Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

No Differences in Renal Function between Balanced 6% Hydroxyethyl Starch (130/0.4) and 5% Albumin for Volume Replacement Therapy in Patients Undergoing Cystectomy: A Randomized Controlled Trial: Erratum
In the article beginning on page 67 in the January 2018 issue, Dr. Pagel ’s name was listed incorrectly in the byline. It should have appeared as Judith-Irina Pagel, M.D. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Some of Us Stay
I was almost angry when I saw you laughing (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

And Before That
In Rhode Island Hospital ’s waiting room, (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Clinical Evidence for Any Effect of Anesthesia on the Developing Brain
A recent U.S. Food and Drug Administration warning advised that prolonged or repeated exposure to general anesthetics may affect neurodevelopment in children. This warning is based on a wealth of preclinical animal studies and relatively few human studies. The human studies include a variety of different populations with several different outcome measures. Interpreting the results requires consideration of the outcome used, the power of the study, the length of exposure and the efforts to reduce the confounding effects of comorbidity and surgery. Most, but not all, of the large population-based studies find evidence for as...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Exposure of Developing Brain to General Anesthesia What Is the Animal Evidence?
Recently, the U.S. Food and Drug Administration issued an official warning to all practicing physicians regarding potentially detrimental behavioral and cognitive sequelae of an early exposure to general anesthesia duringin utero and in early postnatal life. The U.S. Food and Drug Administration concern is focused on children younger than three years of age who are exposed to clinically used general anesthetics and sedatives for three hours or longer. Although human evidence is limited and controversial, a large body of scientific evidence gathered from several mammalian species demonstrates that there is a potential found...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes
Background Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment.Methods Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorall...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Effect of the BASIC Examination on Knowledge Acquisition during Anesthesiology Residency
Conclusions These results support the hypothesis that the introduction of the BASIC Examination is associated with accelerated knowledge acquisition in residency training and provides evidence for the value of the new staged system in promoting desired educational outcomes of anesthesiology training. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Ultrasound-guided Lumbar Plexus Block in Supine Position
THE LUMBAR plexus lies in a fascial plane within the posterior one third of the psoas major muscle.1 The quadratus lumborum muscle lies laterally to the psoas major muscle. It is possible to block the lumbar plexus with a lateral-to-medial trans-quadratus lumborum muscle approach in the supine position. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Intraoperative Phototherapy for Hyperbilirubinemia
HYPERBILIRUBINEMIA or jaundice when severe and if untreated has disastrous yet preventable neurotoxic effects, specifically, bilirubin-induced encephalopathy or kernicterus.1,2 Intraoperative phototherapy using an underbody bili blanket (red arrows) can minimize treatment interruptions, which is preferential during light therapy. Although dual-source (anterior and posterior) light therapy is preferred, this may not allow for operative access to the patient. As seen in these images, the patient should be positioned to provide maximal light to skin interface, with the cautery pad positioned to allow maximal light exposure. P...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Images in Anesthesiology: A Clot in Transit Impending Paradoxical Embolization
PARADOXICAL embolization is rare but possible in patients with a patent foramen ovale (PFO).1,2 The accompanying images exhibit impending paradoxical embolization. A serpentine clot, involving all cardiac chambers (top) is seen extending from right to left atriumvia a PFO (bottom). Such a thrombus that exhibits independent motion is designated as a “clot in transit” (See Video, Supplemental Digital Content,http://links.lww.com/ALN/B550, which demonstrates clot motion). Emergency surgical embolectomy with cardiopulmonary bypass is indicated due to risk of catastrophic systemic embolization.2,3 Perioperative anes...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

This Month in: Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Translational Research in Anesthesia: Animals Vs. Humans
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - March 13, 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 - March 13, 2018 Category: Anesthesiology Source Type: research

