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pearl
1
Even short periods of awareness during general anaesthesia commonly result in severe patient distress and longterm consequences.
Cook TM, Andrade J, Bogod DG et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡ Br J Anaesth. 2014 Oct 1;113(4):560-74.
  Daniel Jolley
comment
1
Wow! They had a 21% incidence of PDPH in their control group (and almost 8% in the treatment arm) because they were using 25g Quincke needles! It is interesting that they have access to ondansetron but presumably not pencil-point needles.
This study leaves me asking why? why? why?
Fattahi Z, Hadavi SM, Sahmeddini MA. Effect of ondansetron on post-dural puncture headache (PDPH) in parturients undergoing cesarean section: a double-blind randomized placebo-controlled study. J Anesth. 2015 Oct 1; 29 (5): 702-7.
  Daniel Jolley
pearl
1
The monoclonal antibody-fragment idarucizumab reliably reverses the thrombin-inhibitor anticoagulant dabigatran ('Pradaxa') within minutes of administration.
Pollack CV, Reilly PA, Eikelboom J et al. Idarucizumab for Dabigatran Reversal. N. Engl. J. Med. 2015 Aug 6;373(6):511-20.
  Daniel Jolley
comment
1
Fascinating. Hazard of small studies but would love to see a mechanism. Big dose of Ondansetron too. Ummm.
Fattahi Z, Hadavi SM, Sahmeddini MA. Effect of ondansetron on post-dural puncture headache (PDPH) in parturients undergoing cesarean section: a double-blind randomized placebo-controlled study. J Anesth. 2015 Oct 1; 29 (5): 702-7.
  Allan Palmer
pearl
0
No significant difference between plain or hyperbaric spinal bupivacaine, though the authors dismissed a faster onset in the hyperbaric group which may be of more practical benefit.
Heng SiaAlex TiongATFrom the Duke-NUS Graduate Medical School, Singapore, Singapore; Medical Board, Obstetrics Gynaecology, Women's Anaesthesia, KK Women's Children's Hospital, Singapore, Singapore; Clinical Research Institute, Singapore, , Tan KH, Sng BL et al. Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery. Anesth. Analg. 2015 Jan 1; 120 (1): 132-140.
  Allan Palmer
pearl
1
Pre-operative oral carbohydrate decreases postoperative insulin resistance, speeds gastrointestinal functional recovery and reduces hospital stay, most significantly after major surgery.
Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol. 2015 Jun 1;28(3):364-9.
  Daniel Jolley
comment
0
Though has limited application outside of the low-resource setting. This basically shows ketofol is non-inferior to propofol alone, rather than superior.
The audited group is a pretty low-risk one for negative hemodynamic consequences from propofol (alone) sedation. Adding a drug (ketamine) increases technique complexity and needs to be balanced against a demonstrable benefit.
Grace RF, Tang DW, Namel E. An audit of the haemodynamic and emergence characteristics of single-shot 'ketofol'. Anaesth Intensive Care. 2015 Jul 1; 43 (4): 503-5.
  Daniel Jolley
summary
1
A small audit showing the acceptability and absence of significant side effects of ketofol when used for brief procedural sedation (tubal ligation), particularly in the low resource setting.
Patients received a premixed ketofol dose of 0.5 mg/kg ketamine and 0.9 mg/kg propofol after fentanyl 1 mcg/kg.
Notably there was universal hemodynamic stability, although almost half of the audited patients required airway support.
Grace RF, Tang DW, Namel E. An audit of the haemodynamic and emergence characteristics of single-shot 'ketofol'. Anaesth Intensive Care. 2015 Jul 1; 43 (4): 503-5.
  Daniel Jolley
pearl
1
Use of the WHO Surgical Safety Checklist reduces perioperative morbidity and mortality in low resource settings.
Collection: Surgical safety checklists
  Daniel Jolley
summary
1
Implementation of the Surgical Safety Checklist in Ontario, Canada did not reduce surgical morbidity or mortality.
Urbach DR, Govindarajan A, Saskin R et al. Introduction of surgical safety checklists in Ontario, Canada. N. Engl. J. Med. 2014 Mar 13;370(11):1029-38.
  Daniel Jolley