Joining the Angels: Laughing-gas Advertising Divined by Dr. G. W. Chamberlain
An angel guides a young woman skyward (upper image) in this image from the obverse of a trade card from the Ben Z. Swanson Collection of the Wood Library-Museum. On the card ’s reverse, one box (lower) cites two of the weekdays that dental and “nitrous oxide gas” services would be provided at New Egypt, New Jersey, by George Whitehill Chamberlain, D.D.S. (1855 to 1905). In the early 1900s, understandably, most American physicians and dentists shied away from advertising death, dying, or the heavenly hereafter in any connection with th eir anesthetics. Could this 50-yr-old dentist have possibly been divini...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

The On-call Anesthesiologist: A Physiological Fireman?
Cosack& Company ’s 1881 image ofThe Fireman depicts a partially dressed rescuer prepared to leap out of bed —with his right foot planted on the floor and his right hand resting on his trouser-covered fire boots. Ready to launch from sleep at a moment’s notice, the fireman reminds me of the on-call anesthesiologist. Rather than extinguishing flames, the physician-anesthetist is prepared to battle the h eat of malignant hyperthermia. Whether racing off to command an airway or to administer unscheduled anesthetics for ambulanced traumas, “takeback” open-heart cases, or emergency C-sections, t...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Other Factors Affect the Occurrence of Perioperative Respiratory Adverse Events
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Improving External Validity May Jeopardize Internal Validity
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Is a Single Dose of Propofol Good Enough to Prevent Respiratory Complications beyond the Induction Phase?
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Does Intravenous versus Inhalational Induction of Anesthesia Only Decrease Perioperative Respiratory Events during the Induction Period?
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

In Reply
I appreciate the constructive comments of Nguyenet al. with regard to the recent trial published by Ramgolamet al.1 and the accompanying editorial inAnesthesiology.2 I certainly agree with the observation that the work station used may have an impact on how long an inhalational induction would take, and this may have an impact on the likelihood of complications during induction; however, in this case it transpires that the researchers did not use a Draeger Primus (Draeger, Germany) for induction but, as is common in Australia, used a separate anesthesia system with a back bar that connected to a T-piece where wash-in times...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

In Reply
We thank our international colleagues for their interest in our study, “Inhalationalversus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events: A Randomized Controlled Trial, ”1 and have summarized our responses as follows. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Opiates and IV Acetaminophen
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

When Large Administrative Databases Provide Less Relevant Information than Randomized Studies
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

In Reply
We welcome the thoughtful comments by Dr. Steadman and Riouet al., in reply to our study.1 We aimed to evaluate the use of IV acetaminophen and its association with outcomes including opioid utilization, opioid-related adverse effects, and cost and length of hospitalization. Dr. Steadman mentioned several limitations of our study —some justified (and mentioned in our study’s Limitations section) and some less so—and observational research in general. Dr. Steadman states that “A better study would be a randomized double-blinded one in which the only variable would be the use of IV acetaminophenversus...
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Experimental Controls in Lipid Resuscitation Therapy
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Metabolite Palmitoylcarnitine Mediates Intralipid Cardioprotection Rather Than Membrane Receptors
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

In Reply
We have carefully read the letters from Fettiplaceet al. and Zaugget al. regarding our paper1 and would like to respond to their comments. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Enhanced Recovery for Major Abdominopelvic Surgery
Over the last decade, enhanced recovery protocols have become common practice across the country at countless institutions. These protocols entail a multimodal approach to reduce the effects of surgical stress and improve outcomes.1 From a surgical standpoint, this includes the use of minimally invasive techniques and improved patient education before surgery. As anesthesiologists, this has affected the way that we must think aboutnon per os status, fluid therapy, and perioperative pain management. (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2019 Category: Anesthesiology Source Type: research

