Subjects -> MEDICAL SCIENCES (Total: 8687 journals)
    - ANAESTHESIOLOGY (120 journals)
    - CARDIOVASCULAR DISEASES (339 journals)
    - DENTISTRY (293 journals)
    - ENDOCRINOLOGY (149 journals)
    - FORENSIC SCIENCES (42 journals)
    - HEMATOLOGY (158 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (178 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2413 journals)
    - NURSES AND NURSING (371 journals)
    - OBSTETRICS AND GYNECOLOGY (207 journals)
    - ONCOLOGY (386 journals)
    - OTORHINOLARYNGOLOGY (83 journals)
    - PATHOLOGY (100 journals)
    - PEDIATRICS (275 journals)
    - PSYCHIATRY AND NEUROLOGY (834 journals)
    - RESPIRATORY DISEASES (105 journals)
    - RHEUMATOLOGY (79 journals)
    - SPORTS MEDICINE (81 journals)
    - SURGERY (405 journals)

ANAESTHESIOLOGY (120 journals)                     

Showing 1 - 120 of 120 Journals sorted alphabetically
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 61)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 16)
Advances in Anesthesia     Full-text available via subscription   (Followers: 32)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 9)
Ain-Shams Journal of Anaesthesiology     Open Access   (Followers: 3)
Ain-Shams Journal of Anesthesiology     Open Access   (Followers: 1)
Ambulatory Anesthesia     Open Access   (Followers: 9)
Anaesthesia     Hybrid Journal   (Followers: 243)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 72)
Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 61)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 28)
Anaesthesia Reports     Hybrid Journal  
Anaesthesia, Pain & Intensive Care     Open Access  
Anaesthesiology Intensive Therapy     Open Access   (Followers: 9)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 7)
Anestesia Analgesia Reanimación     Open Access   (Followers: 1)
Anestesia en México     Open Access   (Followers: 1)
Anesthesia & Analgesia     Hybrid Journal   (Followers: 288)
Anesthesia : Essays and Researches     Open Access   (Followers: 11)
Anesthesia Progress     Hybrid Journal   (Followers: 6)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology     Hybrid Journal   (Followers: 236)
Anesthesiology and Pain Medicine     Open Access   (Followers: 23)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25)
Anesthesiology Research and Practice     Open Access   (Followers: 15)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Annales Françaises d'Anesthésie et de Réanimation     Full-text available via subscription   (Followers: 4)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 15)
BDJ Team     Open Access   (Followers: 1)
Best Practice & Research Clinical Anaesthesiology     Hybrid Journal   (Followers: 15)
BJA : British Journal of Anaesthesia     Hybrid Journal   (Followers: 256)
BJA Education     Hybrid Journal   (Followers: 71)
BMC Anesthesiology     Open Access   (Followers: 18)
BMJ Supportive & Palliative Care     Hybrid Journal   (Followers: 49)
Brazilian Journal of Anesthesiology     Open Access   (Followers: 5)
Brazilian Journal of Anesthesiology (Edicion en espanol)     Open Access  
Brazilian Journal of Anesthesiology (English edition)     Open Access   (Followers: 1)
Brazilian Journal of Pain (BrJP)     Open Access  
British Journal of Pain     Hybrid Journal   (Followers: 28)
Canadian Journal of Anesthesia/Journal canadien d'anesthésie     Hybrid Journal   (Followers: 48)
Case Reports in Anesthesiology     Open Access   (Followers: 11)
Clinical Journal of Pain     Hybrid Journal   (Followers: 20)
Colombian Journal of Anesthesiology : Revista Colombiana de Anestesiología     Hybrid Journal   (Followers: 1)
Current Anaesthesia & Critical Care     Full-text available via subscription   (Followers: 36)
Current Anesthesiology Reports     Hybrid Journal   (Followers: 4)
Current Opinion in Anaesthesiology     Hybrid Journal   (Followers: 61)
Current Pain and Headache Reports     Hybrid Journal   (Followers: 2)
Der Anaesthesist     Hybrid Journal   (Followers: 10)
Der Schmerz     Hybrid Journal   (Followers: 2)
Der Schmerzpatient     Hybrid Journal  
Douleur et Analgésie     Hybrid Journal  
Egyptian Journal of Anaesthesia     Open Access   (Followers: 3)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
EMC - Anestesia-Reanimación     Hybrid Journal  
EMC - Anestesia-Rianimazione     Hybrid Journal  
EMC - Urgenze     Full-text available via subscription  
European Journal of Anaesthesiology     Hybrid Journal   (Followers: 31)
European Journal of Pain     Full-text available via subscription   (Followers: 28)
European Journal of Pain Supplements     Full-text available via subscription   (Followers: 6)
Global Journal of Anesthesiology     Open Access   (Followers: 2)
Headache The Journal of Head and Face Pain     Hybrid Journal   (Followers: 5)
Indian Journal of Anaesthesia     Open Access   (Followers: 7)
Indian Journal of Pain     Open Access   (Followers: 2)
Indian Journal of Palliative Care     Open Access   (Followers: 9)
International Anesthesiology Clinics     Hybrid Journal   (Followers: 9)
International Journal of Clinical Anesthesia and Research     Open Access  
Itch & Pain     Open Access   (Followers: 2)
JA Clinical Reports     Open Access  
Journal Club Schmerzmedizin     Hybrid Journal  
Journal of Anesthesia & Clinical Research     Open Access   (Followers: 10)
Journal of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8)
Journal of Anesthesia     Hybrid Journal   (Followers: 14)
Journal of Anesthesia History     Full-text available via subscription   (Followers: 2)
Journal of Anesthesiology and Clinical Science     Open Access   (Followers: 1)
Journal of Cellular and Molecular Anesthesia     Open Access  
Journal of Clinical Anesthesia     Hybrid Journal   (Followers: 13)
Journal of Critical Care     Hybrid Journal   (Followers: 43)
Journal of Headache and Pain     Open Access   (Followers: 3)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 3)
Journal of Neurosurgical Anesthesiology     Hybrid Journal   (Followers: 8)
Journal of Obstetric Anaesthesia and Critical Care     Open Access   (Followers: 22)
Journal of Pain     Hybrid Journal   (Followers: 20)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 45)
Journal of Pain Research     Open Access   (Followers: 11)
Journal of Palliative Care     Full-text available via subscription   (Followers: 24)
Journal of Society of Anesthesiologists of Nepal     Open Access   (Followers: 2)
Journal of the Bangladesh Society of Anaesthesiologists     Open Access  
Jurnal Anestesiologi Indonesia     Open Access  
Karnataka Anaesthesia Journal     Open Access   (Followers: 2)
Le Praticien en Anesthésie Réanimation     Full-text available via subscription   (Followers: 2)
Local and Regional Anesthesia     Open Access   (Followers: 8)
Medical Gas Research     Open Access   (Followers: 3)
Medycyna Paliatywna w Praktyce     Open Access   (Followers: 1)
OA Anaesthetics     Open Access   (Followers: 3)
Open Anesthesia Journal     Open Access  
Open Journal of Anesthesiology     Open Access   (Followers: 10)
Pain     Hybrid Journal   (Followers: 61)
Pain Clinic     Hybrid Journal   (Followers: 1)
Pain Management     Hybrid Journal   (Followers: 18)
Pain Medicine     Hybrid Journal   (Followers: 14)
Pain Research and Management     Open Access   (Followers: 8)
Pain Research and Treatment     Open Access   (Followers: 3)
Pain Studies and Treatment     Open Access   (Followers: 3)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 4)
Revista Chilena de Anestesia     Open Access   (Followers: 1)
Revista Colombiana de Anestesiología     Open Access   (Followers: 1)
Revista Cubana de Anestesiología y Reanimación     Open Access   (Followers: 1)
Revista da Sociedade Portuguesa de Anestesiologia     Open Access  
Revista Española de Anestesiología y Reanimación     Hybrid Journal  
Revista Española de Anestesiología y Reanimación (English Edition)     Full-text available via subscription   (Followers: 2)
Romanian Journal of Anaesthesia and Intensive Care     Open Access   (Followers: 1)
Saudi Journal of Anaesthesia     Open Access   (Followers: 7)
Scandinavian Journal of Pain     Hybrid Journal   (Followers: 1)
Southern African Journal of Anaesthesia and Analgesia     Open Access   (Followers: 8)
Sri Lankan Journal of Anaesthesiology     Open Access   (Followers: 2)
Survey of Anesthesiology     Full-text available via subscription   (Followers: 12)
Techniques in Regional Anesthesia and Pain Management     Hybrid Journal   (Followers: 11)
Topics in Pain Management     Full-text available via subscription   (Followers: 2)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 23)


Similar Journals
Journal Cover
Anesthesia & Analgesia
Journal Prestige (SJR): 1.472
Citation Impact (citeScore): 3
Number of Followers: 288  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-2999 - ISSN (Online) 1526-7598
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Reduce, Reuse… Reprocess' Strategies for Extended Use of N95
    • Authors: Wanderer; Jonathan P.; Nathan, Naveen
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do
           We Stand'
    • Authors: Cassorla; Lydia
      Abstract: imageThe coronavirus disease 2019 (COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remains unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • A Developing Nation’s Experience in Using Simulation-Based Training as a
           Preparation Tool for the Coronavirus Disease 2019 Outbreak
    • Authors: Loh; P. S.; Chaw, Sook-Hui; Shariffuddin, Ina I.; Ng, Ching-Choe; Yim, Carolyn C.; Hashim, Noorjahan Haneem Md.
