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pearl
1
Use of succinylcholine is associated with an increased risk of post-operative respiratory complications in a dose-dependent manner.
Schaefer MS, Hammer M, Santer P et al. Succinylcholine and postoperative pulmonary complications: a retrospective cohort study using registry data from two hospital networks. Br J Anaesth. 2020 Oct 1; 125 (4): 629-636.
  Daniel Jolley
pearl
1
Significant CO₂ accumulation occurs during apneic oxygenation with high-flow nasal oxygen, potentially limiting safety during prolonged apnea.
AWG Booth, Vidhani K, Lee PK et al. The Effect of High-Flow Nasal Oxygen on Carbon Dioxide Accumulation in Apneic or Spontaneously Breathing Adults During Airway Surgery: A Randomized-Controlled Trial. Anesth. Analg. 2021 Jul 1; 133 (1): 133-141.
  Daniel Jolley
pearl
1
Although liberal clear-fluid fasting is likely safe for children, similar evidence is still lacking to confirm safety in adults.
Friedrich S, Meybohm P, Kranke P. Nulla Per Os (NPO) guidelines: time to revisit? Curr Opin Anaesthesiol. 2020 Dec 1; 33 (6): 740-745.
  Daniel Jolley
pearl
1
Although epidural analgesia results in a small improvement in acute post-abdominal surgery pain compared to transversus abdominis plane block, the magnitude is small and associated with post-op hypotension.
Desai N, El-Boghdadly K, Albrecht E. Epidural vs. transversus abdominis plane block for abdominal surgery - a systematic review, meta-analysis and trial sequential analysis. Anaesthesia. 2021 Jan 1; 76 (1): 101-117.
  Daniel Jolley
summary
1
Take-away message
• Analgesia post-caesarean section (CS) is of global importance, as both the most frequently performed surgical procedure, and one that is commonly associated with significant pain, impacting maternal experience.
• Fascial blocks, such as the transversus abdominis plane (TAP) and quadratus lumborum block (QLB), have been advocated for use in reducing post-CS pain. This network meta-analysis confirms the equivalent benefit of either block in improving post-operative pain in the absence of using intrathecal morphine.
• Although the QLB is advocated for its potential to reduce both somatic and visceral pain, unlike the TAP block, comparing studies investigating either block did not reveal any significant benefit of TAP over QLB.
• No analgesic benefit was found for either when intrathecal morphine is used (although TAP block may be associated with lower incidence of nausea, vomiting & sedation, in the presence of IT morphine).
• As is common to many meta-analyses, these conclusions are somewhat undermined by the moderate-to-low levels of evidence in the included studies.
El-Boghdadly K, Desai N, Halpern S et al. Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis. Anaesthesia. 2021 Mar 1; 76 (3): 393-403.
  Daniel Jolley
pearl
1
Transversus abdominis plane & quadratus lumborum block both offer equivalent analgesia benefit following caesarean section in the absence of intrathecal morphine, although little or know benefit if intrathecal morphine is used.
El-Boghdadly K, Desai N, Halpern S et al. Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis. Anaesthesia. 2021 Mar 1; 76 (3): 393-403.
  Daniel Jolley
pearl
1
Quadratus lumborum block modestly reduces post-operative pain after caesarean section when intrathecal morphine is not used.
Hussain N, Brull R, Weaver T et al. Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia. Anesthesiology. 2021 Jan 1; 134 (1): 72-87.
  Daniel Jolley
pearl
1
Intraoperative anaesthesia handovers increase the risk of adverse outcomes by 40%.
Boet S, Djokhdem H, Leir SA et al. Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis. Br J Anaesth. 2020 Oct 1; 125 (4): 605-613.
  Daniel Jolley
pearl
1
Deep neuromuscular block does not improve surgical conditions for laparoscopic renal surgery.
GHM Honing, Martini CH, Olofsen E et al. Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery. Br J Anaesth. 2021 Feb 1; 126 (2): 377-385.
  Daniel Jolley
pearl
1
A small QTc prolongation seen with carbetocin is unlikely to be clinically significant.
Clunies-Ross N, Roston TM, Taylor J et al. The Effect of Carbetocin Dose on Transmural Dispersion of Myocardial Repolarization in Healthy Parturients Scheduled for Elective Cesarean Delivery Under Spinal Anesthesia: A Prospective, Randomized Clinical Trial. Anesth. Analg. 2021 Feb 1; 132 (2): 485492485-492.
  Daniel Jolley