Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit: Erratum
On the CME pages of the July and August 2020 issues, theAMA PRA Category 1 Credits ™ were incorrectly listed as 1.5. The American Society of Anesthesiologists designated the journal-based activity in both issues for a maximum of 1.0AMA PRA Category 1 Credits ™. (Source: Anesthesiology)
Source: Anesthesiology - July 27, 2020 Category: Anesthesiology Source Type: research

Of Railroads and Roller Coasters Considerations for Perioperative Blood Pressure Management?
“…[T]he long-standing focus on blood pressure as the only surrogate for perfusion should be tempered…” (Source: Anesthesiology)
Source: Anesthesiology - July 24, 2020 Category: Anesthesiology Source Type: research

Death-associated Protein Kinase 1 Mediates Ventilator-induced Lung Injury in Mice by Promoting Alveolar Epithelial Cell Apoptosis
BackgroundAlveolar epithelial cell apoptosis is implicated in the onset of ventilator-induced lung injury. Death-associated protein kinase 1 (DAPK1) is associated with cell apoptosis. The hypothesis was that DAPK1 participates in ventilator-induced lung injury through promoting alveolar epithelial cell apoptosis.MethodsApoptosis of mouse alveolar epithelial cell was induced by cyclic stretch. DAPK1 expression was altered (knockdown or overexpressed)in vitro by using a small interfering RNA or a plasmid, respectively. C57/BL6 male mice (n = 6) received high tidal volume ventilation to establish a lung injury model. Adeno-as...
Source: Anesthesiology - July 23, 2020 Category: Anesthesiology Source Type: research

Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation A Randomized Controlled Trial
This study was designed to test the hypothesis that patients who received mepivacaine would ambulate earlier than those who received hyperbaric or isobaric bupivacaine for primary total hip arthroplasty.MethodsThis randomized controlled trial included American Society of Anesthesiologists Physical Status I to III patients undergoing primary total hip arthroplasty. The patients were randomized 1:1:1 to 52.5  mg of mepivacaine, 11.25 mg of hyperbaric bupivacaine, or 12.5 mg of isobaric bupivacaine for spinal anesthesia. The primary outcome was ambulation between 3 and 3.5 h. Secondary outcomes inc...
Source: Anesthesiology - July 23, 2020 Category: Anesthesiology Source Type: research

Lung Ultrasound in Emergency and Critically Ill Patients: Number of Supervised Exams to Reach Basic Competence: Erratum
In the article “Lung Ultrasound in Emergency and Critically Ill Patients: Number of Supervised Exams to Reach Basic Competence” published in the April 2020 issue, there is an error in the Methods section. In the third paragraph under “Lung Ultrasound Curriculum and the APECHO Study” on page 902, the senten ce “… (3) interstitial syndrome, defined as the presence of more than two spaced B lines or coalescent B lines, detected in a limited portion of the intercostal space and issued from the pleural line or subpleural consolidations of at least 5 mm;…” should be replac...
Source: Anesthesiology - July 23, 2020 Category: Anesthesiology Source Type: research

Beyond Anesthesia Apoptosis Wiring and Communication Matter!
“Since we continue to grapple with the issue of human relevance for developmental anesthesia neurotoxicity [in animals], why do we celebrate ‘yet another’ experimental neurotoxicity study…?” (Source: Anesthesiology)
Source: Anesthesiology - July 23, 2020 Category: Anesthesiology Source Type: research

Rational Drug Design for Pain Medicine A New Nav1.7 Inhibitor
“…by targeting [sodium channel] Nav1.7, it may be possible to develop an entirely new class of analgesic medications.” (Source: Anesthesiology)
Source: Anesthesiology - July 23, 2020 Category: Anesthesiology Source Type: research

Getting to a New Normal: Mandating That Patients Wear Masks as Hospitals Fully Reopen during the Coronavirus Pandemic: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 21, 2020 Category: Anesthesiology Source Type: research

Subomohyoid –Suprascapular versus Interscalene Block: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 20, 2020 Category: Anesthesiology Source Type: research

Fluid Fasting in Children Solid Science?
“…should the evidence for an association between longer preoperative fasting and [postinduction] hypotension prompt us to change practice and actively reduce fasting times in children?” (Source: Anesthesiology)
Source: Anesthesiology - July 20, 2020 Category: Anesthesiology Source Type: research

