Adjunctive Corticosteroid Treatment in Septic Shock
Interest in the role of the adrenal cortex in the recovery from an infection dates back nearly 100 yr. More than six decades of research on the role of corticosteroid supplementation as an adjunctive treatment for sepsis and septic shock failed to reveal conclusive results. Recently two large-scale randomized controlled trials have added substantial new data to inform opinion regarding the role of corticosteroids in the treatment of septic shock.1,2 In this article, we review the background, the current state of the evidence, and ongoing areas of uncertainty in this field and provide suggestions for clinical practice. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Failure to Rescue as a Surgical Quality Indicator Current Concepts and Future Directions for Improving Surgical Outcomes
Over the past decade, failure to rescue —defined as the death of a patient after one or more potentially treatable complications—has received increased attention as a surgical quality indicator. Failure to rescue is an appealing quality target because it implicitly accounts for the fact that postoperative complications may not always be preventable and is based on the premise that prompt recognition and treatment of complications is a critical, actionable point during a patient’s postoperative course. Although numerous patient and macrosystem factors have been associated with failure to rescue, there is a...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Propofol Sedation Alters Perceptual and Cognitive Functions in Healthy Volunteers as Revealed by Functional Magnetic Resonance Imaging
Editor ’s PerspectiveWhat We Already Know about This TopicLoss of consciousness during anesthesia is associated with a loss of anterior –posterior connectivityHowever, during anesthesia local sensory cortex function may be preservedWhat This Article Tells Us That Is NewDuring propofol sedation, activation on functional magnetic resonance imaging in higher cognitive areas, such as semantic and phonologic processing, is abolished with deep sedation and only partially suppressed with light sedationActivation related to lower sensory processing continues with deep and light sedationBackground Elucidating networks u...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Impact of the World Health Organization Surgical Safety Checklist on Patient Safety
The incidence of surgical complications has remained largely unchanged over the past two decades. Inherent complexity in surgery, new technology possibilities, increasing age and comorbidity in patients may contribute to this. Surgical safety checklists may be used as some of the tools to prevent such complications. Use of checklists may reduce critical workload by eliminating issues that are already controlled for. The global introduction of the World Health Organization Surgical Safety Checklist aimed to improve safety in both anesthesia and surgery and to reduce complications and mortality by better teamwork, communicat...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Central Venous Catheter in the Internal Mammary Vein
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Giant T-wave Inversions in Apical Hypertrophic Cardiomyopathy
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Femoral Vein Thrombus Diagnosed during Ultrasound-guided Femoral Nerve Catheter Placement
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Short-term Physiologic Consequences of Regional Pulmonary Vascular Occlusion in Pigs
Editor ’s PerspectiveWhat We Already Know about This TopicAfter pulmonary artery occlusion (mimicking a pulmonary embolism), perfusion is redistributed to the rest of the lung tissue, but the distribution of ventilation is uncertain.What This Article Tells Us That Is NewData from anesthetized pigs (uninjured lungs) indicate that the perfusion is redistributed as suspected. Similarly, ventilation is redistributed from nonperfused to perfused lung tissue. This limits the increase in dead space and is accompanied by less density in the occluded lung.Background Acute unilateral pulmonary arterial occlusion causes ventila...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Clerihews for Chloroform
A Clerihew is a four-line comic poem with a rigid rhyming scheme, aabb, but no metric requirements. This poetic form was invented by E. C. (Edmund Clerihew) Bentley (1875 –1956), British humorist and author. Bentley’s Clerihews always began with the name of a famous person or character to create a rhyming challenge. The remaining three lines “roasted” the figure, sometimes in a historical context. If Bentley hoped he was inventing a poetic form to replace the limerick, he was unsuccessful, since most anesthesiologists have never heard of a Clerihew. I became aware of them when I was loaned a delight...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Dextromethorphan Analgesia in a Human Experimental Model of Hyperalgesia
