Checking mask ventilation before neuromuscular block

The outdated and misguided notion of there being safety in checking mask ventilation before giving the muscle relaxant persists as shown in this Swedish survey.

“The most common reason for checking mask ventilation was “to gather information about the airway,” while the reason for not using was mostly “that muscle relaxation often improves mask ventilation.”

The latter has been shown to be the case. In any event the difficult airway is already lost after Propofol. Airway guidelines need to incorporate this knowledge in guidelines.


Neuraxial labour analgesia reduces risk of maternal depression at 2 years after childbirth

This prospective study suggests another potential advantage to neuraxial analgesia for vaginal delivery.

It concluded: “For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.”


Association between complications and death within 30 days after noncardiac surgery

It is rare to die in the Operating Room.

This prospective study looked at the rate and cause of death after non-cardiac surgery.

“Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality”


Major Neurologic Complications Associated With Postdural Puncture Headache in Obstetrics

Sometimes considered a nuisance, this study reminds us of the potential serious ramifications of accidental post-dural puncture headache (PDPH) during epidural placement in obstetrics.

The incidence of complications was not negligible in this retrospective review, including: composite of cerebral venous thrombosis and subdural hematoma, bacterial meningitis, depression, headache, and low back pain. PDPH and complications were identified during the delivery hospitalization and up to 1 year post-delivery. 

Early recognition and management is therefore important.


Induction Technique Among Infants and Neonates Undergoing Pyloromyotomy

The decline is Succinylcholine use has been expedited by the arrival of Sugammadex. Succinylcholine is often still preferred where the risk of aspiration is deemed higher.

This study compared rapid sequence induction (RSI) with modified rapid sequence induction (mRSI) in infants.

The conclusion found mRSI acceptable practice: “In infants presenting for pyloromyotomy, anesthetic induction with mRSI compared with RSI was associated with significantly less hypoxemia without an observed increase in aspiration events. In addition, the need for multiple intubation attempts was a strong predictor of hypoxemia. The increased risk of hypoxemia associated with RSI and multiple intubation attempts was even more pronounced in neonatal patients.”


International consensus statement on the use of uterotonic agents during caesarean section

This statement updates use of uterotonic agents. Traditionally Oxytocin has been used in higher then needed doses and this statement reiterates current expert opinion on the use of smaller titrated doses in most situations, especially in elective Cesarean.

They discuss the increasing use of Carbetocin as an alternative, which has the advantage of a longer half life thereby obviating the need for an infusion. Side effects are similar.

Second line agents are discussed also.

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Peripheral Nerve Blocks for Ambulatory Shoulder Surgery

Nerve blocks are now almost universal during shoulder surgery for their superior analgesia. This study reviewed post-discharge outcomes.

A decrease in unplanned admissions was found. There was no improvement in other postoperative outcomes such as emergency department visits, readmissions, mortality, or practical costs.


Cesarean Delivery and Neuraxial Opioids

This consensus statement from SOAP specifically addresses the use of neuraxial Morphine in Cesarean delivery and looks st dosing, safety and monitoring.

It clearly favours the use of neuraxial Morphine as part of a multimodal analgesia regime and how the benefits and risks may be addressed using appropriate monitoring.

It should be reviewed by all who provide Obstetric anesthesia.

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Consensus Statement on Persistent Postoperative Opioid Use

This statement looked at the definition, incidence and risk factors for persistent postoperative opioid use and how it might be dealt with.

“Patient characteristics associated with an increased risk of persistent postoperative opioid use included preoperative opioid use, depression, substance use disorder, preoperative pain conditions, and smoking.”

They discuss in the free full text how health policy may help to curtail persistent opioid use.


Mortality and major morbidity after hip fracture surgery and Anesthesia

This retrospective analysis doesn’t prove causality but findings were in keeping with prior work.

Spinal anesthesia was weakly associated with a lower 90-day mortality following hip fracture surgery, and also associated with improved morbidity evidenced by a lower rate of pulmonary embolism and major blood loss and a shorter hospital length of stay.