      Abstract: imageBackground: The coronavirus disease 2019 (COVID-19) pandemic affected and overwhelmed many health care systems around the world at an unprecedented speed and magnitude with devastating effects. In developing nations, smaller hospitals were unprepared to face this outbreak nor had strategies in place to do so at the beginning. Here, we describe the preparation in an anesthetic department using simulation-based training over 2 weeks, as the number of cases rose rapidly.METHODS: Three areas of priority were identified as follows: staff safety, patient movement, and possible clinical scenarios based on simulation principles in health care education. Staff was rostered and rotated through stations for rapid-cycle deliberate practice to learn donning and doffing of personal protective equipment (PPE) and powered air-purifying respirator (PAPR). For difficult airway management, Peyton’s 4 steps for skills training and Harden’s Three Circle model formed the structure in teaching the core skills. Several clinical scenarios used system probing to elicit inadequacies followed by formal debriefing to facilitate reflection. Finally, evaluation was both immediate and delayed with an online survey after 1 month to examine 4 levels of reaction, learning, behavior, and impact based on the Kirkpatrick Model. Frequency and thematic analysis were then conducted on the quantitative and qualitative data, respectively.RESULTS: A total of 15 of 16 (93%) consultants, 16 (100%) specialists, and 81 (100%) medical officers in the department completed training within 2 consecutive weeks. Reaction and part of the learning were relayed immediately to trainers during training. In total, 42 (39%) trained staff responded to the survey. All were satisfied and agreed on the relevance of training. A total of 41 respondents (98%; 95% confidence interval [CI], 87-99) answered 16 of 20 questions correctly on identifying aerosol-generating procedures (AGP), indications for PPE, planning and preparation for airway management to achieve adequate learning. About 43% (95% CI, 27-59) and 52% (95% CI, 36-68) recalled donning and doffing steps correctly. A total of 92 responses from 33 respondents were analyzed in the thematic analysis. All respondents reported at least 1 behavioral change in intended outcomes for hand hygiene practice (20%), appropriate use of PPE (27%), and airway management (10%). The emerging outcomes were vigilance, physical distancing, planning, and team communication. Finally, the impact of training led to the establishment of institutional guidelines followed by all personnel.CONCLUSIONS: Simulation-based training was a useful preparation tool for small institutions with limited time, resources, and manpower in developing nations. These recommendations represent the training experience to address issues of “when” and “how” to initiate urgent “medical education” during an outbreak.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Effectiveness of Prone Positioning in Nonintubated Intensive Care Unit
           Patients With Moderate to Severe Acute Respiratory Distress Syndrome by
           Coronavirus Disease 2019
    • Authors: Taboada; Manuel; González, Mariana; Álvarez, Antía; González, Irene; García, Javier; Eiras, María; Vieito, María Diaz; Naveira, Alberto; Otero, Pablo; Campaña, Olga; Muniategui, Ignacio; Tubio, Ana; Costa, Jose; Selas, Salomé; Cariñena, Agustín; Martínez, Adrián; Veiras, Sonia; Aneiros, Francisco; Caruezo, Valentín; Baluja, Aurora; Alvarez, Julian
      Abstract: imageBackground: In the treatment for severe acute respiratory distress syndrome (ARDS) from coronavirus disease 2019 (COVID-19), the World Health Organization (WHO) recommends prone positioning (PP) during mechanical ventilation for periods of 12–16 h/d to potentially improve oxygenation and survival. In this prospective observational study, we evaluated the ability of long PP sessions to improve oxygenation in awake intensive care unit (ICU) patients with moderate or severe ARDS due to COVID-19.METHODS: The study was approved by the ethics committee of Galicia (code No. 2020-188), and all patients provided informed consent. In this case series, awake patients with moderate or severe ARDS by COVID-19 admitted to the ICU at University Hospital of Santiago from March 21 to April 5, 2020 were prospectively analyzed. Patients were instructed to remain in PP as long as possible until the patient felt too tired to maintain that position. Light sedation was administered with dexmedetomidine. The following information was collected: number and duration of PP sessions; tissue O2 saturation (Sto2) and blood gases before, during, and following a PP session; need of mechanical ventilation; duration of ICU admission; and ICU outcome. Linear mixed-effects models (LMM) were fit to estimate changes from baseline with a random effect for patient.RESULTS: Seven patients with moderate or severe ARDS by COVID-19 were included. All patients received at least 1 PP session. A total of 16 PP sessions were performed in the 7 patients during the period study. The median duration of PP sessions was 10 hours. Dexmedetomidine was used in all PP sessions. Oxygenation increased in all 16 sessions performed in the 7 patients. The ratio of arterial oxygen partial pressure to fractional inspired oxygen (Pao2/Fio2) significantly increased during PP (change from baseline 110 with 97.5% confidence interval [CI], 19-202) and, after PP, albeit not significantly (change from baseline 38 with 97.5% CI, −9.2 to 85) compared with previous supine position. Similarly, tissue oxygenation underwent a small improvement during PP (change from baseline 2.6% with 97.5% CI, 0.69-4.6) without significant changes after PP. Two patients required intubation. All patients were discharged from the ICU.CONCLUSIONS: We found that PP improved oxygenation in ICU patients with COVID-19 and moderate or severe ARDS. PP was relatively well tolerated in our patients and may be a simple strategy to improve oxygenation trying to reduce the number of patients in mechanical ventilation and the length of stay in the ICU, especially in COVID-19 pandemic.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Adaptation of an Obstetric Anesthesia Service for the Severe Acute
           Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists,
           Workflows, and Development Tools
    • Authors: Li; Yunping; Ciampa, Erin J.; Zucco, Liana; Levy, Nadav; Colella, Meredith; Golen, Toni; Shainker, Scott A.; Lunderberg, J. Mark; Ramachandran, Satya Krishna; Hess, Philip E.
      Abstract: imageBackground: Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training.METHODS: The goals of our workflow and process development were to maximize safety for staff and patients, minimize the risk of contamination, and reduce the waste of unused supplies and materials. We used a cyclical improvement system and the plus/delta debriefing method to rapidly develop workflows consisting of sequential checklists and procedure-specific packs.RESULTS: We designed independent workflows for labor analgesia, neuraxial anesthesia for cesarean delivery, conversion of labor analgesia to cesarean anesthesia, and general anesthesia. In addition, we created procedure-specific material packs to optimize supplies and prevent wastage. Finally, we generated sequential checklists to allow staff to perform standard operating procedures without extensive training.CONCLUSIONS: Collectively, these workflows and tools allowed our staff to urgently care for patients in high-risk situations without prior experience. Over time, we refined the workflows using a cyclical improvement system. We present our checklists and workflows as well as the system we used for their development, so that others may use them to their benefit.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Barrier Devices, Intubation, and Aerosol Mitigation Strategies: Personal
           Protective Equipment in the Time of Coronavirus Disease 2019
    • Authors: Fried; Eric A.; Zhou, George; Shah, Ronak; Shin, Da Wi; Shah, Anjan; Katz, Daniel; Burnett, Garrett W.
