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pearl
1
Spinal chloroprocaine may be more suitable for day-case surgery than lignocaine because of faster block resolution and time to discharge.
Breebaart MB, Teune A, Sermeus LA et al. Intrathecal chloroprocaine vs. lidocaine in day-case surgery: recovery, discharge and effect of pre-hydration on micturition. Acta Anaesthesiol Scand. 2014 Feb 1;58(2):206-13.
  Daniel Jolley
comment
0
The results of the trial should only be considered 'hypothesis forming' rather than practice changing, due to the:
• Small number of subjects in each arm.
• Non-randomised, observational nature of the trial.
• Difficulty generalising these findings to those from different cultural backgrounds.
Ding T, Wang DX, Qu Y et al. Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study. Anesth. Analg. 2014 Aug 1;119(2):383-92.
  Daniel Jolley
summary
1
Women who received epidural analgesia during labour had a lower risk of post-natal depression at 6 weeks (OR 0.30), similar to the lowered risk in those who attended childbirth classes (OR 0.30).
Ding T, Wang DX, Qu Y et al. Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study. Anesth. Analg. 2014 Aug 1;119(2):383-92.
  Daniel Jolley
pearl
1
Labour epidural analgesia may be associated with a lower incidence of post-natal depression.
Ding T, Wang DX, Qu Y et al. Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study. Anesth. Analg. 2014 Aug 1;119(2):383-92.
  Daniel Jolley
summary
1
Although improving, 'harms reporting' in analgesic clinical trials is generally poor. On average the 101 studied analgesic trials met only 60% of harms reporting recommendations.
Smith SM, Daniel R, Pereira A et al. Adherence to CONSORT harms-reporting recommendations in publications of recent analgesic clinical trials: an ACTTION systematic review. Pain. 2012 Dec 1;153(12):2415-21.
  Daniel Jolley
summary
1
Sedation with TCI remifentanil targeting effect site concentration of 3 ng/mL resulted in detectable aspiration in almost 50% of the study participants after 1 hour.
Savilampi J, Ahlstrand R, Magnuson A et al. Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers. Anesthesiology. 2014 Jul 1;121(1):52-8.
  Daniel Jolley
pearl
1
Monitoring depth of anaesthesia in those over 60 yo decreases the incidence of post-operative delirium, though not post-operative cognitive decline.
Radtke FM, Franck M, Lendner J et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013 Jun 1; 110 Suppl 1: i98-105.
  Daniel Jolley
pearl
1
While single-injection supraclavicular nerve block is faster to perform, triple-injection has faster onset and greater block success at 20 minutes.
Arab SA, Alharbi MK, Nada EM et al. Ultrasound-Guided Supraclavicular Brachial Plexus Block: Single Versus Triple Injection Technique for Upper Limb Arteriovenous Access Surgery. Anesth. Analg. 2014 May 1;118(5):1120-5.
  Daniel Jolley
pearl
1
Available evidence does not support the claim that nitrous oxide affects mortality or cardiovascular morbidity.
Imberger G, Orr A, Thorlund K et al. Does anaesthesia with nitrous oxide affect mortality or cardiovascular morbidity? A systematic review with meta-analysis and trial sequential analysis. Br J Anaesth. 2014 Mar 1;112(3):410-26.
  Daniel Jolley
comment
1
Interesting to note that not only did the pudendal nerve block group experience better analgesia than the caudal block group, they were also exposed to a much smaller absolute dose of bupivacaine (0.75 mg/kg vs 2.5 mg/kg). This is important not only because of the safety implications, but also because allows extra LA for top-up if the block is inadequate or fails.
Naja ZM, Ziade FM, Kamel R et al. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth. Analg. 2013 Dec 1;117(6):1401-7.
  Daniel Jolley