Issues
Table of Contents
Anesthesiology
Editorial Board
Anesthesiology
This Month in Anesthesiology
This Month In: Anesthesiology
Science, Medicine, and the Anesthesiologist
Science, Medicine, and the Anesthesiologist
Infographics in Anesthesiology
Care Transitions: Handover Carefully!
Anesthesiology CME Program
Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit
Editorial
Seamless Anesthesia Care: The Handover Process
Comorbidities and the Complexities of Chronic Pain
Letting the Gene out of the Bottle: OPRM1 Interactions
Special Announcements
Journal-related Activities and Other Special Activities at the 2014 American Society of Anesthesiologists Annual Meeting
Henrik Kehlet, M.D., Ph.D., Recipient of the 2014 Excellence in Research Award
Rebecca A. Aslakson, M.D., Ph.D., Recipient of the 2014 Presidential Scholar Award
Perioperative Medicine: Clinical Science
Intraoperative Transitions of Anesthesia Care and Postoperative Adverse Outcomes
Each anesthetic handover increased the risk of any major in-hospital morbidity or mortality by 8%. The adverse effects of handovers were similar for attending anesthesiologists and medically directed residents and certified registered nurse anesthetists. The adverse effects of handovers were virtually identical for residents and certified registered nurse anesthetists.
A Matched Cohort Study of Postoperative Outcomes in Obstructive Sleep Apnea: Could Preoperative Diagnosis and Treatment Prevent Complications?
Respiratory complications were twice as likely in obstructive sleep apnea patients, whether diagnosed before or after surgery, compared to controls. Patients with a preoperative diagnosis of obstructive sleep apnea and prescription for continuous positive airway pressure were less than half as likely to experience cardiovascular complications as those diagnosed after surgery.
Supplemental Digital Content is available in the text.
Interatrial Septum Motion but Not Doppler Assessment Predicts Elevated Pulmonary Capillary Wedge Pressure in Patients Undergoing Cardiac Surgery
Doppler assessment of pulmonary capillary wedge pressure (PCWP) was neither sensitive nor specific enough to be clinically useful in anesthetized and mechanically ventilated patients requiring cardiac surgery. The fixed curve pattern of the interatrial septum was the best predictor of raised PCWP only when the PCWP ≥17 mmHg.
Supplemental Digital Content is available in the text.
Effect of Hydroxyethyl Starch on Postoperative Kidney Function in Patients Having Noncardiac Surgery
Using a large database (44,176 adults patients undergoing noncardiac surgery), a dose-dependent renal toxicity of Hextend (high-molecular weight hydroxyethyl starch) was observed: odds ratio to develop a more serious level of acute kidney injury than crystalloids was 21% (95% CI, 6 to 38%, P < 0.001).
Alterations in the Functional Connectivity of Frontal Lobe Networks Preceding Emergence Delirium in Children
In children without emergence delirium, an electroencephalogram pattern of sleep or drowsy states was observed before peaceful awakening. In children with emergence delirium, arousal with clinical delirium occurred before observation of electroencephalogram patterns of sleep. Frontal regional functional connectivity was significantly elevated in emergence delirium compared with that of matched controls shortly after discontinuation of anesthesia.
Perioperative Medicine: Basic Science
Fibrinogen Concentrate Does Not Suppress Endogenous Fibrinogen Synthesis in a 24-hour Porcine Trauma Model
Administration of human fibrinogen concentrates did not down-regulate endogenous porcine fibrinogen biosynthesis in this animal model.
Thoracic Epidural Anesthesia with Ropivacaine Does Not Compromise the Tolerance of Acute Normovolemic Anemia in Pigs
Thoracic epidural anesthesia does not decrease the tolerance to acute normovolemic anemia in healthy pigs. The hemodynamic compensation of acute anemia is fully preserved, despite sympathetic block.
Amantadine Alleviates Postoperative Cognitive Dysfunction Possibly by Increasing Glial Cell Line-derived Neurotrophic Factor in Rats
Cognitive function was adversely affected by anesthesia and surgery 8 days later. This adverse effect was attenuated by the systemic administration of amantadine. Amantadine increased glial cell line-derived neurotrophic factor (GDNF) levels in glia, and intracerebroventricular administration of anti-GDNF also ameliorated behavioral abnormalities. Amantadine can reduce postoperative cognitive dysfunction by increasing GDNF production and reducing surgeryinduced cerebral inflammation.
Down-regulation of MicroRNA-21 Is Involved in the Propofol-induced Neurotoxicity Observed in Human Stem Cell–derived Neurons
Propofol induced apoptosis of human embryonic stem cell–derived neurons and reduced expression of miR-21. Overexpression of miR-21 reduced this toxicity. Neurons derived from human embryonic stem cell represent a useful model for the study of anesthetic neurotoxicity in humans. miR-21 plays a role in propofol-induced toxicity, and manipulation of miR-21 may serve as a therapeutic approach for prevention of toxicity.
