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comment
1
Though I don't generally trust propensity matched based studies, this one does rather support my pre-existing bias! One can get by with a GA but regional makes life easier for all concerned!
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Allan Palmer
summary
1
A clear and nuanced critique of the Northern Territory government's policy of removing speed limits on sections of the Stuart Highway. Read explores evidence linking driving speed and posted speed limits with vehicle accidents and trauma, noting that for the Territory:
• Northern Territorians are "... three times more likely to die on the roads than people living in other parts of Australia, and at a rate that is equivalent to that in many low- and middle-income countries."
• After the last open speed limits were abolished in 2007, the "Australian road deaths database shows a decrease in fatalities of 3.4 per year on those NT roads..."
He concludes that the NT needs a stronger road safety package that includes removing unlimited speed limits along with driver fatigue, alcohol and seatbelt interventions.
Read DJ. Open speeds on Northern Territory roads: not so fast. Med. J. Aust. 2015 Jul 6;203(1):14-5.
  Daniel Jolley
pearl
1
Crash risk and trauma severity are directly related to vehicle speed and posted speed limit.
Read DJ. Open speeds on Northern Territory roads: not so fast. Med. J. Aust. 2015 Jul 6;203(1):14-5.
  Daniel Jolley
pearl
0
Delirium in critically ill patients is associated with increased mortality, longer stays and post-discharge cognitive effects.
Salluh JI, Wang H, Schneider EB et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jan 1;350:h2538.
  Daniel Jolley
pearl
1
Local anaesthetic wound infiltration for breast surgery has only modest effects on early post-surgical pain.
Byager N, Hansen MS, Mathiesen O et al. The analgesic effect of wound infiltration with local anaesthetics after breast surgery: a qualitative systematic review. Acta Anaesthesiol Scand. 2014 Apr 1; 58 (4): 402-10.
  Daniel Jolley
summary
1
This prospective observational study across eight Canadian hospitals identified post-operative residual paralysis in 64% of patients at extubation and 57% on arrival in the PACU, despite more than 70% of patients receiving reversal with neostigmine.
Rocuronium was the muscle relaxant used in 99% of cases.
Fortier LP, McKeen D, Turner K et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth. Analg. 2015 Aug 1; 121 (2): 366-72.
  Daniel Jolley
pearl
1
Postoperative residual neuromuscular blockade continues to be common and is experienced by the majority of patients receiving muscle relaxants.
Fortier LP, McKeen D, Turner K et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth. Analg. 2015 Aug 1; 121 (2): 366-72.
  Daniel Jolley
summary
1
This retrospective propensity-matched cohort study, used 5 years of data to study 2,644 matched pairs-of-patients with a preoperative diagnosis of severe COPD.
Important exclusions were patients already ventilated, already with pulmonary infections, along with cardiac, emergency & transplant surgery, and those receiving repeat surgery within 30 days.
Receiving general anesthesia was associated with a 43% higher risk of respiratory infection (3.3% vs 2.3%, P = 0.0384), 133% greater risk of prolonged ventilation (2.1% vs 0.9%, P = 0.0008) and 44% greater risk of unplanned post-op intubation (2.6% vs 1.8%, P = 0.0487), when compared with regional anesthesia.
Nonetheless there was no significant mortality difference at 30 days (3.0% vs 2.7%, P = 0.6788).
The mix of regional techniques was 341 epidural, 1713 spinal, and 590 peripheral blocks. Notably, sub-group analysis of epidural-patients showed no difference in pulmonary complications or composite morbidity between epidural and general anesthesia. (Though given relatively small number of epidural patients, this might reflect a lack of power).
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Daniel Jolley
comment
1
This study is important because it looked specifically at patients with COPD, whereas most studies to date (showing somewhat conflicting evidence on the benefit or not of regional anesthesia to perioperative mortality & morbidity) have looked at more general patient populations.
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Daniel Jolley
pearl
1
In patients with chronic obstructive pulmonary disease, use of regional anesthesia is associated with less post-operative morbidity, though not mortality, when compared with general anesthesia.
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Daniel Jolley