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pearl
1
Programmed Intermittent Epidural Boluses delivered by a commerically-available epidural pump, did not improve outcomes over continuous epidural infusion other than a lower incidence of motor block.
Ojo OA, Mehdiratta JE, Gamez BH et al. Comparison of Programmed Intermittent Epidural Boluses With Continuous Epidural Infusion for the Maintenance of Labor Analgesia: A Randomized, Controlled, Double-Blind Study. Anesth. Analg. 2020 Feb 1; 130 (2): 426-435.
  Daniel Jolley
pearl
1
Incivil behaviour by surgeons in a simulated operating room crisis undermines anaesthesia trainee performance across all domains.
Katz D, Blasius K, Isaak R et al. Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Qual Saf. 2019 Sep 1; 28 (9): 750-757.
  Daniel Jolley
pearl
1
Regional anaesthesia-analgesia (paravertebral block + propofol) does not reduce breast cancer recurrence or chronic pain when compared to volatile anaesthesia (sevoflurane).
Sessler DI, Pei L, Huang Y et al. Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. Lancet. 2019 Nov 16; 394 (10211): 1807-1815.
  Daniel Jolley
pearl
1
Perioperative hypersensitivity reactions vary greatly between countries both in incidence and causative agents.
Mertes PM, Ebo DG, Garcez T et al. Comparative epidemiology of suspected perioperative hypersensitivity reactions. Br J Anaesth. 2019 Jul 1; 123 (1): e16-e28.
  Daniel Jolley
pearl
0
Although rare (~1 in 10,000 via NAP6 although varies by region) perioperative anaphylaxis is likely under-reported.
Mertes PM, Ebo DG, Garcez T et al. Comparative epidemiology of suspected perioperative hypersensitivity reactions. Br J Anaesth. 2019 Jul 1; 123 (1): e16-e28.
  Daniel Jolley
pearl
1
Hairdressers demonstrate increased IgE sensitisation to neuromuscular blocking drugs due to occupational exposure to quaternary ammonium ion compounds.
Dong S, Acouetey DS, Guéant-Rodriguez RM et al. Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers. Clin. Exp. Allergy. 2013 Nov 1;43(11):1256-62.
  Daniel Jolley
pearl
0
“Patients suffering from anaphylaxis to succinylcholine crossreact with cis-atracurium in 10% of cases and with rocuronium in 20% of cases. Cross-sensitivity is most frequently observed with rocuronium and less frequently with cis-atracurium.”
Mertes PM, Ebo DG, Garcez T et al. Comparative epidemiology of suspected perioperative hypersensitivity reactions. Br J Anaesth. 2019 Jul 1; 123 (1): e16-e28.
  Daniel Jolley
pearl
1
Life-threatening anaphylaxis occured in approximately 1 in 10,000 anaesthetics (NAP6 UK).
HarperN J NNJNManchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK; Royal College of Anaesthetists, London, UK., Cook TM, Garcez T et al. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Br J Anaesth. 2018 Jul 1; 121 (1): 159-171.
  Daniel Jolley
pearl
1
Fit and healthy women receiving low-dose intrathecal (50-150 mcg) or epidural (1-3 mg) morphine for cesarean section analgesia should have respiratory rate and sedation monitored second-hourly for the first 12 hours.
Bauchat JR, Weiniger CF, Sultan P et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. Anesth. Analg. 2019 Aug 1; 129 (2): 458-474.
  Daniel Jolley
comment
0
The title of this paper is pretty vague and possibly even misleading: “unexpectedly unfavorable outcomes”...? Generally ‘outcome’ is used in service to something broader and longer-term, such as procedural success, long-term comfort, time to discharge, or functional recovery.
A more appropriate and descriptive title would have been: “Remifentanil for abdominal surgery is associated with worse analgesia and more PONV in the PACU.” 👍
Niedermayer S, Heyn J, Guenther F et al. Remifentanil for abdominal surgery is associated unexpectedly unfavorable outcomes. Pain. 2020 Feb 1; 161 (2): 266-273.
  Daniel Jolley