Article Notes
Kinda interesting, but not too surprising given that their technique really just increases the catheterisation threshold (albeit individualized for each patient). Nonetheless the practicality and cost-effectiveness of patients pre-measuring their MBC is questionable. To avoid 27 unnecessary catheterizations they measured 931 pre-operative MBC's.
Small study of data collected more than 15 years ago suggests hemoglobin-based oxygen carrier HBOC-201 may reduce transfusion requirements in a non-cardiac surgery cohort. Although no significant difference in adverse events or mortality, a trend to higher incidence of both among the HBOC-201 group requires a much larger trial to be conducted before any conclusion regarding safety of such a novel therapy can be made.
I find the existence of this study perplexing. This meta-analysis appears to simply confirm basic neuromuscular pharmacology and age-related cardiovascular changes. The unanswered question is why are they so interested in using mivacurium anyway?
I conclude that good conditions for tracheal intubation are more likely when using a muscle relaxant other than mivacurium.
Despite the statistical significance of this finding, I question the clinical significance and appropriateness – especially in the context of ongoing questions regarding the safety of HES solutions and given there are alternative interventions also shown to reduce symptomatic hypotension in this setting.
Despite frequent incidence of hypotension, no cases of stroke were observed in this audit of 4,169 shoulder surgeries performed in the beach-chair position. Notably though, 97% of the cases were performed under brachial plexus block with intravenous sedation rather than a general or relaxant technique.
The authors estimate the upper limit incidence of stroke in the sitting position under regional anaesthesia as 1 in 1,429 (0.07%).