David Mackey, M.D., has organized a fascinating series of commentaries by national leaders in the construction and use of clinical data registries by regulatory agencies and physician practices, the first two of which appear in this month's issue:

  • Mackey: Can We Finally Conquer the Problem of Medical Quality? The Systems-based Opportunities of Data Registries and Medical Teamwork, p. 225

  • Jain et al. : A Public-Private Strategy to Advance the Use of Clinical Registries, p. 227

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Can We Finally Conquer the Problem of Medical Quality? The Systems-based Opportunities of Data Registries and Medical Teamwork 225

David C. Mackey 

A Public-Private Strategy to Advance the Use of Clinical Registries 227

Sachin H. Jain, Patrick H. Conway, and Donald M. Berwick 

What Are We Looking For? The Question of Resident Selection 230

Lee A. Fleisher, Alex S. Evers, Jeanine Wiener-Kronish, and John A. Ulatowski 

Making Sedation Safer: Is Simulation the Answer? 232

Carl E. Rosow 

Do We Need to Pay Toll on the Bridge from Innate Immunity to Ventilator-induced Diaphragm Atrophy? 234

Maria T. Kuipers, Catharina W. Wieland, and Marcus J. Schultz 

Ultrasound versus  Fluoroscopy in Image-guided Pain Treatment: Use Caution 236

Asokumar Buvanendran and James P. Rathmell 

Ebenezer Hopkins Frost (1824–1866): William T.G. Morton's First Identified Patient and Why He Was Invited to the Ether Demonstration of October 16, 1846 238

Ryan LeVasseur and Sukumar P. Desai 

Ebenezer Hopkins Frost was the first identified patient of William T.G. Morton to receive anesthesia. We suggest why he was invited to attend the ether demonstration of October 16, 1846.

Factors Affecting Admission to Anesthesiology Residency in the United States: Choosing the Future of Our Specialty 243

Gildàsio S. de Oliveira, Jr., Tulsi Akikwala, Mark C. Kendall, Paul C. Fitzgerald, John T. Sullivan, Christopher Zell, and Robert J. McCarthy 

The objective of this study was to examine factors associated with admission to anesthesiology residency in the United States. The study was a retrospective cohort evaluation of the 2010–2011 residency applicants. Applicants' characteristics and objective factors used to select trainees were extracted. The primary outcome was a successful match to an anesthesiology residency. The odds (99% CI) for successful match were 3.6 (3.1 to 4.2) for U.S. medical school graduates, 2.6 (2.3 to 3.0) for applicants with U.S. licensing exam part two scores greater than 210, and 1.2 (1.1 to 1.3) for female applicants. The odds (99% CI) for a successful match for applicants younger than 29 yr were 3.3 (2.0 to 5.4) and 2.8 (1.9 to 4.2). The average applicant had no peer-reviewed scholarly productivity. Although anesthesiology residency acceptance was primarily associated with U.S. medical school attendance and step 2 board scores, the authors' study suggests an influence of age and gender bias in the selection process. Peer-reviewed scholarly production among applicants and prior graduate education did not appear to influence candidate selection.

A Simulation Study of Common Propofol and Propofol-Opioid Dosing Regimens for Upper Endoscopy: Implications on the Time Course of Recovery 252

Cris D. LaPierre, Ken B. Johnson, Benjamin R. Randall, and Talmage D. Egan 

Propofol-remifentanil interaction models of respiratory compromise and no response to esophageal instrumentation were built and used along with a model of loss of responsiveness to simulate effects from published dosing schemes for upper endoscopy.

Cutaneous Vasoconstriction Affects Near-infrared Spectroscopy Determined Cerebral Oxygen Saturation during Administration of Norepinephrine 263

Henrik Sørensen, Niels H. Secher, Christoph Siebenmann, Henning B. Nielsen, Matthias Kohl-Bareis, Carsten Lundby, and Peter Rasmussen 

A common vasopressor, norepinephrine, reduces the near-infrared spectroscopy-determined cerebral oxygenation. This study provides evidence that skin oxygenation affects near-infrared spectroscopy, thus explaining the discrepancy between calculated cerebral capillary oxygen and the near-infrared spectroscopy-determined saturation during administration of norepinephrine.

High Intraoperative Inspired Oxygen Does Not Increase Postoperative Supplemental Oxygen Requirements 271

Natalie Mackintosh, Matthew C. Gertsch, Harriet W. Hopf, Nathan L. Pace, Julia White, Rebecca Morris, Candice Morrissey, Victoria Wilding, and Seth Herway 

Use of high inspired oxygen (more than 90%vs.  30%) was not associated with increased oxygen requirement postoperatively. High inspired oxygen may be reasonable in lower risk surgery to improve wound oxygenation and possibly reduce surgical site infection.

