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Anaesthesia Latest Evidence Newsletter

October 2016

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Training Calendar 2016

All sessions are 1 hour

November (1pm)

Thurs 3rd Statistics Fri 11th Information resources Mon 14th Literature Searching Tues 22nd Critical Appraisal

Wed 30th Statistics

Future dates to be confirmed

Your Outreach Librarian – Jo Hooper

Whatever your information needs, the library is here to help. Just email us at [email protected]

Outreach: Your Outreach Librarian can help facilitate evidence-based practice for all in the team, as well as assisting with academic study and research. We also offer one-to-one or small group training in literature searching, critical appraisal and medical staistics. Get in touch: [email protected]

Literature searching: We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the librarians for a 1 to 1 session where we can guide you through the process of creating a well-focused literature research. Please email requests to [email protected]

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Contents Journal Tables of Contents...... 3 Anaesthesia ...... 3 Anasthesia & Analgesia ...... 6 ...... 7 British Journal of Anaesthesia ...... 8 Current Opinion in Anaesthesiology ...... 13

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Journal Tables of Contents

 Anesthesia & Analgesia  Anesthesiology  British Journal of Anaesthesia  Current Opinion in Anaesthesiology  Anaesthesia November 2016; Volume 71, Issue 11

Time for a breath of fresh air: Rethinking training in (pages 1259–1264) S. D. Marshall and N. Chrimes

Position, position, position – terminology during stomach ultrasound in pregnant women (pages 1264–1267) S. M. Kinsella Xenon anesthesia for all, or only a select few? (pages 1267–1272) E. Neice and M. H. Zornow

A national survey of practical airway training in UK anaesthetic departments. Time for a national policy? (pages 1273–1279) 4

N. H. Lindkær Jensen, T. M. Cook and F. E. Kelly

High-flow humidified nasal oxygenation vs. standard face mask oxygenation(pages 1280–1283) Pillai, V. Daga, J. Lewis, M. Mahmoud, M. Mushambi and D. Bogod

Changes in qualitative and quantitative ultrasound assessment of the gastric antrum before and after elective caesarean section in term pregnant women: a prospective cohort study (pages 1284– 1290) Rouget, D. Chassard, C. Bonnard, M. Pop, F. P. Desgranges and L. Bouvet

PDF(218K) Estimated costs before, during and after the introduction of the emergency laparotomy pathway quality improvement care (ELPQuIC) bundle (pages 1291–1295) M. O. Eveleigh, T. E. Howes, C. J. Peden and T. M. Cook

PDF(152K) Sleep disturbance in patients taking opioid medication for chronic back pain (pages 1296–1307) J. A. Robertson, R. J. Purple, P. Cole, Z. Zaiwalla, K. Wulff and K. T. S. Pattinson ☛ CPD available at http://www.learnataagbi.org

PDF(886K) A randomised controlled trial comparing the effects of propofol with isoflurane in patients with diastolic dysfunction undergoing coronary artery bypass graft surgery (pages 1308– 1316) Ammar, K. Mahmoud, A. Elkersh and Z. Kasemy

PDF(340K) A randomised controlled trial comparing two popliteal nerve catheter tip positions for postoperative analgesia after day-case hallux valgus repair (pages 1317–1323) L. Ambrosoli, L. Guzzetti, M. Chiaranda, S. Cuffari, M. Gemma and G. Cappelleri

Construct validity of a novel assessment tool for ultrasound-guided axillary (pages 1324–1331) O. M. A. Ahmed, B. D. O'Donnell, A. G. Gallagher, D. S. Breslin, C. M. Nix and G. D. Shorten Speak up! Barriers to challenging erroneous decisions of seniors in anaesthesia(pages 1332–1340) T. Beament and S. J. Mercer

A prospective randomised study of a rigid video-stylet vs. conventional lightwand intubation in cervical spine-immobilised patients (pages 1341–1346) H. Seo, E. Kim, J. D. Son, S. Ji, S. W. Min and H. P. Park

Remifentanil tolerance and hyperalgesia: short-term gain, long-term pain? (pages 1347–1362) E. H. Y. Yu, D. H. D. Tran, S. W. Lam and M. G. Irwin

Life is lognormal! What to do when your data does not follow a normal distribution(pages 1363– 1366) S. W. Choi

Professor Stanley Feldman BSc, MB, FRCA : Emeritus Magill Professor of Anaesthesia, Chelsea and Westminster Hospital, London, UK (pages 1367–1368) W. Harrop-Griffiths and N. Soni

Awake fibreoptic intubation, videolaryngoscopy and training (page 1369) M. Ince, M. Jackson, N. Plummer, H. Simmons, L. Talbot, H. Greenlee and On behalf of the North 5

West Research and Audit Group

Stroke following inadvertent carotid artery catheterisation (page 1370) M. P. Plummer and A. Lavinio

Virtual training in research methods (pages 1370–1372) Smith

Cadaver models for regional anaesthesia training (page 1372) J. P. Seeley

Paravertebral block and access to the paravertebral space (pages 1372–1373) E. Pushpanathan and A. Pawa

Bath Boarding Card and risk stratification (page 1373) D. Belch and V. Perkins

Bath Boarding Card and risk stratification – a reply (pages 1373–1374) T. M. Cook, C. J. Peden, S. Richards, S. J. Dalton and T. E. Howes

Measuring the clinical impact of National Audit Projects (pages 1374–1376) T. M. Cook

Sedation for transfemoral aortic valve transplantation (TAVI) (page 1376) J. Lambert and S. Anwar

Sedation for transfemoral aortic valve transplantation (TAVI) – a reply (pages 1376–1377) L. F. Miles, A. A. Klein, G. Martinez and J. F. Irons

Can linear cognitive aids always be used in anaesthesia? (pages 1377–1378) Blanie and D. Benhamou Abandoning cricoid – 2 (page 1378) M. T. Gwinnutt and J. A. Gwinnutt

Discontinuation of Enk Atomiser (page 1379) D. Sirota

Tracheal tube pilot balloon fault (page 1379) Burlinson and M. Sange

Tracheal tube pilot balloon fault – a reply (pages 1379–1380) S. Murphy

Cap mount confusion in a DARTM HME Filter (page 1380) S. Sanderson and A. Ball

Potential for hypoxic mixture delivery using a Flexima 2 (pages 1380– 1381) Turnbull and T. Dexter

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Anasthesia & Analgesia October 2016 - Volume 123 - Issue 4

Opioids and Adverse Effects: More Than Just Opium Dreams Wanderer, Jonathan P.; Nathan, Naveen Anesthesia & Analgesia. 123(4):805, October 2016.

Expanding Venous Thromboembolism Prophylaxis for At-Risk Obstetric Patients: Recommendations From the National Partnership Bundle Friedman, Alexander M.; Smiley, Richard M. Anesthesia & Analgesia. 123(4):806-808, October 2016

Integrating the New Thromboprophylaxis Guidelines Into Obstetric Anesthesia Practice Leffert, Lisa; Landau, Ruth Anesthesia & Analgesia. 123(4):809-811, October 2016.

Publication Bias: The Elephant in the Review Dalton, Jarrod E.; Bolen, Shari D.; Mascha, Edward J. Anesthesia & Analgesia. 123(4):812-813, October 2016

Stroke and Intraoperative Hypotension: To Sleep, Perchance to Stroke—Ay, There’s the Rub Drummond, John C. Anesthesia & Analgesia. 123(4):814-815, October 2016.

Society for the Advancement of Patient Blood Management and Anesthesia & Analgesia: A New Collaboration and Home for Blood Management Research Hassan, Nabil E.; Tibi, Pierre R.; Marques, Marisa B. Anesthesia & Analgesia. 123(4):816-817, October 2016.

Opioid-Induced Hallucination: Distressful or Sought After? Tan, MinYi; Gan, Tong Joo Anesthesia & Analgesia. 123(4):818-819, October 2016.

Development and Validation of a Risk Stratification Score for Children With Congenital Heart Disease Undergoing Noncardiac Surgery Faraoni, David; Vo, Daniel; Nasr, Viviane G.; More Anesthesia & Analgesia. 123(4):824-830, October 2016.

A Near-Field Clutter Artifact Mimicking Pulmonary Thrombus During Transesophageal Echocardiography Liang, Yafen; Alvis, Bret; Rice, Mark J.; More Anesthesia & Analgesia. 123(4):831-833, October 2016

Opioid-induced Hallucinations: A Review of the Literature, Pathophysiology, Diagnosis, and Treatment Sivanesan, Eellan; Gitlin, Melvin C.; Candiotti, Keith A. Anesthesia & Analgesia. 123(4):836-843, October 2016.

Does Propofol Anesthesia Lead to Less Postoperative Pain Compared With Inhalational Anesthesia?: A Systematic Review and Meta-analysis Peng, Ke; Liu, Hua-Yue; Wu, Shao-Ru; More 7

Anesthesia & Analgesia. 123(4):846-858, October 2016.

The Impact of Residual Neuromuscular Blockade, Oversedation, and Hypothermia on Adverse Respiratory Events in a Postanesthetic Care Unit: A Prospective Study of Prevalence,... Stewart, Paul A.; Liang, Sophie S.; Li, Qiushuang Susan; More Anesthesia & Analgesia. 123(4):859-868, October 2016.

Effect of Intraoperative Glucose Infusion on Catabolism of Adipose Tissue and Muscle Protein in Patients Anesthetized With Remifentanil in Combination With Sevoflurane During Major... Sawada, Atsushi; Kamada, Yasuhiro; Hayashi, Haruko; More Anesthesia & Analgesia. 123(4):869-876, October 2016.

Synergistic Modulation of γ-Aminobutyric Acid Type A Receptor-Mediated Synaptic Inhibition in Cortical Networks by Allopregnanolone and Propofol Drexler, Berthold; Balk, Monika; Antkowiak, Bernd Anesthesia & Analgesia. 123(4):877-883, October 2016.

