Editorial Views and Policies
(Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

In Reply
We appreciate the interest of Lagieret al. in our article.1 The authors highlighted in their letter the work of Montaigneet al.,2 who have recently published on the circadian rhythm in relation to ischemia reperfusion injury in a single-center retrospective propensity-matched cohort study addressing this subject on 596 (matched-pairs) patients undergoing aortic valve replacement with or without coronary artery bypass grafting, together with a single-center randomized study in 88 patients undergoing isolated aortic valve replacement, in which the perioperative myocardial injury has been assessed with the geometric mean of p...
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Xenon Myocardial Protection in Cardiac Surgery: Effective around the Clock?
(Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Exercise Reverses Nociceptive Sensitization, Upregulated Neuropeptide Signaling, Inflammatory Changes, Anxiety, and Memory Impairment in a Mouse Tibia Fracture Model
Conclusions Daily exercise reversed nociceptive sensitization, inflammation, anxiety, and memory loss after tibia fracture. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Plasticity and Function of Spinal Oxytocin and Vasopressin Signaling during Recovery from Surgery with Nerve Injury
Conclusions : These findings suggest that the capacity for oxytocin signaling in the spinal cord increases after surgery and that spinal oxytocin signaling plays ongoing roles in both sexes in recovery from mechanical hypersensitivity after surgery with known nerve injury. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness A Randomized, Double-blind Trial
Conclusions Preoperative fascia iliaca blockade in addition to intraarticular local anesthetic injection did not improve pain control after hip arthroscopy but did result in quadriceps weakness, which may contribute to an increased fall risk. Routine use of this block cannot be recommended in this patient population. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation The Facet Treatment Study (FACTS), a Randomized, Controlled Clinical Trial
Conclusions This study establishes that facet blocks are not therapeutic. The higher responder rates in the treatment groups suggest a hypothesis that facet blocks might provide prognostic value before radiofrequency ablation. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Syndecan-2 –positive, Bone Marrow–derived Human Mesenchymal Stromal Cells Attenuate Bacterial-induced Acute Lung Injury and Enhance Resolution of Ventilator-induced Lung Injury in Rats
What We Already Know about This TopicHuman mesenchymal stromal cells diminish injury and enhance recovery and repair after ventilator-induced lung injury in animalsCurrent methods of isolating mesenchymal stromal cells result in a heterogeneous mix of cell types, which may be suboptimalWhat This Article Tells Us That Is NewPure subpopulations of bone marrow –derived human mesenchymal stromal cells were isolated on the basis of expression of the cell surface marker syndecan 2Intravenous injection of these cells attenuatedEscherichia coli–induced injury and enhanced resolution of ventilator-induced lung injury in...
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Respiratory Muscle Effort during Expiration in Successful and Failed Weaning from Mechanical Ventilation
Conclusions Weaning failure (vs. success) is associated with increased effort of the expiratory muscles and impaired neuromechanical efficiency of the diaphragm but no difference in tonic activity of the diaphragm. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Dexmedetomidine Prevents Excessive γ-Aminobutyric Acid Type A Receptor Function after Anesthesia
Conclusions Dexmedetomidine prevented excessive α5 γ-aminobutyric acid type A receptor function after anesthesia. This novel α2 adrenergic receptor- and brain-derived neurotrophic factor-dependent pathway may be targeted to prevent delirium. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

