Perioperative Temperature Monitoring
The esophagus and nasopharynx are usually the best temperature monitoring sites during general anesthesia. Alternatives suitable for neuraxial anesthesia and postoperative care include oral and axillary temperatures, along with zero-heat flux forehead temperature. (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

The Coming Age
On the morning of September 11th, 2001, I was a 17-year-old college student on my way to class. I got to campus just in time to hear announcements that all classes for the day had been cancelled. I didn ’t understand why, all I knew was that I had time to sit in the library and study. From the window I could see it across the East River, smoke billowed, the faces of dozens of my classmates stared first in disbelief then in horror as the south tower collapsed, followed 29 minutes later by the nort h tower. Little did we know, we were witnessing the birth of a new age. (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Pulse Wave Analysis to Estimate Cardiac Output
Pulse wave analysis enables cardiac output to be estimated continuously and in real time. Pulse wave analysis methods can be classified into invasive, minimally invasive, and noninvasive and into externally calibrated, internally calibrated, and uncalibrated methods. (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Fighting with COVID-19
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Functional MRI: Basic Principles and Emerging Clinical Applications for Anesthesiology and the Neurologic Sciences, 1st Edition
Edited by RamachandranRamani. Oxford, United Kingdom, Oxford University Press, 2018. Pages: 264. ISBN-13: 978-0190297763. ISBN-10: 019029776X. Price: $28.68. (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Correcting Acid Base Interpretation for High Altitudes
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Volatile Agents versus Propofol in Cardiac Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Volatile Agents versus Propofol in Cardiac Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Association between Neuraxial Labor Analgesia and Neonatal Morbidity after Operative Vaginal Delivery A Retrospective Cross-sectional Study
BackgroundUp to 84% of women who undergo operative vaginal delivery receive neuraxial analgesia. However, little is known about the association between neuraxial analgesia and neonatal morbidity in women who undergo operative vaginal delivery. The authors hypothesized that neuraxial analgesia is associated with a reduced risk of neonatal morbidity among women undergoing operative vaginal delivery.MethodsUsing United States birth certificate data, the study identified women with singleton pregnancies who underwent operative vaginal (forceps- or vacuum-assisted delivery) in 2017. The authors examined the relationships betwee...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Modeling the Effect of Excitation on Depth of Anesthesia Monitoring in γ-Aminobutyric Acid Type A Receptor Agonist ABP-700
ConclusionsThe GABAA receptor agonist ABP-700 shows the expected suppressive effects for BIS and MOAA/S, but also disinhibitory effects for BIS associated with involuntary muscle movements and reduced by pretreatment. Our model provides information about involuntary muscle movements that may be useful to improve depth of anesthesia monitoring for GABAA receptor agonists.Editor ’s PerspectiveWhat We Already Know about This TopicThe γ-aminobutyric acid type A receptor agonist cyclopropyl-methoxycarbonyl metomidate (ABP-700), a second-generation analog of etomidate, produces a rapid onset of sedation and deep gene...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Major Short-term Complications of Arterial Cannulation for Monitoring in Children
ConclusionsThe overall major complication rate of arterial cannulation for monitoring purposes in children is low (0.2%). All complications occurred in femoral arterial lines in children younger than 5 yr of age, with the greatest complication rates in infants and neonates. There were no complications in distal arterial cannulation sites, including more than 3,000 radial cannulations.Editor ’s PerspectiveWhat We Already Know about This TopicPerioperative arterial cannulation is routinely performed in childrenArterial cannulation is known to have a risk of serious complications; however, the rates of complication are ...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Anesthesiologist Age and Sex Influence Patient Perceptions of Physician Competence