      Abstract: imageBackground: Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect health care workers (HCWs) from exposure to coronavirus disease 2019 (COVID-19) during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19.METHODS: Two commonly used barrier devices, an intubation box and a clear plastic intubation sheet, were evaluated using a physiologically accurate cough simulator. Aerosols were modeled using a commercially available fog machine, and droplets were modeled with fluorescein dye. Both particles were propelled by the cough simulator in a simulated intubation environment. Data were captured by high-speed flash photography, and aerosol and droplet dispersion were assessed qualitatively with and without a barrier in place.RESULTS: Droplet contamination after a simulated cough was seemingly contained by both barrier devices. Simulated aerosol escaped the barriers and flowed toward the head of the bed. During barrier removal, simulated aerosol trapped underneath was released and propelled toward the HCW at the head of the bed. Usage of the intubation sheet concentrated droplets onto a smaller area. If no barrier was used, positioning the patient in slight reverse Trendelenburg directed aerosols away from the HCW located at the head of the bed.CONCLUSIONS: Our observations imply that intubation boxes and sheets may reduce HCW exposure to droplets, but they both may merely redirect aerosolized particles, potentially resulting in increased exposure to aerosols in certain circumstances. Aerosols may remain within the barrier device after a cough, and manipulation of the box may release them. Patients should be positioned to facilitate intubation, but slight reverse Trendelenburg may direct infectious aerosols away from the HCW. Novel barrier devices should be used with caution, and further validation studies are necessary.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic:
           Operationalizing an Obstetric Intensive Care Unit
    • Authors: Martinez; Rebecca; Bernstein, Kyra; Ring, Laurence; Ona, Samsiya; Baptiste, Caitlin; Syeda, Sbaa; Aziz, Aleha; Robinson, Kenya; Valderrama, Natali; Sheen, Jean-Ju; D’Alton, Mary; Goffman, Dena; Gyamfi-Bannerman, Cynthia; Moroz, Leslie; Landau, Ruth
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Living Large: Insights into Managing the Obese Patient
    • Authors: Nathan; Naveen
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • The Obese Patient: Facts, Fables, and Best Practices
    • Authors: Moon; Tiffany S.; Van de Putte, Peter; De Baerdemaeker, Luc; Schumann, Roman
      Abstract: imageThe prevalence of obesity continues to rise worldwide, and anesthesiologists must be aware of current best practices in the perioperative management of the patient with obesity. Obesity alters anatomy and physiology, which complicates the evaluation and management of obese patients in the perioperative setting. Gastric point-of-care ultrasound (PoCUS) is a noninvasive tool that can be used to assess aspiration risk in the obese patient by evaluating the quantity and quality of gastric contents. An important perioperative goal is adequate end-organ perfusion. Standard noninvasive blood pressure (NIBP) is our best available routine surrogate measurement, but is vulnerable to greater inaccuracy in patients with obesity compared to the nonobese population. Current NIBP methodologies are discussed. Obese patients are at risk for wound and surgical site infections, but few studies conclusively guide the exact dosing of intraoperative prophylactic antibiotics for them. We review evidence for low-molecular-weight heparins and weight-based versus nonweight-based administration of vasoactive medications. Finally, intubation and extubation of the patient with obesity can be complicated, and evidence-based strategies are discussed to mitigate danger during intubation and extubation.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Intraoperative Ketamine for the Opioid-Naïve Patients: Move Along Folks,
           Nothing to See Here'
    • Authors: Bhatia; Anuj; Orhurhu, Vwaire; Cohen, Steven P.
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Analgesic Effect of Intraoperative Intravenous S-Ketamine in Opioid-Naïve
           Patients After Major Lumbar Fusion Surgery Is Temporary and Not
           Dose-Dependent: A Randomized, Double-Blind, Placebo-Controlled Clinical
    • Authors: Brinck; Elina C. V.; Maisniemi, Kreu; Kankare, Jyrki; Tielinen, Laura; Tarkkila, Pekka; Kontinen, Vesa K.
      Abstract: imageBackground: Severe pain often accompanies major spine surgery. Opioids are the cornerstone of postoperative pain management but their use can be limited by numerous side effects. Several studies claim that adjuvant treatment with intravenous (IV) ketamine reduces opioid consumption and pain after back surgery. However, the exact role of ketamine for this indication is yet to be elucidated. We compared 2 different doses of S-ketamine with placebo on postoperative analgesic consumption, pain, and adverse events in adult, opioid-naïve patients after lumbar fusion surgery.METHODS: One hundred ninety-eight opioid-naïve patients undergoing lumbar spinal fusion surgery were recruited to this double-blind trial and randomly assigned into 3 study groups: Group C (placebo) received a preincisional IV bolus of saline (sodium chloride [NaCl] 0.9%) followed by an intraoperative IV infusion of NaCl 0.9%. Both groups K2 and K10 received a preincisional IV bolus of S-ketamine (0.5 mg/kg); in group K2, this was followed by an intraoperative IV infusion of S-ketamine (0.12 mg/kg/h), while in group K10, it was followed by an intraoperative IV infusion of S-ketamine (0.6 mg/kg/h). Postoperative analgesia was achieved by an IV patient-controlled analgesia (IV PCA) device delivering oxycodone. The primary end point was cumulative oxycodone consumption at 48 hours after surgery. The secondary end points included postoperative pain up to 2 years after surgery, adverse events, and level of sedation and confusion in the immediate postoperative period.RESULTS: The median [interquartile range (IQR)] cumulative oxycodone consumption at 48 hours was 154.5 [120] mg for group K2, 160 [109] mg for group K10, and 178.5 [176] mg for group C. The estimated difference was −24 mg between group K2 and group C (97.5% confidence interval [CI], −73.8 to 31.5; P = .170) and −18.5 mg between group K10 and C (97.5% CI, 78.5–29.5; P = .458). There were no significant differences between groups.Postoperative pain scores were significantly lower in both ketamine treatment groups at the fourth postoperative hour but not later during the 2-year study period.The higher ketamine dose was associated with more sedation. Otherwise, differences in the occurrence of adverse events between study groups were nonsignificant.CONCLUSIONS: Neither a 0.12 nor a 0.6 mg/kg/h infusion of intraoperative IV S-ketamine was superior to the placebo in reducing oxycodone consumption at 48 hours after lumbar fusion surgery in an opioid-naïve adult study population. Future studies should assess ketamine’s feasibility in specific study populations who most benefit from reduced opioid consumption.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Inflammation After Surgical Trauma: Bleeding or Clotting'
    • Authors: Dutton; Richard P
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • The Attributable Mortality of Postoperative Bleeding Exceeds the
           Attributable Mortality of Postoperative Venous Thromboembolism
    • Authors: Bellomy; Melissa L.; Engoren, Milo C.; Martin, Barbara J.; Shi, Yaping; Shotwell, Matthew S.; Hughes, Christopher G.; Freundlich, Robert E.
      Abstract: imageBackground: Bleeding and venous thromboembolic disease are considered important sources of postoperative morbidity and mortality. Clinically, treatment of these 2 disorders is often competing. We sought to better understand the relative contributions of bleeding and venous thromboembolic disease to postoperative attributable mortality in a national cohort.METHODS: A retrospective analysis of the 2006–2017 American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was performed to assess the adjusted odds ratio and attributable mortality for postoperative bleeding and venous thromboembolism, adjusted by year.RESULTS: After adjustment for confounding variables, bleeding exhibited a high postoperative attributable mortality in every year studied. Venous thromboembolism appeared to contribute minimal attributable mortality.CONCLUSIONS: Bleeding complications are a consistent source of attributable mortality in surgical patients, while the contribution of venous thromboembolic disease appears to be minimal in this analysis. Further studies are warranted to better understand the etiology of this disparity.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Chasing Shadows, Catching Smoke, and Estimating Anaphylaxis to Sugammadex
    • Authors: Johnson; Ken B.; Dutton, Richard P .
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Incidence of Anaphylaxis to Sugammadex in a Single-Center Cohort of 19,821
    • Authors: Burbridge; Mark A.
