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pearl
1
Propofol 1 mg/kg reduces emergence delirium in children, without increasing nausea, vomiting or length of PACU stay, unlike fentanyl 1 mcg/kg.
Kim MS, Moon BE, Kim H et al. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth. 2013 Feb 1;110(2):274-80.
  Daniel Jolley
summary
1
Four-quadrant transversus abdominis plane block with bilateral posterior TAP catheters for 48 hours provides analgesia equivalent to epidural analgesia in patients having laparoscopic colorectal surgery.
Niraj G, Kelkar A, Hart E et al. Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial. Anaesthesia. 2014 Apr 1;69(4):348-55.
  Daniel Jolley
summary
1
Studies assessing the efficacy and safety of nitrous oxide analgesia during labour are generally of poor quality making it difficult to make any conclusions about this intervention.
Likis FE, Andrews JC, Collins MR et al. Nitrous oxide for the management of labor pain: a systematic review. Anesth. Analg. 2014 Jan 1; 118 (1): 153-67.
  Daniel Jolley
summary
1
The SLIP-2 score (Surgical Lung Injury Prediction) was found to offer acceptable accuracy in predicting the risk of post-operative ARDS in high-risk surgical patients (ROC 0.84).
Kor DJ, Lingineni RK, Gajic O et al. Predicting Risk of Postoperative Lung Injury in High-risk Surgical Patients: A Multicenter Cohort Study. Anesthesiology. 2014 May 1; 120 (5): 1168-81.
  Daniel Jolley
summary
1
This small study (N=60) found no significant clinical difference between bolus phenylephrine and phenylephrine infusion when used to maintain maternal blood pressure during caesarean section conducted under spinal anaesthesia.
Doherty A, Ohashi Y, Downey K et al. Phenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia: a double-blind randomized clinical trial to assess hemodynamic changes. Anesth. Analg. 2012 Dec 1;115(6):1343-50.
  Daniel Jolley
pearl
1
The 'Assess Respiratory Risk in Surgical Patients in Catalonia' risk score can predict post-operative pulmonary complications with adequate utility.
Mazo V, Sabaté S, Canet J et al. Prospective External Validation of a Predictive Score for Postoperative Pulmonary Complications. Anesthesiology. 2014 Aug 1;121(2):219-31.
  Daniel Jolley
pearl
1
Transversus abdominis plane block does not improve post-caesarean analgesia in women receiving regional anaesthesia with intrathecal morphine.
McKeen DM, George RB, Boyd JC et al. Transversus abdominis plane block does not improve early or late pain outcomes after Cesarean delivery: a randomized controlled trial. Can J Anaesth. 2014 Jul 1;61(7):631-40.
  Daniel Jolley
summary
1
This large, retrospective observational study found that neuraxial anaesthesia was associated with a significantly lower risk of both pneumonia (OR 0.51) and composite systemic infection (OR 0.77) than general anaesthesia in patients undergoing knee arthroplasty.
Liu J, Ma C, Elkassabany N et al. Neuraxial Anesthesia Decreases Postoperative Systemic Infection Risk Compared with General Anesthesia in Knee Arthroplasty. Anesth. Analg. 2013 Oct 1;117(4):1010-6.
  Daniel Jolley
comment
0
This analysis is not practice-changing, but instead highlights our continued lack of understanding of the outcome benefit (or not) of neuraxial versus general anaesthesia in high risk patient groups.
Interestingly, it is also a meta-analysis of meta-analyses, demonstrating that there are limits to the answers that re-analysing existing data may provide.
Guay J, Choi PT, Suresh S et al. Neuraxial Anesthesia for the Prevention of Postoperative Mortality and Major Morbidity: An Overview of Cochrane Systematic Reviews. Anesth. Analg. 2014 Sep 1;119(3):716-25.
  Daniel Jolley
pearl
1
Neuraxial anaesthesia when compared with general anaesthesia may reduce 30 day mortality in patients with intermediate-to-high cardiac risk.
Guay J, Choi PT, Suresh S et al. Neuraxial Anesthesia for the Prevention of Postoperative Mortality and Major Morbidity: An Overview of Cochrane Systematic Reviews. Anesth. Analg. 2014 Sep 1;119(3):716-25.
  Daniel Jolley