A Tale of Different Populations: Disparities in Obstetric Anesthesia: Erratum
In the October 2019 issue, there are two errors in the Infographics in Anesthesiology image entitled “A Tale of Different Populations: Disparities in Obstetric Anesthesia.” (1) The patient demographic icons and labels “Hispanic” and “African-American” should be switched. (2) “General anesthesia for c-sections, national cohort, 2016” should be “General anesthesia for c-sections, na tional cohort, 1999-2002,” reflecting the years of the cohort rather than year of publication. (Source: Anesthesiology)
Source: Anesthesiology - July 15, 2020 Category: Anesthesiology Source Type: research

Dear Dr. Park, it ’s June again
Dear Dr. Park, it ’s June again, (Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Perioperative Management of Oral Glucose-lowering Drugs in the Patient with Type 2 Diabetes
Diabetes mellitus is a group of metabolic disorders, characterized by hyperglycemia, resulting from relative insulin deficiency, often on a background of insulin resistance (type 2 diabetes), or (near) absolute insulin deficiency related to autoimmune pathophysiology (type 1 diabetes). The most common form is type 2 diabetes, and its global prevalence is rising as a result of changes in lifestyle and lengthening of life expectancy.1,2 An estimated 463 million people aged 20 to 79 yr have diabetes,3 which corresponds to 9.3% of the adult population and represents a four-fold increase in diabetes prevalence since 1980.4 Pati...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

scrubbing out
my patient just died and i am now outside the or and i hear the family crying behind the white walls and moments before my white hands had held her white hands and i kept saying you are going to breathe and you are going to breathe and you are going to breathe and when i was 16 i got into a horrible accident that still stutters my step and the impact i felt then of the glass cutting new words into my mouth and the pavement rouging my skin was less than the pressure i crushed into her failing chest for she was going to breathe and she hugged me before the operation with softness and she said she was nervous like a newborn c...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Substance Use Disorder in Physicians after Completion of Training in Anesthesiology in the United States from 1977 to 2013
Conclusions A substantial proportion of anesthesiologists who develop substance use disorder after the completion of training die of this condition, and the risk of relapse is high in those who survive.Editor ’s PerspectiveWhat We Already Know about This TopicSubstance use disorders among anesthesiologists are common and hazardous to both the involved physicians and their patientsThe incidence of substance abuse among U.S. anesthesiologists remains unclear, as does the relapse risk and consequent mortalityWhat This Article Tells Us That Is NewThe estimated cumulative 30-yr incidence of substance abuse among graduates...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting The iMODIPONV Randomized Controlled Trial
Background Suboptimal tissue perfusion and oxygenation during surgery may be responsible for postoperative nausea and vomiting in some patients. This trial tested the hypothesis that muscular tissue oxygen saturation –guided intraoperative care reduces postoperative nausea and vomiting.Methods This multicenter, pragmatic, patient- and assessor-blinded randomized controlled (1:1 ratio) trial was conducted from September 2018 to June 2019 at six teaching hospitals in four different cities in China. Nonsmoking women, 18 to 65 yr old, and having elective laparoscopic surgery involving hysterectomy (n = 800) were randomly...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Electroencephalogram Burst-suppression during Cardiopulmonary Bypass in Elderly Patients Mediates Postoperative Delirium
Background Intraoperative burst-suppression is associated with postoperative delirium. Whether this association is causal remains unclear. Therefore, the authors investigated whether burst-suppression during cardiopulmonary bypass (CPB) mediates the effects of known delirium risk factors on postoperative delirium.Methods This was a retrospective cohort observational substudy of the Minimizing ICU [intensive care unit] Neurological Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) trial. The authors analyzed data from patients more than 60 yr old undergoing cardiac surgery (n = 159). Univariate and multivariable regre...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Protective Device during Airway Management in Patients with Coronavirus Disease 2019 (COVID-19)
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Transesophageal Echocardiography Probe Sheath to Decrease Provider and Environment Contamination
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Remote Control and Monitoring of GE Aisys Anesthesia Machines Repurposed as Intensive Care Unit Ventilators
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Intubation and Ventilation amid COVID-19: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Intubation and Ventilation amid COVID-19: Reply
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Considerations for Assessing Risk of Provider Exposure to SARS-CoV-2 after a Negative Test
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Dexmedetomidine Activation of Dopamine Neurons in the Ventral Tegmental Area Attenuates the Depth of Sedation in Mice
Background Dexmedetomidine induces a sedative response that is associated with rapid arousal. To elucidate the underlying mechanisms, the authors hypothesized that dexmedetomidine increases the activity of dopaminergic neurons in the ventral tegmental area, and that this action contributes to the unique sedative properties of dexmedetomidine.Methods Only male mice were used. The activity of ventral tegmental area dopamine neurons was measured by a genetically encoded Ca2+ indicator and patch-clamp recording. Dopamine neurotransmitter dynamics in the medial prefrontal cortex and nucleus accumbens were measured by a genetica...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Getting to a New Normal: Mandating That Patients Wear Masks as Hospitals Fully Reopen during the Coronavirus Pandemic
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Videolaryngoscopy Intubation in Patients with COVID-19 How to Minimize Risk of Aerosolization?
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Plastic Bronchitis
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Enhanced Recovery after Lumbar Spine Fusion A Randomized Controlled Trial to Assess the Quality of Patient Recovery
Background Prospective trials of enhanced recovery after spine surgery are lacking. We tested the hypothesis that an enhanced recovery pathway improves quality of recovery after one- to two-level lumbar fusion.Methods A patient- and assessor-blinded trial of 56 patients randomized to enhanced recovery (17 evidence-based pre-, intra-, and postoperative care elements) or usual care was performed. The primary outcome was Quality of Recovery-40 score (40 to 200 points) at postoperative day 3. Twelve points defined the clinically important difference. Secondary outcomes included Quality of Recovery-40 at days 0 to 2, 14, and 56...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Dorsal Root Ganglion Stimulation Alleviates Pain-related Behaviors in Rats with Nerve Injury and Osteoarthritis
Background Dorsal root ganglion field stimulation is an analgesic neuromodulation approach in use clinically, but its mechanism is unknown as there is no validated animal model for this purpose. The authors hypothesized that ganglion stimulation is effective in reducing pain-like behaviors in preclinical chronic pain models.Methods The authors provided ganglion stimulation or spinal cord stimulation to rats with traumatic neuropathy (tibial nerve injury), or osteoarthritis induced by intraarticular knee monosodium iodoacetate, or without injury (na ïve). Analgesia was evaluated by testing a battery of pain-related ref...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

