In Reply
We thank Dr. Grocott for his interest in our publication and for raising an important question regarding the beneficial effects of cerebrospinal fluid (CSF) drainage during aortic aneurysm repairs to protect the spinal cord: Is it a common practice or standard of care? (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Micro Air Bubble in Psoas Muscle Is It Psoas Muscle Abscess or Nerve Block?
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

In Reply
We appreciate Dr. Asakura for his interest in our recent article titled “Enhanced Needle Visibility by Micro Air Bubble in Ultrasound-guided Nerve Block”1 published in Anesthesiology this year. (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Clinical Anesthesia, 8th edition
I was truly excited when given the opportunity to reviewClinical Anesthesia, 8th edition. As a program director and die-hard educator, I like to take the opportunity to review the resources available to my learners to make informed recommendations, plus I was due for an upgrade of my reference library! (Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Call for Papers and Abstracts 28th Annual Anesthesiology Journal Symposium: What ’s New in the Old?
(Source: Anesthesiology)
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

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

Survey Research
SUMMARY Surveys provide evidence on practice, attitudes, and knowledge. However, conducting good survey research is harder than it looks. The authors aim to provide guidance to both researchers and readers in conducting and interpreting survey research. Like all research, surveys should have clear research question(s) using the smallest possible number of high-quality, essential, survey questions (items) that will interest the target population. Both researchers and readers should put themselves in the position of the respondents. The survey questions should provide reproducible results (reliable), measure what they are su...
Source: Anesthesiology - January 25, 2019 Category: Anesthesiology Source Type: research

