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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
Substance P-Saporin for Bone Cancer Pain in Dogs: Can Man’s Best Friend Solve the Lost in Translation Problem in Analgesic Development?
Humanitarian Surgery: A Call to Action for Anesthesiologists
Consciousness and the 21st Century Operating Room
Exome Sequencing: One Small Step for Malignant Hyperthermia, One Giant Step for Our Specialty—Why Exome Sequencing Matters to All of Us, Not Just the Experts
Horace Wells’ “Humbug Affair” Occurred at Massachusetts General Hospital? Humbug!
Sleep, Respiration, and Pain: A Potential Nexus for Chronic Pain Risk?
Special Articles
Horace Wells’ Demonstration of Nitrous Oxide in Boston
The Foregger Midget: A Machine that Traveled
Perioperative Medicine
Simultaneous Electroencephalographic and Functional Magnetic Resonance Imaging Indicate Impaired Cortical Top–Down Processing in Association with Anesthetic-induced Unconsciousness
Supplemental Digital Content is available in the text.
Both simultaneous electroencephalographic and functional magnetic resonance imaging measurement confirmed a decreased connectivity in frontoparietal feedback networks with propofol-induced unconsciousness.
Using Exome Data to Identify Malignant Hyperthermia Susceptibility Mutations
Supplemental Digital Content is available in the text.
In 870 volunteers not ascertained for malignant hyperthermia susceptibility, numerous variants in RYR1 and CACNA1S genes were observed, some consistent and others inconsistent with presumed pathogenicity in current databases.
Exome Sequencing Reveals Novel Rare Variants in the Ryanodine Receptor and Calcium Channel Genes in Malignant Hyperthermia Families
Exome sequencing of DNAs from four pedigrees associated with malignant hyperthermia identified novel genetic variant in each. The increased sensitivity of exome sequencing combined with allele frequency data is a powerful approach to identify rare genetic variants–associated malignant hyperthermia.
Realizing Improved Patient Care through Human-centered Operating Room Design: A Human Factors Methodology for Observing Flow Disruptions in the Cardiothoracic Operating Room
There were an average of about 100 flow disturbances per case. One third of the disturbances were related to operating room layout and design.
Positive End-expiratory Pressure Influences Echocardiographic Measures of Diastolic Function: A Randomized, Crossover Study in Cardiac Surgery Patients
Individual pulsed wave Doppler and tissue Doppler indices of left ventricular diastolic function are subject to change with increasing positive end-expiratory pressure in postoperative cardiac surgery patients. The presence of positive pressure ventilation should thus be taken into account when evaluating echocardiographic indices of diastolic function.
Assessment of Homology Templates and an Anesthetic Binding Site within the γ-Aminobutyric Acid Receptor
Supplemental Digital Content is available in the text.
Molecular modeling revealed a putative intersubunit binding site for propofol that predicted the potency of propofol congeners for receptor potentiation. This approach might provide the basis for high-throughput in silico screening of novel anesthetic compounds.
Bumetanide, an Inhibitor of Cation-chloride Cotransporter Isoform 1, Inhibits γ-Aminobutyric Acidergic Excitatory Actions and Enhances Sedative Actions of Midazolam in Neonatal Rats
Bumetanide, a selective inhibitor of the transporter NKCC1, reduced neuroexcitatory effects in hippocampal slices and increased sedation by midazolam in neonatal rat. The neuroexcitatory effects and reduced sedative activity of midazolam in neonatal rats appear to involve increased intracellular chloride produced by NKCC1.
Effect of Hemorrhage and Hypotension on Transcranial Motor-evoked Potentials in Swine
Treatment of hemorrhage-induced hypotension and reductions in potential amplitude was less effective with phenylephrine than with epinephrine, which also increased cardiac output and oxygen delivery. This animal model suggests that monitoring cardiac output facilitates treatment of hemorrhage-induced reductions in motor-evoked potentials in spine surgery.
Critical Care Medicine
13C NMR Metabolomic Evaluation of Immediate and Delayed Mild Hypothermia in Cerebrocortical Slices after Oxygen–Glucose Deprivation
Supplemental Digital Content is available in the text.
Spectroscopy in a highly controlled brain oxygen–glucose-deprivation slice model using neonatal rats was used during three different mild hypothermia protocols. Starting mild hypothermia simultaneously with oxygen–glucose-deprivation compared with delayed or no hypothermia is associated with higher pyruvate carboxylase throughput. This suggests that glial integrity is one key component of the neuroprotective effect of mild hypothermia.
