Anaesthesia
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Editorial Comment
Taking stock of anaesthetic databases: enough data, time for action!
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Review Meta Analysis
Meta-analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy.
Controversy exists regarding the best choice of anaesthesia for carotid endarterectomy. We aimed to evaluate the peri-operative outcomes of local vs. general anaesthesia for carotid endarterectomy. We conducted a systematic search of electronic information sources and applied a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators and limits in each of the electronic databases. ⋯ On trial sequential analysis of the randomised trials, the Z-curve did not cross the α-spending boundaries or futility boundaries for stroke, mortality and transient ischaemic attack, suggesting that more trials are needed to reach conclusive results. Our meta-analysis of observational studies suggests that local anaesthesia for carotid endarterectomy may be associated with lower peri-operative morbidity and mortality compared with general anaesthesia. Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials.
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Observational Study
Using middle finger length to determine the internal diameter of uncuffed tracheal tubes in paediatrics.
The selection of an appropriately-sized tracheal tube is of critical importance in paediatric patients to reduce both the risk of subglottic stenosis from a tracheal tube that is too large, and inadequate ventilation or poor end-tidal gas monitoring from a tracheal tube that is too small. Age formulae are widely used, but known to be unreliable, often resulting in a need to change the tracheal tube. Previous work has shown that the length of the middle finger and the internal diameter can both be used to guide depth of tracheal tube insertion. ⋯ We found a linear relationship between uncuffed tracheal tube internal diameter and median middle finger length for each size of tracheal tube. Relationship between middle finger length and cuffed tracheal tube internal diameter was less clear. We propose that the formula: 'middle finger length (cm) (round up to nearest 0.5) = internal diameter of uncuffed tracheal tube (mm)' may be an improvement compared with age formulae for selecting uncuffed tracheal tubes in children, although this requires formal testing.
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Randomized Controlled Trial
A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery.
We evaluated the effect of pre-operative serratus anterior plane block on postoperative pain and opioid consumption after thoracoscopic surgery. We randomly allocated 89 participants to block with 30 ml ropivacaine 0.375% (n = 44), or no block without placebo or sham procedure (n = 45). We analysed results from 42 participants in each group. ⋯ Block decreased dissatisfaction with pain management, categorised as 'highly unsatisfactory', 'unsatisfactory', 'neutral', 'satisfactory' or 'highly satisfactory': 1/2/21/18/0 vs. 1/14/15/11/1, p = 0.0038. There were no differences in the rates of nausea, vomiting, dizziness or length of hospital stay. Serratus anterior plane block may be used to reduce pain and opioid use after thoracoscopic lung surgery.