May's Anesthesia Digest

This month featured multiple practical articles on pediatric anesthesia. These articles include the use of maternal voice recordings to decrease emergence delirium, nebulized precedex in endoscopy, and a dose-finding propofol-precedex study for MRI cases. Preoperative oral caffeine as prophylaxis against post-spinal hypotension in patients undergoing orthopedic lower limb surgery: A

A dose-ranging pilot trial of dexmedetomidine-propofol in children undergoing magnetic resonance imaging

The Takeaway An anesthetic plan with propofol infusion and single dexmedetomidine provides a safe sedation and didn't significantly extend recovery time. Study Design * 79 children aged 1-12, scheduled for MRI * Single-center, prospective, sequential, dose-ranging trial * ASA I-III, natural airway, intravenous access prior to sedation * Propofol-Only cohort received an

Effects of Dexmedetomidine Combined With Lidocaine Topical Administration on Cough Reflex During Extubation in Thyroidectomy Patients: A Randomized Clinical Trial

The Takeaway topical administration of dexmedetomidine, when combined with lidocaine, significantly enhances the reduction in both the incidence and intensity of cough reflex during extubation Study Design * 180 patients (60 per group) * Inclusion criteria: female patients aged 18 to 65, ASA I or II, BMI 18 to 30 kg/m²

Comparative efficacy of sugammadex and neostigmine in postoperative nausea and vomiting management: a meta‑analysis of randomized controlled trials

In this meta-analysis, reversal with sugammadex decreased PONV metrics, especially when given at after the return of the second twitch.

The effect of repeated maternal voice orientation on postoperative emergence agitation in children following tonsillectomy and adenoidectomy: A randomized controlled trial

Delivering prerecorded, repeated maternal voice orientation via noise cancelling headphones decreased emergence agitation in pediatric patients undergoing tonsillectomy and adenoidectomy

Effect of nebulized dexmedetomidine on gag reflex suppression and sedation quality in pediatric patients undergoing gastrointestinal endoscopy: a randomized controlled trial

Nebulized precedex significantly decreased gag and cough reflexes, anesthetic requirements, and enhanced endoscopist satisfaction.

Preoperative oral caffeine as prophylaxis against post-spinal hypotension in patients undergoing orthopedic lower limb surgery: A randomized, placebo-controlled, double-blinded study

A preoperative administration of 200 mg caffeine tablet can reduce hypotensive episodes and ephedrine requirements within the first hour of spinal anesthesia.

April's Anesthesia Digest

Here is the The Sedation Station's curated list of anesthesia articles published in the month of April. Combined Use of Dexmedetomidine and Hydrocortisone to Prevent New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: A Randomized Clinical Trial Combining dexmedetomidine and hydrocortisone effectively reduces POAF incidence after CABG,

Combined Use of Dexmedetomidine and Hydrocortisone to Prevent New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: A Randomized Clinical Trial

Combining dexmedetomidine and hydrocortisone effectively reduces POAF incidence after CABG, with manageable side effects

First-pass success rate and predictive factors for stylet use in videolaryngoscopic intubations with a Macintosh blade: a prospective observational study

"Routine stylet preparation may not be necessary for elective videolaryngoscopic intubations with a Macintosh blade in patients with a longer sternomental distance, increased thyromental height, and normal cervical spine mobility"

Redefining pain management: investigating the efficacy and safety of erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a meta analysis of randomized controlled trials

"The erector spinae plane block (ESPB) appears to be the preferred option for acute postoperative pain and opioid reduction in adults undergoing laparoscopic cholecystectomy."

