Anesthesia E-ssential

October 30, 2012 

Vital Signs

FDA Releases Customer Lists of Compounding Pharmacy Implicated in Fungal Meningitis Outbreak
Following the recent outbreak of fungal meningitis, the Food and Drug Administration (FDA) has released two lists of customers (consignees) who received products that were shipped on or after May 21, 2012 from New England Compounding Center’s Framingham, Mass. facility.
The first list includes customer names and addresses, organized by state. The second list contains the same basic information as the first list, but is organized alphabetically by customer name and also includes the specific products shipped, the quantities of product shipped, and the shipping date.
Additional Patient Notification Advised
On Oct. 15, the FDA announced that a patient with possible meningitis potentially associated with epidural injection of an additional NECC product, triamcinolone acetonide, has been identified through active surveillance and reported to FDA. Triamcinolone acetonide is a type of steroid injectable product made by NECC. The cases of meningitis identified to date had been associated with methylprednisolone acetate, another similar steroid injectable product.
For further information, see the FDA MedWatch Safety Alert webpage.
It is important for all clinicians to monitor and stay informed about this ongoing outbreak. For news and updates, we encourage all members and other healthcare professionals to regularly check the AANA website at See also, the FDA’s Fungal Meningitis Update webpage at


The Pulse

  • Celebrate National Nurse Anesthetists Week—Promotional Items Available November 1
  • In Memoriam: AANA Past President Marie Bader
  • Plan Now to Attend the Business of Anesthesia Workshop
  • Introducing New Opportunity from AANA Affinity Program Partner
  • AANA State Government Affairs Division Represented at State Health Policy Conference
  • Last-Minute Action List for CRNA Pain Care Rule—Don’t Delay!
  • FPDs: Register Now for the Fall Assembly Leadership Academy
  • CRNA-PAC Donors: Mark Your Calendar for Your AANA Post-Election Conference Call
  • Be Sure to Vote by Nov. 6!
  • AANA Attends CDC’s Health Infection Control Practices Advisory Committee Meeting
  • AANA Participates in NIH Interagency Pain Research Coordinating Committee Meeting
  • When Health Plans Do Not Pay for Services Following a Healthcare Associated Infection, Health Quality Does Not Improve
  • AMA Continues Attacks on AANA-backed Provider Nondiscrimination Law
  • Remembering a Friend to CRNAs:  Sen. Arlen Specter

Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Inside the Association
Celebrate National Nurse Anesthetists Week—Promotional Items Available November 1
CRNAs all across the country are gearing up for the 14th annual National Nurse Anesthetists Week, to be celebrated Jan. 20-26. The theme for 2013 is "Patient Care Extraordinaire." Promotional items, including posters, buttons, ink pens, table tents, and the ever-popular Nurse Anesthetists Week logo merchandise, including T-shirts and mugs, will be available for purchase. The AANA has switched to an easy and convenient all-online ordering system for this year’s promotional items. Visit the website at beginning in November. The AANA website will feature downloadable items such as sample press releases and ideas for promoting National Nurse Anesthetists Week. Please note: Ordering is now online-only. Phone, fax, or mail orders will not be accepted.
In Memoriam: AANA Past President Marie Bader
Marie “Mitzi" Bader, 94, passed away peacefully on Sunday, Oct. 21, 2012 at Arbors Care Center, Toms River, N.J. Bader served as AANA president in 1968-69, and as president of the New Jersey Association of Nurse Anesthetists in 1965. At the national level, she was very active, and served as chair on the Resolutions Committee from 1951-1952; a member of the Approval of Minutes Committee from 1952-1953; a member of the Educational Loan and Scholarship Committee from 1953-1954; a member of the Approval of Schools Committee, from 1964-1966; a trustee on the AANA Board of Trustees from 1953-1955; vice president from 1966-67; president-elect in 1967-1968; and president from 1968-1969. She was honored by AANA for attending their national convention 50 years in a row. Read more about Marie Bader’s life and career here.

