Article Notes

• Hide
  • Pearls
  • Summaries
  • Comments

pearl
1
Clonidine improves post-operative analgesia, reduces nausea & vomiting, improves hemodynamic stability, does not prolong wakening, and does not improve cardiac outcomes.
Sanchez MC, De M, Forget P. What is the place of clonidine in anesthesia? Systematic review and meta-analyses of randomized controlled trials. J Clin Anesth. 2017 May 1; 38: 140-153.
  Daniel Jolley
pearl
1
Sugammadex use does not avoid either the need or benefit of neuromuscular monitoring, although it does result in less residual neuromuscular block than neostigmine reversal.
Kotake Y, Ochiai R, Suzuki T et al. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesth. Analg. 2013 Aug 1;117(2):345-51.
  Daniel Jolley
pearl
1
Neostigmine administration after clinical recovery of neuromuscular function to TOFR ≥ 0.9 appears to be neither beneficial or detrimental.
Murphy GS, Szokol JW, Avram MJ et al. Neostigmine Administration after Spontaneous Recovery to a Train-of-Four Ratio of 0.9 to 1.0: A Randomized Controlled Trial of the Effect on Neuromuscular and Clinical Recovery. Anesthesiology. 2018 Jan 1; 128 (1): 27-37.
  Daniel Jolley
comment
1
I agree with Allan. This is the best available evidence for Ephedrine vs Phenylephrine to treat hypotension post-spinals in LSCS.
Veeser M, Hofmann T, Roth R et al. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand. 2012 Aug 1; 56 (7): 810-6.
  Chris Tan
pearl
1
Use of intraoperative cerebral oximetry may reduce post-operative cognitive decline.
Zorrilla-Vaca A, Healy R, Grant MC et al. Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials. Can J Anaesth. 2018 May 1; 65 (5): 529-542.
  Daniel Jolley
pearl
1
Intubation using a tracheal stylet in the ETT significantly increases the incidence of post-operative sore throat.
Komasawa N, Nishihara I, Minami T. Effects of stylet use during tracheal intubation on postoperative pharyngeal pain in anesthetized patients: A prospective randomized controlled trial. J Clin Anesth. 2017 May 1; 38: 68-70.
  Daniel Jolley
pearl
1
Epidural fentanyl at concentrations up to 2 mcg/mL does not effect breastfeeding rates in women who have previously successfully breastfed.
Lee AI, McCarthy RJ, Toledo P et al. Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial. Anesthesiology. 2017 Oct 1; 127 (4): 614-624.
  Daniel Jolley
comment
1
Excellent study and long-awaited conclusion!
Davidson AJ, Disma N, de JC et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet. 2016 Jan 16; 387 (10015): 239-50.
  Chris Tan
comment
1
Adding high dose adrenaline to spinal solution? I'm not sure that's wise. Potential general or specific vasoconstriction in intracerebral capillaries, for benefit of 40 mins added sensory block time.
Katz D, Hamburger J, Gutman D et al. The Effect of Adding Subarachnoid Epinephrine to Hyperbaric Bupivacaine and Morphine for Repeat Cesarean Delivery: A Double-Blind Prospective Randomized Control Trial. Anesth. Analg. 2018 Jul 1; 127 (1): 171-178.
  Chris Tan
pearl
1
High-risk obstructive sleep apnoea patients identified by STOP-Bang screening suffer higher risk of post-operative adverse events and longer hospital stays.
Nagappa M, Patra J, Wong J et al. Association of STOP-Bang Questionnaire as a Screening Tool for Sleep Apnea and Postoperative Complications: A Systematic Review and Bayesian Meta-analysis of Prospective and Retrospective Cohort Studies. Anesth. Analg. 2017 Oct 1; 125 (4): 1301-1308.
  Daniel Jolley