Anaesthesia Latest Evidence Newsletter February 2016 Outreach Your Outreach Librarian can help facilitate evidence-based practise for all Anaesthesia staff, as well as assisting with academic study and research. We can help with literature searching, obtaining journal articles and books, and setting up individual evidence alerts. 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 and introduce you to the health databases access via NHS Evidence. Critical Appraisal Training We also offer one-to-one or small group training in literature searching, accessing electronic journals, and critical appraisal/Statistics. These are essential courses that teach how to interpret clinical papers. For more information, email: [email protected] Books Books can be searched for using SWIMS our online catalogue at www.swims.nhs.uk. Books and journals that are not available on site or electronically may be requested from other locations. Please email requests to: [email protected] Contents 1: Latest database articles 2: Tables of Contents from February’s Anaesthesia journals 3: New activity in UpToDate 4: Latest relevant Systematic Reviews from the Cochrane Library 5: Quick exercise Latest Database Articles If you require full articles please email: [email protected] Title: Hypotensive Anesthesia Is Associated With Shortened Length of Hospital Stay Following Orthognathic Surgery. Citation: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, Jan 2016, vol. 74, no. 1, p. 130-138 (January 2016) Author(s): Ettinger, Kyle S, Yildirim, Yavuz, Weingarten, Toby N, Van Ess, James M, Viozzi, Christopher F, Arce, Kevin Abstract: To evaluate the impact of induced hypotensive anesthesia on length of hospital stay (LOS) for patients undergoing maxillary Le Fort I osteotomy in isolation or in combination with mandibular orthognathic surgery. A retrospective cohort study design was implemented and patients undergoing a Le Fort I osteotomy as a component of orthognathic surgery at the Mayo Clinic from 2010 through 2014 were identified. The primary predictor variable was the presence of induced hypotensive anesthesia during orthognathic surgery. Hypotensive anesthesia was defined as at least 10 consecutive minutes of a mean arterial pressure no higher than 60 mmHg documented within the anesthetic record. The primary outcome variable was LOS in hours after completion of orthognathic surgery. The secondary outcome variable was the duration of surgery in hours. Multiple covariates also abstracted included patient age, patient gender, American Society of Anesthesiologists score, complexity of surgical procedure, and volume of intraoperative fluids administered during surgery. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables. A total of 117 patients were identified undergoing Le Fort I orthognathic surgery in isolation or in combination with mandibular surgery. Induced hypotensive anesthesia was significantly associated with shortened LOS (odds ratio [OR] = 0.33; 95% confidence interval [CI], 0.12-0.88; P = .026) relative to patients with normotensive regimens. This association between hypotensive anesthesia and LOS remained statistically significant in a subgroup analysis of 47 patients in whom isolated Le Fort I surgery was performed (OR = 0.13; 95% CI, 0.03-0.62; P = .010). Induced hypotensive anesthesia was not statistically associated with shorter duration of surgery. Induced hypotensive anesthesia represents a potential factor that minimizes postoperative LOS for patients undergoing routine maxillary orthognathic surgery alone or in combination with mandibular procedures. Hypotensive anesthesia does not appear to be effective in minimizing the duration of surgery within this same patient population. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved. Title: What lessons for clinical practice can be learned from systematic reviews of animal studies? The case of anesthetic neurotoxicity. Citation: Paediatric anaesthesia, Jan 2016, vol. 26, no. 1, p. 4-5 (January 2016) Author(s): Loepke, Andreas W, Vutskits, Laszlo Title: Comparative Effectiveness of Two Ultrasound-Guided Regional Block Techniques for Surgical Anesthesia in Open Unilateral Inguinal Hernia Repair. Citation: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, Jan 2016, vol. 35, no. 1, p. 177-182 (January 2016) Author(s): Steffel, Lauren, Kim, T Edward, Howard, Steven K, Ly, Daphne P, Kou, Alex, King, Robert, Mariano, Edward