Safety

Pediatric Regional Anesthesia Complications

A somewhat reassuring study on pediatric anesthesia regional anesthesia that included both peripheral nerve and neuraxial blocks finds: “In a prospective multicenter cohort of more than 100,000 blocks in children, there were no cases of permanent neurologic deficit associated with regional anesthesia. The rate of transient neurologic deficit was low at 2.4 per 10,000, and the incidence of local anesthesia toxicity was also low at 0.76 per 10,000”.

There was only one epidural abscess, and one epidural hematoma in a paravertebral block. Transient neurological deficits did not differ between peripheral and neuraxial blocks. Importantly, no additional risk was observed with placing blocks under general anesthesia.

The most common adverse events were benign catheter-related failures (4%).

link

Canadian Anesthesia Incident Reporting System

In compliance with WHO patient safety recommendations and other international initiatives, the Canadian Anesthesia Incident Reporting System (CAIRS) is now online at cairs.ca

It is an anonymous, confidential site whose input will be analyzed by experts who will in time deliver feedback to CAS members, to whom it is at present limited.

A full description is available here, link

 

Neuraxial Morphine / Diamorphine & Cesarean Respiratory Depression

A systematic review of the use of neuraxial Morphine and Diamorphine found that the highest and lowest prevalences of  clinically significant respiratory depression after Cesarean delivery with the use of clinically relevant doses of neuraxial morphine ranged between 1.63 per 10,000 (95% CI, 0.62–8.77) and 1.08 per 10,000 (95% CI, 0.24–7.22), respectively. This study review is reassuring on the safety of neuraxial opioid analgesia at current practice doses (eg. 0.1 – 0.15mg spinal Morphine).

link

 

Propofol in Egg or Soy Allergy

A perennial concern is answered by the AAAAI: “Patients who are allergic to foods, including soy and egg, are allergic to proteins in the foods and are not allergic to the oils or fats in the foods. Soybean oil and egg lecithin may contain trace amounts of residual protein, however no allergic reactions have been demonstrated to be caused by this”.

link

And the same narrative applies to the shellfish and iodine misconception!

OSA and Opioid Prescribing

In surgical patients, a retrospective study showed a worrying rate of opioid prescribing (86%) at hospital discharge in patients with known or suspected Obstructive Sleep Apnea (OSA).

Such patients, many of whom are morbidly obese, are at increased risk of respiratory obstruction and depression, and guidelines (such as from the ASA) recommend closer monitoring as well as using multimodal non-opioid analgesia. Where opioid analgesia is required, the Society for Ambulatory Anesthesia advises against ambulatory surgery if pain control cannot be provided with predominantly non-opioid techniques in such patients. Even in-patients with OSA are frequently not properly monitored in high dependency units.

There is still clearly ample room for prescriber education in opioid risk evaluation and mitigation, and OSA patients are at special risk when discharged on opioids (and indeed even as in-patients).

Link

CXR after Ultrasound-Guided CVP

A study questions the routine use of chest x-ray after central venous line insertion with ultrasound guidance.  Rates of pneumothorax and misplacement were very low, especially using the right internal jugular approach.

Not included is the utility of ultrasound in detecting pneumothorax, which in conjunction with ultrasound guidance may make chest x-ray a choosing unwisely intervention in the future

link