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The flaw with many closed loop TIVA-BIS studies, such as this one, is that they unquestionably assume reliability of BIS and are not powered for important morbidity or mortality outcomes.
This study while professing to show 'superiority' of a closed-loop system, really just shows that when given a monitor target the algorithm can more accurately and rapidly adjust the TIVA to maintain this. This may well be a good outcome, but does not necessarily equate to 'good' or safe anesthesia.
It's important to note that BIS has been validated essentially as an awareness alarm, not (yet) as a guide to appropriate depth of anesthesia.
Orliaguet GA, Lambert FB, Chazot T et al. Feasibility of Closed-loop Titration of Propofol and Remifentanil Guided by the Bispectral Monitor in Pediatric and Adolescent Patients: A Prospective Randomized Study. Anesthesiology. 2015 Apr 1;122(4):759-67.
  Daniel Jolley
pearl
1
Closed loop control of propofol/remi TIVA targeting BIS 40-60 is more precise than manual control.
Orliaguet GA, Lambert FB, Chazot T et al. Feasibility of Closed-loop Titration of Propofol and Remifentanil Guided by the Bispectral Monitor in Pediatric and Adolescent Patients: A Prospective Randomized Study. Anesthesiology. 2015 Apr 1;122(4):759-67.
  Daniel Jolley
pearl
1
In high risk cardiac surgery, anesthesia with either sevoflurane or TIVA results in comparable postoperative mortality and morbidity.
Landoni G, Guarracino F, Cariello C et al. Volatile compared with total intravenous anaesthesia in patients undergoing high-risk cardiac surgery: a randomized multicentre study. Br J Anaesth. 2014 Dec 1;113(6):955-63.
  Daniel Jolley
pearl
1
Perioperative gabapentin does not significantly improve pain after neuraxial caesarean section.
Monks DT, Hoppe DW, Downey K et al. A Perioperative Course of Gabapentin Does Not Produce a Clinically Meaningful Improvement in Analgesia after Cesarean Delivery: A Randomized Controlled Trial. Anesthesiology. 2015 Aug 1;123(2):320-6.
  Daniel Jolley
summary
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A enjoyable trip down memory lane with Prof. Kester Brown. A brief description of the history of barbiturates and their structure activity relationships, culminating in the seven decade dominance of thiopentone.
The second half of this paper briefly describes the drugs that have challenged thiopentone, those you will likely have used (propofol, etomidate) and those most likely not (propanidid, althesin, gamma-hydroxybutyrate).
An quick and enjoyable read. Click through for the full-text.
Brown TC. Thiopentone and its challengers. Paediatr Anaesth. 2013 Oct 1;23(10):957-8.
  Daniel Jolley
pearl
1
Prophylactic ondansetron does not prevent shivering during cesarean section under regional block.
Browning RM, Fellingham WH, O'Loughlin EJ et al. Prophylactic ondansetron does not prevent shivering or decrease shivering severity during cesarean delivery under combined spinal epidural anesthesia: a randomized trial. Reg Anesth Pain Med. 2013 Jan 1;38(1):39-43.
  Daniel Jolley
pearl
1
Surgical Pleth Index-guided analgesia may not be valid for use in children.
Park JH, Lim BG, Kim H et al. Comparison of Surgical Pleth Index-guided Analgesia with Conventional Analgesia Practices in Children: A Randomized Controlled Trial. Anesthesiology. 2015 Jun 1;122(6):1280-7.
  Daniel Jolley
pearl
1
Surgical Pleth Index-guided analgesia used during pediatric tonsillectomy results in worse post-operative analgesia than BP and HR guided analgesia dosing.
Park JH, Lim BG, Kim H et al. Comparison of Surgical Pleth Index-guided Analgesia with Conventional Analgesia Practices in Children: A Randomized Controlled Trial. Anesthesiology. 2015 Jun 1;122(6):1280-7.
  Daniel Jolley
pearl
1
Tight intraoperative blood glucose control is associated with postop delirium after cardiac surgery.
Saager L, Duncan AE, Yared JP et al. Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery. Anesthesiology. 2015 Jun 1;122(6):1214-23.
  Daniel Jolley
pearl
1
TAP block provides superior analgesia to caudal block, though is less effective at preventing bladder spasms after paediatric lower abdominal surgery.
Bryskin RB, Londergan B, Wheatley R et al. Transversus Abdominis Plane Block Versus Caudal Epidural for Lower Abdominal Surgery in Children: A Double-Blinded Randomized Controlled Trial. Anesth. Analg. 2015 Aug 1;121(2):471-8.
  Daniel Jolley