Nasal High-Flow Therapy for Newborn Infants

High flow nasal oxygen has become a popular alternative to non-invasive ventilation and as a means of apneic oxygenation during airway management.

This neonatal study did not replicate its advantages described in other studies:

“Nasal high-flow therapy was not shown to be noninferior to CPAP and resulted in a significantly higher incidence of treatment failure than CPAP when used in nontertiary special care nurseries as early respiratory support for newborn infants with respiratory distress. ”

link

Stress, burnout, depression and work satisfaction among UK anaesthetic trainees

There is increasing awareness of mental health and well-being in physicians. This full text article studies some of the worrisome statistics in UK trainees in Anesthesia.

The authors “observed a high prevalence of perceived stress; 37% (95%CI 32–42%), burnout risk 25% (21–29%) and depression risk 18% (15–23%), and found that these issues frequently co‐exist. Having no children, > 3 days sickness absence in the previous year, ≤ 1 h.week−1of exercise and > 7.5 h.week−1 of additional non‐clinical work were independant predictors of negative psychological outcomes”.

Hopefully these results will help inform the identification and management of risk factors. However this should not substitute for improving safe workplaces and work scheduling, workload and practice.

Full text

Malignant Hyperthermia in Pregnancy

A European group issues guidelines for MH in Pregnancy. As always, neuraxial anesthesia is preferred, and guidelines are otherwise similar to the non-obstetric population.

Of note:

  1. The mother is known or suspected to be MH-susceptible (in this case even the fetus may be MH-susceptible)
  2. The fetus may be MH-susceptible but not the mother (because the father of the child is known or suspected to be MH-susceptible).

Full text

SGLT Inhibitors and Diabetic Ketoacidosis

The popularity of SGLT Inhibitors has increased with purported cardiovascular and renal benefits. Issues have arisen however and this consensus addresses the reported cases of normoglycemic diabetic ketoacidosis.

Pertinent to perioperative care, “SGLT inhibitors should be withheld or discontinued prior to any medical procedure (ideally for 3 days), particularly if the patient will be reducing food intake or will not be allowed to eat or drink for some time before and after the procedure.”

Full text link

Early Neuromuscular Blockade in ARDS

The fashion that has returned for early neuromuscular block in ARDS was tested in this study.

“Among patients with moderate-to-severe ARDS who were treated with a strategy involving a high PEEP, there was no significant difference in mortality at 90 days between patients who received an early and continuous cisatracurium infusion and those who were treated with a usual-care approach with lighter sedation targets”.

link

Tramadol and Persistent Opioid Use

Faced with the opioid epidemic, many have turned to postoperative use of Tramadol in the belief it has less misuse potential.

This observational study finds however that: “People receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids”.

They advocate reclassifying Tramadol and urge caution in its prescription.

link

Intraoperative Seizures During Elective Craniotomy

This retrospective study found that the incidence of intraoperative seizures during elective craniotomy with evoked potential monitoring is low. 

The overall incidence of intraoperative seizures was 2.3%. Independent risk factors for intraoperative seizures were seizure history, diagnosis of intracranial tumor, and temporal craniotomy. 

Intraoperative prophylactic anticonvulsant use was protective.

link

Post Dural Puncture Headache Treatment

A new guideline from the Obstetric Anaesthetists Association underlines how little evidence is really available to guide management of post dural puncture headache. Epidural Blood Patch remains the best treatment but in general is more effective after 48 hours. Some relief occurs in up to 80%, and complete resolution of pain in about a third. It may need repeating. 20mL blood is suggested or less if back pain develops.

There is insufficient evidence on a whole host of suggested treatments – steroids, gabapentinoids, ACTH, caffeine, triptans, theophylline, neostigmine and atropine, acupuncture, various nerve blocks, and epidural crystalloid.

link