      Abstract: imageBackground: Sugammadex is a modified cyclodextrin that is being increasingly used in anesthetic practice worldwide for the reversal of the aminosteroid neuromuscular blockers rocuronium and vecuronium. Its safety profile, however, is incompletely understood. One such aspect is the incidence of anaphylactic reactions that occur after its administration. While several case reports exist in the literature, there is a paucity of information on the actual incidence of anaphylactic reactions.METHODS: A single-center retrospective chart review identified patients who experienced anaphylaxis to sugammadex in the institutional electronic medical record system. These charts were then reviewed to determine whether the etiology of anaphylaxis was sugammadex administration.RESULTS: Two patients experienced anaphylaxis to sugammadex, which occurred in a single institution cohort of 19,821 patients who received 23,446 total doses. This rate is markedly lower than the 1/300 that the manufacturer’s package insert states and also lower than the 1/2500 that the only other large cohort study performed has reported.CONCLUSIONS: The incidence of anaphylaxis to sugammadex in this cohort of patients was 2 of 19,821 patients, who received a total of 23,446 doses.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • To Retrograde Autologous Prime or Not'
    • Authors: Skubas; Nikolaos J.; Svensson, Lars G.; Bakaeen, Faisal
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Retrograde Autologous Priming in Cardiac Surgery: Results From a
           Systematic Review and Meta-analysis
    • Authors: Hensley; Nadia B.; Gyi, Richard; Zorrilla-Vaca, Andres; Choi, Chun W.; Lawton, Jennifer S.; Brown, Charles H. IV; Frank, Steve M.; Grant, Michael C.; Cho, Brian C.
      Abstract: imageBackground: Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP on perioperative allogeneic red cell transfusions in cardiac surgical patients.METHODS: This study involved a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating the use of RAP in cardiac surgery involving CPB. The primary outcome was intraoperative allogeneic red cell transfusion. Secondary outcomes included whole hospital allogeneic transfusions and adverse events such as acute kidney injury (AKI) and stroke.RESULTS: A total of 11 RCTs (n = 1337 patients) were included, comparing RAP patients (n = 674) to control (n = 663). In addition, 10 observational studies (n = 2327) were included, comparing RAP patients (n = 1257) to control (n = 1070). Overall, RAP was associated with a significantly reduced incidence of intraoperative red cell transfusion (n = 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI], 0.22–0.55, P < .001) compared to controls. This effect was seen among RCTs (n = 10 studies; OR = 0.19; 95% CI, 0.08–0.45, P < .001) and observational studies (n = 8 studies; OR = 0.66; 95% CI, 0.50–0.87, P = .004) in isolation. RAP was also associated with a significantly reduced incidence of whole hospital red cell transfusion (n = 5 studies; OR = 0.28; 95% CI, 0.19–0.41, P < .001). Among the studies that reported AKI and stroke outcomes, there was no statistically significant increased odds of AKI or stroke in either RAP or control patients.CONCLUSIONS: Based on the pooled results of the available literature, RAP is associated with a significant reduction in intraoperative and whole hospital allogeneic red cell transfusion. Use of RAP may prevent hemodilution of cardiac surgical patients and thus, lessen transfusions. Additional high-quality prospective studies are necessary to determine the ideal priming volume necessary to confer the greatest benefit without incurring organ injury.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Linear Regression in Medical Research
    • Authors: Schober; Patrick; Vetter, Thomas R.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Exhaled Propofol Concentrations Correlate With Plasma and Brain Tissue
           Concentrations in Rats
    • Authors: Müller-Wirtz; Lukas M.; Maurer, Felix; Brausch, Timo; Kiefer, Daniel; Floss, Maximilian; Doneit, Jonas; Volk, Thomas; Sessler, Daniel I.; Fink, Tobias; Lehr, Thorsten; Kreuer, Sascha
      Abstract: imageBackground: Propofol can be measured in exhaled gas. Exhaled and plasma propofol concentrations correlate well, but the relationship with tissue concentrations remains unknown. We thus evaluated the relationship between exhaled, plasma, and various tissue propofol concentrations. Because the drug acts in the brain, we focused on the relationship between exhaled and brain tissue propofol concentrations.METHODS: Thirty-six male Sprague-Dawley rats were anesthetized with propofol, ketamine, and rocuronium for 6 hours. Animals were randomly assigned to propofol infusions at 20, 40, or 60 mg·kg−1·h−1 (n = 12 per group). Exhaled propofol concentrations were measured at 15-minute intervals by multicapillary column–ion mobility spectrometry. Arterial blood samples, 110 µL each, were collected 15, 30, and 45 minutes, and 1, 2, 4, and 6 hours after the propofol infusion started. Propofol concentrations were measured in brain, lung, liver, kidney, muscle, and fat tissue after 6 hours. The last exhaled and plasma concentrations were used for linear regression analyses with tissue concentrations.RESULTS: The correlation of exhaled versus plasma concentrations (R2 = 0.71) was comparable to the correlation of exhaled versus brain tissue concentrations (R2 = 0.75) at the end of the study. In contrast, correlations between plasma and lung and between lung and exhaled propofol concentrations were poor. Less than a part-per-thousand of propofol was exhaled over 6 hours.CONCLUSIONS: Exhaled propofol concentrations correlate reasonably well with brain tissue and plasma concentrations in rats, and may thus be useful to estimate anesthetic drug effect. The equilibration between plasma propofol and exhaled gas is apparently independent of lung tissue concentration. Only a tiny fraction of administered propofol is eliminated via the lungs, and exhaled quantities thus have negligible influence on plasma concentrations.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Blood Substitutes and Oxygen Therapeutics: A Review
    • Authors: Jahr; Jonathan S.; Guinn, Nicole R; Lowery, David R.; Shore-Lesserson, Linda; Shander, Aryeh
      Abstract: imageDespite the exhaustive search for an acceptable substitute to erythrocyte transfusion, neither chemical-based products such as perfluorocarbons nor hemoglobin-based oxygen carriers have succeeded in providing a reasonable alternative to allogeneic blood transfusion. However, there remain scenarios in which blood transfusion is not an option, due to patient’s religious beliefs, inability to find adequately cross-matched erythrocytes, or in remote locations. In these situations, artificial oxygen carriers may provide a mortality benefit for patients with severe, life-threatening anemia. This article provides an up-to-date review of the history and development, clinical trials, new technology, and current standing of artificial oxygen carriers as an alternative to transfusion when blood is not an option.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Intraoperative Cardiac Arrest During Adult Liver Transplantation:
           Incidence and Risk Factor Analysis From 7 Academic Centers in the United
    • Authors: Smith; Natalie K; Zerillo, Jeron; Kim, Sang Jo; Efune, Guy E.; Wang, Cynthia; Pai, Sher-Lu; Chadha, Ryan; Kor, Todd M.; Wetzel, David R.; Hall, Michael A.; Burton, Kristen K.; Fukazawa, Kyota; Hill, Bryan; Spad, Mia-Ashley; Wax, David B.; Lin, Hung-Mo; Liu, Xiaoyu; Odeh, Jaffer; Torsher, Laurence; Kindscher, James D.; Mandell, M. Susan; Sakai, Tetsuro; DeMaria, Samuel Jr
      Abstract: imageBackground: Intraoperative cardiac arrest (ICA) has a reported frequency of 1 in 10,000 anesthetics but has a much higher estimated incidence in orthotopic liver transplantation (OLT). Single-center studies of ICA in OLT are limited by small sample size that prohibits multivariable regression analysis of risks.METHODS: Utilizing data from 7 academic medical centers, we performed a retrospective, observational study of 5296 adult liver transplant recipients (18–80 years old) between 2000 and 2017 to identify the rate of ICA, associated risk factors, and outcomes.RESULTS: ICA occurred in 196 cases (3.7% 95% confidence interval [CI], 3.2–4.2) and mortality occurred in 62 patients (1.2%). The intraoperative mortality rate was 31.6% in patients who experienced ICA. In a multivariable generalized linear mixed model, ICA was associated with body mass index (BMI)
