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Although we know that OIH and AOT are issues for remifentanil and may explain the PACU analgesia differences observed in this study, it’s also possible that worse PACU pain scores occur because anesthetists/anesthesiologists have not adequately transitioned from short-acting to longer-acting analgesics at the end of the case.
That is, the findings may represent inadequate pre-emergence analgesia because of the complexity of managing pharmacokinetic transitions, rather than a direct pharmacodynamic effect of remifentanil...
My money is still on this being acute hyperalgesia and tolerance, but keep an open mind...
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
pearl
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Intra-operative remifentanil infusion for intra-abdominal surgery is associated with worse post-operative pain scores and higher analgesic requirements 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
pearl
1
There is no evidence supporting routinely ceasing buprenorphine perioperatively, even up to SL doses of 16mg/d.
Goel A, Azargive S, Lamba W et al. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019 Feb 1; 66 (2): 201-217.
  Daniel Jolley
pearl
1
Buprenorphine does not need to be ceased in patients requiring opioid analgesia post-operatively.
Haber LA, DeFries T, Martin M. Things We Do for No Reason™: Discontinuing Buprenorphine When Treating Acute Pain. J Hosp Med. 2019 Oct 1; 14 (10): 633-635.
  Daniel Jolley
pearl
1
Among older patients undergoing major surgery, there is no difference in 1-year mortality between light and deep general anaesthesia.
Short TG, Campbell D, Frampton C et al. Anaesthetic depth and complications after major surgery: an international, randomised controlled trial. Lancet. 2019 Nov 23; 394 (10212): 1907-1914.
  Daniel Jolley
pearl
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High pholcodine consumption in Australia is associated with higher prevalence of IgE antibodies to suxamethonium and probably a higher risk of anaphylaxis to NMBDs.
Katelaris CH, Kurosawa M, Moon HB et al. Pholcodine consumption and immunoglobulin E-sensitization in atopics from Australia, Korea, and Japan. Asia Pac Allergy. 2014 Apr 1; 4 (2): 86-90.
  Daniel Jolley
pearl
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Cisatracurium has the lowest risk of anaphylaxis of all non-depolarising neuromuscular blocking drugs.
Collection: Anaphylaxis to Rocuronium in Australia & New Zealand
  Daniel Jolley
pearl
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In Australia and New Zealand rocuronium is associated with a higher risk of anaphylaxis when compared to vecuronium or the benzylisoquinolinium NMBDs. This is not the case in North America or Europe.
Collection: Anaphylaxis to Rocuronium in Australia & New Zealand
  Daniel Jolley
pearl
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Intraoperative parecoxib 40mg reduces postoperative shivering, comparable to tramadol.
Li X, Zhou M, Xia Q et al. Effect of parecoxib sodium on postoperative shivering: A prospective, randomised, double-blind clinical trial. Eur J Anaesthesiol. 2014 Apr 1;31(4):225-30.
  Daniel Jolley
pearl
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Fentanyl PCA has a slightly lower incidence of nausea & vomiting than other opioids.
Dinges HC, Otto S, Stay DK et al. Side Effect Rates of Opioids in Equianalgesic Doses Via Intravenous Patient-Controlled Analgesia: A Systematic Review and Network Meta-analysis. Anesth. Analg. 2019 Oct 1; 129 (4): 1153-1162.
  Daniel Jolley