Issues

Of the three outcome measures used, neuropsychological testing and ICD-9 coded clinical outcomes found deficits associated with anesthesia exposure in children while academic achievement tests did not. The variation of the results in published studies assessing the association between anesthetic exposure and cognitive deficits may be dependent on the outcome measure used.

Storing 36 vials of dantrolene at every ambulatory surgery center in the United States would save would save 33 lives per year at an incremental cost-effectiveness ratio of approximately $200,000 (in 2,010 dollars) per life saved, indicating that the recommended guideline is cost-effective.

The investigators conducted a randomized trial of an electronic decision support tool among residents at four training programs. Use of the tool markedly improved adherence to the guidelines compared to memory alone.

Both midazolam groups significantly and comparably reduced the risk of emergence agitation, and the 0.03 mg/kg dose did so without prolonging emergence time.

The results of this randomized blinded study show that the suprazygomatic approach to maxillary nerve block substantially reduces morphine requirements during the first 48 h. By reducing opioid requirements, use of suprazygomatic maxillary nerve blocks may reduce the likelihood of oxygen desaturation from occurring.

Using magnetic resonance imaging as the standard, bedside ultrasound had a positive predictive value of 71%, a negative predicted value of 96%, a sensitivity of 88%, and specificity of 89% for the diagnosis of anesthesia-induced atelectasis.

The investigators conducted a meta-analysis that included 7 nonrandomized checklist studies with a total of 37,339 patients. Use of a checklist significantly reduced complications, wound infections, and blood loss, but not mortality.

The opioid effect on electroencephalography-derived variables was very weak. The effects of sevoflurane and remifentanil on the hypnotic effect measured by bispectral index or entropy were additive but they acted synergistically on Composite Variability Index. Painful stimulation increased the C50 of sevoflurane without changing the structural models for bispectral index and entropy; a more complex parameter shift was found for Composite Variability Index.

Desflurane produces a direct inhibitory action on sinoatrial node pacemaker activity by depressing diastolic depolarization. However, sympathetic activation during desflurane inhalation counteracts the direct inhibitory action of desflurane on the sinoatrial node.

Supplemental Digital Content is available in the text.

Using human lung microvascular endothelial cells, it was shown that ropivacaine and lidocaine attenuated tumor necrosis factor-α–induced neutrophil adhesion and endothelial hyperpermeability via a reduction of Akt, endothelial nitric oxide synthase, and Src activation.

Administration of high-dose dabigatran etexilate to rats resulted in an increase in bleeding time which could be reduced by subsequent administration of coagulation factor concentrates. Routine coagulation assays did not predict the effect of coagulation factor concentrates to reduce bleeding from dabigatran.

Supplemental Digital Content is available in the text.

Anesthetized rabbits with hydrochloric acid–induced lung injury subjected to spontaneous breathing had improved lung injury and improved respiratory function compared with controls who did not spontaneously breathe.

The heat-shock response was activated 24 h before the experimental development of Pseudomonas aeruginosa pneumonia and led to worsened lung endothelial and epithelial permeability, decreased bacterial clearance and increased mortality.

In rats, the spontaneous activity of medium and large neurons was increased after paclitaxel treatment. Gene array studies demonstrated that the expression of several ion channels was altered by paclitaxel treatment potentially providing an explanation for the electrophysiological changes.

Using a rat model of arthritis, diclofenac reduced nociceptive sensitization and reduced additional behaviors suggesting anxiety- and depression-like changes in the animals. The activation of extracellular signaling-related kinase in several brain regions was implicated in these changes.

In a spinal nerve ligation injury model, neutralization of the chemokine CCL3 or administration of an antagonist of its receptor CCR5 attenuated development of early- and late-phase tactile allodynia. Antagonists of CCR5 may be a novel therapeutic approach to the treatment of neuropathic pain.

Supplemental Digital Content is available in the text.

The Serious Complication Repository Project of the Society for Obstetric Anesthesia and Perinatology captured data on nearly 257,000 parturients administered neuraxial or general anesthesia at 30 institutions between 2004 and 2009. Serious anesthesia-related complications were reported for 85 (1/3,000) patients. The most common serious complications were high neuraxial block, respiratory arrest in labor suite, and unrecognized spinal catheter.

Atrial fibrillation is the most common arrhythmia. The anesthetic considerations of endovascular ablation for the treatment of atrial fibrillation are reviewed.