Anesthesiology
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A higher rate of hospital neuraxial labor analgesia is associated with a lower rate of unnecessary general anesthetic cesarean section.
pearl -
Randomized Controlled Trial Multicenter Study
Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.
Why is this interesting?
Lidocaine/lignocaine has been increasingly used intra- and perioperatively as an analgesic adjunct, with further research suggesting a potential neuroprotective effect. Cognitive decline is a common problem following cardiac surgery (40-50%), with lidocaine potentially offering a simple and safe intervention to reduce this complication. Past studies have showed conflicting results.
What did they do?
This Duke University team randomized 478 cardiac surgery patients across multiple centres to lidocaine intraoperatively (1 mg/kg bolus then decreasing infusions across 2.9 / 1.5 / 0.6 mg/kg/h over 48 hours) or blinded control. Cognitive function was assessed at 6 weeks and 1 year.
They found...
No difference in cognitive deficit between lidocaine infusion and saline control at either 6 weeks or 1 year.
Be smart
Intravenous lidocaine infusion remains relatively safe, practical and is still likely a useful analgesic adjunct. Similar to magnesium, which has been shown to be neuroprotective in premature infants but not adult cardiac patients, the problem for lidocaine may well be context rather than physiological benefit itself.
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Randomized Controlled Trial
Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures: A Randomized Controlled Trial.
Dental procedures under sedation can cause hypoxic events and even death. However, the mechanism of such hypoxic events is not well understood. ⋯ Patients under sedation for dental procedure frequently encounter obstructive apnea/hypopnea events. The majority of the obstructive apnea/hypopnea events were not detectable by pulse oximetry. The effectiveness of a small-diameter nasopharyngeal tube to mitigate the events is limited.
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The antidepressant effect of ketamine is associated with increased activity in the reward circuitry of the brain and a suppression of circuitry that mediates perceptual processing of negative emotions. The duration of ketamine effect on these brain structures remains to be defined. ⋯ Single bolus ketamine administration rapidly triggers lasting changes in mesolimbic neural networks to improve pathologic reward and emotional processing in patients with major depressive disorder.