Intravenous Versus Research Articles

Intravenous Versus Oral Omadacycline or Linezolid for Acute Bacterial Skin and Skin Infections: A post hoc Analysis of the OASIS Trials.

Appropriate oral antibiotic therapy for the treatment of acute bacterial skin and skin structure infections (ABSSSI) is a challenge, as current oral treatment guidelines do not fully cover the most common skin pathogens. Both linezolid and omadacycline are available as intravenous or bioequivalent oral formulations. This post hoc analysis of the OASIS-1 (ClinicalTrials.gov identifier NCT02378480) and OASIS-2 (ClinicalTrials.gov identifier NCT02877927) phase 3 trials assessed safety and clinical efficacy of intravenous (IV)-start versus oral (PO)-start therapy in patients treated with omadacycline or linezolid for ABSSSI. In OASIS-1, patients were randomized to IV omadacycline or linezolid, with optional switch to oral therapy, while patients in OASIS-2 received oral omadacycline or linezolid. Treatment was provided for 7-14days in both studies. The primary endpoint was an early clinical response (ECR) at 48 to 72h, defined as survival and ≥ 20% reduction in lesion size, without rescue antibacterial therapy. A total of 645 IV-start inpatients and 735 PO-start outpatients were assessed. Median age was 47years for the IV-start group and 44years for the PO-start group. Most patients had solely gram-positive infections (97% in each group; ECR [85.2% IV-start and 85.0% PO-start]), and the incidence of treatment-emergent adverse events (AEs) was similar between the groups. The most frequent AEs observed were nausea (11.2% [IV-start] versus 18.9% [PO-start]) and subcutaneous abscess (5.6% [IV-start] versus 1.9% [PO-start]). Discontinuation due to AEs was infrequent in both groups (2% [IV-start] versus 1.2% [PO-start]). Oral therapy is equally efficacious to IV therapy when omadacycline or linezolid is used to treat ABSSSIs. These data strengthen the evidence for oral omadacycline as a therapeutic option for ABSSSI, particularly for patients who have experienced treatment failure because of the limitations of other therapies. Clinicaltrials.gov, NCT02378480 and NCT02877927.

Evaluation of Intravenous Versus Intracoronary Adenosine in Coronary Reactivity Testing

Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) obtained through coronary bolus thermodilution are used to assess and treat patients with angina and no obstructive coronary artery disease. Previous studies demonstrate comparable results assessing epicardial ischemia by fractional flow reserve using intravenous (IV) or intracoronary (IC) adenosine. It is unknown if there is a similarity between IC and IV hyperemia with adenosine when performing coronary reactivity testing (CRT). We reviewed CRT data and baseline demographics in a cohort of patients who underwent CRT for ischemia and no obstructive coronary artery disease. We evaluated CFR and IMR in patients whereby maximal hyperemia was obtained by both IC and IV means using linear regression, one-way analysis of variance, Wilcoxon, and Bland-Altman analysis. We assessed 62 patients with a median age of 60.5 years (50 to 67), and 72% were females. The average CFR with IC adenosine was 3.12 (2.31 to 4.06) and 2.71 (2.0 to 3.88) with IV adenosine, with an R2 value of 0.50 (p <0.0001). The average IMR with IC adenosine was 28.23 (16.24 to 50.72) and 22.27 (14.79 to 37.0) with IV adenosine, with an R2 value of 0.33 (p <0.0001). Average intra-method variability between IC and IV adenosine was nonsignificant (p = 0.31 for CFR and p = 0.55 for IMR). Bland-Altman analysis showed reasonable agreement between IV and IC adenosine for CFR and IMR with slightly higher values using IC adenosine. Therefore, in CRT with bolus thermodilution, CFR and IMR values obtained with IC adenosine correlate well with those obtained with IV adenosine. This presents a potential alternative to IV adenosine for bolus thermodilution CRT.

Intravenous Versus Oral Acetaminophen for Post-Tonsillectomy Pain in Children: Which Route Leads to Better Outcomes?

