Management
One of the gloves tore when he stripped them off, and the hair on his forearms was speckled with blood up to the line of the cuffs. He pedaled the sink into life and then scrubbed and rinsed, leaning over so the water would fall away from the wrists and sluice down to the elbow. The desire to scream was still there: pressure just behind the nose and throat but fading. During intense stress he was most aware of himself separating into layers. Fear flattened the mind, but urgency unfolded it, so all the pieces were laid out to use. (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Intrathecal Morphine and Pulmonary Complications after Arthroplasty in Patients with Obstructive Sleep Apnea A Retrospective Cohort Study
Conclusions Low-dose intrathecal morphine, in conjunction with multimodal analgesia, was not reliably associated with postoperative pulmonary complications in patients with obstructive sleep apnea undergoing joint arthroplasty.Editor ’s PerspectiveWhat We Already Know about This TopicIntrathecal morphine is commonly and effectively used for analgesia after joint arthroplasty, but has been associated with postoperative pulmonary complications such as delayed respiratory depressionPatients with obstructive sleep apnea may be at higher risk of these complications, especially if intrathecal morphine is used for analgesia...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Dexamethasone Dose and Early Postoperative Recovery after Mastectomy A Double-blind, Randomized Trial
Conclusions The authors found no evidence of 24 mgversus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.Editor ’s PerspectiveWhat We Already Know about This TopicDexamethasone is an effective antiemetic and may facilitate initial postoperative recovery after mastectomyWhether 24  mg is more effective than 8 mg remains unknownWhat This Article Tells Us That Is NewDexamethasone (24  mg) did not increase the number of patients eligible to skip the po...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Supraspinal Opioid Circuits Differentially Modulate Spinal Neuronal Responses in Neuropathic Rats
This study utilizedin vivo electrophysiology to determine the effects of morphine microinjection into the anterior cingulate cortex, right or left central nucleus of the amygdala, or the rostral ventromedial medulla on spinal wide dynamic range neuronal responses in isoflurane-anesthetized, male Sprague –Dawley rats. Ongoing activity in the ventrobasal thalamus was also measured. In total, 33 spinal nerve ligated and 26 control age- and weight-matched control rats were used.Results Brainstem morphine reduced neuronal firing to 60-g von Frey stimulation in control rats (to 65 ± 12% of control response (means ± 95% CI),P
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Ultrasound to Detect Central Venous Catheter Placement Associated Complications A Multicenter Diagnostic Accuracy Study
Conclusions This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax.Editor ’s PerspectiveWhat We Already Know about This TopicCatheter malposition and pneumothorax are known complications of central line placement. Earlier recognition of these complications can lead to reduced morbidity and mortality. Chest x-ray film...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Saline versus Lactated Ringer ’s Solution The Saline or Lactated Ringer’s (SOLAR) Trial
Conclusions In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer ’s or saline volume replacement. Clinicians can reasonably use either solution intraoperatively.Editor ’s PerspectiveWhat We Already Know about This TopicInfusion of large volumes of saline causes hyperchloremic metabolic acidosisA recent Cochrane review based on 18 small trials reported that major morbidity and mortality were comparable with perioperative saline or lactated Ringer ’s useWhat This Article Tells Us That Is NewIn a large single...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery A Multicenter Randomized Trial
Conclusions The suprascapular block was noninferior to interscalene block with respect to improvement of postoperative pain control, and also for blockade of the superior trunk. These findings suggest that the suprascapular block consistently blocks the superior trunk and qualify it as an effective interscalene block alternative.Editor ’s PerspectiveWhat We Already Know about This TopicInterscalene brachial plexus block is a commonly used procedure for shoulder surgery, but it can be associated with important complicationsWhat This Article Tells Us That Is NewSubomohyoid anterior suprascapular block is noninferior to...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Physiologic Effects of Pulmonary Artery Occlusion: Comment
(Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Physiologic Effects of Pulmonary Artery Occlusion: Reply
(Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks A Randomized Clinical Trial
Background The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the newversus traditional catheter design in the first two days after painful foot/ankle surgery...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Prevention and Prediction of Postsurgical Pain: Reply
(Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Prevention and Prediction of Postsurgical Pain: Comment
(Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Anesthetic Implications of Button Battery Ingestion in Children
Foreign body ingestion is common in young children (those less than 5 yr of age).1,2 Most ingested items pass uneventfully through the gastrointestinal tract, but certain items may prove dangerous due to their size, composition, or location.3,4 The following Clinical Focus Review discusses the increasingly common problem of button battery ingestion, which, when left untreated can rapidly result in life-threatening complications, particularly in young children. The definitive management requires prompt recognition and endoscopic removal of batteries, often necessitating the use of general anesthesia. Awareness of the potent...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Aldosterone Synthase in Peripheral Sensory Neurons Contributes to Mechanical Hypersensitivity during Local Inflammation in Rats
Conclusions Local production of aldosterone by its processing enzyme aldosterone synthase within peripheral sensory neurons contributes to ongoing mechanical hypersensitivity during local inflammationvia intrinsic activation of neuronal mineralocorticoid receptors.Editor ’s PerspectiveWhat We Already Know about This TopicAldosterone is believed to be synthesized exclusively in the adrenal gland through the processing enzyme aldosterone synthaseMineralocorticoid receptors are predominantly expressed in peripheral nociceptive neurons whose activation leads to increased neuronal excitability and mechanical sensitivityWh...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Intraabdominal Pressure Targeted Positive End-expiratory Pressure during Laparoscopic Surgery An Open-label, Nonrandomized, Crossover, Clinical Trial
Background Pneumoperitoneum for laparoscopic surgery is associated with a rise of driving pressure. The authors aimed to assess the effects of positive end-expiratory pressure (PEEP) on driving pressure at varying intraabdominal pressure levels. It was hypothesized that PEEP attenuates pneumoperitoneum-related rises in driving pressure.Methods Open-label, nonrandomized, crossover, clinical trial in patients undergoing laparoscopic cholecystectomy. “Targeted PEEP” (2 cm H2O above intraabdominal pressure) was compared with “standard PEEP” (5 cm H2O), with respect to the transpulmonary and respiratory ...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Artifact Processing Methods Influence on Intraoperative Hypotension Quantification and Outcome Effect Estimates
Conclusions The method of artifact filtering can have substantial effects on estimates of hypotension prevalence. The effect on the association between intraoperative hypotension and postoperative myocardial injury was relatively small. Nevertheless, the authors recommend that researchers carefully consider artifacts handling and report the methodology used.Editor ’s PerspectiveWhat We Already Know about This TopicElectronically collected data are increasingly used for clinical research, but include artifacts and other errorsHow best to filter electronically recorded intraoperative blood pressure remains unknownWhat ...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery
Conclusions Neither perioperative aspirin nor clonidine have significant long-term effects after noncardiac surgery. Perioperative aspirin in patients with previous percutaneous coronary intervention showed persistent benefit at 1 yr, a plausible sub-group effect.Editor ’s PerspectiveWhat We Already Know about This TopicThe Perioperative Ischemic Evaluation-2 study (POISE-2) authors previously reported that neither aspirin nor clonidine reduced a 30-day composite of nonfatal myocardial infarction or death. Aspirin caused perioperative bleeding, and clonidine provoked hypotension and bradycardia.In a subgroup analysis...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Classification of Current Procedural Terminology Codes from Electronic Health Record Data Using Machine Learning
Conclusions Through application of machine learning and natural language processing techniques, highly accurate real-time models were created for anesthesiology Current Procedural Terminology code classification. The increased processing speed anda priori targeted accuracy of this classification approach may provide performance optimization and cost reduction for quality improvement, research, and reimbursement tasks reliant on anesthesiology procedure codes.Editor ’s PerspectiveWhat We Already Know about This TopicThe ability to process anesthesiology procedure code data in an accurate manner is important for clinic...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter –Defibrillators 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Erratum
In the February 2020 issue, the article “Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices” (Anesthesiology 2020; 132:225 –52. doi: 10.1097/ALN.0000000000002821) contains the wrong short title. The correct short title is “Cardiac Implantable Electronic Device Management.” (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Your Hair Will Grow Back a Poppyfield
Pen marked the footpaths (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Cannabis Use Disorder and Surgery A Budding Problem?
