Anesthesiology
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Comparative Study Observational Study
Anaphylaxis Is More Common with Rocuronium and Succinylcholine than with Atracurium.
This retrospective, observational cohort study over 6 years from Auckland, New Zealand identified a 10 fold higher incidence of anaphylaxis for rocuronium than for atracurium.
Also of note, the rate of anaphylaxis to rocuronium was similar to that for suxamethonium.
Anaphylaxis incidence for the three muscle relaxants were approximately:
- Atracurium – 1 in 22,500
- Rocuronium – 1 in 2,500
- Suxamethonium – 1 in 2,000
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Randomized Controlled Trial
Postoperative Bladder Catheterization Based on Individual Bladder Capacity: A Randomized Trial.
Use of an individualised maximum bladder volume in post-op patients reduces the need for catheterization compared with arbitrary 500mL threshold.
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Randomized Controlled Trial
Disruption of Cortical Connectivity during Remifentanil Administration Is Associated with Cognitive Impairment but Not with Analgesia.
The authors investigated the effect of remifentanil administration on resting electroencephalography functional connectivity and its relationship to cognitive function and analgesia in healthy volunteers. ⋯ Remifentanil disrupts the functional connectivity network properties of the electroencephalogram. The findings give new insight into how opioids interfere with the normal brain functions and have the potential to be biomarkers for the sedative effects of opioids in different clinical settings.
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Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related death in the United States; however, it remains poorly characterized in surgical populations. To better inform perioperative transfusion practice, and to help mitigate perioperative TRALI, the authors aimed to better define its epidemiology before and after TRALI mitigation strategies were introduced. ⋯ Perioperative TRALI/possible TRALI is more common than previously reported and its risk increases with greater volumes of blood component therapies. No significant reduction in the combined incidence of TRALI/possible TRALI occurred between 2004 and 2011, despite the introduction of TRALI mitigation strategies. Future efforts to identify specific risk factors for TRALI/possible TRALI in surgical populations may reduce the burden of this life-threatening complication.
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Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion-related fatalities, but its incidence and associated patient and transfusion characteristics are poorly understood. To inform surgical transfusion practice and to begin mitigating perioperative TACO, the authors aimed to define its epidemiology. ⋯ The incidence of perioperative TACO is similar to previous estimates in nonsurgical populations. There was a reduction in TACO rate between 2004 and 2011, with incidence patterns remaining comparable in subgroup analyses. Future efforts exploring risk factors for TACO may guide preventive or therapeutic interventions, helping to further mitigate this transfusion complication.