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pearl
1
High intraoperative PEEP and recruitment manoeuvres during open abdominal surgery do not protect against post-op pulmonary complications, though are associated with intraoperative hypotension.
PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology, Hemmes SN, Gama de AbreuMarceloM et al. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014 Aug 9; 384 (9942): 495-503.
  Daniel Jolley
pearl
1
The ED90 of carbetocin is approximately 15 mcg after elective cesarean section.
Khan M, Balki M, Ahmed I et al. Carbetocin at elective Cesarean delivery: a sequential allocation trial to determine the minimum effective dose. Can J Anaesth. 2014 Mar 1; 61 (3): 242-8.
  Daniel Jolley
comment
0
In my experience, 80% success is about right. It can be a somewhat hit-n-miss technique, though with reasonable evidence to support both safety and potential superiority vs neonatal general anaesthesia. You know pretty much instantly when it hasn't worked.
Frawley G, Bell G, Disma N et al. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes. Anesthesiology. 2015 Jul 1; 123 (1): 55-65.
  Daniel Jolley
comment
1
Why does any study with the words 'adherence' and 'guideline' in the same sentence immediately get my back up. If its a guideline you dont need to ADHERE to it. Think about it, follow it, maybe, but not ADHERE. Grrrrrrrr
McEvoy MD, Hand WR, Stoll WD et al. Adherence to guidelines for the management of local anesthetic systemic toxicity is improved by an electronic decision support tool and designated "reader". Reg Anesth Pain Med. 2014 Jul 1; 39 (4): 299-305.
  Allan Palmer
comment
1
83% success rate. ~20% failure rate. 1:5 failure. Not so sure I would agree with the comment the "failure rate of spinal anaesthesia was low". I like a little more certainty than this!
Frawley G, Bell G, Disma N et al. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes. Anesthesiology. 2015 Jul 1; 123 (1): 55-65.
  Allan Palmer
pearl
0
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
comment
0
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
comment
0
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
summary
1
Chazot et al. describe a 25 yo undergoing a Nissen fundoplication, receiving TCI propofol/remifentanil (targets of 2.3 ug/mL & 4 ng/mL respectively) along with rocuronium. The deep neuromuscular block was reversed with sugammadex 4 mg/kg and the patient awoke within 80 seconds (clinically and BIS > 90) despite TCI targets continuing. No awareness was noted.
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
summary
1
A very practical review of the evidence, indications and rationale for the perimortem cesarean section. Richard Parry describes the specific steps required to perform a PMCS, along with discussion of the pros and cons of different approaches. The importance of multidisciplinary training is emphasised.
Parry R, Asmussen T, Smith JE. Perimortem caesarean section. Emerg Med J. 2016 Mar 1; 33 (3): 224-9.
  Daniel Jolley