Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery
Editor ’s PerspectiveWhat We Already Know about This TopicCardiac surgery is associated with a significant rate of chronic postoperative painFew proven strategies exist to reduce chronic postoperative painWhat This Article Tells Us That Is NewThe administration of pregabalin (14 days) with or without ketamine (2 days) postoperatively reduced the prevalence of pain at 3 and 6 monthsSide effects from pregabalin and ketamine administration were generally mildBackground Persistent postsurgical pain is common and affects quality of life. The hypothesis was that use of pregabalin and ketamine would prevent persistent pain ...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Limb Remote Ischemic Preconditioning Attenuates Lung Injury after Pulmonary Resection under Propofol-Remifentanil Anesthesia: A Randomized Controlled Study: Erratum
In the article “Limb Remote Ischemic Preconditioning Attenuates Lung Injury after Pulmonary Resection under Propofol-Remifentanil Anesthesia: A Randomized Controlled Study” (Li C, Xu M, Wu Y, Li YS, Huang WQ, Liu KX: Anesthesiology 2014; 121:249 –59), theP values in tables 1 and 2 are systematically incorrect, given the descriptive statistics. The authors are unable to locate the primary data to recalculate theP values in these tables. They located the primary data for table 3 and verified that the descriptive data presented in the article are correct. The authors believe that the reported descriptive sta...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial: Erratum
In the article “Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial” (Li C, Li YS, Xu M, Wen SH, Yao X, Wu Y, Huang CY, Huang WQ, Liu KX: Anesthesiology 2013; 118:842 –52), theP values in table 2 are systematically incorrect, given the descriptive statistics. The authors are unable to locate the primary data to recalculate theP values in these tables. The authors believe that the reported descriptive statistics, including tables 1 and 2, are correct, and that the reportedP values are in...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Trendelenburg Position and Morbid Obesity A Respiratory Challenge for the Anesthesiologist
“In bariatric laparoscopic surgery, two specific conditions worsen obesity-related respiratory disorders and increase the anesthetic risk: [pneumoperitoneum   and Trendelenburg position].” (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Incorrect P Values in Two Articles by Ke-Xuan Liu, M.D., Ph.D., et al.
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Mast Cell Degranulation and Fibroblast Activation in the Morphine-induced Spinal Mass Role of Mas-related G Protein-coupled Receptor Signaling
Conclusions Opiates that activate Mas-related G protein-coupled receptor will degranulate mast cells, activate fibroblasts, and result in intrathecal mass formation. Results suggest a mechanistically rational path forward to safer intrathecal opioid therapeutics. (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

In the Recovery Room I Stand at the Bed of My Daughter
Through the hazy twilit moon, (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Observations and Observational Research
“[Anesthesiology announces] another initiative on data analysis plans in observational research. ” (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

