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pearl
1
Nebulized ketamine with dexmedetomidine is suitable and effective for pediatric premedication before outpatient dental surgery.
Zanaty OM El SA. A Comparative Evaluation of Nebulized Dexmedetomidine, Nebulized Ketamine, and Their Combination as Premedication for Outpatient Pediatric Dental Surgery. Anesth. Analg. 2015 Jul 1; 121 (1): 167-171.
  Daniel Jolley
pearl
1
Propofol is best dosed by total body weight, and remifentanil by ideal body weight.
Liu N, Lory C, Assenzo V et al. Feasibility of closed-loop co-administration of propofol and remifentanil guided by the bispectral index in obese patients: a prospective cohort comparison† Br J Anaesth. 2015 Apr 1;114(4):605-14.
  Daniel Jolley
pearl
1
Closed-loop delivery of total intravenous anesthesia with propofol and remifentanil, guided by BIS, is feasible in obese patients.
Liu N, Lory C, Assenzo V et al. Feasibility of closed-loop co-administration of propofol and remifentanil guided by the bispectral index in obese patients: a prospective cohort comparison† Br J Anaesth. 2015 Apr 1;114(4):605-14.
  Daniel Jolley
pearl
1
Learning in a simulated anesthesia crisis is better when the simulation is of independent practice than supervised practice.
Goldberg A, Silverman E, Samuelson S et al. Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice. Br J Anaesth. 2015 May 1;114(5):794-800.
  Daniel Jolley
summary
1
This meta-analysis investigated the benefits and risks of intrathecal morphine and fentanyl, concluding that:
Intrathecal morphine prolongs post-operative analgesia on average more than 8 hours, but at cost of:
• Nausea & vomiting (NNH 10 each)
• Urinary retention (NNH 7)
• Pruritus (NNH 4)
• Respiratory depression (NNH 38-59 for IT morphine 0.05-0.5 mg)
Intrathecal fentanyl prolongs post-operative analgesia on average almost 2 hours, but at a cost of pruritus (NNH 3).
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Daniel Jolley
pearl
1
Intrathecal fentanyl prolongs post-operative analgesia at the expense of increased incidence of pruritus, but with no increase in respiratory depression.
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Daniel Jolley
pearl
1
Intrathecal morphine prolongs post-operative analgesia, but at the expense of increasing nausea, vomiting, pruritus, urinary retention and risk of respiratory depression.
Pöpping DM, Elia N, Marret E et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012 Apr 1;153(4):784-93.
  Daniel Jolley
pearl
1
In those with moderate or severe sleep apnoea, perioperative auto-titrated CPAP improves oxygen saturation and reduces postoperative AHI.
Liao P, Luo Q, Elsaid H et al. Perioperative Auto-titrated Continuous Positive Airway Pressure Treatment in Surgical Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Anesthesiology. 2013 Oct 1;119(4):837-47.
  Daniel Jolley
pearl
1
Epidural analgesia reduces all-cause mortality after cardiac surgery, at the cost of a 1 in 3,500 risk of epidural hematoma.
Landoni G, Isella F, Greco M et al. Benefits and risks of epidural analgesia in cardiac surgery†. Br J Anaesth. 2015 Jul 1;115(1):25-32.
  Daniel Jolley
comment
1
Queen Victoria writing in her journal, reflecting on the birth of Prince Leopold with chloroform:
Dr Snow gave that blessed chloroform and the effect was soothing, quieting and delightful beyond measure.
Caton D. John Snow's practice of obstetric anesthesia. Anesthesiology. 2000 Jan 1;92(1):247-52.
  Daniel Jolley