BackgroundUncovering patients ’ biases toward characteristics of anesthesiologists may inform ways to improve the patient–anesthesiologist relationship. The authors previously demonstrated that patients prefer anesthesiologists displaying confident body language, but did not detect a sex bias. The effect of anesthesiologists ’ age on patient perceptions has not been studied. In this follow-up study, it was hypothesized that patients would prefer older-appearing anesthesiologists over younger-appearing anesthesiologists and male over female anesthesiologists.MethodsThree hundred adult, English-speaking pat...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Volatile Anesthetics Activate a Leak Sodium Conductance in Retrotrapezoid Nucleus Neurons to Maintain Breathing during Anesthesia in Mice: Erratum
In the article beginning on page 824 in the August 2020 issue, there are errors in the author affiliations and in the corresponding author ’s address. (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Aerosol Retention Characteristics of Barrier Devices
ConclusionsBarrier devices may reduce exposure to droplets and aerosol. With meticulous tucking, the glove box and drape tent can retain aerosol during airway management. Devices that are not fully enclosed may direct aerosol toward the laryngoscopist. Aerosol evacuation reduces aerosol content inside fully enclosed devices. Barrier devices must be used in conjunction with body-worn personal protective equipment.Editor ’s PerspectiveWhat We Already Know about This TopicMultiple intubation barrier devices have been developed to block droplet exposure. However, aerosol protection with these devices is either not known ...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Modeling the Effect of Excitation on Depth of Anesthesia Monitoring in γ-Aminobutyric Acid Type A Receptor Agonist ABP-700: Erratum
In the Online First article that published on October 16, 2020, figure 8 was incorrect due to an author error. One of the lines in figure 8, panels C and E, was black instead of red. (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Wood ’s and Guedel’s Legacies Return to the Heartland Reflections from Coleman and Moon
Pioneering anesthesiologists Paul Wood, M.D., and Arthur Guedel, M.D., were Hoosiers who migrated from America ’s Heartland to opposite coasts. Dr. Wood moved east to New York in 1913; Dr. Guedel, west to California in 1928. By 1962, each pioneer had been honored with a namesake anesthesia museum. Fast-forwarding 55 yr, two young anesthesia historians, California’s Jane Moon, M.D., and Pennsylvania’s M elissa Coleman, M.D., met at the 2017 International Symposium of the History of Anesthesia in Boston. Today, these women are chairs of the Wood Library-Museum’s Archives and Museum Committees, respect...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

L-bupivacaine Inhibition of Nociceptive Transmission in Rat Peripheral and Dorsal Horn Neurons
BackgroundAlthough the widely used single L-enantiomers of local anesthetics have less toxic effects on the cardiovascular and central nervous systems, the mechanisms mediating their antinociceptive actions are not well understood. The authors hypothesized that significant differences in the ion channel blocking abilities of the enantiomers of bupivacaine would be identified.MethodsThe authors performed electrophysiologic analysis on rat dorsal root ganglion neuronsin vitro and on spinal transmissionsin vivo.ResultsIn the dorsal root ganglion, these anesthetics decreased the amplitudes of action potentials. The half-maximu...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia A Systematic Review and Meta-analysis
ConclusionsModerate quality evidence suggests that quadratus lumborum block does not enhance analgesic outcomes when combined with or compared with spinal morphine. However, the block improves postcesarean analgesia in the absence of spinal morphine. The clinical utility of this block seems limited to situations in which spinal morphine is not used.Editor ’s PerspectiveWhat We Already Know about This TopicSpinal morphine is the preferred technique for analgesia after cesarean delivery performed under spinal anesthesiaQuadratus lumborum block may offer analgesic benefit, but it is unclear in which patientsWhat This Ar...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Complication Rates in Anesthesia Why Retrospective Studies May Be Extraordinary
“The ideal way to quantify complications is through prospective multicenter registries with clearly defineda priori queries that capture complications. ” (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Aerosol Retention Barriers Roles and Limitations
“…aerosol barrier devices are not a replacement for personal protective equipment.” (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Peer Review Matters: Research Quality and the Public Trust
“Peer review grounds the public trust in the scientific and medical research enterprise…” (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Peer Review …to the Rescue!