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Nonselective Compared With Selective α-Blockade Is Associated With Less
           Intraoperative Hypertension in Patients With Pheochromocytomas and
           Paragangliomas: A Retrospective Cohort Study With Propensity Score
    • Authors: Kong; Hao; Li, Nan; Yang, Xi-Chun; Nie, Xiao-Lu; Tian, Jie; Wang, Dong-Xin
      Abstract: imageBackground: Both selective and nonselective α-blockade are used for preoperative preparation in patients with pheochromocytomas and paragangliomas (PPGLs). However, the effects of different types of α-blockade on perioperative outcomes remain inconclusive. This study was designed to assess the association between the choice of α-blockade and the amount of intraoperative hypertension in patients undergoing surgery for PPGLs.METHODS: In this propensity-matched retrospective cohort study, data of patients who received either selective or nonselective α-blockade preoperatively and underwent surgery for PPGLs were collected. The primary end point was the time-weighted average above the systolic blood pressure (SBP) of 160 mm Hg (TWA-SBP>160 mm Hg), which was calculated as the total area of the SBP-time curve above the SBP of 160 mm Hg and divided by anesthesia duration.RESULTS: A total of 286 patients were included in analysis; of them, 156 received selective α-blockade and 130 nonselective α-blockade. After propensity score matching, 89 patients remained in each group. Patients who received nonselective α-blockade had a lower TWA-SBP>160 (median 0.472 mm Hg, interquartile range [IQR], 0.081–1.300) versus those who received selective α-blockade (median 1.114 mm Hg, IQR, 0.162–2.853; median difference −0.391, 95% confidence interval [CI], −0.828 to −0.032; P = .016); they also had a lower highest SBP during surgery (193 ± 24 mm Hg versus 205 ± 34 mm Hg; mean difference −12, 95% CI, −20 to −3; P = .008). Postoperative outcomes did not differ significantly between the 2 groups.CONCLUSIONS: For patients undergoing surgery for PPGLs, preoperative nonselective α-blockade was associated with less intraoperative hypertension when compared with selective α-blockade.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Intravenous Amisulpride Does Not Meaningfully Prolong the QTc Interval at
           Doses Effective for the Management of Postoperative Nausea and Vomiting
    • Authors: Fox; Gabriel M.; Albayaty, Muna; Walker, Joanna L.; Xue, Hongqi; Darpo, Borje
      Abstract: imageBackground: Postoperative nausea and vomiting (PONV) are significant issues in surgical patients, and additional treatment options are needed. Dopaminergic antiemetics have been popular for their efficacy, but their use has been limited by safety concerns, especially the potential for torsade de pointes arising from QT interval prolongation. Intravenous (IV) amisulpride, a dopamine D2 and D3 antagonist shown to be effective at preventing and treating PONV at doses of 5 and 10 mg, respectively, has a dose-dependent effect on QT but at 5 mg is not associated with clinically meaningful prolongation of the heart rate-corrected QT (QTc) interval. This study was designed to evaluate the QT effect of a 10-mg dose of amisulpride, alone and when simultaneously coadministered with ondansetron, an antiemetic of a different class, also known to prolong the QT interval.METHODS: In this randomized, double-blind, placebo-controlled, 3-period, crossover study, healthy male and female volunteers 18–65 years of age received IV, in a random sequence: (1) amisulpride 10 mg given twice, 2 hours apart; (2) amisulpride 10 mg and ondansetron 4 mg, given simultaneously; and (3) placebo.RESULTS: Thirty subjects were enrolled, and 29 completed all 3 treatment periods. The largest mean placebo-corrected change-from-baseline QT interval corrected for heart rate using Fridericia’s formula (QTcF) (ΔΔQTcF) after the first and second amisulpride dose was 5.2 milliseconds (90% confidence interval [CI], 3.53–6.96 milliseconds) and 8.0 milliseconds (90% CI, 5.49–10.58 milliseconds), respectively. After coadministration of amisulpride and ondansetron, the largest mean ΔΔQTcF was 7.3 milliseconds (90% CI, 5.48–9.16 milliseconds). The slope of the amisulpride concentration–change-from-baseline QTcF (ΔQTcF) relationship was 0.006 ms/ng/mL (90% CI, 0.0020–0.0098). No QTc outliers (absolute QTcF value>480 milliseconds or increase from baseline>30 milliseconds) were seen in any period.CONCLUSIONS: A 10-mg dose of IV amisulpride, given alone or in combination with ondansetron, does not have a clinically significant effect on the QT interval.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Machine Learning Applied to Registry Data: Development of a
           Patient-Specific Prediction Model for Blood Transfusion Requirements
           During Craniofacial Surgery Using the Pediatric Craniofacial Perioperative
           Registry Dataset
    • Authors: Jalali; Ali; Lonsdale, Hannah; Zamora, Lillian V.; Ahumada, Luis; Nguyen, Anh Thy H.; Rehman, Mohamed; Fackler, James; Stricker, Paul A.; Fernandez, Allison M.; Pediatric Craniofacial Collaborative Group
      Abstract: imageBackground: Craniosynostosis is the premature fusion of ≥1 cranial sutures and often requires surgical intervention. Surgery may involve extensive osteotomies, which can lead to substantial blood loss. Currently, there are no consensus recommendations for guiding blood conservation or transfusion in this patient population. The aim of this study is to develop a machine-learning model to predict blood product transfusion requirements for individual pediatric patients undergoing craniofacial surgery.METHODS: Using data from 2143 patients in the Pediatric Craniofacial Surgery Perioperative Registry, we assessed 6 machine-learning classification and regression models based on random forest, adaptive boosting (AdaBoost), neural network, gradient boosting machine (GBM), support vector machine, and elastic net methods with inputs from 22 demographic and preoperative features. We developed classification models to predict an individual’s overall need for transfusion and regression models to predict the number of blood product units to be ordered preoperatively. The study is reported according to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) checklist for prediction model development.RESULTS: The GBM performed best in both domains, with an area under receiver operating characteristic curve of 0.87 ± 0.03 (95% confidence interval) and F-score of 0.91 ± 0.04 for classification, and a mean squared error of 1.15 ± 0.12, R-squared (R2) of 0.73 ± 0.02, and root mean squared error of 1.05 ± 0.06 for regression. GBM feature ranking determined that the following variables held the most information for prediction: platelet count, weight, preoperative hematocrit, surgical volume per institution, age, and preoperative hemoglobin. We then produced a calculator to show the number of units of blood that should be ordered preoperatively for an individual patient.CONCLUSIONS: Anesthesiologists and surgeons can use this continually evolving predictive model to improve clinical care of patients presenting for craniosynostosis surgery.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Lung Ultrasound Findings in the Postanesthesia Care Unit Are Associated
           With Outcome After Major Surgery: A Prospective Observational Study in a
           High-Risk Cohort
    • Authors: Zieleskiewicz; Laurent; Papinko, Mickael; Lopez, Alexandre; Baldovini, Alice; Fiocchi, David; Meresse, Zoe; Boussuges, Alain; Thomas, Pascal Alexandre; Berdah, Stephane; Creagh-Brown, Ben; Bouhemad, Belaid; Futier, Emmanuel; Resseguier, Noémie; Antonini, François; Duclos, Gary; Leone, Marc
      Abstract: imageBackground: Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment.METHODS: Patients with an American Society of Anesthesiologists (ASA) score>1 and who were scheduled for major surgery of>2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models.RESULTS: Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 [7–18] vs 8 [4–12]; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2–11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57–0.71).CONCLUSIONS: When lung ultrasound is performed precociously
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Financial and Clinical Ramifications of Introducing a Novel Pediatric
           Enhanced Recovery After Surgery Pathway for Pediatric Complex Hip
           Reconstructive Surgery
    • Authors: Franklin; Andrew D.; Sobey, Jenna H.; Brenn, B. Randall; Johnson, Samuel R.; Schoenecker, Jonathan G.; Gartley, Alison C.; Shotwell, Matthew S.; Gay, James C.; Wanderer, Jonathan P.
