Olanzapine for the Prevention of Postdischarge Nausea and Vomiting after Ambulatory Surgery A Randomized Controlled Trial
Conclusions When combined with ondansetron and dexamethasone, the addition of olanzapine relative to placebo decreased the risk of nausea and/or vomiting in the 24 hafter discharge from ambulatory surgery by about 60% with a slight increase in reported sedation.Editor ’s PerspectiveWhat We Already Know about This TopicNausea and vomiting after discharge from ambulatory surgery remains common despite use of current antiemetics.What This Article Tells Us That Is NewThe authors randomized women having day surgery to olanzapine 10  mg or placebo. All were also given both dexamethasone and ondansetron.Olanzapine re...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Local Sympathectomy Promotes Anti-inflammatory Responses and Relief of Paclitaxel-induced Mechanical and Cold Allodynia in Mice
Conclusions Local sympathetic nerves control the progression of immune responses in dorsal root ganglia and pain-like behaviors in mice after paclitaxel, raising the possibility that clinical strategies already in use for local sympathetic blockade may also offer an effective treatment for patients experiencing chemotherapy-induced neuropathic pain.Editor ’s PerspectiveWhat We Already Know about This TopicChemotherapy-induced neuropathic pain is a common and difficult-to-treat problemInflammation may support chemotherapy-induced pain by interacting with sensory neuronsWhat This Article Tells Us That Is NewLocal surgi...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Persistent Postoperative Opioid Use A Systematic Literature Search of Definitions and Population-based Cohort Study
Conclusions The incidence of persistent opioid use reported after surgery varies more than 100-fold depending on the definition used. Definitions varied markedly in their sensitivity for identifying adverse opioid-related event, with low sensitivity overall across measures.Editor ’s PerspectiveWhat We Already Know about This TopicPersistent opioid use after surgery is a matter of great concernDefining appropriate opioid prescribing practices and policies depends critically on understanding the rate of and reasons for persistent postoperative opioid useWhat This Article Tells Us That Is NewA systematic search of the l...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Radial Artery Cannulation in Young Children: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Radial Artery Cannulation in Young Children: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Persistent Postoperative Opioid Use Perception, Progress, and Promise
“We cannot begin to understand or even study … persistent postoperative opioid use until we can agree on the definition, use common terminology, and even decide if or whether it is a problem.” (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Intrathecal Morphine versus Intrathecal Hydromorphone for Analgesia after Cesarean Delivery A Randomized Clinical Trial
Conclusions Although the hypothesis was that intrathecal morphine would provide superior analgesia to intrathecal hydromorphone, the results did not confirm this. At the doses studied, both intrathecal morphine and intrathecal hydromorphone provide effective postcesarean analgesia when combined with a multimodal analgesia regimen.Editor ’s PerspectiveWhat We Already Know about This TopicIntrathecal opioids provide effective analgesia after cesarean delivery.Both intrathecal hydromorphone and morphine are now used in the context of multimodal postcesarean pain management plans, although little information regarding co...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

An Infant with Crouzon Syndrome Presenting with Reversible Chronic Airway Obstruction
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Effects of Cognitive Aid on Sugammadex Use: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Effect of Cognitive Aid on Sugammadex Use: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

On the Death of a Tooth
We have been together my lower left canine and I (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Lumbar Puncture
Present your spine to the resident (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery: A Multicenter Randomized Trial: Erratum
The authors of an article published in the April 2020 issue, “Subomohyoid Anterior Suprascapular Blockversus Interscalene Block for Arthroscopic Shoulder Surgery: A Multicenter Randomized Trial, ”1 note two errors in their published article and present below the relevant corrections. (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Pectoralis-II Myofascial Block and Analgesia: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Pectoralis-II Myofascial Block and Analgesia: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER) A Multicenter Matched Cohort Analysis
Conclusions Among a generalizable cohort of adult patients undergoing inpatient surgery at U.S. hospitals, the use of sugammadex was associated with a clinically and statistically significant lower incidence of major pulmonary complications.Editor ’s PerspectiveWhat We Already Know about This TopicApproximately 5% of patients experience a major pulmonary complication after noncardiac surgeryInadequate reversal of neuromuscular blockade increases the risk of pulmonary complicationsIn the United States, sugammadex is used with similar frequency as neostigmine at many hospitalsSugammadex provides more rapid and effectiv...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Lung-protective Ventilation in Cardiac Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Lung-protective Ventilation in Cardiac Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Sugammadex and Postoperative Pulmonary Complications Is Stronger Evidence Required?
“…choosing sugammadex in combination with quantitative neuromuscular monitoring with the intent of reducing the risk of postoperative pulmonary complication is justifiable.” (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Minimal Clinically Important Difference, Maximum Impact
“When selecting a patient-centered outcome…for a large clinical trial…, we must agree what a clinically meaningful difference is.” (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Neurally Adjusted Ventilatory Assist in Difficult Weaning Promising Findings on a Prickly Issue
“…neurally adjusted ventilatory assist may become the preferred mode of mechanical ventilation in difficult-to-wean patients.” (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

