Meta-analysis of 2,325 adults finds remimazolam halves respiratory depression and hypotension during bronchoscopy compared to traditional sedatives

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.

Midline venous catheters (MVCs) have been increasingly utilized as alternatives to peripherally inserted central catheters (PICCs) for intermediate-duration intravenous therapy to preserve central veins and reduce central line-associated bloodstream infections. This systematic review and meta-analysis synthesized data from seven randomized controlled trials (RCTs) encompassing 910 pediatric and adult patients (454 MVC, 456 PICC) identified across PubMed, Embase, Scopus, and Cochrane Central through March 2025. Compared with PICCs, MVCs were associated with a more than twofold higher risk of total complications (RR: 2.57; 95% CI: 1.54–4.31; p = 0.0003), nearly fourfold higher risk of premature catheter removal (RR: 3.91; 95% CI: 1.85–8.27; p = 0.0004), and significantly shorter median dwell time (weighted mean difference: -2.06 days; 95% CI: -3.18 to -0.94; p = 0.0003). Specific mechanical complications were markedly increased with MVCs, including catheter occlusion (RR: 3.61; 95% CI: 2.13–6.11; p < 0.00001), infiltration (RR: 3.77; 95% CI: 1.08–13.14; p = 0.04), and leakage (RR: 2.91; 95% CI: 1.00–8.50; p = 0.05). In contrast, no statistically significant differences were observed between MVCs and PICCs for catheter-related bloodstream infections, venous thrombosis, phlebitis, dislodgement, internal malposition, or local insertion site infections, although event rates were low and confidence intervals wide.