Science, Medicine, and the Anesthesiologist

Adhesion formation is the most common cause of long-term complications after peritoneal surgery. This systematic review and meta-analysis of 28 randomized clinical trials assessed the use of various barrier agents in abdominal surgery. No barriers were associated with an increase in serious adverse events. Oxidized regenerated cellulose and hyaluronate carboxymethylcellulose reduced the incidence of adhesions and reoperations, respectively.

This is the first study to examine potential central sensitization resulting from staged bilateral total knee arthroplasty. Patients experienced greater postoperative pain after the second knee compared with the first as measured by visual analogue scales, patient-controlled analgesic, and rescue analgesics after the first and second operation. The accompanying review article supports the importance of this study, despite the small sample size, and suggests alternative etiologies for the increased pain of the second operation.

This review nicely presents the concept of the “intensive care unit triad” of pain, agitation, and delirium and the appropriate timing and management of these experiences for the patient. Often sedatives are used to minimize agitation and secondarily to ensure maintenance of catheters and monitors. However, the authors suggest that sedatives should be used only after pain and delirium have been addressed using both pharmacologic and nonpharmacologic strategies.

Studies have shown conflicting results as to the benefit of reducing blood glucose levels in critical illness aimed at reducing morbidity and mortality. This randomized study of 1,300 children admitted to the pediatric intensive care unit that were expected to require mechanical ventilation and vasoactive drugs compared outcomes after tight glycemic control or conventional glycemic control. Major clinical outcomes (number of days alive and mechanical ventilation at 30 days) were similar between the groups, demonstrating no benefit of tight glycemic control in this patient population.

Poor adherence to continuous positive airway pressure can have detrimental effects on patients with obstructive sleep apnea. This multicenter, prospective, single-group study found significant improvements in clinical outcomes in patients surgically implanted with an upper-airway stimulation device. The median apnea–hypopnea index decreased significantly, and quality of life scores also improved.

This article explored the potential of somatic cells to undergo nuclear reprogramming in response to external triggers alone. The authors describe a cellular reprogramming event, called stimulus-triggered acquisition of pluripotency whereby external stimuli such as changes in pH generate pluripotent cells. This study demonstrates the importance of epigenetics on the fate of mammalian cells.

The Medicare Patient Safety Monitoring System database presents a unique opportunity to explore changes in adverse-event rates over time. This study included records of more than 60,000 patients who had been hospitalized between 2005 and 2011. The in-hospital adverse-event rates declined significantly among patients with acute myocardial infarction and congestive heart failure. However, there was no change among patients with pneumonia and those with conditions requiring surgery. Therefore, despite national efforts to improve patient safety, additional steps are required.

Medical students play an important part of improving quality and patient safety overall. This study surveyed nearly 400 graduating medical students to develop a tool to assess the students’ perceptions about patient safety as observed on clinical rotations. The survey was found to have construct validity, concurrent validity, and good reliability across cultural factors. This may be an important tool to assess whether students are receiving and understanding clinical experiences that foster positive patient safety practices.