Why Money Alone Can ’t (Always) “Nudge” Physicians The Role of Behavioral Economics in the Design of Physician Incentives
Behavioral economics seeks to define how humans respond to incentives, how to maximize desired behavioral change, and how to avoid perverse negative impacts on work effort. Relatively new in their application to physician behavior, behavioral economic principles have primarily been used to construct optimized financial incentives. This review introduces and evaluates the essential components of building successful financial incentive programs for physicians, adhering to the principles of behavioral economics. Referencing conceptual publications, observational studies, and the relatively sparse controlled studies, the autho...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Images in Anesthesiology: Pulmonary Thromboembolism
Acute pulmonary embolism is a life-threatening event. The most frequent source of pulmonary embolism is iliofemoral deep venous thrombosis, shown in the femoral vein sonogram, as an echogenic density within the lumen with no intraluminal flow (arrow in imageA). Supplemental Digital Content 1 (http://links.lww.com/ALN/B780) shows significant emboli occluding the right upper and middle lobe pulmonary arteries with near complete lack of perfusion of these two lobes (arrows in imageB) on a pulmonary angiogram, a gold standard test for detecting pulmonary embolism. Supplemental Digital Content 2 (http://links.lww.com/ALN/B781) ...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Repair of a Giant Ascending Aortic Pseudoaneurysm Requiring Awake Institution of Cardiopulmonary Bypass
Ascending aortic pseudoaneurysms represent a unique and infrequent complication after type A dissection repair.1 Massive aortic pseu doaneurysms can pre sent as a large suprasternal pulsating mass with tracheal deviation as shown (left andright panels). Contrast-enhanced computerized tomography (right panel) demonstrates a 10  × 6.2 × 13.4–cm pseudoaneurysm caused by mycotic infection of the aortic graft at the area of anastomosis from a type A dissection repair 3 yr before. Perioperative anesthetic considerations include extrinsic compression of surrounding structures, includi...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Double-chambered Right Ventricle
Double-chambered right ventricle is diagnosed with transesophageal or transthoracic echocardiography by the presence of a high-pressure proximal region under the tricuspid valve and a low-pressure distal region near the pulmonary valve with high-velocity, turbulent flow created by anomalous muscle bands in the right ventricular outflow tract (image panelsA andB; PA, pulmonary artery; RV, right ventricle; RVOT, right ventricular outflow tract). The midesophageal right ventricular inflow –outflow view shows classic right ventricular outflow tract obstruction from anomalous muscle narrowing the outflow to a diameter of ...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Pneumoperitoneum after Cardiopulmonary Resuscitation
A 71-yr-old female with a complicated medical history, most notable for laryngeal stenosis, was transferred from an outside hospital after an emergent cricothyroidotomy during cardiopulmonary resuscitation. Upon her arrival to our hospital, a chest tube was inserted for suspected tension pneumothorax in the setting of hemodynamic instability. Chest x-ray film demonstrated free air under right hemidiaphragm (red arrow in left panel). Follow-up axial and coronal cuts of computed tomography of the chest and abdomen revealed moderate-sized pneumoperitoneum (red arrows in right panel) without any obvious abdominal visceral inju...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Identifying and Treating Opioid Side Effects The Development of Methylnaltrexone
Methylnaltrexone Reverses Chronic Opioid-induced Constipation: A Randomized, Controlled Trial. By Yuan CS, Foss JF, O ’Connor M, Osinski J, Karrison T, Moss J, Roizen MF. JAMA 2000; 130:142–8. Reprinted with permission.Context Constipation is the most common chronic adverse effect of opioid pain medications in patients who require long-term opioid administration, such as patients with advanced cancer, but conventional measures for ameliorating constipation often are insufficient.Objective To evaluate the efficacy of methylnaltrexone, the first peripheral opioid receptor antagonist, in treating chronic methadone...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Positive End-expiratory Pressure and Mechanical Power
This study aimed at investigating the effects of increasing mechanical power by selectively modifying its positive end-expiratory pressure component.Methods Thirty-six healthy piglets (23.3  ± 2.3 kg) were ventilated prone for 50 h at 30 breaths/min and with a tidal volume equal to functional residual capacity. Positive end-expiratory pressure levels (0, 4, 7, 11, 14, and 18 cm H2O) were applied to six groups of six animals. Respiratory, gas exchange, and hemodynamic variables were recorded every 6  h. Lung weight and wet-to-dry ratio were measured, and histologic samples we...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Triple-low Alerts Do Not Reduce Mortality A Real-time Randomized Trial
This study tested the hypothesis that providing triple-low alerts to clinicians reduces 90-day mortality.Methods Adults having noncardiac surgery with volatile anesthesia and Bispectral Index monitoring were electronically screened for triple-low events. Patients having triple-low events were randomized in real time, with clinicians either receiving an alert, “consider hemodynamic support,” or not. Patients were blinded to treatment. Helpful responses to triple-low events were defined by administration of a vasopressor within 5 min or a 20% reduction in end-tidal volatile anesthetic concentration within ...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Activation of Parabrachial Nucleus Glutamatergic Neurons Accelerates Reanimation from Sevoflurane Anesthesia in Mice
Conclusions Activation of PBN glutamatergic neurons is helpful to accelerate the transition from general anesthesia to an arousal state, which may provide a new strategy in shortening the recovery time after sevoflurane anesthesia. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Cognitive Effects of Perioperative Pregabalin Secondary Exploratory Analysis of a Randomized Placebo-controlled Study
Conclusions Perioperative pregabalin significantly negatively affected subdomains of executive functioning, including inhibition, and working memory compared to placebo, whereas psychomotor speed was not changed. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery A Randomized Dose-finding Trial
Conclusions Both the 0.050- μg · kg-1· min-1 and 0.075- μg · kg-1· min-1 norepinephrine infusion rates effectively reduced postspinal hypotension during cesarean delivery compared with the 0.025- μg · kg-1· min-1 infusion rate. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy A Systematic Review and Meta-analysis
Conclusions Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery A Retrospective Cohort Study
Conclusions The authors found no association between type of anesthesia used and the long-term prognosis of breast cancer. The results of this retrospective cohort study do not suggest specific selection of IV or inhalation anesthesia for breast cancer surgery. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Blood Pressure and End-tidal Carbon Dioxide Ranges during Aneurysm Occlusion and Neurologic Outcome after an Aneurysmal Subarachnoid Hemorrhage
EDITOR ’S PERSPECTIVEWhat We Already Know about This Topic It remains unknown what end-tidal carbon dioxide and mean arterial pressure are optimal for surgical management of patients with an aneurysmal subarachnoid hemorrhageWhat This Article Tells Us That Is New The investigators retrospectively evaluated 1,099 patients who had endovascular coiling or surgical clipping for subarachnoid hemorrhages There were no clinically important or statistical significant associations between either end-tidal carbon dioxide or mean arterial pressure thresholds and Glasgow Outcome Scale at discharge or three months Other prognosti...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Mechanical Power A Biomarker for the Lung?
“How can we determine when mechanical ventilation is harming the lung…?” (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Analgesic Effects of Hydromorphone versus Buprenorphine in Buprenorphine-maintained Individuals
Conclusions In this acute clinical pain model, high doses of IV hydromorphone (16 to 32  mg) were most effective in achieving analgesia but also displayed higher abuse liability and more frequent adverse events. Cold pressor testing was the most consistent measure of opioid-related analgesia. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Succinylcholine and Dantrolene Inseparable in the Emergency Cupboard?
“[Increased] patient safety is served by mandating that dantrolene be stocked where succinylcholine is available.” (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment Database Analyses and Systematic Review
Conclusions Providers use succinylcholine commonly, including during difficult mask ventilation. Succinylcholine administered without volatile anesthetics may trigger MH events requiring dantrolene. Delayed dantrolene treatment increases the likelihood of MH complications. The data reported herein support stocking dantrolene wherever succinylcholine or volatile anesthetics may be used. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019 An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss, the North American Neuro-Ophthalmology Society, and the Society for Neuroscience in Anesthesiology and Critical Care *
Practice advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories provide a synthesis of scientific literature and analysis of expert opinion, clinical feasibility data, open forum commentary, and consensus surveys. Practice advisories developed by the American Society of Anesthesiologists (ASA) are not intended as standards, guidelines, or absolute requirements, and their use cannot guarantee any specific outcome. They may be adopted, modified, or rejected according to clinical needs and constraints, and they are not intended to replace local institut...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Anesthesia and Cancer Recurrence Context for Divergent Study Outcomes
“…to the extent that propofol–total intravenous anesthesia reduces cancer recurrence … benefit is most probable in patients having major cancer surgery.” (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Visitor
Corridors like desolate arteries, signs declare (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Trusted Evidence: Discovery to Practice
“What is the value proposition of Anesthesiology?…Trusted Evidence: Discovery to Practice. ” (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Winner Announced The Letheon 2 nd Annual Creative Writing Competition
The Editor-in-Chief and the Mind to Mind editor are pleased to announce the winner of our second annual creative writing competition: (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Operation Cancer Resection: Does Anesthetic Approach Matter?
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

