Article Notes

• Hide
  • Pearls
  • Summaries
  • Comments

pearl
1
Performing regional anesthetic blocks in children under general anesthesia is as safe as in sedated or awake children.
Taenzer AH, Walker BJ, Bosenberg AT et al. Asleep Versus Awake: Does It Matter?: Pediatric Regional Block Complications by Patient State: A Report From the Pediatric Regional Anesthesia Network. Reg Anesth Pain Med. 2014 Jul 1;39(4):279-83.
  Daniel Jolley
pearl
1
Suggestive techniques may reduce postoperative anxiety and pain, although not analgesic consumption or nausea.
Kekecs Z, Nagy T, Varga K. The Effectiveness of Suggestive Techniques in Reducing Postoperative Side Effects: A Meta-Analysis of Randomized Controlled Trials. Anesth. Analg. 2014 Dec 1;119(6):1407-19.
  Daniel Jolley
summary
1
This small, pilot study suggests that isoflurane may be more commonly associated with post-operative cognitive dysfunction than desflurane in older patients.
Zhang B, Tian M, Zhen Y et al. The effects of isoflurane and desflurane on cognitive function in humans. Anesth. Analg. 2012 Feb 1;114(2):410-5.
  Daniel Jolley
comment
1
The role of suggestibility just never goes away yet seems rarely considered in our hospital processes. Why has nursing as a science ignored this?
Kekecs Z, Nagy T, Varga K. The Effectiveness of Suggestive Techniques in Reducing Postoperative Side Effects: A Meta-Analysis of Randomized Controlled Trials. Anesth. Analg. 2014 Dec 1;119(6):1407-19.
  Allan Palmer
comment
1
All of these non-invasive monitors have inate variability but if you can see past that they do seem to add value to patient care.
Waldron NH, Miller TE, Thacker JK et al. A Prospective Comparison of a Noninvasive Cardiac Output Monitor Versus Esophageal Doppler Monitor for Goal-Directed Fluid Therapy in Colorectal Surgery Patients. Anesth. Analg. 2014 May 1;118(5):966-75.
  Allan Palmer
comment
1
Nice summary, seems like common sense with very useful number needed to harm data, though from personal experience surprising the NNH for itching was lower for Fentanyl than Morpine
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Allan Palmer
comment
1
In the publicly available version no mention of risks. Locally this technique was popular a while ago but abandonded after a few total spinals and such
Choi S, Rampersaud YR, Chan VW et al. The addition of epidural local anesthetic to systemic multimodal analgesia following lumbar spinal fusion: a randomized controlled trial. Can J Anaesth. 2014 Apr 1;61(4):330-9.
  Allan Palmer
comment
1
So if you use Nitrous oxide the patient will be more deeply asleep than monitors like the BIS will indicate. I can live with that.
Foster BL Liley DT. Nitrous oxide paradoxically modulates slow electroencephalogram oscillations: implications for anesthesia monitoring. Anesth. Analg. 2011 Oct 1;113(4):758-65.
  Allan Palmer
comment
1
CPAP works but with a compliance rate of only 45%, in a research setting, perhaps the devil is in the detail as regards practicality!
Liao P, Luo Q, Elsaid H et al. Perioperative Auto-titrated Continuous Positive Airway Pressure Treatment in Surgical Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Anesthesiology. 2013 Oct 1;119(4):837-47.
  Allan Palmer
comment
1
The interaction has been well described in the lab and this study shows a small difference in children.
Ramirez L, Cros J, Marin B et al. Analgesic interaction between ondansetron and acetaminophen after tonsillectomy in children: The Paratron randomized, controlled trial. Eur J Pain. 2015 May 1;19(5):661-8.
  David Belavy