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pearl
1
Following inadvertent dural puncture, insertion of an intrathecal catheter can provide both excellent labour analgesia and be used if necessary for caesarean section, however IT catheters carry risks and complexities that anaesthetists must be aware of.
Griffiths SK, Russell R, Broom MA et al. Intrathecal catheter placement after inadvertent dural puncture in the obstetric population: management for labour and operative delivery. Guidelines from the Obstetric Anaesthetists' Association. Anaesthesia. 2024 Dec 1; 79 (12): 134813681348-1368.
  Daniel Jolley
pearl
1
A significant proportion of patients experience recallable dreams during anaesthesia, apparently higher with propofol induction & maintenance, and when pre-induction psychological suggestion is used.
Gyulaházi J, Varga K, Iglói E et al. The effect of preoperative suggestions on perioperative dreams and dream recalls after administration of different general anesthetic combinations: a randomized trial in maxillofacial surgery. BMC Anesthesiol. 2015 Jan 1; 15 (1): 1111.
  Daniel Jolley
pearl
1
The economic burden of long COVID in Australia during 2022 was $1.7 billion to $6.3 billion representing 0.07%-0.26% of GDP.
Angeles MR, TTN Dinh, Zhao T et al. The economic burden of long COVID in Australia: more noise than signal? Med. J. Aust. 2024 Nov 4; 221 Suppl 9: S31S39S31-S39.
  Daniel Jolley
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