Anesthesia and analgesia
-
Anesthesia and analgesia · May 2019
Meta AnalysisAwake Fiberoptic Intubation Protocols in the Operating Room for Anticipated Difficult Airway: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Why is this important?
This is the first systematic review of RCTs assessing different techniques for conducting awake fibreoptic intubation (AFOI), although the quality of evidence continues to be moderate-low.
Cabrini et al. reviewed 37 RCTs capturing 2,045 AFOI events.
What did they find?
There was no significant success difference among techniques for either local anaesthesia application or procedural sedation, including infusions or boluses of dexmedetomidine, propofol, opioids (fentanyl, sufentanil, remifentanil), ±midazolam, or sevoflurane.
Dexmedetomidine sedation resulted in the fewest desaturation events, and sevoflurane the fewest apnoea events.
Opioids used on their own (ie. without benzodiazepines) resulted in the highest patient recall, particularly remifentanil.
Also of interest...
When conducted by trained experts, AFOI is safe and effective regardless of technique and only very uncommonly results in intubation failure (0.59%) or severe adverse events (0.34%). No permanent morbidity or death was identified.
The take-home message:
When choosing a technique for awake fibre optic intubation, do what you do best – generally this will be what you and your institution are most experienced with.
summary -
Anesthesia and analgesia · May 2019
Observational StudyDevelopment and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa.
Checklists for managing crises during cesarean section are practical to implement in low and middle-income countries, and significantly improve task completion in simulated emergencies.
pearl -
Anesthesia and analgesia · May 2019
Randomized Controlled TrialResident Competency and Proficiency in Combined Spinal-Epidural Catheter Placement Is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial.
Physician educators must balance the need for resident procedural education with clinical time pressures as well as patient safety and comfort. Alternative educational strategies, including e-learning tools, may be beneficial to orient novice learners to new procedures and speed proficiency. We created an e-learning tool (computer-enhanced visual learning [CEVL] neuraxial) to enhance trainee proficiency in combined spinal-epidural catheter placement in obstetric patients and performed a randomized controlled 2-center trial to test the hypothesis that use of the tool improved the initial procedure performed by the anesthesiology residents. ⋯ CEVL neuraxial is a novel prerotation teaching tool that may enhance the traditional initial teaching of combined spinal-epidural procedures in obstetric anesthesiology. Future research should examine whether the use of web-based learning tools impacts long-term provider performance or patient outcomes.
-
Anesthesia and analgesia · May 2019
Acute Kidney Injury and Risk of Death After Elective Surgery: Prospective Analysis of Data From an International Cohort Study.
Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood. ⋯ The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.
-
Anesthesia and analgesia · May 2019
Multicenter Study Observational StudyPerioperative Epidural Use and Risk of Delirium in Surgical Patients: A Secondary Analysis of the PODCAST Trial.
Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3. ⋯ Postoperative epidural use was not associated with a reduced overall incidence of delirium. However, longitudinal analysis revealed reduced adjusted odds of experiencing an episode of delirium in the epidural group. Epidural use was also associated with reduced postoperative pain and opioid consumption. An appropriately designed follow-up study is warranted to further analyze the relationship among epidural use, postoperative delirium, and related outcomes.