Browsing by Author "Mason, Jill"

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    Laryngeal Mask Airway Use in Morbidly Obese Patients Undergoing General Anesthesia
    (2017) Mason, Jill
    The use of laryngeal mask airways with morbidly obese patients remains controversial. A recent legal case involving the use of a laryngeal mask airway with a morbidly obese patient who aspirated during the anesthetic found the anesthesia providers negligent. We sought evidence examining the use of laryngeal mask airways with obese patients undergoing surgery. One Cochrane systematic review and a randomized controlled trial met our inclusion criteria. Subjects received general anesthesia with a laryngeal mask airway. Outcomes included the ability to successfully place a laryngeal mask airway, ease and time of insertion, ability to ventilate, hypoxemia, presence of laryngospasm/ bronchospasm, and/or evidence of aspiration. The trials had some methodologic concerns including the inability to blind anesthesia providers, not including exclusively morbidly obese subjects, not powered to detect all complications such as aspiration, and overall small sample sizes. The investigators reported few problems when using these devices with obese subjects. However, because of the limited amount and quality of the evidence and the catastrophic nature of potential complications, future research must be done before a recommendation can be made regarding the use of these devices with morbidly obese patients.
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    Opioid-sparing Effects of Transversus Abdominis Plane Block in Elective Hysterectomy: A Systematic Review and Meta-analysis
    (2018) Mason, Jill
    Posthysterectomy pain is caused by abdominal incision and traumatic manipulation of the intra-abdominal structures. Optimal pain management consists of a multimodal pain regimen combined with transversus abdominis plane (TAP) block. We searched PubMed, EMBASE, and Cochrane Database for randomized controlled trials evaluating the opioid-sparing effects of TAP block in patients undergoing hysterectomy. The primary outcome was morphine consumption in the perioperative phase extending to 48 hours alter surgery. The secondary outcomes were pain scores at rest and during coughing, time of first postoperative analgesia, and incidence of postoperative nausea and vomiting (PONV) and sedation. Twenty-three trials were selected consisting of 1,554 patients. Morphine consumption showed a reduction of 3.6 mg intraoperatively (mean difference [MD], -3.57; 95% CI, -6.88 to -0.25); 2.9 mg in the recovery room (MD, -2.86; 95% CI, -5.55 to -0.15); 3.4 mg at 24 hours (MD, -3.43; 95% CI, -6.77 to -0.09), and 29 mg at 48 hours (MD, -28.68; 95% CI, -44.35 to -13.01) after surgery in favor of TAP block. Pain scores were lower at rest, and the incidence of PONV and sedation were reduced. Although opioid-sparing effects of TAP block were significant perioperatively, its clinical application is debatable because of substantial heterogeneity across studies.
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