Issues
Table of Contents
Anesthesiology
Editorial Board
Anesthesiology
This Month in Anesthesiology
This Month In: Anesthesiology
Anesthesiology CME Program
Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit
Editorial
Patient Safety: Anesthesiology Contributions and Supplements to the American Society of Anesthesiologists' Annual Meeting
Adult Congenital Heart Disease Patients Undergoing Noncardiac Surgery and the Role of Anesthesiologists as Perioperative Physicians
A Burning Issue: Preventing Patient Fires in the Operating Room
Targeting Aspiration Pneumonitis
Sleeping to Survive?: The Impact of Volatile Anesthetics on Mortality in Sepsis
Special Announcements
James C. Eisenach, M.D., Recipient of the 2013 Excellence in Research Award
Sachin Kheterpal, M.D., M.B.A., Recipient of the 2013 Presidential Scholar Award
Perioperative Medicine
Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease
In an administrative database of over 10,000 adults with congenital heart disease undergoing major noncardiac surgery, in-hospital mortality was increased compared with a well-matched comparison cohort. Adult congenital heart disease is an independent predictor of increased perioperative mortality.
Flammability of Surgical Drapes and Materials in Varying Concentrations of Oxygen
Supplemental Digital Content is available in the text.
Test samples of five surgical materials were ignited in three oxygen concentrations. At 21% oxygen, all materials tested met the Standard for Flammability of Clothing Textiles established by the Consumer Product Safety Commission. When exposed to 100% oxygen, all surgical materials tested would be categorized as unacceptable for consumer wear.
Selective β1-Antagonism with Bisoprolol Is Associated with Fewer Postoperative Strokes than Atenolol or Metoprolol: A Single-center Cohort Study of 44,092 Consecutive Patients
While the β-blockers metoprolol and atenolol reduce the risk of perioperative myocardial infarction, they also increase the risk of postoperative stroke. A retrospective cohort study was undertaken to determine whether the more β1-selective agent bisoprolol would be associated with a lower risk of postoperative stroke in patients undergoing noncardiac, nonneurological surgery at the University Health Network in Toronto, Ontario, Canada. A matched cohort of 2,462 patients, half of whom received bisoprolol while the other half received either metoprolol or atenolol, was created using a propensity score estimating the probability of being exposed to bisoprolol. The primary outcome, a stroke within 7 days of surgery, occurred in 2 patients taking bisoprolol and 10 patients taking metoprolol or atenolol. These results, along with those of other studies, suggest the risk of stroke associated with less selective β1-blockers results from inhibition of β2-mediated cerebral vasodilation.
Patient Injuries from Anesthesia Gas Delivery Equipment: A Closed Claims Update
The number of claims related to gas delivery, their severity, and their fraction of the total decreased markedly. Provider error continues to contribute, as does failure to complete a full machine check.
Surgery at the End of Life: A Pilot Study Comparing Decedents and Survivors at a Tertiary Care Center
In 747 consecutive all-payer patients seen at a preoperative assessment center, 5% were dead within 1 yr. Compared to survivors, decadents were more likely to undergo palliative or diagnostic rather than elective procedures.
The Anesthesia in Abdominal Aortic Surgery (ABSENT) Study: A Prospective, Randomized, Controlled Trial Comparing Troponin T Release with Fentanyl–Sevoflurane and Propofol–Remifentanil Anesthesia in Major Vascular Surgery
No significant differences in troponin levels were observed between patients receiving volatile versus total intravenous anesthesia after elective abdominal aortic surgery. These prospective randomized data suggest that volatile anesthesia is no more protective than total intravenous anesthesia.
Does Goal-directed Fluid Therapy Affect Postoperative Orthostatic Intolerance?: A Randomized Trial
This prospective, double-blinded, randomized clinical trial demonstrated that patients with orthostatic intolerance had increased length of hospital stay after open prostatectomy but goal-directed therapy did not reduce the prevalence of orthostatic intolerance after surgery.
Individually Optimized Hemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit: A Prospective, Randomized Controlled Trial
Early goal-directed therapy using stroke volume variation, cardiac index, and optimized global end-diastolic volume index reduces intensive care unit stay after cardiac surgery.
Perioperative Auto-titrated Continuous Positive Airway Pressure Treatment in Surgical Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial
In this randomized open-labeled clinical trial enrolling 177 patients with obstructive sleep apnea, auto-titrated continuous positive airway pressure (CPAP) successfully reduced the apnea hypopnea index whereas it remained abnormally high without the treatment. Despite the effectiveness, only 26–48% of the patients used the CPAP for more than 4 h per night during the perioperative nights.