Caseous Calcification of the Mitral Annulus Mimic and Malady
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Images in Anesthesiology: Inadvertent Extracorporeal Membrane Oxygenation Cannulation across a Patent Foramen Ovale
Extracorporeal membrane oxygenation cannula malposition represents one of the most consequential complications from surgical placement, as demonstrated in the case of this 54-yr-old woman placed on venovenous extracorporeal membrane oxygenation because of primary graft dysfunction after bilateral lung transplantation and persistent hypoxemia. Chest radiograph (image A) demonstrates the position of the outflow cannula (19-French) —accessed through the right femoral vein—within the right atrium. The inflow cannula (21-French) was accessedvia the left femoral vein into the inferior vena cava in this patient. Trans...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Measuring Clinical Productivity of Anesthesiology Groups Surgical Anesthesia at the Facility Level
Benchmarking and comparing group productivity is an essential activity of data-driven management. For clinical anesthesiology, accomplishing this task is a daunting effort if meaningful conclusions are to be made. For anesthesiology groups, productivity must be done at the facility level in order to reduce some of the confounding factors. When industry or external comparisons are done, then the use of total ASA units per anesthetizing sites allows for overall productivity comparisons. Additional productivity components (total ASA units/h, h/case, h/operating room/d) allow for leaders to develop productivity dashboards. Wit...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Non –steady State Modeling of the Ventilatory Depressant Effect of Remifentanil in Awake Patients Experiencing Moderate-to-severe Obstructive Sleep Apnea
Editor ’s PerspectiveWhat We Already Know about This TopicPatients with obstructive sleep apnea are often said to have increased sensitivity to opioid-induced ventilatory depressionWhat This Article Tells Us That Is NewThe hypothesis that patients with moderate-to-severe obstructive sleep apnea are more sensitive to remifentanil-induced ventilatory depression was tested in 20 control patients with mild or no obstructive sleep apnea and 30 patients with moderate-to-severe obstructive sleep apnea, defined as an apnea/hypopnea index of 15 or more episodes per hour of sleepThe predicted remifentanil effect site concentra...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Sphygmomanometer for Invasive Blood Pressure Monitoring in a Medical Mission
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Aging and Relevance in Academic Medicine
How have 65 years passed in the blink of an eye? I have often written about my mentors, my respect for them, and how I held them in considerable awe. I think of how they stayed relevant through the years, even though they physically declined. I recall one of them telling me, “I stood where you are now, and you will stand where I am.” They understood my situation as a young physician climbing the ladder of position, practice, and scholarship, but I failed to understand their predicament, which is now mine: how to stay relevant as an aging academic physician. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Madelung ’s Disease and Airway Management
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery: Erratum
In the article “Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery” (Sun LY, Chung AM, Farkouh ME, van Diepen S, Weinberger J, Bourke M, Ruel M: Anesthesiology 2018; 129:440 –7), errors were discovered in two references. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Morphine Exacerbates Postfracture Nociceptive Sensitization, Functional Impairment, and Microglial Activation in Mice
Editor ’s PerspectiveWhat We Already Know about This TopicOpiates, including morphine, remain a key component in the management of postsurgical pain; however, perioperative use of opiates is associated with a slower resolution of pain and functional statusIt is possible that the delayed recovery attendant with the administration of morphine may be attributable to morphine-induced enhancement of neuroinflammationWhat This Article Tells Us That Is NewIn a mouse tibia fracture and intramedullary pinning model, injury-induced allodynia and neuroinflammation, in particular microglial activation, were significantly increas...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Low Incidence of Biphasic Allergic Reactions in Patients Admitted to Intensive Care after Anaphylaxis
Conclusions The authors observed a low incidence of biphasic reactions in patients admitted to an intensive care unit after anaphylaxis, at a rate equivalent to that reported in other patient groups. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Long-term Impact of Crystalloid versus Colloid Solutions on Renal Function and Disability-free Survival after Major Abdominal Surgery
Conclusions In patients undergoing major open abdominal surgery, there was no evidence of a statistically significant difference in long-term renal function between a balanced hydroxyethyl starch and a balanced crystalloid solution used as part of intraoperative goal-directed fluid therapy, although there was only limited power to rule out a clinically significant difference. However, disability-free survival was significantly higher in the colloid than in the crystalloid group. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Amisulpride for the Rescue Treatment of Postoperative Nausea or Vomiting in Patients Failing Prophylaxis A Randomized, Placebo-controlled Phase III Trial
Conclusions A single 10-mg dose of intravenous amisulpride was safe and more effective than placebo at treating established postoperative nausea or vomiting in patients failing postoperative nausea or vomiting prophylaxis. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome Insights from the LUNG SAFE Study
Conclusions Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Influence of Sex and Body Language on Patient Perceptions of Anesthesiologists
Editor ’s PerspectiveWhat We Know about This TopicPatient perception of physician competence may depend on physician sex and body languageWhat This Article Tells Us That Is NewActor anesthesiologists who maintained confident, high-power poses were considered smarter, more competent, more likely to be seen as leaders, and preferred by patients to care for a family memberSex of the actor did not alter perceptions of competenceBackground Patient perception of physician competence is important. The role of body language and physician sex on patient perceptions has not been investigated. The authors hypothesized that pati...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Pounds of Prevention but Only Ounces of Cure The Need for More Research on the Treatment of Postoperative Nausea and Vomiting
“...there is a lack of high- quality, randomized controlled trials of postoperative nausea and vomiting treatment, with or without preceding prophylaxis...” (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Heterogeneity in Intensive Care Low Severity Does Not Mean Low Risk!
“...[M]ild for a medical condition [like ARDS] severe enough to require intensive care unit admission may already signify severe in terms of outcome...” (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Quadratus Lumborum Block Anatomical Concepts, Mechanisms, and Techniques
The objective of this article is to review the relevant anatomy, potential mechanisms, approaches, and techniques and summarize the clinical evidence for quadratus lumborum block. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Nitric Oxide Donor Prevents Neonatal Isoflurane-induced Impairments in Synaptic Plasticity and Memory
Conclusions Early disruption of PDZ domain –mediated protein–protein interactions alters spine morphology, synaptic function, and memory. These results support a role for PDZ interactions in early anesthetic exposure–produced cognitive impairment. Prevention of recognition memory and long-term potentiation deficits with a NO donor supp orts a role for theN-methyl-d-aspartate receptor/PSD-95/neuronal NO synthase pathway in mediating these aspects of isoflurane-induced cognitive impairment. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Where ’s the Beef? How Much Can We Skimp on Pharmacokinetic–Pharmacodynamic Data?
“We should be very cautious drawing conclusions in the language of pharmacokinetic–pharmacodynamics when there are no drug concentration (pharmacokinetic) data.” (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function: A Randomized Clinical Trial: Erratum
In the article “Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function: A Randomized Clinical Trial” (Ederoth P, Dardashti A, Grins E, Brondén B, Metzsch C, Erdling A, Nozohoor S, Mokhtari A, Hansson MJ, Elmér E, Algotsson L, Jovinge S, Bjursten H: Anesthesiology 2018; 128:710 –7), there is an error in figures 3 and 4. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Anesthesiologist Specialization and Use of General Anesthesia for Cesarean Delivery
Editor ’s PerspectiveWhat We Already Know about This TopicObstetric specialty societies recommend neuraxial anesthesia, when possible, for cesarean deliveryCurrent data regarding the association of obstetric anesthesiologist specialization and use of general anesthesia for cesarean delivery remain lackingWhat This Manuscript Tells Us That Is NewMaternal and provider factors are strongly associated with use of general anesthesia for cesarean deliveryPatients receiving care from obstetric-specialized anesthesiologists are 29% less likely to receive general anesthesia for cesarean deliveryBackground Guidelines for obste...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Adverbs of the Heart
Tucked in a pocket (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Understanding Research Methods and the Readers ’ Toolbox: A New Article Type
“Understanding Research Methods articles are written for nonexperts who want to understand not only the ‘what’ of journal content but also the ‘how’ by which it was obtained...” (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 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 - January 25, 2019 Category: Anesthesiology Source Type: research

