Anesthetic Considerations for Thoracoabdominal Aortic Aneurysm Repair (Case Scenario) 1093

The perioperative management of the patient undergoing open thoracoabdominal aortic aneurysm repair is reviewed.

Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality 963

One in 760 hospitalizations for delivery is complicated by near-miss morbidity or mortality and these patients at risk can be identified.

Prolonged Central Venous Desaturation Measured by Continuous Oximetry Is Associated with Adverse Outcomes in Pediatric Cardiac Surgery 1033

Continuous central venous oximetry is a potential target parameter in high-risk pediatric patients. See the accompanying Editorial View on  page 926 

Offset Analgesia in Neuropathic Pain Patients and Effect of Treatment with Morphine and Ketamine 1063

Reduced or absent offset analgesia indicates the inability to modulate pain perception in chronic neuropathic pain patients.

Potential Adverse Ultrasound-related Biological Effects: A Critical Review (Review Article) 1109

The biological effects of ultrasound, as reported in animal and human studies, are reviewed.

Protective and Detrimental Effects of Sodium Sulfide and Hydrogen Sulfide in Murine Ventilator-induced Lung Injury 1012

Oxidative stress from mechanical ventilation can lead to serious complications including death. This study assessed the protective effects of inhaled hydrogen sulfide (0, 1, 5, or 60 ppm) and intravascular sodium sulfide (Na2S) (single bolus infusion of 0.55 mg/kg) in anesthetized mice with high tidal volume (HVT) (40 mg/kg) ventilation for 4 h. Low-dose hydrogen sulfide did not alter lung injury induced by high tidal volume. The highest dose, 60 ppm hydrogen sulfide, accelerated ventilator-induced lung injury. In contrast, intravenous sodium sulfide reduced pulmonary neutrophil infiltration and edema. Oxidative stress-induced depletion of glutathione was also prevented by sodium sulfide. This study suggests beneficial effects of sodium sulfide in preventing lung injury during mechanical ventilation. See the accompanying Editorial View on  page 921 

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Effect of Single Recombinant Human Erythropoietin Injection on Transfusion Requirements in Preoperatively Anemic Patients Undergoing Valvular Heart Surgery 929

Despite its risks, blood transfusion is often required during cardiac surgeries. This prospective, single-center, single-blinded, randomized, parallel-arm controlled trial evaluated the effects of a single preoperative bolus of erythropoietin and an iron supplement 1 day before surgery. The incidence of transfusion was significantly lower in patients who received erythropoietin compared with saline controls (86%vs.  59%), as was the mean number of packed erythrocytes transfused. Patients who received erythropoietin had a significantly greater reticulocyte count 4 and 7 days postoperatively compared with controls. This study suggests that preoperative administration of erythropoietin and iron may be beneficial to conserve blood in anemic patients undergoing cardiac surgeries. See the accompanying Editorial View on  page 912 

Intraoperative Acceleromyography Monitoring Reduces Symptoms of Muscle Weakness and Improves Quality of Recovery in the Early Postoperative Period 946

Intraoperative neuromuscular blockade can result in residual blockade in the postanesthesia care unit (PACU) which may repair clinical recovery. In this study, patients (N = 155) were randomized to receive either intraoperative acceleromyography or conventional qualitative train-of-four rations monitoring (control group) in the PACU after intraoperative neuromuscular blockade. Patients who received acceleromyography monitoring had a significantly lower incidence of residual blockade, fewer symptoms of muscle weakness, and reduced overall weakness compared with the control group. This randomized study suggests that acceleromyography monitoring may improve PACU care and recovery. See the accompanying Editorial View on  page 918