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1
The role of suggestibility just never goes away yet seems rarely considered in our hospital processes. Why has nursing as a science ignored this?
Kekecs Z, Nagy T, Varga K. The Effectiveness of Suggestive Techniques in Reducing Postoperative Side Effects: A Meta-Analysis of Randomized Controlled Trials. Anesth. Analg. 2014 Dec 1;119(6):1407-19.
  Allan Palmer
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1
All of these non-invasive monitors have inate variability but if you can see past that they do seem to add value to patient care.
Waldron NH, Miller TE, Thacker JK et al. A Prospective Comparison of a Noninvasive Cardiac Output Monitor Versus Esophageal Doppler Monitor for Goal-Directed Fluid Therapy in Colorectal Surgery Patients. Anesth. Analg. 2014 May 1;118(5):966-75.
  Allan Palmer
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1
Nice summary, seems like common sense with very useful number needed to harm data, though from personal experience surprising the NNH for itching was lower for Fentanyl than Morpine
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Allan Palmer
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1
In the publicly available version no mention of risks. Locally this technique was popular a while ago but abandonded after a few total spinals and such
Choi S, Rampersaud YR, Chan VW et al. The addition of epidural local anesthetic to systemic multimodal analgesia following lumbar spinal fusion: a randomized controlled trial. Can J Anaesth. 2014 Apr 1;61(4):330-9.
  Allan Palmer
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1
So if you use Nitrous oxide the patient will be more deeply asleep than monitors like the BIS will indicate. I can live with that.
Foster BL Liley DT. Nitrous oxide paradoxically modulates slow electroencephalogram oscillations: implications for anesthesia monitoring. Anesth. Analg. 2011 Oct 1;113(4):758-65.
  Allan Palmer
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1
CPAP works but with a compliance rate of only 45%, in a research setting, perhaps the devil is in the detail as regards practicality!
Liao P, Luo Q, Elsaid H et al. Perioperative Auto-titrated Continuous Positive Airway Pressure Treatment in Surgical Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Anesthesiology. 2013 Oct 1;119(4):837-47.
  Allan Palmer
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1
The interaction has been well described in the lab and this study shows a small difference in children.
Ramirez L, Cros J, Marin B et al. Analgesic interaction between ondansetron and acetaminophen after tonsillectomy in children: The Paratron randomized, controlled trial. Eur J Pain. 2015 May 1;19(5):661-8.
  David Belavy
pearl
0
After total knee joint replacement, surgical infiltration with local anaesthesia gives better analgesia with fewer side effects than intrathecal morphine.
Essving P, Axelsson K, Åberg E et al. Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth. Analg. 2011 Oct 1;113(4):926-33.
  Allan Palmer
summary
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Intermittent epidural bolus when compared with continuous epidural infusion for labour analgesia results in slightly reduced local anaesthetic use and a small improvement in maternal satisfaction. Caesarean section and instrumental delivery rates were not significantly statistically different.
George RB, Allen TK, Habib AS. Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesth. Analg. 2013 Jan 1; 116 (1): 133-44.
  Daniel Jolley
pearl
2
The use of a cognitive aid improves the performance of non-technical skills during simulated 'can't intubate, can't oxygenate' crisis.
Marshall SD Mehra R. The effects of a displayed cognitive aid on non-technical skills in a simulated 'can't intubate, can't oxygenate' crisis. Anaesthesia. 2014 Jul 1;69(7):669-77.
  Daniel Jolley