Week in review March 6-11
Myron Yaster MD
Cerebral autoregulation monitoring: an approach to individualized blood pressure management to protect the brain during and after heart surgery?
Ken M. Brady, MD and R. Blaine Easley, MD
Original article
Brady KM, Hudson A, Hood R, DeCaria B, Lewis C, Hogue CW. Personalizing the Definition of Hypotension to Protect the Brain. Anesthesiology. 2020 Jan;132(1):170-179. PMID: 31644437
When dealing with hypotension perioperatively “How low is low”? When do you need to intervene? What is the lower limit of autoregulation in the newborn?
Association ≠ Causation
Myron Yaster MD, Elliot Krane MD, and Steven J. Weisman MD
Original article
Alice Kate Cummings Joyner, Michael R King, Conrad Safranek, Gomathy Parvathinathan, Elizabeth De Souza, T Anthony Anderson. Health Care Burden Associated With Adolescent Prolonged Opioid Use After Surgery. Anesth Analg. 2023 Feb 1;136(2):317-326. PMID: 35726884
Patients with prolonged opioid use after surgery (POUS, defined as ≥1 opioid prescription filled between 90 and 180 days after surgery, have increased total and individual health care costs and increased health care visits compared to patients without POUS. The author’s presumption that the need and prolonged use of opioids following surgery is unjustified and leads to abuse and negative health care consequences. We disagree.
The BARF Scale
Myron Yaster MD, Genie Heitmiller MD, and Melissa Brooks Peterson MD
Original article
Mehernoor F Watcha, Andrew D Lee, Eduardo Medellin, M Toni Felberg, Sudha A Bidani. Clinical Use of the Pictorial Baxter Retching Faces Scale for the Measurement of Postoperative Nausea in Children. Anesth Analg. 2019 Jun;128(6):1249-1255. PMID: 31094795
The pictorial BARF scale is inexpensive, easy to use, and can be used to quantify nausea in children ≥ 6 years of age.
Ditching Desflurane for the good of Planetary Health
Elizabeth E Hansen, MD PhD and Diane W Gordon, MD
From the BBC (https://www.bbc.com/news/health-64347191) The National Health Service of Scotland plans to ban Desflurane.
Inhaled anesthetics are greenhouse gases (GHGs), and desflurane has nearly 50 times the greenhouse gas emissions of sevoflurane when used clinically. We don’t have a national health service in the U.S. Speak to your hospital about banning desflurane locally in your hospitals. It’s good for the environment and your hospital’s bottom line.
Reader response
Meera Gangadharan MD, University of Texas Health Science Center in Houston/ McGovern Medical School, Houston, TX invites all PAAD readers to register for the Mass Casualty Workshop at SPA 2023 on Friday, March 31st from 3pm to 6pm 2023. Robert Christensen MD, University of Michigan used ChatGPT, a new articial intelligence program to generate a PAAD. The implications are enormous. Diane Gordon MD, Children’s Hospital Colorado, announces that the SPA Special Interest Group for Sustainability will meet at 3pm Central time, in room 404, Level 4 during the SPA meeting.