High-throughput Screening in Larval Zebrafish Identifies Novel Potent Sedative-hypnotics
Conclusions Photomotor response assays in zebrafish larvae are a mechanism-independent platform for high-throughput screening to identify novel sedative-hypnotics. The variety of chemotypes producing hypnosis is likely much larger than currently known. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Maternal Body Mass Index and Use of Labor Neuraxial Analgesia A Population-based Retrospective Cohort Study
Conclusions Our findings suggest that the likelihood of receiving neuraxial analgesia is only marginally increased for morbidly obese women compared to women with normal body mass index. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery
Conclusions Hypotension is a potentially modifiable risk factor for perioperative stroke. The study ’s findings suggest that mean arterial pressure may be an important intraoperative therapeutic hemodynamic target to reduce the incidence of stroke in patients undergoing cardiopulmonary bypass. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Do Hospitals Performing Frequent Neuraxial Anesthesia for Hip and Knee Replacements Have Better Outcomes?
What We Already Know about This TopicNeuraxial anesthesia is being used more frequently for elective hip and knee replacementsIt is unclear whether increasing rates of hospital-level use of neuraxial anesthesia are associated with beneficial medical or economic outcomesWhat This Article Tells Us That Is NewNational administrative data demonstrate that increasing frequency of neuraxial anesthesia use is not associated with improved clinical outcomesHowever, hospitals using neuraxial anesthesia frequently did observe a decrease in inpatient costs compared to hospitals that did not use neuraxial anesthesia at allBackground Ne...
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Processed Electroencephalogram Monitoring and Postoperative Delirium A Systematic Review and Meta-analysis
What We Already Know about This TopicUp to 20% of patients undergoing major surgery experience postoperative delirium or cognitive dysfunctionIntraoperative management strategies to reduce the risk of postoperative delirium remain unclearWhat This Article Tells Us That Is NewThe heterogeneity of cognitive dysfunction primary studies prevents meaningful meta-analysesMeta-analysis of five randomized controlled trials demonstrated that use of intraoperative processed electroencephalogram monitoring is associated with a decreased risk of postoperative deliriumBackground Postoperative delirium complicates approximately 15 to 20...
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery
Conclusions Patients who developed delirium had greater decline in a composite measure of cognition and in visuoconstruction and processing speed domains at 1 month. The differences in cognitive change by delirium were not significant at 1 yr, with the exception of processing speed. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Critical Role of the Surgeon –Anesthesiologist Relationship for Patient Safety
This article explores functional and dysfunctional aspects of the relationship, identifies some negative stereotypes each profession has of the other and calls for research to better characterize and understand how to i mprove working relationships. Suggestions are given for what an ideal relationship might be and actions that surgeons and anesthesiologists can take to improve how they work together. The goal is safer care for patients, and more joy and meaning in work for surgeons and anesthesiologists. (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

