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pearl
1
Intermittent Epidural Bolus improves maternal pain control & satisfaction, and reduces labor duration, motor block & local anaesthetic consumption.
Hussain N, Lagnese CM, Hayes B et al. Comparative analgesic efficacy and safety of intermittent local anaesthetic epidural bolus for labour: a systematic review and meta-analysis. Br J Anaesth. 2020 Oct 1; 125 (4): 560-579.
  Daniel Jolley
comment
0
@Doctormatt interestingly, not only is the pressor-sparing & hypotension-reducing benefits of prophylactic ondansetron not seen among elderly or frail patients – but it doesn't even seem to occur outside Caesarean sections! (at least wasn't when I last looked).
Xiao F, Wei C, Chang X et al. A Prospective, Randomized, Double-Blinded Study of the Effect of Intravenous Ondansetron on the Effective Dose in 50% of Subjects of Prophylactic Phenylephrine Infusions for Preventing Spinal Anesthesia-Induced Hypotension During Cesarean Delivery. Anesth. Analg. 2020 Aug 1; 131 (2): 564-569.
  Daniel Jolley
comment
1
Question is, can this finding be extrapolated/demonstrated in frail elderly patients receiving spinal anaesthesia for other reasons.
Xiao F, Wei C, Chang X et al. A Prospective, Randomized, Double-Blinded Study of the Effect of Intravenous Ondansetron on the Effective Dose in 50% of Subjects of Prophylactic Phenylephrine Infusions for Preventing Spinal Anesthesia-Induced Hypotension During Cesarean Delivery. Anesth. Analg. 2020 Aug 1; 131 (2): 564-569.
  Matthew Smith
pearl
1
Mental three-dimensional rotation training is associated with improved ultrasound-guided regional anaesthesia technical skills.
Hewson DW, Knudsen R, Shanmuganathan S et al. Effect of mental rotation skills training on ultrasound-guided regional anaesthesia task performance by novice operators: a rater-blinded, randomised, controlled study. Br J Anaesth. 2020 Aug 1; 125 (2): 168-174.
  Daniel Jolley
pearl
1
Early initiation of norepinephrine infusion in septic shock is associated with decreased short-term mortality.
Li Y, Li H, Zhang D. Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis. Crit Care. 2020 Aug 6; 24 (1): 488.
  Daniel Jolley
pearl
1
Perioperative β-blocker use should be tailored for patient and surgical risk factors, most importantly because of the association with increased mortality and stroke when their use is generalised.
Wang X, Fernandez C, Kertai MD. Perioperative β-blocker use: what is new in 2020? Curr Opin Anaesthesiol. 2020 Jun 1; 33 (3): 417-422.
  Daniel Jolley
pearl
1
Pre-spinal-anaesthesia administration of IV ondansetron 4 mg reduces the ED50 of prophylactic phenylephrine infusion by 26% among patients undergoing elective Caesarean section.
Xiao F, Wei C, Chang X et al. A Prospective, Randomized, Double-Blinded Study of the Effect of Intravenous Ondansetron on the Effective Dose in 50% of Subjects of Prophylactic Phenylephrine Infusions for Preventing Spinal Anesthesia-Induced Hypotension During Cesarean Delivery. Anesth. Analg. 2020 Aug 1; 131 (2): 564-569.
  Daniel Jolley
pearl
1
High-inspired 80% FiO₂ shows no safety compromise when compared with standard 30-35% FiO₂ among surgical patients.
Mattishent K, Thavarajah M, Sinha A et al. Safety of 80% vs 30-35% fraction of inspired oxygen in patients undergoing surgery: a systematic review and meta-analysis. Br J Anaesth. 2019 Mar 1; 122 (3): 311-324.
  Daniel Jolley
pearl
1
Left-lateral tilt has no effect on neonatal acid-base status when maternal blood pressure is maintained with crystalloid coload & phenylephrine infusion during elective cesarean delivery.
Lee AJ, Landau R, Mattingly JL et al. Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid-Base Status: A Randomized Controlled Trial. Anesthesiology. 2017 Aug 1; 127 (2): 241-249.
  Daniel Jolley
pearl
1
Phenylephrine & noradrenaline show similar incidence of bradycardia when used for postspinal hypotension prophylaxis during Caesarean section.
Mohta M, Garg A, Chilkoti GT et al. A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section. Anaesthesia. 2019 Jul 1; 74 (7): 850-855.
  Daniel Jolley