Intravenous Versus Oral Acetaminophen for Post-Tonsillectomy Pain in Children: Which Route Leads to Better Outcomes?

Continued Intravenous Versus First Week Transition to Oral Antibiotic Therapy in Bloodstream Infections: A Systematic Review and Meta-Analysis.

Bloodstream infections (BSIs) are a major public health concern worldwide, requiring prompt and effective antibiotic therapy. Traditionally, intravenous (IV) antibiotics have been preferred for their rapid action and consistent absorption. However, interest is growing in transitioning to oral (PO) antibiotics when suitable, due to similar pharmacokinetics, improved patient outcomes, and reduced healthcare costs. This meta-analysis aims to evaluate the clinical effectiveness of switching from IV to PO antibiotics for both gram-negative and gram-positive BSIs. Scopus, Embase, and PubMed databases were comprehensively searched until March 2023. The review included randomized controlled trials and cohort studies comparing continued IV therapy with early transition from IV to PO antibiotics within the first week of admission. Inclusion criteria encompassed studies involving adult patients (≥18 years) and reporting specific outcomes such as treatment success, mortality, and hospital readmissions. Meta-analysis of 17 studies comprising 11,245 patients demonstrated higher treatment success rates overall (OR: 1.40, P=0.04), particularly in gram-negative infections (OR: 1.42, P=0.05). However, this effect was not statistically significant in the gram-positive subgroup (OR: 1.41, P=0.036). Oral switch significantly reduced all-cause mortality overall (OR: 0.35, P=0.003), especially in gram-negative infections (OR: 0.22, P=0.008), but not significantly in gram-positive infections (OR: 0.60, P=0.09). Both gram-negative and gram-positive infections benefited from shorter hospital stays (P<0.0001), despite significant heterogeneity. Hospital readmission rates did not significantly differ between IV and oral switch groups (P=0.53). Our meta-analysis suggests potential benefits of early transition from IV to PO antibiotics for BSIs, including improved treatment outcomes and shorter hospital stays without an increased risk of readmission. However, these findings are subject to selection bias, and further standardized randomized trials are essential to validate these results.

Effects of Preoperative Intravenous Versus Subcutaneous Tranexamic Acid on Postoperative Periorbital Ecchymosis and Edema Following Upper Eyelid Blepharoplasty: A Prospective, Randomized, Double-Blinded, Placebo-Controlled, Comparative Study.

To compare the effects of preoperative tranexamic acid (TXA) administered intravenously (IV) versus subcutaneously on postoperative ecchymosis and edema in patients undergoing bilateral upper eyelid blepharoplasty. A prospective, double-blinded, placebo-controlled study of patients undergoing bilateral upper eyelid blepharoplasty at a single-center. Eligible participants were randomized to preoperatively receive either (1) 1 g of TXA in 100 ml normal saline IV, (2) 50 µl/ml of TXA in local anesthesia, or (3) no TXA. Primary outcomes included ecchymosis and edema at postoperative day 1 (POD1) and 7 (POD7). Secondary outcomes included operative time, pain, time until resuming activities of daily living, patient satisfaction, and adverse events. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), ecchymosis scores were significantly lower on POD1 (1.31 vs. 1.56 vs. 2.09, p = 0.02) and on POD7 (0.51 vs. 0.66 vs. 0.98, p = 0.04) among those that received TXA. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), significant reductions in edema scores occurred in those that received TXA on POD1 (1.59 vs. 1.43 vs. 1.91, p = 0.005) and on POD7 (0.85 vs. 0.60 vs. 0.99, p = 0.04). By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA) patients treated with intravenous and local subcutaneous TXA preoperatively were more likely to experience shorter operative times (10.8 vs. 11.8 vs. 12.9 minutes, p = 0.01), reduced time to resuming activities of daily livings (1.6 vs. 1.6 vs. 2.3 days, p < 0.0001), and higher satisfaction scores at POD1 (8.8 vs. 8.7 vs. 7.9, p = 0.0002). No adverse events occurred were reported. In an analysis of 106 patients, preoperative TXA administered either IV or subcutaneously safely reduced postoperative ecchymosis and edema in patients undergoing upper eyelid blepharoplasty. While statistical superiority between intravenous versus local subcutaneous TXA treatment was not definitively identified, our results suggest clinical superiority with IV dosing.