Neuroprotection against Traumatic Brain Injury by Xenon, but Not Argon, Is Mediated by Inhibition at the N-Methyl-d-Aspartate Receptor Glycine Site
Given after traumatic injury to hippocampal slices, xenon (and argon to a lesser degree) halves the secondary neuronal injury. N-methyl-d-aspartate antagonism is an important component of this protective effect.
Pain Medicine
Nocturnal Intermittent Hypoxia Is Independently Associated with Pain in Subjects Suffering from Sleep-disordered Breathing
In a review of over 634 individuals in the Cleveland Family Study, a study of genetics in obstructive sleep apnea, nocturnal oxyhemoglobin desaturation was independently associated with morning headache, headache disrupting sleep, chest pain while in bed, and pain disrupting sleep.
Intrathecal Substance P-Saporin in the Dog: Distribution, Safety, and Spinal Neurokinin-1 Receptor Ablation
Supplemental Digital Content is available in the text.
Lumbar intrathecal injection of substance P-saporin, 15 μg, resulted in loss of neurons in the spinal cord dorsal horn expressing the neurokinin-1 receptor. A larger dose, 150 μg, resulted in progressive lower limb paresis and loss of motor neurons in the ventral horn expressing the neurokinin-1 receptor.
Intrathecal Substance P-Saporin in the Dog: Efficacy in Bone Cancer Pain
Substance P-saporin (SAP) is a chemical conjugate of substance P, a tachykinin neuropeptide, and saporin, a recombinant version of a ribosomal-inactivating protein, that selectively destroys superficial neurokinin-1 receptor bearing cells in the spinal dorsal horn when it is administered intrathecally. Bone cancer is commonly associated with severe pain that evolves over time and is refractory to conventional pain therapies in both dogs and humans. Seventy companion dogs with bone cancer pain were randomly assigned to receive standard analgesic therapy alone or with intrathecally administered SAP. Intrathecally administered SAP produced a time-dependent antinociceptive effect; owners requested unblinding and additional intervention by 6 weeks in 74% of control dogs and 24% of SAP-treated dogs. There was no evidence of deafferentiation in the SAP-treated dogs, but hind limb weakness and ataxia were observed in some dogs receiving cisternal injections of SAP before doses for animals with front limb tumors were decreased.
Effect of Deep Tissue Incision on pH Responses of Afferent Fibers and Dorsal Root Ganglia Innervating Muscle
Using a muscle–nerve preparation from the rat hind paw, the authors were able to demonstrate that incision sensitizes afferent nerve fibers serving deep tissues. Acid-sensing ion channels may be responsible for this pain-related sensitization.
Epigenetic Regulation of Spinal CXCR2 Signaling in Incisional Hypersensitivity in Mice
In mice, histone modification as one epigenetic mechanism is important to hypersensitivity after incision, and at least one epigenetic target after incision is change in CXCR2 expression.
Education: Images in Anesthesiology
An Unusual Transversus Abdominis Plane Block: Anatomic Variation in the Internal Oblique Muscle
A Preoperative Headache
Education: Anesthesia Literature Review
Anesthesia Literature Review
Education: Clinical Concepts and Commentary
Perioperative Gabapentinoids: Choice of Agent, Dose, Timing, and Effects on Chronic Postsurgical Pain
This article summarizes the current evidence for the use of gabapentinoids in the perioperative setting and provides useful clinical recommendations regarding dosing, timing, and choice of agent.
Education: Mind to Mind
November Hill
Informed Consent
It Just Doesn’t Make Good Business Sense
Correspondence
Sustaining a Reduction in Fresh Gas Flow Rates
Opioid Tolerance or Opioid Withdrawal?
In Reply
Reviews of Educational Material
Essentials of Palliative Care. Edited By Nalini Vadivelu, M.D., Alan David Kaye, M.D., Ph.D., Jack M. Berger, M.S., M.D., Ph.D. New York, Springer Science+Business Media, 2013. Pages: 539. Price: $69.95.
Anesthesiology Reflections from the Wood Library-Museum
The Last Known Image of Paul Meyer Wood, M.D.
Drs. Betcher and Annis Formally Open the Wood Library-Museum in Park Ridge
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