless PA-coated Duracon prosthesis used in patients with RA may provide improved fixation of tibial components although we could not demonstrate improvement in this small controlled series. LEVEL OF EVIDENCE: Therapeutic Level II. See the Guidelines for Authors for a complete description of levels of evidence.

The effect of warm humidified CO2 on the dissipation of residual gas following laparoscopy in piglets.

STUDY OBJECTIVE: To determine whether residual gas volume reduces more quickly after insufflation with humidified CO(2) compared with dry CO(2). DESIGN: Animal study (Canadian Task Force classification I). SETTING: University. INTERVENTION: Piglets were randomly divided into two groups of five and underwent abdominal insufflation with either cold, dry CO(2) or warm, humidified CO(2). MEASUREMENTS AND MAIN RESULTS: Following insufflation, anteroposterior and lateral gas-bubble radiographic images were obtained at 5, 15, 30, 45, and 60 minutes, and the area of each gas-bubble profile calculated. Blood samples were obtained at 0, 2, 4, and 5 hours, and they were analyzed for IL-1beta and TNFalpha. Peritoneal tissue samples were obtained on euthanasia at 5 hours for histological analysis. The results indicate that following pneumoperitoneum, residual CO(2) dissipates more rapidly when the gas is heated and humidified compared with when it is cool and dry. This is associated with a reduction in the duration of the inflammatory response as measured by TNF alpha production, although no histologic differences in the peritoneal tissue were observed. CONCLUSION: Heating and humidifying CO(2) leads to faster dissipation of residual gas associated with a reduced duration of inflammation, which may contribute toward a reduction in postlaparoscopic pain.

Adult liver transplantation at UCL: update 2002.

The authors present the results of a single centre study of 587 liver transplants performed in 522 adults during the period 1984-2002. Results have improved significantly over time due to better pre-, peri- and post-transplant care. One, five, ten and fifteen year actuarial survivals for the whole patient group are 81.2; 69.8; 58.9 and 51.2%. The high incidence of de novo tumors (12.3%), of cardiovascular diseases (7.5%) and of end-stage renal function (3.6%) should be further incentives to tailor the immunosuppression to the individual patient and to direct the attention of the transplant physician to the long-term quality of life of the liver recipient.