The change from earth's anoxic to oxic atmosphere in relation to the development of life is discussed. See the accompanying Editorial View on  page 1 

Total intravenous anesthesia was not associated with improved neurologic outcome in traumatic brain injury.

Orally administered cannabis extract did not show analgesic efficacy.

The need for large randomized trials to determine whether treatment strategies aimed at glucose control will improve patient outcomes is reviewed. See the accompanying Editorial View on  page 1 

1 Obesity is a major cause of type 2 diabetes, clinically evidenced as hyperglycemia. The altered glucose homeostasis is caused by faulty signal transduction via  the insulin signaling proteins which results in decreased glucose uptake by the muscle, altered lipogenesis, and increased glucose output by the liver. The etiology of this derangement in insulin signaling is related to a chronic inflammatory state, which modifies the insulin signaling proteins' functions. There are substantial differences in the molecular mechanisms of insulin resistance among different organs. Multipronged therapies aimed at rectifying obesity-induced anomalies in the central nervous system and peripheral tissues may be beneficial in obesity-induced insulin resistance.

The Laryngeal Tube Suction II (LTSII) is a recent revision of the Laryngeal Tube Suction. This study compared insertion and ventilation profiles of LTSII and ProSeal ™ Laryngeal Mask Airway (PLMA™) in anesthetized patients. The rate of successful insertion, insertion time, airway leak pressure, tidal volume, and postoperative airway morbidity were among many parameters measured. Insertion was successful in 37 and 48 of 50 patients with LTSII and PLMA™, respectively. The PLMA™ was superior to the LTSII in most measures of ventilation performance. Airway management with LTSII is inferior to that with PLMA™.

In this editorial, Hogan reviews and comments on the implications of a pharmacogenomics study of nitrous oxide by Nagele et al.  In Nagele et al. 's study, patients with a certain genetic mutation develop higher plasma homocysteine levels after nitrous oxide anesthesia than normal patients. The study suggests that deleterious events after nitrous oxide exposure may be enriched in a subset of patients with certain genetic predisposition. Hogan states that trials of nitrous oxide exposure in the clinical setting will be substantially strengthened by inclusion of single-carbon genotyping. Furthermore, knowing in advance who can breathe nitrous oxide without fear of clinically relevant hyperhomocysteinemia may help to sustain its safe use in the future.

Recent investigations have focused on increased operating room (OR) throughput without increasing total OR time. The authors examined if a system of parallel processing for lower extremity joint arthroplasties sustainably reduces nonoperative time and increases throughput. The high-throughput parallel processing strategy included neuraxial anesthesia, an induction room, patient selection, an additional circulating nurse, and specific end-of-case transfer to recovery. Throughput increased from 2.6 to 3.4 arthroplasties per day per room. Both nonoperative time and operative time decreased. Because joint arthroplasties generated a positive margin greater than the incremental cost, the high-throughput system improved financial performance. See the accompanying Editorial View on  page 3 

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