Anesthesia and analgesia
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Anesthesia and analgesia · May 2019
Meta AnalysisAwake Fiberoptic Intubation Protocols in the Operating Room for Anticipated Difficult Airway: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Why is this important?
This is the first systematic review of RCTs assessing different techniques for conducting awake fibreoptic intubation (AFOI), although the quality of evidence continues to be moderate-low.
Cabrini et al. reviewed 37 RCTs capturing 2,045 AFOI events.
What did they find?
There was no significant success difference among techniques for either local anaesthesia application or procedural sedation, including infusions or boluses of dexmedetomidine, propofol, opioids (fentanyl, sufentanil, remifentanil), ±midazolam, or sevoflurane.
Dexmedetomidine sedation resulted in the fewest desaturation events, and sevoflurane the fewest apnoea events.
Opioids used on their own (ie. without benzodiazepines) resulted in the highest patient recall, particularly remifentanil.
Also of interest...
When conducted by trained experts, AFOI is safe and effective regardless of technique and only very uncommonly results in intubation failure (0.59%) or severe adverse events (0.34%). No permanent morbidity or death was identified.
The take-home message:
When choosing a technique for awake fibre optic intubation, do what you do best – generally this will be what you and your institution are most experienced with.
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Anesthesia and analgesia · May 2019
Observational StudyDevelopment and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa.
Checklists for managing crises during cesarean section are practical to implement in low and middle-income countries, and significantly improve task completion in simulated emergencies.
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