This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

A Calculated Risk: Comparing Perioperative Assessment Tools
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

As for “Fresh Laughing Gas”—Get It Out of Jehl Free....
As New York City ’s “French Dentist,” Dr. Jehl ran his accommodating dental office until 9pm every day of the week, including Sundays. Language posed no barriers as he was conversational in French, German, Spanish, and English. The obverse of his trade cards were floral (left); the reverse, practical. Promising “Fresh Laughing Gas always on hand,” (right) Dr. Jehl administered nitrous oxide and extracted teeth for free; “no charge,” as long as patients were purchasing “artificial teeth” from him. (Copyright © the American Society of Anesthesiologists’ Wood Li...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Not a Pipe Dream: Crescent Interest in Free ’s Vegetable Anesthetic
From his George Street office in York, Pennsylvania, Dr. Harry A. Free promised to “extract teeth without pain, by the use” of his Vegetable Anesthetic (upper left). Advertised on a trade card featuring a sleepy, pipe-puffing crescent moon (right), Free ’s proprietary concoction of botanical sedatives extended the anesthetic duration of nitrous oxide. By December of 1892, Dr. Free felt compelled to defend his Vegetable Anesthetic after a patient’s delayed complications were reported to have been linked to Free’s anesthetic. In an advertisemen t countering what Dr. Free regarded as libelous cla...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

How Hertzler ’s Local Anesthesia Saw More Than Local Military Action
A textbook authored at the University of Kansas by surgeon Arthur Hertzler, M.D.,The Technic of Local Anesthesia was published in its 6th edition by 1937 (left andcenter). During the month before transferring theChandeleur (upper right) from San Francisco ’s Western Pipe and Steel Company to the United States Navy, the seaplane tender received this copy of Hertzler’s book for its Medical Department (lower right). Ferrying aviators, shipping cargo, and tendering seaplanes, the USSChandeleur and this “local” book witnessed military action in the waters of the South Pacific and off the shores of the Ph...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

