Prone positioning improves oxygenation & reduces mortality among non-intubated COVID positive patients, but does not appear to reduce the intubation rate.
Pre-induction high-flow nasal oxygenation may be an acceptable alternative to traditional face-mask pre-oxygenation, with patient-comfort benefits.
Spinal anaesthesia with BIS-targeted sedation did not reduce post-operative delirium after lumbar fusion, compared to non-targeted general anaesthesia.
The ultra-short-acting benzodiazepine remimazolam, may be an acceptable alternative to propofol for induction and maintenance of anaesthesia in high-risk patients.
Caudal dexmedetomidine improves analgesia duration & reduces analgesia need without increasing complications, when compared to local anaesthesia alone in children.
All commonly-used anaesthetic agents cause some degree of upper airway collapse, although dexmedetomidine probably has the least impact.
Van Decar et al. on the diagnosis and management of intra-operative diabetes insipidus concludes:
For the average adult patient, urine output >125 mL/h is consistent with polyuria. Urinary osmolality and specific gravity should be obtained and levels <300 mOsm/kg and <1.003, respectively, are consistent with hypotonic urine.
It is prudent to rule out other causes of polyuria including hyperglycemia, uremia, or iatrogenic causes including diuretic or mannitol administration.
Serum electrolytes and osmolality should also be obtained, and a high sodium (>146 mmol/L) and plasma osmolality (>300 mOsm/kg) are typically seen with DI.
Treatment should focus on replacement of free water deficit with a balanced salt solution, pharmacotherapy including DDAVP or vasopressin as appropriate, and close monitoring of patient’s fluid and electrolyte status.
Common anaesthetic agents, including propofol, dexmedetomidine, sevoflurane, ketamine & opioids, can rarely cause intraoperative diabetes insipidus.
Ultrasound-guided caudal injection does not improve overall success or block performance time compared to landmark caudal injection, but does improve first-puncture success and reduce complications.
Intrathecal opioids significantly prolong & benefit post-caesarean section analgesia.