Knowledge
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Also see Carbon Footprint from Anaesthetic gas use [pdf] from the UK’s Sustainable Development Unit.
comment
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The pressure to practice truly patient-focused, evidence-based medicine weighs on every anaesthetist and anaesthesiologist. Yet as the volume of evidence has grown, so has the expectation to always provide the highest quality care.
There is a trap of unknown knowns: evidence known in the greater medical-knowledge body but that we are naively ignorant of.
Bastardising William Gibson (1993), we risk that the evidence:
“…is already here – it's just not very evenly distributed.”
The greatest challenge for evidence-based anaesthesia continues to be the translation of research findings into actual practice change. The key to this is the intersection between quality, personal relevance, general significance, and credibility. But how can we achieve this?
summary
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- Does peri-operative intravenous dexamethasone reduce pain and opioid consumption after caesarean delivery? YES
- Are the effects statistically significant? YES
- Are the effects clinically significant? Possibly, though pain scores are only modestly improved and the reduction in opioid use is only small.
- Are the findings applicable to my patient population? Possibly, though the majority of studies were performed in Middle East, Asian & South Asian hospitals, and with diverse post-operative analgesic regimes.
- Is peri-operative dexamethasone safe? Probably, though few studies were adequately powered to identify less-common potential side effects, such as infection or delayed wound healing.
- Quality of evidence is low to modest. Notably, the primary outcome for most studies was PONV reduction, not post-operative pain.
- Should this evidence result in routine practice change? Probably not at this stage. IV dexamethasone may however be an appropriate intervention in select patient groups.
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