Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2021
Randomized Controlled Trial Multicenter Study Comparative StudyHead Rotation Reduces Oropharyngeal Leak Pressure of the i-gel and LMA® Supreme™ in Paralyzed, Anesthetized Patients: A Randomized Trial.
This airway study is a neat little randomised-but-not-blinded study of the effect of head rotation on the oropharyngeal leak pressure of both the i-gel and LMA Supreme 2nd generation supraglottic airways.
The researchers investigated the leak pressure (OPLP) of the i-gel and LMA Supreme in paralysed patients with the head: 1. neutral, 2. rotated 30°, and 3. rotated 60°. They found that rotation of the head through 30° and 60° progressively increased OPLP by a clinically-significantly amount (0° vs 60° 5.5 cmH2O (3.3-7.8) & 6.5 cmH2O (5.1-8.0) respectively).
Before you get too excited...
The result however may not be reliably applicable to all populations, notably the study subjects were overwhelmingly small (x̄ ~160cm & 60kg) Japanese women (71%), receiving a TIVA muscle-relaxant anaesthetic (propofol, remifentanil, rocuronium). How well this improvement-with-rotation holds up among, for example, spontaneously ventilating large Caucasian males, is unclear.
Bottom-line
When using an i-gel or LMA Supreme 2nd generation supraglottic airway, careful head rotation to 60° may increased oropharyngeal leak pressure and so assist with ventilation troubleshooting. However head and neck rotation of anaesthetised, paralysed patients should be performed gently and cautiously – you are after all, not a chiropractor!
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Anesthesia and analgesia · Mar 2021
In Pursuit of an Opioid-Free Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative.
Opioids have been a central component of routine adult and pediatric anesthesia for decades. However, the long-term effects of perioperative opioids are concerning. Recent studies show a 4.8%-6.5% incidence of persistent opioid use after surgery in older children and adults. This means that >2 million of the 50 million patients undergoing elective surgeries in the United States each year are likely to develop persistent opioid use. With this in mind, anesthesiologists at Bellevue Clinic and Surgery Center assembled an interdisciplinary quality improvement team focused on 2 goals: (1) develop effective anesthesia protocols that minimize perioperative opioids and (2) add value to clinical services by maintaining or improving perioperative outcomes while reducing costs. This article describes our project and findings but does not attempt to make inferences or generalizations about populations outside our facility. ⋯ By utilizing dexmedetomidine, nonsteroidal anti-inflammatory drugs, and regional anesthesia for pediatric ambulatory surgeries at our facility, perioperative opioids were minimized without compromising patient outcomes or value.
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Anesthesia and analgesia · Mar 2021
Comparative StudyThe Effect of the No Pain Labor & Delivery-Global Health Initiative on Cesarean Delivery and Neonatal Outcomes in China: An Interrupted Time-Series Analysis.
The proportion of live births by cesarean delivery (CD) in China is significant, with some, particularly rural, provinces reporting up to 62.5%. The No Pain Labor & Delivery-Global Health Initiative (NPLD-GHI) was established to improve obstetric and neonatal outcomes in China, including through a reduction of CD through educational efforts. The purpose of this study was to determine whether a reduction in CD at a rural Chinese hospital occurred after NPLD-GHI. We hypothesized that a reduction in CD trend would be observed. ⋯ In a large, rural Chinese hospital, live births by CD were lower following NPLD-GHI and associated with increased use of labor epidural analgesia. We also found decreasing NICU admissions. International-based educational programs can significantly alter practices associated with maternal and neonatal outcomes.
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Anesthesia and analgesia · Mar 2021
Meta AnalysisThe Diagnostic Accuracy of Noninvasive Methods to Measure the Intracranial Pressure: A Systematic Review and Meta-analysis.
Although invasive monitoring is the standard method for intracranial pressure (ICP) measurement, it is not without potential for serious complications. Noninvasive methods have been proposed as alternatives to invasive ICP monitoring. The study aimed to investigate the diagnostic accuracy of the currently available noninvasive methods for intracranial hypertension (ICH) monitoring. ⋯ Our study showed several promising tools for diagnosing ICH. Moreover, we demonstrated that using multiple, readily available, noninvasive methods is better than depending on a single sign such as physical examination or CT alone.