Issues

This meta-analysis found that accuracy and precision of continuous noninvasive arterial pressure monitoring devices are larger than what was defined as acceptable by the Association for the Advancement of Medical Instrumentation.

In an observational study of 6,005 patients using propensity score matching, perioperative use of inotropes was independently associated with increased 1-yr mortality (adjusted hazard ratio of 2.5). The results indicate that the beneficial effects of current inotropic drugs may be limited to only short-term hemodynamic improvement in patients after cardiac surgery.

In 1,627 patients undergoing coronary artery bypass graft surgery, those with a GNAS haplotype resulting in low expression and function of Gαs showed double the risk of death compared with other haplotypes. In this high-risk group, those who also received β-blockers showed triple the risk of death. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT

Supplemental Digital Content is available in the text.

The elimination clearance of dexmedetomidine was increased by 43% in subjects with seizure disorders taking phenytoin or carbamazepine. Patients taking phenytoin or carbamazepine may require higher than normal maintenance doses of dexmedetomidine to maintain the desired level of sedation/anesthesia.

In a study of 300 parturients receiving intrathecal fentanyl and bupivacaine for labor analgesia, these drugs interacted in a clearly synergistic manner.

In a case-controlled open-labeled study of 53 chronic obstructive pulmonary disease patients, patients breathing 100% oxygen during emergence had lower arterial oxygen levels after 60 min compared with patients breathing 30% oxygen balanced with nitrogen.

In animals with sensitized airway, combination of phosphodiesterase 4 inhibitors, particularly a new generation roflumilast, and sevoflurane exerted additive airway relaxation via an increase in airway smooth muscle cyclic adenosine monophosphate levels.

Administration of the alarmin high-mobility group box 1 protein produced memory dysfunction in mice. A neutralizing antibody to high-mobility group box 1 protein reduced memory dysfunction and prevented the inflammatory response following tibial surgery, indicating a major initiating role for this mediator in postoperative memory dysfunction.

The investigators tested and refined the previously reported surgical lung injury prediction model in a multicenter cohort of 1,562 at-risk surgical patients. Sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20–29 and ≥30 breaths/min), Fio₂ greater than 35%, and Spo₂ less than 95% were all significant predictors of acute respiratory distress syndrome.

Supplemental Digital Content is available in the text.

Comparisons between 14 people with sepsis to 9 similar patients without sepsis documented a significant loss of diaphragm muscle volume compared with the psoas muscle volume in the septic patients. The loss of diaphragm muscle was associated with loss of strength

Using a rat model of lesions of the nucleus tractus solitarii and various adrenergic antagonists, it was shown that α1- adrenoceptors are the cornerstone for this phenotype.

A novel model of ventilator-associated pneumonia, caused by oropharyngeal instillation of Pseudomonas aeruginosa, was developed in tracheally intubated pigs, positioned in anti-Tredelenburg. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT

Supplemental Digital Content is available in the text.

In a review of over 500,000 women enrolled in an insurance plan from 6 months before pregnancy through parturition, 14% received at least one dose of an opioid during pregnancy. Over 1 in 20 women received an opioid during the first trimester, and prevalence of opioid exposure varied several-fold across states, being generally lowest in the Northeast and highest in the South.

Hypersensitivity to chemical, thermal, and mechanical stimuli was observed bilaterally in complex regional pain syndrome (CRPS) patients when compared with control unaffected subjects. Thermal and mechanical hyperalgesia were greater in the CRPS-affected compared with that in the contralateral hands. The results suggest that central sensitization may explain some pain symptoms in patients with CRPS

In a review of over 22,000 German patients across a wide variety of surgical procedures, predictors of severity of acute postoperative pain were reproducible. Younger age, female sex, and preoperative pain intensity all were associated with statistically significant, but small increases in postoperative pain across procedures. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT

Supplemental Digital Content is available in the text.

In 16 patients scheduled for shoulder surgery, injection of solution 1 mm from a brachial plexus root resulted in low (8.2 psi) opening injection pressure, whereas injection of solution with the needle apposed to the root resulted in high (20 psi) opening injection pressure. These results suggest that high (>15 psi) opening injection pressure may indicate needle–nerve contact and avoiding injection in this condition might improve patient safety.

Pulmonary thromboendarterectomy is the most effective therapy for chronic thromboembolic pulmonary hypertension. The pathophysiology, anesthetic management, and perioperative outcomes of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary thromboendarterectomy are reviewed.

The current data suggest that buprenorphine–naloxone may provide pain relief in patients with chronic pain with opioid dependence or addiction. Studies are needed to assess the implication of buprenorphine–naloxone in clinical anesthesia and perioperative pain management.