A Stress Test for the Brain: Sedation-induced Deficits
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Numbing a World of Hurt: T. D. Waterbury Cruises from Cocaine to Carbolic Acid
Following the discovery of cocaine ’s local anesthetic properties, some entrepreneurs began concocting their own proprietary compounds of topical and injectable cocaine, thereby sidestepping the expense of cocaine-laden nostrums and patent medicines. Neither a dentist nor a pharmacist, businessman Thomas D. Waterbury (1866 to 1921) launched his namesake dental chain by 1897 with a “New Botanical Discovery” (lower) that was compounded with something not-so-new: cocaine. His Waterbury Dental Parlors (upper) in Brooklyn and then Manhattan were successful enough to fund a 2-yr cruise around the world with his...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Chloroform, Ether, or Nitrous Oxide at Night? Light for Liberty from F. T. Grimes, M.D., D.D.S.
Filed by its inventor, Dr. Franklin T. Grimes of Liberty in Clay County, Missouri, United States Patent 110648 was granted in January of 1871 for his “Improvement in lamps.” The patent diagram (upper right) features an oil reservoir and a wicked lamp. As a dental advertising broadside (left) spells out, “Chloroform, Ether…and Nitrous Oxide” (lower right) could now be administered more readily during the evenings, courtesy of lamps patented by Dr. Grimes. Yes, even explosive ether was administered around Grimes patented lamps. (Copyright © the American Society of Anesthesiologists’ ...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Chloroforming Coughs? A Tin of Gibson ’s Linseed, Liquorice, and Chlorodyne
During an 1848 cholera outbreak in India, British Army Surgeon J. Collis Browne, M.R.C.S. (1819 to 1884) used Chlorodyne —his formulation of laudanum, cannabis, and chloroform—as an antidiarrheal remedy. Years later, he partnered with London pharmacist J. T. Davenport to mass-market Chlorodyne as a panacea. From Manchester, England, Robert Gibson& Sons combined Chlorodyne with Linseed and Liquorice in decorative tins of cough lozenges (above). By 1901 these “beautifully enameled counter show tins” were advertised to American professionals and the public as filled with cough lozenges that “...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Airs and Affairs: Adulteration and Adultery around Dr. Oliver Walcott Hall
After earning his D.D.S. in 1879 from the Pennsylvania College of Dental Surgery, Oliver Walcott Hall made anesthesia history on Boston ’s Tremont Street as an early advocate of “Vitalized Air” (above), which, in this case, was nitrous oxide adulterated with alcohol and chloroform. After his wife had passed away, a stunned Dr. Hall stumbled across evidence of adultery and made legal history by filing an “alienation of affection” case against his late wife’s lover. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.) (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Did Dr. Robert S. Kramer Conduct the First Surgical Anesthetic of the Twenty-first Century?
After American Robert Scott Kramer, M.D. (b. 1956), of Concord, New Hampshire, signed up for a 3-month stint oflocum tenens work in New Zealand, he began working in Invercargill (M āori:Waih ōpai), a town at the southern tip of South Island, New Zealand. Situated just west of the International Date Line, New Zealand was preparing to become the world ’s first industrialized nation to celebrate the arrival of Year 2000. As a non-Kiwi anesthesiologist and the low man on the totem pole (Māori:pou whenua), 43-yr-old Kramer found himself covering emergencies at Southland Hospital (above, Dr. Kramer ’s identificati...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Carbon-Tetrachloride Anesthesia? Edmund Andrews ’s Efforts before Oxygenating Nitrous Oxide
Chicago surgeon Edmund Andrews is best known for encouraging in 1868 the oxygenation of nitrous oxide anesthetics. However, 1 yr earlier, Dr. Andrews had spent time observing CCl4 or carbon tetrachloride anesthesia in London hospitals. On returning to Chicago, Dr. Andrews noted that the tetrachloride of carbon promised “freedom from nauseating effects,” such as those caused by ether. However, when Dr. Andrews’s friend, Dr. Sherman, administered the promising new agent to their patient in Chicago, the patient’s “pulse and respiration both suddenly ceased.” An unnerved Dr. Andrews determin...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Cerebral Amyloid and Cognition after Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Cerebral Amyloid and Cognition after Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Hypotension and Stroke in Cardiac Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Hypotension and Stroke in Cardiac Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Propofol and Outcome from Colon Cancer Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Propofol and Outcome from Colon Cancer Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Neuroanesthesia A Problem-Based Learning Approach
Neuroanesthesia: A Problem-Based Learning Approach is a welcome addition to the literature in the sometimes unapproachable and often dry world of instructional materials designed for those desiring to further their neuroanesthesia skills, education, and training. By using a problem-based learning approach, David E. Traul and Irene P. Osborn have taken the complex world of neuroanesthesia and broken it down into digestible and applicable cases, not only for those studying for board exams, but also for those anesthesiologists and trainees who seek a quick “refresher” in many facets of neuroanesthesia. The 29 high...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Postlaryngectomy Stoma versus Tracheostomy Implications for Perioperative Airway Management
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