Intravenous Versus Locally Injected Tranexamic Acid in a Fragility Hip Fracture Population: A Retrospective Review.

Evaluate differences between blood transfusion and complication rates among fragility hip fracture patients treated with locally injected (Local) versus intravenous (IV) tranexamic acid (TXA). Design: Retrospective comparative cohort. Tertiary referral orthopaedic specialty hospital; Level I trauma center. Patients aged 50 years and over who underwent surgical treatment for a proximal femur fragility fracture (Orthopedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 31A and 31B). Between March 2018 and April 2022 with or without the use of local TXA during wound closure or IV TXA. Postoperative blood transfusion, venous thromboembolism, surgical site infections, and 30-day readmissions compared between those who received IV TXA, Local TXA, and controls that did not receive any TXA. Seven hundred forty-six patients (258 received IV TXA, 252 received Local TXA, and 236 controls that did not receive any TXA) were studied. Both Local and IV TXA groups received fewer blood transfusion versus controls. IV TXA was associated with a transfusion rate reduction of 12% compared with Local TXA ( P < 0.001). Regression analysis indicated that IV TXA reduced the odds of a postoperative blood transfusion by 48% compared with Local TXA ( P = 0.017). There were no differences in complication rates among the groups; however, patients receiving IV TXA had a significantly lower 30-day readmission rate (5%) than the control (13.9%) or Local (13.8%) TXA groups ( P = 0.001). IV TXA significantly reduced the risk of postoperative transfusion compared with controls and patients receiving Local TXA. There was no increased risk of complications, and a lower 30-day readmission was observed for the IV TXA group. IV TXA seems to be a safe and effective way to reduce postoperative blood transfusion in patients with fragility hip fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Intravenous Versus Intraperitoneal Dexamethasone Effects on Postoperative Nausea, Vomiting, and Pain After Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial

Intravenous Versus Intraperitoneal Dexamethasone Effects on Postoperative Nausea, Vomiting, and Pain After Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial

Maternal Hydration with Intravenous Versus Oral Therapy in the Correction of Isolated Oligohydramnios in the third Trimester of Pregnancy

Objective: To compare the effectiveness of oral hydration versus intravenous hydration therapy in correcting amniotic fluid volume in women presenting with isolated oligohydramnios in the third trimester.&#x0D; Methodology: A randomized controlled study was conducted at the Department of Obstetrics &amp; Gynaecology, Pakistan Institute of Medical Sciences, Islamabad, over six months from March 2021 to September 2021. One hundred and twenty-six patients were enrolled, with 63 in each group. Patients with AFI &lt; 5 cm in the third trimester, singleton pregnancies, and no associated maternal or fetal risk factors were included. Demographic data, AFI at baseline, and hydration details were collected. Patients were divided into two groups: one received oral rehydration solution (ORS) every 30 minutes, and the other received intravenous (IV) lactated Ringers solution over one week. APGAR scores at 1 &amp; 5 minutes were compared between the two study groups using independent samples t-test. P value ≤0.05 was taken as significant.&#x0D; Results: Both groups were comparable in terms of demographic parameters and pre-intervention water intake. AFI increased significantly in both groups compared to baseline at various intervals and persisted even one week after the completion of the study. Urine specific gravity decreased significantly after one week in both groups. Birthweight and Apgar scores at 1 and 5 minutes were comparable in both groups.&#x0D; Conclusion: Both oral and intravenous hydration significantly increased amniotic fluid volume and were equally effective in correcting isolated oligohydramnios in the third trimester. Oral hydration is a non-invasive, cost-effective, and convenient alternative to intravenous hydration, offering potential benefits for pregnant women without the need for hospital admission or IV lines.

