How to Catch Unicorns (and Other Fairytales)
“…inadequate management of clinical neuromuscular blockade is one of the recurrent, frequent failures in many practices…” (Source: Anesthesiology)
Source: Anesthesiology - December 12, 2017 Category: Anesthesiology Source Type: research

Acknowledgment
The Editor-in-Chief and the Editors of Anesthesiology would like to thank the following individuals for their participation in the editorial review process. Their contributions are sincerely appreciated. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Announcements
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist: Erratum
In the Science, Medicine, and the Anesthesiologist section starting on page A13 of the July 2017 issue, the summary for “Trial of pregabalin for acute and chronic sciatica” includes a misstatement in the take home message, which reads: “Pregabalin may not be effective in treating sciatic pain and may result in more adverse events, although the study may have been underpowered to detect a difference.” The last part of the sentence, “although the study may have been underpowered to detect a difference” should have been removed. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Chad Brummett, M.D., Recipient of the 2017 James C. Cottrell, M.D., Presidential Scholar Award: Erratum
In the article beginning on page 611 in the October 2017 issue, the middle initial of Dr. Cottrell is listed incorrectly in the title and text. The correct name of the award is “2017 James E. Cottrell, M.D., Presidential Scholar Award.” (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

The Trip
Nursing the gentle curve of afternoon, (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Stem Cell –based Therapies for Sepsis
Sepsis is a life-threatening syndrome resulting in shock and organ dysfunction stemming from a microbial infection. Sepsis has a mortality of 40% and is implicated in half of all in-hospital deaths. The host immune response to microbial infection is critical, with early-phase sepsis characterized by a hyperinflammatory immune response, whereas the later phase of sepsis is often complicated by suppression. Sepsis has no treatment, and management remains supportive. Stem cells constitute exciting potential therapeutic agents for sepsis. In this review, we examine the rationale for stem cells in sepsis, focusing on mesenchyma...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Long-axis Ultrasonic Images of the Pediatric Larynx and Trachea with a Cuffed Endotracheal Tube
A LONG-AXIS (LAX) view of the trachea and larynx in a 3-yr-old girl after intubation with a cuffed endotracheal tube (4.0-mm internal diameter) (fig. A), and a short-axis (SAX) view of the trachea with a transverse tracheal width of 7.0  mm before intubation (fig. B), were obtained using an ultrasound apparatus with an L12-2 MHz probe. The cricothyroid membrane was palpated around 25  mm from the suprasternal notch etch. Hyperechoic shadows mostly indicated anterior membranes of the cricoid or tracheal cartilage. The saline-inflated cuff position was confirmed below the cricoid cartilage in the trachea. The s...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Bilateral Upper Lobe Bronchi Originating from the Trachea
A 6-DAY-OLD 1,720-g female with multiple congenital anomalies was found to have abnormal bronchial anatomy during otolaryngologic evaluation by rigid bronchoscopy. Computed tomography with three-dimensional maximal intensity projection reconstruction of the chest revealed that the trachea first bifurcated into the bilateral main bronchi that supplied the right and left upper lobes (A). Distal to this bifurcation was a narrow tracheal segment (1  mm in diameter at its narrowest;B) that extended to a second, inferior bifurcation consistent with the true carina (C). This bifurcation led to the left and right middle and...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Images in Anesthesiology: Proper Positioning of an Impella 2.5 and CP Heart Pump
THE Impella microaxial heart pump (Abiomed, USA) is approved for temporary left ventricular support to increase cardiac output and decrease myocardial oxygen demand.1 –3 Inserted percutaneously through the femoral or axillary artery, the Impella catheter (fig. A) sits in the mid-left vetricular space, with its inlet area approximately 3.5  cm below the aortic annulus and its outlet area in the ascending aorta. Proper positioning of the Impella 2.5 and Impella CP can be verified by two waveforms called the placement signal (red) and motor current (green). The placement signal displays pressure (in millimeters m...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

This Month in: Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Pressor vs. Pressor: A Comparison of Phenylephrine & amp; Norepinephrine
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