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Evaluation of Biomarkers in Critical Care and Perioperative Medicine A Clinician ’s Overview of Traditional Statistical Methods and Machine Learning Algorithms
SUMMARYInterest in developing and using novel biomarkers in critical care and perioperative medicine is increasing. Biomarkers studies are often presented with flaws in the statistical analysis that preclude them from providing a scientifically valid and clinically relevant message for clinicians. To improve scientific rigor, the proper application and reporting of traditional and emerging statistical methods (e.g., machine learning) of biomarker studies is required. This Readers ’ Toolbox article aims to be a starting point to nonexpert readers and investigators to understand traditional and emerging research method...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Dioscorides and the Magical Mandrake: An Anesthetic for Wellcome ’s Tabloids
In the early twentieth century, Sir Henry Wellcome (1853 to 1936) —philanthropist, collector, and pharmaceutical magnate—commissioned artist Ernest Board to paint key achievements in medical history.Dioscorides Describing the Mandrake (1909) shows the first-century Greek physician Pedanius Dioscorides (right) characterizing the mystical mandrake (Mandragora officinarum) for his magnificentDe Materia Medica. A woman (center) echoes a popularized sixth-century image of Euresis, goddess of discovery, gifting Dioscorides the plant (center left), and an artist (left) recreates its anthropomorphic form. Like Wellcome...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Byline Backstory No. 11: Something Old, Something New —Antiques and Resuscitations Bond a Future Curator’s Family with the Muse of Anaesthesia
To thank me, an Ursinus College senior, for sending her a Christmas card from Scotland the year before, Ramona, an Ursinus junior, found me late in 1976 in our Pennsylvania college ’s only computer room. I was immediately enchanted. Luckily, she followed me to Baltimore, garnering her postgraduate social work degree the year before I earned my M.D. at Johns Hopkins. Ramona encouraged my interests in traveling (left) and collecting antiques (her Eucaine bottle find,lower right), both of which I use curatorially to this day. We married in 1980 and never questioned my choice of anesthesiology as a medical specialty &mda...
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Spinal Morphine versus Quadratus Lumborum: A C-Section Showdown
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - December 9, 2020 Category: Anesthesiology Source Type: research

Intensive Care Psychosis
Egged on by the televisions across the hall, (Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Necessary Heroes and Ethos, from Fighting Nazis to COVID-19
Healthcare workers on the front lines today face the danger of contracting COVID-19 while treating infected patients, and possibly even dying of this deadly disease. In fact, as of July 2020, over 3,000 healthcare workers have died of COVID-19 worldwide.1 This sad state of affairs is likely due to the stunning virulence of the SARS-CoV-2 virus, and the shocking lack of foresight and stewardship that have left many healthcare workers without sufficient personal protective equipment such as N95 respirator masks. Yet this is neither the first nor likely the last time that doctors, nurses, and others will risk their own lives ...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Severe Intraoperative Hemorrhage during Craniectomy in a Patient with Polyostotic Fibrous Dysplasia
(Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Platelet Function Testing in Patients on Antiplatelet Therapy before Cardiac Surgery
Based on variable pharmacodynamic responsiveness and platelet reactivity recovery after discontinuation of P2Y12 receptor inhibitors, preoperative platelet function testing may individualize discontinuation and be a part of transfusion algorithm triggering targeted postpump hemostatic management. (Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Genomic Screening for Malignant Hyperthermia Susceptibility
It is timely to consider the utility and practicability of screening for malignant hyperthermia susceptibility using genomic testing. Here the authors pose a simple, but bold question: what would it take to end deaths from malignant hyperthermia? The authors review recent advances and propose a scientific and clinical pathway toward this audacious goal to provoke discussion in the field. (Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Ultrasound-guided Visualization of Subglottic Secretions in Intubated Patients
Supplemental Digital Content is available in the text. (Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery
ConclusionsScreening for frailty and cognitive impairment preoperatively using the FRAIL scale and the Animal Verbal Fluency test in older elective spine surgery patients identifies those at high risk for the development of postoperative delirium.Editor ’s PerspectiveWhat We Already Know about This TopicPostoperative delirium is a common complication in older surgical patients.Frailty and cognitive impairment are associated with postoperative delirium but are rarely assessed preoperatively. This may be due to the time and burden required for screening.What This Article Tells Us That Is NewScreening for frailty and co...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

A Pilot Trial of Platelets Stored Cold versus at Room Temperature for Complex Cardiothoracic Surgery