What I Didn ’t See
I saw (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Femoral Artery Dissection after Adductor Canal Block
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Understanding the Effects of General Anesthetics on Cortical Network Activity Using Ex Vivo Preparations
General anesthetics have been used to ablate consciousness during surgery for more than 150 yr. Despite significant advances in our understanding of their molecular-level pharmacologic effects, comparatively little is known about how anesthetics alter brain dynamics to cause unconsciousness. Consequently, while anesthesia practice is now routine and safe, there are many vagaries that remain unexplained. In this paper, the authors review the evidence that cortical network activity is particularly sensitive to general anesthetics, and suggest that disruption to communication in, and/or among, cortical brain regions is a comm...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Focused Cardiac Ultrasound during Amniotic Fluid Embolism
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries
This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery.Methods This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or pro...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Fibrin Sheath Formation during Mechanical Circulatory Support Another Reason for Transesophageal Echocardiographic Monitoring
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event
Conclusions Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Extrafasicular and Intraperineural, but No Endoneural, Spread after Deliberate Intraneural Injections in a Cadaveric Study
Conclusions After deliberate intraneural injection, longitudinal and circumferential extrafascicular spread occurred in all instances in the neural compartments that contained adipocytes, but not in the relatively solid endoneurium of the fascicles. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Opioid Sensitivity in Children with and without Obstructive Sleep Apnea
Conclusions No differences in the remifentanil concentration –miosis relation were seen in children with or without obstructive sleep apnea. The dose and duration of remifentanil administered did not alter ventilatory parameters in either group. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures A Randomized Controlled Trial
Editor ’s PerspectiveWhat We Already Know about This TopicDental procedures under sedation can cause hypoxic events and even death. However, the mechanism of such hypoxic events is not well understood.What This Article Tells Us That Is NewApnea and hypopnea occur frequently during dental procedures under sedation. The majority of the events are not detectable with pulse oximetry. Insertion of a nasal tube with small diameter does not reduce the incidence of apnea/hypopnea.Background Intravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypo...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery A Randomized Controlled Trial
Conclusions Intravenous lidocaine administered during and after cardiac surgery did not reduce postoperative cognitive decline at 6 weeks. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia
This study tested the hypothesis that rapid eye movement sleep disturbances would be present in ad olescent rats treated with anesthesia on postnatal day 7.Methods Forty-four neonatal rats were randomly allocated to treatment with anesthesia consisting of midazolam, nitrous oxide, and isoflurane or control conditions for 2  h or 6 h. Electroencephalographic and electromyographic electrodes were implanted and recordings obtained between postnatal days 26 and 34. The primary outcome was time spent in rapid eye movement sleep. Data were analyzed using two-tailed unpairedt tests and two-way repeated measures anal...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Machine Learning for Anesthesiologists: A Primer: Erratum
In the infographic “Machine Learning for Anesthesiologists: A Primer” (Wanderer JP, Rathmell JP:Anesthesiology 2018; 129:A29) from the October 2018 issue of Anesthesiology, references 3 and 4 should be switched. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia: Erratum
In the article “Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia” (Lunardi N, Sica R, Atluri N, Salvati KA, Keller C, Beenhakker MP, Goodkin HP, Zuo Z: Anesthesiology 2019; 130:981 –94), the figure 2 image and legend were incorrect. They should have appeared as follows: (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

If We Don ’t Learn from Our Critical Events, We’re Likely to Relive Them Debriefing Should Be the Norm
“…[I]nterdisciplinary team de-briefings, including members ofall involved role groups, is an essential step toward narrowing the patient safety gap that still remains... ” (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Dynamic Cortical Connectivity during General Anesthesia in Healthy Volunteers
Editor ’s PerspectiveWhat We Already Know about This TopicAnesthetic-induced loss of consciousness is accompanied by changes in functional connectivity within and between brain networks.What This Article Tells Us That Is NewDespite a stable surgical level of anesthesia and the absence of noxious stimuli, connectivity patterns are not static but rather fluctuate dynamically and nonrandomly over time. These results suggest that single or static connectivity patterns may not be able to discriminate levels of consciousness.Background Recent studies of anesthetic-induced unconsciousness in healthy volunteers have focused ...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Pediatric Risk Stratification Is Improved by Integrating Both Patient Comorbidities and Intrinsic Surgical Risk
In this study, the authors used the American College of Surgeons National Surgical Quality Improvement Program Pediatric database to demonstrate the relationship between the intrinsic surgical risk and 30-day mortality and develop and validate an accessible risk stratification model that includes the surgical procedures in addition to the patient comorbidities and physical status.Methods A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database was performed. The incidence of 30-day mortality was the primary outcome. Surgical Current Procedural Terminology...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Dynamic Cortical Connectivity during General Anesthesia in Surgical Patients
Editor ’s PerspectiveWhat We Already Know about This TopicAnimal data, along with recent human observations (in this issue ofAnesthesiology*), suggest that cortical oscillations and connectivity shift dynamically during what appears to be stable general anesthesiaClinical evidence in the perioperative setting to support these observations is currently lackingWhat This Article Tells Us That Is NewDuring anesthesia and surgery, cortical networks display a dynamic interplay among brain states, rather than a static equilibriumThese findings suggest that a single measure of connectivity may not be a reliable correlate of ...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Syncopated Tempi of the Anesthetized Brain
“…[C]ompare the function of the conscious brain to that of an orchestra making music.” (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Breathing under Anesthesia A Key Role for the Retrotrapezoid Nucleus Revealed by Conditional Phox2b Mutant Mice
Editor ’s PerspectiveWhat We Already Know about This TopicMany if not all drugs used in anesthesia and analgesia can produce potentially severe respiratory depressionMaintenance of breathing under anesthesia is linked to the drive exerted by the retrotrapezoid nucleus on the respiratory central pattern generatorThe retrotrapezoid nucleus neurons that stimulate breathing during anesthesia are carbon dioxide –sensitive noncatecholaminergic neurons that expressPhox2b, a master gene for the development of autonomic neuronsThe conditional mouse model with the +7Ala repeat mutation targeted to the retrotrapezoid nucl...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

General Anesthesia for Cesarean Delivery Occasionally Essential but Best Avoided
“…[I]n the absence of contraindications, neuraxial anesthesia has been and remains the gold standard anesthetic for cesarean delivery.” (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research