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pearl
1
Opioid-free anesthesia for laparoscopic abdominal surgery is associated with significant PONV reduction.
CAB da Silveira, ACD Rasador, HJS Medeiros et al. Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial sequential analysis. Can J Anaesth. 2024 Nov 1; 71 (11): 146614851466-1485.
  Daniel Jolley
pearl
1
SGLT-2 anti-hyperglycaemic drugs should be withheld 72 hours preoperatively to avoid the risk of euglycaemic ketoacidosis.
Stewart PA, Nestor CC, Clancy C et al. The peri-operative implications of sodium-glucose co-transporter 2 inhibitors: a narrative review. Anaesthesia. 2025 Jan 1; 80 (1): 859485-94.
  Daniel Jolley
comment
0
This is a bit of a crazy case: >9mg/kg of sugammadex used and there’s some surprise they couldn’t reestablish neuromuscular blockade after.
Sakai Y, Tsutsumi YM, Wakamatsu N et al. A case where rocuronium was unable to achieve neuromuscular block immediately after sugammadex administration. J. Med. Invest. 2011 Feb 1;58(1-2):163-5.
  Daniel Jolley
comment
1
Very interesting study out of Brisbane, revising previous estimates that suggested sugammadex hypersensitivity could be as high as 1 in 2,500. Crimmins et al. found in their data the incidence was 5-20 times less common (95% CI).
Crimmins D, Crilly H, van C et al. Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort. Br J Anaesth. 2025 Jan 1; 134 (1): 727972-79.
  Daniel Jolley
pearl
1
Sugammadex hypersensitivity is between 1 in 12,5000 and 1 in 50,000 perioperative exposures.
Crimmins D, Crilly H, van C et al. Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort. Br J Anaesth. 2025 Jan 1; 134 (1): 727972-79.
  Daniel Jolley
pearl
1
Neuraxial labour analgesia for vaginal delivery is associated with a significant reduction in the risk of severe maternal morbidity.
Guglielminotti J, Landau R, Daw J et al. Use of Labor Neuraxial Analgesia for Vaginal Delivery and Severe Maternal Morbidity. JAMA Netw Open. 2022 Feb 1; 5 (2): e220137.
  Daniel Jolley
pearl
1
Labour epidural analgesia is associated with a 35% reduction in severe maternal morbidity, and even greater in those preterm or with medical comorbidity.
Kearns RJ, Kyzayeva A, LOE Halliday et al. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ. 2024 May 22; 385: e077190e077190.
  Daniel Jolley
pearl
1
The pain of subcutaneous 1% lignocaine injection is significantly less than cannulation pain across all peripheral cannula sizes down to 22-gauge.
Langham BT Harrison DA. Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula? Anaesthesia. 1992 Oct 1;47(10):890-1.
  Daniel Jolley
pearl
1
Pain severity of local anaesthetic infiltration for spinal anaesthesia predicts post-caesarean pain.
Orbach-Zinger S, Aviram A, Fireman S et al. Severe pain during local infiltration for spinal anaesthesia predicts post-caesarean pain. Eur J Pain. 2015 Oct 1; 19 (9): 1382-8.
  Daniel Jolley
pearl
1
Patients with past depression or depressive-symptoms preoperatively have significantly greater risk of post-operative delirium (RR 1.91, 95% CI 1.68-2.17).
Diep C, Patel K, Petricca J et al. Incidence and relative risk of delirium after major surgery for patients with pre-operative depression: a systematic review and meta-analysis. Anaesthesia. 2024 Nov 1; 79 (11): 123712491237-1249.
  Daniel Jolley