Residual Neuromuscular Block in the Elderly: Incidence and Clinical Implications: Erratum: Erratum
In the May 2016 issue, the erratum on page 1201 published Online First (Publish Ahead-of-Print) using an incorrect DOI. The DOI used when the erratum published in the issue (10.1097/01.anes.0000481944.99941.7e) is the correct one. (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

In Sickness and in Health(care)
You never know when patients thank you, (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Pediatric Central Line –associated Acute Deep Vein Thrombosis
(Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Aberrant Right Subclavian Artery An Important Variant of the Aortic Arch
(Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery A Prospective Blinded Observational Study
Conclusions Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment. (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Intraoperative Electrosurgical Electromagnetic Interference in Patients with Implantable Cardioverter Defibrillators Is It Safe?
“There are two options to disable therapy [implantable cardioverter defibrillators]: place a magnet or reprogram the device. Both have their drawbacks.” (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Comparing Apples to Oranges?
“[Beyond survival]…there are few long-term follow-up data, including functional outcomes, in patients who received extracorporeal membrane oxygenation for [acute respiratory distress syndrome].” (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

General Anesthesia and the Cortex Communication Breakdown?
“[Is] general anesthesia really a state of communication breakdown across the cortex? [What are] the implications for clinical monitoring?” (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Toward Understanding Cerebral Blood Flow during Cardiopulmonary Bypass Implications for the Central Nervous System
In this study, we examined the relationship of regional cerebral blood flow (CBF) to mean arterial pressure, systemic blood flow, partial pressure of arterial carbon dioxide (PaCO2), nasopharyngeal temperature, and hemoglobin during hypothermic nonpulsatile cardiopulmonary bypass (CPB). Regional CBF was determined by clearance of xenon 133 in 67 patients undergoing coronary bypass grafting procedures. There was a significant decrease in regional CBF (55% decrease) during CPB, with nasopharyngeal temperature and PaCO2 being the only two significant factors (p
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Hyphenated
They make room to cut you away, (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Quality of Life and Lung Function in Survivors of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome
Editor ’s PerspectiveWhat We Already Know about This TopicExtracorporeal membrane oxygenation is used in severe acute respiratory distress syndrome; whereas the long-term complications among survivors of acute respiratory distress syndrome treated without extracorporeal membrane oxygenation are well described, the status of extracorporeal membrane oxygenation survivors is poorly understoodWhat This Article Tells Us That Is NewIn a single-center cohort of acute respiratory distress syndrome survivors, management with (vs. without) extracorporeal membrane oxygenation resulted in similar survival at 1 yr, pulmonary func...
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Preload Dependence Is Associated with Reduced Sublingual Microcirculation during Major Abdominal Surgery
Editor ’s PerspectiveWhat We Already Know about This TopicWhether sublingual microcirculation reflects systemic preload remains unknownWhat This Article Tells Us That Is NewThirty-two preload dependent episodes were identified in 17 patientsEpisodes were accompanied by reduced arterial pressure and stroke volume, along with reduced sublingual microcirculationFluid administration improved microcirculation and stroke volume, but not blood pressureSublingual microcirculation might be an indicator of vascular volumeBackground Dynamic indices, such as pulse pressure variation, detect preload dependence and are used to pre...
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Propofol Anesthesia Increases Long-range Frontoparietal Corticocortical Interaction in the Oculomotor Circuit in Macaque Monkeys
Conclusions Propofol anesthesia induces coherent oscillations and increases certain frontoparietal interactions in oculomotor cortices. Frontal eye field and lateral intraparietal area show increased coherence and phase-amplitude coupling. Visual areas 2 and 1, which have similar anatomic projection patterns, show similar increases in phase-amplitude coupling, suggesting higher order feedback increases in influence during propofol anesthesia relative to wakefulness. This suggests that functional connectivity between frontal and parietal areas is not uniformly decreased by anesthetics. (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - March 12, 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 - March 12, 2019 Category: Anesthesiology Source Type: research