Effects of Total Intravenous Versus Inhalational Anesthesia on Bleeding During Endoscopic Ear Surgery: Preliminary Results From a Case-Control Study.

To assess the impact of the type of maintenance anesthesia on the bleeding conditions of the surgical field and hemodynamic parameters during endoscopic ear surgery (EES), comparing totally intravenous inhalational anesthesia (TIVA) with inhalational anesthesia (IA). Retrospective case-control study. Tertiary referral center. Fifteen consecutive EES cases performed with TIVA between 2019 and 2020 at our Institution were matched to a control group of patients who underwent EES with IA in the same period. Patients with American Society of Anesthesiologists IV grade, acute otitis before surgery, congenital or acquired coagulopathies, use of anti-inflammatory drugs, or antiaggregant or anticoagulant therapy in the 5 days before the intervention were excluded. Both primary and revision tympanoplasty and stapes surgery were considered. Surgical videos were reviewed to quantify the entity of bleeding according to the Modena Bleeding Score. Hemodynamic parameters during surgery were retrospectively collected. A comparison between the two groups was performed. No statistically significant differences between the two groups in terms of bleeding were found at any of time point evaluated. The tympanomeatal flap elevation resulted in the bloodiest step in both groups. Hemodynamic parameters were similar in both groups ( p > 0.05). These preliminary data do not support a significant difference in bleeding conditions and hemodynamic parameters between EES patients receiving TIVA and those receiving IA. Further studies involving a higher number of patients will improve our understanding on how maintenance anesthesia with TIVA may be beneficial in terms of bleeding control as compared with IA for patients undergoing EES.

Intravenous Versus Rectal Contrast in CT Imaging for Abdominal Gunshot Wounds.

CT imaging with rectal contrast historically has been a useful tool to help identify potential colon/rectal injuries; however, recent trends have shown less utilization of rectal contrast, in favor of IV contrast CT imaging alone. A retrospective review of patients with abdominal gunshot wounds was carried out to compare the two CT imaging techniques. An analysis of patients with colorectal injuries was conducted. Patients with IV contrast had a sensitivity of 84% and specificity of 96.8%. The PPV was 87.5% and NPV was 95.8%. In the IV and rectal contrast group, the sensitivity was 88.9% and specificity was 90.5%. The PPV was 80% and NPV was 95%. The proportion of missed injuries between the two was not statistically significant, p=0.18. The study suggests that while CT imaging with rectal contrast confidently identifies colon/rectal injuries, there are often secondary findings that will correctly prompt surgical exploration.

A Randomized Comparison of Intravenous Versus Nebulized Routes for Administering Dexmedetomidine and Ketamine Combination to Facilitate Awake Fibreoptic Intubation.

Introduction Awake fibreoptic intubation is a technique used to secure the airway of patients who are havingpredicted difficult intubation. We compared two routes, intravenous and nebulized, for administering a combination of ketamine and dexmedetomidine to patients requiring sedation for fibreoptic intubation. Methods and materials After approval of the institutional ethics committee, 64 patients between 18 and 60 years belonging to the American Society of Anesthesiologists physical status I or II and having predicted difficult airway were randomized to receive study medications through either intravenous (group I, n = 32) or nebulized (group N, n = 32) routes. Group I patients were given a combination of ketamine and dexmedetomidine through intravenous route. Group N patients were nebulized with a combination of ketamine and dexmedetomidine. The time required for awake fiberoptic intubation was the primary outcome variable. In addition, sedation score, cough severity, patient tolerance, intubating condition, hemodynamic changes, recall of events and discomfort during intubation, and any adverse events in the perioperative period were also compared. Results Compared to group N, the time needed to intubate the patients was significantly less in group I (75.69 ± 10.83 versus 49.19 ± 3.60 seconds, p < 0.001). Observer assessment sedation/alertness score (p < 0.001), cough severity (p < 0.001), patient tolerance (p < 0.001), and intubating condition (p = 0.001) were statistically significant, all conditions being better in group I. Patient discomfort and recall of the procedure were statistically similar between the groups. Conclusions The efficacy of a combination of dexmedetomidine and ketamine through the intravenous route is better than the nebulized route for patients undergoing awake fibreoptic intubation.