      Abstract: imageBackground: Enhanced recovery after surgery pathways confer significant perioperative benefits to patients and are currently well described for adult patients undergoing a variety of surgical procedures. Robust data to support enhanced recovery pathway use in children are relatively lacking in the medical literature, though clinical benefits are reported in targeted pediatric surgical populations. Surgery for complex hip pathology in the adolescent patient is painful, often requiring prolonged courses of opioid analgesia. Postoperative opioid-related side effects may lead to prolonged recovery periods and suboptimal postoperative physical function. Excessive opioid use in the perioperative period is also a major risk factor for the development of opioid misuse in adolescents. Perioperative opioid reduction strategies in this vulnerable population will help to mitigate this risk.METHODS: A total of 85 adolescents undergoing complex hip reconstructive surgery were enrolled into an enhanced recovery after surgery pathway (October 2015 to December 2018) and were compared with 110 patients undergoing similar procedures in previous years (March 2010 to September 2015). The primary outcome was total perioperative opioid consumption. Secondary outcomes included hospital length of stay, postoperative nausea, intraoperative blood loss, and other perioperative outcomes. Total cost of care and specific charge sectors were also assessed. Segmented regression was used to assess the effects of pathway implementation on outcomes, adjusting for potential confounders, including the preimplementation trend over time.RESULTS: Before pathway implementation, there was a significant downward trend over time in average perioperative opioid consumption (−0.10 mg total morphine equivalents/90 days; 95% confidence interval [CI], −0.20 to 0.00) and several secondary perioperative outcomes. However, there was no evidence that pathway implementation by itself significantly altered the prepathway trend in perioperative opioid consumption (ie, the preceding trend continued). For postanesthesia care unit time, the downward trend leveled off significantly (pre: −5.25 min/90 d; 95% CI, −6.13 to −4.36; post: 1.04 min/90 d; 95% CI, −0.47 to 2.56; Change: 6.29; 95% CI, 4.53–8.06). Clinical, laboratory, pharmacy, operating room, and total charges were significantly associated with pathway implementation. There was no evidence that pathway implementation significantly altered the prepathway trend in other secondary outcomes.CONCLUSIONS: The impacts of our pediatric enhanced recovery pathway for adolescents undergoing complex hip reconstruction are consistent with the ongoing improvement in perioperative metrics at our institution but are difficult to distinguish from the impacts of other initiatives and evolving practice patterns in a pragmatic setting. The ERAS pathway helped codify and organize this new pattern of care, promoting multidisciplinary evidence-based care patterns and sustaining positive preexisting trends in financial and clinical metrics.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • The Current State of Combined Pediatric Anesthesiology–Critical Care
           Practice: A Survey of Dual-Trained Practitioners in the United States
    • Authors: Welch; Timothy P.; Kilbaugh, Todd J.; McCloskey, John J.; Juriga, Lindsay L.; Abdallah, Arbi Ben; Fehr, James J.
      Abstract: imageBackground: Combined practice in pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM) was historically common but has declined markedly with time. The reasons for this temporal shift are unclear, but existing evidence suggests that length of training is a barrier to contemporary trainees. Among current practitioners, restriction in dual-specialty practice also occurs, for reasons that are unknown at present. We sought to describe the demographics of this population, investigate their perceptions about the field, and consider factors that lead to attrition.METHODS: We conducted a cross-sectional, observational study of physicians in the United States with a combined practice in PA and PCCM. The survey was distributed electronically and anonymously to the distribution list of the Pediatric Anesthesia Leadership Council (PALC) of the Society for Pediatric Anesthesia (SPA), directing the recipients to forward the link to their faculty meeting our inclusion criteria. Attending-level respondents (n = 62) completed an anonymous, 40-question multidomain survey.RESULTS: Forty-seven men and 15 women, with a median age of 51, completed the survey. Major leadership positions are held by 44%, and 55% are externally funded investigators. A minority (26%) have given up one or both specialties, citing time constraints and politics as the dominant reasons. Duration of training was cited as the major barrier to entry by 77%. Increasing age and faculty rank and lack of a comparably trained institutional colleague were associated with attrition from dual-specialty practice. The majority (88%) reported that they would do it all again.CONCLUSIONS: The current cohort of pediatric anesthesiologist–intensivists in the United States is a small but accomplished group of physicians. Efforts to train, recruit, and retain such providers must address systematic barriers to completion of the requisite training and continued practice.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Stickler Syndrome: Airway Complications in a Case Series of 502 Patients
    • Authors: Zimmermann; Julia; Stubbs, Daniel J.; Richards, Allan J.; Alexander, Philip; McNinch, Annie M.; Matta, Basil; Snead, Martin P.
      Abstract: imageBackground: Patients with Stickler syndrome often require emergency surgery and are often anesthetized in nonspecialist units, typically for retinal detachment repair. Despite the occurrence of cleft palate and Pierre-Robin sequence, there is little published literature on airway complications. Our aim was to describe anesthetic practice and complications in a nonselected series of Stickler syndrome cases. To our knowledge, this is the largest such series in the published literature.METHODS: We retrospectively identified patients with genetically confirmed Stickler syndrome who had undergone general anesthesia in a major teaching hospital, seeking to identify factors that predicted patients who would require more than 1 attempt to correctly site an endotracheal tube (ETT) or supraglottic airway device (SAD). Patient demographics, associated factors, and anesthetic complications were collected. Descriptive statistical analysis and logistic regression modeling were performed.RESULTS: Five hundred and twoanesthetic events were analyzed. Three hundred ninety-five (92.7%) type 1 Stickler and 63 (96.9%) type 2 Stickler patients could be managed with a single attempt of passing an ETT or SAD. Advanced airway techniques were required on 4 occasions, and we report no major complications. On logistic regression, modeling receding mandible (P = .0004) and history of cleft palate (P = .0004) were significantly associated with the need for more than 1 attempt at airway manipulation.CONCLUSIONS: The majority of Stickler patients can be anesthetized safely with standard management. If patients have a receding mandible or history of cleft, an experienced anesthetist familiar with Stickler syndrome should manage the patient. We recommend that patients identified to have a difficult airway wear an alert bracelet.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Variation in Patient-Reported Advance Care Preferences in the Preoperative
    • Authors: Udelsman; Brooks V.; Govea, Nicolas; Cooper, Zara; Chang, David C.; Bader, Angela; Meyer, Matthew J.
      Abstract: imageBackground: High-quality shared decision-making for patients undergoing elective surgical procedures includes eliciting patient goals and treatment preferences. This is particularly important, should complications occur and life-sustaining therapies be considered. Our objective was to determine the preoperative care preferences of older higher-risk patients undergoing elective procedures and to determine any factors associated with a preference for limitations to life-sustaining treatments.METHODS: Cross-sectional survey conducted between May and December 2018. Patients ≥55 years of age presenting for a preprocedural evaluation in a high-risk anesthesia clinic were queried on their desire for life-sustaining treatments (cardiopulmonary resuscitation, mechanical ventilation, dialysis, and artificial nutrition) as well as tolerance for declines in health states (physical disability, cognitive disability, and daily severe pain).RESULTS: One hundred patients completed the survey. The median patient age was 68. Most patients were Caucasian (87%) and had an American Society of Anesthesiologists (ASA) score of III (88%). The majority of patients (89%) desired cardiopulmonary resuscitation. However, most patients would not accept mechanical ventilation, dialysis, or artificial nutrition for an indefinite period of time. Similarly, most patients (67%–81%) indicated they would not desire treatments to sustain life in the event of permanent physical disability, cognitive disability, or daily severe pain.CONCLUSIONS: Among older, higher-risk patients presenting for elective procedures, most patients chose limitations to life-sustaining treatments. This work highlights the need for an in-depth goals of care discussion and establishment of advance care preferences before a procedure or operative intervention.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Pediatric Anesthesia Severe Adverse Events Leading to Anesthetic Morbidity
           and Mortality in a Tertiary Care Center in a Low- and Middle-Income
           Country: A 25-Year Audit
    • Authors: Khoso; Nasir; Ghaffar, Waleed B.; Abassi, Shemila; Khan, Fauzia A.
