Neural Selective Cryoneurolysis with Ice Slurry Injection in a Rat Model
Conclusions Ice slurry injection selectively targets the rat sciatic nerve, causing no damage to surrounding tissue. Injection of ice slurry around the rat sciatic nerve induced decreased nociceptive response from the baseline through neural selective cryoneurolysis.Editor ’s PerspectiveWhat We Already Know about This TopicAchieving long-lasting surgical site anesthesia can be problematicCryoneurolysis is effective in providing long-lasting analgesia, but current techniques are nonselective for neural tissueWhat This Article Tells Us That Is NewUsing a rat sciatic nerve block model, an injectable biocompatible ice sl...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Patient Blood Management Effectiveness and Future Potential
Before major surgery, 30 to 40% of patients are anemic, an important consideration that is associated with increased erythrocyte transfusions, prolonged hospital length of stay, more frequent intensive care admissions, infections, and thromboembolic events, and mortality.1 –4 Surgical bleeding contributes to anemia, increases transfusions, and independently increases mortality.5 In addition, transfusion of allogeneic blood products is associated with increased morbidity and mortality6 and increased costs, and allogeneic blood products are a limited resource.6 –8 Therefore, as a pragmatic solution, the concept o...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

An ER Doctor Finds His Daughter in Critical Condition
The operating room sounds oddly like jazz. (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively
Background Iron-deficiency anemia is a common perioperative condition and increases perioperative morbidity and mortality. Timely diagnosis and treatment are important. This retrospective cohort study tested the hypothesis that a newly developed preprocedure evaluation protocol diagnoses more patients with iron-deficiency anemia than the traditional practice of obtaining a complete blood count followed by iron studies.Methods The preprocedure anemia evaluation is an order for a complete blood count and reflex anemia testing, which can be completed with a single patient visit. A hemoglobin concentration of 12  g/dl o...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Individualized Fluid Management Using the Pleth Variability Index A Randomized Clinical Trial
Conclusions Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications.Editor ’s PerspectiveWhat We Already Know about This TopicThe role of guided fluid management remains unclear, with contradictory trial results.The noninvasive plethysmographic variability index is one method of guiding fluid administration.What This Article Tells Us That Is NewThe investigators randomized 447 moderate-risk major arthroplasty patients to plethysmographic-guidedversus...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Assessing and Reversing the Effect of Direct Oral Anticoagulants on Coagulation
Direct oral anticoagulants have improved anticoagulation options for many patients, but they present challenges regarding monitoring and reversal of anticoagulant activity. Anesthesiologists are likely to encounter patients taking direct oral anticoagulants in a variety of clinical settings including scheduled procedures, emergency procedures, trauma, and critical care units. This review focuses on the pharmacokinetics of direct oral anticoagulants, testing methods to assess anticoagulant activity, and the use of reversal agents, to give the practicing anesthesiologist the necessary knowledge to manage situations encounter...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Setup of a Dedicated Coronavirus Intensive Care Unit Logistical Aspects
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery A Systematic Review and Meta-analysis
Conclusions Clinicians should consider accuracy and feasibility when choosing a frailty instrument. Strong evidence in both domains support the Clinical Frailty Scale, while the Fried Phenotype may require a trade-off of accuracy with lower feasibility.Editor ’s PerspectiveWhat We Already Know about This TopicPreoperative frailty has been associated with adverse postoperative outcomesIt remains unclear which frailty scale is the best predictor of adverse postoperative outcomesWhat This Article Tells Us That Is NewThis meta-analysis of 45 articles identified that specific frailty scales may be better predictors for so...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Flying with a Compass Goals of Care in the Perioperative Setting
I met VC in an inpatient progress note. I felt I was standing by the window, watching the attending on rounds come and sit by the bed of this dying retired family doctor. I could almost hear the pleasant, unhurried conversation about VC ’s life and what he wanted from what remained of it. The note immortalized in the electronic health record was written with poetic brevity and it was the most beautiful, succinct, and thorough description of goals of care I’d ever seen. (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Collapse of Global Neuronal States in Caenorhabditis elegans under Isoflurane Anesthesia
