Issues

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Pharmacologic inhibition of the ubiquitin–proteasome pathway, using epoxomicin, did not protect the diaphragm against oxidative stress or atrophy in anesthetized, mechanically ventilated rats.

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.

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.

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.

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.

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.

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.

Mechanical ventilation may be a major contributor to pulmonary fibrosis in patients with the acute respiratory distress syndrome.