Randomised Controlled Trial of Intravenous Versus Oral Iron in Treatment of Iron Deficiency Anaemia After Variceal Bleeding in Patients with Cirrhosis

Randomised Controlled Trial of Intravenous Versus Oral Iron in Treatment of Iron Deficiency Anaemia After Variceal Bleeding in Patients with Cirrhosis

Intravenous Versus Wetting Solution Magnesium Sulphate to Counteract Epinephrine Cardiac Adverse Events in Abdominal Liposuction: A Randomized Controlled Trial.

The increased frequency of liposuction has resulted in more complications being reported. Adding epinephrine to the wetting solution could induce some cardiac adverse effects, some of which may be fatal. For instance, magnesium sulfate (MgSO4) is known for its cardioprotective effects. This study aimed to evaluate the efficacy of intravenous (IV) versus wetting solution containing MgSO4 in decreasing such cardiac adverse events during abdominal liposuction. This randomized controlled study included 129 adult cases undergoing abdominal liposuction under general anesthesia. The participants were divided into 3 groups: Group I (control group) was only subjected to the injection of the wetting fluid (1 mL 1/1000 epinephrine added to every 1000 mL of normal saline), group II was subjected to IV MgSO4 (40 mg/kg over 1 minute) at the same time of installing the wetting solution, and group III was subjected to MgSO4 (40 mg/kg) added to the wetting solution. Intraoperative isoflurane consumption, intraoperative heart rate (HR), mean arterial pressure (MAP), and postoperative pain scores were significantly lower in the MgSO4 groups (groups II and III) than group I. Cardiac adverse events (sinus tachycardia and premature ventricular contractions (PVCs)) were also significantly less frequent in groups II and III compared to group I. Adding MgSO4, either through IV or subcutaneous routes, is associated with lower intraoperative HR, MAP, and postoperative pain scores and a remarkable decrease in epinephrine-induced cardiac adverse events during liposuction.

Comparison between Weekly Intravenous Versus Daily Oral Vitamin B12 Supplementation in Vitamin B12 Deficiency Anemia [Courage-12]: A Randomized, Open Label, Single Centre Study

