Article Notes

• Hide
  • Pearls
  • Summaries
  • Comments

pearl
1
In the absence of airway infection, the use of a laryngeal mask airway in children is associated with fewer postop complications than intubation.
Luce V, Harkouk H, Brasher C et al. Supraglottic airway devices vs tracheal intubation in children: a quantitative meta-analysis of respiratory complications. Paediatr Anaesth. 2014 Oct 1;24(10):1088-98.
  Daniel Jolley
pearl
1
Hydroxylethyl starch fluids increase the risk of acute kidney injury in the critically ill, and offer little benefit to general surgical patients.
Collection: Hydroxylethyl starches: harm and acute liver injury
  Daniel Jolley
summary
1
Collection: Hydroxylethyl starches: harm and acute liver injury
Hydroxyethyl starches, such as Hespan, Voluven, Volulyte, Tetrahes and Hestar, have been shown in several large trials to increase the risk of acute kidney injury (AKI) and/or the need for renal replacement therapies among critically ill patients, particulalry those suffering sepsis.
Evidence demonstrating harm among fit & healthy surgical patients is however lacking, notably Giles et al could find no increased risk of adverse event among surgical patients in their 2014 meta-analysis. Nonetheless, given the similar lack of demonstrable benefit of HES fluids for this group, avoidance of use in both the ICU and surgical population is prudent.
  Daniel Jolley
summary
0
Collection: Debunking anesthetic myths
Evidence challenging, debunking or correcting long-held anesthesia dogma.
  Daniel Jolley
pearl
1
Use of an individualised maximum bladder volume in post-op patients reduces the need for catheterization compared with arbitrary 500mL threshold.
Brouwer TA, Rosier PF, Moons KG et al. Postoperative Bladder Catheterization Based on Individual Bladder Capacity: A Randomized Trial. Anesthesiology. 2015 Jan 1;122(1):46-54.
  Daniel Jolley
summary
1
This review and case series examines this uncommon complication following airway management - most commonly after intubation, although not exclusively. Reassuringly hypoglossal nerve palsy resolves in 80% of cases within 4 months.
Shah AC, Barnes C, Spiekerman CF et al. Hypoglossal nerve palsy after airway management for general anesthesia: an analysis of 69 patients. Anesth. Analg. 2015 Jan 1; 120 (1): 105-120.
  Daniel Jolley
pearl
1
Initial liberal fluid resuscitation strategies in trauma patients may be associated with higher mortality.
Wang CH, Hsieh WH, Chou HC et al. Liberal Versus Restricted Fluid Resuscitation Strategies in Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Crit. Care Med. 2014 Apr 1; 42 (4): 954-61.
  Daniel Jolley
pearl
1
There is limited evidence supporting superiority between plain or hyperbaric spinal bupivacaine for spinal cesarean section.
Heng SiaAlex TiongATFrom the Duke-NUS Graduate Medical School, Singapore, Singapore; Medical Board, Obstetrics Gynaecology, Women's Anaesthesia, KK Women's Children's Hospital, Singapore, Singapore; Clinical Research Institute, Singapore, , Tan KH, Sng BL et al. Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery. Anesth. Analg. 2015 Jan 1; 120 (1): 132-140.
  Daniel Jolley
pearl
1
Fentanyl-only epidural infusion shows no benefit over fentanyl/bupiv in respect to duration of labor, motor block, delivery, analgesia, or outcomes.
Craig MG, Grant EN, Tao W et al. A Randomized Control Trial of Bupivacaine and Fentanyl versus Fentanyl-only for Epidural Analgesia during the Second Stage of Labor. Anesthesiology. 2015 Jan 1; 122 (1): 172-7.
  Daniel Jolley
summary
1
The researchers found that in a cohort of 198 patients admitted to ICU after major abdominal cancer surgery, those subjected to a liberal blood transfusion threshold of < 9 g/dL experienced fewer major complications (NNT 6.2) than those subjected to a restrictive transfusion threshold (< 7 g/dL).
Pinheiro J, Vincent JL, Galas FR et al. Transfusion Requirements in Surgical Oncology Patients: A Prospective, Randomized Controlled Trial. Anesthesiology. 2015 Jan 1;122(1):29-38.
  Daniel Jolley