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

One More Step
“Open your eyes Mrs. Jones and I’ll take that breathing tube out.” (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Recovery Room
Like crows huddled to roost through winter nights, your flock of feathery dendrites shifts, relinquishing the blessings of oblivion. The synapses distill calligraphies of dew. What parts are gone? Somewhere else the surgeon molts a sky-blue plumage. You can hear a nurse speak kindly, and reply, but memory stands with one foot on each rim of a crevasse that swallowed tunes that the anesthetist ’s radio played. What parts are gone? Their territories sliced up, paper-thin, are deeply stained. The names emerge: atlas of villages in type almost too small to read. Under high power, past a plexus of swept lanes and plots al...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Multimodality Neuromonitoring in Adult Traumatic Brain Injury A Narrative Review
Neuromonitoring plays an important role in the management of traumatic brain injury. Simultaneous assessment of cerebral hemodynamics, oxygenation, and metabolism allows an individualized approach to patient management in which therapeutic interventions intended to prevent or minimize secondary brain injury are guided by monitored changes in physiologic variables rather than generic thresholds. This narrative review describes various neuromonitoring techniques that can be used to guide the management of patients with traumatic brain injury and examines the latest evidence and expert consensus guidelines for neuromonitoring...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Argatroban and Bivalirudin for Perioperative Anticoagulation in Cardiac Surgery
UNFRACTIONATED heparin (UFH) is the mainstay of anticoagulation for cardiovascular surgery, for patients requiring extracorporeal membrane oxygenation (ECMO), initially for ventricular assist devices (VADs), and for postoperative thrombosis prophylaxis. The elimination half-life of heparin is dose dependent and increases from approximately 30  min after a bolus of 25 U/kg, to 60 min with a bolus of 100 U/kg and 150 min with a bolus of 400 U/kg.1 UFH has many advantages in this setting, including the ability to monitor using standard coagulation assays or point of care tests, including activated clottin...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Infraclavicular Neurovascular Anatomic Anomaly Seen via Ultrasound
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

“Golf Ball” in the Left Ventricular Outflow Tract?
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Large Intracranial Aneurysms in a 2-month-old Female A Rare Occurrence with Serious Anesthetic Challenges
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Images in Anesthesiology: Tracheopharyngeal Fistula from Treated Hypopharyngeal Carcinoma
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

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

Painting the Picture: An Integrated View of Intraoperative Management
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

The Summer of 1884: Nitrous Oxide from Drs. Gross and Basehore
This early color-free image of two well-dressed girls (left) is the obverse of a trade card from the Wood Library-Museum ’s Ben Z. Swanson Collection. “Gross& Basehore, Dentists ” advertised dental extraction services in York, Pennsylvania “without pain, using nitrous oxide gas.” A shoemaker-turned-dentist, Milton H. Gross (1857 to 1935) earned his D.D.S. in 1880 from the Baltimore College of Dental Surgery. Related to one of Dr. Gross’s dental school classmates, Ho race E. Basehore (1862 to 1931) abandoned bartending to become Gross’s preceptee. Analysis of newspaper advertise...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Lord of the Ring: General Metz and Local Anesthesia
Years after trademarking procaine as “Novocain,” U.S.-born German-American Herman A. Metz discovered that this action had unintentionally complicated the American military’s procurement of World War I local anesthetics. A colonel and eventually a general in the National Guard, Metz trademarked a hexagonal ring logo bearing letter s from his company, HA METZ LAB. Metz, his wife, and founding father Alexander Hamilton were memorialized by the naming of Hamilton-Metz Field in Brooklyn, New York. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.) (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

