By Tom Heaton

For some time now I have been meaning to have a good look at what the evidence is around the management of post-op nausea and vomiting (PONV). As a particularly unpleasant side effect of what we do, it also seems to me to be a bit more of an unpredictable one. Different clinicians I have worked with have put different weight on the numerous risk factors and adjusted the prophylactic antiemetic choices accordingly, with practice ranging from zero to triple agent prophylaxis. Whilst aware of the different risk factors, I hadn't heard much about calculating the contribution that these factors make, and thus how to use them to make a more supported decision. The recent publication of the ‘Consensus Guidelines for the Management of Postoperative Nausea and Vomiting’ was therefore just what I was looking for. Published in Anesthesia & Analgesia in Jan 2014, the guidance was put together by the Society for Ambulatory Anesthesiology and is well worth a read if you haven’t yet had the chance. The aim of this post was to have a look at a few of the keys points in the document and try and summarise them.

By Tom Heaton

This week it was my turn to present a paper at our local journal club. After a bit of searching for an exciting paper, I settled on this paper looking at the effect of age on spinal anaesthetic dose requirements. ‘The Effect of Age on the Median Effective Dose (ED50) of Intrathecally Administered Plain Bupivacaine for Motor Block’ was looking at an area of anaesthetic practice that I had been meaning to look into for a while; namely to see what evidence was out there about the factors that impact on the effectiveness of spinals. This interest was piqued by some recent reading around hip fracture management, including the National Hip Fracture Database Sprint Audit, which highlight problems with intraoperative hypotension as well as the rather large range of local anaesthetic doses used. How low can we go with our doses? Is there any point in going low with them? What factors impact on the dose we give? This paper starts having a look at this topic with some interesting results.