Issues

In 500 patients with cardiac risk factors undergoing noncardiac surgery with nitrous oxide, methylenetetrahydrofolate reductase gene variant did not alter homocysteine concentration or the incidence of cardiac injury. Vitamin B₁₂, although decreasing homocysteine concentration, did not alter the incidence of cardiac injury.

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Residual rocuronium-induced neuromuscular blockade at the reappearance of the fourth twitch in response to train-offour stimulation can be reversed within 5 min by 1.0 and 2.0 mg/kg sugammadex. A sugammadex dose of 0.5 mg/kg can reverse such residual neuromuscular blockade in less than 10 min.

White patients with similar body mass index undergoing general or orthopedic surgery were matched to comparable black patients within the same hospitals. After matching, blacks had induction-to-recovery room duration 7 min longer than whites (P = 0.0019), 6 min reflect cut-to-close time (P = 0.0032).

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In 106 patients randomized to receive spinal anesthesia for surgery without general anesthetics or with isoflurane or desflurane, isoflurane was associated with an increase in cerebrospinal fluid concentrations of Aβ40 and desflurane with a decrease in Aβ42. This clinical work parallels observations in animals, but its relevance to cognition after surgery remains uncertain.

The choice of potent volatile anesthetic may prolong hospitalization, increasing the cost of patient care. The hypothesis that duration of hospitalization is longer in patients anesthetized with isoflurane than in patients anesthetized with sevoflurane was tested first in a propensity-matched retrospective analysis and subsequently in a prospective alternatingintervention trial. The retrospective study, which included 2,898 triplets matched on anesthetic used, found the duration of hospitalization was shorter in patients anesthetized with sevoflurane or desflurane than in those anesthetized with isoflurane. However, the prospective trial, which included 1,584 operations, found no difference in length-of-stay between patients anesthetized with isoflurane and those anesthetized with sevoflurane. This illustrates the importance of testing the results of even a very robust retrospective analysis with an appropriately designed prospective study.

Most children are vitamin D deficient after congenital heart disease surgery, secondary to borderline preoperative levels and significant intraoperative decline. Lower vitamin D levels were associated with worse clinical outcome.

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The effects of volatile anesthetics on synchronization between electrocorticogram recordings in sheep were analyzed. In contrast to global synchrony, local cortical synchrony increased during anesthesia, which might contribute to the loss of long-range synchrony and information integration critical to consciousness.

Using a novel lung imaging technique that uses synchrotron radiation, the administration of positive end-expiratory pressure was shown to improve aeration in collapsed lung but not to eliminate overventilation of normal lung units in experimental lung injury.

The effective lung volume participating in gas exchange was estimated at the bedside by the differential Fick method and shown to be highly correlated with the end-expiratory lung volume, suggesting its use clinically.

Skeletal muscle ryanodine receptor proteins with a mutation associated with malignant hyperthermia were transiently expressed in human embryonic kidney cells. The authors could show enhanced sensitivity and intensity of the calcium mobilization response to specific pharmacologic stimulation of the ryanodine receptor of six mutant proteins compared with the wild type.

Using the acute hippocampal slice, the authors provide evidence that sevoflurane-induced preconditioning (4%, 60 min given before a 5-min period of hypoxia) attenuates the decrease in adenosine triphosphate stores, but not the changes in sodium and potassium levels. These results suggest that improved adenosine triphosphate content, but not Na+ or K+ levels, correlates with improved physiological recovery induced by sevoflurane preconditioning.

Acute statin treatment decreased macrophage infiltration of atherosclerotic lesions, as visualized with in vivo fluorescence-mediated tomography, in mice. The results suggested that short-term statin treatment may produce favorable effects to stabilize atherosclerotic plaques and decrease cardiovascular risk.

In 3- and 7-day-old rats, intrathecal injection of 0.5% levobupivacaine produced temporary spinal anesthesia, but did not increase apoptosis or result in histologic or behavioral neurotoxicity.

In normal sheep lungs mechanically ventilated (over 16 h, 8 ml/kg, zero positive end-expiratory pressure), progressive derecruitment is associated with increased regional shunt, implying insufficient hypoxic pulmonary vasoconstriction, and incipient inflammation.

Administration of probiotics in septic mice decreased mortality and systemic bacteremia and led to decreased apoptosis of colonic epithelium, decreased colonic epithelial proliferation, and decreased systemic and colonic cytokine expression.

In this meta-analysis of data from more than 1,200 patients, systemically administered magnesium decreased postoperative pain a small, statistically significant amount; a reduction in morphine use was clearly evident. The reduction in both pain and morphine use indicates magnesium has some utility as an analgesic adjunct after surgery.

Over a 10-yr period, 20 anesthesiologists referred to one institution after hiatus from practice underwent a simulation-based reentry program. The group was heterogeneous, and simulation aided the assessors in making recommendations.

This commentary seeks to clarify the recommendations and highlight the debate regarding the perioperative management of hemostasis in intracerebral hemorrhage.