The Feasibility of a Completely Automated Total IV Anesthesia System for Cardiac Surgery Zaouter, Cedrick; Hemmerling, Thomas M.; Lanchon, Romain; More Anesthesia & Analgesia. 123(4):885-893, October 2016.

Ultrasound Identification of the Guidewire in the Brachiocephalic Vein for the Prevention of Inadvertent Arterial Catheterization During Internal Jugular Central Venous Catheter... Bowdle, Andrew; Jelacic, Srdjan; Togashi, Kei; More Anesthesia & Analgesia. 123(4):896-900, October 2016.

Impact of an Analgesia-Based Sedation Protocol on Mechanically Ventilated Patients in a Medical Intensive Care Unit Faust, Andrew C.; Rajan, Pearl; Sheperd, Lyndsay A.; More Anesthesia & Analgesia. 123(4):903-909, October 2016.

The Amount of Fluid Given During Surgery That Leaks Into the Interstitium Correlates With Infused Fluid Volume and Varies Widely Between Patients Nishimura, Akiko; Tabuchi, Yoko; Kikuchi, Mutsumi; More Anesthesia & Analgesia. 123(4):925-932, October 2016

Targeted Coagulation Management in Severe Trauma: The Controversies and the Evidence Winearls, James; Reade, Michael; Miles, Helen; More Anesthesia & Analgesia. 123(4):910-924, October 2016.

The Association Between Mild Intraoperative Hypotension and Stroke in General Surgery Patients Hsieh, Jason K.; Dalton, Jarrod E.; Yang, Dongsheng; More Anesthesia & Analgesia. 123(4):933-939, October 2016.

Anesthesiology November 2016 - Volume 33 - Issue 11

To streamline the guideline challenge: The European Society of Anaesthesiology policy on guidelines development 8

De Robertis, Edoardo; Longrois, Dan

Work stress and satisfaction in relation to personality profiles in a sample of Dutch anaesthesiologists: A questionnaire survey van der Wal, Raymond A.B.; Bucx, Martin J.L.; Hendriks, Jan C.M.; More

Stressors in anaesthesiology: development and validation of a new questionnaire: A cross- sectional study of Portuguese anaesthesiologists Lapa, Teresa A.; Carvalho, Sérgio A.; Viana, Joaquim S.; More

Stressors in anaesthesiology: development and validation of a new questionnaire: A cross- sectional study of Portuguese anaesthesiologists Lapa, Teresa A.; Carvalho, Sérgio A.; Viana, Joaquim S.; More

The efficacy of local in the early postoperative period after total knee arthroplasty: A systematic review and meta-analysis Seangleulur, Alisa; Vanasbodeekul, Pramook; Prapaitrakool, Sunisa;

Clinical concentrations of morphine are cytotoxic on proliferating human fibroblasts in vitro Aguirre, José; Borgeat, Alain; Hasler, Melanie;

Is there any analgesic benefit from preoperative vs. postoperative administration of etoricoxib in total knee arthroplasty under ?: A randomised double-blind... Munteanu, Ana Maria; Cionac Florescu, Simona; Anastase, Denisa Madalina

Modelling of the optimal bupivacaine dose for spinal anaesthesia in ambulatory surgery based on data from systematic review Lemoine, Adrien; Mazoit, Jean X.; Bonnet, Francis

Incidence and severity of chronic pain after caesarean section: A systematic review with meta- analysis Weibel, Stephanie; Neubert, Katharina; Jelting, Yvonne

Anaesthesia and orphan disease: sedation with ketofol in two patients with Joubert syndrome Atalay, Yunus O.; Soylu, Aysegul Idil; Tekcan, Demet

Anaesthesia and orphan disease: Hutchinson–Gilford progeria syndrome, a case report and summary of previous cases Vreeswijk, Sebastiaan J.M.; Claahsen, Hedi L.; Borstlap, Wilfred A

The in elective paediatric day case ENT surgery: a prospective audit Thorning, Geoff; Robb, Peter; Ewah, Bernadette;

British Journal of Anaesthesia Volume 117 suppl 2 September 2016

P. Foëx, H. Higham 9

Preoperative fast : a harbinger of perioperative adverse cardiac events Br. J. Anaesth. (2016) 117 (3): 271-274 Extract

G. G. Collee Valid consent – A pathway to improved care Br. J. Anaesth. (2016) 117 (3): 274-275 Extract

A. A. J. Van Zundert, S. P. Gatt, and R. P. Mahajan Continuing to excel in anaesthesia through the ‘big five’: teaching, training, testing, quality, and research Br. J. Anaesth. (2016) 117 (3): 276-279 Extract

C. C. Frankling, J. Yeung, P. Dark, and F. Gao I spy with my little eye something beginning with S: spotting sepsis Br. J. Anaesth. (2016) 117 (3): 279-281 Extract

N. M. Gibbs and W. M. Weightman A forcing strategy to improve the evaluation of clinical superiority in anaesthesia trials Br. J. Anaesth. (2016) 117 (3): 281-283 Extract FREE Full Text (HTML) FREE Full Text (PDF)

P. Guilabert, G. Usúa, N. Martín, L. Abarca, J. P. Barret, and M. J. Colomina Editor's Choice: Fluid resuscitation management in patients with burns: update Br. J. Anaesth. (2016) 117 (3): 284-296 d Abstract FREE Full Text (HTML) FREE Full Text (PDF)

K. El-Boghdadly, C. Madjdpour, and K. J. Chin Thoracic paravertebral blocks in abdominal surgery – a systematic review of randomized controlled trials Br. J. Anaesth. (2016) 117 (3): 297-308 Abstract

C. J. Malm, E. C. Hansson, J. Åkesson, M. Andersson, C. Hesse, C. Shams Hakimi, and A. Jeppsson Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: a prospective observational study Br. J. Anaesth. (2016) 117 (3): 309-315 Abstract

J. F. Heusdens, S. Lof, C. W. A. Pennekamp, J. C. Specken-Welleweerd, G. J. de Borst, W. A. van Klei, L. van Wolfswinkel, and R. V. Immink

Validation of non-invasive arterial pressure during carotid endarterectomy Br. J. Anaesth. (2016) 117 (3): 316-323 Abstract

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A. Toner, N. Jenkins, and G. L. Acklandthe POM-O Study Investigators Baroreflex impairment and morbidity after major surgery Br. J. Anaesth. (2016) 117 (3): 324-331 Abstract

A. Restoux, S. Grassin-Delyle, N. Liu, C. Paugam-Burtz, J. Mantz, and M. Le Guen Pilot study of closed-loop anaesthesia for liver transplantation Br. J. Anaesth. (2016) 117 (3): 332-340 Abstract

T. Boulain, D. Garot, P. Vignon, J.-B. Lascarrou, D. Benzekri-Lefevre, and P.-F. Dequin for the Clinical Research in Intensive Care and Sepsis (CRICS) Group Predicting arterial blood gas and lactate from central venous blood analysis in critically ill patients: a multicentre, prospective, diagnostic accuracy study Br. J. Anaesth. (2016) 117 (3): 341-349 Abstract

J. W. Steiner, D. I. Sessler, N. Makarova, E. J. Mascha, P. N. Olomu, J. W. Zhong, C. T. Setiawan, A. E. Handy, B. N. Kravitz, and P. Szmuk Use of deep laryngeal during in children: a randomized clinical trial Br. J. Anaesth. (2016) 117 (3): 350-357 Abstract

J. Harju, M.-L. Kalliomäki, H. Leppikangas, M. Kiviharju, and A. Yli-Hankala Surgical pleth index in children younger than 24 months of age: a randomized double-blinded trial Br. J. Anaesth. (2016) 117 (3): 358-364 Abstract

J. S. Khan, P. J. Devereaux, Y. LeManach, and J. W. Busse Patient coping and expectations about recovery predict the development of chronic post-surgical pain after traumatic tibial fracture repair Br. J. Anaesth. (2016) 117 (3): 365-370 Abstract

T. Ledowski, J. Burke, and J. Hruby Surgical pleth index: prediction of postoperative pain and influence of arousal Br. J. Anaesth. (2016) 117 (3): 371-374 Abstract

P. Howells, D. Thickett, C. Knox, D. Park, F. Gao, O. Tucker, T. Whitehouse, D. McAuley, and G. Perkins The impact of the acute respiratory distress syndrome on outcome after oesophagectomy Br. J. Anaesth. (2016) 117 (3): 375-381 Abstract

S. Kulhari, N. Bharti, I. Bala, S. Arora, and G. Singh Efficacy of pectoral versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial Br. J. Anaesth. (2016) 117 (3): 382-386 Abstract 11

L. Carline, G. A. McLeod, and C. Lamb A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks Br. J. Anaesth. (2016) 117 (3): 387-394

S. Doi, N. Cho, and T. Obara Stellate ganglion block increases blood flow in the anastomotic artery after superficial temporal artery–middle cerebral artery bypass Br. J. Anaesth. (2016) 117 (3): 395-396 Extract

F. Espitalier, S. De Lamer, T. Bourguignon, and F. Remérand Giant pseudoaneurysm of the left ventricle Br. J. Anaesth. (2016) 117 (3): 396-397 Extract

J. Mallat Positive end-expiratory pressure-induced increase in central venous pressure to predict fluid responsiveness: don't forget the peripheral venous circulation! Br. J. Anaesth. (2016) 117 (3): 397-399 do Extract

K. Lakhal, S. Ehrmann, and T. Boulain Predictive performance of passive leg raising in patients with atrial fibrillation Br. J. Anaesth. (2016) 117 (3): 399 doi Extract