Background A comprehensive understanding of how anesthetics facilitate a reversible collapse of system-wide neuronal function requires measurement of neuronal activity with single-cell resolution. Multineuron recording was performed inCaenorhabditis elegans to measure neuronal activity at varying depths of anesthesia. The authors hypothesized that anesthesia is characterized by dyssynchrony between neurons resulting in a collapse of organized system states.Methods Using light-sheet microscopy and transgenic expression of the calcium-sensitive fluorophore GCaMP6s, a majority of neurons (n = 120) in theC. elegans head were s...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Rapid COVID-19 –related Clinical Adaptations and Unanticipated Risks
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients A Randomized Controlled Trial
Background Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation.Methods This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the n...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Emergency Open-source Three-dimensional Printable Ventilator Circuit Splitter and Flow Regulator during the COVID-19 Pandemic
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Bronchus Intermedius Compression from Idiopathic Thoracic Scoliosis
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Analysis of Laryngoscopy Attempts in Infants: Comment
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Analysis of Laryngoscopy Attempts in Infants: Reply
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Population Kinetics of 0.9% Saline Distribution in Hemorrhaged Awake and Isoflurane-anesthetized Volunteers: Retraction
At the request of the authors, the Editors and Publisher retract the article “Population Kinetics of 0.9% Saline Distribution in Hemorrhaged Awake and Isoflurane-anesthetized Volunteers” by Nyberget al. published in the September 2019 issue of Anesthesiology. (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Balancing Supply and Demand for Blood during the COVID-19 Pandemic
“The threat to the blood supply during this [coronavirus] pandemic is not SARS-CoV-2 itself, but rather the unintended consequences of social distancing on blood drives.” (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Stress Management Training Improves Overall Performance during Critical Simulated Situations A Prospective Randomized Controlled Trial
Conclusions Residents coping with simulated critical situations who have been trained with Tactics to Optimize the Potential showed better overall performance and a decrease in stress level during high-fidelity simulation. The benefits of this stress management training may be explored in actual clinical settings, where a 5-min Tactics to Optimize the Potential reactivation is feasible prior to delivering a specific intervention.Editor ’s PerspectiveWhat We Already Know about This TopicStress may be associated with impaired performance on cognitive tasksStress management training may lead to a reduced response to str...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Magnesium and Bladder Discomfort after Transurethral Resection of Bladder Tumor A Randomized, Double-blind, Placebo-controlled Study
This study hypothesized that among patients having transurethral resection of bladder tumor, magnesium will reduce the incidence of postoperative moderate-to-severe catheter-related bladder discomfort.Methods In this double-blind, randomized study, patients were randomly allocated to the magnesium group (n = 60) or the control group (n = 60). In magnesium group, a 50  mg/kg loading dose of intravenous magnesium sulfate was administered for 15 min, followed by an intravenous infusion of 15 mg · kg−1· h−1 during the intraoperative period. Patients in the control group similarly ...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Manipulating Neural Circuits in Anesthesia Research
The neural circuits underlying the distinct endpoints that define general anesthesia remain incompletely understood. It is becoming increasingly evident, however, that distinct pathways in the brain that mediate arousal and pain are involved in various endpoints of general anesthesia. To critically evaluate this growing body of literature, familiarity with modern tools and techniques used to study neural circuits is essential. This Readers ’ Toolbox article describes four such techniques: (1) electrical stimulation, (2) local pharmacology, (3) optogenetics, and (4) chemogenetics. Each technique is explained, includin...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Bloody Cerebrospinal Fluid Drainage
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Distinct Function of Estrogen Receptors in the Rodent Anterior Cingulate Cortex in Pain-related Aversion
This study hypothesized that the different estrogen receptors in the rostral anterior cingulate cortex play distinct roles in pain-related aversion.Methods Formalin-induced conditioned place avoidance and place escape/avoidance paradigms were used to evaluate pain-related aversion in rodents. Immunohistochemistry and Western blotting were used to detect estrogen receptor expression. Patch-clamp recordings were used to examineN-methyl-d-aspartate –mediated excitatory postsynaptic currents in rostral anterior cingulate cortex slices.Results The administration of the estrogen receptor- β antagonist 4-(2-phenyl-5,7-...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Mechanical Ventilation Guided by Uncalibrated Esophageal Pressure May Be Potentially Harmful
