Article Notes

• Hide
  • Pearls
  • Summaries
  • Comments

summary
1
Fink & Hollman describe and refute several commonly-held myths regarding neuromuscular pharmacology. Their evidence-supported arguments are:
1. Intubating patients without muscle relaxants is less safe and sub-optimal.
2. Even if you know muscle relaxant pharmacokinetics, it is sufficiently unpredictable that neuromuscular monitoring and reversal is still necessary.
3. Post-operative residual curarization (PORC) is clinically significant with real consequences.
4. Postoperative residual curarization (PORC) is common.
5. Postoperative residual curarisation (PORC) (TOFR < 0.9) can only be diagnosed with a quantitative neuromuscular monitor. Clinical tests are insufficient and poorly sensitive.
Fink H Hollmann MW. Myths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade. Minerva Anestesiol. 2012 Apr 1;78(4):473-82.
  Daniel Jolley
pearl
1
Use of the LMA ProSeal when compared with intubation for gynae-laparoscopy does not decrease post-operative pain or PONV.
Griffiths JD, Nguyen M, Lau H et al. A prospective randomised comparison of the LMA ProSeal™ versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy. Anaesth Intensive Care. 2013 Jan 1;41(1):46-50.
  Daniel Jolley
summary
1
Perioperative lidocaine (1.5 mg/kg bolus then 1.5 mg/kg/h until 1 h after skin closure) reduces the incidence of persistent post-surgical pain after breast cancer surgery at 3 months.
Grigoras A, Lee P, Sattar F et al. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery. Clin J Pain. 2012 Sep 1;28(7):567-72.
  Daniel Jolley
pearl
0
Perioperative lidocaine reduces the incidence of persistent post-surgical pain after breast cancer surgery.
Grigoras A, Lee P, Sattar F et al. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery. Clin J Pain. 2012 Sep 1;28(7):567-72.
  Daniel Jolley
summary
1
Excellent anaesthetists were identified by anaesthesia nurses as being:
1. Organised & focused: structured, responsible, and focused approach to work tasks.
2. Good communicators: clear and informative, briefing of team about the plan before induction.
3. Respectful of complexity: humble to the complexity of anaesthesia, admitting own fallibility.
4. Patient-centred: personal contact with the patient before induction.
5. Good situational awareness: fluent in practical work without losing overview.
6. Calm and clear in critical situations, being able to change to a strong leading style.
Larsson J Holmström IK. How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills. Br J Anaesth. 2013 Jan 1; 110 (1): 115121115-21.
  Daniel Jolley
pearl
1
Non-technical skills are of equal importance to technical anaesthesia skills, but are more challenging to define, measure and acquire.
Larsson J Holmström IK. How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills. Br J Anaesth. 2013 Jan 1; 110 (1): 115121115-21.
  Daniel Jolley
pearl
1
Meta-analysis suggests regional scalp block may reduce post-operative pain after craniotomy, although relies on small, low-quality studies.
Guilfoyle MR, Helmy A, Duane D et al. Regional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis. Anesth. Analg. 2013 May 1; 116 (5): 1093-1102.
  Daniel Jolley
pearl
1
30mg intraperitoneal nebulized ropivacaine significantly reduces pain after laparoscopic cholecystectomy, reducing opioid use and speeding ambulation.
Ingelmo PM, Bucciero M, Somaini M et al. Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy: a double-blind, randomized, placebo-controlled trial. Br J Anaesth. 2013 May 1;110(5):800-6.
  Daniel Jolley
pearl
1
Implementation of a Surgical Safety Checklist had a positive, though small, impact on the theatre safety culture in a Norwegian university hospital.
Haugen AS, Søfteland E, Eide GE et al. Impact of the World Health Organization's Surgical Safety Checklist on safety culture in the operating theatre: a controlled intervention study. Br J Anaesth. 2013 May 1;110(5):807-15.
  Daniel Jolley
pearl
1
Renal impairment as indicated by low eGFR is associated with early post-operative mortality, particularly following cardiac or vascular surgery.
Mooney JF, Ranasinghe I, Chow CK et al. Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis. Anesthesiology. 2013 Apr 1;118(4):809-24.
  Daniel Jolley