COVID-19: A Preparation Guide for Anesthesiologists
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Benjamin Harrison Awakens a Navy Anesthetized by America ’s Apathy and Complacency
Union victories at sea during America ’s Civil War were followed by three decades of financial neglect of the United States Navy. Apathy and Complacency combined as powerful anesthetics to naval funding by six consecutive presidential administrations. When a seventh president, Benjamin Harrison (1833 to 1901; U.S. president, 1889 to 1 993), finally championed modernizing the U.S. Navy, he was featured gallantly in 1891 byJudge on one of that satirical magazine ’s cover pictorials. On a rocky outcropping dated “1861,” a drowsy sailor is identified as a “U.S. Marine” (upper right). A pair ...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Shadowing the Abbess: Wood Library-Museum Exhibit Designer John Byrne and His “Superior” Spouse
Son of the cryptographer behind the unsolvable secret code, Chaocipher (1918), John Francis Byrne, Jr. (1929 to 2008,upper left), designed window dressing for Manhattan department stores. When he designed to marry Broadway soprano Patricia “Pat” Neway, John observed wrily that he was also marrying a Mother Superior. Indeed Pat was the 1960 Tony Award winning singer, whose character, the Mother Abbess (lower left), had sung “Climb Ev’ry Mountain” in the originalSound of Music. After resonating as an operatic singer, she retired to acting as a sounding board for John ’s exhibit designs. Us...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Alypin: An Antithetical Anesthetic
The name of alypin, a local anesthetic synthesized in 1905 as a substitute for cocaine, derived from the Greek wordalypeo, meaning “free from pain.” Touted as cheaper, safer, and easier to sterilize than cocaine, alypin gained popularity in ophthalmology, otolaryngology, and dentistry. In spite of its etymology, however, alypin was not quite pain free. Infiltration could be caustic, triggering tissue injury. Oral administra tion left a bitter taste; surplus nasolacrimal drainage from alypin eye drops was thus unpalatable. While alypin, unlike cocaine, did not cause mydriasis, it could still irritate the cornea,...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Byline Backstory No. 5: Physic(k)al Pursuits at Ursinus with Mauchly ’s Skateboard, Snyder’s Unicycle…and Einstein’s Bike?
At Pennsylvania ’s Ursinus College, Professor John W. Mauchly, Ph.D. (1907 to 1980,upper left), often taught physics classes from his jet-propelled skateboard. While tinkering with computing components, he had hoped to record and analyze mountains of meteorologic data to, someday, forecast the weather. (After moving to the University of Pennsylvania, Mauchly would invent the ENIAC, the first general purpose computer.) One of Mauchly ’s successors as chair of physics at Ursinus was Manhattan Project scientist Evan S. Snyder, Ph.D. (1923 to 2009,lower left). Rather than a skateboard, Dr. Snyder rode a unicycle to...
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction A Retrospective Cohort Study
Conclusions In adults recovering from noncardiac surgery, even small postoperative increases in plasma creatinine, corresponding to stage I kidney injury, are associated with renal dysfunction 1 to 2 yr after surgery. Even mild postoperative renal injury should therefore be considered a clinically important perioperative outcome.Editor ’s PerspectiveWhat We Already Know about This TopicPerioperative acute kidney injury is commonIt is unclear whether this merely represents a transient increase in creatinine or has prognostic valueWhat This Article Tells Us That Is NewPatients with mild postoperative kidney injury (sta...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Massive Facial Plexiform Neurofibromatosis Anesthetic Concerns
(Source: Anesthesiology)
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation
Patients with sepsis commonly require invasive procedures and frequently have an associated coagulopathy.1 In a recent observational survey conducted in Japan, among 1,895 patients with sepsis treated in intensive care units, 29% were diagnosed with sepsis-induced coagulopathy, a term that is synonymous with disseminated intravascular coagulation (DIC) as defined by laboratory criteria.2 In patients with sepsis, the imbalance in clot generation (coagulation) and clot breakdown (fibrinolysis) is a pivotal response that occurs due to host defense mechanisms but is associated with the development of organ dysfunction.3,4 In a...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