Streams of Unconsciousness I: Amnesia Reflected in Lethe
French illustrator Gustave Dor é (1832–83) depicted Dante, the author ofThe Divine Comedy being immersed (above) by an acquaintance, Matilda, in the Underworld ’s River Lethe, “whose waters bring oblivion of things evil.” Known as the River of Forgetfulness or Oblivion, Lethe was believed by ancient Greeks to erase the memories of previous lives from the souls of the dead. Moreover, Lethe was the plutonic stream after which dentist-anesthetist Willia m Morton branded his ether as “Letheon.” Ironically, Morton’s famous 1846 public demonstration of surgical etherization failed...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Dr. C. H. Cannon ’s Armamentarium: “Local Anaesthetics…Gas or Either”
From the Wood Library-Museum ’s Ben Z. Swanson Collection, dentist Charles H. Cannon (c. 1847–1909) had problems managing the printer of his trade card (above). First, his printer misspelled Cannon ’s anesthetic armamentarium as “localAnaesthetics, also withGas orEither. ” Then the advertising was printed downhill on the card. Because dentist Cannon was listed in the 1896 but not the 1897 directory for Providence, Rhode Island, we can surmise that he did not arrive in Walpole, New Hampshire, until late in 1896 or in 1897. Because the druggist referred to on this c ard, N. H. Wheeler, ended up ...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Dibucaine, Cinchocaine, or Nupercaine? CIBA ’s Trademarked Long-acting Amide Local Anesthetic
In 1930, pioneering British surgeon-anesthetist W. Howard Jones published his clinical experiences with a long-acting amide local anesthetic related to “butyloxycinchoninic acid diethlyethylendiamide.” That lengthy chemical designation would be abbreviated to dibucaine in the United States and cinchocaine internationally (“cincho” reflecting the chemical similarity to quinine). Dr. Jones published articles about this anesthetic initially un der the brand name Percaine, but he predicted that Americans would brand it as Nupercaine. Indeed, from Summit, New Jersey, CIBA Pharmaceuticals would eventually...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Monkeying Outside Central Park Zoo: Hasbrouck Advertises His Nitrous Oxide
At the Arsenal building near the southeast corner of Central Park, New York ’s Central Park Zoo was less than a two-mile walk north of the dental offices of Dr. Ferdinand Hasbrouck. Perhaps monkeys at the zoo inspired Hasbrouck to advertise with this trade card titled, “Tickle me under the Chin.” Having earned his dental doctorate in Philadelphia, Hasbrouck delighted in poking fun at Manhattan’s Colton Dental Association, many of whose dentists lacked academic training in either dentistry or anesthetics. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesth...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Taking Pains with Aloe for More Than 35 Centuries: From Tightening Skin to Loosening Bowels
Native to the southwest Arabian peninsula, species of the Aloe have provided soothing and antiseptic preparations for wounds and burns since at least the time that the Ebers papyrus was composed (c. 1550 BCE). A Greek surgeon in the Roman army, Dioscorides lauded the bitter juice of aloe for “conglutinating of wounds and loosening of the belly.” Indeed, aloe was prized as a laxative orally and as a healing astringent topically. As depicted on this French-language trade card from the Liebig Company (above),Aloe perryi (Zanzibar or Socotrine Aloe), is native to Socotra, an island east of Somalia. Closely related ...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Dr. Brown Doubles Down: A With-and-without Trade Card for Laughing Gas Anesthesia
From the Wood Library-Museum ’s Ben Z. Swanson Collection, the lone image from the obverse of this c. 1892 trade card for Brown’s Dental Rooms featured a happy visage (left) in one direction which, by optical illusion, appears to transform into an unhappy face (right) from the reverse angle. This “upside-down style of with-and-without card” contrasts patient satisfaction with or without nitrous oxide anesthesia for dental extraction. With his ski-jump nose, bell crown cap, and WITH nitrous oxide, the smiling patient (left) rejoices, “I took Laughing Gas…and had my Teeth Extracted withou...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

