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pearl
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As has been often said "With great power comes great responsibility"! - and social media use in healthcare is a prime example.
Steele S, Adcock C, Steel A. Ethical, legal and professional issues arising from social media coverage by UK Helicopter Emergency Medical Services. Emerg Med J. 2016 Jan 1; 33 (1): 57-60.
  Allan Palmer
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We are so used to using systemic high potency treatments it is sometimes easy to forget the simple stuff!
Ahmed SU, Zhang Y, Chen L et al. Effect of 1.5% Topical Diclofenac on Clinical Neuropathic Pain. Anesthesiology. 2015 Jul 1;123(1):191-8.
  Allan Palmer
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Given the relatively low propofol TCI target (NB: 50% wake @ 1.07 mcg/mL and 50% orientated @ 0.95 mcg/mL), even in the presence of remifentanil, I wonder whether this is more a case of unrecognized light anaesthesia than sugammadex waking someone up.
Case in point, the demonstrated effect of rocuronium on BIS in awake volunteers: Response of bispectral index to neuromuscular block in awake volunteers
Chazot T, Dumont G, Le M et al. Sugammadex administration results in arousal from intravenous anaesthesia: a clinical and electroencephalographic observation. Br J Anaesth. 2011 Jun 1;106(6):914-6.
  Daniel Jolley
pearl
1
Perimortem cesarean section is a heroic intervention that may be beneficial in maternal arrest, though is unlikely to do further harm.
Katz V, Balderston K, DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am. J. Obstet. Gynecol. 2005 Jun 1;192(6):1916-20; discussion 1920-1.
  Daniel Jolley
pearl
1
Anesthesia with nitrous oxide preserves awake features of the EEG leading to inappropriately higher BIS values.
Foster BL Liley DT. Nitrous oxide paradoxically modulates slow electroencephalogram oscillations: implications for anesthesia monitoring. Anesth. Analg. 2011 Oct 1;113(4):758-65.
  Daniel Jolley
pearl
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Propofol and thiopentone are physiochemically compatible when mixed.
Prankerd RJ Jones RD. Physicochemical compatibility of propofol with thiopental sodium. Am J Health Syst Pharm. 1996 Nov 1;53(21):2606-10.
  Daniel Jolley
pearl
1
Video-laryngoscopy in pediatric anesthesia improves glottis visualization but prolongs intubation time and increases failure.
Sun Y, Lu Y, Huang Y et al. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2014 Oct 1; 24 (10): 1056-65.
  Daniel Jolley
pearl
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The addition of ketamine to lignocaine-based IVRA (Bier's block) significantly improved analgesia and patient satisfaction without increasing side effects.
Abdel-Ghaffar HS, Kalefa MA, Imbaby AS. Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia. Reg Anesth Pain Med. 2014 Sep 1; 39 (5): 418-22.
  Daniel Jolley
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The flaw with many closed loop TIVA-BIS studies, such as this one, is that they unquestionably assume reliability of BIS and are not powered for important morbidity or mortality outcomes.
This study while professing to show 'superiority' of a closed-loop system, really just shows that when given a monitor target the algorithm can more accurately and rapidly adjust the TIVA to maintain this. This may well be a good outcome, but does not necessarily equate to 'good' or safe anesthesia.
It's important to note that BIS has been validated essentially as an awareness alarm, not (yet) as a guide to appropriate depth of anesthesia.
Orliaguet GA, Lambert FB, Chazot T et al. Feasibility of Closed-loop Titration of Propofol and Remifentanil Guided by the Bispectral Monitor in Pediatric and Adolescent Patients: A Prospective Randomized Study. Anesthesiology. 2015 Apr 1;122(4):759-67.
  Daniel Jolley
pearl
1
Closed loop control of propofol/remi TIVA targeting BIS 40-60 is more precise than manual control.
Orliaguet GA, Lambert FB, Chazot T et al. Feasibility of Closed-loop Titration of Propofol and Remifentanil Guided by the Bispectral Monitor in Pediatric and Adolescent Patients: A Prospective Randomized Study. Anesthesiology. 2015 Apr 1;122(4):759-67.
  Daniel Jolley