Anaesthesia
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Review
Choice of local anaesthetic for epidural caesarean section: a Bayesian network meta-analysis.
Rapid-onset epidural local anaesthesia can avoid general anaesthesia for caesarean delivery. We performed a Bayesian network meta-analysis of direct and indirect comparisons to rank speed of onset of the six local anaesthetics most often used epidurally for surgical anaesthesia for caesarean delivery. We searched Google Scholar, PubMed, EMBASE, Ovid, CINAHL and CENTRAL to June 2019. ⋯ Speed of onset was similar to bupivacaine 0.5% after ropivacaine 0.75% and l-bupivacaine 0.5%: 1.6 (-1.4 to 4.8) min faster and 0.4 (-2.2 to 3.0) min faster, respectively. The rate (95%CrI) of intra-operative hypotension was least after l-bupivacaine 0.5%, 315 (236-407) per 1000, and highest after 2-chloroprocaine 3%, 516 (438-594) per 1000. The rate (CrI) of intra-operative supplementation of analgesia was least after ropivacaine 0.75% 48 (19-118) per 1000 and highest after 2-chloroprocaine 3%, 250 (112-569) per 1000.
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Randomized Controlled Trial
Reversal of neuromuscular blockade with sugammadex during continuous administration of anaesthetic agents: a double-blind randomised crossover study using the bispectral index.
Sugammadex, a specific reversal agent for steroidal neuromuscular blocking drugs, has on occasion been reported to be associated with clinical signs of awakening. We performed a study to systematically search for an increase in bispectral index values and signs of awakening in patients maintained under general anaesthesia following sugammadex administration. Patients, scheduled to receive general anaesthesia with neuromuscular blockade, were included in this double-blind randomised crossover study. ⋯ Saline had no effect on bispectral index values, clinical signs of awakening or degree of neuromuscular blockade. This study confirms that reversal of neuromuscular blockade with sugammadex may be associated with clinical signs of awakening despite maintenance of anaesthesia. Intravenous anaesthesia should be maintained until complete recovery of muscle function is achieved, especially when sugammadex is administered.
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Randomized Controlled Trial Comparative Study
Determining the effective pre-oxygenation interval in obstetric patients using high-flow nasal oxygen and standard flow rate facemask: a biased-coin up-down sequential allocation trial.
Using biased-coin sequential allocation, we sought to determine the effective time interval in 90% of healthy parturients to achieve a target endpoint end-tidal oxygen of ≥ 90% using standard flow rate facemask and high-flow nasal oxygen. Eighty healthy parturients were randomly assigned to standard facemask (n = 40) or high-flow nasal oxygen (n = 40) groups; half of the parturients in the high-flow nasal oxygen group also used a simple no-flow facemask to minimise air entrainment. The effective time interval for 90% of parturients to achieve the target endpoint for standard facemask was 3.6 min (95%CI 3.3-6.7 min), but could not be estimated for the high-flow nasal oxygen groups with or without an additional simple facemask, as eight minutes was insufficient to achieve the target endpoint for 55% and 92% of parturients, respectively. ⋯ After four minutes, the target endpoint was reached by 100% in the standard facemask, 80% in the high-flow nasal oxygen with simple facemask and 67% in the high-flow nasal oxygen groups. Beyond four minutes, there was no improvement in pre-oxygenation success using high-flow nasal oxygen. In conclusion, under the conditions of our study, the effective time interval for 90% of parturients to achieve an end-tidal oxygen ≥ 90% for standard flow rate facemask was estimated to be 3.6 min, but could not be estimated for high-flow nasal oxygen groups even after eight minutes.