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pearl
1
Maternal sedation with local anaesthetic infiltration is comparable to spinal anaesthesia for women undergoing minimally-invasive fetal surgery, and in fact improves maternal hemodynamic stability.
Ferschl MB, Feiner J, Vu L et al. A Comparison of Spinal Anesthesia Versus Monitored Anesthesia Care With Local Anesthesia in Minimally Invasive Fetal Surgery. Anesth. Analg. 2020 Feb 1; 130 (2): 409-415.
  Daniel Jolley
pearl
1
New guidelines for paediatric button battery ingestion recommend preoperative administration with honey and/or sucralfate, and post-removal irrigation with 0.25% acetic acid.
Hoagland MA, Ing RJ, Jatana KR et al. Anesthetic Implications of the New Guidelines for Button Battery Ingestion in Children. Anesth. Analg. 2020 Mar 1; 130 (3): 665-672.
  Daniel Jolley
pearl
1
Pre-operative infusion of 5mL/kg of 5% dextrose before laparoscopic cholecystectomy reduces post-operative nausea & vomiting by ~30%.
Salman N, Aykut A, Ü Sabuncu et al. Dextrose administration may reduce the incidence of postoperative nausea and vomiting after laporoscopic cholecystectomy: a double blind randomized controlled trial. Minerva Anestesiol. 2020 Apr 1; 86 (4): 379-386.
  Daniel Jolley
pearl
1
In ventilated critical care patients, both T-piece and pressure support ventilation are comparable as spontaneous breathing trial techniques in their ability to predict successful extubation.
Li Y, Li H, Zhang D. Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis. Crit Care. 2020 Feb 26; 24 (1): 67.
  Daniel Jolley
pearl
1
Deep neuromuscular block does not significantly change the global or regional lung physiological effects seen with robotic laparoscopic surgery.
Brandão JC, Lessa MA, Motta-Ribeiro G et al. Global and Regional Respiratory Mechanics During Robotic-Assisted Laparoscopic Surgery: A Randomized Study. Anesth. Analg. 2019 Dec 1; 129 (6): 156415731564-1573.
  Daniel Jolley
pearl
1
The combination of general anaesthesia with low tidal volume and moderate-to-high PEEP reduces post-operative pulmonary complications in the general surgical population.
Deng QW, Tan WC, Zhao BC et al. Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials. Br J Anaesth. 2020 Mar 1; 124 (3): 324-335.
  Daniel Jolley
pearl
1
Modern cuffed endotracheal tubes are a superior airway device for children and neonates, offering better ventilation mechanics, fewer tube changes, and fewer short-term respiratory complications, with no clinically significant downside.
Collection: Use of cuffed endotracheal tubes in pediatric anesthesia
  Daniel Jolley
pearl
1
In a wet-lab cannot-intubate cannot-oxygenate front-of-neck access simulation, a needle-cannula technique resulted in faster and more reliable oxygen delivery than scalpel-bougie.
Rees KA, O'Halloran LJ, Wawryk JB et al. Time to oxygenation for cannula- and scalpel-based techniques for emergency front-of-neck access: a wet lab simulation using an ovine model. Anaesthesia. 2019 Sep 1; 74 (9): 1153-1157.
  Daniel Jolley
comment
1
What is automatic tube compensation? Glad you asked!
"Automatic tube compensation (ATC) is a new option to compensate for the non-linearly flow-dependent pressure drop across an endotracheal or tracheostomy tube (ETT) during inspiration and expiration. ATC is based on a closed-loop working principle. ATC is not a true ventilatory mode but rather a new option which can be combined with all conventional ventilatory modes."
– Guttmann 2002
Thomas J, Weiss M, Cannizzaro V et al. Work of breathing for cuffed and uncuffed pediatric endotracheal tubes in an in vitro lung model setting. Paediatr Anaesth. 2018 Sep 1; 28 (9): 780-787.
  Daniel Jolley
pearl
1
Although cuffed paediatric endotracheal tubes increase work-of-breathing and inspiratory pressures, this is easily compensated for by pressure support ventilation with automatic tube compensation, and so has limited clinical significance.
Thomas J, Weiss M, Cannizzaro V et al. Work of breathing for cuffed and uncuffed pediatric endotracheal tubes in an in vitro lung model setting. Paediatr Anaesth. 2018 Sep 1; 28 (9): 780-787.
  Daniel Jolley