And the Band Played On The Unrelenting Search for Preventative Analgesia
“So where do we go from here … given the financial, clinical, and psychosocial consequences of persistent postsurgical pain[?]” (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Just the FACTS The Role of Diagnostic Blocks in Lumbar Facet Interventions
“We simply lack a good strategy for efficiently selecting those who will receive benefit from radiofrequency ablation [for low back pain].” (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Weaning from Mechanical Ventilation Have We, so Far, Missed a Crucial Point?
“…[E]xpiratory muscle recruitment significantly contributes to the total respiratory effort of the patient during weaning from mechanical ventilation.” (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Gone Fishing …
“…the first to employ [the Zebrafish] model to discover new anesthetics, and the results are promising.” (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Postoperative Delirium and Postoperative Cognitive Dysfunction Two Sides of the Same Coin?
“…[is] delirium…simply a marker for other factors that may contribute to postoperative cognitive dysfunction risk…[or does] delirium itself actually contribute to longer-term postoperative cognitive dysfunction[?]” (Source: Anesthesiology)
Source: Anesthesiology - August 14, 2018 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Electrical Impedance Tomography for Confirmation of Lung Isolation during One-lung Ventilation: Erratum
In the Online First article published on March 26, 2018, a sentence on image C is missing. The last paragraph should read: “Image A shows electrical impedance tomography during deep spontaneous breathing with ventilation throughout both lungs. Image B illustrates the ventral shift of ventilation in both lungs with collapse of dependent lung areas, during manual ventilation after induction of anesthesia.3 Image C confirms correct lung separation by lack of ventilation signals of the left lung. Finally, image D shows ventilation of both lungs following resumption of spontaneous breathing after discontinuing anesthesia....
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Subjective Objective: A Researcher ’s Narrative on Human Relationships
“Will she have her clothes on?” asked the suspicious mother standing before me. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Liquid Lightness
I settle deeper in the chair as if in sediment, (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Neuroinflammation and Central Sensitization in Chronic and Widespread Pain
Chronic pain is maintained in part by central sensitization, a phenomenon of synaptic plasticity, and increased neuronal responsiveness in central pain pathways after painful insults. Accumulating evidence suggests that central sensitization is also driven by neuroinflammation in the peripheral and central nervous system. A characteristic feature of neuroinflammation is the activation of glial cells, such as microglia and astrocytes, in the spinal cord and brain, leading to the release of proinflammatory cytokines and chemokines. Recent studies suggest that central cytokines and chemokines are powerful neuromodulators and ...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Presumed β-Lactam Allergy and Cross-reactivity in the Operating Theater A Practical Approach
A β-lactam allergy is the most common suspected in-hospital drug allergy, with an incidence of 5 to 17% in hospitalized patients and up to 35% in the surgical population at the preoperative assessment clinic.1 –5 Thus, the team in the operating theater will be confronted with these patients when perioperative antibiotic prophylaxis is needed. Frequently, the consequence of a presumed β-lactam allergy is that all β-lactam antibiotics are avoided, because of the possibility of cross-reactivity, and an alternative antibiotic,e.g., clindamycin, vancomycin, or ciprofloxacin, is prescribed.1 This may be a sh...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Adenoid Facies
A 13-yr-old girl came for orthodontic correction of the facial features during general anesthesia with nasal intubation. Preanesthetic evaluation revealed a 9-month history of nasal obstruction, snoring, and typical adenoid facies. Nasopharyngeal x-ray was significant for adenoid hypertrophy (Panel A,arrow). Adenoid facies1 is defined as the open-mouthed appearance in children, associated with a narrow nose, shortened upper lip (Panel B), narrow palate, high palatal vault, and dental crowding (Panel C). (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Application of Focused Assessment Ultrasound in Trauma to Perioperative Medicine A Tool to Quickly Diagnose Postoperative Hemorrhage
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Classic Papers Revisited: My Love Affair with the Venous System
The Pathophysiology of Aortic Cross-clamping and Unclamping. By Gelman S. ANesthesiology 1995; 82:1026 –60. Reprinted with permission. Aortic cross-clamping (AoX) and unclamping are associated with severe hemodynamic disturbances in virtually all organs and systems. The main hemodynamic changes induced by AoX result from an increase in impedance to aortic flow, an increase in systemic vascular resi stance and afterload, blood volume redistribution caused by collapse and constriction of venous vasculature distal to the aortic clamp, and a subsequent increase in preload. Preload may not increase if the aorta is clamped...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

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

How Low Can You Go? Minimum Dosage and Safety of Intraneural Sciatic Nerve Blocks
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - July 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 - July 17, 2018 Category: Anesthesiology Source Type: research

Streams of Unconsciousness V: Stability Reflected in the Pyriphlegethon
As represented by the Italian poet Dante, the plutonic rivers Lethe, Styx, Acheron, and Cocytus can be interpreted as supplying amnesia, hypnosis, analgesia, and akinesia, respectively —later regarded as properties of general anesthesia. However, of the five great streams of the Greco-Roman underworld, only the molten river Pyriphlegethon (Greek for “fire-flaming”) boils the souls of the most violent offenders. Indeed, egregious and impulsive behaviors of tyrants, murderers, and other violent offenders melt away in the lava-like Pyriphlegethon. By flowing over and engulfing the violent, the river stabiliz...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Planocaine: Procaine by May & amp; Baker Ltd. of Dagenham
With John May (1809 to 1893) directing wholesale operations and William Garrad Baker (1815 to 1902) supervising manufacturing and delivery, the pharmaceutical firm of May& Baker (M&B) was founded in 1839 in London. Three years after M&B ’s surviving founder had passed away, Germany’s Alfred Einhorn synthesized the local anesthetic procaine in 1905. Eventually, M&B became one of several non-German companies whose brands of procaine competed against Novocaine, Germany ’s leading procaine. The 5 ml ampoule (above) of 2% procaine solution was branded “Planocaine” by May&...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Liebig ’s Trade Card for Numbing but Toxic Aconite
As advertised by a beef extract company named after chloroform codiscoverer Justus von Liebig, this portion of a trading card ’s obverse is from the Italian-language version of the 1904 “Poisonous Plants” series. A deadly member ofRanunculaceae, the Buttercup Family, the depicted aconite (Aconitum napellus,right) is better known as monkshood or wolf ’s bane. Also illustrated are tribesmen (left) carefully applying aconite to the tips of their arrows, darts, and spears. Brushing against this toxic plant can produce dizziness, vomiting, and even death. Historically, dilute quantities of aconite have b...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