Y.-L. Kwak, N. Kim, and J.-K. Shim Reply Br. J. Anaesth. (2016) 117 (3): 400 Extract

S. Saha Liberal transfusion strategy improves survival in perioperative but not in critically ill patients Br. J. Anaesth. (2016) 117 (3): 400-401 Extract

G. M. Liumbruno, G. Biancofiore, G. Marano, C. Mengoli, and M. Franchini Liberal transfusion strategy improves survival in perioperative but not in critically ill patients Br. J. Anaesth. (2016) 117 (3): 401 Extract

R. Wise, D. Bishop, nd R. Rodseth Perioperative populations are not homogeneous Br. J. Anaesth. (2016) 117 (3): 402 Extract

E. Fominskiy and G. Landoni Reply 12

Br. J. Anaesth. (2016) 117 (3): 402-403 Extract

E. Fominskiy and G. Landoni Reply Br. J. Anaesth. (2016) 117 (3): 403-404 Extract

E. Fominskiy and G. Landoni Reply Br. J. Anaesth. (2016) 117 (3): 404 Extract

M. J. Bennett, C. Brodie, N. M. Idris, A. El-Kheir, S. Asopa, and P. Robbins Patient factors that influence cerebral desaturation during transcatheter aortic valve implantation Br. J. Anaesth. (2016) 117 (3): 404-405 Extract

N. Patrick Mayr, A. Hapfelmeier, K. Martin, A. Kurz, P. van der Starre, B. Babik, D. Mazzitelli, R. Lange, G. Wiesner, and P. Tassani-Prell Reply Br. J. Anaesth. (2016) 117 (3): 405 Extract

N. Komasawa, H. Kido, and T. Minami Cricoid pressure force retention analysis using a simulator Br. J. Anaesth. (2016) 117 (3): 405-406 Extract

C. Thorborg, E.-P. Horn, H. Mofid, and F. Langer Reversal by the specific antidote, idarucizumab, of elevated dabigatran exposure in a patient with rectal perforation and paralytic ileus Br. J. Anaesth. (2016) 117 (3): 407-409 Extract

F.-P. Desgranges, J.-N. Evain, E. Pereira de Souza Neto, D. Raphael, O. Desebbe, and D. Chassard Does the plethysmographic variability index predict fluid responsiveness in mechanically ventilated children? A meta-analysis Br. J. Anaesth. (2016) 117 (3): 409-410 Extract

M. Boon, C. Martini, S. Broens, E. van Rijnsoever, T. van der Zwan, L. Aarts, and A. Dahan Improved postoperative oxygenation after antagonism of moderate neuromuscular block with sugammadex versus neostigmine after extubation in ‘blinded’ conditions Br. J. Anaesth. (2016) 117 (3): 410-411 do Extract

B. Miller Physical Diagnosis of Pain: an Atlas of Signs and Symptoms Br. J. Anaesth. (2016) 117 (3): 412 do Extract

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Preoperative coronary calcium score is predictive of early postoperative cardiovascular complications in liver transplant recipients Br. J. Anaesth. (2016) 117 (3): 413 Extract FREE Full Text (HTML) FREE Full Text (PDF)

Current Opinion in Anaesthesiology October 2016 - Volume 29 - Issue 5

Intraoperative neurophysiologic monitoring: utility and anesthetic implications Gunter, Ashley; Ruskin, Keith J.

Cerebral vasospasm: current understanding Rao, Ganne S. Umamaheswara; Muthuchellappan, Radhakrishnan

Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection Gruenbaum, Shaun E.; Meng, Lingzhong; Bilotta, Federico

Recent advances in epilepsy management Ernst, Lia D.; Boudreau, Eilis A.

Anesthetic management and human factors in the intraoperative MRI environment Berkow, Lauren C

Anaesthesia for neuroradiology: thrombectomy: ‘one small step for man, one giant leap for anaesthesia’ Wijayatilake, Dhuleep S.; Ratnayake, Gamunu; Ragavan, Dassen

Intraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanesthesia procedures Badenes, Rafael; García-Pérez, María L.; Bilotta, Federico

Microglial role in the development of chronic pain Suter, Marc R.

New modalities of neurostimulation: high frequency and dorsal root ganglion Roy, Lance A.; Gunasingha, Rathnayaka Mudiyanselage Kalpanee D.; Rauck, Richard

Medial branch nerve block and ablation as a novel approach to pain related to vertebral compression fracture Solberg, Joseph; Copenhaver, David; Fishman, Scott M.

Ultrasound indications for chronic : an update on the most recent evidence Perrine, Donald C.; Votta-Velis, Gina; Borgeat, Alain

Adjuvants to long-acting local anesthetics: custom-made postoperative analgesia Kettner, Stephan C.

Teaching concepts in ultrasound-guided regional anesthesia Kessler, Jens; Wegener, Jessica T.; Hollmann, Markus W.; More 14

Regional anesthesia in pain management Curatolo, Michele

Which patients benefit from regional anaesthesia? Poyser, Thomas; Murugesan, Sailakshmi; Smith, Andrew

Adjunct analgesic drugs to local anaesthetics for neuroaxial blocks in children Lundblad, Märit; Lönnqvist, Per-Arne

Safety and efficiency of dexmedetomidine as adjuvant to local anesthetics Marhofer, Peter; Brummett, Chad M.

NIHR signal: Epidural anaesthesia helps return of bowel function after abdominal surgery 27 September 2016 - Publisher: National Institute for Health Research Signal This is an expert commentary of a Cochrane review which pooled the results of 94 RCTs (n=5846) and found epidural anaesthetics (with or without an opioid) promote the return of gut function after abdominal surgery. Read Summary

Signal: Epidural anaesthesia helps return of bowel function after abdominal surgery Source: NIHR Dissemination Centre - 27 September 2016 ...form of abdominal surgery under . Treatment groups received an epidural...NICE guidance on the use of epidural anaesthesia or opioid injections following abdominal...form of abdominal surgery under general anaesthesia. Treatment groups received an epidural... Read Summary

Anaesthesia Review Team Guidance [PDF] Source: Royal College of Anaesthetists - 19 September 2016 Anaesthesia Review Team Guidance 2015 1Anaesthesia... INTRODUCTION AND BACKGROUND The Anaesthesia Review Team (ART), otherwise known...toward local resolution to improve the anaesthesia services they offer. This can be in...

Anaesthesia Review Team - Invited Review Request Proforma [DOC] Source: Royal College of Anaesthetists - 19 September 2016 ...RCoANews | Find us on Facebook Page of 3 Anaesthesia Review Team – Invited Review Request...the College will provide a copy of the Anaesthesia Review Team (ART) final report as...will the review need to cover? ☐ Anaesthesia ☐ Anaesthesia/Intensive Care ...

Anaesthetic interventions for prevention of awareness during surgery Anthony G Messina, Michael Wang, Marshall J Ward, Chase C Wilker, Brett B Smith, Daniel P Vezina, Nathan Leon Pace Online Publication Date: October 2016 15

Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS) Polpun Boonmak, Suhattaya Boonmak, Malinee Laopaiboon Online Publication Date: October 2016

Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery Ana Licina, Sharan Sidhu, Jing Xie, Crispin Wan Online Publication Date: September 2016

Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children Ewan D McNicol, Aikaterini Tzortzopoulou, Roman Schumann, Daniel B Carr, Aman Kalra Online Publication Date: September 2016

Hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section Ban Leong Sng, Fahad Javaid Siddiqui, Wan Ling Leong, Pryseley N Assam, Edwin SY Chan, Kelvin H Tan, Alex T Sia Online Publication Date: September 2016

Ultrasound‐guided arterial cannulation for paediatrics Marie Aouad‐Maroun, Christian K Raphael, Samia K Sayyid, Fadi Farah, Elie A Akl Online Publication Date: September 2016

Fast‐track cardiac care for adult cardiac surgical patients Wai‐Tat Wong, Veronica KW Lai, Yee Eot Chee, Anna Lee Online Publication Date: September 2016

Single, double or multiple‐ techniques for non‐ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm Ki Jinn Chin, Javier E Cubillos, Husni Alakkad Online Publication Date: September 2016

OpenAthens login required. Register here: https://openathens.nice.org.uk/

 Overview of anesthesia and anesthetic choices o Preoperative risk assessment o General anesthesia o Common anesthesia procedures o Goals of anesthesia o Summary and recommendations

 Spinal anesthesia: Technique o Preparation for spinal anesthesia o Summary and recommendations

 Techniques and devices for airway management for anesthesia: Supraglottic devices 16

(including laryngeal mask airways) o Patients with gastroesophageal reflux disease o Summary and recommendations

 Anesthesia for tonsillectomy with or without adenoidectomy in children o Anesthetic management for adenotonsillectomy o Summary and recommendations

 Anesthesia for head and neck surgery o Monitoring o Summary and recommendations

 Anesthesia for the patient with myasthenia gravis o Anesthesia management o Summary and recommendations

 Anesthesia for endovascular aortic repair o General anesthesia o with monitored anesthesia care (MAC) o Regional neuraxial anesthesia o Summary and Recommendations

 Cardiovascular problems in the post-anesthesia care unit (PACU) o Assessment and treatment of underlying causes o Initial assessment and treatment o Noxious stimuli o Summary and recommendations

 Anesthesia for elective eye surgery o Anesthesia for cataract surgery o Summary and recommendations

 Anesthesia for aortic surgery requiring deep hypothermia o Anesthetic management o Summary and recommendations

Age and the anaesthetist published August 2016.

Blood components and their alternatives 2016 published July 2016.

