Preparation of Modern Anesthesia Workstations for Malignant Hyperthermia–susceptible Patients: A Review of Past and Present Practice (Review Article) 205
Modern anesthesia workstations are not adequately prepared for the current Malignant Hyperthermia Association of the United States guidelines.
An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach™): A 2-year Prospective Validation in Patients for Elective Abdominal, Gynecologic, and Thyroid Surgery 25
Tracheal intubation can be achieved successfully in a large cohort of patients with a new management algorithm. See the accompanying Editorial Views on page 3 and page 7
High Incidence of Burnout in Academic Chairpersons of Anesthesiology: Should We Be Taking Better Care of Our Leaders? (Original Investigations in Anesthesiology) 181
Predictors of burnout in U.S. academic chairs are reviewed. See the accompanying Editorial View on page 1
Risk of Burnout in Perioperative Clinicians: A Survey Study and Literature Review (Original Investigations in Anesthesiology) 194
Factors associated with lower burnout scores are reviewed. See the accompanying Editorial View on page 1
Management of Intraoperative Hypoxemia during One-lung Ventilation (Case Scenario) 167
Strategies to prevent and correct hypoxemia during one-lung ventilation are reviewed.
Impact of Preoperative Statin Therapy on Adverse Postoperative Outcomes in Patients Undergoing Vascular Surgery 98
The renal and cardioprotective benefits of chronic statin therapy on postoperative morbidity are well established; however, their benefit on other systems is less well known. An observational study of 1,674 patients with or without preoperative chronic statin therapy undergoing aortic reconstruction was conducted. Based on the Revised Cardiac Risk Index (RCRI), statins were associated with a reduced global and cardiac mortality, including a twofold reduction in the risk of postoperative myocardial infarction and necrosis. However, the risks of pneumonia, multiple organ dysfunction syndrome, and surgical complications were not significantly reduced in patients receiving chronic statins. Overall, chronic statin therapy was associated with a reduction in both cardiac and vascular outcomes after aortic reconstruction.
Routine Clinical Practice Effectiveness of the Glidescope in Difficult Airway Management: An Analysis of 2,004 Glidescope Intubations, Complications, and Failures from Two Institutions 34
This study describes real-world experiences with the Glidescope video laryngoscope (GVL; Verathon Inc., Bothell, WA) for difficult airway management to assess its clinical utility. Adult patients undergoing general anesthesia using endotracheal intubation at two institutions were included. Of 71,570 patients, the GVL was used in 2,048 intubations. In 81% of cases the GVL was used on patients with preoperative predictors of difficulty. The success rate was 92% when GVL was used as the initial intubation device, 98% in patients with no predictors, and 94% when used as a rescue device. Neck anatomy, thyromental distance, cervical motion, and institution were significantly associated with GVL failures. Overall, the success rates with GVL were high, although failures did occur and providers should be able to intubate using various techniques. See the accompanying Editorial Views on page 3 and page 7
Preoperative Cerebral Oxygen Saturation and Clinical Outcomes in Cardiac Surgery 58
Reduced intraoperative cerebral oxygen saturation (Sco2) has been associated with higher rates of morbidity and mortality, including cognitive dysfunction, stroke, and coma. This prospective observational cohort study was conducted to assess the association between preoperative Sco2and clinical outcomes in 1,178 patients scheduled for cardiac surgery with cardiopulmonary bypass. Thirty-day mortality was 3.5%, and 13.3% of patients had major morbidity (two or more major complications and/or high dependency unit stay of 10 days or more). Nonsurvivors at 30 days had a lower Sco2than survivors. Sco2values equal to or lower than 50% were an independent risk factor for both 30-day and 1-yr mortality. Overall preoperative Sco2levels were indicative of the degree of cardiopulmonary dysfunction and were associated with mortality and morbidity. See the accompanying Editorial View on page 12