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pearl
1
A higher rate of hospital neuraxial labor analgesia is associated with a lower rate of unnecessary general anesthetic cesarean section.
Guglielminotti J, Landau R, Li G. Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries. Anesthesiology. 2019 Jun 1; 130 (6): 912922912-922.
  Daniel Jolley
comment
0
We’re still doing too many unnecessary general anaesthetic cesarean sections. It is not enough to be confident that we can conduct a ‘safe’ GA CS (ie. misperceived as meaning a low mortality risk), when avoidable GA CS are still associated with a spectrum of morbidity.
Definitely falls into the category of ‘just because we can, doesn’t mean we should’...
Guglielminotti J, Landau R, Li G. Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries. Anesthesiology. 2019 Jun 1; 130 (6): 912922912-922.
  Daniel Jolley
pearl
1
Articulating positive expectations of analgesia efficacy preoperatively improves postoperative pain scores and analgesia satisfaction.
Benson S, Hagen S, Hoffmann O et al. Can a brief psychological expectancy intervention improve postoperative pain? A randomized, controlled trial in patients with breast cancer. Pain. 2019 Jul 1; 160 (7): 1562-1571.
  Daniel Jolley
pearl
1
Checklists for managing crises during cesarean section are practical to implement in low and middle-income countries, and significantly improve task completion in simulated emergencies.
Alexander LA, Newton MW, McEvoy KG et al. Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa. Anesth. Analg. 2019 May 1; 128 (5): 993-998.
  Daniel Jolley
pearl
1
Although routine videolaryngoscopy does not improve overall success rate of adult nasal intubation, it does improve first pass success, laryngeal visualization and shortens intubation time.
Jiang J, Ma DX, Li B et al. Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation: A systematic review and meta-analysis of randomised controlled trials. J Clin Anesth. 2019 Feb 1; 52: 6-16.
  Daniel Jolley
pearl
1
Neuraxial anesthesia is associated with lower rates of perioperative transfusion in patients undergoing bilateral total hip replacement when compared to general anesthesia, although not significantly with other post-operative outcomes.
Burton BN, Padwal JA, Swisher MW et al. Postoperative outcomes with neuraxial versus general anesthesia in bilateral total hip arthroplasty. J Clin Anesth. 2019 Feb 1; 52: 71-75.
  Daniel Jolley
pearl
1
Dexmedetomidine may reduce post-operative delirium and at one month post-operative cognitive decline in elderly patients, associated with changes in brain-derived neurotrophic factor.
Cheng XQ, Mei B, Zuo YM et al. A multicentre randomised controlled trial of the effect of intra-operative dexmedetomidine on cognitive decline after surgery. Anaesthesia. 2019 Jun 1; 74 (6): 741-750.
  Daniel Jolley
pearl
1
Children who are exposed to multiple general anaesthetics before age three demonstrate deficits on neurosphycological testing, although not children with a single exposure.
Zaccariello MJ, Frank RD, Lee M et al. Patterns of neuropsychological changes after general anaesthesia in young children: secondary analysis of the Mayo Anesthesia Safety in Kids study. Br J Anaesth. 2019 May 1; 122 (5): 671-681.
  Daniel Jolley
pearl
1
Maternal desaturation is common during remifentanil PCA analgesia for labour.
Messmer AA, Potts JM, Orlikowski CE. A prospective observational study of maternal oxygenation during remifentanil patient-controlled analgesia use in labour. Anaesthesia. 2016 Feb 1; 71 (2): 171-6.
  Daniel Jolley
pearl
1
In women receiving a remifentanil PCA for labour analgesia, detectable hypoxia occurs in 25% of women and neonatal CPR potentially related to remifentanil in 1 in 300 babies.
Melber AA, Jelting Y, Huber M et al. Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010-2015). Int J Obstet Anesth. 2019 Aug 1; 39: 12-21.
  Daniel Jolley