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The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Perioperative Management of Obstructive Sleep Apnea presents an updated report of the Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea.

Supplemental Digital Content is available in the text.

In this prospective cohort study, both nonobstructive sleep apnea (n = 20) and obstructive sleep apnea (n = 38) patients suffered sleep disturbance particularly on postoperative night 1 and significantly increased frequencies of sleep-disordered breathing particularly on postoperative night 3.

Series of pre- and postoperative polysomnographic recordings in 376 adult patients undergoing various types of anesthesia and surgeries revealed that severity of preoperative sleep-disordered breathing, aging, and postoperative opioid dose are associated with postoperative sleep-disordered breathing severity.

Incidence of swallowing dysfunction increased more than double during partial neuromuscular block in healthy elderly individuals without impairment of coordination between swallowing and breathing. Reduced upper esophageal sphincter tone did not recover even at the train-of-four ratio of 0.9.

In 67 anesthetized and nonparalyzed adult patients with nonobstructed upper airway, real-time ultrasonography of the antrum for the detection of gastric insufflation revealed that pressure-controlled ventilation with inspiratory pressure of 15 cm H2O and zero positive end-expiratory pressure achieved lower occurrence of gastric insufflation with proper lung ventilation during anesthesia induction.

In 30 patients scheduled for coronary surgery with fentanyl or midazolam anesthesia, mild hyperventilation (Paco2, 30 mmHg) reduced cerebral blood flow by 60%, did not alter cerebral metabolic rate for oxygen or glucose, but increased net cerebral lactate efflux, consistent with partial impairment of cerebral aerobic metabolism.

In a single-center, cluster-randomized trial (n = 12,032 patients, 79 anesthesiologists), implementation of a postoperative nausea and vomiting prediction model without specific treatment recommendation did not reduce the postoperative nausea and vomiting incidence (odds ratio, 0.97; 95% CI, 0.87–1.10).

The incidence of major complications was significantly reduced, with a relative risk of 0.7 (95% CI, 0.55–0.88). The duration of hospitalization was also significantly reduced from a median of 17 to 15 days.

Target-controlled infusions based on published hydromorphone pharmacokinetic parameters underestimated observed plasma concentrations in 49 cardiac surgery patients receiving hydromorphone for postoperative pain management. A new hydromorphone pharmacokinetic model with a smaller initial distribution volume and age- and body weight-adjusted pharmacokinetic parameters was developed that may improve dosing in patients undergoing cardiac surgery.

Supplemental Digital Content is available in the text.

Selective lesion of cholinergic medial septal neurons enhanced sensitivity to isoflurane and prolonged isoflurane anesthesia.

Female mouse pups exposed to sevoflurane anesthesia exhibited deficits in classic maternal behaviors after delivery, an effect which was prevented by coadministration of the antioxidant, hydrogen gas with sevoflurane. Previous anesthesia exposure did not alter oxytocin or vasopressin release in the maternal mice after delivery.

Lactic acid infusion enhances low-flow extracorporeal carbon dioxide removal; this system, therefore, may be of great utility in critically ill patients.

Supplemental Digital Content is available in the text.

In rats undergoing hemorrhage to a mean arterial pressure of 34 mmHg for 1 h followed by resuscitation, there was acute dysfunction of the soleus, but not diaphragm muscles, accompanied by a greater reduction in blood flow to the soleus than the diaphragm. These results suggest that acute diaphragmatic dysfunction may be uncommon in hemorrhagic shock.

Rats were used to show that irritation of the uterus with mustard oil provoked colonic hypermotilty. These effects were shown to be dependent on local transient receptor potential subfamily ankyrin 1 channel activation and spinal NR2B receptor stimulation.

Peripheral inflammation increases spinal levels of PGI₂, which in turn stimulates cyclic adenosine monophosphate production and glutamate release. Correspondingly, spinal neuron IP receptor blockade causes analgesia. These results provide a framework for understanding PGI₂ participation in spinal nociceptive signaling.

Supplemental Digital Content is available in the text.

In mice oxaliplatin causes sensitization to both cold and mechanical stimuli, most prominently in the forepaws. Administration of the antioxidant agent SS-31 reduced both the nociceptive sensitization and the accumulation of reactive oxygen species.

Electroacupuncture alleviates sensory and affective components of pain through specific mechanisms and may be used to decrease pain medication dosages.