Conclusions This study shows that low-dose (30-mg) dextromethorphan is antihyperalgesic in humans on the areas of primary and secondary hyperalgesia and reverses peripheral and central neuronal sensitization. Because dextromethorphan had no intrinsic antinociceptive effect in acute pain on healthy skin,N-methyl-d-aspartate receptor may need to be sensitized by pain for dextromethorphan to be effective. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Foramen Magnum Stenosis and Spinal Cord Compression in Achondroplasia
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Measuring Childbirth Outcomes Using Administrative and Birth Certificate Data
Conclusions Maternal and newborn outcomes should be jointly reported because hospital rates of maternal morbidity and newborn morbidity are poorly correlated. This can be done using a childbirth composite measure alongside separate measures of maternal and newborn outcomes. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Measuring What Matters to Moms Most
“[C]urrently, the field of obstetric anesthesiology is bereft of useful quality measures.” (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Lung Pharmacokinetics of Tobramycin by Intravenous and Nebulized Dosing in a Mechanically Ventilated Healthy Ovine Model
Editor ’s PerspectiveWhat We Already Know about This TopicFor most bacterial pneumonia, the lung interstitium is considered to be the site of infection, and adequate antibiotic concentrations are important for drug effectDespite systemic antibiotic therapy, therapeutic failure is common, perhaps due to poor lung penetration, and resulting low interstitial space fluid antibiotic concentrationsIncreasing systemic antibiotic doses in order to increase interstitial space fluid antibiotic concentrations could lead to toxicities such as nephrotoxicityWhat This Article Tells Us That Is NewIn a mechanically ventilated health...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

The Unappreciated Role of Carbon Dioxide in Ventilation/Perfusion Matching
“Much of the emphasis in…gas exchange physiology is oxycentric, and carbon dioxide is often neglected and…may be more important than oxygen in regulation.” (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Impact of an Opioid Safety Initiative on Patients Undergoing Total Knee Arthroplasty A Time Series Analysis
Conclusions A system-wide initiative combining guideline dissemination with audit and feedback was effective in significantly decreasing opioid prescriptions in populations undergoing total knee arthroplasty, while minimally impacting pain scores. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Imaging the Injured Lung: Mechanisms of Action and Clinical Use: Erratum
In the Online First article published on January 17, 2019, “Imaging the Injured Lung: Mechanisms of Action and Clinical Use” (Cereda M, Xin Y, Goffi A, Herrmann J, Kaczka DW, Kavanagh BP, Perchiazzi G, Yoshida T, Rizi RR: Anesthesiology 2019; doi: 10.1097/ALN.0000000000002583. [Epub ahead of print]), the Research Support section does not acknowledge one of the grants that supported the work of Dr. Cereda (grant No. R01HL137389), and grant No. RO1HL139066 was awarded to Dr. Rizi, Dr. Cereda, and Mr. Xin (not Dr. Xin). The Research Support section should read as follows: “This work was supported in part by ...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Toxicologic and Inhibitory Receptor Actions of the Etomidate Analog ABP-700 and Its Metabolite CPM-Acid
Conclusions High dose ABP-700 infusions produce involuntary muscle movements and seizures in Beagle dogsvia distinct mechanisms. CPM-acid inhibits both GABAA and glycine receptors at the high (~100 × clinical) plasma concentrations achieved during the dog studies, providing a plausible mechanism for the seizures. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery
Conclusions Point of care ultrasound can be used to evaluate postoperative diaphragmatic function. On the first postoperative day, diaphragmatic dysfunction was less common after video-assisted than after the thoracotomic surgery and is associated with postoperative pulmonary complications. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

If You Thought That Night Float Solved Everything, Keep Dreaming
“[N]ight float can have negative effects on [resident] sleep and thus is less of a magic bullet than some may have thought.” (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Anesthesiology Resident Night Float Duty Alters Sleep Patterns An Observational Study