      Abstract: imageBackground: The analysis of adverse events, including morbidity and mortality (M&M), helps to identify subgroups of children at risk and to modify clinical practice. There are scant data available from low- and middle-income countries. Our aim was to estimate the proportion of pediatric patients with various severe adverse events in the perioperative period extending to 48 hours and to describe the clinical situations and causes of those events.METHODS: We reviewed the M&M database of the Department of Anesthesiology between 1992 and 2016. A data collection tool was developed, and the outcomes were standardized. Each case was reviewed independently and subsequently discussed between 2 reviewers to identify a major primary causative factor.RESULTS: The total number of pediatric cases during this period was 48,828. Seventy-six significant adverse events were identified in 39 patients (8 patients [95% confidence interval {CI}, 5.7–10.9] per 10,000). Thirteen patients had multisystem involvement, and hence the total number of events exceeded the number of patients. Respiratory events were the most common (33.5%). Thirteen patients had perioperative cardiac arrest within 48 hours of surgery (2.6 [95% CI, 1.3–4.3] per 10,000), 7 of these were infants (54%), 5 of whom had congenital heart disease (CHD). Eleven of these 39 patients died within 48 hours (2.0 [95% CI, 1.1–4.0] per 10,000).In 13 cases, anesthesia was assessed to be the predominant cause of morbidity (2.6 per 10,000), whereas in 26 cases, it contributed partially (5.32 per 10,000). There was only 1 death solely related to anesthesia (0.2 per 10,000), and this death occurred before the start of surgery.CONCLUSIONS: Adverse events were uncommon. Respiratory complications were the most frequent (33%). Infants, especially those with CHD, were identified as at a higher risk for perioperative cardiac arrest, but this association was not tested statistically. Twenty-eight percent of the patients who suffered events died within 48 hours. Increased access to anesthesia drugs and practice improvements resulted in a decline in perioperative cardiac arrests.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Interview Data Highlight Importance of “Same-State” on
           Anesthesiology Residency Match
    • Authors: Love; Ephy R.; Dexter, Franklin; Reminick, Jason I.; Sanford, Joseph A.; Karan, Suzanne
      Abstract: imageBackground: The US residency application, interview, and match processes are costly and time-intensive. We sought to quantify the importance of an applicant being from the same-state as a residency program in terms of how this impacted the number of interviews needed to match.METHODS: We examined data from interview scheduling software used by 32 programs located in 31 US states and 1300 applicants for the US anesthesiology recruitment cycles from 2015 to 2018. Interviewee data (distance from program, region, numbers of interviews, and program at which interview occurred) were analyzed to quantify the effect of the interviewee being from the same state as the residency program on the odds of matching to that program. Other variables of interest (medical school, current address, US Medical Licensing Exam [USMLE] Step 1 and 2 clinical knowledge [CK] scores, Alpha Omega Alpha [AOA] status, medical school ranking) were also examined as controls. Confidence intervals (CI) were calculated for the ratios of odds ratios.RESULTS: An interviewee living in the same state as the interviewing program could have 5.42 fewer total interviews (97.5% CI, 3.02–7.81) while having the same odds of matching. The same state effect had an equivalent value as an approximately 4.14 USMLE points-difference from the program’s mean (97.5% CI was 2.34–5.94 USMLE points). Addition of whether the interviewee belonged to an affiliated medical school did not significantly improve the model; same-state remained significant (P < .0001) while affiliated medical school was not (P = .40).CONCLUSIONS: Our analysis of anesthesiology residency recruitment using previously unstudied interview data shows that same-state locality is a viable predictor of residency matching and should be strongly considered when evaluating whether to interview an applicant.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • The Effects of Nitroglycerin on the Oxytocin Dose–Response Profile in
           Oxytocin-Desensitized and Naïve Human Myometrium: An In Vitro Study
    • Authors: Jayasooriya; Gayani S.; Carvalho, Jose C. A.; Luca, Alice; Balki, Mrinalini
      Abstract: imageBackground: Nitroglycerin is used for acute reduction in uterine tone. Prolonged oxytocin exposure causes desensitization of oxytocin receptors. It is unknown if nitroglycerin exposure impacts the subsequent action of oxytocin in the setting of oxytocin receptor desensitization. This study investigated the effects of nitroglycerin on oxytocin-desensitized and oxytocin-naïve human myometrium and the subsequent response to oxytocin dose–response testing in vitro.METHODS: Myometrial samples from 17 elective cesarean deliveries were divided into strips and allocated to 1 of 4 groups: (1) oxytocin desensitized and no nitroglycerin; (2) oxytocin desensitized and nitroglycerin; (3) oxytocin naïve and nitroglycerin; and (4) oxytocin naïve and no nitroglycerin. Final analysis included 28 strips per group. Nitroglycerin groups were exposed to incremental concentrations of nitroglycerin, while no nitroglycerin groups were kept in control (physiological salt) solution. All groups then underwent oxytocin dose–response testing. Primary outcome was motility index (amplitude × frequency; grams × contractions per 10 minutes [g·c/10 min]). Secondary outcomes were amplitude (g), frequency (contractions/10 minutes), and area under the curve (g·s). All outcomes (nitroglycerin and oxytocin dose–response periods) were expressed as a percentage change from baseline. Values were log transformed, compared using regression modeling and reported as the ratio of 2 geometric means (relative difference).RESULTS: No significant difference was observed in motility index following nitroglycerin administration in oxytocin-desensitized versus oxytocin-naïve groups (relative difference = 19.0%; 95% confidence interval [CI], −32.6 to 109.9; P = .55). On oxytocin dose–response testing, motility index was highest in oxytocin-naïve and no nitroglycerin samples (group 4) (1.356 g·c/10 minutes) followed by oxytocin-naïve and nitroglycerin (group 3) (0.882 g·c/10 minutes), oxytocin-desensitized and no nitroglycerin (group 1) (0.769 g·c/10 minutes), and oxytocin-desensitized and nitroglycerin (group 2) (0.651 g·c/10 minutes) samples. Motility index was significantly reduced in group 1 vs 4 (relative difference = −43.3%; 95% CI, −66.5 to −4.1; P = .034) and group 2 vs 4 (relative difference = −52.0%; 95% CI, −70.9 to −20.8; P = .004). While in groups 3 vs 4, both amplitude (relative difference = −17.8%; 95% CI, −30.9 to −2.2; P = .27) and area under the curve (AUC; relative difference = −17.5%; 95% CI, −30.7 to −1.8; P = .030) were reduced.CONCLUSIONS: Nitroglycerin-induced relaxation was not different between oxytocin-desensitized and oxytocin-naïve human myometrial strips in vitro. However, oxytocin-induced contractility was attenuated after nitroglycerin exposure in both oxytocin-desensitized and oxytocin-naïve samples, with maximum attenuation observed in desensitized tissues. This finding warrants further clinical studies to explore uterine responsiveness to oxytocin in women with oxytocin-augmented labors after nitroglycerin administration.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Nonopioid GTS-21 Mitigates Burn Injury Pain in Rats by Decreasing Spinal
           Cord Inflammatory Responses
    • Authors: Zhou; Yinhui; Leung-Pitt, Yiuka; Deng, Hao; Ren, Yang; You, Zerong; Kem, William R.; Shen, Shiqian; Zhang, Wei; Mao, Jianren; Martyn, J. A. Jeevendra
      Abstract: imageBackground: Burn injury (BI) pain consists of inflammatory and neuropathic components and activates microglia. Nicotinic alpha 7 acetylcholine receptors (α7AChRs) expressed in microglia exhibit immunomodulatory activity during agonist stimulation. Efficacy of selective α7AChR agonist GTS-21 to mitigate BI pain and spinal pain-mediators was tested.METHODS: Anesthetized rats after hind-paw BI received intraperitoneal GTS-21 or saline daily. Allodynia and hyperalgesia were tested on BI and contralateral paw for 21 days. Another group after BI receiving GTS-21 or saline had lumbar spinal cord segments harvested (day 7 or 14) to quantify spinal inflammatory-pain transducers or microglia activation using fluorescent marker, ionized calcium-binding adaptor protein (Iba1).RESULTS: BI significantly decreased allodynia withdrawal threshold from baseline of ~9–10 to ~0.5–1 g, and hyperalgesia latency from ~16–17 to ~5–6 seconds by day 1. Both doses of GTS-21 (4 or 8 mg/kg) mitigated burn-induced allodynia from ~0.5–1 to ~2–3 g threshold (P = .089 and P = .010), and hyperalgesia from ~5–6 to 8–9 seconds (P < .001 and P < .001) by day 1. The GTS-21 group recovered to baseline pain threshold by day 15–17 compared to saline-treated, where the exaggerated nociception persisted beyond 15–17 days. BI significantly (P < .01) increased spinal cord microgliosis (identified by fluorescent Iba1 staining), microglia activation (evidenced by the increased inflammatory cytokine), and pain-transducer (protein and/or messenger RNA [mRNA]) expression (tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], nuclear factor-kappa B [NF-κB], interleukin-6 [IL-6], Janus-associated kinase signal transducer and activator of transcription 3 [JAK-STAT3], and/or N-methyl-d-aspartate receptor [NMDAR]). GTS-21 mitigated pain-transducer changes. The α7AChR antagonist methyllycaconitine nullified the beneficial effects of GTS-21 on both increased nociception and pain-biomarker expression.CONCLUSIONS: Nonopioid, α7AChR agonist GTS-21 elicits antinociceptive effects at least in part by decreased activation spinal-cord pain-inducers. The α7AChR agonist GTS-21 holds promise as potential therapeutic adjunct to decrease BI pain by attenuating both microglia changes and expression of exaggerated pain transducers.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Dexmedetomidine Provides Cardioprotection During Early or Late Reperfusion
