Perioperative gabapentin does not significantly improve pain after neuraxial caesarean section.
A enjoyable trip down memory lane with Prof. Kester Brown. A brief description of the history of barbiturates and their structure activity relationships, culminating in the seven decade dominance of thiopentone.
The second half of this paper briefly describes the drugs that have challenged thiopentone, those you will likely have used (propofol, etomidate) and those most likely not (propanidid, althesin, gamma-hydroxybutyrate).
An quick and enjoyable read. Click through for the full-text.
Prophylactic ondansetron does not prevent shivering during cesarean section under regional block.
Surgical Pleth Index-guided analgesia may not be valid for use in children.
Surgical Pleth Index-guided analgesia used during pediatric tonsillectomy results in worse post-operative analgesia than BP and HR guided analgesia dosing.
Tight intraoperative blood glucose control is associated with postop delirium after cardiac surgery.
TAP block provides superior analgesia to caudal block, though is less effective at preventing bladder spasms after paediatric lower abdominal surgery.
Cardiac arrest is rare in pregnancy (1 in 30,000) and resuscitation is founded on the same approach used for the non-pregnant patient, focusing on:
- Calling for help
- A B C (D)
- Good for mother = good for baby
However, unique to maternal resuscitation:
- Airway difficulties are more likely.
- Aortocaval compression dramatically impedes resuscitation – employ left lateral tilt!
- Consider perimortem cesarean section
The rationale for Perimortem Cesarean Section is:
- The presence of baby and gravid uterus severely limits resuscitation of the mother.
- Emergency cesarean section at cardiac arrest is done for the mother’s benefit, not the baby.
- A decision to perform emergency CS must be made within 4 minutes of arrest, and the baby delivered within 5 minutes. (Although there is some evidence of benefit when performed up to 10 minutes after arrest.)
- The only equipment required is a scalpel and an appropriately skilled doctor.
Seems pretty convincing. Doesnt block bladder spasm, which would be predictable via known anatomy.
An extensive collection of research debunking a range of myths and misconceptions regarding the way we use neuromuscular blocking drugs.
- Myth 1: Modern relaxants are so reliable and predictable that monitoring is unnecessary.
- Myth 2: Post-op residual paralysis is neither common or important.
- Myth 3: Post-op residual paralysis is easy to identify.
- Myth 4: Sugammadex makes residual paralysis a non-issue. (it might, but only if it is routinely available and used!)
- Myth 5: Using propofol and remifentanil we can avoid relaxants for intubation all together.
- Myth 6: Neuromuscular blockade has no effect on BIS.
And bonus myth: deep relaxation is necessary for improving surgical access during laparoscopy.