Month: May 2019

Trajectories of Pain Intensity in Adults with Disabling Subacute or Chronic Neck Pain

A randomized study examined pain trajectories over one year in people with the common condition of subacute and chronic neck pain.

The conclusion informs prognosis : “Most individuals with disabling subacute or chronic neck pain show improvement in pain intensity over a year. However, a quarter present unfavorable trajectories. High pain intensity at baseline, depressive symptoms, younger age, female sex and sudden onset of pain are factors associated with unfavorable trajectories.”.

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Prolonged Perioperative Use of Pregabalin and Ketamine & Chronic Pain

This was a randomized study in cardiac surgery. Patients were randomly assigned to receive either usual care, pregabalin (150 mg preoperatively and twice daily for 14 postoperative days) alone, or pregabalin in combination with a 48-h postoperative infusion of intravenous ketamine at 0.1 mg · kg−1 · h−1.

Conclusions: Preoperative administration of 150 mg of pregabalin and postoperative continuation twice daily for 14 days significantly lowered the prevalence of persistent pain after cardiac surgery.

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Postoperative Delirium and Cognitive Dysfunction

Based on observational studies, the overlap and divergence between postoperative delirium and short and long term cognitive dysfunction was examined. The effect of surgery and anesthesia on the brain continues to be not clearly understood.

“Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up.”

The authors conclude “Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.”

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Patient Outcomes & Pharmacist Participation in Multidisciplinary Critical Care Teams

This systematic review and meta-analysis studied the effect of pharmacist involvement in critical care.

The results encourage multidisciplinary care beyond medical teams alone:

“Including critical care pharmacists in the multidisciplinary ICU team improved patient outcomes including mortality, ICU length of stay in mixed ICUs, and preventable/nonpreventable adverse drug events.”

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Early Sedation with Dexmedetomidine in Critically Ill Patients

Dexmedetomidine has become an agent touted to reduce delirium, sedate without respiratory depression and improve analgesia in both OR and ICU settings.

This study examined its use as a sole early sedation agent in critically ill patients. Results were not overly impressive.

“Among patients undergoing mechanical ventilation in the ICU, those who received early dexmedetomidine for sedation had a rate of death at 90 days similar to that in the usual-care group and and required supplemental sedatives to achieve the prescribed level of sedation. More adverse events were reported in the dexmedetomidine group”

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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. ”

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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.

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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).

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