Stop Interfering! Intraoperative Management of ICDs
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Dr. C. R. Agnew ’s Choice: Cocaine Anesthesia Discoverer Over U.S. President
At a meeting in 1884 in Heidelberg, Germany, a paper was presented —the world’s first on using cocaine as a topical (surface) anesthetic. The author was a surgical intern in Vienna named Carl Koller, M.D. (1857 to 1944). A conference attendee, New Yorker Henry Noyes, M.D., reported Koller’s discovery in the October 11, 1884, issue of theNew York Medical Record. One week later, Noyes ’s colleague, ophthalmologist Cornelius Rea Agnew, M.D. (1830 to 1888,right) was delighted to publish his own clinical cases confirming the effectiveness of Koller ’s cocaine anesthesia. Ironically, Agnew passed aw...
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Pure Nitrous Oxide and Possibly Phthisis from Dr. J. K. Carmichael
Brother of a horseman, James K. Carmichael (1864 to 1894) was raised in Rensselaer County, New York. After studying dentistry, he set up practice in Hartford, Connecticut. There he met the daughter of a harness maker, his future wife Jennie Pearl. Dr. Carmichael issued this trade card (top) from his Main Street “head-quarters for pure nitrous oxide gas” (bottom). A few years after his 1888 marriage, his pulmonary tuberculosis became so severe that a Dr. Pease had to cover the office. While battling “phthisis” at a health resort in Colebrook, New Hampshire, 29-yr-old Dr. Carmichael died. Back in the ...
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Acid –Base Reports Need a Text Explanation
(Source: Anesthesiology)
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Esophageal Pressure Monitoring in the Critically Ill Obese Subject
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Endovascular Retrieval of Broken Arterial Cannulas
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Automated Titration of Vasopressor Infusion Using a Closed-loop Controller In Vivo Feasibility Study Using a Swine Model
In this study of pigs with normovolemic hypotension induced by administration of sodium nitroprusside, an automated closed-loop vasopressor administration device was able to maintain mean arterial pressure within 5 mmHg of 80 mmHg for 98% of the intraoperative period. This suggests that norepinephrine can be accurately titrated using an automated infusion device in order to maintain target blood pressure.Background Multiple studies have reported associations between intraoperative hypotension and adverse postoperative complications. One of the most common interventions in the management of hypotension is vasopressor admini...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Aquaporin 5 –1364A/C Promoter Polymorphism Is Associated with Pulmonary Inflammation and Survival in Acute Respiratory Distress Syndrome
Editor ’s PerspectiveWhat We Already Know about This TopicAcute respiratory distress syndrome is defined according to clinical criteria, but lack of precise characterization may contribute to negative trials and impede personalized care. Polymorphisms of aquaporin-5, a key mediator of inflammation, may impact outcome.What This Article Tells Us That Is NewIn acute respiratory distress syndrome attributable to bacterial pneumonia, the C-allele of the aquaporin-5 –1364A/C promoter polymorphism is associated with less pulmonary inflammation and greater survival. This may improve characterization of acute respirator...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Acute Respiratory Distress Syndrome Biomarkers, Mechanisms, and Water Channels
“Genetic studies…have revealed associations between genotype and outcome in patients with ARDS.” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Wake Up, Neurons! Astrocytes Calling
“Glia…now emerge as surprising actors in anesthetic mechanisms…[interfering] with energy production in glia leads to delayed emergence from anesthesia.” (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Morning in the Surgical Waiting Area
We drove through darkness, sky spread thick (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Operating Room Fires
Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.e., laser, “Bovie”), and a fuel. This review analyzes each fire ingredient to determine the optimal clinical strategy to reduce the risk of fire. Surgical checklists, team training, and the specific management of an operating room fire are also reviewed....
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Nitric Oxide Story
We examined the effects on systemic oxygenation and blood pressure of inhaling up to 80 parts per million by volume of NO at fraction of inspired oxygen 0.9 for up to 30 min by six inf ants with persistent pulmonary hypertension of the newborn. In all infants, this treatment rapidly and significantly increased preductal oxygen saturation; in five infants, postductal oxygen saturation and oxygen tensions also increased. Inhalation of NO did not cause systemic hypotension or raise m ethemoglobin. These data suggest that low levels of inhaled NO have an important role in the reversal of hypoxemia due to persistent pulm...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

B-lines Visualization and Lung Aeration Assessment Mind the Ultrasound Machine Setting
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Propofol-associated Green Hair Discoloration
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

A Neurologic Examination for Anesthesiologists Assessing Arousal Level during Induction, Maintenance, and Emergence
This article reviews the main components of the neurologic examination focusing primarily on the brainstem examination. It details the components of the brainstem examination that are most re levant for patient management during induction, maintenance, and emergence from general anesthesia. The examination is easy to apply and provides important complementary information about the patient’s arousal level that cannot be discerned from vital signs and electroencephalogram measures. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Driving Pressure during Thoracic Surgery A Randomized Clinical Trial
Conclusions Application of driving pressure –guided ventilation during one-lung ventilation was associated with a lower incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

