General Medical News

A little alcohol is good for you? The NIH study to prove it is being funded by – alcohol companies!  link

And people binge drink a lot, definitely not good  link

Foot orthoses for heel pain? Save your money  link

Traumatic brain injury in children associated with secondary ADHD some years later, especially with family dysfunction and lower maternal education.  link

High midlife fitness associated with reduced dementia risk in 44 year longitudinal study, though a small group in Sweden  link

‘Stunning”, “game-changer” etc. are red flag terminology. MS radical treatment using stem cell transplant. Press reports are not peer reviewed studies, we haven’t seen the study  link

After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide.   link

In Type 2 Diabetes DPP-4 Inhibitors link to inflammatory bowel disease ?  link

Tai Chi as good as aerobic exercise in Fibromyalgia. Anything but opioids!  link

 

 

 

Anesthesia and The Developing Brain

An update on the continuing research into potential anesthetic neurotoxicity in the developing brain in pediatric anesthesia. “The most recent evidence suggests that a single, brief exposure to a general anesthetic does not cause overt neurocognitive deficits in either neonatal laboratory animals or human infants. However, it is still premature to conclude whether anesthetic drugs administered early in life cause harm”.

anesth&anal link

Intrathecal Morphine in Laparoscopic Bowel Surgery

Pain is by no means minimal after laparoscopic colonic resection and a study using intrathecal Morphine with Bupivacaine (0.3/12.5 with age adjustment) showed better analgesia and faster recovery. There was increased pruritus and nausea, and respiratory depression was curiously not studied on the first night. Overall patient satisfaction was similar as was actual length of stay. Benefits appear confined to the first day.  The study was not a convincing win for intrathecal morphine but may have application in selected patients, or need further study in ERAS protocols.  link

An earlier study was less enthusiastic about the benefits  link

 

Amisulpride for PONV

A study on postoperative nausea and vomiting found this dopamine antagonist atypical anti-psychotic effective in combination with either ondansetron or dexamethasone. All 1,100+ participants were female and at high risk of nausea and vomiting. Side effects were infrequent and no Q-T  prolongation reported. Further study is needed to compare with other combination therapies. Amisulpride has not been approved in the US.

link

 

Phenylephrine vs. Ephedrine in OB

Phenylephrine has largely supplanted Ephedrine for neuraxial anesthesia related hypotension during Cesarean due to the latter’s association with fetal acidosis, despite an unclear clinical significance. A current study in a more defined population of pre-eclampsia with non-reassuring fetal heart rate finds fetal pH and other blood gas parameters, as well as Apgar Scores to be no different between the two agents.

They conclude that maternal hemodynamics and heart rate etc should determine best (or both) vasopressors. link