Dexmedetomidine IV Prolongs ISBPB

The conclusion of this study was: “Intravenous Dexmedetomidine at a dose of 2.0 μg/kg significantly increased the duration of Interscalene Brachial Plexus Block analgesia without prolonging motor blockade and reduced the cumulative opioid consumption at the first 24 hours in patients undergoing arthroscopic shoulder surgery“. There was no greater degree of hypotension, bradycardia or sedation.

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Nebulized Dexmedetomidine Sedation

A study compared nebulized Dexmedetomidine 2mcg/kg, Ketamine 2mg/kg and Midazolam 0.2mg/kg for sedation in children 3 – 7 year olds prior to GA for bone marrow aspiration.  “Preschool children premedicated with nebulised dexmedetomidine had more satisfactory sedation, shorter recovery time, and less postoperative agitation than those who received nebulised ketamine or midazolam“.

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Weekly Medical News

Marriage confers lower cardiovascular risk!  link

WHO declares compulsive video gaming an addictive behaviour disorder.  link

American Academy of Pediatrics condemns Border Security and Immigration Reform Act ‘s impact on children. link

Methadone and Buprenorphine reduce mortality after nonfatal opioid overdose  link

Generic Suboxone approved in US  link

Do viruses play a role in Alzheimer’s ?  link

NSAID use around conception was associated with increased risk of miscarriage link

High risk of death from  drug and many other causes  after non fatal opioid overdoses.  link

 

Spinal Bupivacaine and Fentanyl and Fetal Heart Rate

A study suggests that hyperbaric bupivacaine in combination with Fentanyl may produce more increase in uterine tone and fetal heart rate abnormalities than bupivacaine alone. These changes were short lived and the clinical significance is controversial but as there was no difference in analgesia, they suggest Fentanyl may be either unnecessary or doses could be lower in the spinal component of CSE.

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Dexmedetomidine Reduces Delirium

Another study continues to support the promising role of Dexmedetomidine as an agent to reduce delirium in the surgical population. This meta-analysis in the BJA concludes: “Dexmedetomidine may reduce postoperative delirium incidence for adult cardiac and non-cardiac surgical patients. The optimal dose and timing of dexmedetomidine and influence on other outcomes or particular patient populations with risk factors warrants further studies”.

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Perioperative Peripheral Nerve Injury After General Anesthesia

A review article discusses the incidence, mechanisms, diagnosis and prevention of peripheral nerve injuries during general anesthesia. It is an area still in evolution, as it is found that anesthesia care is appropriate in 90% of cases. Concepts such as ischemia, inflammation, “double crush”, mechanical factors are discussed as well as evoked potential monitoring like SSEP, nerve conduction studies and EMG.

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Intravenous Acetaminophen in Colectomy

A retrospective study of the use of iv Acetaminophen for open colectomies found that about 25% received it, half of whom only a single dose, but any benefit compared to oral Acetaminophen was marginal; oral acetaminophen appeared superior when using more than 1 dose on postoperative day 1.

There is a large cost difference. This study used data from the Premier Healthcare Database. Pending further perhaps randomized studies, and allowance for multimodal and regional analgesic techniques, there is little economic or analgesic advantage to using intravenous Acetaminophen compared to oral.

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The findings echo what was found in the ER setting – blog link