The Pager Goes Off
The pager goes off. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function
Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia &n...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Down: Death through the Eyes of an Intern
I stood in the trauma bay of my hospital, watching snowflakes fall outside through the windows as we waited. A “red trauma”; gunshot wound to the head, per EMS radio. We always refer to the diagnosis, not the patient, at this stage when there is no person to know, and when the focus is just how to keep the diagnosis alive. Seeing as I did not have much to offer as a mere intern, I stood around twiddling my gloved thumbs, waiting for the gunshot to arrive. Since there were no diet orders to change or social workers to talk to, my minimal intern skills would prove useless in this trauma setting, so I would be abl...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Mitochondrial Function in Astrocytes Is Essential for Normal Emergence from Anesthesia in Mice
Editor ’s PerspectiveWhat We Already Know about This TopicIn mice, restriction of loss of the mitochondrial complex I geneNdufs4 to glutamatergic neurons confers a profound hypersensitivity to volatile anesthetics.Astrocytes are crucial to glutamatergic synapse functioning during excitatory transmission.What This Article Tells Us That Is NewIn a tamoxifen-activated astrocyte-specificNdufs4(KO) mouse, the induction EC50s for tail clamp in both isoflurane and halothane were similar between the control and astrocyte-specificNdufs4(KO) mice at 3 weeks after 4-hydroxy tamoxifen injection. However, the emergent concentrati...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest
Editor ’s PerspectiveWhat We Already Know about This TopicRapid response to witnessed, pulseless cardiac arrest is associated with increased survival.What This Article Tells Us That Is NewAssessment of witnessed, pulseless cardiac arrests occurring at 538 hospitals during a 9-yr period indicates that CPR did not occur immediately at 0  min in 5.7% of patients despite guidelines for instantaneous initiation. Delay in initiation of CPR was associated with significantly decreased survival.Time to initiation of CPR and subsequent time to initiation of administration of defibrillation shock (for shockable arrhythmi...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Acute Fatty Liver of Pregnancy Pathophysiology, Anesthetic Implications, and Obstetrical Management
Acute fatty liver of pregnancy is a potentially morbid obstetric complication characterized by acute hepatic failure secondary to fatty infiltration of the liver. The resultant effects include coagulopathy, electrolyte abnormalities, and multisystem organ dysfunction. Management of this condition requires an anesthesiologist ’s understanding of both its pathophysiology and its obstetric impact for appropriate recognition and management. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

The American Society of Anesthesiologists Practice Parameter Methodology
The methodology used during the development of American Society of Anesthesiologists evidence-based practice parameters, from conceptualization through final adoption of the documents, is described. Features of the methodology include the literature search, review and analysis, survey development and application, and consolidation of the full body of evidence used for preparing clinical practice recommendations. Anticipated risks of bias, validation of the process, and the importance of the documents for clinical use are discussed. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 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 - February 12, 2019 Category: Anesthesiology Source Type: research

From Two Lungs to One: Optimizing Ventilation
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Never Mind Its Past Cocaine and Celery: Celerina ’s Alcohol “Treated” Alcoholism
Advertising its previously cocaine-laced panacea, Celerina, the Rio Chemical Company of St. Louis (and then New York City) released this ink blotter (upper panel) by 1916, promising that Celerina could still treat (lower panel) fatigue, infirmity, loss of energy, etc. The company may also have been reacting to the American Medical Association ’s blistering 1915 critique of Celerina’s vegetable cocktail (Cola, Viburnum, Celery, Ladyslipper, and Prickly Ash) as lacking “any recognizable activity.” As for treating “dipsomaniacs” with “84-proof” Celerina, the AMA exclaimed, &ldqu...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Etherist Crawford Long on a Cinderella Stamp
By founding the Cinderella Stamp Club (1959), editing their journalThe Cinderella Philatelist, and authoring their classic 152-page bookCinderella Stamps (1970), British brothers Leon and Maurice Williams popularized the collecting of stamp-like but nonpostal “emissions.” Philatelist James Mackay defined Cinderellas as “virtually anything resembling a postage stamp, but not issued for postal purposes by a government postal administration.” For anesthesiologists, one of the more interesting Cinderella stamps is this one (above) depicting the left profile of pioneering etherist Crawford W. Long, M.D. ...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research