Although there remains much conflicting evidence, largely of a low-quality observational nature, the highest quality evidence to date refutes assertions that epidural fentanyl reduces breastfeeding rates.
Notably Lee et al.’s 2017 RCT of over 300 women showed no effect of epidural fentanyl up to 2 mcg/mL and successful maternal breastfeeding up to 6 weeks.
Epidural fentanyl at concentrations up to 2 mcg/mL does not effect breastfeeding rates in women who have previously successfully breastfed.
The association of anesthesia in the sitting beach-chair position with intra-operative stroke, continues to be controversial. Although some studies have identified this as a risk, it is still a rare complication, albeit devastating.
Expert opinion suggests intra-arterial blood pressure monitoring is best practice, but most importantly with consideration for actual cerebral perfusion pressure given the sitting position.
Some research suggests regional anaesthesia, possibly combined with spontaneous ventilation GA (rather than relaxation GA with IPPV) offers unique benefits that better maintain cerebral oxygenation, although the exact difference is unclear.
Similarly, the benefit and role of non-invasive cerebral perfusion monitoring has not been conclusively shown, although it appears logical that it may offer benefit in these patients.
Case studies of patients suffering cerebral ischaemia under beach-chair, do point to combinations of poor intra-operative blood pressure management and possibly pre-existing mild cardiovascular disease (eg. hypertension) as contributing to some degree.
Excellent study and long-awaited conclusion!
Adding high dose adrenaline to spinal solution? I'm not sure that's wise. Potential general or specific vasoconstriction in intracerebral capillaries, for benefit of 40 mins added sensory block time.
High-risk obstructive sleep apnoea patients identified by STOP-Bang screening suffer higher risk of post-operative adverse events and longer hospital stays.
Brain tissue oxygentation monitoring after severe traumatic brain injury may improve mortality and neurological morbidity compared with ICP monitoring alone.
Prophylactic intraoperative IV pentazocine reduces the incidence and severity of post-operative pruritis due to intrathecal morphine used for elective Caesarean section.
Really really good summary article of the current state of play in Anaesthesia for ECT
Its truly amazing what medical students will volunteer for ....!