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O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2 0 1 5
Putting 3 Anesthesia Dogmas to Sleep
It's time to banish these old ideas about anesthesia.
M
any commonly
held dogmas of
anesthesia are
passed down from mentor to
student and eventually
become institutional "knowl-
edge" because people have
never questioned them. We
know, however, that it's
always incumbent upon practitioners to ask the most important ques-
tion we can ever ask, which is why, and to review the research our-
selves. Here are a few examples of anesthesia dogmas that should be
banished.
Dogma No. 1: Women who are breastfeeding should "pump and dump"
for 24 hours after being given a general anesthetic.
The reality: The total dose of anesthetic drugs ingested by breastfeeding
infants is negligible, as is the intestinal absorption of these drugs by
suckling infants. That's why many experts say the best advice for
nursing mothers is to continue breastfeeding as soon as they're awake
enough to safely do so (see osmag.net/xMFu6J and osmag.net/J6tzJN).
The only exceptions are premature infants and those suffering from
apnea, as respiratory depression problems could arise. In those cases,
it's a good idea to consider waiting 24 hours.
Dogma No. 2: You do not have to reverse muscle relaxant if you detect 4
strong twitches in a train-of-four (TOF) assessment.
A N E S T H E S I A A L E R T
Mike MacKinnon, CRNA
z WRIST ASSESSMENT Four strong twitches aren't
enough to preclude the need for reversal agents.
Mike
MacKinnon,
CRNA