Vital Signs Monitoring with Wearable Sensors in High-risk Surgical Patients A Clinical Validation Study
Conclusions All sensors were highly accurate for HR. For RR, the EarlySense, SensiumVitals sensor, and Masimo Radius-7 were reasonably accurate for RR. The accuracy for RR of the HealthPatch sensor was outside acceptable limits. Trend monitoring with wearable sensors could be valuable to timely detect patient deterioration.Editor ’s PerspectiveWhat We Already Know about This TopicChanges in vital signs are an important indicator of physiological decline and hence provide opportunities for early recognition and intervention; however, in the hospital ward, vital signs are usually measured intermittently. In between suc...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome
Conclusions In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofolversus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined.Editor ’s PerspectiveWhat We Already Know about This TopicBrugada syndrome is an inherited cardiac ion channel disorder that pl...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Not All Pericardiac Fluid Is Pericardial Ultrasound of Pericardial Effusion and Two of Its Mimics
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Intraoperative Oxidative Damage and Delirium after Cardiac Surgery
Conclusions Intraoperative oxidative damage was associated with increased postoperative delirium and neuronal injury, and the association between oxidative damage and neuronal injury was stronger among patients with increased blood –brain barrier disruption.Editor ’s PerspectiveWhat We Already Know about This TopicPostoperative delirium occurs in approximately 25% of cardiac surgery patients.Hyperoxic cerebral perfusion during cardiac surgery has been associated with increased postoperative delirium, and oxidative damage may mediate this association.What This Article Tells Us That Is NewIn a cohort of 400 cardi...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Anticoagulation Management and Antithrombin Supplementation Practice during Veno-venous Extracorporeal Membrane Oxygenation A Worldwide Survey
Background There is a lack of consensus on how to manage anticoagulation during veno-venous extracorporeal membrane oxygenation, including antithrombin monitoring and supplementation. The authors ’ aim was to determine current practice in a large number of extracorporeal membrane oxygenation centers around the world.Methods This was an electronic survey disseminated in 2018 to directors and coordinators of extracorporeal membrane oxygenation centers as well as to extracorporeal membrane oxygenation experts. Participating centers were classified according to some covariates that may affect practice, including 2017 gro...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Button Battery Ingestion A True Surgical and Anesthetic Emergency
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Positive End-expiratory Pressure and Distribution of Ventilation in Pneumoperitoneum Combined with Steep Trendelenburg Position
Background Pneumoperitoneum and a steep Trendelenburg position during robot-assisted laparoscopic prostatectomy have been demonstrated to promote a cranial shift of the diaphragm and the formation of atelectasis in the dorsal parts of the lungs. However, neither an impact of higher positive end-expiratory pressure (PEEP) on preserving the ventilation in the dorsal region nor its physiologic effects have been fully examined. The authors hypothesized that PEEP of 15 cm H2O during robot-assisted laparoscopic prostatectomy might maintain ventilation in the dorsal parts and thus improve lung mechanics.Methods In this randomized...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Transfusion of Uncrossmatched Group O Erythrocyte-containing Products Does Not Interfere with Most ABO Typings
Conclusions The transfusion of smaller quantities of uncrossmatched type O erythrocyte-containing products, in particular up to 10 units, does not usually interfere with determining the recipient ’s ABO type. The early collection of a type and screen sample is important.Editor ’s PerspectiveWhat We Already Know about This TopicUncrossmatched erythrocyte units that are provided to a massively bleeding patient whose ABO group is unknown must be type O to ensure compatibility. The effect of transfusing type O units on the ability to subsequently determine the patient ’s ABO group is not known.What This Artic...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury
Conclusions Adult patients undergoing noncardiac surgery demonstrate varying associations with distinct levels of hypotension when stratified by preoperative risk factors. Specific levels of absolute hypotension, but not relative hypotension, are an important independent risk factor for acute kidney injury.Editor ’s PerspectiveWhat We Already Know about This TopicAcute kidney injury occurs in 13% of patients undergoing major surgery and is associated with a six-fold increased risk of mortality.Single-center studies have demonstrated an association between intraoperative hypotension and acute kidney injury.What This A...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Influence of St. John ’s Wort on Intravenous Fentanyl Pharmacokinetics, Pharmacodynamics, and Clinical Effects A Randomized Clinical Trial
Conclusions St. John ’s wort did not alter fentanyl pharmacokinetics, pharmacodynamics or clinical effects, suggesting no effect on hepatic clearance or blood-brain barrier efflux. Patients taking St. John’s wort will likely not respond differently to IV fentanyl for anesthesia or analgesia.Editor ’s PerspectiveWhat We Already Know about This TopicThe popular herbal medicine, St. John ’s wort, is a potent inducer of several cytochrome P450 enzymes, including CYP3A4, which plays a role in the metabolism of fentanyl. St. John’s wort may also influence the expression of P-glycoprotein, which can ...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Pain Response to Open Label Placebo in Induced Acute Pain in Healthy Adult Males