Plan Now to Attend the Business of Anesthesia Workshop
The Business of Anesthesia Workshop will be held Jan. 26, 2013, at the Waldorf Astoria Hotel in Naples, Fla. This successful program was originally presented prior to the 2012 Mid-Year Assembly and received very positive feedback from all participants. The agenda will include expert speakers presenting information on various aspects of business as it relates to nurse anesthesia practices. Topics include practical information on the nuts and bolts of billing, coding, and reimbursement options. Sessions will explore the financial impact of various practice models on nurse anesthesia economics, a primer on compliance and RAC audits, contract negotiation and legal issues. For additional program information, visit the AANA website.

Introducing New Opportunity from AANA Affinity Program Partner
We are pleased to announce that you are invited to buy Guaranteed Life Insurance from United of Omaha Life Insurance Company! Click here for more information.

AANA State Government Affairs Division Represented at State Health Policy Conference
The AANA State Government Affairs (SGA) Division was represented at the 25th Annual State Health Policy Conference held by the National Academy for State Health Policy. The conference, held October 15-17, brought together hundreds of state health policy leaders, administrators and experts to discuss and be educated regarding healthcare exchanges, Medicaid, essential health benefits, delivery system reform, public health, children’s health insurance, and more. Speakers at the conference included a number of senior state officials, as well as high ranking members of the healthcare business community. The AANA SGA believes that the information and insight gained at this conference will contribute to our ability to successfully navigate the changing world of state healthcare policy, especially in light of the rapid change currently underway as a result of the state level implementation of the Patient Protection and Affordable Care Act. 

Last-Minute Action List for CRNA Pain Care Rule—Don’t Delay!
On or about Nov. 1, the Medicare agency is slated to publish a final rule on Medicare coverage of CRNA chronic pain management services as part of its 2013 physician fee schedule final rule.  Until and after that date, AANA members can continue using to be heard on this critical CRNA practice issue. Don’t delay: Act now!
  • What is the AANA member last-minute to-do list to ensure CRNA voices are heard, and to maximize the possibility of a final rule that is favorable to CRNAs and their patients? Every AANA member can contact Congress via  Tell your legislator that continuing Medicare coverage of CRNA chronic pain management services is important, and that you hope he or she will contact Medicare in favor of it.
  • Be prepared for future action. With Congress headed for a post-election “lame duck” session, the AANA and its allies must continue to educate lawmakers as a protection against potential harmful anti-CRNA “poison pill” language being included behind closed doors in end-of-year budget bills.  Time that CRNAs spend educating their lawmakers over the past year or so about this issue will be very important during the “lame duck” session.
  • One more development: The Medicare agency on Oct. 19 transmitted the 2013 Physician Fee Schedule final rule to the White House Office of Management and Budget for final review before its publication, anticipated Nov. 1 or 2.  The CRNA pain care issue was part of the 2013 Physician Fee Schedule proposed rule in June.
FPDs: Register Now for the Fall Assembly Leadership Academy
Is your state’s Federal Political Director (FPD) registered for the AANA Fall Assembly Leadership Academy FPD Track Nov. 15-19 in Colorado Springs?  Many state associations transition leadership in the fall – and this is your reminder to be sure your FPD is locked in for this critical educational conference by clicking here.
We have developed an exciting and innovative program for all of our outstanding FPDs – to help make sense of the 2012 elections from the perspective of CRNAs, and to help you organize your state for effective CRNA advocacy and the 2013 Mid-Year Assembly in Washington.  This FPD track at the Fall Assembly Leadership Academy replaces the separate FPD conference held in February of odd-numbered years, so don’t wait …be sure to sign up now!
CRNA-PAC Donors: Mark Your Calendar for Your AANA Post-Election Conference Call
CRNA-PAC donors for FY 2012 and 2013 are invited to “save the date” for a post-election conference call hosted by CRNA-PAC Chair Ruth Morris, CRNA, MS, and featuring guest appearances from AANA President Janice Izlar, CRNA, DNAP, and President-elect Dennis Bless, CRNA, MS, during which the CRNA impact of the Nov. 6 elections will be the topic of conversation. The call will be held Wed., Nov. 7, from 8-9 pm ET, and all donors to the CRNA-PAC since Aug. 1, 2011, are receiving email invitations to attend and participate.
Be Sure to Vote by Nov. 6!
The AANA reminds every member that Nov. 6 is Election Day. While every member’s strong voice in Washington begins with excellent clinical practice, the next most important civic responsibility of a CRNA is to vote for the candidates of your choice.

