brain barrier. When administered to mice in combination with propofol — as an alternative to
the combination of fentanyl and propofol — isovaline produced both general anesthesia and
conscious sedation without increasing the risks of respiratory depression or other adverse
events, leading researchers to conclude that its margin of safety may be considerably higher
than that of fentanyl.
• Answers make for better questions. Do you give patients brochures about their anesthe-
sia options? If so, they're likely to be more knowledgeable and engaged, finds a study present-
ed at Anesthesiology 2015. A comparison of 59 patients who weren't given brochures and 67
patients who were, found that the latter group were significantly more likely to discuss their
anesthesia choices and ask questions about regional anesthesia. Additionally, the brochures,
which explained risks and benefits of different types of anesthesia, and which included space
for questions and notes, did not increase anxiety and uncertainty.
"Clearly, more information is always helpful," says Karen L. Posner, PhD, of the
Department of Anesthesiology and Pain Medicine at the University of Washington, who pre-
sented the findings. "Helping patients understand their choices allows them to feel fully
prepared to discuss their options and make a mutually agreed upon decision in partnership
with their physician anesthesiologist." — Jim Burger
F E B R U A R Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 1 5 5
A previous problem spot
One study (osmag.net/QKu3qK) found that combining adductor canal
and iPACK blocks improved physical therapy and reduced hospi-
tal length of stay for total knee patients. I now use both blocks for
all of the total knees I work on, and patients who've previously
had total knees with only femoral blocks say they're amazed by
the improvement.
OSM
Mr. MacKinnon (mmackinnon123@gmail.com) is a partner in
a CRNA-only practice in Arizona. He is the past president of the
Arizona Association of Nurse Anesthetists and teaches airway manage-
ment, ultrasound-guided regional anesthesia and the
business of anesthesia via his company, CE2You (ce2you.com).
