Neuraxial Anesthesia and Thromboembolism

It has been a long held view that spinal and epidural anesthesia reduce thromboembolism but a current study seeks to quantify this. However it seems to be a weak effect with a Number Needed to Treat of 500.

30 day readmission rates (but not mortality) were also reduced.

Neuraxial anesthesia may contribute to thromboembolism reduction but should not be the sole prophylaxis. And of course the ASRA guidelines for its use with anticoagulants enter the equation.

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Music and Surgery

A meta-analysis confirms previous impression that music before and after surgery, and during regional anesthesia reduces anxiety and pain modestly, although studies had some risk of bias. I think the perpetual debate on what type of music can be tolerated by different personnel in the OR can be rendered moot by playing the patients choice of music, this tending to be supported by this evidence.

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Operating Room Attire

This topic is a perennial topic for argument between specialties. Like cellphone usage, policies are best based on evidence and at least all the stakeholders got together and released this statement on the American College of Surgeons site, recommending collaborative recommendations, ear coverage not supported, no favoured hat type but bouffant caps may be the worst, and suggesting further study and evidence.

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Anesthesia and Pediatric Development

A story that just won’t go away, and there must  be reason for concern regarding the Pediatric brain and anesthesia. This time from Australia, with the conclusion:

”Children exposed to general anesthesia before 4 years have poorer development at school entry and school performance. While the association among children with 1 hospitalization with 1 general anesthesia and no other hospitalization was attenuated, poor numeracy outcome remained.”

Ped Anesth link