Anesthetic Protection of Neurons Injured by Hypothermia and Rewarming: Roles of Intracellular Ca2+and Excitotoxicity 280

Philip E. Bickler, Daniel E. Warren, John P. Clark, Pablo Gabatto, Maren Gregersen, and Heather Brosnan 

Isoflurane, sevoflurane, and xenon reduce damage to hippocampal neurons exposed to cold and rewarming injury. With isoflurane, the mechanism involves limiting glutamate excitotoxicity/N -methyl-D-aspartate receptor-mediated Ca2+overload, but the protection may be transient.

Volatile Anesthetics Reduce Invasion of Colorectal Cancer Cells through Down-regulation of Matrix Metalloproteinase-9 293

Björn Müller-Edenborn, Birgit Roth-Z'graggen, Kamila Bartnicka, Alain Borgeat, Alexandra Hoos, Lubor Borsig, and Beatrice Beck-Schimmer 

This study demonstrates that sevoflurane and desflurane attenuate neutrophil matrix metalloproteinase-9 release, leading to a reduced tumor invasion in vitro .

What Factors Affect Intrapartum Maternal Temperature? A Prospective Cohort Study: Maternal Intrapartum Temperature 302

Michael A. Frölich, Alice Esame, Kui Zhang, Jihua Wu, and John Owen 

We recorded hourly temperatures in 81 women with induced labor. Slightly more than half of the women showed a small positive temperature trend. Epidural analgesia had no effect on maternal temperature.

Hemodynamic and Hormonal Stress Responses to Endotracheal Tube and ProSeal Laryngeal Mask AirwayTMfor Laparoscopic Gastric Banding 309

Michele Carron, Stefano Veronese, Walter Gomiero, Mirto Foletto, Donato Nitti, Carlo Ori, and Ulderico Freo 

Stress responses to endotracheal tube are hazardous to patients with higher cardiovascular risk. Compared with endotracheal tube, ProSeal Laryngeal Mask AirwayTM(Laryngeal Mask Airway Company, Jersey, United Kingdom) reduces stress responses and muscle relaxant dosage in obese patients undergoing laparascopic gastric banding.

Postoperative QT Interval Prolongation in Patients Undergoing Noncardiac Surgery under General Anesthesia 321

Peter Nagele, Swatilika Pal, Frank Brown, Jane Blood, J. Philipp Miller, and Joshua Johnston 

Postoperative QT interval prolongation is common. Several perioperatively administered drugs are associated with a substantial QT interval prolongation.

Toll-like Receptor 4 Signaling in Ventilator-induced Diaphragm Atrophy 329

Willem-Jan M. Schellekens, Hieronymus W. H. van Hees, Michiel Vaneker, Marianne Linkels, P. N. Richard Dekhuijzen, Gert Jan Scheffer, Johannes G. van der Hoeven, and Leo M. A. Heunks 

Mechanical ventilation induces diaphragm muscle atrophy. The current study demonstrates that Toll-like receptor 4 signaling plays a role in the development of ventilator-induced diaphragm muscle atrophy, most likely through increased expression of cytokines and activation of lysosomal autophagy in the diaphragm.

In Vitro  Hemostatic Properties of French Lyophilized Plasma 339

Christophe Martinaud, Corinne Civadier, Sylvain Ausset, Catherine Verret, Anne-Virginie Deshayes, and Anne Sailliol 

The authors investigated the in vitro  properties of French lyophilized plasma before and after lyophilization and found a decrease of factors V/VIII. Global capacity to induce clot formation in vitro  seems to be preserved.

Accuracy of Ultrasound-guided Nerve Blocks of the Cervical Zygapophysial Joints 347

Andreas Siegenthaler, Sabine Mlekusch, Sven Trelle, Juerg Schliessbach, Michele Curatolo, and Urs Eichenberger 

Ultrasound imaging is an accurate technique for cervical zygapophysial joint nerve blocks in volunteers, except for the medial branch blocks of C7.

Estimation of the Contribution of Norketamine to Ketamine-induced Acute Pain Relief and Neurocognitive Impairment in Healthy Volunteers 353

Erik Olofsen, Ingeborg Noppers, Marieke Niesters, Evan Kharasch, Leon Aarts, Elise Sarton, and Albert Dahan 

Norketamine has an effect opposite to that of ketamine on pain relief.

Differential Effects of Peripheral versus  Central Coadministration of QX-314 and Capsaicin on Neuropathic Pain in Rats 365

Jun Shen, Lyle E. Fox, and Jianguo Cheng 

Peripheral blockade of transient receptor potential vanilloid receptor 1-expressing nociceptive afferents by perisciatic injection of the QX-314/capsaicin combination reduced neuropathic allodynia and hyperalgesia. Central blockade by intrathecal injection invoked spontaneous pain-like behaviors in rats.

Trigeminal Nerve Injury ErbB3/ErbB2 Promotes Mechanical Hypersensitivity 381

Fei Ma, Liping Zhang, and Karin N. Westlund 

Trigeminal ganglion neuron sensitization in the context of ErbB signaling activation potentially in peripheral glial Schwann cells, as well as lapatinib reduction of the sensitization, suggests an innovative direction with therapeutic potential.

