I found the topic of this article quite potentially useful, as there is little value in measuring or quantifying data when, in fact, you are not measuring what you think you are measuring. The article was basically asking if the measurement of neuromuscular blockade using the muscles of the face and orbit really tells us much about the overall recovery of skeletal muscle function. And the narrower answer being sought by the anesthetist is whether there is sufficient muscle function for effective ventilation. A noble question, to be sure.
I was a bit confused on the methodology, however. If we have the ability to compare the two methods simultaneously in the OR prior to transport to the PACU, would not our baseline give us more useful data when evaluating the PACU values? It may be rare, but recurarization is still a potential phenomenon, and having two data sets from the period prior to arriving in the PACU could help eliminate these types of variables. Even noting the difference between the two assessments in the OR might shed light on the usefulness of these different measurement locations.
I would have liked to see 100% of patients assessed both with qualitative measurement at the orbicularis muscles AND quantitative measurement at the adductor pollicis. This would provide real-time comparative data devoid of possible time sensitive effects.
A recent abstract (APRIL 29, 2011 VOLUME 5 | NUMBER 4), under the “Comments” section, stated:
“The use of shell fish toxins such as neoSTX [neosaxitoxin] for anesthesia and analgesia looks to be very promising.”
While shellfish toxins (e.g. the toxin of Conus magus, or the Cone of Magi or the Magician’s Cone) have yielded substances showing promise in pain research (e.g. ziconotide), the substance to which the original article referred was neosaxotoxin, which is, to the best of my knowledge, derived from dinoflagellates and not from shellfish. Dinoflagellates are unicellular protists usually found as marine plankton. They are responsible for “red tides” and for bioluminescence in sea water.
Conus sp. is an animal. Dinoflagellates are more properly thought of as algae (phytoplankton).
This is, as the title says, a pedantic quibble, and does not detract from the informative nature of the abstract from an article describing a promising area of pharmacological research into ion channels and nociception. I have learned that the misidentification of dinoflagellates as shellfish was present in the original article.
Jim Carroll, CRNA
In the 2010 edition of Anesthesia Abstract, volume 4 number 10, Steve Wooden evaluates an article from “Pain Physician” on the effectiveness of lumbar interlaminar epidural injections. In the article the authors used a combination of lidocaine and betamethasone for ESIs treating back pain. The authors asked question, “would local anesthetic be as effective as local anesthetic& steroid?”. Their conclusion was that interlaminar ESI with local only is as effective as LA/steroid. Mr. wooden goes on to state he is using more saline and less LA/steroid for his I-ESIs and then asks what other are doing?
It is my understanding most CRNAs pain management are using bupivacaine and a depo-steroid. I am curious and would like to know how many are using lidocaine? I would also like to know how many responses Mr. Wooden has received?
The current issue on transfusion is absolutely outstanding. I really do not think most anesthesia providers think much about the implications of transfusion, nor do we necessarily do everything we can to minimize the risks.
I would add one more important risk to transfusions that many people do not know about. Although the American Red Cross (ARC) is not the only service that provides blood products in this country, it is by far the most active in blood collection and distribution. Few people know that in 1993, the ARC had such extensive safety problems with its blood products that a court order was issued to force ARC to clean up its act. Although a reorganization was complete in 1997, an FDA inspection in 2002 found that the ARC continued to have major safety issues with blood collection and distribution. Subsequent efforts have been made to correct these issues, but it must be kept in mind that the collection and distribution of blood products have potential safety issues beyond the physiologic risks described in your abstracts.
Every effort should be made to use tranfusion only as a last resort in my opinion.
Thanks again for these outstanding abstracts and your wonderful contribution to the evolution of Anesthesia Abstracts.
Steve Wooden, CRNA MS
I really enjoyed your latest issue. It seemed that every article/abstract was placed there just for my practice ! In the article about Ketamine speeding the onset of good intubating conditions with injected rocuronium you made a statement under the “comments” section to this effect… I have long made it a practice to add 50 milligrams of Propofol to 200 milligrams of Propofol for induction…” Is there a chance you might have intended to say that you have long made a practice of adding 50 milligrams of KETAMINE to 200 milligrams of PROPOFOL? Just checking.