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pearl
1
Learning in a simulated anesthesia crisis is better when the simulation is of independent practice than supervised practice.
Goldberg A, Silverman E, Samuelson S et al. Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice. Br J Anaesth. 2015 May 1;114(5):794-800.
  Daniel Jolley
summary
1
This meta-analysis investigated the benefits and risks of intrathecal morphine and fentanyl, concluding that:
Intrathecal morphine prolongs post-operative analgesia on average more than 8 hours, but at cost of:
• Nausea & vomiting (NNH 10 each)
• Urinary retention (NNH 7)
• Pruritus (NNH 4)
• Respiratory depression (NNH 38-59 for IT morphine 0.05-0.5 mg)
Intrathecal fentanyl prolongs post-operative analgesia on average almost 2 hours, but at a cost of pruritus (NNH 3).
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Daniel Jolley
pearl
1
Intrathecal fentanyl prolongs post-operative analgesia at the expense of increased incidence of pruritus, but with no increase in respiratory depression.
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Daniel Jolley
pearl
1
Intrathecal morphine prolongs post-operative analgesia, but at the expense of increasing nausea, vomiting, pruritus, urinary retention and risk of respiratory depression.
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Daniel Jolley
pearl
1
In those with moderate or severe sleep apnoea, perioperative auto-titrated CPAP improves oxygen saturation and reduces postoperative AHI.
Liao P, Luo Q, Elsaid H et al. Perioperative Auto-titrated Continuous Positive Airway Pressure Treatment in Surgical Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Anesthesiology. 2013 Oct 1;119(4):837-47.
  Daniel Jolley
pearl
1
Epidural analgesia reduces all-cause mortality after cardiac surgery, at the cost of a 1 in 3,500 risk of epidural hematoma.
Landoni G, Isella F, Greco M et al. Benefits and risks of epidural analgesia in cardiac surgery†. Br J Anaesth. 2015 Jul 1;115(1):25-32.
  Daniel Jolley
comment
1
Queen Victoria writing in her journal, reflecting on the birth of Prince Leopold with chloroform:
Dr Snow gave that blessed chloroform and the effect was soothing, quieting and delightful beyond measure.
Caton D. John Snow's practice of obstetric anesthesia. Anesthesiology. 2000 Jan 1;92(1):247-52.
  Daniel Jolley
pearl
1
Harrington rods are not a contraindication to epidural analgesia but do increase insertion difficulty, technique failure and complications, particularly dural puncture and subdural placement.
Ho AM, Ngan WD, Chung DC. Should laboring parturients with Harrington rods receive lumbar epidural analgesia? Int J Gynaecol Obstet. 1999 Oct 1;67(1):41-3.
  Daniel Jolley
summary
1
A case report and brief literature review examining the efficacy and complications of labor epidural analgesia in patients with Harrington rods after scoliosis surgery.
Ho, Ngan Kee & Chung reviewed 52 reported cases in the literature showing:
• Successful catheter insertion on first attempt in 47%
• Satisfactory and uncomplicated analgesia in 55%.
• Dural puncture in 4%.
• Subdural catheterization in 4%.
Lowest success rates, highest repeated-attempts and highest complication rates (DP 8%, failure 8%, poor analgesia 55%) occurred in those with a spinal surgery scar extending below the epidural insertion point.
Ho AM, Ngan WD, Chung DC. Should laboring parturients with Harrington rods receive lumbar epidural analgesia? Int J Gynaecol Obstet. 1999 Oct 1;67(1):41-3.
  Daniel Jolley
summary
1
Collection: Interesting obstetric epidural articles
Articles of interest relevant to labor epidural analgesia, both specifically focusing on obstetric epidurals and more peripherally relevant to obstetric labor analgesia.
  Daniel Jolley