Background Esophageal balloon calibration was proposed in acute respiratory failure patients to improve esophageal pressure assessment. In a clinical setting characterized by a high variability of abdominal load and intrathoracic pressure (i.e., pelvic robotic surgery), the authors hypothesized that esophageal balloon calibration could improve esophageal pressure measurements. Accordingly, the authors assessed the impact of esophageal balloon calibration compared to conventional uncalibrated approach during pelvic robotic surgery.Methods In 30 adult patients, scheduled for elective pelvic robotic surgery, calibrated end-ex...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Association between Use of Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers and Postoperative Delirium
Background Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve cognitive function. The authors therefore tested the primary hypothesis that preoperative use of angiotensin inhibitors is associated with less delirium in critical care patients.Post hoc, the association between postoperative use of angiotensin system inhibitors and delirium was assessed.Methods The authors conducted a single-site cohort study of adults admitted to Cleveland Clinic critical care units after noncardiac procedures between 2013 and 2018 who had at least one Confusion Assessment Method delirium assessment. Patients w...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Risk Factors for Failure to Rescue in Myocardial Infarction after Noncardiac Surgery A Cohort Study
Conclusions Routinely identified patient and surgical factors predict risk of failure to rescue after perioperative myocardial infarction.Editor ’s PerspectiveWhat We Already Know about This TopicPatients experiencing perioperative myocardial infarction are at high risk for mortalityWhich patients are at highest risk of failure to rescue (death after a complication)What This Article Tells Us That Is NewIn a multinational cohort of 8,923 patients experiencing perioperative myocardial infarction after intermediate to high-risk noncardiac surgery, one in five died within 30 daysPatients age 85 yr or older, and those wit...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Goal-directed Therapy Why Benefit Remains Uncertain
“...recent robust trials [of goal-directed fluid therapy] with large sample sizes have shown little or no benefit.” (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Personalizing the Definition of Hypotension to Protect the Brain: Erratum
In the January 2020 issue, the Clinical Focus Review article “Personalizing the Definition of Hypotension to Protect the Brain” (Brady KM, Hudson A, Hood R, DeCaria B, Lewis C, Hogue CW. Anesthesiology 2020; 132:170 –9. doi: 10.1097/ALN.0000000000003005) contains an error in the next to last paragraph. The authors erroneously stated that 1.35 mmHg should be subtracted from blood pressure measured at the heart level for each 1 cm of head elevation such as with “beach chair” patient positioning. The aim o f that subtraction is to obtain an estimate of the blood pressure at the Circle of W...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Ketamine and Magnesium for Refractory Neuropathic Pain A Randomized, Double-blind, Crossover Trial
Conclusions The results of this trial in neuropathic pain refuted the hypothesis that ketamine provided pain relief at 5 weeks and cognitive –emotional benefitversus placebo and that a combination with magnesium had any additional analgesic effect.Editor ’s PerspectiveWhat We Already Know about This TopicThe use of low-dose ketamine infusion for the treatment of chronic pain has expanded rapidly despite a paucity of data supporting the practiceMagnesium ion, like ketamine, is a blocker ofN-methyl-d-aspartate receptor function that may have analgesic properties in some settingsWhat This Article Tells Us That Is ...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

“Nonroutine Events” as a Nonroutine Outcome for Perioperative Systems Research
“[I]n health services research, we have seen a shift away from the acceptance of process outcomes as valid measures of intervention effectiveness.” (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Incidence and Classification of Nonroutine Events during Anesthesia Care
Conclusions This study describes characteristics of intraoperative nonroutine events in a cohort of cases at three academic hospitals. Nonroutine event –containing cases were commonly associated with patient impact and injury. Thus, nonroutine event monitoring in conjunction with traditional error reporting may enhance our understanding of potential intraoperative failure modes to guide prospective safety interventions.Editor ’s PerspectiveWhat We Already Know about This TopicA nonroutine event is defined as any aspect of clinical care perceived by clinicians or observers as a deviation from optimal care for a ...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Management of the Traumatic Airway Obstructed by Foreign Body
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Practice Guidelines for Central Venous Access: Reply
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Practice Guidelines for Central Venous Access: Comment
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Priming Cardiopulmonary Bypass in Pediatric Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Priming Cardiopulmonary Bypass in Pediatric Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Ketamine for Chronic Pain Old Drug New Trick?
