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1mcg/kg fentanyl as sole intraoperative analgesic is less than most instutions would administer and may explain a high baseline postoperative agitation rate.
Abdulatif M, Ahmed A, Mukhtar A et al. The effect of magnesium sulphate infusion on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia. Anaesthesia. 2013 Oct 1;68(10):1045-52.
  Pieter Peach
pearl
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Routine lorazepam premedication before surgery does not improve patient experience but does prolong time to extubation, even among anxious patients.
Maurice-Szamburski A, Auquier P, Viarre-Oreal V et al. Effect of sedative premedication on patient experience after general anesthesia: a randomized clinical trial. JAMA. 2015 Mar 3;313(9):916-25.
  Daniel Jolley
pearl
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Intraoperative dexamethasone for antiemesis does not appear to significantly alter glucostasis during the first 24 post-operative hours in non-diabetic patients.
Murphy GS, Szokol JW, Avram MJ et al. The Effect of Single Low-Dose Dexamethasone on Blood Glucose Concentrations in the Perioperative Period: A Randomized, Placebo-Controlled Investigation in Gynecologic Surgical Patients. Anesth. Analg. 2014 Jun 1;118(6):1204-12.
  Daniel Jolley
summary
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Collection: Carbetocin at Cesarean Section
Carbetocin is a long-acting synthetic oxytocin analog. Although a 100 mcg dose is currently recommended, there is still some question as to the ideal dose. Dosing as low as 20 mcg may possibly be equally effective.
Carbetocin is currently only recommended for use during elective cesarean delivery, obviating the need for a post-operative oxytocin infusion currently practiced in many countries. In some countries it is also used after vaginal delivery.
It is at least as efficacious as intravenous oxytocin, and may possibly be superior at reducing postpartum haemorrhage.
Due to it's comparatively high cost compared with oxytocin however, the economic benefit of avoiding post-operative oxytocin infusions has not been demonstrated.
In the scenario of emergency cesarean section after labor augmentation with oxytocin, a much larger dose is likely required and carbetocin cannot be recommended.
One study has suggested a post-operative analgesic benefit of carbetocin vs oxytocin, although the evidence base for this is far from conclusive.
  Daniel Jolley
pearl
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Maintaining anesthesia with either sevoflurane or propofol for laparoscopic gynaecology surgery has no differential effect on post-operative pain.
Pokkinen SM, Yli-Hankala A, Kalliomäki ML. The effects of propofol vs. sevoflurane on post-operative pain and need of opioid. Acta Anaesthesiol Scand. 2014 Sep 1; 58 (8): 980-5.
  Daniel Jolley
summary
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Collection: Postoperative mortality and intraoperative anesthetic depth
There has been some observational evidence that a greater depth of anesthesia, as measured by BIS, may be associated with an increase in post-operative mortality. In particular the association of the "triple low state" (low BIS, low volatile-ET, low MAP) with post-operative mortality is worrying.
Completion of the Balanced Anaesthesia Study Group’s large RCT looking at this issue however brings us as close to a final word as we may expect. Short et al. (2019) showed no difference in 1-year mortality for older patients undergoing major surgery, whether they received a deep (BIS target 35) or light (BIS target 50) general anaesthetic.
It is likely that earlier observational studies were showing the consequences of intraoperative hypotension resulting from anaesthetic depth, rather than anaesthetic depth itself.
  Daniel Jolley
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Great to see a new agent in the pipeline but why oh why use BIS as an endpoint as by definition BIS has never been calibrated against the new agent.
Monagle J, Siu L, Worrell J et al. A Phase 1c Trial Comparing the Efficacy and Safety of a New Aqueous Formulation of Alphaxalone with Propofol. Anesth. Analg. 2015 Oct 1; 121 (4): 914-924.
  Allan Palmer
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If what you are currently doing works for you keep doing it. If it doesn't, use hyperbaric!
Sia AT, Tan KH, Sng BL et al. Use of hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section. Cochrane Db Syst Rev. 2013 Jan 1;5:CD005143.
  Allan Palmer
summary
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A case report describing the first-reported, successful and safe use of Xenon-based anesthesia in an MH-susceptible 31 year old male.
The authors conclude that this case, along with previous investigation of Xe in susceptible-swine animal models and in vitro human muscle biopsy testing, show that Xenon is likely safe for use in MH-susceptible individuals.
Carlomagno M, Esposito C, Marra A et al. Xenon anaesthesia in a patient with susceptibility to malignant hyperthermia: A case report. Eur J Anaesthesiol. 2016 Feb 1; 33 (2): 147-50.
  Daniel Jolley
pearl
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Phaxan™, an alphaxalone-cyclodextrin preparation offers fast-onset & short-duration anesthesia equivalent to propofol without pain on injection and with less hypotension.
Monagle J, Siu L, Worrell J et al. A Phase 1c Trial Comparing the Efficacy and Safety of a New Aqueous Formulation of Alphaxalone with Propofol. Anesth. Analg. 2015 Oct 1; 121 (4): 914-924.
  Daniel Jolley