2 Minute Medicine ® - Anesthesiology

1. In women undergoing cesarean delivery under epidural anesthesia, the administration of esketamine produced transient sedation and clinically insignificant analgesia, with no significant effect on neonatal depression. Evidence Rating Level : 1 (Excellent) Epidural anesthesia is commonly used during cesarean delivery. However, some patients still experience pain and discomfort during the surgery due to an incomplete block of the splanchnic nerve. Therefore, additional analgesics like opioids and dexmedetomidine are often administered...

1. No association was found between maternal opioid treatment in the immediate postpartum period and adverse outcomes in infants after 30 days. Evidence Rating Level: 2 (Good) Study Rundown: Opioid toxicity is not currently thought to be an adverse effect in infants breastfed from mothers requiring opioids for immediate postpartum analgesia, due to the low levels of opioids diffusing into breast milk. However, there is ongoing concern and uncertainty, as seen in health regulatory bodies that recommend caution when using opioids when breastfeeding in the postpartum period...

1. Among patients undergoing shoulder arthroscopy, the use of dexmedetomidine as an adjuvant to an erector spinae plane block reduced intraoperative and postoperative opioid requirements. Evidence Rating Level: 1 (Excellent) Shoulder arthroscopy continues to be one of the most frequently performed orthopedic surgery. As postoperative pain is a significant consequence of this surgery, good pain management is key to optimal surgical results and recovery following surgery. Currently, several analgesic strategies such as regional nerve blocks, local anesthetic, non-steroidal anti-inflammatory drugs, intravenous opioids, and patient-controlled analgesia are commonly used modalities...

Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization : https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801581 1. In patients with newly initiated antipsychotic medications following infection-related hospitalization, discontinuation rates were lower among atypical antipsychotic users compared to haloperidol users. Evidence Rating Level: 2 (Good) Delirium, characterized by an acute change in mental status and cognition, presents a significant health care burden...

1. In this randomized controlled trial, adding a transversus abdominis plane (TAP) block to the multimodal analgesia protocol decreased the rescue morphine use compared to patients who did not receive the TAP block in patients receiving elective open gynecologic surgery Evidence Rating Level: 1 (Excellent) Enhanced recovery after surgery (ERAS) protocols are designed to minimize stress created by surgery and to improve patient recovery following surgery. Most ERAS pathways avoid opioid use with multimodal pain management, which can lead to decreased opioid-related adverse effects such as nausea and vomiting...

1. Labor epidural analgesia does not affect rate of exclusive breastfeeding up to 6 months Evidence Rating Level: 2 (Good) Exclusive breastfeeding (EBF) is recommended for the first 6 months after birth by the World Health Organization. With labor epidural analgesia (LEA) become increasingly used, the impact of LEA on EBF has been questioned, with controversial results found in previous studies. This Chinese cross-sectional survey included 537 healthy mothers who had vaginal delivery and included questions to investigate breast feeding practice up to 6 months, LEA use during labor and other factors such as maternal sociodemographic characteristics, obstetric conditions, and breast feeding supports...

1. The use of oral dexmedetomidine as premedication prior to neurosurgery increased preoperative sedation and reduced the stress reaction induced by tracheal intubation under general anesthesia.  Evidence Rating Level: 1 (Excellent)  Preoperative anxiety can significantly impact an individual’s experience prior to surgery and cause many physical manifestations such as increased incidence of nausea, vomiting, and postoperative pain. There is evidence that suggests that premedication for peri-operative anxiety improves quality of anesthesia and surgical recovery...

Effects of a Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life: A Randomized Clinical Trial : https://read.qxmd.com/read/36542401   1. In patients with Bipolar Disorder Type 1, a smartphone-based self-management intervention decreased relapse risk in individuals in asymptomatic recovery but not in those with a higher relapse risk. Evidence Rating Level: 1 (Excellent)  Bipolar disorder, characterized by episodes of mania and depression, is a severe mental illness that causes significant disability even with appropriate pharmacological therapy...

1. Supraphysiological oxygen administration during surgery is associated with higher incidence of kidney, myocardial and lung injury Evidence Rating Level: 2 (Good) Greater than 80% of patients undergoing general anesthesia are exposed to oxygen administration higher than that required to maintain normal blood oxygen levels. There are potentially harmful effects of supplemental oxygen administration, however, due to the consequences of hypoxemia, supplemental oxygen is a common component of anesthesia. This retrospective cohort study included 350, 657 patients who underwent surgical procedures longer than 120 minutes under general anesthesia and measured clinical outcomes based on level of oxygen exposure including acute kidney injury (measured using the Kidney Disease Improving Global Outcomes) myocardial injury (defined as a troponin >0...

1. Low-dose ketamine was effective in reducing the incidence of shivering following spinal anesthesia compared to tramadol. Evidence Rating Level: 2 (Good) Following spinal anesthesia in orthopedic patients, post-spinal shivering is a common complication. Shivering that is untreated can lead to increased wound pain, metabolic demand, oxygen consumption, and ultimately, hemostatic dysfunction. Literature investigating prophylactic agents to improve post-spinal shivering is limited. In this prospective cohort study, 516 patients undergoing orthopedic surgery under spinal anesthesia were divided into two groups: patients receiving an intravenous prophylactic dose of Ketamine or Tramadol prior to anesthesia...

Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study : https://read.qxmd.com/read/36384481 1. In adult females undergoing day gynecological surgery, this randomized controlled trial found that opioid-reduced analgesia using esketamine did not result in improved postoperative nausea and vomiting (PONV) when compared to opioid analgesia. 2. There was no significant difference in subjective pain following surgery between patients who had opioid analgesia and opioid-reduced analgesia using esketamine...

1. In patients with a high risk of extubation failure, using pressure-support ventilation (PSV) for spontaneous breathing trials did not result in more ventilator-free days than breathing trials conducted with T-piece ventilation. 2. Rates of reintubation did not differ significantly in the PSV or T-piece ventilation groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: Reducing the amount of time that patients are exposed to invasive mechanical ventilation is crucial to avoid complications. Therefore, the early identification of patients who are able to breathe spontaneously on their own can hasten the time to tracheal extubation and reduce the duration of mechanical ventilation...

1. In pregnant patients undergoing non-elective cesarean section, the use of glycopyrrolate does not significantly reduce vasopressor requirements and prevent hypotension compared to placebo. Evidence Rating Level: 1 (Excellent) In cesarean sections, spinal anesthesia is a frequently used anesthetic technique; however, hypotension is a common adverse event which has negative implications on both maternal health and neonatal outcomes. Recent studies have explored the use of glycopyrrolate during spinal anesthesia as it increases maternal heart rate and consequently maintains cardiac output, while having a minimal effect on the fetus due to its inability to cross the placental barrier...

1. The use of esketamine in combination with propofol significantly reduced the risk of perioperative hypotension during abortive surgery compared to propofol and fentanyl. Evidence Rating Level: 1 (Excellent) Opioid analgesics commonly used in anesthesia practice such as fentanyl and propofol are associated with respiratory and circulatory system depression. Esketamine is a N-methyl-D-aspartate receptor (NMDA) antagonist which has a milder respiratory depression effect and lower circulatory excitation compared to its other analgesic counterparts due to its rapid onset and offset action...

A Healthy Lifestyle is Positively Associated with Mental Health and Well-Being and Core Markers in Ageing : https://read.qxmd.com/read/36171556 1. A healthy lifestyle defined by diet, smoking status, physical activity, alcohol consumption, and BMI was associated with better mental health outcomes. Evidence Rating Level: 2 (Good) It is well known that unhealthy lifestyles are associated with adverse health outcomes such as cardiovascular disease, respiratory illness, and mental health disorders. While many studies have examined individual health behaviors and their effects on health, the synergistic effects of multiple lifestyle modifications on mental well-being have not been thoroughly investigated...

1. Spinal anesthesia, as compared with general anesthesia, was associated with a small but significant increase in pain and prescription analgesic use after hip fracture surgery. 2. Patient satisfaction with care did not differ between groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Spinal and general anesthesia confer similar survival and recovery outcomes for hip fracture surgery. Thus, the choice between these anesthesia procedures may be determined by patient preference based on associated risks and benefits...

1. In a cohort of patients undergoing breast surgery, erector spinae plane block improved the quality of recovery compared to the control. Evidence Rating Level : 1 (Excellent) Regional anesthesia techniques are commonly used for breast surgery. The erector spinae plane block is a newer technique for delivering regional anesthesia to patients undergoing breast surgery. It has proven to reduce pain severity and opioid consumptions. However, there is a lack of data with regards to the quality of recovery in patients following this procedure...

1. This retrospective cohort study with 866 453 adults demonstrated that as overlapping anesthesiologist responsibilities increased, the risk of morbidity and 30-day mortality for surgical patients increased. 2. Future studies should evaluate the consequences of one anesthesiologist covering multiple operating rooms under direct care by anesthesiology residents. Evidence Rating Level: 2 (Good) Study Rundown: Overlapping responsibilities across different medical specialties has been linked to poor patient outcomes...

1. Ciprofol was just as effective to propofol for general anesthesia induction in patients undergoing gynecological surgery and presents fewer adverse events. Evidence Rating Level: 1 (Excellent) In anesthesia practice, propofol is traditionally used to induce and maintain general anesthesia. While it does have a strong utility, propofol also may cause several adverse effects such as the inhibition of the circulatory and respiratory systems. As such, alternative drug choices for general anesthesia are needed...

1. For elderly patients receiving elective abdominal surgery, there was no significant difference in the rate of composite major in-hospital postoperative complications in older patients receiving etomidate or propofol for induction. 2. In patients who received etomidate versus propofol, there was a significantly higher incidence of postoperative pulmonary complications, specifically pneumonia. Evidence Rating Level: 1 (Excellent) Study Rundown:   The use of etomidate as an intravenous anaesthetic is controversial; its hemodynamic stability is a benefit for induction in high-risk patients, but it can potentially cause adrenal insufficiency postoperatively and has a controversial impact on outcomes, including pneumonia in trauma patients, which causes people to generally favour propofol as an induction agent...