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pearl
1
Intraoperative hypotension is associated with postoperative kidney injury after non cardiac surgery.
Sun LY, Wijeysundera DN, Tait GA et al. Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery. Anesthesiology. 2015 Sep 1;123(3):515-23.
  Daniel Jolley
comment
0
I find this study a little perplexing:
1. A 40 IU oxytocin infusion over 30 minutes is uncommon practice in Australia. (This strikes me as a study used to disprove strange local obstetric dogma!)
2. Investigating the benefits of a 5 IU bolus in addition to this is hardly likely to produce a significant effect, given this essentially compares 45 IU to 40 IU over ~35 minutes.
40 IU over 30 minutes is an infusion with 'bolus-like' characteristics! 1.7 IU per minute!
King KJ, Douglas MJ, Unger W et al. Five unit bolus oxytocin at cesarean delivery in women at risk of atony: a randomized, double-blind, controlled trial. Anesth. Analg. 2010 Dec 1;111(6):1460-6.
  Daniel Jolley
pearl
2
Labouring women already exposed to oxytocin require a higher dose of oxytocin after cesarean section than non-labouring women to achieve the same uterotonic effect.
Lavoie A, McCarthy RJ, Wong CA. The ED90 of Prophylactic Oxytocin Infusion After Delivery of the Placenta During Cesarean Delivery in Laboring Compared with Nonlaboring Women: An Up-Down Sequential Allocation Dose-Response Study. Anesth. Analg. 2015 Jul 1; 121 (1): 159-164.
  Daniel Jolley
pearl
1
The incidence of post-operative nausea and vomiting is about 30% lower following xenon anesthesia compared with traditional volatile anesthesia.
Schaefer MS, Apfel CC, Sachs HJ et al. Predictors for postoperative nausea and vomiting after xenon-based anaesthesia. Br J Anaesth. 2015 Jul 1;115(1):61-7.
  Daniel Jolley
pearl
1
Elective surgery can itself precipitate post-traumatic stress disorder even in the absence of intra-operative awareness.
Whitlock EL, Rodebaugh TL, Hassett AL et al. Psychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials. Anesth. Analg. 2015 Jan 1; 120 (1): 87-95.
  Daniel Jolley
comment
1
Excellent review article on interactions between Regional anaesthesia and the newer oral anticoagulants
Benzon HT, Avram MJ, Green D et al. New oral anticoagulants and regional anaesthesia. Br J Anaesth. 2013 Dec 1;111 Suppl 1:i96-113.
  Allan Palmer
pearl
1
Perioperative lignocaine infusion reduces postoperative pain and nausea, and may improve GIT function and speed hospital discharge.
Kranke P, Jokinen J, Pace NL et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Db Syst Rev. 2015 Jan 1 (7): CD009642.
  Daniel Jolley
comment
1
"Xenopus is a genus of highly aquatic frogs native to sub-Saharan Africa. Twenty species are in the Xenopus genus" – interesting animal to use really.
Okura D, Horishita T, Ueno S et al. Lidocaine Preferentially Inhibits the Function of Purinergic P2X7 Receptors Expressed in Xenopus Oocytes. Anesth. Analg. 2015 Mar 1; 120 (3): 597-605.
  pdg.50
pearl
1
BIS monitoring significantly reduces the risk of awareness under general anesthesia in high-risk adult surgical patients.
Myles PS, Leslie K, McNeil J et al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004 May 29;363(9423):1757-63.
  Daniel Jolley
comment
1
Caveat - the Cochrane review noted low level evidence for changes in length of hospital stay or reduced complications, 2' to poor blinding in some studies. Safe as fasting though.
Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol. 2015 Jun 1;28(3):364-9.
  pdg.50