Article Notes
Another useful review of neuraxial tranexamic acid, although not indexed by pubmed. Full-text below:
Gupta et al., Tranexamic acid: Beware of anaesthetic misadventures, J Obst Anaesth Crit Care 2018.
Take this one with a large grain of salt. At best it shows cerebral perfusion was safely maintained in this small cohort of patients receiving a rather unique, though not personalized, anesthetic recipe.
It’s very unlikely that this 22 patient observational study is sufficiently powered to reassure concerns that prone positioning does not effect cerebral blood flow, although it does point in that direction.
Also see Carbon Footprint from Anaesthetic gas use [pdf] from the UK’s Sustainable Development Unit.
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It’s a sad indictment on a minority in the medical community that this kind of technology is now necessary...
We’re still doing too many unnecessary general anaesthetic cesarean sections. It is not enough to be confident that we can conduct a ‘safe’ GA CS (ie. misperceived as meaning a low mortality risk), when avoidable GA CS are still associated with a spectrum of morbidity.
Definitely falls into the category of ‘just because we can, doesn’t mean we should’...
It’s notable how poor the evidence base is for many drugs for use in children. This is indicative of the lack of studies rather than efficacy, though is always worth remembering. Even from Germany, the Land of Tramadol, this Cochrane review could not unearth significant evidence for using tramadol for pediatric post-operative pain.
Post-operative cognitive problems are a growing worldwide concern, especially with our aging surgical population – but as this Cochrane review points out, we still don’t know the answers to even some simple questions, like ‘Is there a difference between TIVA and volatile anesthesia?’
Continue to watch this space...
The more I think about these results, the more interesting it is.
Reducing instrumental delivery rate is a real benefit for women, though is this due to avoiding epidurals or some other difference? How do we balance the issues of safety, analgesia, perineal trauma and maternal satisfaction? And how do we communicate this to labouring women in a meaningful way?
Questions questions...