Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2018
Randomized Controlled TrialIn-Line Filtration Reduces Postoperative Venous Peripheral Phlebitis Associated With Cannulation: A Randomized Clinical Trial.
Why should you care?
Not only is venous cannulation a common procedure, but so is resultant thrombophlebitis – occurring in up to 75% of patients. This has important morbidity, patient-experience and economic consequences.
What does this study add?
Although many risk factors have been identified (insertion sterility, location, access technique, drug use, micro-particles, etc.), Villa and friends investigated whether in-line filters would reduce phlebitis incidence.
This modest, single-center trial randomized surgical patients between in-line filter (for 96 hours) or standard line, before anesthesia induction. Filter user reduced thrombophlebitis 13-fold at 48 hours, and at 96 hours sustained potency of 50% more of the cannulae.
What sort of filters did they use?
They used an 11 cm2 positively-charged 0.2 µm filter for fluid and most drugs, a 4.5 cm2 1.2 µm filter for propofol infusions, and a positively-charged 1.65 cm2 0.2 µm for opioid infusions.
The filters did slow gravity-fed infusion rates as they aged, however this was not clinically significant when using a peristaltic pump.
The take-home...
We should be better stewards of our patient's IV access. For short-term access <48h focus should be on technique and sterility, but for access needed for 48h or longer, an inline filter offers significant benefit with limited downside.
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Anesthesia and analgesia · Dec 2018
Meta AnalysisFluid Challenge During Anesthesia: A Systematic Review and Meta-analysis.
Pulse Pressure Variation and Stroke Volume Variation has limited sensitivity and specificity when assessing the response to intra-operative fluid challenge.
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Anesthesia and analgesia · Dec 2018
Randomized Controlled TrialInfluence of Nasal Tip Lifting on the Incidence of the Tracheal Tube Pathway Passing Through the Nostril During Nasotracheal Intubation: A Randomized Controlled Trial.
For safe nasotracheal intubation without middle turbinate injury, the tracheal tube should pass through the lower pathway, which is beneath the inferior turbinate and immediately above the nasal floor of the nostril. The purpose of this study was to assess the influence of nasal tip lifting on the incidence of passing preformed nasal Ring-Adair-Elwyn (RAE) tubes through the lower pathway during nasotracheal intubation. ⋯ The nasal tip lifting maneuver helped to guide preformed nasal RAE tubes into the lower pathway during nasotracheal intubation.
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Anesthesia and analgesia · Dec 2018
Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group.
As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. ⋯ Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed.
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Anesthesia and analgesia · Dec 2018
Randomized Controlled TrialAddition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial.
Postdural puncture headache (PDPH) lacks a standard evidence-based treatment. A patient treated with neostigmine for severe PDPH prompted this study. ⋯ Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood-brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH. The results are consistent with previous studies and clinical reports of neostigmine activity.