Ondansetron Reverses Antihypersensitivity from Clonidine in Rats after Peripheral Nerve Injury: Role of γ-Aminobutyric Acid in α2-Adrenoceptor and 5-HT3 Serotonin Receptor Analgesia 389

Ken-ichiro Hayashida, Masafumi Kimura, Masaru Yoshizumi, Shotaro Hobo, Hideaki Obata, and James C. Eisenach 

Spinal γ-aminobutyric acid contributes to antihypersensitivity from stimulation of spinal α2-adrenergic and 5-HT3 receptors in rats after nerve injury. Blockade of spinal 5-HT3 receptors reduced α2-adrenoceptor-mediated antihypersensitivity via  reducing spinal γ-aminobutyric acid release in nerve-injured rats.

Case Scenario

Severe Emergence Agitation after Myringotomy in a 3-yr-old Child 399

Souhayl Dahmani, Jean Mantz, and Francis Veyckemans 

Images in Anesthesiology

Bone Cement Embolism 407

Jonathan B. Cohen 

Pneumoscrotum as the Presenting Symptom of Pneumothorax and Pneumoperitoneum after Jet Ventilation 408

Colin Wilson, Adam Green, Stephen Bader, and David Graf 

Anesthesia Literature Review 409

Clinical Concepts and Commentary

Innate Immune Dysfunction in Trauma Patients: From Pathophysiology to Treatment 411

Karim Asehnoune, Antoine Roquilly, and Edward Abraham 

Major alterations of innate immunity are associated with increased risk for nosocomial infections in trauma patients. Recent insights into posttraumatic immune dysfunction have defined new targets for immunointervention that hold promise for improving outcomes in such critically ill patients.


The Metronome 417

Richard J. Novak 

Panic 418

Shawn A. Platt 

Cardiac Anesthesiologist: The Friend of the Heart 420

Sandeep Kumar Kar 

Deposition in New York 422

Stephen Harvey 

Use of Recombinant Factor VIIa in Patients with Amniotic Fluid Embolism 423

Marian Knight, Kate Fitzpatrick, Jennifer J. Kurinczuk, and Derek Tuffnell 

In Reply

Barbara L. Leighton, Michael H. Wall, Ellen M. Lockhart, Louise E. Phillips, and Amanda J. Zatta 

Flow Chart for Amniotic Fluid Embolism Management: A Tricky Tool 424

Guilherme Holck and Michaela K. Farber 

In Reply

Laura S. Dean and David D. Hood 

The Devil in the Details 425

Mitchell H. Tsai and Ian H. Black 

In Reply

Duminda N. Wijeysundera and W. Scott Beattie 

Predictors of Analgesic Response to Sympathetic Blockade in Complex Regional Syndrome Type 1: No Conclusive Answers but Best to Get Standard Medical Therapy Right First 427

Michael J. E. Neil 

In Reply

Frank van Eijs, José Geurts, Maarten van Kleef, Catharina G. Faber, Roberto S. Perez, Alfons G. H. Kessels, and Jan Van Zundert 

Considerations for Evaluating the Accuracy of Hemoglobin Monitoring 429

Michael O'Reilly 

In Reply

Richard L. Applegate II, Steven J. Barr, Carl E. Collier, and Martin W. Allard 

Perioperative Ischemic Optic Neuropathy and Spine Surgery: Are We Asking the Right Questions? 431

Paul Martin Kempen 

Could the Open Door Crack on Perioperative Visual Loss Be Even Bigger?

Robert M. Raw 

It's Still the Water

C. Philip Larson, Jr. 

In Reply

Lorri A. Lee, Steven Roth, Michael M. Todd, Karen L. Posner, Nayak L. Polissar, Moni B. Neradilek, Nancy J. Newman, Robert A. Caplan, Frederick W. Cheney, and Karen B. Domino, for The Postoperative Visual Loss Study Group 

Author-created Surrogate Time Intervals Misrepresents Actual Times 436

Amr E. Abouleish and Stanley W. Stead 

Flawed Model Misrepresents the Impact of Anesthesiologists to Patient Safety in the Real World

Jerry A. Cohen, Norman A. Cohen, James D. Grant, and Daniel J. Cole 

In Reply

Franklin Dexter and Richard H. Epstein 

In Reply

James C. Eisenach 

Understanding the Mechanics of Laryngospasm Is Crucial for Proper Treatment 441

M. Ramez Salem, George J. Crystal, and Usharani Nimmagadda 

Ebenezer Hopkins Frost 442

Rajesh P. Haridas 

A Towering View of Charles T. Jackson's Grave 292

George S. Bause 

Albert Schweitzer's Favorite Anesthetist, His Wife Helene 308

George S. Bause 

Edison's Polyform 398

George S. Bause 


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