wears off in 40 to 45 minutes, instead of the usual hour-plus you'd
typically get with bupivacaine, is potentially invaluable in the get-
'em-up and get-'em-out world of same-day surgery.
"Its metabolism by ester hydrolysis may ultimately make it a
favorite for short-duration spinals and other blocks in the outpatient
arena," says Dr. Doyle, adding that, like bupivacaine, its cardiotoxic
effects are minimal, and, like lidocaine, it has minimal neurotoxic
impact.
That should translate to a shorter time in the PACU and a shorter
recovery time. In fact, one study found that patients given Clorotekal
were ready to be discharged about 80 minutes sooner (150 vs. 230
minutes) than the bupivacaine group. Clorotekal also has a quicker
onset time and has been associated with a lower urinary retention
rate than other anesthetics.
2. Video laryngoscopy
By now every provider knows about video laryngoscopes, but the day
may be coming when intubating with direct laryngoscopy feels like
typing a term paper on a manual Smith-Corona.
"The really big change [in video laryngoscope design] that has hap-
pened over the last 5 or 10 years is the advent of portable high-level
batteries and high-resolution screens that are like what we have on
phones," says Dr. Piracha. "Before, what we had was pseudo-portable
— you had to wheel the device into the room. Now, with newer tech-
nologies, it's literally in your pocket."
So, it's time to toss out the old handle and blade? Probably not — at
least not until video scopes become as ubiquitous as mobile phones.
"There are those who make the case that direct laryngoscopy is now
obsolete," says Dr. Doyle, "but I think that anesthesia providers
should still be trained in direct laryngoscopy, in addition to video
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