An Online Educational Platform in the COVID-19 Pandemic
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Intraoperative Circuit Leak Likely Caused by Surgical Prep
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Goal-directed versus Standard Fluid Therapy to Decrease Ileus after Open Radical Cystectomy A Prospective Randomized Controlled Trial
Conclusions Goal-directed fluid therapy may not be an effective strategy for lowering the risk of postoperative ileus in patients undergoing open radical cystectomy.Editor ’s PerspectiveWhat We Already Know about This TopicPostoperative ileus is a common complication after intraabdominal surgeriesPrevious studies have found mixed evidence for benefit in goal-directed intraoperative fluid therapy over standard fluid therapyWhat This Article Tells Us That Is NewIn a randomized trial of goal-directedversus standard fluid therapy in patients having radical cystectomy, there was no difference in the primary outcome of pos...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Prophylactic Intrathecal Morphine and Prevention of Post-Dural Puncture Headache: A Randomized Double-blind Trial: Erratum
In the article “Prophylactic Intrathecal Morphine and Prevention of Post-Dural Puncture Headache: A Randomized Double-blind Trial” published in the May 2020 issue, the termsintrathecal morphine andintrathecal saline are reversed in the Abstract and Results section. (Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Ephedrine versus Phenylephrine Effect on Cerebral Blood Flow and Oxygen Consumption in Anesthetized Brain Tumor Patients A Randomized Clinical Trial
Conclusions The cerebral metabolic rate of oxygen changes in peritumoral and normal contralateral regions were similar between ephedrine- and phenylephrine-treated patients. In the normal contralateral region, ephedrine was associated with an increase in cerebral blood flow and regional cerebral oxygen saturation compared with phenylephrine.Editor ’s PerspectiveWhat We Already Know about This TopicPhenylepherine may reduce regional cerebral oxygen saturation in anesthetized patients without cerebral pathology when compared with ephedrineWhat This Article Tells Us That Is NewIn adult patients with brain tumors, there ...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Defining Hypotension during Anesthesia: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Defining Hypotension during Anesthesia: Reply
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Dexmedetomidine Exerts an Anti-inflammatory Effect via α 2 Adrenoceptors to Prevent Lipopolysaccharide-induced Cognitive Decline in Mice
This study determined the mechanism(s) for the benefit provided by dexmedetomidine in a medical illness in mice induced by lipopolysaccharide.Methods Cognitive decline, peripheral and hippocampal inflammation, blood –brain barrier permeability, and inflammation resolution were assessed in male mice. Dexmedetomidine was administered in the presence of lipopolysaccharide and in combination with blockers. Cultured macrophages (RAW 264.7; BV-2) were exposed to lipopolysaccharide ± dexmedetomidine ± yohimbine; t umor necrosis factor α release into the medium and monocyte NFκB activity was determi...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Population Volume Kinetics in Volunteers: Reply: Retraction
The correspondence published Online First on February 20, 2020, “Population Volume Kinetics in Volunteers: Reply”1 has been retracted because the original article being discussed, “Population Kinetics of 0.9% Saline Distribution in Hemorrhaged Awake and Isoflurane-anesthetized Volunteers,”2 has been retracted at the request of the authors. (Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Population Volume Kinetics in Volunteers: Comment: Retraction
The correspondence published Online First on February 20, 2020, “Population Volume Kinetics in Volunteers: Comment”1 has been retracted because the original article being discussed, “Population Kinetics of 0.9% Saline Distribution in Hemorrhaged Awake and Isoflurane-anesthetized Volunteers,”2 has been retracted at the request of the authors. (Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Mineralocorticoid Dysfunction during Critical Illness A Review of the Evidence
The recent demonstration of the significant reduction in mortality in patients with septic shock treated with adjunctive glucocorticoids combined with fludrocortisone and the effectiveness of angiotensin II in treating vasodilatory shock have renewed interest in the role of the mineralocorticoid axis in critical illness. Glucocorticoids have variable interactions at the mineralocorticoid receptor. Similarly, mineralocorticoid receptor –aldosterone interactions differ from mineralocorticoid receptor–glucocorticoid interactions and predicate receptor–ligand interactions that differ with respect to cellular ...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