In Reply
We are gratified, but not surprised, by the interest in our recent article,1 given that we examined one of the oldest recommendations regarding maternal position for cesarean delivery. In their letters, Rileyet al.2 and Shayeganet al.3 correctly note that cardiac output was slightly lower among women kept supine, and that more phenylephrine was required (probably related). The goal of anesthetic management, however, is not to maintain specific hemodynamic parameters, but rather to maintain adequate or optimal conditions for mother and fetus. There is no evidence that the lower cardiac output or increased phenylephrine requ...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Should Not Be Abandoned
(Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Neonatal Outcome after Maternal Supine Position for Elective Cesarean Delivery under Spinal Anesthesia: Was the Umbilical Cord Blood Sampling Procedure Reliable?
(Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Left Uterine Tilt for Cesarean Delivery Significantly Improves Maternal Hemodynamics and Should Not Be Considered Outdated Dogma
(Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

In Reply
We appreciate the interest of Liuet al. in our article.1 This offers the opportunity to put more emphasis on the role of sedation level, displayed by the parameter bispectral index, on analgesic monitoring. As Liuet al. pointed out, the patients ’ Bispectral Index (BIS) values in the study were lower than recommended values during surgical procedures. As they assumed in their letter, these low values are caused by the initial bolus of propofol for induction of general anesthesia and successful placement of the laryngeal mask. Persistence of low BIS values with a standard dosage of propofol of 4 to 5 mg ·...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Bispectral Index and Detection of Noxious Stimuli
(Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Pro- versus Antinociceptive Nongenomic Effects of Neuronal Mineralocorticoid versus Glucocorticoid Receptors during Rat Hind Paw Inflammation
Conclusions The enhanced mechanical sensitivity of inflamed hind paws accompanied with corticosteroid receptor upregulation in spinal and peripheral sensory neurons was attenuated immediately after glucocorticoid receptor agonist and mineralocorticoid receptor antagonist administration, suggesting acute nongenomic effects consistent with detected membrane-bound corticosteroid receptors. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Dexmedetomidine Impairs Diaphragm Function and Increases Oxidative Stress but Does Not Aggravate Diaphragmatic Atrophy in Mechanically Ventilated Rats
This study tested the hypothesis that dexmedetomidine could inhibit ventilator-induced diaphragmatic dysfunction.Methods Twenty-four rats were separated into three groups (n = 8/group). Two groups were mechanically ventilated during either dexmedetomidine or pentobarbital exposure for 24  h, referred to as interventional groups. A third group of directly euthanized rats served as control. Force generation, fiber dimensions, proteolysis markers, protein oxidation and lipid peroxidation, calcium homeostasis markers, and glucose transporter–4 (Glut-4) translocation were measured in the diaphragm.Results Diaphragm...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Effect of Maternal Body Mass Index on Postpartum Hemorrhage
Conclusions The authors ’ findings suggest that, at most, maternal obesity has a modest effect on hemorrhage risk. The direction of the association between hemorrhage and body mass index may differ by delivery mode. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Prolonged Catheter Use and Infection in Regional Anesthesia A Retrospective Registry Analysis
Conclusions Infection risk in catheter use increases over time, especially after four days. Infected catheters should be removed as soon as practical.Visual Abstract An online visual overview is available for this article athttp://links.lww.com/ALN/B683. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Dopamine D2-receptor Antagonist Droperidol Deepens Sevoflurane Anesthesia
This study examined the effect of the D2 receptor antagonist droperidol on sevoflurane anesthesia by examining α and slow wave electroencephalogram oscillations.Methods Forty-five patients, age 20 to 60 yr, were enrolled. Frontal electroencephalograms were continuously collected for offline analysisvia Bispectral Index monitoring. After induction of anesthesia, end-tidal sevoflurane concentration was deliberately maintained at 1%, and intravenous droperidol (0.05  mg/kg bolus) was administered. Electroencephalogram changes were examined in power spectrum and bicoherence, before and 10 min after droperid...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia A Randomized Clinical Trial
Conclusions Labor analgesia quality, assessed by need for provider- and patient-administered supplemental analgesia and hourly bupivacaine consumption was not improved by high-rate epidural bolus administration. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