“…data on outcomes associated with cannabis use and surgery are nascent at best…” (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Dynamics of Ketamine-induced Loss and Return of Consciousness across Primate Neocortex
Conclusions Ketamine generates unique intracortical dynamics during its altered states of consciousness, suggesting fundamentally different neuronal processes from propofol. The gradually shifting dynamics suggest a continuously conscious or dreaming state while unresponsive under ketamine until its deeper stage with the slow-delta oscillations. Somatosensory processing is preserved during ketamine anesthesia, but multisensory processing appears to be diminished under ketamine and through recovery.Editor ’s PerspectiveWhat We Already Know about This TopicKetamine increases both fast and slow oscillations in the prima...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Intravenous Fluids Which Recipe?
“…can we now safely give saline to all noncardiac surgical patients, particularly higher-risk patients?” (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Implications of Practice Variability
“There is…no basis for giving clinical pathways a ‘free pass’ on evidence. Instead, they should be rigorously tested in context-sensitive robust and properly designed trials—just the way drugs and devices are.” (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Rational Perioperative Opioid Management in the Era of the Opioid Crisis
“Let us avoid making surgical patients pay with unnecessary suffering for the opioid overprescribing sins of others.” (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Neutralizing Complement C5a Protects Mice with Pneumococcal Pulmonary Sepsis
Conclusions Systemic C5a is elevated in pneumonia patients. Neutralizing C5a protected against lung and liver injury in pneumococcal pneumonia in mice. Early neutralization of C5a might be a promising adjunctive treatment strategy to improve outcome in community-acquired pneumonia.Editor ’s PerspectiveWhat We Already Know about This TopicPneumonia, sepsis, and immune dysregulation cause morbidity and mortalityC5a is a component of the complement system and a proinflammatory mediator that modulates the innate immune response in critical illnessDisruption of the C5a receptor axis with antibodies or antagonists was prev...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Reconstituted High-density Lipoprotein Therapy Improves Survival in Mouse Models of Sepsis
Background High-density lipoproteins exert pleiotropic effects including antiinflammatory, antiapoptotic, and lipopolysaccharide-neutralizing properties. The authors assessed the effects of reconstituted high-density lipoproteins (CSL-111) intravenous injection in different models of sepsis.Methods Ten-week-old C57BL/6 mice were subjected to sepsis by cecal ligation and puncture or intraperitoneal injection of Escherichia coli or Pseudomonas aeruginosa pneumonia. CSL-111 or saline solution was administrated 2 h after the sepsis. Primary outcome was survival. Secondary outcomes were plasma cell-free DNA and cytokine concent...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Individualized Positive End-expiratory Pressure and Regional Gas Exchange in Porcine Lung Injury
Background In acute respiratory failure elevated intraabdominal pressure aggravates lung collapse, tidal recruitment, and ventilation inhomogeneity. Low positive end-expiratory pressure (PEEP) may promote lung collapse and intrapulmonary shunting, whereas high PEEP may increase dead space by inspiratory overdistension. The authors hypothesized that an electrical impedance tomography –guided PEEP approach minimizing tidal recruitment improves regional ventilation and perfusion matching when compared to a table-based low PEEP/no recruitment and an oxygenation-guided high PEEP/full recruitment strategy in a hybrid model...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - March 10, 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 - March 10, 2020 Category: Anesthesiology Source Type: research

The Great Fluid Debate: Normal Saline versus Balanced Crystalloid
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Could “Hood’s Sarsaparilla” Root Out Uncle Sam’s Rash of Pains?
