Turning down fresh gas flow is what cuts sevoflurane's carbon; the absorbent barely registers

The edition in brief

Pooling 132 patients from three studies, an Anesthesiology analysis found first-hour sevoflurane emissions rose linearly with fresh gas flow, from 2.4 to 18.6 kg CO2 equivalent between 0.2 and 4 l/min, while carrier gas and carbon dioxide absorbent together contributed under 3% even in closed-circuit delivery; lowering flow and end-tidal concentration is what matters. A meta-analysis of 10 randomised trials found perioperative intravenous lidocaine reduced 24-hour pain after spine surgery by 0.83 points and morphine use by 11.6 mg, with a clinically meaningful effect after instrumented fusion and complex surgery but almost none after decompression, a post hoc finding. A randomised comparison in 44 patients found electromyographic monitoring at the abductor digiti minimi matched the adductor pollicis for rocuronium onset and sugammadex recovery, except on the dominant hand, where the little finger recovered about 90 seconds early. In 102 high-risk women having gynaecological laparoscopy, fospropofol cut nausea and vomiting in the first six hours (5.9% vs 19.6%) compared with propofol, with no difference at 24 hours and slower extubation. The FDA lists an ongoing Class II recall of a lidocaine 5% ointment from Taro for failing content uniformity at stability testing. The pearl covers checking the train-of-four ratio before extubation.