Knowledge

Collections of articles, notes and knowledge from the metajournal community.

Interesting obstetric epidural articles

Epidural Obstetric anesthesia
Articles of interest relevant to labor epidural analgesia, both specifically focusing on obstetric epidurals and more peripherally relevant to obstetric labor analgesia.
summary
- Randomized Controlled Trial
  
  A Randomized Control Trial of Bupivacaine and Fentanyl versus Fentanyl-only for Epidural Analgesia during the Second Stage of Labor.
  
  Anesthesiology. 2015 Jan 1; 122 (1): 172-7.
  
  Fentanyl-only epidural infusion shows no benefit over fentanyl/bupiv in respect to duration of labor, motor block, delivery, analgesia, or outcomes.
  pearl
- Review
  
  Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis.
  
  Anesth. Analg. 2013 Jan 1; 116 (1): 133-44.
- Meta Analysis
  
  Extending epidural analgesia for emergency Caesarean section: a meta-analysis.
  
  Br J Anaesth. 2011 Nov 1;107(5):668-78.
  
  Lidocaine with epinephrine is the most optimal solution for epidural top-up for emergency caesarean section. Adding fentanyl further speeds onset.
  pearl
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What dose of rocuronium is required to reestablish neuromuscular block after using sugammadex

Collection
- Article
  
  A case series of re-establishment of neuromuscular block with rocuronium after sugammadex reversal.
  
  J Anesth. 2016 Jun 1; 30 (3): 534-7.
- Clinical Trial
  
  Repeat dosing of rocuronium 1.2 mg kg-1 after reversal of neuromuscular block by sugammadex 4.0 mg kg-1 in anaesthetized healthy volunteers: a modelling-based pilot study.
  
  Br J Anaesth. 2010 Oct 1;105(4):487-92.
- Case Reports
  
  A case where rocuronium was unable to achieve neuromuscular block immediately after sugammadex administration.
  
  J. Med. Invest. 2011 Feb 1;58(1-2):163-5.
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Healthcare Kaizen: Continuous Improvement

Collection
- Article
  
  Improving health care from the bottom up: Factors for the successful implementation of kaizen in acute care hospitals.
  
  Plos One. 2021 Jan 1; 16 (9): e0257412e0257412.
- Article
  
  What drives continuous improvement project success in healthcare?
  
  Int J Health Care Qual Assur. 2017 Feb 13; 30 (1): 435743-57.
- Article
  
  Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement.
  
  BMJ Open. 2016 Jul 29; 6 (7): e012256e012256.
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SBAR and anaesthetic handover communication

Collection
- Article
  
  SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study.
  
  BMJ Open. 2014 Jan 1; 4 (1): e004268.
- Guideline
  
  Recommendations of the German Association of Anesthesiology and Intensive Care Medicine (DGAI) on structured patient handover in the perioperative setting : The SBAR concept.
  
  Anaesthesist. 2016 Dec 1; 65 (Suppl 1): 1-4.
- Comparative Study
  
  SBAR improves nurse-physician communication and reduces unexpected death: A pre and post intervention study.
  
  Resuscitation. 2013 Sep 1;84(9):1192-6.
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Does subcutaneous local anaesthetic reduce the pain of cannulation?

Collection
Yes! Despite anaesthesiologist and anaesthetist reluctance to infiltrate with lignocaine/lidocaine before peripheral cannulation, we have several decades of evidence showing that:
- The pain of subcutaneous 1% lignocaine injection is significantly less than cannulation pain across all cannula sizes.
- Patients prefer pre-cannulation LA infiltration.
summary
- Randomized Controlled Trial
  
  Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula?
  
  Anaesthesia. 1992 Oct 1;47(10):890-1.
  
  The pain of subcutaneous 1% lignocaine injection is significantly less than cannulation pain across all peripheral cannula sizes down to 22-gauge.
  pearl
- Randomized Controlled Trial
  
  The use of pre-cannulation local anaesthetic and factors affecting pain perception in the emergency department setting.
  
  Emerg Med J. 2001 May 1;18(3):175-7.
- Comparative Study
  
  Appropriate use of local anaesthetic for venous cannulation.
  
  Anaesthesia. 1992 Mar 1;47(3):210-2.
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