From Kraits to Crates: How Asia Shared Snake Oil with America
As with the salmon, the black-banded sea krait, also known as the Chinese sea snake or Japanese erabu, is high in omega-3 fatty acids, which do not harden in cold waters. Chinese rail workers in the 1860s and levee workers in the 1870s helped introduce snake oil liniments to the American West. Public interest in snake oil peaked in 1893 after a self-styled “Rattlesnake King” peddled his liniment at the World’s Columbian Exposition. Before crowds of fairgoers, Clark Stanley (born c. 1854) slit open live rattlers, boiled them, and at least pretended to skim off the surfacing oils to add to his “Clark ...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Crimean Thornapple Depicted by Liebig ’s Extract of Meat Company
These images are from the French language version of the trade card distributed by the Liebig Company, which was famous for both producing beef extract and being named after Professor Justus von Liebig, one of chloroform ’s discoverers. Relying on the coasts of the Black and Caspian Seas as sources forDatura stramonium, the Liebig Company depicted a Crimean Russian peasant spilling out a basket (upper right) of harvested thornapple fruits. Collected fruits were sorted and decorticated at the Liebig factory (lower left), where a powerful anticholinergic slurry of scopolamine, hyoscyamine, and atropine could be extract...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Birkett Advertises Hurd ’s Apparatus for Anesthesia with Vitalized Air
Born in Rochester, New York, and raised in London, England, Charles H. Birkett (1856 to 1932) returned home in 1873 to learn dentistry. After 13 yr of dental practice in East Liverpool, Ohio, Birkett visited Cleveland dentist George H. Hurd (1829 to 1904) in 1886 to acquire one of the Clevelander ’s early “Vitalized Air” vaporizers for adding trace amounts of alcohol and chloroform to unoxygenated nitrous oxide. Impressed with Hurd’s ideas, Birkett began advertising on trade cards, such as the oneabove, that Birkett ’s was the only practice in the “vicinity licensed and using Hurd’...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Neurosurgical Intensive Care
Neurocritical care as a subspecialty has grown rapidly over the last two decades, including fast-growing new techniques in neuromonitoring, neuroimaging, and various therapeutic tools.Neurosurgical Intensive Care by Javed Siddiqi is a focused, concise handbook that provides a quick review mainly for residents and fellows receiving training in neurocritical care, but also provides a useful refresher for other healthcare professionals providing care to critically ill neurosurgical patients. The book has 31 chapters with some changes in the table of contents and the addition of two chapters compared with the first edition. Ne...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We would like to thank Drs. Schalkwyk and Hammer for their interest in our article.1 We do agree that the central venous catheter may be in the internal thoracic vein. Due to limitations of word count for the article, it was not feasible for us to comment on other possible positions for the central vein catheter. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Unusual Catheter Placement on Chest Radiograph: Two Dimensions, Two Possible Locations (or More)
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Taller People Should Have as Their Normal a Higher Body Mass Index
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We thank Chamaraux-Tran and Beloeil for their letter and concern about our article.1 Since the lidocaine used in our experiment was water soluble, ethanol was not required as a solvent. Therefore, there was no effect of ethanol in our experiment. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Distal Subclavian Cannulation and Extravasation
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Solvent Matters!
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

In Reply
Webbet al. note our conclusion that “the combination of femoral and sciatic nerve blocks provides the best analgesia”1 and assert that it is “not surprising that anesthetizing multiple nerves is superior to blocking a single nerve.” In fact, it was hardly a forgone conclusion that sciatic nerve blocks are necessary, because femoral nerve blocks alone work fairly well and might have proven sufficient, especially when combined with sup plemental nonopioid systemic analgesics. Our results clearly show that sciatic nerve blocks significantly augment the benefit of femoral nerve blocks, and—importa...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Perioperative Pain Management for Total Knee Arthroplasty: Need More Focus on the Forest and Less on the Trees
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

In Reply
We would like to thank Dr. Cattano for his comments regarding our article, “A Perioperative Systems Design to Improve Intraoperative Glucose Monitoring Is Associated with a Reduction in Surgical Site Infections in a Diabetic Patient Population.”1 Our local implementation of the glucose bundle primarily focused on (1) implementation of intraoperative decision support, (2) departmental agreement around the utility of intraoperative glucose monitoring, and (3) broadened availability of intraoperative glucose point-of-care testing. The implementation of this bundle was a free-standing initiative, not linked to any ...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Clinical Technology and Glucose Management
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Avoidance of Hyperoxemia during Cardiopulmonary Bypass: Why Does Pathophysiology Not Always Translate into Clinical Outcome?
(Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

