Intermittent intraperitoneal lidocaine at 50 mg/h reduces post-operative morphine consumption by almost 50% after open abdominal hysterectomy.
Intermittent intraperitoneal lidocaine at 50mg/h during open abdominal hysterectomy exerts analgesic effects via local mechanisms rather than central.
Dexamethasone provides effective PONV prophylaxis (NNT 3.7). There is however no benefit of an 8 to 10 mg IV dose over a lower 4 to 5 mg dose.
Meta-analysis of 10 RCTs totalling 633 subjects showed that while pain at rest following laparoscopic surgery was reduced by transverse abdominis plane block, early (0-4 h) pain was only moderately reduced (-2.4 cm) and late pain (24 hours) minimally reduced (-1.3 cm). Pain with movement was not significantly different between TAP blocks and controls.
TAP block reduced early and late pain at rest after laparoscopic surgery, though not pain with movement.
TAP block reduces pain severity, morphine consumption and opioid side effects after caesarean section when intrathecal morphine is not used.
POISE showed that for every 1000 patients receiving metoprolol, 15 were prevented from suffering a myocardial infract, 3 from requiring cardiac revascularization along with 7 new cases of atrial fibrillation, but at a cost of causing an excess 8 deaths, 5 strokes, 53 hypotensive events and 42 episodes of bradycardia.
The harm associated with perioperative beta-blockade, at least in the form of non-titrated extended-release metoprolol, is greater than the demonstrated benefit. For every two cases of myocardial infract avoided there is one excess death.
Perioperative metoprolol in at-risk patients undergoing non-cardiac surgery reduced major cardiovascular adverse events but increased mortality.
Multiple labour epidural top-up boluses, caesarean section urgency or care by non-obstetric anaesthetists increase risk of failed epi anaesthesia.
Retrospective studies show that a single anesthesia exposure before age 3 may undermine language acquisition and abstract reasoning, and exposure to two or more anesthetics before age 2 almost doubles the risk of attention-deficit hyperactivity disorder, although in both cases causality has not yet been established.