Journal Club 2019-2020

    Dr. Shah gave a concise review of the Nimmagadda, et al article. This study found that preoxygenation should be performed whenever there is an anticipated interruption of O2 delivery such as in high risk patients, before and during awake fiberoptic intubation.
   Dr. Kim gave an excellent review on the article by Min et al. The study found that administering neuromuscular blockade before checking mask ventilation may increase mask tidal volumes and shorten the time to intubation during induction of general anesthesia in patients with normal airways. There were larger tidal volumes during mask ventilation and earlier tracheal intubation in the early rocuronium group than in the late group. Some limitations were the small sample size and the fact that timing of NM blockade may be important in patients with difficult airways; these patients were excluded for reasons of patient safety.
   The third article by Lewis et al was reviewed by Dr Taft. He gave a detailed talk and showed that currently there is no evidence for videolaryngoscopy reducing the number of intubation attempts or the incidence of hypoxia. There was also no evidence that the use of videolarngoscopes affects time required for intubation.

    Dr Ma gave a concise review of the Bluth et al article. The authors sought to determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. This was a randomized clinical trial of 2013 adults from over 20 countries. The primary outcome was a composite of pulmonary complications within the first 5 postoperative days. They concluded that in this patient population, using a higher level of PEEP and alveolar recruitment maneuvers did not reduce postoperative pulmonary complications.
    Dr. Siddique gave an excellent review on the Clivio et al. article. This meta-analysis concluded that within a range of 0.5-2 mg·kg, intravenous lidocaine dose dependently prevents intubation-, extubation-, and opioid-induced cough in adults and children with NNTs ranging from 8 to 3. Dr. Siddique also reviewed the cough reflex and cough physiology.

    Dr Shuminov gave a concise review of the Krishna et al article. The authors examined the analgesic efficacy of bilateral erector spinae (ESP) block compared with conventional treatment for pain after cardiac surgery in adult patients. This study found that ESP block provided better pain relief at rest for longer duration as compared to intravenous paracetamol and tramadol. It was noted in the discussion that the study was not a blinded study and this could have influenced care from the anesthesia care team.
    Dr. Pasiliao gave an excellent review on the Anwar et al article. This article found that preoperative administration of 150 mg pregabalin and postoperative continuation twice daily for 14 days significantly lowered the prevalence of persistent pain after cardiac surgery.
    Dr. Mitchell presented the Khan et al article well. This study found that persistent pain after breast surgery is a common problem and there are no established interventions known to decrease its development. This pilot trial could be a stepping stone for development of a larger trial. Interestingly, it was noted in discussion that persistent pain was characterized as two months in this study and as three months for the other studies. This study had various limitations: a very small sample size, multiple types of surgery, and a lack of assessment of neuropathic pain in the office .