Introduction: The prevalence of symptomatic and asymptomatic Vitamin B12 deficiency is 47% in North India. The treatment for Vitamin B12 deficiency is either injectable or oral Vitamin B12 supplementation. Intramuscular VB12 is given as multiple doses of once daily or alternate day Vitamin B12 injections based on the general consensus. However, in hematology, we commonly use intravenous Vitamin B12 instead of intramuscular since most patients are thrombocytopenic. Many hematologists favor the oral route over injectable route. There are no definitive guidelines on the use of intravenous Vitamin B12 (VB12). Direct comparison of intravenous to oral VB12 has not been carried out till date. Hence, we decided to explore weekly dosing of intravenous VB12 in Vitamin B12 deficiency anemia and compare it with oral VB12 supplementation. It would be essential to seek evidence for the most effective route for the treatment of Vitamin B12 deficiency anemia. Objectives: The primary objective was to evaluate Vitamin B12 level at 5 weeks from the start of therapy and the delta change in Vitamin B12 level in both weekly intravenous and oral VB12 arms. Post-therapy improvement in signs and symptoms, Hemoglobin (Hb), MCV (in fl) response were the secondary objectives. Methodology: This was a prospective, randomized, open-label, interventional pilot study comparing daily oral versus weekly intravenous Vitamin B12 replacement at a tertiary care center between May 2020 to December 2021. Patients with anemia (for age and gender) and a pre-therapy vitamin B12 levels below 250 pg/ml were enrolled in the study. The participants were randomized using blocks of 2, 4 and 6 randomly generated by the software. The allocation concealment was done using sequentially numbered, opaque sealed envelopes (SNOSE) and monitored by the central coordinator. The participants in weekly intravenous arm received VB12 1000mcg intravenous (IV) once a week for 4 weeks whereas daily oral arm received oral VB12 1500mcg once a day for 4 weeks. All participants received 5mg Folic acid tablet orally once a day. The pre-specified baseline as well as post-therapy investigations were carried out. The statistical analysis was done as planned. Results: Overall, majority of the participants were females (64.8%) and the a median age was 32 years (Q1-Q3, 21 to 52). The most common presenting symptoms were easy fatiguability (48%), hairfall (37%), and parasthesia (19%). On comparing the two groups, the pre-therapy mean Vitamin B12 level in the oral VB12 and weekly IV VB12 group was 157 ± 66 pg/ml and 173 ± 55 pg/ml (p=0.59) respectively and post-therapy mean Vitamin B12 level was 870 ± 348 and 1273 ± 511 (p=0.02) respectively. The post therapy VB12 level was statistically significant in weekly IV VB12 group, though the delta change in vitamin B12 level was not significant among the groups. The baseline hemoglobin in oral VB12 and weekly IV VB12 groups was 10.9 ± 1.3 g/dl and 10.5 ± 2.1 g/dl (p=0.5) respectively and the post-therapy Hb was 12.1 ± 1.3 g/dl and 12.3 ± 1.1 g/dl (p=0.7) respectively. The mean change in Hb was not significant on comparison between the two groups (p=0.65). The pre-therapy MCV in the oral VB12 group and weekly IV VB12 group was 86.5 ± 9.5 fl and 88.1 ± 17.9 fl (p=0.5) whereas post-therapy MCV was 83.1 ± 9.5 fl and 83.2 ±10.7 fl (p=0.9) respectively. Conclusion: Normalization of vitamin B12 level was seen with both oral and intravenous vitamin B12, however, the weekly intravenous supplementation showed a statistically significant increase in vitamin B12 level than daily oral supplementation. Considering that the IV route provided a faster increase in vitamin B12 level, it could be a better option in patients with severe vitamin B12 deficiency anemia. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Comparison of Intravenous Versus Intra-Umbilical Oxytocin for Blood Loss and Placental Separation Time for Active Management of Third Stage of Labour

Objectives: To comparison intravenous (IV) versus intra-umbilical oxytocin for blood loss and placental separation time for active management of third stage of labour (TSL). Methodology: This randomized controlled trial was done at “The department of Obstetrics &amp; Gynaecology”, Sialkot Medical College, Sialkot, Pakistan from December 2021 to May 2022. A total of 100 women (50 in each group), aged 18-40 years with singleton cephalic pregnancy having active labour were randomly allocated to either Group-A (IV oxytocin) or Group-B (intra-umbilical oxytocin). Time of placental separation along with blood loss were noted in all women. Results: In a total of 100 women, mean age was 27.1±7.18 years. Mean gestational age was 38.12±1.3 weeks. Mean blood loss in Group-A (IV group) was 416.80±23.24 ml vs. 186.74±34.72 ml in Group-B (intraumbilical group), p&lt;0.0001. Placental separation time was 4.84±1.22 minutes in Group-A versus 1.70±0.72 minutes min in Group-B (p&lt;0.0001). Conclusion: Mean blood loss and time of placental separation were significantly less with intra-umbilical oxytocin in comparison to IV oxytocin for active management of TSL. Keywords: Blood loss, intraumbilical, intravenous, oxytocin

Comparison Adverse Events on Intravenous Versus Subcutaneous Trastuzumab as Part of Adjuvant Therapy for Breast Cancer

Comparison Adverse Events on Intravenous Versus Subcutaneous Trastuzumab as Part of Adjuvant Therapy for Breast Cancer

Intravenous Versus Subcutaneous Insulin in Management of Hyperglycaemia in Intensive Care Unit