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Health Database Articles

1. Mode of anaesthesia and funic acid base status during emergency cesarean delivery in acute fetal compromise: A randomized trial Source: Anesthesia and Analgesia; Sep 2016; vol. 123 (no. 3); p. 255 Publication Type(s): Journal: Conference Abstract Author(s): Jain K.; P V.; Makkar J.K.; Gainder S.; S V. Available in full text at Anesthesia and Analgesia - from Ovid Abstract:Background & Objectives: The effects of different modes of anesthesia on fetal acid base status indicated due to acute fetal compromise in low risk pregnancies warrants further data.1,2 This trial compared the effects of spinal or general anaesthesia on fetal acid base status in low risk parturients requiring emergency CD indicated due to acute fetal compromise. Materials & Methods: 90 laboring parturients taken up for emergency CD (category 2) due to nonreassuring FHR were included. They were randomized to receive standard general anaesthesia or spinal anaesthesia with hyperbaric bupivavcaine (10mg with 20mug Fentanyl). Systolic BP was maintained between 90 to 110% of baseline using boluses of phenylephrine (50mug). The primary outcome variable was cord pH<7.20 or base excess >12 meq/L. Results: Incidence of foetal acidosis was observed in both the groups (Table 1). The mean UA pH in both groups was comparable.[Gp GA:7.23+/-0.07;GpSA:7.22+/- 0.07;p=0.46). There was no incidence of perinatal asphyxia. Immediate neonatal outcome was favorable with either technique. Umbilical artery Pao2 was significantly higher in GA group (p=0.015; t test). Predelivery maternal pH was comparable between the groups(p=0.13).Haemodynamics parameters were comparable between the two groups. Conclusion: In our opinion, either technique is safe if the anaesthesiologist is skilled. Nevertheless, spinal anaesthesia using prophylactic phenylephrine may be the technique of choice considering its simplicity, efficacy and safety. (Table Presented).

2. Effectiveness of interventions aimed at improving anaesthesia and perioperative outcomes in low and middle income countries: A systematic review and meta-analysis Source: Anesthesia and Analgesia; Sep 2016; vol. 123 (no. 3); p. 748 Publication Type(s): Journal: Conference Abstract Author(s): Howell V. Available in full text at Anesthesia and Analgesia - from Ovid Abstract:Background & Objectives: With the changing global burden of disease, surgery is increasingly being seen as a global health priority. However, perioperative outcomes from surgery are noticeably worse in low-income and lower-middle-income countries (LMICs). In high-income countries a focus on patient safety and quality improvement has led to advancements in care, but evidence from these countries is often unsuitable for translation to LMICs. This systematic review aims to review and analyse the evidence for interventions intended to improve perioperative outcomes in LMICs. Materials & Methods: Medline, Embase, CINAHL Plus, Global Health, LILACS and African Index Medicus databases were searched to find intervention studies from LMICs published after 1990 that were aimed at improving perioperative outcomes. In addition Google Scholar, 18

ReliefWeb, MSF Field Research and Clinical Trials websites were searched. Randomised and non- randomised controlled trials, cohort studies and before-and-after studies that involved patients undergoing general or regional anaesthesia, but not cardiac surgery, were all included. The primary outcome of interest was . Included studies were assessed for quality against GRADE criteria, and the Cochrane Collaboration's tool for assessing risk of bias was also used. Results: 3515 articles were screened, with 26 full text articles read. 3 studies were included in the review, which undertook interventions in 7 hospitals in 6 low or middle-income countries. All 3 studies evaluated implementing the WHO Surgical Safety Checklist in the perioperative period. One study also introduced pulse oximetry. The meta-analyses show a statistically significant reduction in any postoperative complication (Risk Ratio 0.55, 95% Confidence Interval 0.40-0.76), and in surgical site infections (RR 0.43, 95% CI 0.29-0.66) following introduction of the checklist. There was no statistically significant impact on mortality (RR 0.71, 95% CI 0.46-1.10). All studies were graded as very low quality evidence. Conclusion: This review highlights the paucity of studies from LMICs that examine the impact of interventions on perioperative mortality. However, it does strengthen the evidence that implementation of the WHO Surgical Safety Checklist in LMICs may reduce postoperative complications and surgical site infections.

3. Impact of sufentanil on the depth of sedation measured by during induction of anaesthesia with propofol in the elderly-a randomised trial Source: Anesthesia and Analgesia; Sep 2016; vol. 123 (no. 3); p. 203 Publication Type(s): Journal: Conference Abstract Author(s): Lysakowski C.; Elia N.; Czarnetzki C.; Dumont L.B.; Tramer M.R.; De Valence T. Available in full text at Anesthesia and Analgesia - from Ovid Abstract:Background & Objectives: Available data suggest that both advanced age or concomitant administration of a strong opioid with propofol influence bispectral index (BIS) values. We compared BIS values during propofol induction with or without concomitant opioid in elderly patients. Materials & Methods: Elderly patients > 65 years scheduled for elective surgery were included in this randomised, double-blind, placebo controlled study. They received either sufentanil, initial effect site concentration of 0.3 ng ml-1, or placebo. Thereafter propofol administration was started in both groups with initial concentration of 0.5 mug ml- 1 that was increased stepwise by 0.5 mug ml-1 until the loss of consciousness (LOC OAAS/S <2). BIS values were recorded at each propofol concentration until LOC. Results: Seventy-one patients completed the study (placebo: 36: sufentanil 35). Mean age was 72.3 (sd: 5.8), and mean BIS value at baseline was 96.8 (sd: 2.1). 41% of included patients were women. After administration of the study drug, BIS value decreased slightly more with sufentanil compared with placebo (92.6 (7.1) vs 95.4 (2.82); mean difference: 2.82 95%CI (0.28 to 5.36), p=0.030). Mean BIS values at loss of consciousness were higher in sufentanil than in placebo group (75.0 (8.6) vs 70.0 (8.0); mean difference 5.0 95%CI (1.07 to 8.93), p=0.013), and the difference was greater in men (7.25 95%CI (2.64 to 11.8); p=0.003) than in women (2.12 95%CI (-4.79 to 9.02) p=0.534). Conclusion: Administration of sufentanil has an impact on BIS values at LOC in elderly. The recommended BIS values are questionable when sufentanil is used with propofol in patients more than 65 years of age. The influence of sex in this context should be further investigated.

4. Analgesic effect of hamstring block after anterior cruciate ligament (ACL) reconstruction compared with intra-articular injection of local anaesthesia: A prospective non-randomized trial Source: Regional Anesthesia and Pain Medicine; 2016; vol. 41 (no. 5) 19

Publication Type(s): Journal: Conference Abstract Author(s): Cabaton J.; Gallet D.; Sonnery Cottet B.; Pic J.B. Abstract:Background and Aims: Effective pain control is necessary for outpatient arthroscopic ACL Reconstruction to permit early discharge and improved patient satisfaction and outcome.(1) can delay the discharge and is feared by surgeons. (2) In this study the post operative analgesic effect of hamstring donor-site block was compared with intra articular injection of the (LA) agent. Methods: A before-after study was performed during two periods of 3 months, including all ACL reconstructions by hamstring graft achieved by the same surgeon. The first ARTICULAR group received intra-articular injection of 20 mL 7.5mg/ml ropivacaine. The second GRAFT group received hamstring donor-site LA with the same 20mL of 7.5mg/ml ropivacaine, through an arthroscopic sleeve. The patients had general anesthesia after short-acting premedication, without regional anesthesia, a PONV prevention, oral multimodal postoperative analgesia and intensive local cryotherapy. The rescue pain killer at home was tramadol. Patients were called at Day1 afer surgery. Results: 255 patients were included (129 BEFORE/126 AFTER). 178 patients answered the phone call at Day1 (62%), with 79 patients in each group. There was no statistically significant difference in the pain scores measured by VAS between the groups, neither on the need for a rescue pain killer. A statistical correlation was found (p <0.001) between tramadol use and nausea-vomiting. Conclusions: A donor-site block in ACL reconstruction is found to be equally effective in controlling the postoperative pain as that of an intra articular injection of the LA agent, with satisfying pain scores. (Table Presented).

5. Magnesium sulphate as an adjuvant to upper limb regional anaesthesia and its effect on duration of analgesia, motor and sensory block: A meta-analysis Source: Regional Anesthesia and Pain Medicine; 2016; vol. 41 (no. 5) Publication Type(s): Journal: Conference Abstract Author(s): Sharma N.; Mayhew D.; Singh S.; Banerjee A. Abstract:Background and Aims: Shoulder arthroscopy is performed, not only as a diagnostic tool but also therapeutically, most suitably under an interscalene block [Anesth Analg 1999; 89:1 21 6-1220.]. Prolonged duration of local anaesthetics is desirable as patients develop severe pain on the first postoperative day after the effect of the local anaesthetic (LA) has worn off. A number of LA adjuvants including magnesium sulphate [Ain-Shams Journal of Anesthesiology 2015, 08:402-406], have been evaluated for their ability to prolong the duration of LA block with varied results. We performed a meta-analysis to find out if addition of magnesium sulphate prolongs the duration of motor block. Methods: Pubmed, EMBASE, national, international conferences and google scholar search using words magnesium sulphate, magnesium sulfate, brachial plexus block, interscalene, axillary, supraclavicular retrieved RCT's comparing LA versus LA + magnesium for upper limb surgery.. The data were analysed using RevMan software. The primary outcome was the duration ofmotor block. Secondary outcomes included duration of sensory block and duration of analgesia. Results: 10 Trials (618 patients) were included in the meta-analysis. Addition of magnesiumsulphate prolonged duration of motor blockSMD(95% CI) -1.54 [-2.55, -0.54], P = 0.003. Secondary outcomes as in Table 1. Conclusions: Addition of magnesium sulphate to LA prolongs the duration of motor block, sensory block and duration of analgesia. Magnesium sulphate has antinociceptive effects by blocking the N-methyl-D-aspartate receptor and associated calcium channels, thus preventing the central sensitization that is caused by peripheral nociceptive stimulation (Figure Presented).

6. Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes - a systematic review and meta-analysis 20

Source: Anaesthesia; Oct 2016; vol. 71 (no. 10); p. 1222-1233 Publication Type(s): Journal: Review Author(s): Qiu Q.; Choi S.W.; Wong S.S.C.; Irwin M.G.; Cheung C.W. Abstract:Propofol is used both for induction and maintenance of anaesthesia. Recent evidence shows that propofol has analgesic properties. This meta-analysis evaluated differences in postoperative analgesia between maintenance with intravenous propofol and inhalational anaesthetics. Fourteen trials met inclusion criteria and were included. Our outcomes were pain scores 2 and 24 h after surgery. No significant difference in pain scores was found at 2 h after surgery (Hedge's g (95% CI) -0.120 (-0.415-0.175) (p = 0.425). Propofol was associated with a statistically significant, albeit marginal, reduction in pain scores 24 h after surgery (Hedge's g (95% CI) -0.134 (-0.248 to -0.021) (p = 0.021). Data were insufficient to allow a meaningful analysis regarding 24-h morphine-equivalent consumption. Propofol was associated with reduced postoperative nausea and vomiting (relative risk (95%CI) 0.446 (0.304-0.656) (p < 0.0001). In conclusion, this meta-analysis suggests that propofol improves postoperative analgesia compared with inhalational anaesthesia 24 h after surgery, with a lower incidence of nausea and vomiting. Copyright © 2016 The Association of Anaesthetists of Great Britain and Ireland

7. Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care Source: Anaesthesia; Sep 2016; vol. 71 (no. 9); p. 1091-1100 Publication Type(s): Journal: Review Author(s): Heiberg J.; Canty D.J.; Royse C.F.; El-Ansary D.; Royse A.G. Abstract:Focused echocardiography is becoming a widely used tool to aid clinical assessment by anaesthetists and critical care physicians. At the present time, most physicians are not yet trained in focused echocardiography or believe that it may result in adverse outcomes by delaying, or otherwise interfering with, time-critical patient management. We performed a systematic review of electronic databases on the topic of focused echocardiography in anaesthesia and critical care. We found 18 full text articles, which consistently reported that focused echocardiography may be used to identify or exclude previously unrecognised or suspected cardiac abnormalities, resulting in frequent important changes to patient management. However, most of the articles were observational studies with inherent design flaws. Thirteen prospective studies, including two that measured patient outcome, were supportive of focused echocardiography, whereas five retrospective cohort studies, including three outcome studies, did not support focused echocardiography. There is an urgent requirement for randomised controlled trials. Copyright © 2016 The Association of Anaesthetists of Great Britain and Ireland

8. Focused echocardiography: A systematic review of diagnostic and clinical decision-making in anaesthesia and critical care Source: Anaesthesia; 2016 Publication Type(s): Journal: Article In Press Author(s): Heiberg J.; Canty D.J.; Royse C.F.; El-Ansary D.; Royse A.G. Abstract:Focused echocardiography is becoming a widely used tool to aid clinical assessment by anaesthetists and critical care physicians. At the present time, most physicians are not yet trained in focused echocardiography or believe that it may result in adverse outcomes by delaying, or otherwise interfering with, time-critical patient management. We performed a systematic review of electronic databases on the topic of focused echocardiography in anaesthesia and critical care. We found 18 full text articles, which consistently reported that focused echocardiography may be used 21

to identify or exclude previously unrecognised or suspected cardiac abnormalities, resulting in frequent important changes to patient management. However, most of the articles were observational studies with inherent design flaws. Thirteen prospective studies, including two that measured patient outcome, were supportive of focused echocardiography, whereas five retrospective cohort studies, including three outcome studies, did not support focused echocardiography. There is an urgent requirement for randomised controlled trials. Copyright © The Association of Anaesthetists of Great Britain and Ireland.

9. Intramuscular local anaesthetic infiltration at closure for post-operative analgesia in lumbar spine surgery: A systematic review and meta-analysis Source: British Journal of Neurosurgery; 2016; vol. 30 (no. 2); p. 163 Publication Type(s): Journal: Conference Abstract Author(s): Perera A.P.; Kostusiak M.; Chari A.; Khan A.A.; Luoma A.M.V.; Casey A. Abstract:Objectives To identify whether intramuscular local anaesthetic infiltration prior to wound closure was effective in reducing post-operative pain and facilitating early discharge following lumbar spine surgery. Design Systematic review and meta-analysis. Subjects Randomised controlled trials were eligible for inclusion. Methods This review was conducted according to the PRISMA statement and was registered with the PROSPERO database. Key outcomes examined included time to first analgesic demand, post-operative opiate usage, visual analogue score (VAS) at 1, 12 and 24 hours and post-operative length of stay. Results 11 publications were included. A total of 438 patients were included; 212 (control group) and 226 (intervention group). Local anaesthetic infiltration resulted in a prolonged time to first analgesic demand (mean difference (M.D) 65.88 mins, 95% CI 23.70, 108.06, p=0.002) and a significantly reduced post-operative opiate demand (M.D. -9.71mg, 95% CI -15.07, -4.34, p=.0004). There was a small but statistically significant reduction in post-operative VAS at 1 hour (M.D. -0.87 95%CI -1.55, -0.20, p=0.01). Conclusions Intramuscular local anaesthetic infiltration reduces post-operative analgesic requirement and prolongs the time to first analgesic demand following lumbar surgery. In the current climate of economic austerity, local anaesthetic infiltration could provide an important tool in facilitating day case lumbar spine surgery. Key research priorities include optimising the choice and strength of agent and formal health-economic analyses.

10. PROtocolized care to reduce HYpotension after spinal anaesthesia (ProCRHYSA randomized trial): Study protocol for a randomized controlled trial Source: Contemporary Clinical Trials Communications; Dec 2016; vol. 4 ; p. 39-45 Publication Type(s): Journal: Article Author(s): Ceruti S.; Minotti B.; De Vivo S.; Anselmi L.; Saporito A.; De Christophoris P. Abstract:Background The PROtocolized Care to Reduce HYpotension after Spinal Anaesthesia (ProCRHYSA trial) is an unblinded, randomized, monocentric, prospective, three-arm, parallel-group trial aimed at assessing the role of a controlled volemic repletion in reducing both clinically significant hypotension rate and total amount of fluid administered in patients undergoing spinal anaesthesia. Methods/Design Aim of the study is assessing the effectiveness of a non-invasive tests to guide a titrated volemic repletion before spinal anesthesia in order to reduce post-spinal hypotension rate. After local ethical committee approval of the study (Comitato Etico Cantonale Ref. N. CE2796), we will randomize patients undergoing elective surgery under spinal anesthesia into two parallel groups: in the first vena cava ultrasound will be used in order to assess adequacy of patients' volemic status and consequently guide the administration of crystalloids boluses; in the second 22

passive legs raising test will be used instead of ultrasound for the same purpose. Discussion The hypothesis we want to test is that the using of these two experimental methods before spinal anaesthesia, compared to the standard method (empirical fluid administration) can reduce the impact of systemic hypotension through an adequate titrated volemic repletion, avoiding both hypotension and fluid overload. The final purpose is to ensure that spinal anaesthesia is performed in the safest way possible. Conclusions The study will offer a new insight on the possible role of vena cava ultrasound and passive legs raising test as screening tools to prevent hypotension after spinal anesthesia. These tests were already validated in a critical environment, but to the best of our knowledge this is the first time they are applied to an elective surgical population. Trial registration The trial was registered on May 2014 on www.clinicalstrial.gov with the number NCT02070276. Copyright © 2016 The Authors

11. Topical anaesthetics for premature ejaculation: A systematic review and meta-analysis Source: Sexual Health; 2016; vol. 13 (no. 2); p. 114-123 Publication Type(s): Journal: Review Author(s): James M.M.-S.; Cooper K.; Ren K.; Kaltenthaler E.; Dickinson K.; Cantrell A.; Wylie K.; Frodsham L.; Hood C. Abstract:Eutectic Mixture of Local Anaesthetics (EMLA) is recommended for use off-label as a treatment for premature ejaculation (PE). Other topical anaesthetics are available, some of which have been evaluated against oral treatments. The purpose of this systematic review was to evaluate the evidence from randomised controlled trials (RCTs) for topical anaesthetics in the management of PE. Bibliographic databases including MEDLINE were searched to August 2014. The primary outcome was intra-vaginal ejaculatory latency time (IELT). Methodological quality of RCTs was assessed. IELT and other outcomes were pooled across RCTs in a meta-analysis. Between-trial heterogeneity was assessed. Nine RCTs were included. Seven were of unclear methodological quality. Pooled evidence (two RCTs, 43 participants) suggests that EMLA is significantly more effective than placebo at increasing IELT (P<0.00001). Individual RCT evidence also suggests that Topical Eutectic-like Mixture for Premature Ejaculation (TEMPE) spray and lidocaine are both significantly more effective than placebo (P<0.003; P<0.00001); and lidocaine gel is significantly more effective than sildenafil or paroxetine (P<0.01; P<0.0001). TEMPE spray is associated with significantly more adverse events than placebo (P<0.003). More systemic adverse events are reported with tramadol, sildenafil and paroxetine than with lidocaine gel. Diverse methods of assessing sexual satisfaction and ejaculatory control with topical anaesthetics are reported and evidence is conflicting. Topical anaesthetics appear more effective than placebo, paroxetine and sildenafil at increasing IELT in men with PE. However, the methodological quality of the existing RCT evidence base is uncertain. Copyright © CSIRO 2016.