18 F-florbetapir Positron Emission Tomography –determined Cerebral β-Amyloid Deposition and Neurocognitive Performance after Cardiac Surgery
Conclusions In this study, postoperative cognitive dysfunction was not associated with 6-week cortical amyloid deposition. The relationship between cognitive dysfunction and regional amyloid burden and the rate of postoperative amyloid deposition merit further investigation. (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery A Randomized Controlled Trial
The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery.Methods In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12  h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12&thins...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function A Randomized Clinical Trial
Background Acute kidney injury is a common complication after cardiac surgery, leading to increased morbidity and mortality. One suggested cause for acute kidney injury is extracorporeal circulation –induced ischemia–reperfusion injury. In animal studies, cyclosporine has been shown to reduce ischemia–reperfusion injury in the kidneys. We hypothesized that administering cyclosporine before extracorporeal circulation could protect the kidneys in patients undergoing cardiac surgery.Methods The Cyclosporine to Protect Renal Function in Cardiac Surgery (CiPRICS) study was an investigator-initiated, double-bli...
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Competence: The Link between Education and Quality Patient Care
“…[S]tandardized and validated simulation scenarios paired with valid and reliable performance assessment scores can discriminate between senior and junior trainees….[T]he decision about whether a resident’s performance meets a threshold of competence must be the next step in educational res earch.” (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Anesthesiology Board Certification Changes A Real-time Example of “Assessment Drives Learning”
“…[A]s a first step in the evaluation of changes in the certification examination process, and as an example of how to gather validity evidence, the trend to a higher knowledge standard is promising.” (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Anesthesia and Neurodevelopment in Children Perhaps the End of the Beginning
“The potential for adverse neurodevelopmental effects of anesthetics is clearly a complex problem and the answers are not ‘obvious’...[and] we grapple with the specific question of whether animal findings translate to children…” (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Young Brain and Anesthesia: Refusal of Anesthesia Is Not an Option!
“…[T]here may be risk associated with exposure to general anesthesia…[but] surgery without adequate anesthesia and analgesia is simply not an option.” (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

The Challenges of Translation
“…what do we do when…animal studies do not translate to or may even diverge from clinical findings?” (Source: Anesthesiology)
Source: Anesthesiology - March 13, 2018 Category: Anesthesiology Source Type: research

Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018 A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology *
Update Highlights In October 2014, the American Society of Anesthesiologists Committee on Standards and Practice Parameters recommended that new practice guidelines addressing moderate procedural sedation and analgesia be developed. These new guidelines:Replace the “Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists: An Updated Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists,” published in 2002.1Specifically address moderate sedation. They do not address mild or deep sedation and do not address the educational, training, or c...
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research

Announcements
(Source: Anesthesiology)
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research

Call for Papers Point of Care Ultrasound in Perioperative, Critical Care, and Pain Medicine
(Source: Anesthesiology)
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research

CASQ1 Gene Is an Unlikely Candidate for Malignant Hyperthermia Susceptibility in the North American Population: Erratum
In the February 2013 issue, the article on page 344 published with an incorrect DOI. The correct DOI for this article is 10.1097/01.anes.0000530185.78660.da. (Source: Anesthesiology)
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research

Then It Was Dark and Cold
It was a sunny, warm, clear day until brute celestial geometry choked off standard photon dissemination. Then it was dark and cold. (Source: Anesthesiology)
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research

Hospital Waiting Room
A celebrity ’s polished face assures great care is taken to protect those inside the magazine. Anyone can forgive the discoloration on the floor, or a distant flat note breaking through a door in the pleasant yellows of the family room. Here magazines serve two functions, the first purely aesthetic: to hide t he chipping paint on tables. The second is to muffle the hours of uncertainty entombed inside the hospital. When you get out, and your mother is cured, you will remember the ad for new lipstick, rush to the store, and thank it for showing mercy. (Source: Anesthesiology)
Source: Anesthesiology - February 14, 2018 Category: Anesthesiology Source Type: research