“Ketamine is exceedingly use-ful in … anesthesia and … psychiatry. Despite these suc-cesses, we struggle to identify clear roles for ketamine in patients affected by chronic pain.” (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Perioperative Neurocognitive Disorder: Comment
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Perioperative Neurocognitive Disorder: Reply
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Anesthesia as Decoupling?
“…do general anesthetics equally disrupt relationships between all neurons, or...between particular functional networks…?” (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Uncertainty and Certainty
“An unsuspecting public cannot differentiate between preprint postings and peer-reviewed, published, trusted evidence.” (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 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 - June 17, 2020 Category: Anesthesiology Source Type: research

Ketamine for Neuropathic Pain: an Infusion of Relief?
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

The Surgeon As “Swindler”: A Corny Use of Chloroform
Hidden in the Wood Library-Museum Archives is this bifold sheet (top left) containing three autograph pages of “Riddles from Miss C. Corbet” of Adderley, England. Dated “Jany 10th / 56 ” (1856,top right), there are 19 riddles in all. The riddler was 20-year-old Clara Anna Corbet (1835 to 1916), the fourth of eight children born to soon-to-be Rector Richard Corbet and his wife Eleanor. In one instance, Clara likened “a surgeon using Chloroform,” who “cuts away without…pain,” to “a swindler,” who “cuts away without paying” (bottom). Miss Corbet, h...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Shadowing the Abbot: Wood Library-Museum Graphic Illustrators Bill and Janet Lyle
An earlier vignette reflected Wood Library-Museum (WLM) exhibit designer John Byrne “Shadowing the Abbess.” We now segue with “Shadowing the Abbot”: Father John Henry (bottom, standing left), the final Abbot of St. Herman ’s Monastery in Cleveland, Ohio. When the monastery’s wheelchair lift at the men’s shelter needed repairs, these were funded by the author and accomplished by electrician William “Bill” Lyle (upper left). Before mastering the Ohio electrical code to full licensurewithout a mentor, Mr. Lyle had taught himself every graphics version of Photoshop and Illu...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Aftershocks for Quake-rattled Frueh: Dan “Wood’s Local Anaesthetic” Levels Its Namesake
Named for a Union general from Indiana, Hoosier dentist Daniel Macauley Wood (1868 to 1934) moved to Ohio as founding business manager by 1900 for Cincinnati ’s Union Painless Dentists (left, “Uncle Sam” holds “Old Glory” on their trade card’s obverse). In 1906, Wood began training his replacement, a patriotic Spanish-American War veteran who had actually been born on Independence Day, Dr. John F. Frueh (1877 to 1920). The hapless Frueh had recently married in Cincinnati after his original wedding plans had been flattened by the Great 1906 San Francisco Earthquake. Dr. Frueh took pains t...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research