Objective: To compare the efficacy and safety of intravenous Insulin infusion versus subcutaneous Insulin in the management of hyperglycaemia in intensive care.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Medical Intensive Care Unit of Combined Military Hospital Malir, from Jul to Sep 2021.&#x0D; Methodology: 68 individuals admitted to the Medical ICU with the blood sugar levels of more than 180 mg/dl were included. Patients on one side of Intensive Care Unit were administered intravenous Insulin infusion, and on the other side were administered subcutaneous Insulin to control blood sugars. Age, gender, previous history of diabetes and use of Insulin and glycosylated haemoglobin were recorded. Efficacy of regimen was judged based on ability to achieve target glucose levels, mean blood glucose levels and total days of ICU stay. Adverse events like hypoglycaemia and hypokalaemia were recorded.&#x0D; Results: Out of 68 individuals, 27 (39.70%) were administered intravenous Insulin infusion, and 41 (60.29%) were administered subcutaneous Insulin. In the intravenous Insulin group, 22 (81.5%) individuals achieved target blood glucose compared to 29 (70.7%) in the subcutaneous Insulin group. The mean blood sugars in the intravenous group were 157.11 ± 25.54 mg/dl, whereas 168.32 ± 30.49 mg/dl in the subcutaneous group (p-value=0.164). The frequency of hypoglycaemia and hypokalaemia was more in the intravenous group than in the subcutaneous group.&#x0D; Conclusion: Optimal blood sugar levels were better achieved with intravenous Insulin than with subcutaneous Insulin. However, the frequency of adverse effects was also more with intravenous Insulin, so better monitoring and management are..............

The Efficacy and Safety of Intravenous Tranexamic Acid Versus Rectal Misoprostol in Reducing Blood Loss During Abdominal Myomectomy. A Randomized Comparative Study

The Efficacy and Safety of Intravenous Tranexamic Acid Versus Rectal Misoprostol in Reducing Blood Loss During Abdominal Myomectomy. A Randomized Comparative Study

Comparative Study between Intramuscular Ephedrine Versus Intravenous Ondansetron Versus Intravenous Dexamethasone for Prevention of Spinal Anaesthesia-Induced Hypotension in Parturients Undergoing Caesarean Section

Comparative Study between Intramuscular Ephedrine Versus Intravenous Ondansetron Versus Intravenous Dexamethasone for Prevention of Spinal Anaesthesia-Induced Hypotension in Parturients Undergoing Caesarean Section

Total Intravenous Anesthesia Versus Inhalation Anesthesia on Postoperative Analgesia and Nausea and Vomiting After Bariatric Surgery: A Systematic Review and Meta-Analysis.

Anesthesia for patients with morbid obesity can be challenging because of increased risk of opioid-related adverse events, postoperative nausea and vomiting (PONV), and poor pain control. We conducted a systematic review and meta-analysis to compare the safety and efficacy of total intravenous anesthesia (TIVA) with inhalation anesthesia in patients undergoing bariatric surgery. We searched MEDLINE, EMBASE, CENTRAL, and the Clinical Trials Registry database from inception to July 22, 2020. Primary outcomes were postoperative pain and PONV scores. Secondary outcomes included opioid requirements, intraoperative time, complications, and time to recovery. Grading of Recommendations Assessment, Development, and Evaluation framework was used to rate the certainty of evidence. Among 722 studies identified in our search, 7 randomized studies involving a total of 682 patients met the inclusion criteria. Bariatric surgery with TIVA resulted in a lower incidence of nausea (relative risk [RR], 0.54; 95% CI, 0.31-0.94; P = 0.03; moderate certainty) and vomiting (RR, 0.31; 95% CI, 0.13-0.74; P = 0.008; moderate certainty). There was no difference in postoperative pain at 30 minutes, 1 hour, or 24 hours, or in postoperative opioid requirements. Patients undergoing bariatric surgery with TIVA had significantly lower incidence of PONV but no difference in postoperative pain when TIVA was compared to inhalation anesthesia techniques. These benefits should be considered in order to improve the quality of care and enhance recovery for the bariatric population, who are at an increased baseline risk of perioperative complications. Future adequately powered randomized controlled trials are needed to compare the efficacy of the anesthesia regimens in patients undergoing bariatric surgery.