The Trademarked Red “Elixir of Life,” Hall’s Coca Wine
From the Wood Library-Museum ’s Ben Z. Swanson Collection, the obverse (left) of this advertising card for Hall ’s Coca Wine features Dudley Hardy’s ca.1916 depiction of a lady apparently enjoying the wine as a so-called “Elixir of Life.” As to “What Is It?” (right), readers learn from the card ’s reverse about the “wonderful feats of endurance” accomplished by native Bolivians and Peruvians after chewing “only a few Coca leaves.” A subsequent anecdote features a knighted professor from the University of Edinburgh who had climbed Ben Voirlich twice &ld...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Crying Foul on Chloroforming Fowl
On the morning of November 28, 1912, farmer William A. Smith alerted the police that his covered wagon had been burglarized while parked curbside, under a streetlight, at “Fulton and West Market streets” in the Elk Street Market of Buffalo, New York. Thieves had broken into cages; had stolen five turkeys, five geese, and 15 chickens; and had then driven the fowl away, presumably in another wagon. Sleeping in wagons within earshot of Smith’s, a hundred fellow fa rmers heard nary a squawk; neither were there any feathers in the coops to suggest that robbers had wrestled with any of the birds. As recorded in...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Anesthesia: The Gift of Oblivion and the Mystery of Consciousness.
When I started reading this book, I thought it was going to be a story about anesthesia. Instead, it is a book mostly about the lack of anesthesia among patients undergoing surgery; that is, it is a story of intraoperative awareness. The author lives in Melbourne, Australia, and has described her visits and the studies of some of the individuals around the world who have investigated anesthesia recall, including: Kate Leslie, M.B.B.S., M.D., M.Epid., M.Hlth.Serv.Mt., F.A.N.Z.C.A., F.A.H.M.S., of the University of Melbourne (Melbourne, Victoria, Australia); J. Edmond I. Eger, II, M.D., since deceased, labeled by the author ...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We appreciate the response of Rosenet al. to our recent article, “Temporal Trends in Difficult and Failed Tracheal Intubation in a Regional Community Anesthetic Practice,”1 including their highlighting the importance of the anesthesia community as subject matter experts in airway management. We concur with the authors ’ assertion that mask ventilation, as the precursor to endotracheal intubation and a critical airway management skill, deserves a similar level of scrutiny and study. Mastery of the technical skill of mask ventilation is absolutely critical to the safe practice of anesthesiology but also to ...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Airway Management: The Less Popular Skill of Bag-mask Ventilation
(Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We thank Dr. Kendall for his repeated interest in our investigations and his valuable comments. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Surrogates or Outcomes: What Should We Measure?
(Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Brain Dynamics and Temporal Summation of Pain Predicts Neuropathic Pain Relief from Ketamine Infusion
Conclusions These findings suggest that brain and behavioral measures have the potential to prognosticate and develop ketamine-based personalized pain therapy. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Ultrasound Elastography for Rapid, Real-time Detection of Localized Muscular Reaction in Malignant Hyperthermia –susceptible Pigs
Editor ’s PerspectiveWhat We Already Know about This TopicAwareness of a patient ’s malignant hyperthermia predis position based on diagnostic testing is essential to preventing serious malignant hyperthermia eventsThein vitro contracture test after surgical muscle biopsy is a well-established and comprehensive diagnostic testGenetic testing can be used to confirm malignant hyper thermia susceptibility but not to exclude itWhat This Article Tells Us That Is NewIn vivo ultrasound (shear-wave) elastography detected a temporary increase in local tissue stiffness soon after intramuscular injection of halothane and ...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Preclinical Pharmacology in the Rhesus Monkey of CW 1759-50, a New Ultra-short Acting Nondepolarizing Neuromuscular Blocking Agent, Degraded and Antagonized by L -Cysteine
Conclusions CW 1759-50, similar to gantacurium, is an ultra-short acting neuromuscular blocking agent, antagonized byl-cysteine, in the monkey. The circulatory effects, however, are much reduced in comparison with gantacurium, suggesting a trial in humans. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Etomidate and Etomidate Analog Binding and Positive Modulation of γ-Aminobutyric Acid Type A Receptors Evidence for a State-dependent Cutoff Effect
Editor ’s PerspectiveWhat We Already Know about This TopicPositive γ-aminobutyric acid type A (GABAA) receptor modulators bind with higher affinity when the receptor is in the open state, increasing the fraction of open state receptors and, thereby, enhancing receptor functionAppending a phenyl ring substituent group onto the phenyl ring of etomidate abolished its conformational state selectivity and binding site selectivity, reducing the intrinsic efficacy of etomidate and turning it into an anesthetic-selective competitive GABAA receptor antagonistWhat This Article Tells Us That Is Newγ-Aminobutyric aci...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Resting-state Dynamics as a Cortical Signature of Anesthesia in Monkeys
Editor ’s PerspectiveWhat We Already Know about This TopicAnesthesia-induced loss of consciousness is paralleled by a disruption of frontoparietal functional correlation, as measured by functional magnetic resonance imaging and electroencephalography. However, it is still unclear how anesthesia induces such a corticocortical disconnection.Dynamic-resting state is a recent analytical method to study large-scale brain networks, allowing the clustering of functional magnetic resonance images into functional brain states.What This Article Tells Us That Is NewWhen moving from wakefulness to anesthesia, the anatomical stru...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery
Editor ’s PerspectiveWhat We Already Know about This TopicPropofol may better preserve host defenses against cancerWhether cancer recurrence is less likely with propofol than volatile anesthesia remains unknownWhat This Article Tells Us That Is NewThe authors conducted a propensity-matched retrospective analysis of 1,158 patients who had colon cancer surgeryPatients anesthetized with propofol had better overall survivalBackground Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elect...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Effect of Equipotent Doses of Propofol versus Sevoflurane Anesthesia on Regulatory T Cells after Breast Cancer Surgery
Conclusions Changes in immune cells were similar with propofol and sevoflurane during breast cancer surgery. The effect of anesthetics on the perioperative immune activity may be minimal during cancer surgery. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Caffeine Accelerates Emergence from Isoflurane Anesthesia in Humans A Randomized, Double-blind, Crossover Study
Conclusions Intravenous caffeine is able to accelerate emergence from isoflurane anesthesia in healthy males without any apparent adverse effects. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients
Conclusions Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Impact of the Choice of Risk Model for Identifying Low-risk Patients Using the 2014 American College of Cardiology/American Heart Association Perioperative Guidelines
Conclusions There is wide variability in the predicted risk of cardiac complications using different risk-prediction tools. Including more than one prediction tool in clinical guidelines could lead to differences in decision-making for some patients depending on which risk calculator is used. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Comparison of the TOFscan and the TOF-Watch SX during Recovery of Neuromuscular Function
Conclusions Good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated TOFscan was observed throughout all stages of neuromuscular recovery. (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Midazolam and Dexmedetomidine Affect Neuroglioma and Lung Carcinoma Cell Biology In Vitro and In Vivo
Editor ’s PerspectiveWhat We Already Know about This TopicDexmedetomidine reduces cellular apoptosis, and it has been demonstrated previously that this antiapoptotic effect can not only increase cancer cell proliferation and migration but also reduce survival in experimental models of cancer growth.Midazolam has proapoptotic effects and can reduce cancer cell survival. The mechanisms by which midazolam suppresses cancer cell progression remain to be defined.What This Article Tells Us That Is NewAs expected, dexmedetomidine enhanced cancer cell proliferation and migration, primarily by the upregulation of antiapoptoti...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery —2018
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. ...
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Highways of the Brain, Traffic of the Mind
“…constraining traffic to more inflexible patterns on the highways of the brain may be one reason why general anesthetics suppress consciousness.” (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Preoperative Cardiac Evaluation before Noncardiac Surgery Reverend Bayes ’s Risk Indices and Optimal Variables
“[What are] the implications of advocating different risk algorithms on the decision for further diagnostic evaluation and potential interventional strategies[?]” (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Workflow Eats Optimum Care for Lunch
Given the documented struggles anesthesiologists have getting themselves to use any kind of quantitative monitoring system, one wonders, “Why bother”? (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Postoperative Brain Function Toward a Better Understanding and the American Society of Anesthesiologists Perioperative Brain Health Initiative
“Is everyone using the same vocabulary to describe the [same] phenomenon [of postoperative brain (dys)function]?” (Source: Anesthesiology)
Source: Anesthesiology - October 17, 2018 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Pharmacokinetic Properties of a Sufentanil Sublingual Tablet Intended to Treat Acute Pain: Erratum
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Preanesthesia Premedication The “Monaldi” Protocol
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Vanishing Point
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Neurocognitive Function after Cardiac Surgery From Phenotypes to Mechanisms
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Reducing the Incidence of Substance Use Disorders in Anesthesiology Residents 13 Years of Comprehensive Urine Drug Screening
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Saber-sheath Tracheal Deformity
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Reinke ’s Edema Implications for Airway Management
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Delayed Tension Pneumomediastinum after Cardiac Surgery
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Images in Anesthesiology: Persistent Pulmonary Interstitial Emphysema
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Machine Learning for Anesthesiologists: A Primer
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Haunted Anesthesia? Spirited Herbs in Mayo ’s Vegetable Vapor
Frustrated by his failure to find a balanced combination of sedative herbs to extend the duration of nitrous-oxide anesthesia, Urial K. Mayo, D.D.S. (1816 to 1900), sought advice from a neighboring Boston spiritualist. From Mayo ’s self-described “spiritual revelation” sprang the “vegetable vapor” anesthetic that the dentist patented in 1885. Regarding both his nitrous oxide and the “spirit” (the ethyl alcohol dissolving his herbs) as stimulants, Mayo balanced their effects with herbal depressants, such asHumulus lupulus ( “hops” orH on the grinning jack-o ’-lante...
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