Before the onetime sassafras-based “root beer” of today, sarsaparilla (pronounced “sass-puh-RILL-uh”;Smilax sp.) reigned as America ’s vine for flavoring beverages and remedies. Originally a Native American treatment for gastrointestinal and dermatologic complaints, sarsaparilla began to be used for “blood disorders,” scurvy, scrofula, syphilis, and even leprosy. Popularizing this panacea was Vermont native Charles Ira Hoo d (1845 to 1922), who had moved to Lowell, Massachusetts, to apprentice as a pharmacist. After compounding his namesake sarsaparilla in 1876, Hood marketed it na...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Arthur Guedel ’s Nugget of Gold: Dislodged by One “Blade” and Snatched by Another?
Eight years at Johns Hopkins taught me many jokes contrasting “fleas” (internists, “the last to leave the carcass”) with “blades” (surgeons, self-explanatory). Later, I shared these morsels of merriment with Wood Library-Museum Trustee Rod Calverley (1938 to 1995,lower left). In turn, Rod regaled me with stories about Dr. Arthur Guedel (1883 to 1956,upper left) and the latter ’s namesake laryngoscope (right), which brandished a broad blade —at a fixed acute angle—with which inexperienced laryngoscopists could easily damage patients’ dental work. Over decades, Gued...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Riots of Discovery: Joseph Priestley ’s Home Laboratories in England and America
An English theologian and natural philosopher, Joseph Priestley (1733 to 1804) discovered many gases, including “dephlogisticated air” or oxygen in 1774. However, his sympathies toward revolutionaries abroad and religious “Dissenters” at home soon made Priestley unpopular with the Crown and the Church of England. In 1791, he abandoned his English home in Birmingham just before an angry mob looted (left) and then burned it to the ground. Political and professional outcasts, Joseph and his wife Mary joined their children in America, settling in rural Northumberland, Pennsylvania, in 1794. Wasting no t...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Byline Backstory No. 3: An Assassination Transforms an Aspiring Naturalist into a Future Physician
With astronauts blasting off from my extended backyard next to Cape Canaveral, I remember scrawling “1963” on the dust jacket (middle) of the book that I read in second grade, my 328-page copy ofThe Voyage of the Beagle by Charles Darwin (left). A second inspiration encouraging me to become a naturalist was my third-grade teacher, Mrs. Ruby Gammage, who was ranked as one of the nation ’s top 100 “Elementary Science and Mathematics” educators. However, on November 22, 1963, a tearful Mrs. Gammage asked the class to suspend calculating cylindrical volumes in order to hear the radio broadcasting ...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

The Waiting Room
I can gracefully afford this trip (Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Ultrasound-guided Medial Branch Blocks, Facet Joint, and Multifidus Muscle Injections How It Is Done under One Needle Insertion Point!
