Article Notes
- A 40 IU oxytocin infusion over 30 minutes is uncommon practice in Australia. (This strikes me as a study used to disprove strange local obstetric dogma!)
- Investigating the benefits of a 5 IU bolus in addition to this is hardly likely to produce a significant effect, given this essentially compares 45 IU to 40 IU over ~35 minutes.
Researchers compared induction with propofol (2.5 mg/kg), alfentanil (15 µg/kg) and rocuronium (0.6 mg/kg) to using propofol (2.5 mg/kg) and alfentanil (40 µg/kg) alone. Patients who did not receive muscle relaxants experienced more sore throat and hoarseness, more hypotension and bradycardia and a 10 times greater incidence of intubation difficulty.
And surprising to no obstetric anaesthesiologists... 🤔🙄
"...we have a case in our series in which a woman suffering from postpartum paraesthesia attempted a claim against the anaesthetist although she had received neither epidural nor spinal anaesthesia!
It is often only when an anaesthetic medicolegal opinion is sought that the obstetric nature of the injury is appreciated."
Schlaich et al. compared intubation using only propofol and remifentanil with the addition of rocuronium at various doses (0.3, 0.45, 0.6 mg/kg) in four groups of 30 patients. Intubating conditions were poor in 40% of those not receiving rocuronium, versus almost universally good conditions (89 of 90) when rocuronium was used.
I find this study a little perplexing:
40 IU over 30 minutes is an infusion with 'bolus-like' characteristics! 1.7 IU per minute!
It is important to note that the drivers of growth in Office Based Anesthesia are primarily economic and professional autonomy focused rather than patient care or quality of care. That is not to say these former priorities are in opposition to patient-centered goals, just that the patient is not the primary diver of this shift.
This analysis is not practice-changing, but instead highlights our continued lack of understanding of the outcome benefit (or not) of neuraxial versus general anaesthesia in high risk patient groups.
Interestingly, it is also a meta-analysis of meta-analyses, demonstrating that there are limits to the answers that re-analysing existing data may provide.