AANA President Janice Izlar, CRNA, DNAP, with Sen. Jerry Moran (R-KS) and Rep. Jan Schakowsky (D-IL-9) – examples of lawmakers from both major political parties who both know and respect CRNAs and the work that they do.
AANA Attends CDC’s Health Infection Control Practices Advisory Committee Meeting
Healthcare acquired infection (HAI) control and prevention is critical at all times for CRNAs, a matter of major public interest whenever an HAI outbreak occurs, and always a matter of interest to the Healthcare Infection Control Practices Advisory Committee (HICPAC) advising federal agencies key to CRNA practice.
The HICPAC is a panel of 14 external infection control experts who provide advice and guidance to the Centers for Disease Control and Prevention (CDC) and the Secretary of the Department of Health and Human Services (HHS) on a wide range of work relating to CRNA practice, including guidelines for infection prevention, infection outbreak surveillance, and drafting infection prevention task worksheets for use in hospitals. The AANA was present at its most recent meeting in Washington, DC.
AANA Practice Committee member Paul Austin, CRNA, PhD, and AANA DC staff member Romy Gelb-Zimmer, MPP, attended the CDC’s HICPAC meeting October 11-12.  The agenda for the meeting included updates on HHS activities for HAIs and a new initiative on adverse drug events involving opioids, anticoagulants, and anti-diabetic medications; an update on the draft guidelines for prevention of infections among patients in neonatal intensive care units; draft guidelines for the prevention of surgical site infections; draft guidelines for facility adjudication of infection data; and an update from the HICPAC surveillance working group. 
AANA Participates in NIH Interagency Pain Research Coordinating Committee Meeting
The AANA-backed Pain Care Act adopted by Congress as part of health reform is beginning to take further shape as a major interagency coordinating panel met Oct. 22 in Washington to outline further strategies to create a comprehensive population health strategy for pain prevention, treatment, management and research, and to implement the Institute of Medicine report “Relieving Pain.” The AANA was there participating.
The National Institutes of Health (NIH) Interagency Pain Research Coordinating Committee (IPRCC) is a federal advisory committee created by the Department of Health and Human Services to enhance pain research efforts and promote collaboration across the government, with the ultimate goals of advancing fundamental understanding of pain and improving pain-related treatment strategies. The committee of seven federal members and 12 nongovernment members, including two anesthesiologists, met to discuss topics including the upcoming “Opioids and Chronic Pain Workshop” sponsored by the NIH Consensus Development Program, the NIH Centers of Excellence in Pain Education program, and the federally funded pain portfolio. 
In AANA written testimony, President Janice Izlar, CRNA, DNAP, pledged “full support and expertise to work collaboratively with the IPRCC, other professional organizations and the pain community to develop a population-level pain prevention and management strategy with a focus on pain care, research and education.”  In addition, AANA DC’s Christine Zambricki, CRNA, DNAP, FAAN, presented brief oral comment on the role of CRNAs in providing pain management services, particularly in rural and frontier states. Assistant Secretary for Health Howard Koh, MD, MPH, charged the committee to expand its role beyond research and accept responsibility to create a comprehensive population-level strategy for pain prevention, treatment, management and research.  The AANA continues monitoring this activity. Learn more about the IPRCC at 
When Health Plans Do Not Pay for Services Following a Healthcare Associated Infection, Health Quality Does Not Improve
Health plans’ nonpayment for healthcare services following healthcare acquired infections does not improve healthcare quality, according to a major new study published in the New England Journal of Medicine.  The issue is important for CRNAs, as government and private health plans look to changes in payment to drive improvements and cost reductions in healthcare generally.  See the abstract at
AMA Continues Attacks on AANA-backed Provider Nondiscrimination Law
The American Medical Association (AMA) is continuing its attacks on the AANA-backed “provider nondiscrimination” provision of the Affordable Care Act, slated to take effect Jan. 1, 2014 – meaning that the AANA and its allies on and off of Capitol Hill can reasonably be expected to have to work to keep this provision intact in the new Congress taking office this January.
As part of the AMA posting items for its November 2012 House of Delegates meeting, the AMA Board of Trustees’ report in response to the AMA’s June 2012 resolution concerning the nondiscrimination language has been posted at  AANA continues working on Capitol Hill and in government agencies to protect and implement this critical pro-competitive, pro-consumer, cost-saving health reform provision.
Remembering a Friend to CRNAs: Sen. Arlen Specter
A longtime consistent congressional friend of CRNAs has passed. Sen. Arlen Specter (R, then D-PA) supported CRNA practice and repeal of physician supervision of CRNA services, in particular during the height of debate over the issue in the late 1990s and early 2000s. He was 82. The Washington Post ran an obituary spanning his nearly 50 years in public life, including his service as Pennsylvania’s longest tenured U.S. Senator.
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes.  All contributions to CRNA-PAC are voluntary.  You may refuse to contribute without reprisal.  The guidelines are merely suggestions.  You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute.  Federal law requires CRNA-PAC to use our best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. I am a US Citizen.


