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Delirium in critically ill patients is associated with increased mortality, longer stays and post-discharge cognitive effects.
Salluh JI, Wang H, Schneider EB et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jan 1;350:h2538.
  Daniel Jolley
pearl
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Local anaesthetic wound infiltration for breast surgery has only modest effects on early post-surgical pain.
Byager N, Hansen MS, Mathiesen O et al. The analgesic effect of wound infiltration with local anaesthetics after breast surgery: a qualitative systematic review. Acta Anaesthesiol Scand. 2014 Apr 1; 58 (4): 402-10.
  Daniel Jolley
summary
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This prospective observational study across eight Canadian hospitals identified post-operative residual paralysis in 64% of patients at extubation and 57% on arrival in the PACU, despite more than 70% of patients receiving reversal with neostigmine.
Rocuronium was the muscle relaxant used in 99% of cases.
Fortier LP, McKeen D, Turner K et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth. Analg. 2015 Aug 1; 121 (2): 366-72.
  Daniel Jolley
pearl
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Postoperative residual neuromuscular blockade continues to be common and is experienced by the majority of patients receiving muscle relaxants.
Fortier LP, McKeen D, Turner K et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth. Analg. 2015 Aug 1; 121 (2): 366-72.
  Daniel Jolley
summary
1
This retrospective propensity-matched cohort study, used 5 years of data to study 2,644 matched pairs-of-patients with a preoperative diagnosis of severe COPD.
Important exclusions were patients already ventilated, already with pulmonary infections, along with cardiac, emergency & transplant surgery, and those receiving repeat surgery within 30 days.
Receiving general anesthesia was associated with a 43% higher risk of respiratory infection (3.3% vs 2.3%, P = 0.0384), 133% greater risk of prolonged ventilation (2.1% vs 0.9%, P = 0.0008) and 44% greater risk of unplanned post-op intubation (2.6% vs 1.8%, P = 0.0487), when compared with regional anesthesia.
Nonetheless there was no significant mortality difference at 30 days (3.0% vs 2.7%, P = 0.6788).
The mix of regional techniques was 341 epidural, 1713 spinal, and 590 peripheral blocks. Notably, sub-group analysis of epidural-patients showed no difference in pulmonary complications or composite morbidity between epidural and general anesthesia. (Though given relatively small number of epidural patients, this might reflect a lack of power).
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Daniel Jolley
pearl
1
In patients with chronic obstructive pulmonary disease, use of regional anesthesia is associated with less post-operative morbidity, though not mortality, when compared with general anesthesia.
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Daniel Jolley
pearl
1
Negative post-anesthetic cognitive effects are still present one week after both desflurane or propofol anesthesia.
Lindqvist M, Schening A, Granstrom A et al. Cognitive recovery after ambulatory anaesthesia based on desflurane or propofol: a prospective randomised study. Acta Anaesthesiol Scand. 2014 Oct 1;58(9):1111-20.
  Daniel Jolley
summary
1
This retrospective audit identified an association between the introduction of unrestricted access to sugammadex and a fall in 'anaesthetic theatre time'. Mean hospital stay was also observed to be 0.8 days shorter after introduction of sugammadex, but was not statistically significant after adjusting for confounders.
Watts RW, London JA, van RM et al. The influence of unrestricted use of sugammadex on clinical anaesthetic practice in a tertiary teaching hospital. Anaesth Intensive Care. 2012 Mar 1;40(2):333-9.
  Daniel Jolley
pearl
1
Unrestricted access to sugammadex both increases the use of sugammadex and changes patterns of muscle relaxant drug choice by anaesthetists.
Watts RW, London JA, van RM et al. The influence of unrestricted use of sugammadex on clinical anaesthetic practice in a tertiary teaching hospital. Anaesth Intensive Care. 2012 Mar 1;40(2):333-9.
  Daniel Jolley
summary
1
Ledowski et al. investigated the effect of unrestricted access to sugammadex in an Australian teaching hospital with a retrospective observational audit.
Use of both sugammadex and amino steroid relaxants increased dramatically, with average reversal costs per case increasing by AUS$85.
Although there was no change in anaesthesia, surgical or PACU time, there was a statistically significant decrease in median time from surgery to hospital discharge (0.2 days shorter) after introduction of sugammadex. Do to the nature of the study, it is nevertheless impossible to infer a causal link.
Ledowski T, Hillyard S, Kozman A et al. Unrestricted access to sugammadex: impact on neuromuscular blocking agent choice, reversal practice and associated healthcare costs. Anaesth Intensive Care. 2012 Mar 1;40(2):340-3.
  Daniel Jolley