“No Charge” Laughing Gas at Carmichael & amp; Company of Troy, New York
From the Wood Library-Museum ’s Ben Z. Swanson Collection, the images (above) were extracted from an 1880 broadside from Troy, New York. While transitioning his dental practice between buildings on Fifth and then Fourth Streets, Dr. Joseph S. Carmichael was extracting teeth “Day and Evening” over Hall’s Dry Goods Store on Troy’s Congress Street. To attract patients, Dr. Carmichael offered to administer “no charge” laughing gas with each 25-cent dental extraction. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiolog y.) (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Coca Bitters —Numbing the Fatigue Rather Than the Pain
Historically, the debilitating, recurring fevers of malaria were remedied with cinchona (quininevs. shivering) and coca (cocainevs. fatigue) —botanically, a bark and a leaf, respectively. However, quinine has direct antimalarial properties, which coca lacks. This reality did not prevent New York City’s Quichua [sic] Coca Company from falsely advertising the malaria-fighting powers of pharmaceuticals and beverages mixed with the company ’s Coca Bitters. The printer’s proof (above) of the logo for those bitters trademarked a presumably cocaine-driven Quechuan Amerindian hiking through Peruvian jungle ...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We want to thank Dr. Brock-Utne for his valuable contribution. Undoubtedly, pericardial effusion with ensuing tamponade is a possible complication of any central venous catheter with a high mortality.1 Peripherally inserted central venous lines may even carry a greater risk due to catheter tip migration with changes of arm position.2 (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Central Venous Lines in Low-birth-weight Newborns: Watch Out
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We would like to thank Drs. Slagt and van Eijk for their interesting comments regarding our recent publication.1 These authors suggested that the complexity of surgery, resulting in a longer procedure (1  h longer in the crystalloid group), and not the type of fluid was responsible for the higher incidence of postoperative complications in the crystalloid group, due to a higher inflammatory response. We have no data to support more complex surgeries in the crystalloid group beyond the surgical tim e because surgical procedures and incidences of high-risk surgery were comparable in the two groups. Additionally, blood...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Colloids in Major Abdominal Surgery: Are They Really Better?
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We thank Drs. Phillips and Stewart for their interest in our article.1 The effect of neostigmine when given at the time neuromuscular recovery remains controversial, and Drs. Phillips and Stewart raise some important questions. We welcome the opportunity to respond to their queries. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We thank Drs. Phillips and Stewart for their interest in the work by Murphyet al.1 and our accompanying editorial.2 They “respectfully questioned five areas of the study” by Murphyet al., and we are delighted to respond; we feel this topic has significant implications on clinical care and that a thorough understanding of the effects of neostigmine on neuromuscular transmission is paramount for optimal anesthetic care and patient safety. (Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Catching a Unicorn: Neostigmine and Muscle Weakness —Not Neostigmine for All, but Quantitative Monitoring for Everyone!
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We thank Dr. Mussoet al. for the comments on our recently published paper.1 They correctly point out that the shoulder joint innervation is not limited to the suprascapular nerve. While we agree with this statement, it seems that the contribution of other nerves is modest as compared to the suprascapular nerve. Indeed, the suprascapular block does not provide a full sensory block; however, when it comes to postoperative analgesia, the differences we observed between suprascapular and interscalene blocks were not clinically important. This suggests that the use of multimodal analgesia is sufficient to mitigate any differenc...
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research

Intraoperative Considerations of the Suprascapular Nerve Block
(Source: Anesthesiology)
Source: Anesthesiology - July 17, 2018 Category: Anesthesiology Source Type: research