ConclusionsThis pilot trial supports the feasibility of platelets stored cold for up to 14 days and provides critical guidance for future pivotal trials in high-risk cardiothoracic bleeding patients.Editor ’s PerspectiveWhat We Already Know about This TopicPlatelets are stored at room temperature (20 ° to 24°C) with constant agitation for 5 to 7 days to maximize recovery and survivalin vivo after transfusionCold storage of platelets at 2 ° to 6°C would provide extended shelf life, and laboratory investigations indicate improved hemostatic function, which may be beneficial for treatment of bleedingWhat...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Uncertainty and Certainty: Reply
(Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Uncertainty and Certainty: Comment
(Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Warming Up to Cold-stored Platelets
“…cold-stored platelets…have potential to mitigate septic reactions[,]…extend product shelf-life[,] and are in clinical trials.” (Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Hypotension Prediction Index for Prevention of Hypotension during Moderate- to High-risk Noncardiac Surgery A Pilot Randomized Trial
ConclusionsIn this pilot trial, index guidance did not reduce the amount of intraoperative hypotension. Half of the alerts were not followed by treatment, presumably due to short warning time, complex treatment algorithm, or clinicians ignoring the alert. In the future we plan to use a lower index alert threshold and a simpler treatment algorithm that emphasizes prompt treatment.Editor ’s PerspectiveWhat We Already Know about This TopicHypotension prediction algorithms commonly use arterial waveform features derived from arterial blood pressure monitoring. Whether they reduce the duration and severity of hypotension,...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Perioperative Management of Aneurysmal Subarachnoid Hemorrhage A Narrative Review
Aneurysmal subarachnoid hemorrhage is an acute neurologic emergency. Prompt definitive treatment of the aneurysm by craniotomy and clipping or endovascular intervention with coils and/or stents is needed to prevent rebleeding. Extracranial manifestations of aneurysmal subarachnoid hemorrhage include cardiac dysfunction, neurogenic pulmonary edema, fluid and electrolyte imbalances, and hyperglycemia. Data on the impact of anesthesia on long-term neurologic outcomes of aneurysmal subarachnoid hemorrhage do not exist. Perioperative management should therefore focus on optimizing systemic physiology, facilitating timely defini...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

A Pharmacokinetic and Pharmacodynamic Study of Oral Dexmedetomidine
ConclusionsOral administration of dexmedetomidine in doses between 300 and 700 mcg was associated with decreases in heart rate and mean arterial pressure. Despite low oral absorption, the 700-mcg dose scheme reached clinically relevant concentrations for possible use as a sleep-enhancing medication.Editor ’s PerspectiveWhat We Already Know about This TopicDexmedetomidine is an alpha-2 adrenergic agonist sedative that is approved for intravenous usePlasma dexmedetomidine concentrations between 0.2 ng/mg and 0.3 ng/ml result in rousable sedationLow plasma dexmedetomidine concentrations are associated with decreased mea...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Acid-sensing Ion Channel 3 Overexpression in Incisions Regulated by Nerve Growth Factor Participates in Postoperative Nociception in Rats
ConclusionsAcid-sensing ion channel 3 overexpression in incisions contributes to postoperative guarding and mechanical nociception. Bidirectional transport of ASIC3 between incised tissues and dorsal root ganglion neurons occurs through the sciatic nerve. Nerve growth factor regulates ASIC3 expression after plantar incision through the phosphoinositide 3 –kinase/protein kinase B signaling pathway.Editor ’s PerspectiveWhat We Already Know about This TopicThe low pH of surgical wounds contributes to postoperative painAcid-sensing ion channels such as acid-sensing ion channel 3 are structures that sensitize nocice...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Ketamine Pharmacokinetics A Systematic Review of the Literature, Meta-analysis, and Population Analysis
ConclusionsA meta-analytical analysis of ketamine pharmacokinetics was successfully completed despite large heterogeneity in study characteristics. Differences in output of the meta-analytical approach and a combined analysis of 14 raw data sets were small, indicative that the meta-analytical approach gives a clinically applicable approximation of ketamine population parameter estimates and may be used when no raw data sets are available.Editor ’s PerspectiveWhat We Already Know about This TopicThere has been a renewed interest in ketamine because of potentially new indicationsA broad range of models have been publis...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Oral Dexmedetomidine Promotes Non-rapid Eye Movement Stage 2 Sleep in Humans
ConclusionsThese results demonstrate that the nighttime administration of a solid oral dosage formulation of dexmedetomidine is associated with increased non-REM 2 sleep and decreased REM sleep. Spindle density during dexmedetomidine sleep was not associated with overnight improvement in the motor sequence task.Editor ’s PerspectiveWhat We Already Know about This TopicDexmedetomidine is an alpha-2 adrenergic agonist sedative that is approved for intravenous useA continuous infusion of dexmedetomidine promotes non –rapid eye movement stage 2 sleep neurophysiologyA single nighttime loading dose of intravenous dex...
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Pulmonary Outcomes and Sugammadex versus Neostigmine: Reply
(Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research

Pulmonary Outcomes and Sugammadex versus Neostigmine: Comment
(Source: Anesthesiology)
Source: Anesthesiology - November 11, 2020 Category: Anesthesiology Source Type: research