Accuracy of Cerebral Monitoring in Detecting Cerebral Ischemia during Carotid Endarterectomy: A Comparison of Transcranial Doppler Sonography, Near-infrared Spectroscopy, Stump Pressure, and Somatosensory Evoked Potentials 563
In awake patients undergoing carotid endarterectomy, stump pressure monitoring, near-infrared spectroscopy, and transcranial Doppler sonography provide similar accuracy for the detection of cerebral ischemia.
Fiberoptic Intubation and Laryngeal Morbidity: A Randomized Controlled Trial 585
Vocal cord sequelae after fiberoptic intubation with a flexible silicon tube were similar to conventional tracheal intubation.
Guidelines for Cardiac Management in Noncardiac Surgery Are Poorly Implemented in Clinical Practice: Results from a Peripheral Vascular Survey in The Netherlands 537
Poor agreement between American College of Cardiology/American Heart Association guideline recommendations for perioperative care and daily clinical practice.
See the accompanying Editorial View on page 526
Is Low-dose Droperidol “QT” Safe? 531
The December 2001 Food and Drug Administration (FDA) black box warning about droperidol, commonly used as premedication for postoperative nausea and vomiting, was based on 10 case reports. To determine the true incidence of QTc prolongation and/or drug-induced torsade de pointes (TdP) associated with droperidol use, Nuttall et al. conducted a retrospective study using the electronic Anesthesia Quality Assurance database at their institution. They reviewed charts of surgical patients from three years prior to December 2001 and from three years after the FDA warning. Prior to the black box warning, 12% of patients received droperidol for antiemesis; none were administered droperidol after the warning. Of an estimated 16,791 patients exposed to droperidol, none experienced documented torsade de pointes. In light of these findings, the FDA warning may be excessive and unnecessary for low-dose droperidol therapy. See the accompanying Editorial View on page 524
Norepinephrine Tested as Strategy for Resuscitation after Hemorrhagic Shock 591
Poloujadoff et al. subjected rats to uncontrolled hemorrhagic shock to test the efficacy of norepinephrine for resuscitation. Different doses of norepinephrine (from 0 to 500 μg · 100 g−1· h−1) were given in four hypotensive and four normotensive resuscitation groups, and animals were observed for 210 min posthemorrhage. Rats treated with high doses of norepinephrine died early. Survival significantly improved when norepinephrine was infused early at a rate of 50 μg · 100 g−1· h−1in both the normotensive and hypotensive resuscitation groups. More widely available than vasopressin, norepinephrine might be a useful strategy in resuscitation after hemorrhagic shock. See the accompanying Editorial View on page 529
Midazolam and Children's Preoperative Anxiety Studied 545
In some children, midazolam does not relieve presurgery anxiety. Kain et al. administered a series of behavioral tests, including the modified Yale Preoperative Anxiety Scale (mYPAS), to children scheduled for surgery and their parents. Based on the mYPAS and other scores, 14.1% of the children were nonresponders to midazolam. Correlation analysis revealed that these children tended to be younger, more emotional, and more anxious at baseline. Alternative anxiety-reducing strategies, including behavioral techniques, may be in order for this subgroup of children before surgery.
Effects of Hemodilution during Cardiac Surgery on Postoperative Cognition 577
Patients over the age of 65 scheduled for coronary artery bypass surgery were randomized to receive moderate (hematocrit ≥ 27%) or profound (hematocrit 15–18%) hemodilution during cardiopulmonary bypass. Authors Mathew et al. measured the patients' cognitive function preoperatively and 6 weeks postoperatively, to determine the effects of hemodilution on cognition. The trial was terminated after randomization of only 108 patients due to significant pulmonary complications evidenced in the moderate hemodilution group. In the patients who did complete the study, greater neurocognitive impairment was observed in those older patients receiving extreme hemodilution.
Intracranial Venous Thrombosis in the Parturient (Review Article) 652
This article has been selected for the Anesthesiology CME Program.