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pearl
1
A single 60 mg/kg IV dose of magnesium sulphate does not impede rocuronium reversal by sugammadex.
Czarnetzki C, Tassonyi E, Lysakowski C et al. Efficacy of Sugammadex for the Reversal of Moderate and Deep Rocuronium-induced Neuromuscular Block in Patients Pretreated with Intravenous Magnesium: A Randomized Controlled Trial. Anesthesiology. 2014 Jul 1;121(1):59-67.
  Daniel Jolley
summary
1
Despite increasing the likelihood of a Cormack-Lehane grade 1 view, pooled results from the studies showed no difference between the Pentax Airway Scope and standard Macintosh laryngoscope for:
• Rate of intubation on first attempt.
• Time for intubation.
• Incidence of oral or pharyngeal injury.
Hoshijima H, Kuratani N, Hirabayashi Y et al. Pentax Airway Scope(®) vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis. Anaesthesia. 2014 Aug 1;69(8):911-8.
  Daniel Jolley
pearl
1
The Pentax Airway Scope improves laryngeal view compared with the standard Macintosh laryngoscope but does not facilitate intubation.
Hoshijima H, Kuratani N, Hirabayashi Y et al. Pentax Airway Scope(®) vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis. Anaesthesia. 2014 Aug 1;69(8):911-8.
  Daniel Jolley
summary
1
Real-time ultrasound guidance of central line insertion dramatically reduces the incidence of procedural failure (RR 0.18), arterial puncture (RR 0.25), haematoma (RR 0.30), pneumothorax (RR 0.21), and haemothorax (RR 0.10). Studies specifically investigating children and infants were however too small to make significant conclusions.
Wu SY, Ling Q, Cao LH et al. Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology. 2013 Feb 1;118(2):361-75.
  Daniel Jolley
pearl
1
Real-time ultrasound guidance for central line insertion significantly reduces complications and adverse events.
Wu SY, Ling Q, Cao LH et al. Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology. 2013 Feb 1;118(2):361-75.
  Daniel Jolley
pearl
2
Dexmedetomidine 150 mcg significantly extends the duration of ropivacaine interscalene block by almost 30% without significant adverse effect.
Fritsch G, Danninger T, Allerberger K et al. Dexmedetomidine Added to Ropivacaine Extends the Duration of Interscalene Brachial Plexus Blocks for Elective Shoulder Surgery When Compared with Ropivacaine Alone: A Single-Center, Prospective, Triple-Blind, Randomized Controlled Trial. Reg Anesth Pain Med. 2014 Jan 1; 39 (1): 37-47.
  Daniel Jolley
pearl
1
A single-penetration dual-injection block of the sciatic and saphenous nerves was faster to perform but equally effective as traditional techniques.
Børglum J, Johansen K, Christensen MD et al. Ultrasound-Guided Single-Penetration Dual-Injection Block for Leg and Foot Surgery: A Prospective, Randomized, Double-blind Study. Reg Anesth Pain Med. 2014 Jan 1;39(1):18-25.
  Daniel Jolley
pearl
1
Midazolam 0.03 mg/kg IV given to children pre-emergence reduces delirium without a clinically significant delay in emergence.
Cho EJ, Yoon SZ, Cho JE et al. Comparison of the Effects of 0.03 and 0.05 mg/kg Midazolam with Placebo on Prevention of Emergence Agitation in Children Having Strabismus Surgery. Anesthesiology. 2014 Jun 1;120(6):1354-61.
  Daniel Jolley
comment
0
Although this Cochrane review supports the belief that epidural and paravertebral blocks may reduce persistent-surgical pain after thoracotomy or breast cancer surgery respectively, the authors highlight the low total number of subjects (only 339 patients) in the five trials analysed. This is enough evidence to consider the PSP-benefits of regional anesthesia, but far from enough to be conclusive or change practice.
Andreae MH Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013 Nov 1; 111 (5): 711-20.
  Daniel Jolley
pearl
1
Epidural anesthesia may reduce post-thoracotomy chronic pain (OR 0.33) and paravertebral block reduce that following breast ca surgery (OR 0.37).
Andreae MH Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013 Nov 1; 111 (5): 711-20.
  Daniel Jolley