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Authors: Jessica L. Booth, M.D. et al Anesthesiology published on May 11, 2017 Background: The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine […]
Read MoreEdited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM Use of nonsteroidal anti-inflammatory drugs (NSAIDs) for even 1 week is associated with increased risk for myocardial infarction, a meta-analysis in The BMJ finds. Using individual patient data from four studies from healthcare databases, researchers identified over 61,000 cases of acute MI and 385,000 controls […]
Read MoreWriting Committee for the VISION Study Investigators, JAMA 2017 Apr 25; 317:1642 Most troponin elevations were not obviously symptomatic. In a 2014 study, investigators showed that even modestly elevated non–high-sensitivity troponin T levels during the 3 days after noncardiac surgery were associated independently with excess 30-day mortality (NEJM JW Gen Med Apr 1 2014 and Anesthesiology 2014; 120:564). Now, this […]
Read MoreAuthors: Pickering JW et al., Ann Intern Med 2017 Apr 18; However, samples for the troponin assay should be drawn at least 3 hours after symptom onset, and a positive troponin does not rule in acute myocardial infarction. Several studies have demonstrated the potential utility of high-sensitivity cardiac troponin T (hs-cTnT) assays combined with electrocardiograms (ECGs) in […]
Read MoreAuthors: Roy G. Soto, M.D. et al ASA Monitor 05 2017, Vol.81, 30-31. Mivacurium is a benzylisoquinolinium nondepolarizing neuromuscular-blocking drug that was developed in the early 1980s and disappeared from the U.S. market in 2006. It was reintroduced in December 2016, and many have asked what the appropriate niche is for this seemingly resurrected medication. Since […]
Read MoreInterview with Alec Peniche, MD, Lawrence Poree, MD, PhD, Xiaobing Yu, MD Patient-controlled anesthesia (PCA) is not new to pain management, but using intrathecal patient-controlled anesthesia (IT-PCA) does remain a controversial topic amidst concerns over patient safety. However, a team of researchers at the University of California San Francisco recently reported their first successful case […]
Read MoreASA Monitor 05 2017, Vol.81, 42-43. Review of unusual patient care experiences is a cornerstone of medical education. Each month, the AQI-AIRS Steering Committee abstracts a patient history submitted to the Anesthesia Incident Reporting System (AIRS) and authors a discussion of the safety and human factors challenges involved. Real-life case histories often include multiple clinical decisions, […]
Read MoreStephanie R. Sibal, MSN, RN, HACP ASA Monitor 05 2017, Vol.81, 40-41. Stephanie R. Sibal, MSN, RN, HACP, is Quality Manager, Anesthesia Associates of Boise, Idaho. Collection of data is all well and good, but improvement in patient outcomes requires the ability to turn information into action. The AQI Practice Quality Improvement Committee (PQIC) will collect […]
Read MoreAuthors: Sin B et al., J Emerg Med 2017 Mar 6; Morphine plus ketamine performed better than morphine alone in this randomized, double-blind study. Researchers performed a double-blind, randomized, placebo-controlled trial to evaluate the safety and effectiveness of subdissociative dose ketamine as an adjunct to morphine for acute pain. Sixty adult patients presenting to a level II […]
Read MoreThe American College of Cardiology, together with the American Heart Association and the Heart Failure Society of America, have issued the second part of their guideline update on heart failure management. The first part was issued in May 2016. The new update includes the following strong recommendations based on high-quality evidence: Natriuretic peptide biomarkers should […]
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