lefort !

A nice rundown of Anesthetic considerations available at Continuing Education in Anesthesia, Critical Care and Pain (2014): http://ceaccp.oxfordjournals.org/content/early/2013/06/28/bjaceaccp.mkt027.full

A few of the key points:

  • Nasal intubation preferred, and smooth extubation is essential
  • Watch out for local anesthestic toxicity, and they use lots of epinephrine
  • PONV is critical to avoid – use copious anti-emetics and go for TIVA
  • Remifentanil helps smoothen anesthetic and smoothens extubation
  • P/O ICU is historical, blood loss is minimal
  • Severe malocclusion can be intubation difficult
  • Surgeons prefer induced hypotension to minimize bleeding, remi helps this
  • Know post-op if patient will have wired jaw (clippers at bedside in pacu)
Quite the jaw thrust
Quite the jaw thrust (from Elsevier, via article cited)

Midazolam for PONV

From Wick, Elizabeth, and Christopher L. Wu. “The Effect of Intravenous Midazolam on Postoperative Nausea and Vomiting: A Meta-Analysis.” (2015).

The gist: Midaz at any point reduces PONV by up to 40%!

BACKGROUND: Research has shown that high-risk surgical patients benefit from a multimodal therapeutic approach to prevent postoperative nausea and vomiting (PONV). Our group sought to investigate the effect of administering IV midazolam on PONV.
METHODS: This meta-analysis included 12 randomized controlled trials (n = 841) of adults undergoing a variety of surgical procedures that investigated the effect of both preoperative and intraoperative IV midazolam on PONV in patients undergoing general anesthesia.
RESULTS: Administration of IV midazolam was associated with significantly reduced PONV (risk ratio [RR] = 0.55; 95% confidence interval [CI], 0.43–0.70), nausea (RR = 0.62; 95% CI, 0.40–0.94), vomiting (RR = 0.61; 95% CI, 0.45–0.82), and rescue antiemetic administration (RR = 0.49; 95% CI, 0.37–0.65) within 24 hours. Individual subgroup analyses of trials excluding the use of thiopental for induction, trials of either female sex or high-risk surgery, trials involving nitrous oxide maintenance, and trials using midazolam in combination with known antiemetics all yielded similar reductions in PONV end points within 24 hours of surgery.
CONCLUSIONS: Administration of preoperative or intraoperative IV midazolam is associated with a significant decrease in overall PONV, nausea, vomiting, and rescue antiemetic use. Providers may consider the administration of IV midazolam as part of a multimodal approach in preventing PONV.