Meta-analysis of 910 patients finds midline catheters carry higher mechanical complications and shorter dwell times than PICCs

Procedural sedation during fiberoptic bronchoscopy requires maintaining patient comfort while preventing airway compromise, respiratory depression, and hemodynamic instability. Remimazolam, an ultra-short-acting ester-based benzodiazepine hydrolyzed by tissue esterases, was evaluated in this meta-analysis of 16 randomized controlled trials comprising 2,325 adult patients undergoing fiberoptic bronchoscopy across five databases through January 2026. Compared with active controls (dexmedetomidine, midazolam, and propofol), remimazolam significantly reduced the incidence of respiratory depression (relative risk [RR]: 0.51, 95% CI: 0.36–0.73, p < 0.001), hypotension (RR: 0.50, 95% CI: 0.34–0.73, p < 0.001), and bradycardia (RR: 0.37, 95% CI: 0.22–0.65, p = 0.001). Sedation onset was significantly faster than dexmedetomidine (mean difference [MD]: -2.19 minutes), though slightly slower than propofol (MD: +0.49 minutes). Procedural success rates were high and comparable between groups (RR: 1.12, 95% CI: 0.98–1.28, p = 0.097). Patients receiving remimazolam experienced significantly shorter emergence times (-1.79 minutes vs dexmedetomidine; -4.37 minutes vs midazolam) and spent significantly less time in the post-anesthesia care unit (PACU stay shortened by 3.58 minutes vs dexmedetomidine and 6.70 minutes vs midazolam).

Maternal obesity is a major contributor to prolonged labor and cesarean birth, but the specific dynamics of prostaglandin cervical ripening in severe obesity remain incompletely defined. This study analyzed data from 1,322 patients at >= 37 weeks gestation with cervical dilation <= 2 cm who received vaginal misoprostol (25 µg every 3 hours for up to 5 doses followed by standardized oxytocin) in a cluster randomized controlled trial conducted between May 2021 and September 2022. Overall, 264 participants (20.0%) had severe obesity (BMI >= 40 kg/m2) and 1,058 (80.0%) had BMI < 40 kg/m2. Patients with severe obesity were significantly more likely to present with a completely closed cervix at induction initiation. After controlling for hospital clustering, initial cervical dilation, chronic hypertension, and diabetes using generalized estimating equations, individuals with severe obesity experienced significantly longer total induction duration (adjusted mean difference: 3.5 hours, 95% CI: 1.9–4.8), longer first stage of labor (adjusted mean difference: 2.2 hours, 95% CI: 0.6–3.8), and extended oxytocin administration (adjusted mean difference: 2.5 hours, 95% CI: 1.1–3.8). Furthermore, patients with BMI >= 40 kg/m2 required more misoprostol doses and had significantly reduced odds of achieving vaginal delivery (adjusted odds ratio: 0.6, 95% CI: 0.4–0.8).

During emergency decompressive craniectomy for traumatic brain injury (TBI) with acute subdural hematoma, maintaining cerebral perfusion pressure while controlling intracranial pressure (ICP) is paramount. Propofol-based total intravenous anesthesia (TIVA) provides favorable metabolic suppression but frequently induces dose-dependent vasodilation and hypotension requiring vasopressor support. In this prospective, double-blind, three-arm randomized controlled trial, 150 adults undergoing emergency craniectomy were randomized 1:1:1 to receive adjunctive subanaesthetic ketamine (0.5 mg/kg/h), lidocaine (2 mg/kg/h), or placebo alongside target-controlled infusion of propofol titrated to maintain mean arterial pressure within 20% of baseline. Mean propofol consumption was significantly lowest in the ketamine group (100.73 ± 31.72 µg/kg/min) compared with lidocaine (115.86 ± 38.11 µg/kg/min) and placebo (131.53 ± 44.54 µg/kg/min; p < 0.001). Ketamine administration also significantly decreased intraoperative fentanyl requirements (63.85 ± 36.23 µg vs 83.64 ± 32.27 µg for lidocaine vs 153.55 ± 57.28 µg for placebo; p < 0.001) and reduced median vasopressor boluses (2 vs 3 vs 3; p = 0.031). Importantly, intracranial pressure, cerebral perfusion pressure, intraoperative brain relaxation scores, and Glasgow Outcome Scale-Extended scores were comparable across all three groups, demonstrating that low-dose ketamine did not adversely affect intracranial dynamics.