Efficacy of erector spinae plane block for postoperative pain management: A meta-analysis and trial sequential analysis of randomized controlled trials

Erector Spinae Plane Block (ESPB) significantly reduced postop pain up to 48h, decreased postop opioid consumption, lowered postoperative nausea and vomiting (PONV), and without severe adverse events

The effect of neuromuscular blocking reversal agents on perioperative neurocognitive function after general anaesthesia: a systematic review and meta-analysis

The Takeaway Sugammadex was associated with improved early perioperative neurocognitive function compared to neostigmine when used to reverse neuromuscular blockade Physiology Refresh Neostigmine works indirectly by inhibiting acetylcholinesterase, the enzyme that breaks down acetylcholine (ACh) at the neuromuscular junction. By preventing ACh degradation, neostigmine increases the concentration of ACh in

pulse oximeter

Evaluation of pulse oximeter at the nasal septum during general anesthesia: comparison with finger oximeter

"Considering the higher stability to hypothermia with a similar accuracy, nasal septum pulse oximetry may be an attractive alternative to finger pulse oximetry."

dexmedetomidine

Anesthetic-sparing effect of dexmedetomidine during total intravenous anesthesia for children undergoing dental surgery: A randomized controlled trial

"A 1 mcg/kg bolus of Dexmedetomidine reduced the propofol and remifentanil requirements during anesthesia maintenance in children when administered as a postinduction bolus."

Epidural analgesia versus dural puncture epidural analgesia in labouring parturients: a meta-analysis of randomised controlled trials

The Takeaway Dural Puncture Epidural analgesia is associated with faster onset, fewer motor and unilateral block, and improved sacral sparing compared with epidural analgesia. Study Design * Identified randomised controlled trials comparing epidural analgesia with DPE analgesia in laboring parturients published up to October 2024 * The primary outcome was time to

lidocaine

IV lidocaine with propofol-based sedation for colonoscopy: a systematic review and meta-analysis with trial sequential analysis

"During colonoscopy, the addition of intravenous lidocaine to propofol-based sedation reduced propofol consumption, shortened awakening time, mitigated post-procedural pain and enhanced patient satisfaction"

melatonin

A Comparison of the Effect of Two Doses of Oral Melatonin as Premedication on Orientation Score, Induction Compliance, and Emergency Agitation of Children Undergoing Elective Surgeries: A Double-Blinded Randomized Trial

In pediatric surgical patients, the melatonin dosage does not affect children’s compliance with induction but impacts their postoperative behavior by reducing the likelihood of agitation.

IV dexmedetomidine vs IV lidocaine in attenuating airway reflexes during recovery of thyroidectomy patients

The Takeaway Following thyroid surgery, dexmedetomidine was more effective in reducing the cough reflex during the tracheal extubation period. Study Design * 140 participants * ASA I or II * Exclusion Criteria: ASA class III or IV, refusing the procedure or study participation, patients with asthma, chronic cough,or symptoms of an upper

High FiO2 After Re-starting Two-Lung Ventilation in Thoracic Surgery Increases Risk of Lung Injury

The Takeaway The results of this study suggest a unique sensitivity to alveolar hyperoxia at the time of lung reinflation and raise the possibility that restricting the inspired oxygen fraction during lung reinflation could reduce injury and related sequelae. Our findings imply that a 10% increase in FiO2 during the

Intraperitoneal Dexamethasone and Dexmedetomidine Reduce PONV After Laparoscopic Cholecystectomy

The Takeaway Intraperitoneal dexamethasone, dexmedetomidine, and their combination reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy Study Design * Prospective randomized triple-blind study * 240 patients aged 20–50 years, ASA Class I or II * Exclusion criteria were a history of psychotic illnesses, Parkinson’s disease, motion disorder, and a history

IOH

A Meta-Analysis Evaluating Outcomes following use of Low, Moderate, and High Blood Pressure Treatment Thresholds

To reduce cardiac, renal, and neurological complications, targeting MAP >65 mmHg is a reasonable threshold for most patients. However, individualized BP management is crucial, especially for high-risk patients.

hepatectomy

Tranexamic Acid is Safe in Hepatectomy while Reducing Blood Transfusions and Post Op Drainage

Tranexamic acid can help reduce blood transfusions in hepatectomy without added risk, although more studies are needed to refine dosing and safety profiles.

In Patients with Chronic Kidney Disease, Cisatracurium with Neostigmine Reversal is Safer than Rocuronium and Sugammadex

The Takeaway Patients with Chronic Kidney Disease who were given rocuronium and reversed with sugammadex had a significantly higher risk for acute cardiovascular and pulmonary complications when compared to patients who were administered cisatracurium plus neostigmine Study Design * Retrospective observational study * Propensity-matched study including 20,548 patients with CKD Physiology