Conclusions Open label placebos might play a role in multimodal analgesic concepts.Editor ’s PerspectiveWhat We Already Know about This TopicPlacebo treatments even if known to the patient to be placebo, so-called “open label placebo,” may be effective in reducing chronic painThe effects of the extent of placebo education are poorly understoodWhat This Article Tells Us That Is NewUsing a well-characterized electrical pain sensitization model in human volunteers, the effects of short versus detailed placebo educational protocols were measuredOpen label placebo treatment reduced pain sensitization in the vo...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Global Safe Pediatric Anesthesia Care
“[In low- and middle-income countries] pediatric upskilling of existing anesthesia workforces, including nonphysician anesthesia providers, is necessary.” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Pediatric Perioperative Mortality in Kenya A Prospective Cohort Study from 24 Hospitals
Conclusions The authors have established a baseline pediatric perioperative mortality rate that is greater than 100 times higher than in high-income countries. The authors have identified factors associated with an increased mortality, such as not using the Safe Surgery Checklist. This analysis may be helpful in establishing pediatric surgical care systems in low –middle income countries and develop research pathways addressing interventions that will assist in decreasing mortality rate.Editor ’s PerspectiveWhat We Already Know about This TopicThe pediatric surgical load in low- and middle-income countries is g...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Controversies in Perioperative Antimicrobial Prophylaxis
Although clinical guidelines for antibiotic prophylaxis across a wide array of surgical procedures have been proposed by multidisciplinary groups of physicians and pharmacists, clinicians often deviate from recommendations. This is particularly true when recommendations are based on weak data or expert opinion. The goal of this review is to highlight certain common but controversial topics in perioperative prophylaxis and to focus on the data that does exist for the recommendations being made. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Reduced Sensitivity to Anesthetic Agents upon Lesioning the Mesopontine Tegmental Anesthesia Area in Rats Depends on Anesthetic Type
Conclusions Inability to induce anesthesia in lesioned animals using normally effective doses of etomidate, propofol, and pentobarbital suggests that the mesopontine tegmental anesthesia area is the effective target of these, but not necessarily all, GABAergic anesthetics upon systemic administration. Cortical and spinal functions are likely suppressed by recruitment of dedicated ascending and descending pathways rather than by direct, distributed drug action.Editor ’s PerspectiveWhat We Already Know about This TopicLesions of the mesopontine tegmental anesthesia area in the brainstem render rats strongly insensitive...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Impact of Pulse Oximetry Surveillance on Rescue Events and Intensive Care Unit Transfers: A Before-and-After Concurrence Study: Erratum
In the February 2010 issue, the article “Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: A before-and-after concurrence study” (Taenzer AH, Pyke JB, McGrath SP, Blike GT: Anesthesiology 2010; 112:282 –7. doi: 10.1097/ALN.0b013e3181ca7a9b) contains an error in the denominator label for rates of rescue events presented. The correct denominator label is patient days, not discharges. This error does not alter the findings of the study. Clarification of the terminology, however, will allow other or ganizations implementing the same or similar technology to improve unde...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in Healthy Volunteers: A Nonblinded Randomized Crossover Study: Erratum
In the November 2019 issue, the article “Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in Healthy Volunteers” (Lodenius Å, Maddison KJ, Lawther BK, Scheinin M, Eriksson LI, Eastwood PR, Hillman DR, Fagerlund MJ, Walsh JH: Anesthesiology 2019; 131:962 –73. doi: 10.1097/ALN.0000000000002883) contains an error. In the Results section of the Abstract, median (interquartile range) pharyngeal critical pressure “0.3 (−9.2 to 1.4)” should be “−0.3 (−9.2 to 1.4).” The corrected sentence reads: “Median (interquartile range) pharyngeal ...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Sparking the Discussion about Vaping and Anesthesia
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Controversies in Perioperative Antimicrobial Prophylaxis: Erratum
In the Online First article published on December 4, 2019, “Controversies in Perioperative Antimicrobial Prophylaxis” (Decker BK, Nagrebetsky A, Lipsett PA, Wiener-Kronish JP, O’Grady NP: Controversies in Perioperative Antimicrobial Prophylaxis,Anesthesiology 2019; doi: 10.1097/ALN.0000000000003075. [Epub ahead of print]) there are two errors. On page 2, the sentence “Although vancomycin provides appropriate antimicrobial coverage for Gram-positive flora (the predominant cause of surgical site infections in clean procedures) from a microbiologic standpoint, the increased administration time of 1 to ...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Anticoagulation and Antithrombin in Veno-venous Extracorporeal Membrane Oxygenation
“[T]he best management for extracorporeal membrane oxygenation, including the anticoagulation agent and laboratory monitoring tests, remains elusive…” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Oxidative Stress Response and Delirium after Cardiac Surgery Can Circulating Biomarkers Refine New Therapeutic Paradigms?
