2 Minute Medicine ® - Anesthesiology

1. Low-volume local anesthetic with intravenous dexamethasone reduced the incidence of diaphragmatic paresis and provided equivalent analgesic duration compared to the conventional volume of local anesthetic in arthroscopic shoulder surgery Evidence Rating Level: 1 (Excellent) Severe postoperative pain is common in patients undergoing arthroscopic shoulder surgery. Therefore, appropriate analgesia and rehabilitation are key for recovery. Interscalene brachial plexus block provides effective analgesia after arthroscopic shoulder surgery but carries a high risk of diaphragmatic paresis...

1. In this randomized controlled trial involving critically ill adults undergoing tracheal intubation, those who were preoxygenated with bilevel-positive airway pressure had a lower incidence of hypoxemia than those who received preoxygenation with an oxygen mask alone. 2. Noninvasive ventilation appeared to have greater benefit among patients with a higher body-mass index. Evidence Rating Level: 1 (Excellent) Study Rundown: Hypoxemia occurs in up to twenty percent of tracheal intubations in critically ill patients...

1. In this randomized controlled trial, using the video laryngoscope significantly increased the success of first-attempt intubation in neonates compared to direct laryngoscopes. 2. Lowest oxygen saturation levels recorded were also higher with video laryngoscope use.  Evidence Rating Level: 1 (Excellent) Study Rundown: Typically when neonates are intubated, it is on an urgent basis, such as when they are experiencing respiratory failure in the neonatal intensive care unit (NICU) or the delivery room. Neonates who undergo repeated endotracheal intubation attempts have associations with greater adverse events, including severe oxygen desaturation and bradycardia...

1. Adults with chronic low back pain (CLBP) randomized into a 6-week pain intervention education program were observed to have significantly relieved burden of pain-related disability and overall pain intensity when combined with the physiotherapeutic standard of care. 2. Measures of self-reported well being also improved significantly more in the pain education group compared to the control group.  Evidence Rating Level: 1 (Excellent) Chronic low back pain (CLBP) is a pervasive condition contributing significantly to pain-related disability worldwide...

1. Patients randomized to receive the paravertebral block (PVB) and erector spinae plane block (ESPB) had significantly more effective prevention and minimization of the impacts of post-herpetic neuralgia (PHN) in the acute period post-Herpes Zoster infection. 2. Patients randomized to receive PVB or ESPB additionally required less oral rescue analgesics and reported significantly higher quality of life at 15, 30, and 60 days post-block compared to controls.  Evidence Rating Level: 1 (Excellent) Herpes Zoster (HZ, or shingles) is a reactivation of the Varicella Zoster virus, and a painful dermatomal rash is usually a defining acute feature of the condition...

1. Ketamine was non-inferior to morphine at analgesic pain reduction for out-of-hospital pain management. 2. There was, however, an increased number of adverse events in the ketamine group, though the majority of these were associated with emergence phenomenon and did not require intervention. Evidence Rating Level: 1 (Excellent) Pain is a common symptom experienced outside of the hospital, which is currently being researched to shore up inadequacies, especially for those experiencing traumatic pain. There is much discussion in this research over which analgesic is the best to prescribe for out-of-hospital pain...

1. In emergency patients with hip fracture and severe pain, patients randomize to receive early ultrasound-guided femoral nerve block (FNB) were observed with reduced preoperative opioid consumption without delaying time to optimal pain control, compared with standard care.  Evidence Rating Level : 1 (Excellent) Hip fractures are common painful injuries among elderly patients. 50 to 70% of patients experience severe pain, while 40% may receive sub-optimal pain management. While opioids are frequently employed for initial pain management, the prevalence of adverse effects associated with opioid use underscores the necessity for exploring alternative approaches...

1. In this randomized controlled trial, ventilator-associated pneumonia (VAP) was prevented by employing inhaled amikacin in mechanically ventilated patients exceeding three-day duration. 2. Inhaled amikacin was associated with a reduction in VAP incidence during a 28-day follow-up period. Evidence Rating Level: 1 (Excellent) Study Rundown: VAP typically occurs 48 hours or more post-mechanical ventilation via an endotracheal tube or tracheostomy, contributing to escalated antimicrobial usage, resistance, prolonged intensive care unit (ICU) stays, and heightened mortality...

1. The augmentation of usual intraoperative care with support from the Anesthesiology Control Tower (ACT) did not have an impact on the avoidance of postoperative hypothermia or hyperglycemia compared to the control group. 2. While there was no significant difference in other secondary or clinical outcomes, appropriate intraoperative glucose measurement was more common among patients with diabetes in the intervention group. Evidence Rating Level: 1 (Excellent) Study Rundown: Telemedicine—defined by the World Health Organization as using communication technologies for diagnosis and treatment—has seen significant growth over the past decade...

1. There was a steady increase in daily step counts, improvement in health-related quality of life scores, and a decrease in fatigue scores in the postpartum period. 2. There was no significant difference in daily step counts between women who used neuraxial labor analgesia and those who did not.  Evidence Rating Level : 1 (Excellent) Early mobilization plays a vital role in enhanced recovery after surgery (ERAS), reducing thromboembolism and complications while improving physical recovery and pain relief...

1. In this randomized controlled trial, video laryngoscopy in the context of critically ill adults in the emergency department or intensive care unit (ICU) led to higher rates of success on first intubation attempts than direct laryngoscopy. 2. There was no significant difference in safety outcomes between groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: The use both of video and direct laryngoscopy for tracheal intubation is supported by international airway management guidelines. Trials comparing the two intubation approaches have shown mixed results on patient outcomes such as a successful first attempt in intubation, an important indicator of reduced risk for life-threatening complications...

1. In postoperative patients randomized to receive either 30% FiO 2 and 60% FiO 2 via mechanical ventilation while under general anesthesia, there was no difference in the incidence of postoperive alectasis between the two groups.  Evidence Rating Level: 1 (Excellent) A sizeable proportion of patients undergoing surgery with mechanical ventilation under general anesthesia develop postoperative atelectasis, which itself lends to longer hospital stays and increased 90-day mortality. The literature investigating which amount of inspired oxygen fraction (FiO 2 ) is optimal for patients under general anesthesia has been conflicting...

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...