A Central Amygdala –Ventrolateral Periaqueductal Gray Matter Pathway for Pain in a Mouse Model of Depression-like Behavior
Background The mechanisms underlying depression-associated pain remain poorly understood. Using a mouse model of depression, the authors hypothesized that the central amygdala –periaqueductal gray circuitry is involved in pathologic nociception associated with depressive states.Methods The authors used chronic restraint stress to create a mouse model of nociception with depressive-like behaviors. They then used retrograde tracing strategies to dissect the pathway from the central nucleus of the amygdala to the ventrolateral periaqueductal gray. The authors performed optogenetic and chemogenetic experiments to manipul...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Cervical Lymphadenopathy Masquerading as the Interscalene View of the Brachial Plexus
(Source: Anesthesiology)
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Countering Opioid-induced Respiratory Depression in Male Rats with Nicotinic Acetylcholine Receptor Partial Agonists Varenicline and ABT 594
Background Opioids can induce significant respiratory depression when administered as analgesics for the treatment of acute, postoperative, and chronic pain. There are currently no pharmacologic means of reversing opioid-induced respiratory depression without interfering with analgesia. Further, there is a growing epidemic of opioid overdose that could benefit from therapeutic advancements. The aim of this study was to test the ability of two partial agonists of α4β2 nicotinic acetylcholine receptors, varenicline (used clinically for smoking cessation) and ABT 594 (tebanicline, developed as an analgesic), to red...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Multimodal Analgesic Regimen for Spine Surgery A Randomized Placebo-controlled Trial
Conclusions An analgesic pathway based on preoperative acetaminophen and gabapentin, combined with intraoperative infusions of lidocaine and ketamine, did not improve recovery in patients who had multilevel spine surgery.Editor ’s PerspectiveWhat We Already Know about This TopicMultimodal analgesia is a strongly advocated approach for perioperative pain managementMultimodal analgesia has not been carefully evaluated for spine surgeryWhat This Article Tells Us That Is NewAdult spine surgery patients were randomized to placebo or to the combination of acetaminophen, gabapentin, ketamine, and lidocaineThe Quality of Rec...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Ventilatory Mechanics in the Patient with Obesity
Obesity is a pathologic increase in the body adipose tissue that is associated with an augmented incidence of chronic health-threatening conditions, such as diabetes, cardiovascular diseases, and cancer.1 In 2015, 12% of the world adult population and 5% of the world pediatric population were obese, with the highest prevalence among women aged 60 to 64 yr living in high-income countries.2 Since 1980, the incidence of obesity has globally increased across all age classes and sociodemographic levels.2 The higher rates of this increase were observed among children. In the United States, one of the countries most affected by t...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Glottic Web An Abnormal Cry for Help
(Source: Anesthesiology)
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use
Background Zygapophyseal (facet) joint interventions are the second most common interventional procedure in pain medicine. Opioid exposure after surgery is a significant risk factor for chronic opioid use. The aim of this study was to determine the incidence of new persistent use of opioids after lumbar facet radiofrequency ablation and to assess the effect of postprocedural opioid prescribing on the development of new persistent opioid use.Methods The authors conducted a retrospective cohort study using claims from the Clinformatics Data Mart Database (OptumInsight, USA) to identify opioid-na ïve patients between 18 ...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Measuring Childbirth Outcomes: Comment
(Source: Anesthesiology)
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Measuring Childbirth Outcomes: Reply
(Source: Anesthesiology)
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Machine Learning Prediction of Postoperative Emergency Department Hospital Readmission
Conclusions A machine learning approach to predicting postoperative readmission can produce hospital-specific models for accurately predicting 30-day readmissionsvia the emergency department. Moreover, these predictions can be confidently calculated at 36 h after surgery without consideration of discharge-level data.Editor ’s PerspectiveWhat We Already Know about This TopicUnplanned hospital readmissions are a focus of quality improvement, national benchmarking, and payment incentives in the United StatesThe accuracy of commonly used peer-reviewed readmission prediction algorithms at specific hospitals may be limited...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Comparison of Neonatal and Adult Fibrin Clot Properties between Porcine and Human Plasma
Conclusions The authors identified similar age-related patterns in structure, mechanical, and degradation properties between adults and neonates in porcine and human samples. These findings suggest that piglets are an appropriate preclinical model of neonatal coagulopathy. The authors also show the feasibility ofin vitro model application through analysis of novel hemostatic therapies as applied to dilute neonatal porcine plasma.Editor ’s PerspectiveWhat We Already Know about This TopicNeonatal fibrinogen exists in a fetal form until maturation and is structurally and functionally distinct from adult fibrinogenReplac...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Insights into the Chemical Discovery of Remifentanil
Design, Synthesis, and Pharmacological Evaluation of Ultrashort- to Long-acting Opioid Analgetics. By Feldman PL, James MK, Brackeen MF, Bilotta JM, Schuster SV, Lahey AP, Lutz MW, Johnson MR, Leighton HJ. J Med Chem 1991; 34:2202-8. Copyright 1991 American Chemical Society. Reprinted with permission. In an effort to discover a potent ultrashort-acting µ-opioid analgetic that is capable of metabolizing to an inactive species independent of hepatic function, several classes of 4-anilidopiperidine analgetics were synthesized and evaluated. One series of compounds displayed potent µ-opioid agonist activity with a ...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research

Source-level Cortical Power Changes for Xenon and Nitrous Oxide –induced Reductions in Consciousness in Healthy Male Volunteers
Background Investigations of the electrophysiology of gaseous anesthetics xenon and nitrous oxide are limited revealing inconsistent frequency-dependent alterations in spectral power and functional connectivity. Here, the authors describe the effects of sedative, equivalent, stepwise levels of xenon and nitrous oxide administration on oscillatory source power using a crossover design to investigate shared and disparate mechanisms of gaseous xenon and nitrous oxide anesthesia.Methods Twenty-one healthy males underwent simultaneous magnetoencephalography and electroencephalography recordings. In separate sessions, sedative, ...
Source: Anesthesiology - April 15, 2020 Category: Anesthesiology Source Type: research