The importance of detection and prophylaxis in MRSA colonized patients in the surgical and intensive care unit context is discussed.

The value of planning tailored sedation for the intensive care unit patient and situation is reviewed. See the accompanying Editorial View on  page 1268 

These results suggest that positive end-expiratory pressure should be reduced in prone patients. See the accompanying Editorial View on  page 1262 

An optical needle could allow for reliable identification of the epidural space during needle placement.

An overview of research on the nitrate-nitrite-nitric oxide pathway with emphasis on relevance in anesthesiology and intensive care is reviewed.

Despite its numerous benefits, problems with patient controlled analgesia (PCA) devices can lead to serious errors and patient harm or death. In a longitudinal retrospective cohort study, critical incident reports attributed to PCA errors were assessed before and after implementation of new safety interventions. Before the intervention, PCA errors occurred in less than 1% of 25,198 patients; 21 errors involved pump programming. After the safety interventions were implemented, there were no PCA programming errors and total PCA errors were decreased as well. Despite the overall low incidence of errors, this study demonstrates that steps, such as use of newer PCA pumps, preprinted physician orders, and nurse and patient education, may be taken to improve the safety of patients receiving PCA.

Although it is clear that many drugs used in anesthesia are respiratory depressive, the mechanisms of these effects on oxygen sensing and signaling through the carotid body are not known. The carotid bodies were removed from six patients undergoing unilateral neck dissection because of head and neck cancer to investigate gene expression and protein localization in the carotid bodies. Expression for proteins involved in the oxygen-sensing pathway such as heme oxygenase 2, potassium channels, and subunits for γ-aminobutyric acid, nicotinic acetylcholine, purine, and dopamine receptors were identified. This study is the first to demonstrate the presence of human oxygen-sensing receptors and signaling proteins in the human carotid body, which are influenced by anesthesia.

Postoperative pulmonary complications (PPC) may occur in as many as 19% of patients undergoing surgery. However, the factors for identifying patients at risk have not yet been defined for a broad population of patients. This prospective, multicenter, randomized study evaluated and validated risk factors for PPC in patients undergoing surgery (N = 2,464). Patients with a PPC had a higher 30-day mortality compared with those without. Low preoperative arterial oxygen saturation, acute respiratory infection within 1 month, age, preoperative anemia, upper abdominal or intrathoracic surgery, longer surgery duration, and emergency surgery were identified as independent risk factors for PPC. These seven risk factors may be used as an index to assess patient risk for PPC.

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