Table of Contents
This Month in Anesthesiology
Science, Medicine, and the Anesthesiologist
Infographics in Anesthesiology
Anesthesiology CME Program
Modifications in catheter materials, tip design, and orifice number and arrangement have been introduced over the past several decades in an attempt to improve analgesic and anesthetic outcomes.
Perioperative Medicine: Clinical Science
Cumulative Duration of “Triple Low” State of Low Blood Pressure, Low Bispectral Index, and Low Minimum Alveolar Concentration of Volatile Anesthesia Is Not Associated with Increased Mortality
In a review of over 16,000 patients, there was no association between duration of triple low state intraoperatively and either perioperative or intermediate-term mortality.
Predictors of Patient Medication Compliance on the Day of Surgery and the Effects of Providing Patients with Standardized yet Simplified Medication Instructions
In over 1,000 patients in a case-control study design, use of a simple, multicolored Preoperative Patient Medication Instruction sheet improved compliance with instructions.
Economic Trends from 2003 to 2010 for Perioperative Myocardial Infarction: A Retrospective, Cohort Study
Charges for patients with perioperative myocardial infarction were about $100,000 greater than in patients without infarctions. However, mortality remained nearly unchanged over the 8-yr period, and incremental costs decreased slightly.
Gastric sonography can provide information about the volume of the stomach. Ultrasound assessment of gastric volume by clinical anesthesiologists is highly reproducible with high intrarater and interrater reliability.
Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers
Using randomized cross-over study design, continuous slow infusion of radionuclide tracer into the pharynx in 26 healthy volunteers revealed incidence of pulmonary aspiration, directly determined by the tracer in the lung field, during remifentanil (48%) than during placebo infusion (12%). Subjective symptoms such as swallowing difficulty and hand grip strength were not associated with the aspiration.
Efficacy of Sugammadex for the Reversal of Moderate and Deep Rocuronium-induced Neuromuscular Block in Patients Pretreated with Intravenous Magnesium: A Randomized Controlled Trial
A 60 mg/kg intravenous dose of magnesium sulfate administered before induction of anesthesia had no effect on the ability of recommended doses of sugammadex to reverse neuromuscular blockade produced by an intubating dose of rocuronium after spontaneous recovery to moderate and deep levels of blockade.
Perioperative Medicine: Basic Science
Fast-spiking Cell to Pyramidal Cell Connections Are the Most Sensitive to Propofol-induced Facilitation of GABAergic Currents in Rat Insular Cortex
In brain slices from the insular cortex, propofol preferentially enhanced fast spiking GABAergic interneuron connections to pyramidal neurons. This suppresses excitatory output from the cortex.
Disruption of Hippocampal Neuregulin 1–ErbB4 Signaling Contributes to the Hippocampus-dependent Cognitive Impairment Induced by Isoflurane in Aged Mice
Isoflurane in 100% oxygen significantly impaired the hippocampus-dependent cognitive function assessed at 48 h by the fear conditioning test in mice. This effect was mediated at least in part via disruption of the neurotrophic factor–dependent NRG1–ErbB4 signaling in the parvalbumin-positive interneurons.
Critical Care Medicine: Clinical Science
Lysis Onset Time as Diagnostic Rotational Thromboelastometry Parameter for Fast Detection of Hyperfibrinolysis
In an in vitro assay, this study investigated which thromboelastometric hemostatic parameters could be valuable for fast diagnosis of the severity of hyperfibrinolysis, and then confirmed the findings in a patient population with hyperfibrinolysis.
Critical Care Medicine: Basic Science
The relative hyperleptinemia of class 1 obesity or exogenous leptin administration was protective in experimental sepsis. This suggests leptin is a possible novel therapy for sepsis.
Inhibition of the Ubiquitin–Proteasome Pathway Does Not Protect against Ventilator-induced Accelerated Proteolysis or Atrophy in the Diaphragm
Pharmacologic inhibition of the ubiquitin–proteasome pathway, using epoxomicin, did not protect the diaphragm against oxidative stress or atrophy in anesthetized, mechanically ventilated rats.
Pain Medicine: Clinical Science
Proteinase-activated Receptor 1 Contributed to Up-regulation of Enkephalin in Keratinocytes of Patients with Obstructive Jaundice
In patients with cholestasis who were scheduled to surgery, postoperative morphine consumption was decreased. In skin biopsies, expression of enkephalin was significantly increased. In a parallel rodent study, in rats with experimentally induced cholestasis, skin enkephalin expression, and nociceptive thresholds were increased. The administration of protease-activated receptors-1 antagonist reduced skin enkephalin expression. Protease activated receptors-1 receptor activation increases skin enkephalin expression and may serve as a novel therapeutic option for treatment of postoperative pain.
Polymorphism in the ADRB2 Gene Explains a Small Portion of Intersubject Variability in Pain Relative to Cervical Dilation in the First Stage of Labor
In modeling hourly labor pain as a function of cervical dilatation in approximately 200 women through the course of labor, ADRB2 explained less than 1% of intersubject variance, considerably less than that of induction of labor.
Pain Medicine: Basic Science
(R,S)-Ketamine Metabolites (R,S)-norketamine and (2S,6S)-hydroxynorketamine Increase the Mammalian Target of Rapamycin Function
Antidepressant effects of subanesthetic doses of (R,S)-ketamine may be due to a combination of interrelated effects at the α7-nicotinic acetylcholine receptor (α7-nAChR) produced by (R,S)-ketamine and its metabolites. One effect is increased protein expression via the mammalian target of rapamycin (mTOR) signaling pathway, which is initiated by antagonism of α7-nAChR and is reflected by increased monomeric serine racemase expression.
Supplemental Digital Content is available in the text.
Long-term Application of Glycine Transporter Inhibitors Acts Antineuropathic and Modulates Spinal N-methyl-d-aspartate Receptor Subunit NR-1 Expression in Rats
The long-term inhibition of glycine transporters GlyT1 and GlyT2 reduces neuropathic pain–related behavior in a rat model without neuromotor or respiratory side effects. The modulation of spinal N-methyl-d-aspartate receptors seems to contribute to this effect.
Supplemental Digital Content is available in the text.
Education: Images in Anesthesiology
Images in Anesthesiology: Endoluminal Computed Tomography: A Novel Technology for Assessment of Large Airway Pathologies
Education: Original Investigations in Education
Predicting Case Volume from the Accumulating Elective Operating Room Schedule Facilitates Staffing Improvements
In a review of 146 consecutive surgical days at one academic medical center, case volume could be predicted with high accuracy 1 to 2 weeks in advance, allowing a closer match of staffing to demand.
Education: Clinical Concepts and Commentary
Recent data suggest that adopting a lung protective ventilation strategy will benefit healthy surgical patients. The authors examine the data, and suggest exercising caution prior to implementing a practice change that will affect a massive population.
Education: Review Article
Mechanical Ventilation–associated Lung Fibrosis in Acute Respiratory Distress Syndrome: A Significant Contributor to Poor Outcome
Mechanical ventilation may be a major contributor to pulmonary fibrosis in patients with the acute respiratory distress syndrome.
Education: Mind to Mind
Reviews of Educational Material
Anesthesiology Reflections from the Wood Library-Museum