From Brooklyn ’s Master Laughing Gasser: “Dr. Colton’s Dentifrice… for Rigg’s Disease”
In 1844 Gardner Q. Colton administered nitrous oxide while dentist John M. Riggs (1811 to 1885) extracted a molar from his volunteer patient, nitrous-oxide pioneer Dr. Horace Wells. Dr. Riggs would be honored eventually by the dental eponym “Rigg’s disease”; Colton, by his namesake Manhattan firm, the Colton Dental Association (CDA), which provided nitrous oxide for dental anesthesia. When Colton franchised his CDA to Brooklyn, New York, he placed in charge his nephew Edward Gould Colton, M.D. (1841 to 1930). An 1868 graduate of the Bellevue Hospital Medical College, E. G. Colton practiced and lived in Br...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Racing Around: “Albany Dentist” G. E. Hill and “Vitalized Air”
Born in Cocksackie, New York, dentist George E. Hill (ca. 1847 to 1923) spent the final half of his life residing in Scranton, Pennsylvania, and eventually wintering in Indianola, Florida. His winter-themed trade card (left) is overstamped with the logo (right) of Hill ’s branch office in Buffalo, New York. From all his offices, Dr. Hill promoted his “Vitalized Air” anesthetic, which consisted of nitrous oxide adulterated with alcohol and chloroform. So, why the Buffalo office? During most of his years in dentistry, the Albany-trained dentist had raced mostl y around the states of New York and Pennsylvani...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Christmas Suspense about Hosting the Columbian Exposition …and, Indirectly, the “Post-Graduate School of Anaesthesia”
Hiding from Santa Claus behind the curtain, four children populate a circular illustration that is suspended like a Christmas tree ornament on the cover of the December 28, 1889, issue ofJudge, a weekly magazine of political satire. Dangling from the fireplace mantle are four Christmas stockings labeled with the names of St. Louis, Chicago, New York, and Washington —each a city hoping that Santa would fill that city’s stocking with the job of hosting the Columbian Exposition. Signed “[Grant E.] Hamilton” by its political cartoonist, the illustration was captioned: “SUSPENSE! Which one will get...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Brown Describes Bolivian Coca-Leaf Chewing: A Remedy Gathered versus Altitude and Attitude?
In 1876 author Robert Brown, Ph.D., began publishing his book series,The Countries of the World: Being a Popular Description of the Various Continents, Islands, Rivers, Seas, and Peoples of the Globe. In the third volume, he depicted the coca shrub, the pesticide-like cocaine of which wards off insects. However, the stimulant properties of the cocaine alkaloid led to what Brown captioned as “Gathering the Coca Plant (Erythroxylon coca) in Bolivia ” (above). As landlocked descendants of the Incans, many indigenous Bolivians kept laboring on the steep Andes or on the highland plateau by carrying a “little l...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

A “Dopeless” Diamond Belied Koca Nola’s Cocaine-laced Content
Because it had been widely used in soft drinks in the 1890s, cocaine gained rapid acceptance as a local anesthetic. In 1904 Thomas H. Austin founded the Koca Nola Company, a soft-drink firm that produced copycat cocaine-laced beverages in Atlanta, the hometown of the largest cola company in the world at that time. By 1907 the Koca Nola diamond logo (above) had been trademarked. On the diamond, Koca Nola is touted as “The Great Tonic” that is not only “Delicious” but “Dopeless.” Unfortunately for the beverage company, federal chemists isolated cocaine in a jug of their Koca Nola. Conseque...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Ideal Body Weight Is Not Really Ideal
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Anesthesia, Consciousness, and Language
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

In Reply
We thank Drs. Dreyfuss and Saumon for their comments on our recent work on one-hit models to study the biotrauma hypothesis.1 I agree that our study supports some of his earlier concerns and that my view has been too simplistic. However, it is important to note that our recent work does not discredit the biotrauma hypothesis itself. What our work suggests is that the biotrauma hypothesis is difficult to study in one-hit models using ventilation as the only hit, because in such models, there is either mild inflammation without lung injury or severe mechanical injury followed by secondary inflammation. One-hit models, theref...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

What Is the Role of Cytokines during Ventilator-induced Lung Injury?
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

In Reply
We appreciate Dr. Xueet al.’s interest in our paper. Several points are made that require clarification. First, the notion that occurrence and severity as well as duration of acute kidney injury (AKI) in the early postoperative period after cardiac surgery is responsible for major adverse kidney events has been called into question by studies that demonstrated that only part of the risk for major adverse kidney events comes from an early AKI in the postoperative period.1 These patients are also at risk for late AKI and progression of underlying chronic kidney disease and risk for death unrelated to AKI. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Can Remote Ischemic Preconditioning Really Improve Long-term Kidney Outcomes after Cardiac Surgery?
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

In Reply
Drs. Venkata, Upadhyay, and Talari expressed concern about our assessment of pain in elderly patients, assuming their limited ability to self-report. We agree that lack of precise evaluation of cognitive function of participants at baseline is a limitation of the present study. However, we excluded persons who already had been certified as disabled, by the Long-term Care Insurance information, at the start of the follow-up; therefore, all analytic subjects were considered to be capable of fully understanding the questionnaire and making valid and reliable responses.1 (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Pain as a Predictor of Disability in Elderly Population
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Situations Where Intravenous Lidocaine Should Not Be Used as an Analgesic Adjunct?
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

In Reply
We thank Dr. Roth for his response to our Clinical Concepts and Commentary article.1 Although the risk of local anesthetic toxicity in patients receiving intravenous lidocaine in combination with local anesthetic for wound infiltration or peripheral nerve block is an appropriate concern, to our knowledge no published data exist on this topic. Therefore, it is not possible to formulate recommendations. Intravenous lidocaine is a component of many enhanced recovery protocols and is an alternative to epidural analgesia in patients for whom placement is difficult or contraindicated.2,3 Patients undergoing major abdominal proce...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Transfusion-associated Circulatory Overload or Degassing?
(Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