The Patent Trail from Etherist W. T. G. Morton to Laughing-Gas Pioneer G. Q. Colton
In 1849 by marrying Elizabeth, sister of ether patentee W. T. G. Morton, G. H. P. Flagg clinched a job the following year as his brother-in-law Morton ’s dental assistant. By 1861, still on Tremont Street some seven years after having left Morton’s office, Flagg had become senior partner of the Boston dental firm of “Flagg& Osgood ” (upper advertisement). In 1864 his junior partner ’s brother, James, patented the thermoregulating nitrous-oxide generators modified by A. W. Sprague for G. Q. Colton’s use throughout the United States and over in Europe. As implied by his 1868 testimonia...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Laughing “Gas Administered”: A Deathbed Blotter from Bucharest’s Horace David
Two years after Bucharest became a capital city, a nearly 4-yr-old Horace S. David arrived in 1883 at the Port of New York as a Romanian immigrant. A decade later, after moving from state to state, his family settled finally in New York. Three years after earning his D.D.S. from New York Dental School, Dr. David was naturalized in 1905 as a U.S. citizen. From the Wood Library-Museum ’s Ben Z. Swanson Collection, the ink blotter (above) advertised his services, including “Gas Administered.” Sadly, the blotter was issued by his Manhattan office just shortly before Dr. David passed away at 50 yr of age. (Cop...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Missouri ’s New York Dental Rooms: Advertising Laughing Gas in English and German
Although born in Philadelphia, Dr. Robert T. Sanders (1830 to 1898) spent most of his dental career in Missouri. In 1871 he began practicing dentistry in St. Louis under his trademark of “New York Dental Rooms.” As imprinted up the right side of this trade card’s obverse (left), his office was on Washington Street. He practiced at that location from 1875 to 1888, which helps in dating this trade card. Fluent in English and German, Dr. Sanders promised, for 50 cents, painless dental extractions either “with gas” or “von gas” (bothright). This made him particularly popular with the w...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Morphine, Cocaine, and the Euthanasia of King George V
In a 1924 contribution toLancet, Dr. F. G. Chandler extolled the value of “Cocaine in Euthanasia,” particularly for patients who were terminal with pulmonary tuberculosis. A dozen years later, British King George V (1865 to 1936,left) was terminally bronchitic, bedridden, and passing repeatedly in and out of consciousness. Shortly after 11pm on January 20, 1936, the Physician-in-Ordinary to the King administered a pair of lethal doses intravenously, to hasten the struggling monarch ’s demise. This regicide was only revealed a half century later in the diary of the euthanizer, Lord Dawson of Penn (1864 to ...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

