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
Translational Research and the Perioperative Phenotype: University of Michigan
Increased Risk of Awareness under Anesthesia: An Issue of Consciousness or of Memory?
Complications of Laryngeal Masks in Children: Big Data Comes to Pediatric Anesthesia
Neural and Immune Consequences of Traumatic Brain Injury: Does Propofol Reduce the Impact?
The Scientific Journey to Predicting and Preventing Postoperative Pain: Recalling Dr. Wall’s Stories along the Way
“Seeing” How Our Drugs Work Brings Translational Added Value
Equivalent Efficacy of Hydroxyethyl Starch 130/0.4 and Human Serum Albumin: If Nothing Is the Same, Is Everything Different? The Importance of Context in Clinical Trials and Statistics
Special Articles
Altered States: Psychedelics and Anesthetics
An Analysis of Methodologies That Can Be Used to Validate if a Perioperative Surgical Home Improves the Patient-centeredness, Evidence-based Practice, Quality, Safety, and Value of Patient Care
Perioperative Medicine
Increased Risk of Intraoperative Awareness in Patients with a History of Awareness
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.
Failure of the Laryngeal Mask Airway Unique™ and Classic™ in the Pediatric Surgical Patient: A Study of Clinical Predictors and Outcomes
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.
Six Percent Hydroxyethyl Starch 130/0.4 (Voluven®) versus 5% Human Serum Albumin for Volume Replacement Therapy during Elective Open-heart Surgery in Pediatric Patients
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.
Patient Selection for Day Case-eligible Surgery: Identifying Those at High Risk for Major Complications
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.
Predictors of Survival from Perioperative Cardiopulmonary Arrests: A Retrospective Analysis of 2,524 Events from the Get With The Guidelines-Resuscitation Registry
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.
Perioperative Metoprolol and Risk of Stroke after Noncardiac Surgery
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.
Reconfiguration of Network Hub Structure after Propofol-induced Unconsciousness
Propofol reconfigures the brain’s network hub structure. Reconfiguration of hub structure may explain the observed loss of frontal–parietal feedback connectivity.
Incidence, Predictors, and Outcome of Difficult Mask Ventilation Combined with Difficult Laryngoscopy: A Report from the Multicenter Perioperative Outcomes Group
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.
Critical Care Medicine
Propofol Limits Microglial Activation after Experimental Brain Trauma through Inhibition of Nicotinamide Adenine Dinucleotide Phosphate Oxidase
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.
Critical Role of Interleukin-11 in Isoflurane-mediated Protection against Ischemic Acute Kidney Injury in Mice
Isoflurane increased interleukin-11 synthesis in human and mouse proximal tubular cells via TGF-β1 signaling to protect against ischemic acute kidney injury.
Positive End-expiratory Pressure Increments during Anesthesia in Normal Lung Result in Hysteresis and Greater Numbers of Smaller Aerated Airspaces
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.
Pain Medicine
Pain in 1,000 Women Treated for Breast Cancer: A Prospective Study of Pain Sensitivity and Postoperative Pain
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.
Effect of Catechol-o-methyltransferase-gene (COMT) Variants on Experimental and Acute Postoperative Pain in 1,000 Women undergoing Surgery for Breast Cancer
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.
Survey Criteria for Fibromyalgia Independently Predict Increased Postoperative Opioid Consumption after Lower-extremity Joint Arthroplasty: A Prospective, Observational Cohort Study
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.
Lidocaine Patch (5%) in Treatment of Persistent Inguinal Postherniorrhaphy Pain: A Randomized, Double-blind, Placebo-controlled, Crossover Trial
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.
Pregabalin Rectifies Aberrant Brain Chemistry, Connectivity, and Functional Response in Chronic Pain Patients
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.
Classic Papers Revisited
Therapeutic Benefit of the Anesthesiologist–Patient Relationship
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.
Education: Images in Anesthesiology
Icteric Vocal Cords Recorded during Video Laryngoscopy
Anomalous Origin of the Left Pulmonary Artery from the Right Pulmonary Artery (Pulmonary Artery Sling)
Education: Anesthesia Literature Review
Anesthesia Literature Review
Education: Review Article
Perioperative Organ Injury
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.
Education: Mind to Mind
Value-based Healthcare
I Am With You
A Critical Care Holiday Poem
Reviews of Educational Material
The Signal and the Noise: Why So Many Predictions Fail—But Some Don’t. By Nate Silver. United Kingdom, Penguin Press, 2012. Pages: 544. Price: $27.95.
The Good Nurse: A True Story of Medicine, Madness, and Murder. By Charles Graeber. New York, Twelve–Hachette Book Group, 2013. Pages: 320. Price: $26.99.
Anesthetic Uptake and Action. By Edmond I Eger, II, M.D. Philadelphia, Williams & Wilkins, 1974. Pages: 383. Price: $18.47 (used).
Anesthesiology Reflections from the Wood Library-Museum
“I Awaken to Glory”
Man and His Health
Colon-Morales’ Uterine Displacement Device
Announcement and Call For Abstracts
2014 ANNUAL JOURNAL SYMPOSIUM
Acknowledgment
Acknowledgment
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