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pearl
1
Companion presence during labour epidural placement reduces maternal anxiety and improves maternal satisfaction.
Morell E, Peralta FM, Higgins N et al. Effect of companion presence on maternal satisfaction during neuraxial catheter placement for labor analgesia: a randomized clinical trial. Int J Obstet Anesth. 2019 May 1; 38: 66-74.
  Daniel Jolley
pearl
1
In a rabbit-model of infant front-of-neck airway rescue, a cuffed 3.0 mm ETT was non-inferior to uncuffed 3.5 mm ETT for success & time-to-perform, but required greater force.
Thomas J, Alonso E, Wendel PD et al. Cuffed versus uncuffed tracheal tubes in a rabbit training model for establishing an emergency front-of-neck airway in infants: a prospective trial. Br J Anaesth. 2022 Feb 1; 128 (2): 382-390.
  Daniel Jolley
pearl
1
Prone positioning improves oxygenation & reduces mortality among non-intubated COVID positive patients, but does not appear to reduce the intubation rate.
Fazzini B, Page A, Pearse R et al. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Br J Anaesth. 2022 Feb 1; 128 (2): 352362352-362.
  Daniel Jolley
pearl
1
Pre-induction high-flow nasal oxygenation may be an acceptable alternative to traditional face-mask pre-oxygenation, with patient-comfort benefits.
Tremey B, Squara P, De H et al. Hands-free induction of general anaesthesia: a randomised pilot study comparing usual care and high-flow nasal oxygen. Minerva Anestesiol. 2020 Nov 1; 86 (11): 1135-1142.
  Daniel Jolley
pearl
1
Spinal anaesthesia with BIS-targeted sedation did not reduce post-operative delirium after lumbar fusion, compared to non-targeted general anaesthesia.
Brown CH, Edwards C, Lin C et al. Spinal Anesthesia with Targeted Sedation Based on Bispectral Index Values Compared with General Anesthesia with Masked Bispectral Index Values to Reduce Delirium: The SHARP Randomized Controlled Trial. Anesthesiology. 2021 Dec 1; 135 (6): 9921003992-1003.
  Daniel Jolley
pearl
1
The ultra-short-acting benzodiazepine remimazolam, may be an acceptable alternative to propofol for induction and maintenance of anaesthesia in high-risk patients.
Doi M, Hirata N, Suzuki T et al. Safety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients (ASA Class III): results of a multicenter, randomized, double-blind, parallel-group comparative trial. J Anesth. 2020 Aug 1; 34 (4): 491-501.
  Daniel Jolley
pearl
1
Caudal dexmedetomidine improves analgesia duration & reduces analgesia need without increasing complications, when compared to local anaesthesia alone in children.
Shah UJ, Nguyen D, Karuppiaah N et al. Efficacy and safety of caudal dexmedetomidine in pediatric infra-umbilical surgery: a meta-analysis and trial-sequential analysis of randomized controlled trials. Reg Anesth Pain Med. 2021 May 1; 46 (5): 422-432.
  Daniel Jolley
pearl
1
All commonly-used anaesthetic agents cause some degree of upper airway collapse, although dexmedetomidine probably has the least impact.
Ehsan Z, Mahmoud M, Shott SR et al. The effects of Anesthesia and opioids on the upper airway: A systematic review. Laryngoscope. 2016 Jan 1; 126 (1): 270-84.
  Daniel Jolley
summary
2
Van Decar et al. on the diagnosis and management of intra-operative diabetes insipidus concludes:
For the average adult patient, urine output >125 mL/h is consistent with polyuria. Urinary osmolality and specific gravity should be obtained and levels <300 mOsm/kg and <1.003, respectively, are consistent with hypotonic urine.
It is prudent to rule out other causes of polyuria including hyperglycemia, uremia, or iatrogenic causes including diuretic or mannitol administration.
Serum electrolytes and osmolality should also be obtained, and a high sodium (>146 mmol/L) and plasma osmolality (>300 mOsm/kg) are typically seen with DI.
Treatment should focus on replacement of free water deficit with a balanced salt solution, pharmacotherapy including DDAVP or vasopressin as appropriate, and close monitoring of patient’s fluid and electrolyte status.
Van LM, Reynolds EG, Sharpe EE et al. Perioperative Diabetes Insipidus Caused by Anesthetic Medications: A Review of the Literature. Anesth. Analg. 2022 Jan 1; 134 (1): 828982-89.
  Daniel Jolley
pearl
3
Common anaesthetic agents, including propofol, dexmedetomidine, sevoflurane, ketamine & opioids, can rarely cause intraoperative diabetes insipidus.
Van LM, Reynolds EG, Sharpe EE et al. Perioperative Diabetes Insipidus Caused by Anesthetic Medications: A Review of the Literature. Anesth. Analg. 2022 Jan 1; 134 (1): 828982-89.
  Daniel Jolley