Issues

Compared to colloid (hydroxyethyl starch 6% 130/0.4), normovolemic hemodilution with crystalloid (balanced electrolyte solution) produced greater renal hypoxia indicating the diluent may be a factor when evaluating hemodilution and acute kidney injury.

This individual patient level meta-analysis indicates that increased postoperative B-type natriuretic peptide predicts mortality, cardiac mortality, mortality or nonfatal myocardial infarction, and cardiac failure at 30 days and 180 days or more after noncardiac surgery.

In a secondary analysis of an observational study of 1,025 coronary artery bypass graft surgical patients, increased perioperative plasma B-type natriuretic peptide independently predicted 5-yr heart failure hospitalization and heart failure death.

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In an open-label parallel arm study of 100 patients with acute respiratory distress syndrome receiving low tidal volume ventilation, sending the anesthesia providers an alert with a recommended tidal volume of 6 ml/kg resulted in a significant reduction in tidal volume delivered during anesthesia compared with conventional care. Complications and major morbidity did not differ between groups.

Intraoperative high Fio₂ decreases the risk of surgical site infection in surgical patients receiving prophylactic antibiotics, has a weak beneficial effect on nausea, and does not increase the risk of postoperative atelectasis.

In healthy rats, calabadion 1 produced a dose-dependent reversal of neuromuscular blockade from cisatracurium and rocuronium without affecting heart rate, blood pressure, or arterial blood gas tensions or pH.

The results demonstrate that neuromuscular depression during train-of-four monitoring is due to a decline in nerve terminal Ca²⁺ currents. More profound stimulation conditions seem to be required for depletion of acetylcholine stores.

Using postnatal rat hippocampal slice cultures, the authors demonstrated that xenon used at 1 minimum alveolar concentration-equivalent concentration increased apoptosis similar to sevoflurane and isoflurane at equipotent concentrations, and that this effect was abolished by preconditioning the tissue with a subtoxic concentration of isoflurane.

Using a model of mechanically ventilated piglets in the absence of brain injury, the authors could show that neither 24 h of 50% inhalated xenon nor fentanyl, alone or in combination, induced apoptosis in the neonatal pig brain in normothermic or hypothermic conditions. Isoflurane 2% was found to induce apoptosis in this experimental paradigm.

At subanesthetic concentrations isoflurane and sevoflurane produce developmental effects in neonatal rats acting via similar mechanisms that may involve an increase in neuronal activity. At the same time, substantial differences in the effects of the two drugs suggest differences in the mechanisms mediating their actions and in their safety profile for neonatal anesthesia.

Allogeneic erythrocyte transfusion of older erythrocytes causes pulmonary dysfunction that is characterized by marked neutrophil/macrophage infiltration. Moreover, transfusion interacted with cardiopulmonary bypass to increase lung injury

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ICI 174,864 with or without low volumes of Ringer’s lactate, dose-dependently increased blood pressure and prolonged short-term survival in rats subjected to uncontrolled hemorrhagic shock. Survival was markedly higher in rats treated with ICI 174,864 than those with standard fluid resuscitation once bleeding was controlled.

In 30 critically ill adult patients mechanically ventilated more than 10 days, extremity muscle weakness assessed by medical research council score was an independent predictor of swallowing dysfunction and symptomatic aspiration after extubation.

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This study suggests that high-frequency oscillatory ventilation at higher frequencies minimizes lung stress and tidal volume, resulting in less lung injury and reduced local lung inflammation.

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Prolonged administration of pyridostigmine (25 mg·kg^-1·day^-1) leads to neuromuscular impairment, even if discontinued for 24 h. This impairment appears to be associated with, but is also independent of, acetylcholine receptor downregulation.

The effectiveness of spinal cord stimulation in the treatment of neuropathic pain depends on stimulation frequency and intensity. In a rat model of neuropathic pain, the intensity-dependent (20%, 40%, 80% of motor threshold) attenuation of pain by bipolar spinal cord stimulation at frequencies of 50 Hz, 1 kHz, and 10 kHz was studied on three consecutive days after L5 spinal nerve ligation. At a stimulation intensity that was 80% of the motor threshold, 1-kHz spinal cord stimulation reduced mechanical hypersensitivity more than 50-Hz stimulation did, with an earlier onset of analgesic effect (day 1 vs. day 2). The effect of 1-kHz stimulation was observed even at 40% of the motor threshold. The C-fiber component of wide dynamic range neuronal wind-up was reduced only at a 50-Hz stimulation frequency. Pain relief by kilohertz level and 50-Hz stimulation may involve different peripheral and spinal segmental mechanisms.

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These studies in rats suggest that although both volatile and injectable anesthetics reduce overall spinal nociceptive signaling, they unexpectedly do not alter peptide release from primary afferents; only fentanyl and the combination of isoflurane and nitrous oxide exert a presynaptic effect by blocking dorsal horn substance P release.

Identification of all published questionnaires used to measure patient satisfaction with anesthesia, and the qualitative appraisal of the psychometric development and validation processes of these tools are discussed.