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pearl
2
Muscle paralysis alone in an awake subject can cause significant drop in the Bispectral Index Score (BIS) to below that normally indicating unconsciousness and deep anaesthesia.
Schuller PJ, Newell S, Strickland PA et al. Response of bispectral index to neuromuscular block in awake volunteers†. Br J Anaesth. 2015 Jul 1;115 Suppl 1:i95-i103.
  Daniel Jolley
comment
1
This is a most fascinating study, both academically, clinically and psychologically. The full Method deserves to be read, along with the participant's description of their experience in the Results.
...fasciculations attributable to suxamethonium were painful, and the ensuing paralysis was experienced as a feeling of profound heaviness, ‘as if someone had pulled the plug and drained the fluid out’.
Schuller PJ, Newell S, Strickland PA et al. Response of bispectral index to neuromuscular block in awake volunteers†. Br J Anaesth. 2015 Jul 1;115 Suppl 1:i95-i103.
  Daniel Jolley
pearl
1
75% of cases of accidental awareness under general anaesthesia are likely preventable.
Cook TM, Andrade J, Bogod DG et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡ Br J Anaesth. 2014 Oct 1;113(4):560-74.
  Daniel Jolley
pearl
2
Experiencing paralysis during awareness under general anaesthesia, even without pain, is in particular associated with distress and longterm harm.
Cook TM, Andrade J, Bogod DG et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡ Br J Anaesth. 2014 Oct 1;113(4):560-74.
  Daniel Jolley
pearl
1
Even short periods of awareness during general anaesthesia commonly result in severe patient distress and longterm consequences.
Cook TM, Andrade J, Bogod DG et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡ Br J Anaesth. 2014 Oct 1;113(4):560-74.
  Daniel Jolley
comment
1
Wow! They had a 21% incidence of PDPH in their control group (and almost 8% in the treatment arm) because they were using 25g Quincke needles! It is interesting that they have access to ondansetron but presumably not pencil-point needles.
This study leaves me asking why? why? why?
Fattahi Z, Hadavi SM, Sahmeddini MA. Effect of ondansetron on post-dural puncture headache (PDPH) in parturients undergoing cesarean section: a double-blind randomized placebo-controlled study. J Anesth. 2015 Oct 1; 29 (5): 702-7.
  Daniel Jolley
pearl
1
The monoclonal antibody-fragment idarucizumab reliably reverses the thrombin-inhibitor anticoagulant dabigatran ('Pradaxa') within minutes of administration.
Pollack CV, Reilly PA, Eikelboom J et al. Idarucizumab for Dabigatran Reversal. N. Engl. J. Med. 2015 Aug 6;373(6):511-20.
  Daniel Jolley
comment
1
Fascinating. Hazard of small studies but would love to see a mechanism. Big dose of Ondansetron too. Ummm.
Fattahi Z, Hadavi SM, Sahmeddini MA. Effect of ondansetron on post-dural puncture headache (PDPH) in parturients undergoing cesarean section: a double-blind randomized placebo-controlled study. J Anesth. 2015 Oct 1; 29 (5): 702-7.
  Allan Palmer
pearl
0
No significant difference between plain or hyperbaric spinal bupivacaine, though the authors dismissed a faster onset in the hyperbaric group which may be of more practical benefit.
Heng SiaAlex TiongATFrom the Duke-NUS Graduate Medical School, Singapore, Singapore; Medical Board, Obstetrics Gynaecology, Women's Anaesthesia, KK Women's Children's Hospital, Singapore, Singapore; Clinical Research Institute, Singapore, , Tan KH, Sng BL et al. Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery. Anesth. Analg. 2015 Jan 1; 120 (1): 132-140.
  Allan Palmer
pearl
1
Pre-operative oral carbohydrate decreases postoperative insulin resistance, speeds gastrointestinal functional recovery and reduces hospital stay, most significantly after major surgery.
Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol. 2015 Jun 1;28(3):364-9.
  Daniel Jolley