Two Commonly Used Anesthetics Produce Different Metabolic Patterns in Children's Unconscious Brains
study published in Anesthesiology examines two commonly used anesthetics that create distinct metabolic patterns in the brains of unconscious children. Researchers from Stony Brook University discovered that the inhalant gas anesthetic sevoflurane produces more lactate, a marker for enhanced or changed brain metabolism, compared with the intravenous anesthetic propofol. Earlier pediatric literature reported that sevoflurane may be linked to emergence delirium, during which a child is inconsolable, irritable, or uncooperative. The study examined the potential association between emergence delirium and specific brain metabolites like lactate. Researchers analyzed 59 children ages two to seven years who underwent magnetic resonance imaging under anesthesia with either sevoflurane or propofol. Applied proton magnetic resonance spectroscopy scans were obtained of the parietal cortex after roughly 60 minutes of anesthesia, and upon gaining consciousness, children were assessed based on the pediatric anesthesia emergence delirium scale. The findings suggest that sevoflurane was associated with higher concentrations of lactate and glucose compared with children who were given propofol. "Higher levels of lactate in the brain could lead to anxiety and/or delirium during emergence from anesthesia and in the immediate post-operative period," said study authors Helene Benveniste and Zvi Jacob.
From "Two Commonly Used Anesthetics Produce Different Metabolic Patterns in Children's Unconscious Brains"
Outcome Magazine (10/24/2012)

STUDY: Language Disparities Among Latino Women in Labor Impacts Use of Epidurals
Presented at the ANESTHESIOLOGY 2012 annual meeting, a new study found that the role of women's primary language directly impacts whether or not they receive an epidural when delivering a baby. While epidurals continue to be the most effective method for pain management during labor, evidence suggests there are racial and ethnic differences in the use of them. "Our study was the first to evaluate disparities among English and Spanish-speaking Hispanic women admitted for delivery of their first infant," said study author Paloma Toledo, MD, of Northwestern University. Funded by the Agency for Healthcare Research and Quality, the investigation evaluated electronic medical record data for nearly 1,500 Hispanic women who gave birth at large urban hospitals. Researchers found that the use of epidurals was lower for Spanish-speaking Hispanic women, with just 66 percent receiving an epidural, than for English-speaking Hispanic women, 81 percent of whom opted for an epidural.
From "STUDY: Language Disparities Among Latino Women in Labor Impacts Use of Epidurals"
Hispanically Speaking News (10/19/12)