Editor ’s PerspectiveWhat We Already Know about This TopicNight float is one mechanism for fulfilling resident call responsibilities while avoiding prolonged clinical care that violates duty hoursWhat This Article Tells Us That Is NewIn anesthesiology residents conducting six consecutive nights of clinical care, three nights of recovery did not appear to restore normal sleep architecture, raising questions about this practiceBackground Residency programs utilize night float systems to adhere to duty hour restrictions; however, the influence of night float on resident sleep has not been described. The study aim was to...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Hepatitis C Contamination of Medication Vials Accessed with Sterile Needles and Syringes
Conclusions Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days. Furthermore, cleaning the vial diaphragm with 70% isopropyl alcohol is not sufficient to eliminate the risk of hepatitis C virus infectivity. This highlights the potential risks associated with sharing medications between patients. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Cross-talk between Human Spinal Cord μ-opioid Receptor 1Y Isoform and Gastrin-releasing Peptide Receptor Mediates Opioid-induced Scratching Behavior
Editor ’s PerspectiveWhat We Already Know about This TopicThe spinal administration of opioids can cause intense pruritisInteractions between specific μ-opioid receptor isoforms and the gastrin releasing peptide receptor in spinal tissues likely mediate morphine-induced pruritusWhat This Article Tells Us That Is NewHuman spinal cord tissue expresses the 1Y isoform of the μ-opioid receptor, and that isoform functionally interacts with the gastrin releasing peptide receptor to cause cellular calcium influxBlocking interactions between the 1Y isoform and the gastrin releasing peptide receptor does not reduce opioi...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Central Sensitization, N -methyl- d -aspartate Receptors, and Human Experimental Pain Models Bridging the Gap between Target Discovery and Drug Development
“[Can] human pain models… facilitate the translation of mechanism-based targets identified in animal models to clinically effective drugs[?]” (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Discharge Readiness after Propofol with or without Dexmedetomidine for Colonoscopy A Randomized Controlled Trial
Editor ’s PerspectiveWhat We Already Know about This TopicIt is unknown whether adding low-dose dexmedetomidine to propofol for colonoscopies enhances hemodynamic stability without prolonging recoveryWhat This Article Tells Us That Is NewOne hundred and one patients were randomly assigned to propofol alone or propofol combined with low-dose dexmedetomidine for outpatient colonoscopies, both groups targeting a Bispectral Index of 60Adding dexmedetomidine provoked hypotension and prolonged recoveryBackground Enhanced recovery protocols employ various approaches to minimize detrimental side effects of anesthetizing agen...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Discovering Pain in Newborn Infants
Randomised Trial of Fentanyl Anesthesia in Preterm Babies Undergoing Surgery: Effects on the Stress Response. By Anand KJ, Sippell WG, and Aynsley-Green A. Lancet 1987; 1:243 –8. Reprinted with permission. In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide andd-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 μg/kg intravenously) to the anesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, an...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Preadmission Statin Use and 90-day Mortality in the Critically Ill A Retrospective Association Study
This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality.Methods This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these ...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Nebulized Antibiotics Epithelial Lining Fluid Concentrations Overestimate Lung Tissue Concentrations
“…measuring [lung] epithelial lining fluid antibiotic concentrations in patients receiving inhaled antibiotics is not an appropriate method for assessing lung tissue concentrations.” (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium Results of the REDUCE Study
Conclusions Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Insomnis
Slow-drip dilutes the blood, (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Better Care through Better Measurement: Toward Healthy Mothers and Newborns
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Joseph Priestley ’s Retorts: Spirited Dissent and Gaseous Discoveries
