Advances in the Management of Sepsis and in the Understanding of Key Immunologic Defects of the Disorder (Review Article) 1349

Current therapy for sepsis and future immunotherapeutic approaches are reviewed.

Use of Recombinant Factor VIIa in Patients with Amniotic Fluid Embolism: A Systematic Review of Case Reports 1201

Patients treated with Factor VIIa had significantly worse outcomes than cohorts who did not receive the drug.

Lipid Resuscitation of Bupivacaine Toxicity: Long-chain Triglyceride Emulsion Provides Benefits over Long- and Medium-chain Triglyceride Emulsion 1219

Long-chain triglyceride emulsion was associated with fewer recurrences of asystole after resuscitation and lower myocardial bupivacaine concentrations. See the accompanying Editorial View on  page 1151 

Buprenorphine Metabolites, Buprenorphine-3-glucuronide and Norbuprenorphine-3-glucuronide, Are Biologically Active 1251

Glucuronide metabolites of buprenorphine may contribute to its analgesic effects.

Relationship between Bispectral Index Values and Volatile Anesthetic Concentrations during the Maintenance Phase of Anesthesia in the B-Unaware Trial 1209

Bispectral index frequently correlates poorly with end tidal volatile anesthetic gas concentrations. See the accompanying Editorial View on  page 1149 

Genetic Variation, β-Blockers, and Perioperative Myocardial Infarction (Review Article) 1316

β-blockers are commonly used for prevention and treatment of perioperative myocardial infarction yet may have an unfavorable risk profile. This review presents evidence on the molecular, cellular, and physiologic consequences of genetic variation in the enzyme that metabolizes β-blockers, cytochrome p450 2D6. Genetic variation may alter adrenergic signaling and subsequently play a role in the variations in response to β-blocker therapy for patients with perioperative myocardial infarction.

Figure. No caption available.

Figure. No caption available.

Simulation-based Assessment of Pediatric Anesthesia Skills (Original Investigations in Education) 1308

Simulation studies are becoming increasingly more popular for training and assessment of clinical skills. In this study, residents and fellows (N = 35) were evaluated using 10 simulation scenarios of perioperative pediatric anesthesia care. The content-based checklist scores were deemed reliable and valid. Overall performance correlated with experience. The lowest scores were achieved on the appendicitis with sepsis scenario (45.5%) and the highest scores were achieved on the bronchospasm scenario (66.0%). These scenarios may be helpful for competency assessments for pediatric anesthesiologists.

Opioid Association with Serotonin Syndrome: Implications to the Practitioners (Case Scenario) 1291

Interactions between opioids and serotonergic agents can result in a life-threatening serotonin syndrome. This paper describes two case studies of patients who developed drug-induced serotonin syndrome. Both patients were eventually properly diagnosed, medications discontinued, and symptoms resolved. These cases emphasize the need for increased knowledge of drug-drug interactions, and clinical diagnostic criteria for serotonin syndrome. Furthermore, these cases support the ability to prevent mortality from serotonin syndrome with early and accurate diagnosis and treatment.