A Comparison of Red Cell Rejuvenation versus Mechanical Washing for the Prevention of Transfusion-associated Organ Injury in Swine
Conclusions Reversal of the red cell storage lesion by rejuvenation reduces transfusion-associated organ injury in swine. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Vasculotide, an Angiopoietin-1 Mimetic, Restores Microcirculatory Perfusion and Microvascular Leakage and Decreases Fluid Resuscitation Requirements in Hemorrhagic Shock
Conclusions Targeting Tie2 restored microvascular leakage and microcirculatory perfusion and reduced fluid resuscitation requirements in an experimental model of hemorrhagic shock. Therefore, the angiopoietin/Tie2 system seems to be a promising target in restoring microvascular integrity and may reduce organ failure during hemorrhagic shock. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Microvascular Permeability after an Acute and Chronic Salt Load in Healthy Subjects A Randomized Open-label Crossover Intervention Study
The objective of this study was to assess sodium-induced changes in blood pressure and body weight as primary outcomes and also in microvascular permeability, sublingual microcirculatory dimensions, and urinary glycosaminoglycan excretion in healthy subjects.Methods Twelve normotensive males followed both a low-sodium diet (less than 50 mmol/day) and a high-sodium diet (more than 200 mmol/day) for eight days in randomized order, separated by a crossover period. After the low-sodium diet, hypertonic saline (5 mmol sodium/liter body water) was administered intravenously in 30  min.Results Both sodium interventions did...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Alphaxalone Binds in Inner Transmembrane β + –α − Interfaces of α1β3γ2 γ-Aminobutyric Acid Type A Receptors
Conclusions Alphaxalone binds in transmembrane β+–α− pockets of synaptic GABAA receptors that are adjacent and intracellular to sites for the potent anesthetics etomidate and propofol. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage
Conclusions The use of cell salvage for cases at high risk for obstetric hemorrhage is economically reasonable; routine cell salvage use for all cesarean deliveries is not. These findings can inform the development of public policies such as guidelines on management of obstetric hemorrhage. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death A Substudy of the POISE-2 Trial
Background The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days.Methods This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of ...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Propofol-induced Changes in α-β Sensorimotor Cortical Connectivity
Conclusions The decrease in functional connectivity between sensory and motor cortices, despite an increase in local spectral power, suggests that propofol causes a functional disconnection of cortices with increases in autonomous activity within cortical regions. This pattern occurs across diseases evaluated, suggesting that these may be generalizable effects of propofol in patients with movement disorders and beyond. Sensorimotor network disruption may underlie anesthetic-induced loss of volitional control. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Incidence of Artifacts and Deviating Values in Research Data Obtained from an Anesthesia Information Management System in Children
Conclusions Not all values in anesthesia information management systems are valid. The incidence of artifacts stored in the present pediatric anesthesia practice was low for heart rate and oxygen saturation, whereas noninvasive and invasive blood pressure and end-tidal carbon dioxide had higher artifact incidences. Deviating values are more often artifacts than values in a normal range, and artifacts are associated with the phase of anesthesia and anesthetic technique. Development of (automatic) data validation systems or solutions to deal with artifacts in data is warranted. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Defining the Intrinsic Cardiac Risks of Operations to Improve Preoperative Cardiac Risk Assessments
Conclusions A continuum of intrinsic cardiac risk exists among operations. Grouping operations into broad categories inadequately accounts for the intrinsic cardiac risk of individual operations. (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Impact of a Novel Multiparameter Decision Support System on Intraoperative Processes of Care and Postoperative Outcomes
Background The authors hypothesized that a multiparameter intraoperative decision support system with real-time visualizations may improve processes of care and outcomes.Methods Electronic health record data were retrospectively compared over a 6-yr period across three groups: experimental cases, in which the decision support system was used for 75% or more of the case at sole discretion of the providers; parallel controls (system used 74% or less); and historical controls before system implementation. Inclusion criteria were adults under general anesthesia, advanced medical disease, case duration of 60  min or long...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

An Anesthesiologist ’s Perspective on the History of Basic Airway Management The “Progressive” Era, 1904 to 1960
This third installment of the history of basic airway management discusses the transitional —“progressive”—years of anesthesia from 1904 to 1960. During these 56 yr, airway management was provided primarily by basic techniques with or without the use of a face mask. Airway maneuvers were inherited from the artisanal era: head extension and mandibular advancement. The most common ma neuver was head extension, also used in bronchoscopy and laryngoscopy. Basic airway management success was essential for traditional inhalation anesthesia (ether, chloroform) and for the use of the new anesthetic agents (...
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Mitigating Microvascular Leak during Fluid Resuscitation of Hemorrhagic Shock
“[T]he endothelium is a promising target for intervention in clinical shock...” (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Reporting of Observational Research in A nesthesiology The Importance of Data Quality: Trust but Verify
“Every clinician who uses an [anesthesia information management system] is at ‘ground zero’ for artifact generation … and should recognize and consider ways to reduce the artifacts that might produce faulty and potentially harmful research and quality improvement conclusions.” (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Regulatory Landscape for Clinical Decision Support Technology
“The current U.S. Food and Drug Administration (FDA) regulatory requirements for clinical decision support systems are still under development.” (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Risk Prediction Tools The Need for Greater Transparency
“If risk prediction tools are to be used in clinical care, it is essential that they be vetted with the same care as any new drug or medical device.” (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Decision Support Alerts Importance of Validation
“It might seem obvious that decision support alerts can only be beneficial.... But it is also true that alerts that seem obviously beneficial may not be.” (Source: Anesthesiology)
Source: Anesthesiology - January 17, 2018 Category: Anesthesiology Source Type: research

Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies 2018 An Updated Report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies *
Update Highlights This Practice Advisory updates the “Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies: An Updated Report by the American Society of Anesthesiologists Task Force on the Prevention of Perioperative Peripheral Neuropathies,” adopted by the American Society of Anesthesiologists in 2010 and published in 201 1.†† In October 2016, the Committee on Standards and Practice Parameters elected to search for new evidence to determine if recommendations in the existing Practice Advisory continue to be supported by current evidence. The resultant Advisory, presented ...
Source: Anesthesiology - December 12, 2017 Category: Anesthesiology Source Type: research

Announcements
(Source: Anesthesiology)
Source: Anesthesiology - December 12, 2017 Category: Anesthesiology Source Type: research

Call for Papers Point of Care Ultrasound in Perioperative, Critical Care, and Pain Medicine
(Source: Anesthesiology)
Source: Anesthesiology - December 12, 2017 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - December 12, 2017 Category: Anesthesiology Source Type: research