           Mediated by Different Mitochondrial K+-Channels
    • Authors: Raupach; Annika; Karakurt, Elif; Torregroza, Carolin; Bunte, Sebastian; Feige, Katharina; Stroethoff, Martin; Brandenburger, Timo; Heinen, André; Hollmann, Markus W.; Huhn, Ragnar
      Abstract: imageBackground: Cardioprotective interventions—such as pharmacological postconditioning—are a promising strategy to reduce deleterious consequences of ischemia and reperfusion injury (I/RI) in the heart, especially as timing and onset of myocardial infarction are unpredictable. Pharmacological postconditioning by treatment with dexmedetomidine (Dex), an α2-adrenoreceptor agonist, during reperfusion protects hearts from I/RI, independently of time point and duration of application during the reperfusion phase. The mitochondrial ATP-sensitive K+ (mKATP) and mitochondrial large-conductance calcium-sensitive potassium channel (mBKCa) play a pivotal role in mediating this cardioprotective effect. Therefore, we investigated whether Dex-induced cardioprotection during early or late reperfusion is mediated variously by these mitochondrial K+-channels.METHODS: Hearts of male Wistar rats were randomized into 8 groups and underwent a protocol of 15 minutes adaption, 33 minutes ischemia, and 60 minutes reperfusion in an in vitro Langendorff-system. A 10-minute treatment phase was started directly (first subgroup, early reperfusion) or 30 minutes (second subgroup, late reperfusion) after the onset of reperfusion. Control (Con) hearts received vehicle only. In the first subgroup, hearts were treated with 3 nM Dex, 100 µM mKATP-channel blocker 5-hydroxydecanoate (5HD) or 1 µM mBKCa-channel blocker Paxilline (Pax) alone or with respective combinations (5HD + Dex, Pax + Dex). Hearts of the second subgroup received Dex alone (Dex30’) or in combination with the respective blockers (5HD + Dex30’, Pax + Dex30’). Infarct size was determined with triphenyltetrazoliumchloride staining. Hemodynamic variables were recorded during the whole experiment.RESULTS: During early reperfusion (first subgroup), the infarct size reducing effect of Dex (Con: 57% ± 9%, Dex: 31% ± 7%; P< .0001 versus Con) was completely abolished by 5HD and Pax (52% ± 6%; Pax + Dex: 53% ± 4%; each P< .0001 versus Dex), while both blockers alone had no effect on infarct size (5HD: 54% ± 8%, Pax: 53% ± 11%). During late reperfusion (second subgroup) the protective effect of Dex (Dex30’: 33% ± 10%, P< .0001 versus Con) was fully abrogated by Pax (Pax + Dex30’: 58% ± 7%, P < .0001 versus Dex30’), whereas 5HD did not block cardioprotection (5HD + Dex30’: 36% ± 7%). Between groups and within each group throughout reperfusion no significant differences in hemodynamic variables were detected.CONCLUSIONS: Cardioprotection by treatment with Dex during early reperfusion seems to be mediated by both mitochondrial K+-channels, whereas during late reperfusion only mBKCa-channels are involved.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • The Clinical Use of Cricoid Pressure: First, Do No Harm
    • Authors: Zdravkovic; Marko; Rice, Mark J.; Brull, Sorin J.
      Abstract: imageApplication of cricoid pressure (CP) during rapid sequence induction and intubation sequence has been a “standard” of care for many decades, despite limited scientific proof of its efficacy in preventing pulmonary aspiration of gastric contents. While some of the current rapid sequence induction and intubation guidelines recommend its use, other international guidelines do not, and many clinicians argue that there is insufficient evidence to either continue or abandon its use. Recently published articles and accompanying editorials have reignited the debate on the efficacy and safety of CP application and have generated multiple responses that pointed out the various (and significant) limitations of the available evidence. Thus, a critical discussion of available data must be undertaken before making a final clinical decision on such an important patient safety issue. In this review, the authors will take an objective look at the available scientific evidence about the effectiveness and safety of CP in patients at risk of pulmonary aspiration of gastric contents. We suggest that current data are inadequate to impose clinical guidelines on the use of CP because we acknowledge that currently there is not, and there may never be, a method to prevent aspiration in all patients. In addition, we reiterate that a universally accepted medical-legal standard for approaching the high-risk aspiration patient does not exist, discuss the differences in practice between the US and international practitioners regarding use of CP, and propose 5 recommendations on how future studies might be designed to obtain optimal scientific evidence about the effectiveness and safety of CP in patients at risk for pulmonary aspiration.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Creating a Residency Program for Years to Come: An Exceptional Experience
    • Authors: Mukhdomi; Taif J.
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Gender Balance in Anesthesiology: Is a Change of Societal Mindset
    • Authors: von Ungern-Sternberg; Britta S.; Sommerfield, Aine
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Potential Harm of Elimination of Score Reporting for the United States
           Medical Licensing Examination Step 1 Examination to Anesthesiology
           Residency Selection
    • Authors: Markham; Travis H.; de Haan, Johanna B.; Guzman-Reyes, Sara; Brollier, Lauren D.; Campbell, Amber N.; Pivalizza, Evan G.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Macrocirculation and Microcirculation: The “Batman and Superman” Story
           of Critical Care Resuscitation
    • Authors: Khanna; Ashish K.; Karamchandani, Kunal
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Observation of Complement Protein Gene Expression Before and After Surgery
           in Opioid-Consuming and Opioid-Naive Patients
    • Authors: Johnson; Ken B.; Light, Alan R.; Odell, Daniel W.; Stuart, Ami R.; Radtke, Jacob; Light, Kathleen C.
      Abstract: imageOpioids may influence inflammation. We compared genes associated with pain and inflammation in patients who consumed opioids (3–120 mg of oral morphine equivalents per day) with those who did not for differential expression. White blood cells were assayed in 20 patients presenting for total lower extremity joint replacement. We focused on messenger ribonucleic acid expression of complement proteins. We report that the expression of a complement inhibitor, complement 4 binding protein A, was reduced, and the expression of a complement activator, complement factor D, was increased in opioid-consuming patients. We conclude that opioid consumption may influence expression of complement activators and inhibitors.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Daily Caffeine Consumption Does Not Influence Acupuncture Analgesia in
           Healthy Individuals: A Preliminary Study
    • Authors: Cao; Jin; Tu, Yiheng; Lang, Courtney; Vangel, Mark; Park, Joel; Liu, Jiao; Wilson, Georgia; Gollub, Randy; Orr, Scott; Kong, Jian
      Abstract: imageAnimal studies suggest that caffeine may interfere with acupuncture analgesia. This study investigated the modulation effect of daily caffeine intake on acupuncture analgesia in 27 healthy subjects using a crossover design. We found that real acupuncture increased pain thresholds compared to sham acupuncture. Further, there was no association between caffeine intake measurements of daily caffeine use, duration of caffeine consumption, or their interaction and preacupuncture and postacupuncture pain threshold changes. Our findings suggest that daily caffeine intake may not influence acupuncture analgesia in the cohort of healthy subjects who participated in study.
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Critical Care Medicine Review: 1000 Questions and Answers
    • Authors: Šribar; Andrej
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Practical Chronic Pain Management
    • Authors: Forget; Patrice
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • Improving the Utility of Electroencephalogram-Guided Anesthesia for
           Prevention of Postoperative Delirium
    • Authors: Reis; Katherine; Clebone, Anna
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • CO2 is Good for You!
    • Authors: Yaster; Myron; Gross, Jeffrey B.
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
  • In Response
    • Authors: Gilbertson; Laura E.; Fiedorek, Michael C.; Lam, Humphrey; Austin, Thomas M.
      Abstract: No abstract available
      PubDate: Fri, 01 Jan 2021 00:00:00 GMT-
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762

Your IP address:
Home (Search)
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-