R Abstract: Transversus abdominis plane (TAP) and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described as analgesic adjuncts for inguinal hernia repair, but the efficacy of these techniques in providing intraoperative anesthesia, either individually or together, is not known. We designed this retrospective cohort study to test the hypothesis that combining TAP and II/IH nerve blocks ("double TAP" technique) results in greater accordance between the preoperative anesthetic plan and actual anesthetic technique provided when compared to TAP alone. Based on this study, double TAP may be preferred for patients undergoing open inguinal hernia repair who wish to avoid general anesthesia. Title: Intrathecal Sufentanil Does Not Reduce Shivering During Neuraxial Anesthesia: A Meta- Analysis. Citation: Medical science monitor : international medical journal of experimental and clinical research, Jan 2016, vol. 22, p. 258-266 (2016) Author(s): Feng, Lin Shao, Hong, Gao, Yan, Zhao, Qiu, Liu Yan, Liang, Li An Abstract: BACKGROUND We performed this meta-analysis to evaluate the efficacy of intrathecal sufentanil in preventing shivering during neuraxial anesthesia. MATERIAL AND METHODS We searched the Cochrane Library, PubMed, and Embase for all randomized controlled trials (RCT) on use of intrathecal sufentanil for preventing shivering during neuraxial anesthesia. References of retrieved articles were also screened. The quality of the studies was evaluated by the method recommended by the Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.3 software. The primary outcome was incidence and severity of shivering, and the secondary outcomes were drug-related complications of pruritus, nausea, vomiting, hypotension, and bradycardia. RESULTS Eight original RCTs investigating a total of 1032 patients, of whom 599 received sufentanil and 473 received placebo, met the inclusion criteria. Compared to the placebo group, sufentanil did not reduce incidence of shivering (OR, 0.60; 95% CI, 0.35 to 1.01; P=0.06), but it increased the incidence of pruritus (OR, 12.52; 95% CI, 5.07 to 30.91; P<0.00001). Compared to the placebo group, sufentanil did not increase the incidence of nausea (OR, 0.69; 95% CI, 0.41 to 1.16; P=0.16), hypotension (OR, 0.93; 95% CI, 0.62 to 1.41; P=0.74), or bradycardia (OR, 0.86; 95% CI, 0.41 to 1.82; P=0.70). In addition, sufentanil reduced the incidence of vomiting during neuraxial anesthesia (OR, 0.45; 95% CI, 0.22 to 0.92; P=0.03). CONCLUSIONS Neither epidural nor subarachnoid intrathecal sufentanil reduced shivering during neuraxial anesthesia, but it did increase the incidence of pruritus. Title: Comparison of Anaesthetic Efficacy of 4% Articaine Primary Buccal Infiltration Versus 2% Lidocaine Inferior Alveolar Nerve Block in Symptomatic Mandibular First Molar Teeth. Citation: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, Jan 2016, vol. 26, no. 1, p. 4-8 (January 2016) Author(s): Zain, Muhammad, Rehman Khattak, Shakeel Ur, Sikandar, Huma, Shah, Shafqat Ali, Fayyaz Abstract: To evaluate success of pulpal anaesthesia of mandibular 1st molar by using 4% articaine in buccal infiltration versus 2% lidocaine in inferior alveolar nerve block. Randomized control trial. Department of Operative Dentistry, Sardar Begum Dental College, Gandhara University, Peshawar, from March to August 2014. One hundred and fifty-six emergency patients, who had 1st molar diagnosed with irreversible pulpitis, participated in the study. Subjects were divided into two groups by random allocation. One group received 4% articaine buccal infiltration and the other group received inferior alveolar nerve block of 2% lidocaine. Subjects’self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anaesthetic administration during access cavity preparation and pulp extirpation. Mean age of subjects was 31.46 ±10.994 years. The success rate of 4% buccal infiltration was 76.9%; whereas the success rate of 2% lidocaine inferior alveolar nerve block was 62.8%. There was no statistically significant difference between the two groups. 4% articaine buccal infiltration can be considered a viable alternative to 2% lidocaine inferior alveolar nerve block in securing successful pulpal anaesthesia for endodontic therapy. Title: A systematic review of methodology applied during preclinical anesthetic neurotoxicity studies: important issues and lessons relevant to the design of future clinical research.