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summary
1
Why should I care?
Misuse of opioids is a growing global problem, well established in the US and quickly appearing in many high-resource countries. One person dies every 15 minutes in the US from opioid overdose.
For many affected, the perioperative period is the first exposure event. In the US ~6% of previously opioid-naive patients progress to persistent opioid use after surgery.
What can anaesthetists and anesthesiologists do?
1. Identify patients at risk of opioid dependence.
2. Use multi-modal non-opioid analgesia perioperatively.
3. Educate patients on realistic expectations for post-operative pain.
4. Consider regional techniques intraoperatively when appropriate.
5. Limit discharge prescribing of opioids (42-71% of all postop opioid tablets go unused!).
The bigger picture...
Although inidividual practice changes are important, real impact will come through anesthesiologists as integrators of care (eg. ERAS interventions) and contributions to institutional strategies, patient and provider education.
Take a long view, this problem is not going away in a hurry...
Soffin EM, Lee BH, Kumar KK et al. The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse. Br J Anaesth. 2019 Jun 1; 122 (6): e198e208e198-e208.
  Daniel Jolley
pearl
1
Chewing gum for one hour does not change gastric fluid volume.
Valencia JA, Cubillos J, Romero D et al. Chewing gum for 1 h does not change gastric volume in healthy fasting subjects. A prospective observational study. J Clin Anesth. 2019 Sep 1; 56: 100-105.
  Daniel Jolley
pearl
0
Pre-operative single-shot paravertebral blocks reduce post-operative pain for up to 24 hours after nephrectomy.
Collection: Paravertebral block for post-operative nephrectomy analgesia
  Daniel Jolley
pearl
1
Continuous paravertebral block is an effective alternative to thoracic epidural for managing post-operative pain after open nephrectomy, with a better side-effect profile.
Collection: Paravertebral block for post-operative nephrectomy analgesia
  Daniel Jolley
summary
1
Collection: What are Calabadions? Can they replace sugammadex?
Calabadions are heterocyclics molecule that offers rapid and complete reversal of both aminosteroids, such as rocuronium and vecuronium, and benzylisoquinoline NMBDS, such as atracurium and cisatracurium.
Notably, calabadion 2 binds rocuronium 89 times stronger than sugammadex. Additionally it also binds etomidate and ketamine.
Calabadions are still undergoing pre-human animal testing, and so are some time away from entering clinical practice.
  Daniel Jolley
pearl
1
A higher rate of hospital neuraxial labor analgesia is associated with a lower rate of unnecessary general anesthetic cesarean section.
Guglielminotti J, Landau R, Li G. Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries. Anesthesiology. 2019 Jun 1; 130 (6): 912922912-922.
  Daniel Jolley
pearl
1
Articulating positive expectations of analgesia efficacy preoperatively improves postoperative pain scores and analgesia satisfaction.
Benson S, Hagen S, Hoffmann O et al. Can a brief psychological expectancy intervention improve postoperative pain? A randomized, controlled trial in patients with breast cancer. Pain. 2019 Jul 1; 160 (7): 1562-1571.
  Daniel Jolley
pearl
1
Checklists for managing crises during cesarean section are practical to implement in low and middle-income countries, and significantly improve task completion in simulated emergencies.
Alexander LA, Newton MW, McEvoy KG et al. Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa. Anesth. Analg. 2019 May 1; 128 (5): 993-998.
  Daniel Jolley
pearl
1
Although routine videolaryngoscopy does not improve overall success rate of adult nasal intubation, it does improve first pass success, laryngeal visualization and shortens intubation time.
Jiang J, Ma DX, Li B et al. Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation: A systematic review and meta-analysis of randomised controlled trials. J Clin Anesth. 2019 Feb 1; 52: 6-16.
  Daniel Jolley
pearl
1
Neuraxial anesthesia is associated with lower rates of perioperative transfusion in patients undergoing bilateral total hip replacement when compared to general anesthesia, although not significantly with other post-operative outcomes.
Burton BN, Padwal JA, Swisher MW et al. Postoperative outcomes with neuraxial versus general anesthesia in bilateral total hip arthroplasty. J Clin Anesth. 2019 Feb 1; 52: 71-75.
  Daniel Jolley