Severe Bronchopleural Fistula Patched with a Bronchial Blocker
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Airway Closure during Surgical Pneumoperitoneum in Obese Patients
Conclusions In obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting. (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Giant Left Atrial Myxoma Obstructing Mitral Valve Bloodflow
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children
Propofol administered in conjunction with an opioid such as remifentanil is used to provide total intravenous anesthesia for children. Drugs can be given as infusion controlled manually by the physician or as automated target-controlled infusion that targets plasma or effect site. Smart pumps programmed with pharmacokinetic parameter estimates administer drugs to a preset plasma concentration. A linking rate constant parameter (keo) allows estimation of effect site concentration. There are two parameter sets, named after the first author describing them, that are commonly used in pediatric target-controlled infusion for pr...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

The Error-berg Reconceptualizing Medical Error as a Tool for Quality and Safety
(Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia A Prospective Observational Study
This study therefore aimed to determine the relationship between ambulatory mean arterial pressure and preinduction, postinduction, and intraoperative mean arterial pressures.Methods Ambulatory (automated oscillometric measurements at 30-min intervals) and preinduction, postinduction, and intraoperative mean arterial pressures (1-min intervals) were prospectively measured and compared in 370 American Society of Anesthesiology physical status classification I or II patients aged 40 to 65 yr having elective noncardiac surgery with general anesthesia.Results There was only a weak correlation between the first preinduction and...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Postresuscitation Care after Out-of-hospital Cardiac Arrest Clinical Update and Focus on Targeted Temperature Management
Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post –cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopr...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Oxygenation Impairment during Anesthesia Influence of Age and Body Weight
Editor ’s PerspectiveWhat We Already Know about This TopicDuring anesthesia oxygenation is impaired, especially in the elderly or obese, but the mechanisms are uncertain.What This Article Tells Us That Is NewPooled data were examined from 80 patients studied with multiple inert gas elimination technique and computed tomography. Oxygenation was impaired by anesthesia, more so with greater age or body mass index. The key contributors were low ventilation/perfusion ratio (likely airway closure) in the elderly and shunt (atelectasis) in the obese.Background Anesthesia is increasingly common in elderly and overweight pati...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Perioperative Cardiac Arrests in Children between 1988 and 2005 at a Tertiary Referral Center: A Study of 92,881 Patients: Erratum
In the article “Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center” (Flick RP, Sprung J, Harrison TE, Gleich SJ, Schroeder DR, Hanson AC, Buenvenida SL, Warner DO: Anesthesiology 2007; 106:226 –37) there is an error in the following sentence: “Of the 26 noncardiac patients who experienced CA, 7 had congenital heart disease, such that 87.5% of all patients who experienced perioperative CA had underlying heart disease.” This sentence should have read “76% of all patients,” not “ 87.5% of all patients.” (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Quantitative Research Methods in Medical Education
There has been a dramatic growth of scholarly articles in medical education in recent years. Evaluating medical education research requires specific orientation to issues related to format and content. Our goal is to review the quantitative aspects of research in medical education so that clinicians may understand these articles with respect to framing the study, recognizing methodologic issues, and utilizing instruments for evaluating the quality of medical education research. This review can be used both as a tool when appraising medical education research articles and as a primer for clinicians interested in pursuing sc...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Qualitative Research Methods in Medical Education
This article provides a primer for clinician educators who want to appraise or conduct qualitative research in medical education. This article discusses a definition and the philosophical underpinnings for qualitative research. Using the Standards for Reporting Qualitative Research as a guide, this article provides a step-wise approach for conducting and evaluating qualitative research in medical education. This review will enable the reader to understand when to utilize qualitative research in medical education and how to interpret reports using qualitative approaches. (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Toll-like Receptor 7 Contributes to Inflammation, Organ Injury, and Mortality in Murine Sepsis
Conclusions Toll-like receptor 7 plays an important role in the pathogenesis of polymicrobial sepsis by mediating host innate immune responses and contributes to acute kidney injury and mortality. (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Breathing Life into Pulmonary Physiology How Age and Body Weight Impair Oxygenation
“[R]ecruitment maneuvers may still be useful in overweight (and obese) patients to reduce atelectasis…[but not] in elderly patients…[where] one should consider increasing lung volume, such as through the use of positive end-expiratory pressure…” (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Days Alive and Out of Hospital Validation of a Patient-centered Outcome for Perioperative Medicine
Conclusions Days alive and out of hospital is a feasibly measured patient-centered outcome that is associated with clinically sensible patient characteristics, surgical complexity, in-hospital complications, and longer-term outcomes. Days alive and out of hospital forms a novel patient-centered outcome for future clinical trials and observational studies for adult surgical patients. (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study: Erratum
In the article “Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study” (Taboada M, Doldan P, Calvo A, Almeida X, Ferreiroa E, Baluja A, Cariñena A, Otero P, Caruezo V, Naveira A, Otero P, Alvarez J: Anesthesiology 2018; 129:321 –8), there was a mistake in table 2. The complication of hypoxia less than 80% was 29 patients (14%) in the intensive care unit, but table 2 mistakenly shows 19 patients (14%). The authors regret this error. (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Driving Pressure and Transpulmonary Pressure How Do We Guide Safe Mechanical Ventilation?
Concern over the potential for lung injury due to mechanical ventilation has fueled investigations on lung protection in the operating room.1 –3 Based on the intensive care literature,4 tidal volume (VT) and positive end-expiratory pressure (PEEP) settings have been the focus of intraoperative clinical trials.1 –3 Recent results in acute respiratory distress syndrome (ARDS)5 and surgical patients6,7 have suggested that the benefits associated with VT and PEEP settings are mediated by driving pressures. As our understanding of the physical and biologic effects of mechanical ventilation evolves, the concepts of d...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Midazolam Sedation Induces Upper Limb Coordination Deficits That Are Reversed by Flumazenil in Patients with Eloquent Area Gliomas
This study aimed to determine whether the exacerbated upper limb motor-sensory deficits are mediated through benzodiazepine sites by demonstrating reversibility by flumazenil in patients with gliomas in eloquent areas.Methods This was an interventional, parallel assignment, nonrandomized trial. Study subjects were admitted in the operating room. Patients with supratentorial eloquent area gliomas and volunteers of similar age without neurologic disease were sedated with midazolam, but still responsive and cooperative. Motor and sensory functions for upper extremities were evaluated by the Nine-Hole Peg Test before and after...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Pharmacologic Unmasking of Neurologic Deficits A Stress Test for the Brain
“A [γ-aminobutyric acid–mediated] sedation strategy may serve as a neurologic stress test…[to] strip away neural reserve to reveal subclinical brain vulnerability.” (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Isoflurane Modulates Hippocampal Cornu Ammonis Pyramidal Neuron Excitability by Inhibition of Both Transient and Persistent Sodium Currents in Mice
Editor ’s PerspectiveWhat We Already Know about This TopicNeurotransmitter release from presynaptic nerve terminals is hindered by volatile anesthetics through inhibition of voltage-gated sodium channelsDepression of neuronal activity by volatile anesthetics through direct inhibition of sodium currents in excitatory neurons has not been previously reportedWhat This Article Tells Us That Is NewElectrophysiologic studies show that isoflurane, at clinically relevant concentrations, inhibits both transient and persistent sodium currents on mouse cornu ammonis hippocampal neuronsex vivoThe isoflurane-induced inhibition of...
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

Complications Arise
The Spanish begin their questions with an ¿ (Source: Anesthesiology)
Source: Anesthesiology - June 19, 2019 Category: Anesthesiology Source Type: research

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