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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | A U G U S T 2 0 1 5
ly the equivalent of the induction dose, which I split into thirds and
deliver every 5 to 10 minutes.
• Maintain paralysis to the end, so I can mechanically ventilate the
patient with 100% oxygen to an end tidal concentration near zero (0%
A N E S T H E S I A A L E R T
• Dexamethasone may improve blocks. Perineural dexamethasone
when given as an adjunct to brachial plexus blocks appears to signifi-
cantly extend the duration of blocks and improve post-op pain outcomes, according
to a recent study (osmag.net/xqVED3). Researchers at Northwestern University con-
ducted a meta-analysis of 9 randomized trials involving 760 patients and found that
patients given dexamethasone also consumed fewer opioids. Additionally, there
were no reports of persistent nerve injury related to the perineural administration,
say the authors.
• Regional safer for tots. Regional anesthesia is safer than general for infants, say
researchers who measured the presence of apnea after hernia surgery. There was lit-
tle difference in late apnea, but regional reduced the risk of significant apnea in the
first 30 minutes after surgery, a study of 722 infants found. Andrew Davidson, MD,
author and associate professor at the Royal Children's Hospital in Melbourne,
Australia, calls the study "the strongest evidence to date on how babies should have
anesthesia for hernia repair."
• Different needles don't help. Researchers following up on a manufacturer's
claim that using a larger needle bore reduces the pain of injection were disappoint-
ed to find little to no difference in the levels of pain experienced by patients, accord-
ing to a recent study (osmag.net/ATrN4k) published in Anesthesia Progress.
Patients were given dental injections on each side of their mouths, one side with a
standard-bore 27-gauge needle, the other side with an enlarged-bore (43% wider)
27-gauge needle. Half of the patients were given the standard needle first; the
other half the enlarged-bore needle first. Patients reported nearly identical pain
scores (based on the visual analogue scale) for the 2 needles.
Anesthesia Notebook