“While anesthesia/surgery are clearly inciting factors for delirium,intraoperative strategies to reduce it are sorely lacking. ” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Challenge of Anesthesia Management in Brugada Syndrome
“…[P]ropofol appears to be a safe anesthesia induction agent in Brugada syndrome…” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Automated Continuous Noninvasive Ward Monitoring Validation of Measurement Systems Is the Real Challenge
“[T]he impact of continuous ward monitoring on patient-centered outcomes needs to be investigated in large interventional clinical trials.” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Preoperative Risk, Blood Pressure, and Acute Kidney Injury
“[W]hether targeting blood pressure alone could mitigate the risk of acute kidney injury remains controversial.” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 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 - February 12, 2020 Category: Anesthesiology Source Type: research

Continuous Postoperative Monitoring: Validation of the Next Frontier
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Exploding onto Lancaster ’s Anesthetic Landscape: Dr. Michael A. Becker’s Vitalized Air
After earning his D.D.S. from Cincinnati ’s Ohio College of Dental Surgery, Michael Augustus Becker (1866 to 1938) married in his home state before moving his new wife to Lancaster, Pennsylvania. As manager of the city’s “Albany Dentists” franchise (its trade card obverse with inserts from reverse,above), he was in charge of generating “Vitalized Air” for anesthesia and of vulcanizing rubber for dentures. In the latter capacity, Dr. Becker stood next to a pressurized vulcanizer “when it suddenly burst.” Lancaster’sMorning News reported that boiling water and steam sever...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Tracing “Orinda” from Corneille to Cocaine: A “Matchless” Nom-de-plume , but Outmatched Numbing
After reading the entire Bible at the age of four, Katherine Fowler (1632 to 1664) surprised the English public first as a child prodigy, then as a teenaged polyglot, and finally as a 16-year-old royalist bride to a much older antiroyalist groom. An unabashed Francophile, she was memorialized by the 1667 posthumous publication ofPoems by the Most Deservedly Admired Mrs. Katherine Philips, the Matchless Orinda (its frontispiece,left), which included her brilliant translations of Pierre Corneille ’s tragediesHorace andPomp ée. Over 230 years later, Philips ’nom-de-plume“Orinda” was borrowed for...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Byline Backstory No. 2 —Astronaut-ministering Launched Interest in Science for a Future Anesthesiologist and Curator
The Air Force assigned my father in 1961 to serve as a chaplain in Alaska for 1 year. His wife Suzanne and their youngsters, Brenda, Chris, and me, stayed behind in Pennsylvania. Dad ’s reports on “men in isolation”—those manning lonely radar sites—soon swayed the Air Force to station him next at Florida’s Cape Canaveral, where he met or ministered to all six of the “Mercury 7” (astronauts Shepard through Cooper,left) who flew solo on America ’s first spaceflights. In turn, the sixth Mercury astronaut, Gordon Cooper (lower right) and then a future Gemini astronaut, Tom ...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

An Ode to the Cookie Lady
During my year as a surgical intern, the only work hour restrictions were the limits of human endurance —the 168-h week. It was hard. Your view of reality, of yourself, of others and the world around you became fundamentally altered when the alarm was set for 3:45am and you began seeing patients before the sun came up. What day was it? What season were we in? None of those designations mattered as much as which rotation it was —hepatobiliary month, followed by cardiac, and then the intensive care unit. In a real sense, it was an internment…a forced (yet voluntary) removal from society at large and indoct...
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Artificial Intelligence in Anesthesiology Current Techniques, Clinical Applications, and Limitations
Artificial intelligence has been advancing in fields including anesthesiology. This scoping review of the intersection of artificial intelligence and anesthesia research identified and summarized six themes of applications of artificial intelligence in anesthesiology: (1) depth of anesthesia monitoring, (2) control of anesthesia, (3) event and risk prediction, (4) ultrasound guidance, (5) pain management, and (6) operating room logistics. Based on papers identified in the review, several topics within artificial intelligence were described and summarized: (1) machine learning (including supervised, unsupervised, and reinfo...
