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1
This historical landmark paper demonstrated the terribly-higher maternal mortality during cesarean section performed under general anesthesia vs regional anesthesia in the United States from 1979-1990.
This resulted in the oft-quoted statistic of being '...17 times more likely to die under a GA cesarean section than epidural or spinal.'
It is very important to note that this is a historical article and that the demonstrated very high mortality was greatly contributed to by a culture tolerating inexperienced anesthesia residents performing GA CS after-hours with limited senior support.
Hawkins followed up this study with another in 2011: Anesthesia-related maternal mortality in the United States: 1979-2002. This reassuringly showed a much improved GA CS maternal mortality from 1997-2002 (although still higher than regional CS).
The important take-home from this paper is that a GA cesarean section increases the risk of serious airway events, and if this is not managed by experienced and appropriately trained anaesthetists/anesthesiologists, will result in maternal deaths.
Hawkins JL, Koonin LM, Palmer SK et al. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology. 1997 Feb 1;86(2):277-84.
  Daniel Jolley
pearl
1
Upper airway complications are no different with desflurane than for sevoflurane, isoflurane or propofol anesthesia when using an LMA.
Stevanovic A, Rossaint R, Fritz HG et al. Airway reactions and emergence times in general laryngeal mask airway anaesthesia: A meta-analysis. Eur J Anaesthesiol. 2015 Feb 1; 32 (2): 106-16.
  Daniel Jolley
pearl
1
In patients with atrial fibrillation requiring cessation of warfarin for surgery, bridging anticoagulation does not change the incidence of thromboembolism, although does increase major bleeding.
Douketis JD, Spyropoulos AC, Kaatz S et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N. Engl. J. Med. 2015 Aug 27;373(9):823-33.
  Daniel Jolley
summary
1
This review of five trials investigating the efficacy of mechanical CPR devices (the LUCAS & AutoPulse) concluded that the devices demonstrate no outcome advantage compared with manual CPR, in terms of 30 day survival, survival to discharge, or neurological outcome.
Gates S, Quinn T, Deakin CD et al. Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. Resuscitation. 2015 Sep 1; 94: 91-7.
  Daniel Jolley
summary
2
This controlled study randomised 212 children to either deep plane-of-anesthesia or awake, and either supine or lateral position, for removal of their laryngeal mask at the completion of surgery.
"Deep anesthesia" was defined as ET-sevoflurane 2.2%, stable for 1 minute. The "awake" group had their LMA removed by the PACU nurse after eye opening and/or obeying commands.
Airway complications included desaturation < 90%, stridor, laryngospasm, retching/vomiting, excess secretions and biting. A secondary outcome was also studied, assigning a 'clinical significance score' to the range of complications.
Deep removal in the lateral position was associated with the fewest complications. Deep removal when supine was associated with the most complications.
This study was a follow-up to a two-centre observational audit from 2008.
Thomas-Kattappurathu G, Kasisomayajula A, Short J. Best position and depth of anaesthesia for laryngeal mask airway removal in children: A prospective randomised controlled trial. Eur J Anaesthesiol. 2015 Sep 1; 32 (9): 624-30.
  Daniel Jolley
pearl
2
The fewest airway complications occur when a pediatric LMA is removed deep and in the lateral position.
Thomas-Kattappurathu G, Kasisomayajula A, Short J. Best position and depth of anaesthesia for laryngeal mask airway removal in children: A prospective randomised controlled trial. Eur J Anaesthesiol. 2015 Sep 1; 32 (9): 624-30.
  Daniel Jolley
pearl
1
Intrapartum fetal ECG monitoring and ST-segment analysis does not lead to better fetal or delivery outcomes compared with standard FHR and CTG monitoring.
Belfort MA, Saade GR, Thom E et al. A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis. N. Engl. J. Med. 2015 Aug 13; 373 (7): 632641632-41.
  Daniel Jolley
pearl
1
Regional anesthesia and analgesia confers no oncological-outcome benefit compared with general anesthesia for radical prostatectomy.
Sprung J, Scavonetto F, Yeng T et al. Outcomes After Radical Prostatectomy for Cancer: A Comparison Between General Anesthesia and Epidural Anesthesia with Fentanyl Analgesia: A Matched Cohort Study. Anesth. Analg. 2014 Oct 1;119(4):859-66.
  Daniel Jolley
pearl
1
Methods used to assess the height of spinal block before caesarean section vary widely across literature, textbooks and individual anaesthesia practice.
Hoyle J Yentis SM. Assessing the height of block for caesarean section over the past three decades: trends from the literature. Anaesthesia. 2015 Apr 1;70(4):421-8.
  Daniel Jolley
pearl
1
PCEA with a continuous background is associated with longer second stage and greater instrumented delivery than PCEA without a background.
Heesen M, Böhmer J, Klöhr S et al. The Effect of Adding a Background Infusion to Patient-Controlled Epidural Labor Analgesia on Labor, Maternal, and Neonatal Outcomes: A Systematic Review and Meta-Analysis. Anesth. Analg. 2015 Jul 1; 121 (1): 149-158.
  David Belavy