Critical Care Medicine: Clinical Science
Effects of Dexmedetomidine on Sleep Quality in Critically Ill Patients: A Pilot Study
In selected critically ill patients, dexmedetomidine infusions at night to achieve light levels of sedation increases sleep efficiency and modifies 24-h sleep patterns by shifting sleep to nights.
Supplemental Digital Content is available in the text.
Impact of the Anesthetic Conserving Device on Respiratory Parameters and Work of Breathing in Critically Ill Patients under Light Sedation with Sevoflurane
In intensive care unit patients, Anesthetic Conserving Device (ACD) (AnaConDa®; Sedana Medical AB, Uppsala, Sweden) increases the work of breathing and worsens ventilatory parameters. Sevoflurane use via the ACD with a light-sedation target normalizes respiratory parameters, and may provide an alternative method for sedation, at least, for weaning patients from mechanical ventilation.
Critical Care Medicine: Basic Science
Plasma Volume Expansion with 5% Albumin Compared to Ringer’s Acetate during Normal and Increased Microvascular Permeability in the Rat
One group of animals was subjected to an 11% hemorrhage and then given either 5% albumin in a volume equal to the shed blood volume or Ringer’s acetate at 4.5 times that volume. Another group of animals was subjected to abdominal sepsis and at 3 h, measured plasma volume loss was replaced with either 5% albumin or with Ringer’s acetate in 4.5 times the measured loss. Plasma volume expansion with albumin relative to Ringer’s acetate did not differ between the two groups despite different etiologies for the decrease in plasma volume.
Pain Medicine: Clinical Science
OPRM1 A118G Gene Variant and Postoperative Opioid Requirement: A Systematic Review and Meta-analysis
In a meta-analysis involving 18 studies and more than 4,600 patients, carriers of the G-allele were observed to exhibit higher opioid analgesic requirements. These genetic effects were strongest in Asian patients and those receiving surgery to a viscus.
Lamiophlomis rotata, an Orally Available Tibetan Herbal Painkiller, Specifically Reduces Pain Hypersensitivity States through the Activation of Spinal Glucagon-like Peptide-1 Receptors
Aqueous extracts of Lamiophlomis rotata are effective in reducing pain-related behaviors in animal models of inflammatory, neuropathic, and cancer pain. Two components of L. rotata extracts, shanzhiside methylester (SM) and 8-O-acetyl-SM, are the principal active components. L. rotata extracts, and SM, and 8-O-acetyl-SM may work through spinal GLP-1 receptors to provide the analgesic effects.
Pain Medicine: Basic Science
Brain Neuroplastic Changes Accompany Anxiety and Memory Deficits in a Model of Complex Regional Pain Syndrome
In a model of complex regional pain syndrome (CRPS) in mice, the animals became hypersensitive to light touch, but also exhibited behaviors indicative of anxiety and diminished working memory in some tests. These changes were accompanied by structural changes in several brain regions, suggesting that CRPS can result in broad changes in the central nervous system as well as producing pain.
Supplemental Digital Content is available in the text.
Characterization of a Computationally Designed Water-soluble Human μ-Opioid Receptor Variant Using Available Structural Information
A water-soluble version of the human μ-receptor was developed by mutating specific residues of the molecule. This novel receptor variant has properties similar to those of the native receptor. The development of “safe mutations” in μ-receptor will significantly advance research into the biophysical aspects of μ-receptor activation and the resulting downstream signaling.
Education: Images in Anesthesiology
Images in Anesthesiology: Severe Unilateral Atelectasis during Induction of Anesthesia
Chemosis Secondary to Anterograde Episcleral (Sub-Tenon) Spread of Local Anesthetic during Retrobulbar Eye Block
Supplemental Digital Content is available in the text.
Education: Original Investigations in Education
The Psychological and Physiological Effects of Acute Occupational Stress in New Anesthesiology Residents: A Pilot Trial
In a pilot study of 18 individuals recruited to assess stress at the beginning of residency, 72% consented and participated in assessments of stress, anxiety, resilience, and wellness in addition to physiological biomarkers for stress. The results provide a detailed image of stress conditions during the first months of residency as well as variability data for power analyses for hypothesis testing investigations.
Education: Clinical Concepts and Commentary
Noise in the Operating Room
Education: Mind to Mind
Waiting
One-night Stands …
Correspondence
Effects and Timing of Tranexamic Acid on Transfusion Requirements in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass
In Reply
Lipid Emulsion Increases the Fast Na+ Current and Reverses the Bupivacaine-induced Block: A New Aspect of Lipid Resuscitation?
In Reply
Safe and Scalable Device Design: A Call for Open Standards
In Reply
Reviews of Educational Material
Pharmacology and Physiology for Anesthesia: Foundations and Clinical Applications
Fundamentals of Neuroanesthesia: A Physiologic Approach to Clinical Practice
Anesthesiology Reflections from the Wood Library-Museum
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