From “Secret Preparation” to “Vitalized Air”: Doctored Nitrous Oxide
From the Wood Library-Museum ’s Ben Z. Swanson Collection, this Albany Dental Association trade card used vivid images of a bird and flowers, even in this wintry scene (left). With nearly twice the number of franchises of the pioneering Colton Dental Association, Albany Dental administered no “Colton gas” (nitrous oxide) to patients; rather, they used a proprietary “secret preparation” (right), as mentioned on the reverse of this card from the Reading, Pennsylvania, franchise. By 1891, newspaper advertising in Reading had revealed the secret branding as “vitalized air”—just n...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Anesthetic Powers?: Whiskey for Neonatal Surgery in 1934 Kansas City
On Friday, May 11, 1934, in Kansas City, Missouri, Mrs. Clara Powers (right) reluctantly permitted emergency surgery on her dehydrated baby boy. Sixteen-day-old Harold William Powers (left) had a palpable mass obstructing the passage of fluids through his stomach. After placing a small bag of sugar in the baby ’s mouth, an intern “dropped whisky on the sugar [bag] until the child fell into a stupor.” The surgeon’s local anesthetic supplemented the intern’s whiskey one, and a successful pyloromyotomy was performed. The Monday after the surgery, news headlines nationwide read mistakenly, “...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Association and Effect of Opioid Abuse —Related Readmission
(Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

In Reply
We thank Dr. Pivalizza for his insightful observations on our article.1 We agree that our work does not demonstrate a causal relationship between a history of opioid use and postsurgical readmission, and that our title mistakenly suggests that possibility. Because this study was observational, we expected many covariates to be differentially distributed between opioid abuse or dependence and non-opioid abuse or dependence groups. This relationship was indeed evident from table 2,1 where 29 out of 32 covariates had significantP values. However, we did not choose adjustment covariates based uponP values. We chose covariatesa...
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Waking Up Safer? An Anesthesiologist ’s Record
This author travelogue through modern anesthesia describes the arduous training of anesthesiologists and some momentous events in the development of the specialty, both of which have led to the sophistication of current practices and promises of an even safer future. The book contains historic vignettes, biopic stories, and science commentaries. Reading it is educational and entertaining. (Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Call for Papers and Abstracts 28th Annual A nesthesiology Journal Symposium: What ’s New in the Old?
(Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Announcements
(Source: Anesthesiology)
Source: Anesthesiology - December 19, 2018 Category: Anesthesiology Source Type: research

Acknowledgment
The Editor-in-Chief and the Editors of Anesthesiology would like to thank the following individuals for their participation in the editorial review process. Their contributions are sincerely appreciated. (Source: Anesthesiology)
Source: Anesthesiology - November 13, 2018 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - November 13, 2018 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - November 13, 2018 Category: Anesthesiology Source Type: research