Knowledge

The highest rated collections of articles, notes and knowledge from metajournal.

Use of ROTEM & TEG in obstetric hemorrhage

Hemorrhage Obstetric anesthesia
- Multicenter Study
  
  Peri-partum reference ranges for ROTEM(R) thromboelastometry.
  
  Br J Anaesth. 2014 May 1;112(5):852-9.
- Comparative Study
  
  Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage.
  
  Anaesthesia. 2015 Feb 1;70(2):166-75.
- Case Reports
  
  Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy.
  
  Int J Obstet Anesth. 2015 May 1;24(2):174-9.
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The evidence for perimortem caesarean section

Obstetric anesthesia Resuscitation
Cardiac arrest is rare in pregnancy (1 in 30,000) and resuscitation is founded on the same approach used for the non-pregnant patient, focusing on:
- Recognition
- Calling for help
- A B C (D)
- Good for mother = good for baby
However, unique to maternal resuscitation:
- Airway difficulties are more likely.
- Aortocaval compression dramatically impedes resuscitation – employ left lateral tilt!
- Consider perimortem cesarean section
The rationale for Perimortem Cesarean Section is:
- The presence of baby and gravid uterus severely limits resuscitation of the mother.
- Emergency cesarean section at cardiac arrest is done for the mother’s benefit, not the baby.
- A decision to perform emergency CS must be made within 4 minutes of arrest, and the baby delivered within 5 minutes. (Although there is some evidence of benefit when performed up to 10 minutes after arrest.)
- The only equipment required is a scalpel and an appropriately skilled doctor.
summary
- Review
  
  Perimortem caesarean section.
  
  Emerg Med J. 2016 Mar 1; 33 (3): 224-9.
- Review
  
  Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based?
  
  Resuscitation. 2012 Oct 1;83(10):1191-200.
- Review
  
  Perimortem cesarean delivery: were our assumptions correct?
  
  Am. J. Obstet. Gynecol.. 2005 Jun 1;192(6):1916-20; discussion 1920-1.
  
  Perimortem cesarean section is a heroic intervention that may be beneficial in maternal arrest, though is unlikely to do further harm.
  pearl
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Debunking anesthetic myths

Collection
Evidence challenging, debunking or correcting long-held anesthesia dogma.
summary
- Randomized Controlled Trial
  
  Intraoperative awareness risk, anesthetic sensitivity, and anesthetic management for patients with natural red hair: a matched cohort study.
  
  Can J Anaesth. 2015 Apr 1;62(4):345-55.
  
  Red-haired patients show no greater risk of intraoperative awareness than other phenotypes.
  pearl
- Review
  
  Laparoscopic surgery and muscle relaxants: is deep block helpful?
  
  Anesth. Analg. 2015 Jan 1; 120 (1): 51-58.
- Meta Analysis
  
  Nitrous Oxide-related Postoperative Nausea and Vomiting Depends on Duration of Exposure.
  
  Anesthesiology. 2014 May 1;120(5):1137-45.
  
  Post-op nausea & vomiting incidence is related to duration of nitrous oxide exposure, but is clinically insignificant at under 1 hour exposure.
  pearl
expand collection
How effective is the Transversus Abdominis Plane (TAP) Block?

Regional anesthesia
- Review
  
  Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis.
  
  Br J Anaesth. 2013 Nov 1; 111 (5): 721-35.
  
  Posterior transversus abdominis plane block continues to reduce pain scores and opioid consumption at up to 48 hours, though with lesser magnitude.
  pearl
- Randomized Controlled Trial
  
  Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label,...
  
  Anaesthesia. 2014 Apr 1;69(4):348-55.
- Randomized Controlled Trial
  
  Transversus abdominis plane block does not improve early or late pain outcomes after Cesarean delivery: a randomized controlled trial.
  
  Can J Anaesth. 2014 Jul 1;61(7):631-40.
  
  Transversus abdominis plane block does not improve post-caesarean analgesia in women receiving regional anaesthesia with intrathecal morphine.
  pearl
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Does anesthesia cause post-operative delirium and post-operative cognitive decline?

Perioperative medicine Postoperative complications
- Review
  
  Should general anaesthesia be avoided in the elderly?
  
  Anaesthesia. 2014 Jan 1; 69 Suppl 1 (Suppl 1): 354435-44.
- Randomized Controlled Trial
  
  BIS-guided anesthesia decreases postoperative delirium and cognitive decline.
  
  J Neurosurg Anesthesiol. 2013 Jan 1; 25 (1): 334233-42.
  
  BIS use in elderly patients targeting a BIS of 40-60 may reduce post-operative delirium and post-operative cognitive decline at 3 months.
  pearl
- Randomized Controlled Trial
  
  Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction.
  
  Br J Anaesth. 2013 Jun 1; 110 Suppl 1: i98-105.
  
  Monitoring depth of anaesthesia in those over 60 yo decreases the incidence of post-operative delirium, though not post-operative cognitive decline.
  pearl
expand and show 11 more articles

Knowledge

Use of ROTEM & TEG in obstetric hemorrhage

The evidence for perimortem caesarean section

Debunking anesthetic myths

How effective is the Transversus Abdominis Plane (TAP) Block?

Does anesthesia cause post-operative delirium and post-operative cognitive decline?

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