Practice Guidelines for Chronic Pain Management (Special Article) 810
This document updates the Practice Guidelines for patients with chronic noncancer neuropathic, somatic, or visceral pain syndromes.
From Creatine Kinase-MB to Troponin: The Adoption of a New Standard (Clinical Concepts and Commentary) 1005
The history of the use of biomarkers to increase the rate of perioperative myocardial infarction detection is reviewed.
Role of Intraoperative and Postoperative Blood Glucose Concentrations in Predicting Outcomes after Cardiac Surgery 860
Incremental decreases of intraoperative glucose concentrations did not consistently reduce risk.
Residual Paralysis after Emergence (Clinical Concepts and Commentary) 1013
Adverse effects of residual paralysis after emergence from anesthesia are reviewed.
Simulation-based Assessment in Anesthesiology (Review Article) 1041
The use of simulation for measuring physician skills and competencies is reviewed.
Temporal Trends in the Epidemiology of Severe Postoperative Sepsis after Elective Surgery: A Large, Nationwide Sample 917
Although many epidemiologic studies have examined sepsis, postoperative sepsis specifically is not as well understood. Using the Nationwide Inpatient Sample, elective admissions of adult patients with a length of stay longer than 3 days for common elective operative procedures were analyzed between 1997 and 2006. Of 2,039,776 admissions identified, the rate of severe sepsis rose from 0.3% to 0.9%. This trend persisted after adjusting for relevant covariables. The in-hospital mortality rate for patients with severe postoperative sepsis declined from 44.4% to 34.0%; this trend also persisted after adjustment for relevant covariables. During the 10-yr period studied, there was an increase in the rate of severe postoperative sepsis, despite a concomitant decrease in the in-hospital mortality rate.
Pharmacodynamics and Cardiopulmonary Side Effects of CW002, a Cysteine-reversible Neuromuscular Blocking Drug in Dogs 910
The duration of action of the novel neuromuscular blocking drug, CW002, is dependent on its interactions with exogenous and endogenous cysteines. The current study examined the pharmacodynamics and safety of CW002 in dogs. The ED95was 0.009 mg/kg. At 3 × ED95, onset time was 2.6 ± 0.9 min and duration 47 ± 9 min. l-cysteine (50 mg/kg) injected 1 min after CW002 shortened the duration to 3.7 ± 0.6 min. At 25 × ED95, CW002 reduced mean arterial pressure. Concomitant declines in systemic vascular resistance, mean pulmonary artery pressure, cardiac output, contractility, and lusitropy began at 50 × ED95. However, even at a dose of 100 × ED95the average change in any variable was less than 20%. CW002 is a potent neuromuscular blocking drug that at doses up to 100 × ED95produces modest hemodynamic effects that are not associated with bronchoconstriction or consistent histamine release.
Malpractice Claims Associated with Medication Management for Chronic Pain 948
Medication management is an integral part of chronic pain management and its role in anesthesia chronic pain liability is increasing. Malpractice claims for chronic pain were collected from 2005 to 2008 and compared with other chronic pain claims from the American Society of Anesthesiologists Closed Claims Database. Medication management represented 17% of 295 chronic noncancer pain claims. Compared with other chronic pain claims, claims of medication management were more frequent in younger males with back pain. Most patients were prescribed opioids (94%) and additional psychoactive medications (58%), and had at least one factor associated with medication misuse (80%). Death was the most common outcome in medication management claims and was associated with long-acting opioids, additional psychoactive medications, and more than three factors commonly associated with medication misuse. Most anesthesia malpractice claims for medication management problems involved patients with a history of risk behaviors commonly associated with medication misuse. See the accompanying Editorial View on page 777