E-cigarette and Vaping-associated Lung Injury What ’s Lurking Inside!
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Transient Receptor Potential Cation Channels and Calcium Dyshomeostasis in a Mouse Model Relevant to Malignant Hyperthermia
This study tested the hypothesis that transient receptor potential cation (TRPC) channels are important contributors to the Ca2+ dyshomeostasis in a mouse model relevant to malignant hyperthermia.Methods This study examined the mechanisms responsible for Ca2+ dyshomeostasis inRYR1-p.G2435R mouse muscles and muscle cells using calcium and sodium ion selective microelectrodes, manganese quench of Fura2 fluorescence, and Western blots.ResultsRYR1-p.G2435R mouse muscle cells have chronically elevated intracellular resting calcium and sodium and rate of manganese quench (homozygous greater than heterozygous) compared with wild-...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Coronavirus Epidemics: Reply
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Coronavirus Epidemics: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

A Systems Theoretic Process Analysis of the Medication Use Process in the Operating Room
Conclusions In this study, the authors demonstrated the use of systems theoretic process analysis to describe potential causes of errors in the medication use process in the operating room. Causal scenarios were linked to controllers ranging from the frontline providers up to the highest levels of perioperative management. Systems theoretic process analysis is uniquely able to analyze management and leadership impacts on the system, making it useful for guiding quality improvement initiatives.Editor ’s PerspectiveWhat We Already Know about This TopicMedication error in the operating room is commonSystems theoretic pr...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Preoperative Frailty Assessment: Reply
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Preoperative Frailty Assessment: Comment
(Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Neuromodulation for Pain Treatment Building a Foundation for Future Study
“These findings raise important questions regarding…the study of electrical stimulation for different types of pain.” (Source: Anesthesiology)
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research