Barred from university schooling as a Dissenter (from the Church of England), Joseph Priestley is depicted preaching from a barrel of religious “fanaticism” in this satirical image published in 1790 by London’s William Dent. When questioned (right) as to whether there is “such a thing as a Devil,” Priestley responds with an emphatic “No” as a “Word of Comfort” just before the Devil (left) is about to pitchfork the Separatist clergyman. Although he said “No” to prevailing religious views, Priestley retorted “Yes” to discovering ten gases, includin...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Dr. G. D. Blanchard ’s 25 Years of “Perfect Success” with Gas and Ether
After working as a farm laborer in Braintree, Vermont, George D. Blanchard (1834 to 1885) met and married Ellen Blood in Plainfield. Working 8 miles southwest in Barre, he labored in daguerreotyping and then precepted in dentistry. Two years after the 1862 birth of son Edwin, Dr. Blanchard moved his practice and family another 22 miles southwest to West Randolph, where he advertised eventually (above) that he had “used Gas and Ether for 25 years with perfect success.” Son Edwin earned his D.D.S. in 1885 just months before his father passed away. (Copyright © the American Society of Anesthesiologists’...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

From Baking Up Nitrous Oxide to Making Goals: Rindge Tech ’s L. A. Brennan
From the archives of the Wood Library-Museum, readers can see nitrous oxide –generating apparatus hand-drawn (upper left) in the 1914 laboratory notebook (upper right) of Lawrence A. Brennan of Rindge Technical School in Cambridge, Massachusetts. Young Brennan records how he heated ammonium nitrate to produce laughing gas in his chemistry classroom. Brennan then traded his glassware in for a puck and played hockey at Boston College. About 35 yr after generating laughing gas at Rindge Tech, he “got his jollies” by becoming a Boston College Alumni Association representative. (Copyright © the American S...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

How Springfield ’s Dr. W. F. Andrews Dispensed Ether, Gas, and Books
A native of Portland, Maine, Dr. William Francis Andrews (1852 to 1930) earned his D.D.S. in 1876 at the Maryland Dental College (1876). After moving to Springfield, Massachusetts, he married in 1877 and joined the Masons a year later. In this Ben Z. Swanson Collection trade card from the Wood Library-Museum, Dr. Andrews advertised his prowess at administering [laughing] “Gas and Ether” anesthetics. However, the Wood Library-Museum remembers Dr. Andrews best for cofounding Springfield’s premiere dental library. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anest...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Fred Snite, Jr., Headlined as the “Iron Lung Boy” Who Attended a Wedding
Long before he was paralyzed by poliomyelitis, Frederick Bernard Snite, Jr. (1910 to 1954) shared childhood adventures with Joseph Murray (left) and Mary Grass. Much later, as a 26-yr-old tourist to China in 1936, “Fred” was stricken with infantile paralysis. Fortunately, his financier father could marshal resources to save Fred Jr. with an assortment of “iron lung” and other ventilatory assistance devices. After visiting the Shrine of Miracles in 1939 in Lourdes, France, for spiritual inspiration, Fr ed Jr. witnessed the wedding of Joseph and Mary, his two childhood friends, by using the swiveling ...
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Impact of Choice of Risk Model in Perioperative Guidelines: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Impact of Choice of Risk Model in Perioperative Guidelines: Reply
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Nomenclature for Perioperative Cognitive Disorders: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Nomenclature for Perioperative Cognitive Disorders: Reply
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Individualizing Intraoperative Ventilation: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Individualizing Intraoperative Ventilation: Reply
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

Where ’s the Beef Indeed!
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2019 Category: Anesthesiology Source Type: research

The Experience of a Pain Patient
When I was 17 years old, I thought my life was going perfectly. My days mostly consisted of going to school, playing sports, and trying to stay out of trouble (which was harder than it sounds). I was living in a small farm town in the middle of nowhere Ohio and couldn ’t wait to get out. Honestly, I was a bit cocky; I was a good athlete, for which I received an acceptance to the Air Force Academy, my ticket out of the rural life. I would spend four years in school, and the rest of my life serving my country, not a bad living. This was the grand plan; well, unti l I herniated a disc in my back and found out how horrib...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research