Obstructive Sleep Apnea and Opioid-Induced Respiratory Depression: What do we know?
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Hazard a Swig? The Coca Wine of the Hazards
As “Family and Dispensing Chemists,” the Hazard family distributed an advertising card (left) for Coca Wine, a mixture of the cocaine from coca leaves (upper right) with wine. From their offices in Rhode Island and New York, the Hazards ’ “Erythroxylon Coca” was labeled (lower right) as “An agreeable Stimulant& Tonic for the Brain Nerves and Stomach. ” Adults were directed to drink a “Wineglass Full at or after Meals” and “Children one Half the dose.” Laced with cocaine, such wines and subsequent carbonated beverages became so socially available that coc...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Capsicum Drafts Could Not Relieve Ricksecker ’s Pain of Bankruptcy
Born and raised in Ohio, Theodore Ricksecker (1846 to 1919) moved to Manhattan and began working in 1863 as a drugstore clerk before partnering with a seasoned druggist. Moving on as a solo businessman in 1876 to William Street, Ricksecker confined his wares to perfumes, toiletries, and Capsicum Drafts that he began advertising as “French’s” (above) and rapidly renamed as “Ricksecker’s.” The Capsicum Drafts were dry pads impregnated with chili pepper extract (capsaicin) that chemically warmed up once sprinkled with water. By applying this counterirritant near a painful site, the Drafts b...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Pointers on Dating Lennox ’s Laughing Gas Advertising
From Cleveland, Ohio, the Lennox Chemical Company printed a sunburst logo (right) on the firm ’s advertising cards informing clinicians (upper left) about the “use of nitrous oxid and oxygen.” Since the “oxid” spelling was largely abandoned by the mid-1920s, when was the earliest such a card might have been printed? By 1917 the Lennox Chemical Company was operated by the firm listed on this card in fine print, the Bishop-Babcock-Becker Company (BB B). Curiously, BBB was directory-listed as a manufacturer of “Nitrous Oxide and Oxygen, Carbonic Acid Gas, Epsom Salts and Soda Water Flavors....
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Headlining the Musical Backdrop to Pauline Siegel ’s Caesarean Section “Under Local Anesthesia”
Allen and Pauline Siegel of Chicago, Illinois, seem elated in 1941 following the successful Caesarean-section delivery of their son by obstetrician Edward L. Cornell, as performed “under local anesthesia.” During the procedure, the 29-yr-old mother listened to soothing frequency-modulated (FM) radio music. Her obstetrician insisted on keeping the “pain-calmer” music “from distracting the operating staff.” Seventy-seven years ago, this story made newspaper headline s nationwide. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.) (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Would Chest Compressions from 57 Rescuers Save Albert Frick from Landry ’s Paralysis?
Four days after undergoing two dental extractions, 22-yr-old Albert R. Frick (1904 to 1927) found himself hospitalized in a wheelchair as first his legs weakened and then his diaphragm became completely flaccid from acute ascending or Landry ’s paralysis, now better known as Guillain-Barré syndrome. For 4 days in St. Francis Hospital, Evanston, Illinois, Frick’s employer (far right), Frick ’s father (next to the employer), and scores of friends and coworkers toiled in pairs to rhythmically compress and release Frick ’s chest. Finally, at 10:02pm on Thursday, March 10, 1927, Albert Frick was p...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Lumbar Cerebrospinal Fluid Drains for Thoracic Endovascular Aneurysm Repair Common Practice or Standard of Care?
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research