12. A randomised trial to compare the effect of addition of clonidine or fentanyl to hyperbaric ropivacaine for spinal anaesthesia for knee arthroscopy Source: Southern African Journal of Anaesthesia and Analgesia; 2016; vol. 22 (no. 1); p. 20-24 Publication Type(s): Journal: Article Author(s): Bathari R.; Bhalotra A.R.; Anand R.; Kumar V. Abstract:Objectives: To evaluate the clinical effects of hyperbaric ropivacaine alone and with clonidine or fentanyl for spinal anaesthesia for knee arthroscopy. Methods: Sixty ASA I/ll patients were randomised to receive spinal anaesthesia with hyperbaric ropivacaine alone (Group R), or with clonidine 15 mug (Group RC) or fentanyl 30 mug (Group RF).The sensory and motor block, time to 23

micturition and side effects were assessed. Results:The three groups were similar in mean time to onset of sensory block atTIO, height of block and time to maximum block. Sensory regression to S2 took longer in Groups RF and RC compared with Group R (p = 0.001 and p < 0.01, respectively). Time to requirement of rescue analgesia was longer in Groups RF and RC compared with Group R (p = 0.023 and 0.002, respectively). Time for complete regression of motor blockand time to voiding were longer in group RC compared with group R (p = 0.022 and p = 0.013, respectively). Conclusion:The addition of fentanyl 30 mug to hyperbaric ropivacaine may be superior to the addition of clonidine 15 mug for knee arthroscopy as it provides a similar prolongation of sensory block and analgesia without prolonging motor block and time to micturition. Copyright © 2016 The Author(s).

13. Local anaesthetic wound infiltration for postcaesarean section analgesia: A systematic review and meta-analysis. Source: European journal of anaesthesiology; Oct 2016; vol. 33 (no. 10); p. 731-742 Publication Type(s): Journal Article Author(s): Adesope, Oluwaseyi; Ituk, Unyime; Habib, Ashraf S Abstract:Wound infiltration with local anaesthetics has been investigated as a potentially useful method for providing analgesia after caesarean delivery, but the literature is inconclusive. The objective is to assess the efficacy of local anaesthetic wound infiltration in reducing pain scores and opioid consumption in women undergoing caesarean delivery. Systematic review of randomised controlled trials with meta-analyses. MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled trials (CENTRAL) until December 2015. Randomised controlled trials that assessed the efficacy of local anaesthetic wound infiltration using an infusion or single injection technique for postcaesarean section analgesia. A total of 21 studies were included in the final analysis (11 studies using an infusion technique and 10 studies using single infiltration). Local anaesthetic wound infiltration significantly decreased opioid consumption at 24 h [mean difference -9.69 mg morphine equivalents, 95% confidence interval (CI), -14.85 to -4.52] and pain scores after 24 h at rest (mean difference -0.36, 95% CI, -0.58 to -0.14) and on movement (mean difference -0.61, 95% CI, -1.19 to - 0.03). Subgroup analysis did not suggest a difference in primary outcomes between infusions and single infiltration. Opioid consumption was reduced in patients who did not receive intrathecal morphine but not in those who received intrathecal morphine, although there were very little data in patients receiving intrathecal morphine. Pain scores at rest and on movement at 24 h were reduced with catheter placement below the fascia but not above the fascia. There were no statistically significant reductions in nausea, vomiting or pruritus with local anaesthetic infiltration. Local anaesthetic wound infiltration reduces postoperative opioid consumption but had minimal effect on pain scores and did not reduce opioid-related side-effects in women who had undergone delivery by caesarean section. The review is limited by a paucity of studies using intrathecal morphine and by the indirect comparisons performed for subgroup analyses.

14. Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis. Source: PloS one; 2016; vol. 11 (no. 5); p. e0156448 Publication Type(s): Journal Article Author(s): Stevanovic, Ana; Rossaint, Rolf; Veldeman, Michael; Bilotta, Federico; Coburn, Mark Abstract:Awake craniotomy (AC) renders an expanded role in functional neurosurgery. Yet, evidence for optimal anaesthesia management remains limited. We aimed to summarise the latest clinical evidence of AC anaesthesia management and explore the relationship of AC failures on the used anaesthesia techniques. Two authors performed independently a systematic search of English 24

articles in PubMed and EMBASE database 1/2007-12/2015. Search included randomised controlled trials (RCTs), observational trials, and case reports (n>4 cases), which reported anaesthetic approach for AC and at least one of our pre-specified outcomes: intraoperative seizures, , arterial hypertension, nausea and vomiting, neurological dysfunction, conversion into general anaesthesia and failure of AC. Random effects meta-analysis was used to estimate event rates for four outcomes. Relationship with anaesthesia technique was explored using logistic meta-regression, calculating the odds ratios (OR) and 95% confidence intervals [95%CI]. We have included forty-seven studies. Eighteen reported asleep-awake-asleep technique (SAS), twenty-seven monitored anaesthesia care (MAC), one reported both and one used the awake-awake-awake technique (AAA). Proportions of AC failures, intraoperative seizures, new neurological dysfunction and conversion into general anaesthesia (GA) were 2% [95%CI:1-3], 8% [95%CI:6-11], 17% [95%CI:12-23] and 2% [95%CI:2-3], respectively. Meta-regression of SAS and MAC technique did not reveal any relevant differences between outcomes explained by the technique, except for conversion into GA. Estimated OR comparing SAS to MAC for AC failures was 0.98 [95%CI:0.36-2.69], 1.01 [95%CI:0.52-1.88] for seizures, 1.66 [95%CI:1.35-3.70] for new neurological dysfunction and 2.17 [95%CI:1.22-3.85] for conversion into GA. The latter result has to be interpreted cautiously. It is based on one retrospective high-risk of bias study and significance was abolished in a sensitivity analysis of only prospectively conducted studies. SAS and MAC techniques were feasible and safe, whereas data for AAA technique are limited. Large RCTs are required to prove superiority of one anaesthetic regime for AC.

15. Total intravenous anaesthesia versus single-drug pharmacological antiemetic prophylaxis in adults: A systematic review and meta-analysis. Source: European journal of anaesthesiology; Oct 2016; vol. 33 (no. 10); p. 750-760 Publication Type(s): Journal Article Author(s): Schaefer, Maximilian S; Kranke, Peter; Weibel, Stephanie; Kreysing, Robert; Kienbaum, Peter Abstract:Postoperative nausea and vomiting (PONV) are among the most unfavourable anaesthetic outcomes attributed to the administration of inhaled anaesthetics. Accordingly, inhaled anaesthetics are frequently substituted by propofol when patients are at risk of PONV. As, on some occasions, inhalational anaesthesia may be favourable, the relative impact of propofol anaesthesia needs to be established based on robust data. To compare the effectiveness of a single-drug pharmacological prophylaxis with total intravenous anaesthesia (TIVA) for prevention of PONV. Systematic review of randomised controlled trials with meta-analyses. All available studies until 29 April 2015 were retrieved from MEDLINE, CENTRAL and EMBASE. Randomised controlled trials on adult patients undergoing general anaesthesia with at least one group receiving propofol-based intravenous anaesthesia without further antiemetic prophylaxis, and one group receiving inhalational anaesthesia with single-drug antiemetic prophylaxis. Fourteen studies involving 2051 patients were included. Compared with TIVA, after inhalational anaesthesia and single-drug antiemetic prophylaxis, there was no difference in the overall risk of PONV [relative risk (RR) 1.06, 95% confidence interval (CI) 0.85; 1.32, GRADE rating moderate], nor was there any difference in the risk of postoperative vomiting (RR 1.17, 95% CI 0.78; 1.76), need for rescue medication (RR 1.16, 95% CI 0.68; 1.99) or early PONV (RR 1.06, 95% CI 0.88; 1.27). However, TIVA was associated with an increased risk of late PONV (RR 1.41, 95% CI 1.10; 1.79, P = 0.006). Six studies investigated other side- effects associated with anaesthesia and found no differences between the two groups. Finally, there was evidence of a publication bias that included smaller studies favouring TIVA. This meta-analysis confirms the results from indirect comparisons in individual studies: instead of substituting inhalational anaesthesia with propofol-based TIVA, a similar antiemetic effect can be achieved by adding single-drug pharmacological prophylaxis to the inhalational anaesthetic. This systematic 25

review with meta-analysis was registered at PROSPERO (www.crd.york.ac.uk/PROSPERO), study number CRD42015019571.

16. Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes - a systematic review and meta-analysis. Source: Anaesthesia; Oct 2016; vol. 71 (no. 10); p. 1222-1233 Publication Type(s): Journal Article Review Author(s): Qiu, Q; Choi, S W; Wong, S S C; Irwin, M G; Cheung, C W Abstract:Propofol is used both for induction and maintenance of anaesthesia. Recent evidence shows that propofol has analgesic properties. This meta-analysis evaluated differences in postoperative analgesia between general anaesthetic maintenance with intravenous propofol and inhalational anaesthetics. Fourteen trials met inclusion criteria and were included. Our outcomes were pain scores 2 and 24 h after surgery. No significant difference in pain scores was found at 2 h after surgery (Hedge's g (95% CI) -0.120 (-0.415-0.175) (p = 0.425). Propofol was associated with a statistically significant, albeit marginal, reduction in pain scores 24 h after surgery (Hedge's g (95% CI) -0.134 (-0.248 to -0.021) (p = 0.021). Data were insufficient to allow a meaningful analysis regarding 24-h morphine-equivalent consumption. Propofol was associated with reduced postoperative nausea and vomiting (relative risk (95%CI) 0.446 (0.304-0.656) (p < 0.0001). In conclusion, this meta-analysis suggests that propofol improves postoperative analgesia compared with inhalational anaesthesia 24 h after surgery, with a lower incidence of nausea and vomiting. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

17. Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma. Source: British journal of anaesthesia; Sep 2016; vol. 117 Publication Type(s): Journal Article Author(s): Mercer, S J; Jones, C P; Bridge, M; Clitheroe, E; Morton, B; Groom, P Abstract:Non-iatrogenic trauma to the airway is rare and presents a significant challenge to the anaesthetist. Although guidelines for the management of the unanticipated difficult airway have been published, these do not make provision for the 'anticipated' difficult airway. This systematic review aims to inform best practice and suggest management options for different injury patterns. A literature search was conducted using Embase, Medline, and Google Scholar for papers after the year 2000 reporting on the acute airway management of adult patients who suffered airway trauma. Our protocol and search strategy are registered with and published by PROSPERO (http://www.crd.york.ac.uk/PROSPERO, ID: CRD42016032763). A systematic literature search yielded 578 articles, of which a total of 148 full-text papers were reviewed. We present our results categorized by mechanism of injury: blunt, penetrating, blast, and burns. The hallmark of airway management with trauma to the airway is the maintenance of spontaneous ventilation, intubation under direct vision to avoid the creation of a false passage, and the avoidance of both intermittent positive pressure ventilation and cricoid pressure (the latter for laryngotracheal trauma only) during a rapid sequence induction. Management depends on available resources and time to perform airway assessment, investigations, and intervention (patients will be classified into one of three categories: no time, some time, or adequate time). Human factors, particularly the development of a shared mental model amongst the trauma team, are vital to mitigate risk and improve patient safety. © Crown copyright 2016. 26

18. Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care. Source: Anaesthesia; Sep 2016; vol. 71 (no. 9); p. 1091-1100 Publication Type(s): Journal Article Review Author(s): Heiberg, J; El-Ansary, D; Canty, D J; Royse, A G; Royse, C F Abstract:Focused echocardiography is becoming a widely used tool to aid clinical assessment by anaesthetists and critical care physicians. At the present time, most physicians are not yet trained in focused echocardiography or believe that it may result in adverse outcomes by delaying, or otherwise interfering with, time-critical patient management. We performed a systematic review of electronic databases on the topic of focused echocardiography in anaesthesia and critical care. We found 18 full text articles, which consistently reported that focused echocardiography may be used to identify or exclude previously unrecognised or suspected cardiac abnormalities, resulting in frequent important changes to patient management. However, most of the articles were observational studies with inherent design flaws. Thirteen prospective studies, including two that measured patient outcome, were supportive of focused echocardiography, whereas five retrospective cohort studies, including three outcome studies, did not support focused echocardiography. There is an urgent requirement for randomised controlled trials. © 2016 The Association of Anaesthetists of Great Britain and Ireland. Database: Medline 9. Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review. Source: Systematic reviews; 2016; vol. 5 ; p. 66 Publication Type(s): Research Support, Non-u.s. Gov't Journal Article Author(s): Yeung, Joyce; Patel, Vanisha; Champaneria, Rita; Dretzke, Janine Abstract:With an ageing population, the incidence of hip fractures requiring surgery is increasing. Post-operative delirium is common following hip fracture surgery. Delirium is associated with high mortality and morbidity, poor long-term functional outcomes and institutionalisation. There is some evidence to suggest that perioperative intervention, specifically the anaesthetic technique employed, may reduce the incidence of delirium in this population. The aim of this systematic review is to investigate the impact of anaesthesia type on post-operative delirium. We will conduct a systematic literature review using Embase, MEDLINE, CINAHL and the Cochrane Library (CENTRAL) bibliographic databases and the ZETOC and Web of Science websites. Authors of these trials will be invited to contribute unpublished data. PROSPERO register and clinical trial registers will also be searched to identify any ongoing reviews and trials. Eligible studies will assess the incidence of post- operative delirium in patients having regional or general anaesthesia for hip fracture surgery. The primary outcome of interest will be post-operative delirium; secondary outcomes will include mortality, measures of functional outcome, quality of life, length of hospital stay, discharge location and adverse events. Two reviewers will independently screen references identified by electronic literature searches. Two independent reviewers will extract data from studies fulfilling our inclusion criteria using a piloted data extraction form. Methodological quality and bias of included randomised controlled trials will be assessed using the 'Cochrane Collaborations tool for assessing risk of bias'; for non-randomised studies, this will be assessed using the Newcastle-Ottawa scale. Data on similar outcomes will be pooled when possible. Where possible, meta-analysis will be undertaken using Review Manager (RevMan version 5.3) software. This systematic review will provide an updated evidence base with which to guide clinical practice and research for this group of challenging patients. If the anaesthetic technique employed is shown to reduce the incidence of post-operative 27

cognition dysfunction, then this may lead to a change in evidence-based practice, influence future guidelines and support further randomised controlled trial research. There is no known effective treatment for delirium, creating the urgent need for research into delirium prevention. PROSPERO CRD42015020166.

20. The Post-Anaesthesia N-acetylcysteine Cognitive Evaluation (PANACEA) trial: study protocol for a randomised controlled trial. Source: Trials; 2016; vol. 17 ; p. 395 Publication Type(s): Journal Article Author(s): Skvarc, David R; Dean, Olivia M; Byrne, Linda K; Gray, Laura J; Ives, Kathryn; Lane, Stephen E; Lewis, Matthew; Osborne, Cameron; Page, Richard; Stupart, Douglas; Turner, Alyna; Berk, Michael; Marriott, Andrew J Abstract:Some degree of cognitive decline after surgery occurs in as many as one quarter of elderly surgical patients, and this decline is associated with increased morbidity and mortality. Cognition may be affected across a range of domains, including memory, psychomotor skills, and executive function. Whilst the exact mechanisms of cognitive change after surgery are not precisely known, oxidative stress and subsequent neuroinflammation have been implicated. N-acetylcysteine (NAC) acts via multiple interrelated mechanisms to influence oxidative homeostasis, neuronal transmission, and inflammation. NAC has been shown to reduce oxidative stress and inflammation in both human and animal models. There is clinical evidence to suggest that NAC may be beneficial in preventing the cognitive decline associated with both acute physiological insults and dementia- related disorders. To date, no trials have examined perioperative NAC as a potential moderator of postoperative cognitive changes in the noncardiac surgery setting. This is a single-centre, randomised, double-blind, placebo-controlled clinical trial, with a between-group, repeated- measures, longitudinal design. The study will recruit 370 noncardiac surgical patients at the University Hospital Geelong, aged 60 years or older. Participants are randomly assigned to receive either NAC or placebo (1:1 ratio), and groups are stratified by age and surgery type. Participants undergo a series of neuropsychological tests prior to surgery, 7 days, 3 months, and 12 months post surgery. It is hypothesised that the perioperative administration of NAC will reduce the degree of postoperative cognitive changes at early and long-term follow-up, as measured by changes on individual measures of the neurocognitive battery, when compared with placebo. Serum samples are taken on the day of surgery and on day 2 post surgery to quantitate any changes in levels of biomarkers of inflammation and oxidative stress. The PANACEA trial aims to examine the potential efficacy of perioperative NAC to reduce the severity of postoperative cognitive dysfunction in an elderly, noncardiac surgery population. This is an entirely novel approach to the prevention of postoperative cognitive dysfunction and will have high impact and translatable outcomes if NAC is found to be beneficial. The PANACEA trial has been registered with the Therapeutic Goods Administration, and the Australian New Zealand Clinical Trials Registry: ACTRN12614000411640 ; registered on 15 April 2014.

21. Manual vs. pressure-controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial. Source: Acta anaesthesiologica Scandinavica; Sep 2016; vol. 60 (no. 8); p. 1075-1083 Publication Type(s): Journal Article Author(s): Park, J H; Kim, J Y; Lee, J M; Kim, Y H; Jeong, H W; Kil, H K Abstract:During anaesthetic induction with a facemask, the inconsistent inspiratory flow with 28

manual ventilation (MV) raises the peak airway pressure (PAP), which can be significantly higher than PAP during pressure-controlled ventilation (PCV). In this study, PAP was compared between MV and PCV at the same tidal volume of 8-10 ml/kg during facemask ventilation for anaesthetic induction in children. The occurrence of gastric insufflation (GI) was evaluated with ultrasonography and stethoscopic auscultation. Forty-eight children, aged 0.5-7 years, undergoing elective urologic surgery were randomly allocated into either Group MV or Group PCV. Under light sedation with thiopental iv., ultrasonography (US) was performed and the gastric antrum was identified. After additional thiopental and rocuronium administration, facemask ventilation with a tidal volume of 8- 10 ml/kg was performed for 3 min, whereas respiratory parameters were recorded at 1 min intervals. Real-time US and stethoscopic auscultation were performed for evaluation of GI. In the MV group, PAP was higher at all the time points compared with the PCV group (14 vs. 9.5, 15 vs. 10 and 15 vs. 9 cmH2 O, all P < 0.05). However, there was no difference in the GI occurrence between Group MV and Group PCV (7 vs. 3, P = 0.284). There was no difference between PAP in patients with GI and without GI (P > 0.05). Ultrasonography was more sensitive in detecting GI than the stethoscopic auscultation (10 vs. 5). Gastric antral area was expanded after facemask ventilation in both groups, but there were no intergroup differences. Although PCV provided lower PAP than MV at the same tidal volume, the risk of GI may not be eliminated during facemask ventilation in paralysed small children. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

22. Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial. Source: Lancet (London, England); Sep 2016; vol. 388 (no. 10049); p. 1067-1074 Publication Type(s): Journal Article Author(s): Aitken, Emma; Jackson, Andrew; Kearns, Rachel; Steven, Mark; Kinsella, John; Clancy, Marc; Macfarlane, Alan Abstract:Arteriovenous fistulae are the optimum form of vascular access in end-stage renal failure. However, they have a high early failure rate. Regional compared with local anaesthesia results in greater vasodilatation and increases short-term blood flow. This study investigated whether regional compared with local anaesthesia improved medium-term arteriovenous fistula patency. This observer-blinded, randomised controlled trial was done at three university hospitals in Glasgow, UK. Adults undergoing primary radiocephalic or brachiocephalic arteriovenous fistula creation were randomly assigned (1:1; in blocks of eight) using a computer-generated allocation system to receive either local anaesthesia (0·5% L-bupivacaine and 1% lidocaine injected subcutaneously) or regional (brachial plexus block [BPB]) anaesthesia (0·5% L-bupivacaine and 1·5% lidocaine with epinephrine). Patients were excluded if they were coagulopathic, had no suitable vessels, or had a previous failed ipsilateral fistula. The primary endpoint was arteriovenous fistula patency at 3 months. We analysed the data on an intention-to-treat basis. This study was registered with ClinicalTrials.gov (NCT01706354) and is complete. Between Feb 6, 2013, and Dec 4, 2015, 163 patients were assessed for eligibility and 126 patients were randomly assigned to local anaesthesia (n=63) or BPB (n=63). All patients completed follow-up on an intention-to-treat basis. Primary patency at 3 months was higher in the BPB group than the local anaesthesia group (53 [84%] of 63 patients vs 39 [62%] of 63; odds ratio [OR] 3·3 [95% CI 1·4-7·6], p=0·005) and was greater in radiocephalic fistulae (20 [77%] of 26 patients vs 12 [48%] of 25; OR 3·6 [1·4-3·6], p=0·03). There were no significant adverse events related to the procedure. Compared with local anaesthesia, BPB significantly improved 3 month primary patency rates for arteriovenous fistulae. Regional Anaesthesia UK, Darlinda's Charity for Renal Research. Copyright © 2016 Elsevier Ltd. All rights reserved.

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23. Response to Re: Short-term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double-blinded controlled trial. Source: ANZ journal of surgery; Sep 2016; vol. 86 (no. 9); p. 733 Publication Type(s): Letter Author(s): Mulford, Jonathan

24. Re: Short-term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double-blinded controlled trial. Source: ANZ journal of surgery; Sep 2016; vol. 86 (no. 9); p. 733 Publication Type(s): Letter Author(s): Kehlet, Henrik

25. An embedded checklist in the Anesthesia Information Management System improves pre- anaesthetic induction setup: a randomised controlled trial in a simulation setting. Source: BMJ quality & safety; Oct 2016; vol. 25 (no. 10); p. 739-746 Publication Type(s): Journal Article Author(s): Wetmore, Douglas; Goldberg, Andrew; Gandhi, Nishant; Spivack, John; McCormick, Patrick; DeMaria, Samuel Abstract:Anaesthesiologists work in a high stress, high consequence environment in which missed steps in preparation may lead to medical errors and potential patient harm. The pre-anaesthetic induction period has been identified as a time in which medical errors can occur. The Anesthesia Patient Safety Foundation has developed a Pre-Anesthetic Induction Patient Safety (PIPS) checklist. We conducted this study to test the effectiveness of this checklist, when embedded in our institutional Anesthesia Information Management System (AIMS), on resident performance in a simulated environment. Using a randomised, controlled, observer-blinded design, we compared performance of anaesthesiology residents in a simulated operating room under production pressure using a checklist in completing a thorough pre-anaesthetic induction evaluation and setup with that of residents with no checklist. The checklist was embedded in the simulated operating room's electronic medical record. Data for 38 anaesthesiology residents shows a statistically significant difference in performance in pre-anaesthetic setup and evaluation as scored by blinded raters (maximum score 22 points), with the checklist group performing better by 7.8 points (p<0.01). The effects of gender and year of residency on total score were not significant. Simulation duration (time to anaesthetic agent administration) was increased significantly by the use of the checklist. Required use of a pre-induction checklist improves anaesthesiology resident performance in a simulated environment. The PIPS checklist as an integrated part of a departmental AIMS warrant further investigation as a quality measure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

26. Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anaesthesia in children: a randomised clinical trial. Source: International journal of paediatric / the British Paedodontic Society [and] the International Association of Dentistry for Children; Sep 2016; vol. 26 (no. 5); p. 336-345 Publication Type(s): Journal Article 30

Author(s): Şermet Elbay, Ülkü; Elbay, Mesut; Yıldırım, Sİnem; Kaya, Emİne; Kaya, Can; Uğurluel, Ceren; Baydemİr, Canan Abstract:The purpose of this study was to compare the use of a traditional (TS) and the DentalVibe (DV) Injection Comfort System on the pain of needle insertion and injection of supraperiosteal (SP) anaesthesia into the mandibles and maxillas of children aged 6-12 years. The study was a randomised, controlled, crossover clinical trial, comprising 60 children requiring an operative procedure with SP anaesthesia on both their mandibular and maxillary molars, bilaterally. One of the molars was treated with a TS, and the contralateral tooth was treated with the DV for both arches. On each visit, subjective and objective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Face, Leg, Activity, Cry, Consolability Scale. Patients were asked which technique they preferred. The data were analysed using Wilcoxon signed-rank test, Spearman's correlation test, and Mann-Whitney U-test. No statistically significant differences were noted between TS and DV for pain during injection and needle insertion for supraperiosteal anaesthesia in either the maxillary and mandibular operative procedures. Children experienced similar pain during SP anaesthesia administered with a TS and the DV, regardless of gender and jaw differences. DV was less preferred over the traditional procedure in children. © 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

27. Correction: Study protocol for a pilot, randomised, double-blinded, placebo controlled trial of perineural local anaesthetics and steroids for chronic posttraumatic neuropathic pain in the ankle and foot: the PREPLANS study. Source: BMJ open; 2016; vol. 6 (no. 7); p. e012293corr1 Publication Type(s): Journal Article Database:

28. Study protocol for a pilot, randomised, double-blinded, placebo controlled trial of perineural local anaesthetics and steroids for chronic post-traumatic neuropathic pain in the ankle and foot: the PREPLANS study. Source: BMJ open; 2016; vol. 6 (no. 6); p. e012293 Publication Type(s): Journal Article Author(s): Bhatia, Anuj; Bril, Vera; Brull, Richard T; Perruccio, Anthony; Wijeysundera, Duminda; Alvi, Sabbeh; Lau, Johnny; Gandhi, Rajiv; Mahomed, Nizar; Davis, Aileen M Abstract:Peripheral neuropathic pain (PNP) associated with trauma is often refractory to treatment. Administration of local anaesthetics (LA) and steroids around injured nerves has been proposed as an option for patients unresponsive to conventional treatments for refractory PNP following trauma. There is insufficient evidence to support a large, potentially expensive, full-scale randomised controlled trial (RCT) that involves comparison of effects of perineural steroids and LA against LA or saline injections on analgesia, physical and psychological functioning, and quality of life. There is also a lack of data that would allow estimation of analgesic efficacy or sample size for the full-scale RCT. The objective of this pilot RCT is to yield information to support planning of a full-scale RCT in this population. 30 participants with post-traumatic PNP in the ankle and foot of moderate-to-severe intensity and duration of more than 3 months will be enrolled in this pilot RCT. Participants will be randomised to receive three ultrasound-guided perineural injections of 0.9% saline, 0.25% bupivacaine (a long-acting LA) or a combination of 0.25% bupivacaine and a steroid (methylprednisolone 16 mg per nerve) at weekly intervals. The primary objectives are to determine the feasibility and sample size of a full-scale RCT in this population. The secondary objectives are to evaluate the effect of study interventions on analgesia, persistence of neuropathic pain, 31

psychological and physical function, quality of life and participants' global impression of change at 1 and 3 months after the interventions. In addition, adverse effects associated with perineural injections and with systemic absorption of steroids will also be recorded. The protocol was approved by the University Health Network Research Ethics Board (UHN REB number 15-9584-A). The results will be disseminated in peer-reviewed journals and at scientific conferences. NCT02680548; Pre- results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and- licensing/

29. A low dose of subperiosteal anaesthesia injection versus a high dose of infiltration anaesthesia to minimise the risk of nerve damage at implant placement: A randomised controlled trial. Source: European journal of oral implantology; 2016; vol. 9 (no. 1); p. 59-66 Publication Type(s): Comparative Study Randomized Controlled Trial Journal Article Author(s): Sánchez-Siles, Mariano; Camacho-Alonso, Fabio; Salazar-Sánchez, Noemi; Aguinaga- Ontoso, Enrique; Muñoz, Javier Guardia; Calvo-Guirado, Jose Luis Abstract:To evaluate whether a low-dose subperiosteal anaesthesia is effective in minimising risks of inferior alveolar nerve damage at implant placement when compared to high-dose infiltration anaesthesia. One hundred and twenty patients requiring the placement of a single implant in order to replace a missing first mandibular were randomly allocated to two groups: group A (awake hemilip) subperiosteal crestal injection equal to 0.9 ml of articaine with 0.5% epinephrine and group B (numb hemilip) infiltration equal to 7.2 ml of articaine with 0.5% epinephrine in the vestibular fundus. Intraoperative sensory control using sensory tests was carried out in all patients. Outcome measures were neurological complications, intraoperative and postoperative visual analogue scale (VAS) scores for pain and swelling, and a questionnaire evaluating patient satisfaction. Patients were followed for 1 week postoperatively. There were no cases of nerve injury. Seven days after surgery the postoperative VAS score for pain and swelling was lower in group A in a statistically significant manner (difference = -3.41%; 95% CI: -5.57, -1.26; P = 0.002 and difference = -3.33%; 95% CI: -5.41, - 1.25; P = 0.002, respectively). No nerve damage occurred using either anaesthesia types, therefore the choice of type of anaesthesia is a subjective clinical decision, however it may be preferable to use a low dose (0.9 ml) of subperiosteal anaesthesia, since it is unnecessary to deliver 7.2 ml of articaine to anaesthetise a single mandibular molar implant site.

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