Issues

In a matched cohort analysis of patients drawn from three trials including over 25,000 patients, those with a history of intraoperative awareness had a five-fold increased incidence of awareness compared with propensity-matched controls who did not have a history of awareness. Anesthetic management did not differ between the cohorts; in view of the likely increased risk of awareness, clinicians should consider modifying anesthetic management in patients with a history of awareness.

This study evidenced that laryngeal mask airway failures occur in 0.86% of 11,910 pediatric anesthesia cases with its planned use, and are independently associated with ear/nose/throat procedures, admission status, prolonged surgical duration, airway abnormalities, and patient transport.

This randomized clinical trial demonstrated equivalent efficacy of human albumin versus hydroxyethyl starch for volume replacement in 61 children undergoing cardiac surgery. Although the trial was not powered to assess safety, outcomes measures were not different between the groups.

In a review of nearly 250,000 cases in the National Surgery Quality Improvement Program, early perioperative morbidity and mortality occurred in approximately 1:1,000 patients. Predictors for morbidity and mortality were overweight or obesity, chronic obstructive pulmonary disease, history of transient ischemic attack/stroke, hypertension, prior cardiac surgical intervention, and prolonged operative time.

One third of patients with perioperative cardiac arrests survive to hospital discharge. Two thirds of survivors have good neurological outcome. Shockable rhythms and asystolic arrests were associated with significant location-specific survival variance.

In this retrospective study, routine use of preoperative and intraoperative metoprolol—but not other β blockers—was associated with increased risk of stroke after noncardiac surgery. These data suggest that results of the POISE trial may have reflected a drug-specific effect of metoprolol in perioperative stroke.

Propofol reconfigures the brain’s network hub structure. Reconfiguration of hub structure may explain the observed loss of frontal–parietal feedback connectivity.

This study determined incidence of difficult mask ventilation combined with difficult laryngoscopy to be 0.4% of 176,679 adult cases, and succeeded in identifying 12 independent predictors for the critical situation.

Propofol reduces functional deficit after traumatic brain injury, in an animal model. These neuroprotective effects are mediated in part by inhibition of microglial nicotinamide adenine dinucleotide phosphate oxidase.

Isoflurane increased interleukin-11 synthesis in human and mouse proximal tubular cells via TGF-β1 signaling to protect against ischemic acute kidney injury.

Supplemental Digital Content is available in the text.

In healthy rats, larger lung volumes due to hysteresis were associated with smaller individual airspace dimensions, suggesting opening of previously nonaerated peripheral airspaces, rather than expansion of already opened airspaces.

Supplemental Digital Content is available in the text.

In a study of 1,000 women undergoing breast surgery for cancer, a small portion of the variance in preoperative response to noxious heat and cold testing could be explained by anxiety, the presence of chronic pain, and the number of previous operations. There was a weak correlation between response to experimental pain testing and acute postoperative pain, with largely similar predictive factors across both.

Supplemental Digital Content is available in the text.

In a more complete assessment of variants in the COMT gene in 1,000 women undergoing surgery for breast cancer, there were weak associations with sensitivity to heat or cold pain. The lack of association of COMT variants with acute postoperative opioid requirement raises questions regarding the clinical relevance of this gene in acute postoperative pain.

Supplemental Digital Content is available in the text.

Even though less than 9% of participants met “criteria” for fibromyalgia, increasing degrees of fibromyalgia-like symptoms were independently predictive of increased postoperative opioid requirements.

Supplemental Digital Content is available in the text.

Lidocaine patches (5%) caused pressure pain threshold increases when compared with placebo patch treatment. However, lidocaine patch treatment did not lead to decreases in summed pain intensity differences.

Using three complementary imaging techniques (proton magnetic resonance spectroscopy, functional magnetic resonance imaging, and functional connectivity) in chronic pain patients with fibromyalgia, it was shown that pregabalin treatment reduced brain insula glutamate levels and was associated with decreased connectivity of this structure to the default mode network.

This article is a revisiting of original material published as: Egbert LD, Battit GE, Turndorf H, Beecher HK: The value of the preoperative visit by an anesthetist: A study of doctor–patient rapport. JAMA 1963; 185:553–5.

Prevention and treatment of acute organ injury in surgical patients represents a critical challenge for the field of perioperative medicine. Here, the authors discuss manifestations of perioperative organ injury and provide examples for novel treatment approaches.