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pearl
1
High level evidence does not show any clinically meaningful difference for early vs late labour epidural analgesia, whether on maternal or neonatal outcomes.
Sng BL, Leong WL, Zeng Y et al. Early versus late initiation of epidural analgesia for labour. Cochrane Db Syst Rev. 2014 Oct 9; 2014 (10): CD007238CD007238.
  Daniel Jolley
pearl
1
A greater relief in labor pain with epidural analgesia is associated with lower postpartum depression scores, although with less clinical significance than other risk factors.
Lim G, Farrell LM, Facco FL et al. Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study. Anesth. Analg. 2018 May 1; 126 (5): 159816051598-1605.
  Daniel Jolley
pearl
1
Intending to deliver with labour epidural analgesia and then receiving a labour epidural is associated with slightly lower rate of postnatal depression.
Orbach-Zinger S, Landau R, Harousch AB et al. The Relationship Between Women's Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study. Anesth. Analg. 2018 May 1; 126 (5): 1590-1597.
  Daniel Jolley
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