1. Beach ML, Cohen DM, Gallagher SM et al. Major Adverse Events and Relationship to Nil per Os Status in Pediatric Sedation/Anesthesia Outside the Operating Room: A Report of the Pediatric Sedation Research Consortium. Anesthesiology. 2015 Nov 7. [Epub ahead of print]
CONCLUSIONS: The analysis suggests that aspiration is uncommon. NPO status for liquids and solids is not an independent predictor of major complications or aspiration in this sedation/anesthesia data set. PMID: 26551974
Comments: ACEP has made a statement that urgent procedural sedation and analgesia (PSA) in the ED does not require the patient to be NPO. This was a very large study of >139,000 patients undergoing PSA by anesthesiologists to determine the risk of aspiration in NPO vs. non-NPO patients. If anything, there was a non-statistically significant trend toward fewer aspiration events in patients who were not NPO (0.79/10,000 vs. 0.97/10,000 aspiration events). Unless a patient has a cheeseburger in his or her mouth as you push drugs, you can safely sedate non-NPO patients who need urgent or emergent procedures in the Peds ED.
2. Johnson DJ, Scott AV, Barodka VM et al. Morbidity and Mortality after High-dose Transfusion. Anesthesiology. 2015 Nov 16. [Epub ahead of print]
CONCLUSIONS: Patients receiving high- or very-high-dose transfusion are at especially high risk for hospital-acquired infections and thrombotic events. Mortality increased linearly over the entire dose range and exceeded 50% after 50 erythrocyte units. PMID: 26569167
Comments: Patients who need massive transfusion are, by definition, high risk. But does the amount of blood given offer prognostic information? In massive transfusion, mortality increased 10% for every 10 units of PRBCs in this cohort. This is important information to know as we discuss prognosis with family.
3. Ahmed SU, Zhang Y, Chen L et al. Effect of 1.5% Topical Diclofenac on Clinical Neuropathic Pain. Anesthesiology. 2015 Jul;123(1):191-8. doi: 10.1097/ALN.0000000000000693.
CONCLUSION: The findings indicate that 1.5% TD may serve as an effective treatment option for patients with neuropathic pain from postherpetic neuralgia and complex regional pain syndrome. PMID: 25955980
Comments: The treatment effect was small in this cohort but statistically significant. Any progress in patients with chronic neuropathic pain is helpful. Also, the side effect profile of this medication is minimal, and it can be used in patients without worries about affecting renal function.
Clinical Prediction Rules