The edition · Anaesthesiology
Daily sedation interruption probably lowers ICU mortality, updated Cochrane review finds
Twenty-three trials link a daily sedation hold to shorter ventilation and fewer tracheostomies, cannabis users needed only slightly more propofol, and Baxter's premixed dexmedetomidine bags are under a Class II recall.
The edition in brief
An updated Cochrane review of 23 randomised trials in nearly 6,000 ventilated adults and children found daily sedation interruption probably reduced mortality (RR 0.88, 95% CI 0.77 to 0.99; moderate certainty), ICU stay by about 11% and tracheostomy (RR 0.68), and may shorten ventilation by about 14%, with no clear increase in accidental extubation. A Boston cohort of 341,199 anaesthetics found cannabis use was associated with higher propofol and volatile requirements, but the differences were small (about 7 micrograms per kg per minute of propofol for non-medical users and 0.01 to 0.02 MAC). A secondary analysis of a randomised trial in head and neck free-flap surgery found intraoperative dexmedetomidine at 0.3 micrograms per kg per hour was associated with less delirium in the first five days (14.9% vs 34.7%). The FDA lists a Class II recall of Baxter's premixed dexmedetomidine 400 micrograms in 100 mL bags for manufacturing-practice deviations. The pearl: know the lipid emulsion dose for local anaesthetic toxicity before you need it.
Cannabis users needed slightly more propofol, less than once thought
Cannabis use was linked to only slightly higher propofol and volatile needs; ask about it and titrate to effect rather than raising doses pre-emptively.
Intraoperative dexmedetomidine linked to less delirium after free-flap surgery
Low-dose intraoperative dexmedetomidine may reduce delirium after head and neck free-flap surgery; consider it for high-risk patients pending larger trials.
FDA Class II recall: Baxter premixed dexmedetomidine bags
Check premixed Baxter dexmedetomidine 4 micrograms per mL bags against the Class II recall and quarantine affected stock.
Local anaesthetic toxicity: know the lipid dose before you need it
For local anaesthetic toxicity, stop injecting, support the airway and give 20% lipid emulsion 1.5 mL/kg, then an infusion.
Daily sedation interruption: mortality RR 0.88 across 23 trials
Keep a daily sedation interruption, paired with a breathing trial, as standard for ventilated ICU patients unless there is a specific contraindication.
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