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

“Arterialization” of the Central Venous Pressure Waveform from a Peripheral Arteriovenous Fistula
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Sustained Ventricular Tachycardia Secondary to R-on-T Phenomenon Caused by Temporary Ventricular Epicardial Pacemaker Undersensing after Cardiac Surgery
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Postintubation Tracheal Rupture Detected by Virtual Endoscopy and Curved Planar Reformation
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Sick Sinus Syndrome Sinus Node Dysfunction in the Elderly
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Anesthetic Management Using Multiple Closed-loop Systems and Delayed Neurocognitive Recovery A Randomized Controlled Trial
Conclusions Automated anesthetic management using the combination of three controllers outperforms manual control and may have an impact on delayed neurocognitive recovery. However, given the study design, it is not possible to determine the relative contribution of each controller on the cognition score. (Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery
Editor ’s PerspectiveWhat We Already Know about This TopicThe intraoperative administration of methadone is effective in reducing postoperative painPreventative analgesic interventions may provide protection against the development of persistent postoperative painWhat This Article Tells Us That Is NewUsing data from two previously completed trials, it was observed that a single intraoperative dose of methadone was associated with fewer episodes of pain during the first month after cardiac surgery and the first 3 months after spinal surgeryFewer spine surgery patients who received methadone intraoperatively were recei...
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Intravenous Lidocaine and Postoperative Cognition: Comment
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Intravenous Lidocaine and Postoperative Cognition: Reply
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Opioid-induced Miosis Is Unaltered by Obstructive Sleep Apnea: Comment
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Opioid-induced Miosis Is Unaltered by Obstructive Sleep Apnea: Reply
(Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Perioperative Fluid Therapy for Major Surgery: Erratum
In the May 2019 issue, the article “Perioperative Fluid Therapy for Major Surgery” (Miller TE, Myles PS: Anesthesiology 2019; 130:825 –32. doi: 10.1097/ALN.0000000000002603) contains an error. In the following sentence on page 828, “If a patient is volume-optimized (not fluid responsive) and remains hypotensive (mean blood pressure greater than 65mm Hg and possibly higher in patients with preexisting hypertension), a vasopress or infusion should be considered,” the words “greater than” should be “less than.” The full, corrected sentence reads: “If a patient is vol...
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Heart Rate Control during Experimental Sepsis in Mice Comparison of Ivabradine and β-Blockers
This study assesses the effects of ivabradine, atenolol, and placebo in the setting of murine peritonitis. Mice that received atenololversus ivabradine both experienced a similar and significant decline in heart rate. The mice in the atenolol group also experienced a significant decrease in cardiac output, systolic blood pressure, and left ventricular systolic function that was not experienced by the mice who received ivabradine.Mice who received atenolol versus ivabradine versus placebo did not have significantly different survival 60 h after induction of sepsis. Future studies are needed to determine the value of ivabrad...
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Static and Dynamic Transpulmonary Driving Pressures Affect Lung and Diaphragm Injury during Pressure-controlled versus Pressure-support Ventilation in Experimental Mild Lung Injury in Rats
Conclusions In the mild lung injury model use herein, at the same VT, pressure-support compared to pressure-controlled ventilation did not affect biologic markers. However, pressure-support ventilation was associated with a major difference between static and dynamic transpulmonary driving pressure; when the same dynamic transpulmonary driving pressure and inspiratory time were used for pressure-controlled ventilation, greater lung and diaphragm injury occurred compared to pressure-support ventilation. (Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

Associations of Intraoperative Radial Arterial Systolic, Diastolic, Mean, and Pulse Pressures with Myocardial and Acute Kidney Injury after Noncardiac Surgery A Retrospective Cohort Analysis
Editor ’s PerspectiveWhat We Already Know about This TopicArterial pressure is a complex signal that is characterized by three primary components — systolic, diastolic, and mean pressure, along with a derived component, pulse pressure (systolic minus diastolic pressure)Each blood pressure component reflects distinct hemodynamic variables, and therefore presumably differently influences perfusion of various organsPrevious work identifies associations between intraoperative systolic and mean hypotension with myocardial and kidney injuryWhat This Article Tells Us That Is NewFor each blood pressure component, the a...
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research

From Room 1000
Look there. (Source: Anesthesiology)
Source: Anesthesiology - January 14, 2020 Category: Anesthesiology Source Type: research