Safety Concepts in the Anesthetic Management of Patients

Abstract

1.Jouguelet-Lacoste J, La Colla L, Schilling D, et al: The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: A review of the current literature. Pain Med 16:383, 2015This study reported on data analyzed from 5 meta-analyses and 39 clinical trials assessing the use of ketamine as an adjunctive agent in the management of postoperative pain. Ketamine reduced opioid consumption and reduced the pain score.2.Garg N, Panda NB, Gandhi KA, et al: Comparison of small dose ketamine and dexmedetomidine infusion for postoperative analgesia in spine surgery—A prospective randomized double-blind placebo controlled study. J Neurosurg Anesthesiol 28:27, 2016Both ketamine and dexmedetomidine have analgesic properties at doses less than those commonly used to produce their anesthetic effect. This prospective study compared the efficacy of each agent (ketamine [0.25 mg/kg bolus plus 0.25 mg/kg/hr infusion] with midazolam [10 μg/kg bolus plus 10 μg/kg/hr infusion] vs dexmedetomidine [0.5 μg/kg bolus plus 0.3 μg/kg/hr infusion]) to produce postoperative analgesia. Both agents were effective, with minimal adverse effects, although ketamine did have statistically significant differences in nausea/vomiting and diplopia.3.Peng K, Liu HY, Wu SR, et al: Effects of combining dexmedetomidine and opioids for postoperative intravenous patient-controlled analgesia: A systemic review and meta-analysis. Clin J Pain 31:1097, 2015Motov S, Rockoff B, Cohen V, et al: Intravenous subdissociative-dose ketamine versus morphine for analgesia in the emergency department: A randomized controlled trial. Ann Emerg Med 66:222, 2015Ketamine has analgesic properties at subdissociative doses. This study assessed the efficacy of a low dose of intravenous ketamine as a primary analgesic in the emergency department. The study demonstrated comparable analgesic effects of intravenous ketamine (0.3 mg/kg) compared with intravenous morphine (0.1 mg/kg).4.Scheier E, Gadot C, Leiba R, Shavit I: Sedation with the combination of ketamine and propofol in a pediatric ED: A retrospective case series analysis. Am J Emerg Med 33:815, 2015Propofol-remifentanil and propofol-ketamine combinations have become more popular in the past several years. This study was a retrospective study assessing the use of propofol-ketamine in a pediatric ED population. The study analyzed 429 patients with a mean age of 6.8 years. The authors concluded the drug combination to be effective with minimal adverse effects. This editor believes that minimal advantages ensue by combining ketamine with propofol compared with administering a ketamine bolus upfront.5.Monk TG, Bronsert MR, Henderson WG, et al: Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology 123:307, 2015This was a retrospective cohort study that assessed approximately 47,000 operations on approximately 31,000 patients in the Veterans Affairs system. The population was generally older. Increased 30-day mortality was associated with intraoperative hypotension (systolic blood pressure <70 mm Hg, mean arterial pressure <50 mm Hg, or diastolic blood pressure <30 mm Hg) but not with hypertension.6.Sun LY, Wijeysundera DN, Tait GA: Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology 123:515, 2015This was a retrospective cohort study. The study demonstrated an association between an intraoperative mean arterial pressure of <55 to 60 mm Hg and acute kidney injury. The risk increased with the duration of hypotension.7.Mascha EJ, Yang D, Weiss S, Sessler DI. Intraoperative mean arterial pressure variability and 30-day mortality in patients having noncardiac surgery. Anesthesiology 123:79, 2015Previous studies within this list reported increased mortality and renal injury associated with intraoperative hypotension. This was a retrospective study that sought to find an association between intraoperative blood pressure variability and increased mortality. The study demonstrated increased mortality both with lower mean arterial pressure and increased blood pressure variability; however, the latter was only mildly associated with increased 30-day mortality.8.Lee SM, Takemoto S, Wallace AW: Association between withholding angiotensin receptor blockers in the early postoperative period and 30-day mortality: A cohort study of the Veterans Affairs healthcare system. Anesthesiology 123:288, 2015Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can cause intraoperative hypotension that is refractory to management. This has resulted in some recommendations to discontinue the medications 10 to 24 hours before surgery. At times, delays occur in restarting the medication. This retrospective study assessed the morbidity associated with the preoperative withholding of angiotensin receptor blockers and a delay in their restart.9.Practice advisory for the prevention and management of operating room fires: An updated report by the American Society of Anesthesiologists task force on operating room fires. Anesthesiology 118:271, 2013Much emphasis today is being placed on optimizing patient safety. Operating room fires are among the greatest percentage of anesthetic closed claims. Oral maxillofacial surgeons need to be familiar with protocols for preventing operating room fires as more individuals are involved with esthetic surgery and the use of lasers and electrocautery. This report, published in 2013, discusses fire risk, prevention, and management.