Created June 3, 2015, Last updated over 1 year ago.
A growing collection of landmark papers relevant to anaesthesia and anesthesiology.
These papers are practice changing and hold current, ongoing significance beyond their historical importance.
This is a dynamic and changing document that will be updated, pruned and added to as appropriate. Many of these papers have free full-text provided by the publisher because of their significance.summary
Kurz A, Kurz A, Kurz A et al.
Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group.
N. Engl. J. Med. 1996 May 9;334(19):1209-15.
Rigg JR, Rigg JR, Jamrozik K et al.
Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial.
Lancet. 2002 Apr 13;359(9314):1276-82. 2
Sebel PS, Sebel PS, Sebel PS et al.
The incidence of awareness during anesthesia: a multicenter United States study.
Anesth. Analg. 2004 Sep 1;99(3):833-9, table of contents.
- Kurz A, Kurz A, Kurz A et al.
Created May 21, 2015, Last updated over 1 year ago.
The potential for dexamethasone and other glucocorticoids to prolong peripheral nerve blocks was first noted almost 20 years ago.
While the effect has been observed with several different blocks (upper & lower extremity, and even TAP blocks), the clinical significance varies and several questions still remain:
Is the effect exclusive to perineural dexamethasone? Several studies have observed similar effects for both IV and perineural dexamethasone (though less profound than other papers).
Is the effect safe? This is perhaps the most concerning, as there are suggestions that the effect may represent an enhancement of the well-known neurotoxicity of local anaesthetic agents.
Albrecht E, Albrecht E, Albrecht E et al.
A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks.
Anaesthesia. 2015 Jan 1;70(1):71-83. 3 2 notes
Huynh TM, Huynh TM, Marret E et al.
Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: A meta-analysis of randomised controlled trials.
Eur J Anaesthesiol. 2015 Nov 1; 32 (11): 751-8. 1 note
Noss CD, MacKenzie LD, Kostash MA.
Adjuvant Dexamethasone: Innovation, Farce, or Folly?
Reg Anesth Pain Med. 2014 Nov 1; 39 (6): 540-5. 1 note
Created May 21, 2015, Last updated over 1 year ago.
An extensive collection of research debunking a range of myths and misconceptions regarding our use of neuromuscular blocking drugs.
- Myth 1: Modern relaxants are so reliable and predictable that monitoring is unnecessary.
- Myth 2: Post-op residual paralysis is neither common or important.
- Myth 3: Post-op residual paralysis is easy to identify.
- Myth 4: Sugammadex makes residual paralysis a non-issue. (it might, but only if it is routinely available and used!)
- Myth 5: Using propofol and remifentanil we can avoid relaxants for intubation all together.
- Myth 6: Neuromuscular blockade has no effect on BIS.
And bonus myth: deep relaxation is necessary for improving surgical access during laparoscopy.summary
Fink H, Fink H, Fink H et al.
Myths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade.
Minerva Anestesiol. 2012 Apr 1;78(4):473-82. 1 2 notes
Debaene B, Debaene B, Debaene B et al.
Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action.
Anesthesiology. 2003 May 1;98(5):1042-8. 4 notes
Maybauer DM, Maybauer DM, Maybauer DM et al.
Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium.
Anaesthesia. 2007 Jan 1;62(1):12-7. 1 note
Created August 9, 2015, Last updated over 1 year ago.
“Sugammadex is likely the most exciting drug in clinical neuromuscular pharmacology since the introduction of atracurium and vecuronium in the middle 1980s.” – RD Miller (2007).
Sugammadex (Bridion®) is a remarkable drug – and the anaesthesia community has moved very quickly to embrace the potential of this first ‘selective relaxant binding agent’ (SRBA), despite it’s considerable cost.
Sugammadex offers a new and improved way of reversing aminosteroid muscle relaxation, in particular from rocuronium. The speed at which it reverses even profound neuromuscular blockade is incredible and potentially life saving. Sugammadex’s onset is 10 times faster than neostigmine and three times faster than edrophonium.
Though beyond the parlour-trick of speedy action, or the potential to rescue a cannot-intubate-cannot-ventilate crisis – the biggest benefit of sugammadex for our patients may be in the dramatic reduction of post-operative residual paralysis. A common problem with serious consequences that the anaesthetic community has ignored for far too long.summary
Miller RD, Miller RD, Miller RD et al.
Sugammadex: an opportunity to change the practice of anesthesiology?
Anesth. Analg. 2007 Mar 1;104(3):477-8. 1 note
Sacan O, Sacan O, Sacan O et al.
Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine.
Anesth. Analg. 2007 Mar 1;104(3):569-74. 2 notes
Abrishami A, Abrishami A, Abrishami A et al.
Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.
Cochrane Db Syst Rev. 2009 Jan 1(4):CD007362. 2 notes
- Miller RD, Miller RD, Miller RD et al.
Created May 21, 2015, Last updated almost 2 years ago.
There is some evidence supporting the benefit of perioperative intravenous lignocaine/lidocaine infusion in both laparoscopic and open abdominal surgery.
The strongest evidence supports both improved analgesia and reduction in nausea, with weaker evidence suggesting faster improvement in GIT function and earlier discharge from hospital.
Safety data is reassuring but far from conclusive due to the small size of most studies.summary
De GS, De GS, De GS et al.
Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery.
Anesth. Analg. 2012 Aug 1;115(2):262-7. 2 1 note
Grigoras A, Lee P, Lee P et al.
Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery.
Clin J Pain. 2012 Sep 1;28(7):567-72. 1 2 notes
McCarthy GC, McCarthy GC, Megalla SA et al.
Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials.
Drugs. 2010 Jun 18;70(9):1149-63. 1
- De GS, De GS, De GS et al.