Variation in Hand-Washing Technique May Up Risk for Bacterial Infection From Epidural Anesthesia
While infection passed during the administration of epidural anesthesia is uncommon, the end results can be devastating if it does occur. With an eye toward improving hand-sanitizing protocol as part of the neuraxial analgesia process, Canadian researchers looked for differences in the rate of bacterial colonization in practitioners employing the most popular hand-washing methods. All three techniques involve washing from the hands up to the elbows, and swabs were taken from the inside forearms of 300 randomly selected clinicians in order to compare colonization rates. What the team from the University of Toronto found was that using alcohol gel alone—at least 5 mL—was more effective in lowering bacterial colonization than washing with soap before applying alcohol gel. Lead researcher Naveed Siddiqui, an assistant professor of anesthesia and pain medicine, presented the results at the 2012 annual meeting of the Canadian Anesthesiologists' Society. "There's a possibility of contamination if your forearms are not clean and the epidural catheter touches it," he said, stressing the need to wash to the elbows. "So if you are not wearing a gown, you should be meticulous about using the best technique of hand washing, which should include at least 60 percent alcohol."
From "Variation in Hand-Washing Technique May Up Risk for Bacterial Infection From Epidural Anesthesia"
Anesthesiology News (10/01/12) Vol. 38, No. 10 Vlessides, Michael

Honeybee Bites Can Act as Anesthetics
In a finding that has implications for anesthesia development for humans, researchers now know that honeybees defend themselves by temporarily paralyzing their tiniest enemies with a natural anesthetic delivered through a bite. The anesthetic, 2-heptanone (2-H), produced naturally in some insects and approved in the United States as a food additive, previously was thought to be an alarm pheromone or chemical marker; but a joint effort by European experts has revealed its anesthetic properties. Low-toxicity 2-H can paralyze small insects and mites for one to nine minutes after being bitten by a honeybee, according to the new findings. In human applications, meanwhile, researchers from the School of Biology of Aristotle University in Greece have discovered that 2-H acts similarly to the common local anesthetic lidocaine. Tests on mammal cells have shown that the agent can be used successfully as an anesthetic on people. Pharmaceutical companies are being recruited to continue the development of 2-H for this purpose.
From "Honeybee Bites Can Act as Anesthetics"
Medical News Today (10/17/12) Kearney, Christine 
Muscle Relaxants in Surgery Hiked Hypoxia Risks
Using shorter-acting neuromuscular blocking agents during anesthesia does not mitigate the respiratory risks associated with longer-acting formulations, conclude researchers at Massachusetts General Hospital. Current protocol calls for quantitative neuromuscular monitoring, intermediate-acting neuromuscular blocking agents, and use of a reversal agent; but in light of their findings, the investigators believe current strategies for avoiding postoperative neuromuscular blockade should be "revisited." Their single-site study compared the outcomes of about 18,500 patients who received intermediate-acting neuromuscular blocking agents and an equal number of patients who did not. The drugs increased the odds of two serious respiratory complications occurring after surgery: oxygen desaturation after extubation and reintubation requiring unplanned admission to an intensive care unit within one week of the procedure. Neuromuscular blocking agents "are a risk factor for hypoxic events after extubation and increased reintubation rates," the researchers wrote online in BMJ. "This is important because [these] agents now represent 80 percent of the market volume for neuromuscular blocking agents." Peer responses to the study, however, noted that the research is specific to a specialty medical center; was limited by its observational nature; and does not warrant changes in standard practice.
From "Muscle Relaxants in Surgery Hiked Hypoxia Risks"
MedPage Today (10/16/12) Fiore, Kristina
Experts Suggest Lower Initial Doses of ER Oxymorphone in Elderly
Based on a new study, clinical pain experts believe older patients should be given extended-release (ER) oxymorphone at lower initial doses. Existing research has demonstrated a greater sensitivity to opioid analgesia among older populations, and the new data from Temple University School of Medicine in Philadelphia supports those conclusions. Led by Joseph Pergolizzi, MD, the team there administered ER oxymorphone to 48 healthy subjects: 12 men and 12 women between the ages of 20 and 40 as well as 12 men and 12 women aged 65 to 81 years old. Each received an initial dose of 20 mg and underwent a 48-hour washout period, followed by administration of 20 mg every 12 hours for six days. Older adults—women, especially—had significantly higher plasma drug levels compared to the younger group of subjects. The researchers discovered that it took older women a mean five hours to achieve maximum drug concentrations, compared to 3.5 hours for older men, 1.8 hours for younger women, and 2.5 hours for younger men. Older women also were most likely to suffer from mild adverse events such as nausea, blurred vision, and headache despite receiving 50 mg of naltrexone each day to minimize these side effects. While the study suggests the wisdom of giving older patients lower starting doses of ER oxymorphone, it was based on healthy subjects and did not assess clinical outcomes such as pain relief and more severe adverse events such as sedation and respiratory depression. "Although we need to examine the effects of lower doses in real-life older patients, the assumption is they achieve the same levels of pain relief with lower doses," Pergolizzi remarked. "If that is the case, ER oxymorphone is an attractive treatment option in the elderly ... The caveat, as this study shows, is that we do need to start low and go slow with this drug in this population."
From "Experts Suggest Lower Initial Doses of ER Oxymorphone in Elderly"
Pain Medicine News (10/01/2012) Vol. 10, No. 10 Wild, David 

