Obstructive sleep apnoea patients receiving opioids should have post-operative continuous monitoring.
It’s notable how poor the evidence base is for many drugs for use in children. This is indicative of the lack of studies rather than efficacy, though is always worth remembering. Even from Germany, the Land of Tramadol, this Cochrane review could not unearth significant evidence for using tramadol for pediatric post-operative pain.
Continuous femoral nerve block is better than single-shot femoral nerve block for providing analgesia after total knee replacement.
Femoral nerve block is better than PCA alone after total knee replacement, although comparison to local infiltration is unclear.
Even if beneficial, perioperative lignocaine infusions probably have no analgesic benefit beyond 24 hours post-operatively.
Post-operative cognitive problems are a growing worldwide concern, especially with our aging surgical population – but as this Cochrane review points out, we still don’t know the answers to even some simple questions, like ‘Is there a difference between TIVA and volatile anesthesia?’
Continue to watch this space...
Optimizing depth of anesthesia with a processed EEG (BIS, Entropy, or similar) in surgical patients over 60 yo is probably beneficial by reducing the incidence of post-operative delirium and cognitive decline.
Unlike dexmedetomidine sedation in the critical care setting, intraoperative dexmedetomidine does not reduce postoperative delirium.
Desflurane and propofol anesthesia are associated with similar incidence of post-operative delirium in the obese, elderly undergoing total knee replacement.
Neuraxial morphine does not have a protective effect on headache after unintentional dural puncture.