Real-time Closed-loop Control in a Rodent Model of Medically Induced Coma Using Burst Suppression
A closed-loop anesthesia delivery system using a computer-controlled infusion of propofol can achieve a reliable and accurate real-time control of burst suppression in rats.
Isoflurane in Contrast to Propofol Promotes Fluid Extravasation during Cardiopulmonary Bypass in Pigs
Isoflurane, in contrast to propofol, during cardiopulmonary bypass is associated with a greater increase in fluid extravasation from the intravascular to the interstitial space, resulting in dilution of interstitial fluid and a decrease in interstitial colloid osmotic pressure.
Critical Care Medicine
Relationship between Volume and Survival in Closed Intensive Care Units Is Weak and Apparent Only in Mechanically Ventilated Patients
Supplemental Digital Content is available in the text.
There was no association between unit size and standardized mortality. Factors other than size, such as having full-time intensivists, appear to be the major determinants of mortality.
Accuracy of Plateau Pressure and Stress Index to Identify Injurious Ventilation in Patients with Acute Respiratory Distress Syndrome
Using computed tomography references for morphologic indexes in both a training and a validation group of patients, a Pplat >25 cm H2O and a STRESS INDEX >1.05 were found to be the best thresholds for identifying injurious ventilation.
Pulmonary Blood Flow Increases in Damaged Regions Directly after Acid Aspiration in Rats
Supplemental Digital Content is available in the text.
In the early stage of inflammation after acid-induced acute lung injury, the pulmonary blood flow is distributed heterogeneously. Areas of aspiration damage are congruent with regions of higher blood flow 10 min after injury.
Volatile Anesthetics Improve Survival after Cecal Ligation and Puncture
Exposing septic mice to volatile anesthetics, particularly sevoflurane, significantly improved survival.
Pain Medicine
Epidural Injections for Spinal Pain: A Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials
This systematic review of the literature found that the few available trials directly comparing epidural nonsteroid to nonepidural injections showed no benefit. Indirect comparisons of the techniques from a larger number of trials suggested epidural nonsteroid injections may confer some benefit.
Effect of Perioperative Intravenous Lidocaine Administration on Pain, Opioid Consumption, and Quality of Life after Complex Spine Surgery
Lidocaine administration to patients undergoing complex spine operations reduced pain but not opioid requirements early in the postoperative period.
Cyclosporine-inhibitable Blood–Brain Barrier Drug Transport Influences Clinical Morphine Pharmacodynamics
In 14 healthy volunteers, cyclosporine, an inhibitor of blood–brain barrier transporters, had minimal effects on circulating morphine concentrations, but increased the centrally mediated effect of morphine (miosis). These results suggest that transporter-mediated removal of morphine from the brain plays a role in morphine’s pharmacodynamics after systemic administration.
Education: Images in Anesthesiology
Robotic Surgeries in Patients with Advanced Glaucoma
Tegaderm™ Trauma in the Operating Room
Education: Anesthesia Literature Review
Anesthesia Literature Review
Education: Review Article
Risk Stratification Tools for Predicting Morbidity and Mortality in Adult Patients Undergoing Major Surgery: Qualitative Systematic Review
This article is a qualitative systematic review of risk stratification systems used in major noncardiac, nonneurological surgery, and which have been validated in heterogeneous surgical cohorts.
Education: Mind to Mind
The Anesthesiologist Breathes for You
Fantastic Delusions, Futility and a Family’s Love
Correspondence
Cuffed and Uncuffed Tubes and the Geometric Correlation with Pediatric Airway
In Reply
In Reply
Standard Kaolin-active Thromboelastography Cannot Detect Platelet Inhibition by Clopidogrel
Standard Thromboelastography Should Not Be Used to Assess Candidacy for Neuraxial Procedures in Patients Taking P2Y12 Inhibitors
Multilevel Continuous Intercostal Nerve Block Catheter: A Viable Alternative to Thoracic Epidural for Multiple Rib Fractures?
In Reply
The Power of Unbiased Genetic Screens to Discover Novel Anesthetic Targets
Reviews of Educational Material
Essential Pain Pharmacology: The Prescriber’s Guide. By Howard S. Smith, M.D., and Marco Pappagallo, M.D.; Stephen M. Stahl, M.D. (consultant editor). Cambridge, United Kingdom, Cambridge University Press, 2012. Pages: 575. Price: $75.00.
Anesthesiology Reflections from the Wood Library-Museum
“I Sleep to Awaken”
Dr. Joseph Bryant’s Role in President Grover Cleveland’s Secret Anesthesia and Surgery
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