Nerve Blocks: Do They Increase or Decrease OR Efficiency?
As an increasing number of anesthesia professionals employ nerve blocks to provide pain relief before and after surgery, the question of whether regional anesthesia increases or decreases efficiency arises. Driven by advances in ultrasound technology, nerve blocks have grown in use due to the benefits they can provide to patients over more traditional anesthesia approaches. "The use of nerve blocks as an adjunct or primary source of anesthesia can reduce the incidence of nausea and vomiting and can be near magical in terms of post-op pain relief," according to Dr. Thomas Schares, chief of anesthesia at Desert Regional Medical Center in Palm Springs, Calif. However, experts say the technique is not always used because it can be more time consuming than traditional anesthesia if done with the patient already in the operating room. On the flip side, patients who receive nerve blocks before entering the OR typically do not need to wake up from general anesthesia and can therefore be moved out of the OR as soon as the surgery is completed. The results are faster recovery, reduced pain, fewer side effects, and greater patient satisfaction. However, Schares stresses the lack of evidence that nerve blocks are "superior in an absolute sense" than other anesthesia methods.
From "Nerve Blocks: Do They Increase or Decrease OR Efficiency?"
Becker's Hospital Review (10/18/12) Dunn, Lindsey

What's the Ideal Sedative for Oral Surgery?
A study published in the journal Anesthesia Progress suggests that oral surgery patients who get a blend of propofol and remifentanil experience shorter emergence times from anesthesia as well as faster recoveries and discharges than patients receiving a blend of propofol-ketamine. Researchers examined the effects of the drug combinations on 37 patients who had wisdom teeth extracted. None of the patients reported adverse behavioral effects such as dysphoria or hallucinations, the study noted, but patients in the ketamine group reported mild postoperative euphoria that resolved before discharge. Only a single patient in the ketamine group experienced postoperative nausea and vomiting, although the study observed that may have been due to inadequate compliance with instructions to bite down firmly on surgical-site dressings following the procedure. The heart rates of the ketamine-group patients increased during sedation, but there was no significant difference in oxygen saturation levels between the two groups, according to the data. Surgeons reported being equally satisfied with both drug combinations. The average cost of remifentanil is $4.90 more than ketamine per case, but the cost difference may be offset by the additional time needed to monitor and recover the ketamine patients as well as the additional amount of propofol used, the study authors said.
From "What's the Ideal Sedative for Oral Surgery?"
Outpatient Surgery (10/12/12) Cook, Daniel 
New Malignant Hyperthermia In-Service DVD for Nurses
The Malignant Hyperthermia Association of the United States (MHAUS) is offering a DVD series that explores the appropriate responses to a crisis involving the sometimes fatal condition, which often occurs in patients undergoing surgery. The nine-disc set is arranged for easy discussion of such topics as the updated definition of MH, including signs and symptoms, and how to deal with "Awake MH." It also covers such information as the items that should be stocked on an MH cart and in the medical facility; how to prepare for quick transport of an MH patient from an ambulatory surgery center to a hospital emergency room; and how to prepare all staff for an MH event, including through mock drills. A video trailer and additional details can be found at