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Information Integration and Mesoscopic Cortical Connectivity during Propofol Anesthesia
Conclusions The genuine permutation cross mutual information reflected propofol-induced coupling changes measured at a cortical scale. Loss of consciousness was associated with a redistribution of the pattern of information integration; losing efficient global information transmission capacity but increasing local functional segregation in the cortical network.Editor ’s PerspectiveWhat We Already Know about This TopicCoupling of neuronal oscillations between brain regions is correlated with higher level brain activityPermutation cross mutual information can be used to evaluate information integration in the electroen...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Vital Signs Monitoring with Wearable Sensors in High-risk Surgical Patients A Clinical Validation Study
Conclusions All sensors were highly accurate for HR. For RR, the EarlySense, SensiumVitals sensor, and Masimo Radius-7 were reasonably accurate for RR. The accuracy for RR of the HealthPatch sensor was outside acceptable limits. Trend monitoring with wearable sensors could be valuable to timely detect patient deterioration.Editor ’s PerspectiveWhat We Already Know about This TopicChanges in vital signs are an important indicator of physiological decline and hence provide opportunities for early recognition and intervention; however, in the hospital ward, vital signs are usually measured intermittently. In between suc...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome
Conclusions In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofolversus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined.Editor ’s PerspectiveWhat We Already Know about This TopicBrugada syndrome is an inherited cardiac ion channel disorder that pl...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Not All Pericardiac Fluid Is Pericardial Ultrasound of Pericardial Effusion and Two of Its Mimics
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Intraoperative Oxidative Damage and Delirium after Cardiac Surgery
Conclusions Intraoperative oxidative damage was associated with increased postoperative delirium and neuronal injury, and the association between oxidative damage and neuronal injury was stronger among patients with increased blood –brain barrier disruption.Editor ’s PerspectiveWhat We Already Know about This TopicPostoperative delirium occurs in approximately 25% of cardiac surgery patients.Hyperoxic cerebral perfusion during cardiac surgery has been associated with increased postoperative delirium, and oxidative damage may mediate this association.What This Article Tells Us That Is NewIn a cohort of 400 cardi...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Anticoagulation Management and Antithrombin Supplementation Practice during Veno-venous Extracorporeal Membrane Oxygenation A Worldwide Survey
Background There is a lack of consensus on how to manage anticoagulation during veno-venous extracorporeal membrane oxygenation, including antithrombin monitoring and supplementation. The authors ’ aim was to determine current practice in a large number of extracorporeal membrane oxygenation centers around the world.Methods This was an electronic survey disseminated in 2018 to directors and coordinators of extracorporeal membrane oxygenation centers as well as to extracorporeal membrane oxygenation experts. Participating centers were classified according to some covariates that may affect practice, including 2017 gro...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Button Battery Ingestion A True Surgical and Anesthetic Emergency
(Source: Anesthesiology)
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Positive End-expiratory Pressure and Distribution of Ventilation in Pneumoperitoneum Combined with Steep Trendelenburg Position
Background Pneumoperitoneum and a steep Trendelenburg position during robot-assisted laparoscopic prostatectomy have been demonstrated to promote a cranial shift of the diaphragm and the formation of atelectasis in the dorsal parts of the lungs. However, neither an impact of higher positive end-expiratory pressure (PEEP) on preserving the ventilation in the dorsal region nor its physiologic effects have been fully examined. The authors hypothesized that PEEP of 15 cm H2O during robot-assisted laparoscopic prostatectomy might maintain ventilation in the dorsal parts and thus improve lung mechanics.Methods In this randomized...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Transfusion of Uncrossmatched Group O Erythrocyte-containing Products Does Not Interfere with Most ABO Typings
Conclusions The transfusion of smaller quantities of uncrossmatched type O erythrocyte-containing products, in particular up to 10 units, does not usually interfere with determining the recipient ’s ABO type. The early collection of a type and screen sample is important.Editor ’s PerspectiveWhat We Already Know about This TopicUncrossmatched erythrocyte units that are provided to a massively bleeding patient whose ABO group is unknown must be type O to ensure compatibility. The effect of transfusing type O units on the ability to subsequently determine the patient ’s ABO group is not known.What This Artic...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research

Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury
Conclusions Adult patients undergoing noncardiac surgery demonstrate varying associations with distinct levels of hypotension when stratified by preoperative risk factors. Specific levels of absolute hypotension, but not relative hypotension, are an important independent risk factor for acute kidney injury.Editor ’s PerspectiveWhat We Already Know about This TopicAcute kidney injury occurs in 13% of patients undergoing major surgery and is associated with a six-fold increased risk of mortality.Single-center studies have demonstrated an association between intraoperative hypotension and acute kidney injury.What This A...
Source: Anesthesiology - February 12, 2020 Category: Anesthesiology Source Type: research