Anesthesia and Developing Brains: Unanswered Questions and Proposed Paths Forward
Anesthetic agents disrupt neurodevelopment in animal models, but evidence in humans is mixed. The morphologic and behavioral changes observed across many species predicted that deficits should be seen in humans, but identifying a phenotype of injury in children has been challenging. It is increasingly clear that in children, a brief or single early anesthetic exposure is not associated with deficits in a range of neurodevelopmental outcomes including broad measures of intelligence. Deficits in other domains including behavior, however, are more consistently reported in humans and also reflect findings from nonhuman primate...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Congenital Cardiac Anesthesia: A Case-based Approach
Edited by Laura K.Berenstain and James P.Spaeth. Cambridge University Press, 2021. Pages: 409. ISBN-13: 978-1-108-49416-8.Price: $99.99 (Hardback), $60.49 (Kindle edition). (Source: Anesthesiology)
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
End-tidal Carbon Dioxide for Diagnosing Anaphylaxis in Patients with Severe Postinduction Hypotension
ConclusionsIn case of severe hypotension after anesthesia induction, a low ETco2 contributes to the diagnosis of anaphylaxis, in addition to the classical signs of perioperative immediate hypersensitivity.Editor ’s PerspectiveWhat We Already Know about This TopicAnaphylaxis in the anesthetized patient can be challenging to diagnose as hypotension, the most common manifestation, has multiple causes postinduction. In addition to hypotension, low end-tidal carbon dioxide has also been suggested to be helpful in the diagnosis.What This Article Tells Us That Is NewFrom a retrospective single-center case-control study comparin...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Interscalene Brachial Plexus Block with Liposomal Bupivacaine versus Standard Bupivacaine with Perineural Dexamethasone: A Noninferiority Trial
ConclusionsInterscalene nerve blocks with perineural liposomal bupivacaine provided effective analgesia similar to the perineural standard bupivacaine with dexamethasone. The results show that bupivacaine with dexamethasone can be used interchangeably with liposomal bupivacaine for analgesia after shoulder surgery.Editor ’s PerspectiveWhat We Already Know about This TopicExtending the duration of interscalene nerve block reduces patient discomfort and lowers postoperative opioid consumptionAdjuvants such as dexamethasone and liposomal formulations may prolong anesthetic actionWhat This Article Tells Us That Is NewIntersc...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Epidural Analgesia and Recurrence after Colorectal Cancer Surgery: A Danish Retrospective Registry-based Cohort Study
ConclusionsIn colorectal cancer surgery, epidural analgesia was not statistically significantly associated with less cancer recurrence.Editor ’s PerspectiveWhat We Already Know about This TopicThere are conflicting data regarding the association between epidural analgesia and cancer recurrence after colorectal cancer surgeryWhat This Article Tells Us That Is NewIn a retrospective cohort analysis of 11,618 patients in Danish national colorectal cancer surgery and anesthesia registries, 30% had an epidural catheter inserted for analgesiaThe comparison of 2,980 patients receiving general anesthesia with epidural analgesia m...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Expression Profiles of Immune Cells after Propofol or Sevoflurane Anesthesia for Colorectal Cancer Surgery: A Prospective Double-blind Randomized Trial
ConclusionsPropofol-based anesthesia was not superior to sevoflurane-based anesthesia in terms of alleviating suppression of immune cells including natural killer cells and T lymphocytes during colorectal cancer surgery.Editor ’s PerspectiveWhat We Already Know about This TopicExperimental studies alongside clinical trials yielded contradictory observations on the potential antitumor effects of intravenous-versus volatile anesthetics –based anesthesia regimens in the context of colorectal cancer surgeryVarious immune cells have been suggested to exert antitumor effects during the perioperative periodThe question whethe...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Propofol Anesthesia: A Leap into the Void?
“[In anesthesia] does the brain experience a smooth slide to the depths of oblivion? Or is there a kind of quantum leap into the void?” (Source: Anesthesiology)
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
The Importance of Definitive Trials: The VIXIE Trial
“If inspiratory oxygen concentration does not influence the risk of perioperative myocardial injury, it may be reasonable to conclude that the etiology of perioperative myocardial injury is not ischemic in most instances.” (Source: Anesthesiology)
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Hyperoxia and Antioxidants for Myocardial Injury in Noncardiac Surgery: A 2 × 2 Factorial, Blinded, Randomized Clinical Trial
ConclusionsPerioperative interventions with high inspiratory oxygen fraction and antioxidants did not change the degree of myocardial injury within the first 3 days of surgery. This implies safety with 80% oxygen and no cardiovascular benefits of vitamin C and N-acetylcysteine in major noncardiac surgery.Editor ’s PerspectiveWhat We Already Know about This TopicMyocardial injury after noncardiac surgery is associated with significantly increased morbidity and mortality.Post hoc analyses of several previous trials suggest that intraoperative hyperoxia may associate with increased postoperative acute coronary syndrome and ...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Propofol-induced Unresponsiveness Is Associated with a Brain Network Phase Transition
ConclusionsAround loss of behavioral responsiveness, a small increase in propofol concentrations caused a collapse of long time scale power envelope connectivity and an increase in 10 Hz phase-based connectivity —suggestive of a brain network phase transition.Editor ’s PerspectiveWhat We Already Know about This TopicChanges in levels of consciousness are closely linked to anesthetics-induced dynamic alterations in functional connectivity of the central nervous systemPropofol induces consistent global and regional decreases in functional brain connectivity when measured over the time scale of seconds to tens of secondsT...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
A Legacy with Long -evity: Commemorating Crawford W. Long, M.D.
“In commemoration of the 70th anniversary of the discovery of ether anesthesia…the noble achievement of a great son of this grand old school,” the University of Pennsylvania (crest, upper left) posthumously awarded this medallion (lower right) not to William T. G. Morton, but to a quiet, country physician from Georgia, Crawford W. Long, M.D. The glowing orations from that day are preserved in the copy of Penn ’sUniversity Bulletin held in the Wood Library-Museum Collection. Inscribed to Long, “First to Use Ether as an Anaesthetic in Surgery, March 30, 1842,” the medallion accepted by his daughter Frances Long T...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research
