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In my experience, 80% success is about right. It can be a somewhat hit-n-miss technique, though with reasonable evidence to support both safety and potential superiority vs neonatal general anaesthesia. You know pretty much instantly when it hasn't worked.
Frawley G, Bell G, Disma N et al. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes. Anesthesiology. 2015 Jul 1; 123 (1): 55-65.
  Daniel Jolley
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Why does any study with the words 'adherence' and 'guideline' in the same sentence immediately get my back up. If its a guideline you dont need to ADHERE to it. Think about it, follow it, maybe, but not ADHERE. Grrrrrrrr
McEvoy MD, Hand WR, Stoll WD et al. Adherence to guidelines for the management of local anesthetic systemic toxicity is improved by an electronic decision support tool and designated "reader". Reg Anesth Pain Med. 2014 Jul 1; 39 (4): 299-305.
  Allan Palmer
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83% success rate. ~20% failure rate. 1:5 failure. Not so sure I would agree with the comment the "failure rate of spinal anaesthesia was low". I like a little more certainty than this!
Frawley G, Bell G, Disma N et al. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes. Anesthesiology. 2015 Jul 1; 123 (1): 55-65.
  Allan Palmer
pearl
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As has been often said "With great power comes great responsibility"! - and social media use in healthcare is a prime example.
Steele S, Adcock C, Steel A. Ethical, legal and professional issues arising from social media coverage by UK Helicopter Emergency Medical Services. Emerg Med J. 2016 Jan 1; 33 (1): 57-60.
  Allan Palmer
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We are so used to using systemic high potency treatments it is sometimes easy to forget the simple stuff!
Ahmed SU, Zhang Y, Chen L et al. Effect of 1.5% Topical Diclofenac on Clinical Neuropathic Pain. Anesthesiology. 2015 Jul 1;123(1):191-8.
  Allan Palmer
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Given the relatively low propofol TCI target (NB: 50% wake @ 1.07 mcg/mL and 50% orientated @ 0.95 mcg/mL), even in the presence of remifentanil, I wonder whether this is more a case of unrecognized light anaesthesia than sugammadex waking someone up.
Case in point, the demonstrated effect of rocuronium on BIS in awake volunteers: Response of bispectral index to neuromuscular block in awake volunteers
Chazot T, Dumont G, Le M et al. Sugammadex administration results in arousal from intravenous anaesthesia: a clinical and electroencephalographic observation. Br J Anaesth. 2011 Jun 1;106(6):914-6.
  Daniel Jolley
pearl
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Perimortem cesarean section is a heroic intervention that may be beneficial in maternal arrest, though is unlikely to do further harm.
Katz V, Balderston K, DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am. J. Obstet. Gynecol. 2005 Jun 1;192(6):1916-20; discussion 1920-1.
  Daniel Jolley
pearl
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Anesthesia with nitrous oxide preserves awake features of the EEG leading to inappropriately higher BIS values.
Foster BL Liley DT. Nitrous oxide paradoxically modulates slow electroencephalogram oscillations: implications for anesthesia monitoring. Anesth. Analg. 2011 Oct 1;113(4):758-65.
  Daniel Jolley
pearl
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Propofol and thiopentone are physiochemically compatible when mixed.
Prankerd RJ Jones RD. Physicochemical compatibility of propofol with thiopental sodium. Am J Health Syst Pharm. 1996 Nov 1;53(21):2606-10.
  Daniel Jolley
pearl
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Video-laryngoscopy in pediatric anesthesia improves glottis visualization but prolongs intubation time and increases failure.
Sun Y, Lu Y, Huang Y et al. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2014 Oct 1; 24 (10): 1056-65.
  Daniel Jolley