In Reply
We thank Dr. Boucek for his insightful review of degassing as it relates to blood product transfusion and its clinical comparisons with transfusion-associated circulatory overload. Certainly, we acknowledge that the clinical diagnosis of transfusion-associated circulatory overload is one that remains a challenge for clinicians, both in real time and in retrospective clinical research. Indeed, this has been demonstrated by multiple authors in the field and has compounded the difficulties in studying this important transfusion-related complication. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Suprascapular and Interscalene Nerve Block for Shoulder Surgery A Systematic Review and Meta-analysis
Background Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular blockversus interscalene block for shoulder surgery.Methods Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the diffe...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Prevalence and Prognosis Impact of Patient –Ventilator Asynchrony in Early Phase of Weaning according to Two Detection Methods
Background Patient –ventilator asynchrony is associated with a poorer outcome. The prevalence and severity of asynchrony during the early phase of weaning has never been specifically described. The authors’ first aim was to evaluate the prognosis impact and the factors associated with asynchrony. Their second aim was to compare the prevalence of asynchrony according to two methods of detection: a visual inspection of signals and a computerized method integrating electromyographic activity of the diaphragm.Methods This was an ancillary study of a multicenter, randomized controlled trial comparing neurally adjust...
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Anesthesia with Dexmedetomidine and Low-dose Isoflurane Increases Solute Transport via the Glymphatic Pathway in Rat Brain When Compared with High-dose Isoflurane
Conclusions We propose that anesthetics affect the glymphatic pathway transport not simply by inducing unconsciousness but also by additional mechanisms, one of which is the repression of norepinephrine release. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Sevoflurane Acts on Ubiquitination –Proteasome Pathway to Reduce Postsynaptic Density 95 Protein Levels in Young Mice
Conclusions These data suggest that sevoflurane acts on the ubiquitination –proteasome pathway to facilitate postsynaptic density 95 protein degradation, which then decreases postsynaptic density 95 protein levels, leading to cognitive impairment in young mice. These studies would further promote the mechanistic investigation of anesthesia neurotoxicity in the developing brain. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Impact of Public Reporting of 30-day Mortality on Timing of Death after Coronary Artery Bypass Graft Surgery
Conclusions : In Massachusetts, a state with a long history of publicly reporting cardiac surgery outcomes at day 30, the authors found no evidence of increased mortality occurring immediately after day 30 for patients who underwent coronary artery bypass graft surgery. These findings suggest that delays in withdrawal of life-sustaining therapy do not routinely occur as an unintended consequence of this type of public reporting. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever A Retrospective Cross-sectional Study
Conclusions Magnesium may play a protective role against the development of intrapartum fever. Future work should further explore the association between magnesium dosing and the incidence of maternal fever. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

A Random-allocation Graded Dose –Response Study of Norepinephrine and Phenylephrine for Treating Hypotension during Spinal Anesthesia for Cesarean Delivery
Conclusions Comparative dose –response analysis was completed for norepinephrine and phenylephrine given as a bolus to treat the first episode of hypotension in patients undergoing spinal anesthesia for cesarean delivery. The estimated dose equivalent to phenylephrine 100 µg was norepinephrine 8 µg (95% CI, 6 to 10 µg). Th ese results may be useful to inform the design of future comparative studies. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release An International, Multicenter, Phase 3, Single-blinded, Randomized Noninferiority Trial
Conclusions In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible. (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Synchrony and the Art of Mechanical Ventilation
“The art of mechanical ventilation…synchronizing patient and ventilator…has become very complex indeed.” (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Xenon and Cardioprotection Is This the Light at the End of the Tunnel?
“Xenon is an expensive anesthetic drug, but interest in using it persists because of cardio- and neuroprotective properties demonstrated in animal models.” (Source: Anesthesiology)
Source: Anesthesiology - December 1, 2017 Category: Anesthesiology Source Type: research

Acknowledgment
The Editor-in-Chief and the Editors of Anesthesiology would like to thank the following individuals for their participation in the editorial review process. Their contributions are sincerely appreciated. (Source: Anesthesiology)
Source: Anesthesiology - November 15, 2017 Category: Anesthesiology Source Type: research

Announcements
(Source: Anesthesiology)
Source: Anesthesiology - November 15, 2017 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - November 15, 2017 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - November 15, 2017 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist: Erratum
In the Science, Medicine, and the Anesthesiologist section starting on page A13 of the July 2017 issue, the summary for “Trial of pregabalin for acute and chronic sciatica” includes a misstatement in the take home message, which reads: “Pregabalin may not be effective in treating sciatic pain and may result in more adverse events, although the study may have been underpowered to detect a difference.” The last part of the sentence, “although the study may have been underpowered to detect a difference” should have been removed. (Source: Anesthesiology)
Source: Anesthesiology - November 15, 2017 Category: Anesthesiology Source Type: research

Chad Brummett, M.D., Recipient of the 2017 James C. Cottrell, M.D., Presidential Scholar Award: Erratum
In the article beginning on page 611 in the October 2017 issue, the middle initial of Dr. Cottrell is listed incorrectly in the title and text. The correct name of the award is “2017 James E. Cottrell, M.D., Presidential Scholar Award.” (Source: Anesthesiology)
Source: Anesthesiology - November 15, 2017 Category: Anesthesiology Source Type: research