A greater number of patients experienced a quicker onset of headache relief, without any new complications, from treatment with SPGB versus EBP. We believe that SPGB is a safe, inexpensive, and well-tolerated treatment. We hope that clinical trials will be conducted in the future that will confirm our findings and allow us to recommend SPGB for PDPH treatment prior to offering patients EBP.

Aims Activated charcoal is now being recommended for patients who have ingested potentially toxic amounts of a poison, where the ingested substance adsorbs to charcoal. Combination therapy with gastric lavage and activated charcoal is widely used, although clinical studies to date have not provided evidence of additional ef®cacy compared with the use of activated charcoal alone. There are also doubts regarding the ef®cacy of activated charcoal, when administered more than 1 h after the overdose. The aim of this study was to examine if there was a difference in the effect of the two interventions 1 h post ingestion, and to determine if activated charcoal was effective in reducing the systemic absorption of a drug, when administered 2 h post ingestion. Methods We performed a four-limbed randomized cross-over study in 12 volunteers, who 1 h after a standard meal ingested paracetamol 50 mg kg x1 in 125 mg tablets to mimic real-life, where several factors, such as food, interfere with gastric emptying and thus treatment. The interventions were activated charcoal after 1 h, combination therapy of gastric lavage followed by activated charcoal after 1 h, or activated charcoal after 2 h. Serum paracetamol concentrations were determined by h.p.l.c. Percentage reductions in the area under the curve (AUC) were used to estimate the ef®cacy of each intervention (paired observations). Results There was a signi®cant (P<0.005) reduction in the paracetamol AUC with activated charcoal at 1 h (median reduction 66%, 95% con®dence intervals 49, 76) compared with controls, and a signi®cant (P<0.01) reduction for gastric lavage followed by activated charcoal at 1 h (median reduction 48.2%, 95% con®dence interval 32.4, 63.7) compared with controls. There was no signi®-cant difference between the two interventions (95% con®dence interval for the difference x3.8, 34.0). Furthermore, we found a signi®cant (P<0.01) reduction in the paracetamol AUC when activated charcoal was administered 2 h after tablet ingestion when compared with controls (median 22.7%, 95% con®dence intervals 13.6±34.4). Conclusions These results suggest that combination treatment may be no better than activated charcoal alone in patients presenting early after large overdoses. The effect of activated charcoal given 2 h post ingestion is substantially less than at 1 h, emphasizing the importance of early intervention.

The rate of complication and the time necessary to achieve thrombolysis remain major disadvantages of regional thrombolytic therapy. By lacing the entire length of arterial or arterial bypass graft occlusions in the lower extremities of 49 patients with one of two different bolus doses of urokinase (mean, 52,000 International U in 35 infusions = low-dose group [28 patients]; mean, 230,000 U in 23 infusions = high-dose group [21 patients]) prior to identical continuous infusions, it was possible to demonstrate a decrease in the time needed to complete thrombolysis from 33.6 hours in the low-dose group to 10.4 hours in the high-dose group (P less than .001). The total urokinase dose necessary for successful thrombolysis was also significantly less in the high-dose group (P less than .001). The major complication rate was 22.9% in the low-dose group and 8.7% in the high-dose group, although the difference was not statistically significant. The use of urokinase and a high-dose transthrombus bolus injection technique significantly accelerates thrombolysis, decreases the total urokinase dose needed, and may lower the major complication rate.

(Reg Anesth Pain Med. 2018;43(8):880–884) Postdural puncture headache (PDPH) is a severe and debilitating complication after regional anesthesia in the obstetric population. Approximately 80% of patients suffer from this type of headache after an accidental dural puncture. A PDPH can limit postpartum mother-baby interactions, extend hospital stays, and raise health care costs. The gold standard treatment for postpartum PDPH is an epidural blood patch (EBP). This retrospective study aimed to compare the effectiveness of treatment with EBP to treatment with a sphenopalatine ganglion block (SPGB).

Normal pregnancy leads to a state of chronically increased intra‐abdominal pressure. Obstetric and non‐obstetric conditions may increase intra‐abdominal pressure further, causing intra‐abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state‐of‐the‐art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra‐abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.

The sphenopalatine ganglion (SPG) block is a simple and valuable technique that was discovered over a century ago, but, unfortunately, very few anesthesiology providers are familiar with this block. After some of our recent publications, physicians from different countries have reached out to us requesting more specifics on how we perform our version of the block. In this report, we provide a brief history of the block and demonstrate our three effective, simple, readily available, and inexpensive methodologies with images. We are proud to share that our three SPG block techniques have so far effectively relieved patients of chronic migraines, acute migraines, tension headaches, moderate-to-severe back pain, and post-dural puncture headaches.

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