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pearl
1
Wound infiltration with ropivacaine offers no analgesic benefit after thyroid surgery.
Miu M, Royer C, Gaillat C et al. Lack of Analgesic Effect Induced by Ropivacaine Wound Infiltration in Thyroid Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. Anesth. Analg. 2016 Feb 1; 122 (2): 559-64.
  Daniel Jolley
pearl
1
High-normal fasting plasma glucose (95-99 mg/dL 5.3−5.5 mmol/L) is independently associated with increased cardiovascular risk compared with low-normal FPG (< 80 mg/dL / 4.44 mmol/L).
Shaye K, Amir T, Shlomo S et al. Fasting glucose levels within the high normal range predict cardiovascular outcome. Am. Heart J. 2012 Jul 1;164(1):111-6.
  Daniel Jolley
pearl
1
Alphaxalone may be solubilized in a sulfobutyl-cyclodextrin with potency comparable to both propofol and the historical Cremophor EL preparation, but with a better safety margin than either.
Goodchild CS, Serrao JM, Kolosov A et al. Alphaxalone Reformulated: A Water-Soluble Intravenous Anesthetic Preparation in Sulfobutyl-Ether-β-Cyclodextrin. Anesth. Analg. 2015 May 1; 120 (5): 1025-1031.
  Daniel Jolley
comment
0
A fascinating historical article, both because of it's current relevance and the glimpse it provides of the exploration of a relatively new drug – along with tidbits regarding the safety of the technique:
"This is borne out by the fact that after many thousands of cases had been done, the first case of convulsions occurred. The intravenous Xylocaine had been increased to a very rapid rate and generalized convulsions ensued. For this case, all that was needed, was to stop the drip, supplement respiration with 100% oxygen and wait several minutes for the convulsion to subside. Thiopental sodium and succinylcholine chloride were at hand but not needed. However, it should be emphasized that this technique is not for the beginner."
BARTLETT EE HUTSERANI O. Xylocaine for the relief of postoperative pain. Anesth. Analg. 1961 May 1;40:296-304.
  Daniel Jolley
summary
1
Bartlett and Hutaserani published the first description of the intravenous use of lignocaine for postoperative pain management in 1961.
"THE SEARCH for a nondepressant, long-acting drug to control postoperative pain has gone on for many years. Like many other institutions, ours has run the gamut of drugs as they have been released: nupercaine-in-oil, intravenous procaine, efocaine, intravenous alcohol, d-tubocurarine-in-oil, etc. All have had their drawbacks."
The researchers investigated a progressive range of administration routes and dosages, ultimately reaching 1000 mg lignocaine in 1L IVF given over the duration of surgery. 302 patients receiving intravenous lignocaine were compared to matched controls, finding:
"...during the first 3 postoperative days 83 per cent of the patients who received Xylocaine experienced either no pain or 1+ pain (soreness only) as contrasted with 25 per cent of the controls."
Intravenous lignocaine also dramatically reduced post-operative opioid consumption.
Another group (N=60) received 500 mg lignocaine into the rectus muscles after laparotomy, improving no-pain or 1+ pain incidence to 95%.
BARTLETT EE HUTSERANI O. Xylocaine for the relief of postoperative pain. Anesth. Analg. 1961 May 1;40:296-304.
  Daniel Jolley
comment
1
Whilst evidently valid findings is this not a case of stating the bleeding obvious?
Loughnan TE, Gunasekera E, Tan TP. Improving the C-MAC video laryngoscopic view when applying cricoid pressure by allowing access of assistant to the video screen. Anaesth Intensive Care. 2012 Jan 1;40(1):128-30.
  Allan Palmer
comment
1
Pretty clear cut summary though have to watch for the bradycardias. Looks like Ephedrine is definitely out as a routine in LSCS
Veeser M, Hofmann T, Roth R et al. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand. 2012 Aug 1; 56 (7): 810-6.
  Allan Palmer
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