09-24-19 Take a Deep Breath
Drs. Adam Taft, Ravi Shaw, Youngil Kim and Eric Zabirowicz
6:00 PM @ MART Building, Level 5
• Min SH et al. Randomized Trial Comparing Early and Late Administration of Rocuronium Before and After Checking Mask Ventilation in Patients With Normal Airways. Anesth Analg. 2019 Aug;129(2):380-386 [PubMed]
• Nimmagadda U et al. Preoxygenation: Physiologic Basis, Benefits, and Potential Risks. Anesth Analg. 2017 Feb;124(2):507-517 [PubMed]
• Lewis SR et al. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review. Br J Anaesth. 2017 Sep 1;119(3):369-383 [PubMed]
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.
10-29-19 PEEP and Obesity + Lidocaine and Cough
Drs. Shuran Ma and Usama Siddique
6:00 PM @ Curry Club
• Bluth et al. Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial. JAMA. 2019 Jun 18;321(23):2292-2305. [PubMed]
• Clivio et al. Intravenous Lidocaine for the Prevention of Cough: Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2019 Nov;129(5):1249-1255. [PubMed]
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.
Drs. Mitchell, Shuminov, Pasiliao, and Zabirowicz
6:00 PM @ HSC Galleria
• SN Krishna et al. Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial . J Cardiothorac Vasc Anesth. 2019 Feb;33(2):368-375. [PubMed]
• JS Khan et al. Perioperative Pregabalin and Intraoperative Lidocaine Infusion to Reduce Persistent Neuropathic Pain After Breast Cancer Surgery: A Multicenter, Factorial, Randomized, Controlled Pilot Trial . J Pain. 2019 Aug;20(8):980-993. [PubMed]
• S Anwar et al. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery . Anesthesiology. 2019 Jul;131(1):119-131. [PubMed]
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 .
The remainder of the Journal Club Meetings in 2019-2020 were cancelled due to the covid pandemic.
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