The edition · Anaesthesiology
Supraglottic airways linked to fewer respiratory events in reactive children
Registry data favour a supraglottic airway over intubation for children with a recent cold or asthma, deep block cut early chronic pain after lumbar fusion, and guideline-supporting perioperative trials turn out to hang on a handful of events.
The edition in brief
In 4,878 anaesthetics for children with recent upper respiratory infection, asthma exacerbation or household smoke exposure across 12 Japanese centres, a supraglottic airway at induction was associated with less than half the respiratory adverse events of tracheal intubation (adjusted RR 0.41). A single-centre trial of 180 patients having posterior lumbar fusion found deep neuromuscular block lowered chronic postsurgical pain at three months (19.1% vs 34.8%), but not significantly at six. A secondary analysis of the A2B trial found dexmedetomidine sedation was associated with greater recalled awareness than propofol, with no difference in frightening memories or satisfaction, and the authors do not recommend changing sedative on that basis. A survey of 161 superiority trials cited by perioperative guidelines found a median fragility index of 4, and 1 in paediatric trials. The pearl covers quantitative monitoring when deep block is used.
Deep neuromuscular block reduced three-month chronic pain after lumbar fusion
Deep neuromuscular block may lower early chronic pain after lumbar fusion; consider it, with quantitative monitoring and planned reversal.
Dexmedetomidine sedation linked to greater recalled ICU awareness, not better experience
Dexmedetomidine was associated with greater recalled awareness but no better overall ICU experience than propofol; individualise sedation.
Perioperative guideline evidence often hangs on a few events
Many perioperative guideline recommendations rest on trials where four events would change the result; read the trial before treating a recommendation as fixed.
Deep block needs a number, not a feel
Confirm a measured train-of-four ratio of at least 0.9 before extubation; clinical signs miss residual block.
Supraglottic airway use linked to fewer respiratory events in children with reactive airways
In children with recent respiratory infection or reactive airways, consider a supraglottic airway over intubation when the case allows - respiratory events were less than half as common.
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