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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...
Miller D, Lewis SR, Pritchard MW et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Db Syst Rev. 2018 Aug 21; 8 (8): CD012317CD012317.
  Daniel Jolley
pearl
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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.
Punjasawadwong Y, Chau-In W, Laopaiboon M et al. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Db Syst Rev. 2018 May 15; 5 (5): CD011283CD011283.
  Daniel Jolley
pearl
1
Unlike dexmedetomidine sedation in the critical care setting, intraoperative dexmedetomidine does not reduce postoperative delirium.
Deiner S, Luo X, Lin HM et al. Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial. JAMA Surg. 2017 Aug 16; 152 (8): e171505.
  Daniel Jolley
pearl
1
Desflurane and propofol anesthesia are associated with similar incidence of post-operative delirium in the obese, elderly undergoing total knee replacement.
Tanaka P, Goodman S, Sommer BR et al. The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial. J Clin Anesth. 2017 Jun 1; 39: 17-22.
  Daniel Jolley
pearl
1
Neuraxial morphine does not have a protective effect on headache after unintentional dural puncture.
Brinser ME, Seng DL, Mandell GL et al. Neuraxial morphine after unintentional dural puncture is not associated with reduced postdural puncture headache in obstetric patients. J Clin Anesth. 2019 Feb 1; 52: 58-62.
  Daniel Jolley
comment
1
Finally some evidence to show the inaccuracy of palpation in rescue FON access! This will potentially change my practice. Now I'm more inclined to pre-site the CTM via ultrasound in patients with no necks prior to induction.
Siddiqui N, Yu E, Boulis S et al. Ultrasound Is Superior to Palpation in Identifying the Cricothyroid Membrane in Subjects with Poorly Defined Neck Landmarks: A Randomized Clinical Trial. Anesthesiology. 2018 Dec 1; 129 (6): 1132-1139.
  Chris Tan
comment
0
The more I think about these results, the more interesting it is.
Reducing instrumental delivery rate is a real benefit for women, though is this due to avoiding epidurals or some other difference? How do we balance the issues of safety, analgesia, perineal trauma and maternal satisfaction? And how do we communicate this to labouring women in a meaningful way?
Questions questions...
WilsonMatthew J AMJASchool of Health Related Research, University of Sheffield, Sheffield, UK. Electronic address: m.j.wilson@sheffield.ac.uk., MacArthur C, Hewitt CA et al. Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial. Lancet. 2018 Aug 25; 392 (10148): 662-672.
  Daniel Jolley
pearl
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Intraoperative corticosteroids may decrease postoperative complications, including infection, after major surgery.
Asehnoune K, Vourc'h M, Roquilly A. Corticosteroids administration to improve outcome in high-risk surgical patients. Curr Opin Crit Care. 2018 Dec 1; 24 (6): 575-580.
  Daniel Jolley
pearl
1
Although slightly lowering 5 minute Apgar scores, opioids used to attenuate the maternal pressor response to intubation did not have clinically significant effects on neonates.
Aman A, Salim B, Munshi K et al. Effect on neonatal outcome of pharmacological interventions for attenuation of the maternal haemodynamic response to tracheal intubation: a systematic review. Anaesth Intensive Care. 2018 May 1; 46 (3): 258271258-271.
  Daniel Jolley
pearl
1
Local anesthetic myotoxicity may be clinically significant, particularly with bupivacaine, at higher LA concentrations and with longer exposure.
Hussain N, McCartney C J L CJL Department of Anesthesiology Pain Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada., Neal JM et al. Local anaesthetic-induced myotoxicity in regional anaesthesia: a systematic review and empirical analysis. Br J Anaesth. 2018 Oct 1; 121 (4): 822-841.
  Daniel Jolley