British journal of anaesthesia
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Randomized Controlled Trial
Intrathecal morphine and sleep apnoea severity in patients undergoing hip arthroplasty: a randomised, controlled, triple-blinded trial.
Intrathecal morphine 100mcg did not increase obstructive sleep apnea severity in those undergoing hip arthroplasty under spinal anesthesia.
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Randomized Controlled Trial Comparative Study
Effects of anaesthesia method and tourniquet use on recovery following total knee arthroplasty: a randomised controlled study.
Recovery after total knee arthroplasty was similar for spinal and general anaesthesia across broad post-operative indicators.
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What's the deal?
This lab study from Zhong et al. challenges the assumption that low-flow anaesthesia is economically and environmentally superior during TIVA anaesthetics when volatile agents are not used.
What did they do?
Zhong used a test lung model with fixed CO2 inflow (250 ml/min) ventilated via circle systems of two anaesthetic machines (Dräger Primus and GE Aisys CS2). FGF rates of 1, 2, 4, and 6 L/min were tested, measuring the time to CO2 absorbent exhaustion (when inspired CO2 >0.3 kPa).
An inspired 30% O2/air mixture was used, with the test lung volume-control-ventilated at 12 bpm with 500 mL tidal volumes.
Findings
Results showed that increasing FGF from 1 to 6 L/min resulted in over 90% reduction in running costs with minimal net change to global warming potential. The time to absorbent exhaustion increased non-linearly with higher FGFs, taking over 5-8 days at 6 L/min. Notably, removing the CO2 absorbent entirely and using very high FGF (15-18 L/min) provided minimal additional economic benefit while more than doubling the environmental impact.
"We suggest that 'high-flow anaesthesia', with FGF around 6 L/min, is a viable cost-saving strategy when using a circle system for anaesthetic maintenance without inhalational anaesthetic agents in adults."
Hang-on...
The absolute cost saving (due to reduced soda lime consumption) was actually pretty small, being less than 4% of the total non-staff anaesthetic cost. Although this might still be economically significant when scaled across an entire health system, especially given the simplicity of implementation and the lack of drawback.
Bottom-line
When using total intravenous anaesthesia with modern HME filters, higher fresh gas flows (~6 L/min) are more cost-effective than traditional low-flow techniques, without compromising environmental impact or patient safety.
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Review
Analysis of practices to promote reproducibility and transparency in anaesthesiology research.
Reliable, high-quality research is essential to the field of anaesthesiology. Reproducibility and transparency have been investigated in the biomedical domain and in the social sciences, with both lacking to provide necessary information to reproduce the study findings. In this study, we investigated 14 indicators of reproducibility in anaesthesiology research. ⋯ Anaesthesiology research needs to improve indicators of reproducibility and transparency. By making research publicly available and improving accessibility to detailed study components, primary research can be reproduced in subsequent studies and help contribute to the development of new practice guidelines.
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Randomized Controlled Trial
Pharmacokinetics of ketamine and its major metabolites norketamine, hydroxynorketamine, and dehydronorketamine: a model-based analysis.
Recent studies show activity of ketamine metabolites, such as hydroxynorketamine, in producing rapid relief of depression-related symptoms and analgesia. To improve our understanding of the pharmacokinetics of ketamine and metabolites norketamine, dehydronorketamine, and hydroxynorketamine, we developed a population pharmacokinetic model of ketamine and metabolites after i.v. administration of racemic ketamine and the S-isomer (esketamine). Pharmacokinetic data were derived from an RCT on the efficacy of sodium nitroprusside (SNP) in reducing the psychotomimetic side-effects of ketamine in human volunteers. ⋯ Dutch Cochrane Center 5359.