From “Bagging” Patients to Bagging Dr. Heidbrink, Maker of Anesthesia Machines
Alongside corporate literature, patents, and samples of his Heidbrink breathing bags, did Minnesota dentist –anesthetist Jay Albion Heidbrink (1875 to 1957) ever carry copies of his handwritten memoirs? We can only speculate. What we do know is that “Doctor Heidy” was the most successful American ever to design and mass-produce anesthesia machines. Eventually, decades of Heidbrink manufacturing hist ory merged with that of the “Ohio” line to generate “Heidbrink-Ohio” machines. At some point after his passing, Heidbrink’s leather “doctor’s bag” (above) was de...
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Ohmeda Slide Rule for Pressures and Volumes
For decades, clinicians have appreciated shortcuts for calculating numbers and for converting units of measure. In both surgical and critical care suites, some “seasoned” anesthesiologists and intensivists appreciated using handy slide rules for a host of patient- and apparatus-related tasks. Assisted by this Ohmeda slide rule (upper image), one learned that 150 mmHg equals 20 kPa. On the back (lower image), a tidal volume of 700 ml at a respiratory rate of 10 per min was slide rule –calculated as having a 7 l/min minute volume. The Cleveland-based company founded in 1910 as “Ohio Chemical” sh...
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research

Birth Centennial of Nobel Laureate Skou, an Investigator of Local Anesthetics and the Sodium –Potassium Pump
In 1947 a Danish physician –physiologist, Jens Christian Skou (1918 to 2018,lower right), began working at the Institute for Medical Physiology at Aarhus University. Although his 1951 doctoral dissertation correlated local anesthetic activity with lipid solubility, Skou eventually investigated the physiology of nerves in shore crabs ’ legs. In 1957 Skou became the first to discover an ion-transporting enzyme, the sodium–potassium pump. Forty years later, in Stockholm, Sweden, Skou was awarded his half of the 1997 Nobel Prize in Chemistry. This month, October of 2018, marks the birth centennial of Jens Chr...
Source: Anesthesiology - September 18, 2018 Category: Anesthesiology Source Type: research