From "New Malignant Hyperthermia In-Service DVD for Nurses"
Newswise (10/19/12) 

Does Intraoperative Ketamine Attenuate Inflammatory Reactivity Following Surgery? A Systematic Review and Meta-Analysis
Researchers conducted a systematic review to examine the effect of anesthetic drug ketamine on postoperative inflammation. A total of 14 randomized controlled trials were evaluated involving 684 patients who had undergone surgical operations under general anesthesia. Ketamine had been given before or during the surgery in varied doses. In all, six studies comprising 331 patients were included in the meta-analysis. Ketamine was found to have an anti-inflammatory effect based on concentrations of biomarker interleukin-6 (IL-6). The meta-analysis showed a mean preoperative–postoperative IL-6 concentration difference of -71 pg/mL. The researchers concluded that intraoperative administration of ketamine significantly reduced the early postoperative IL-6 inflammatory response. The authors noted that more in-depth studies should be conducted to examine such things as whether ketamine treatment alters functional outcomes, the mechanisms of its anti-inflammatory effect, and appropriate dosing regimens.
From "Does Intraoperative Ketamine Attenuate Inflammatory Reactivity Following Surgery? A Systematic Review and Meta-Analysis"
Anesthesia & Analgesia (10/12) Vol. 115, No. 4, P. 934 Dale, Ola; Somogyi, Andrew A.; Li, Yibai; et al.

Perineural Clonidine Does Not Prolong Levobupivacaine 0.5 Percent after Sciatic Nerve Block Using the Labat Approach in Foot and Ankle Surgery
A study was held to investigate whether supplementing 0.5 percent levobupivacaine used for posterior sciatic nerve block with 150 µg perineural clonidine would extend the duration of analgesia. The analgesic traits of 20 mL plain levobupivacaine were compared to those of 20 mL levobupivacaine 0.5 percent plus 150 µg clonidine in a posterior sciatic nerve block for foot and ankle surgery, using 60 patients randomized and assigned to receive either levobupivacaine alone or levobupivacaine plus clonidine. Onset and duration of the block, hemodynamic changes during surgery, the need for rescue analgesia and technical or neurologic complications were measured over a 24-hour period. The onset of the sensory block was found to be closely similar, about 10 minutes on average, in both the levobupivacaine and levobupivacaine plus clonidine groups. The time to first request of pain medication also was similar. During surgery, 50 percent of patients in the levobupivacaine plus clonidine group exhibited a decline of more than 20 percent in systolic arterial pressure, versus 28 percent of patients in the levobupivacaine group. No complications in either group were observed over the 24-hour period.
From "Perineural Clonidine Does Not Prolong Levobupivacaine 0.5 Percent after Sciatic Nerve Block Using the Labat Approach in Foot and Ankle Surgery"
Regional Anesthesia & Pain Medicine (10/01/2012) Vol. 37, No. 5, P. 521 Fournier, Roxane; Faut, Alexandre; Chassot, Olivier; et al.
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