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ANAESTHESIOLOGY (121 journals)                     

Showing 1 - 121 of 121 Journals sorted alphabetically
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 62)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 15)
Advances in Anesthesia     Full-text available via subscription   (Followers: 31)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 9)
Ain-Shams Journal of Anaesthesiology     Open Access   (Followers: 2)
Ain-Shams Journal of Anesthesiology     Open Access   (Followers: 1)
Ambulatory Anesthesia     Open Access   (Followers: 9)
Anaesthesia     Hybrid Journal   (Followers: 238)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 72)
Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 62)
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: 6)
Anestesia Analgesia Reanimación     Open Access   (Followers: 1)
Anestesia en México     Open Access   (Followers: 1)
Anesthesia & Analgesia     Hybrid Journal   (Followers: 275)
Anesthesia : Essays and Researches     Open Access   (Followers: 10)
Anesthesia Progress     Hybrid Journal   (Followers: 6)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology     Hybrid Journal   (Followers: 232)
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: 243)
BJA Education     Hybrid Journal   (Followers: 70)
BMC Anesthesiology     Open Access   (Followers: 18)
BMJ Supportive & Palliative Care     Hybrid Journal   (Followers: 47)
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: 19)
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: 9)
Der Schmerz     Hybrid Journal   (Followers: 4)
Der Schmerzpatient     Hybrid Journal  
Douleur et Analgésie     Hybrid Journal  
Egyptian Journal of Anaesthesia     Open Access   (Followers: 2)
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: 30)
European Journal of Pain     Full-text available via subscription   (Followers: 27)
European Journal of Pain Supplements     Full-text available via subscription   (Followers: 5)
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: 8)
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: 13)
Journal of Anesthesia History     Full-text available via subscription   (Followers: 1)
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: 42)
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: 19)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 45)
Journal of Pain Research     Open Access   (Followers: 10)
Journal of Palliative Care     Full-text available via subscription   (Followers: 20)
Journal of Society of Anesthesiologists of Nepal     Open Access   (Followers: 2)
Journal of the Bangladesh Society of Anaesthesiologists     Open Access  
Jurnal Anestesi Perioperatif     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: 13)
Pain Research and Management     Open Access   (Followers: 7)
Pain Research and Treatment     Open Access   (Followers: 2)
Pain Studies and Treatment     Open Access   (Followers: 2)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
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
Anesthesiology
Journal Prestige (SJR): 2.123
Citation Impact (citeScore): 3
Number of Followers: 232  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-3022 - ISSN (Online) 1528-1175
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Ventilators vs. Robots: Optimizing for Obese PEEPle
    • Authors: Wanderer JP; Rathmell JP.
      Abstract: Complex Information for Anesthesiologists Presented Quickly and Clearly
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003534
      Issue No: Vol. 133, No. 4 (2020)
       
  • Science, Medicine, and the Anesthesiologist
    • Abstract: Key Papers from the Most Recent Literature Relevant to Anesthesiologists
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003540
      Issue No: Vol. 133, No. 4 (2020)
       
  • This Month in Anesthesiology
    • PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003535
      Issue No: Vol. 133, No. 4 (2020)
       
  • Anesthesiology
    • PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003543
      Issue No: Vol. 133, No. 4 (2020)
       
  • Anesthesiology
    • PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003565
      Issue No: Vol. 133, No. 4 (2020)
       
  • Instructions for Obtaining A nesthesiology Continuing Medical Education
           (CME) Credit
    • PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003542
      Issue No: Vol. 133, No. 4 (2020)
       
  • Lung Mechanics of the Obese Undergoing Robotic Surgery and the Pursuit of
           Protective Ventilation
    • Authors: Bao X; Vidal Melo MF.
      Pages: 695 - 697
      Abstract: Image: A. Johnson, Vivo Visuals.
      PubDate: Mon, 17 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003504
      Issue No: Vol. 133, No. 4 (2020)
       
  • Anesthetic Drugs and Cancer Progression Fact or Fiction
    • Authors: Cata JP; Sood AK, Eltzschig HK.
      Pages: 698 - 699
      Abstract: Image: Adobe Stock/J. P. Rathmell.
      PubDate: Mon, 17 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003510
      Issue No: Vol. 133, No. 4 (2020)
       
  • Does Delta Connectivity Differentiate Sleep and Anesthesia'
    • Authors: Sanders RD.
      Pages: 700 - 701
      Abstract: “[T]he leap in understanding regarding cortical dynamics with changing propofol concentrations takes us one step closer to understanding the mechanisms of anesthesia and their differences from sleep.”
      PubDate: Wed, 12 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003478
      Issue No: Vol. 133, No. 4 (2020)
       
  • Preoperative Screening for Obstructive Sleep Apnea to Improve Long-term
           Outcomes
    • Authors: Nadler JW; Karan SB, Glance LG.
      Pages: 702 - 704
      Abstract: “…should anesthesiologists take a leading role in the diagnostic workup of patients who screen positive for OSA'”
      PubDate: Tue, 11 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003492
      Issue No: Vol. 133, No. 4 (2020)
       
  • Complete Airway Closure Where, Why, and with What Consequences'
    • Authors: Hedenstierna G.
      Pages: 705 - 707
      Abstract: “...data...illustrate a new observation of respiratory dysfunction, complete airway closure...[that] differs from the classic airway closure phenomenon that can be seen in peripheral airways...”
      PubDate: Mon, 17 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003479
      Issue No: Vol. 133, No. 4 (2020)
       
  • Venoarterial Extracorporeal Membrane Oxygenation If You Cannot Measure It,
           You Cannot Improve It
    • Authors: Shekar K; Donker DW, Brodie D.
      Pages: 708 - 710
      Abstract: “…effective integration of native circulation with temporary mechanical circulatory support to minimize iatrogenic insults is an evolving science.”
      PubDate: Wed, 12 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003487
      Issue No: Vol. 133, No. 4 (2020)
       
  • Journal-related Activities and Other Special Activities at the 2020
           American Society of Anesthesiologists Meeting
    • Authors: Avram MJ; Culley DJ, Kharasch ED, et al.
      Pages: 711 - 717
      Abstract: As in previous years, Anesthesiology will sponsor several sessions at the annual meeting of the American Society of Anesthesiologists, Anesthesiology 2020. Because of COVID-19, this meeting will be 100% virtual. Details about the format and meeting attendance can be found on the website, asahq.org/annualmeeting.
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003537
      Issue No: Vol. 133, No. 4 (2020)
       
  • Ru-Rong Ji, Ph.D., Recipient of the 2020 Excellence in Research Award
    • Authors: Todd MM; Kharasch ED.
      Pages: 718 - 719
      Abstract: THE American Society of Anesthesiologists (ASA) initiated its Excellence in Research Award in 1986, with the first honor to Dr. John Severinghaus. The award recognizes an individual for outstanding achievement in research that has or is likely to have an important impact on the practice of anesthesiology, and must represent a body of original, mature, and sustained contributions to the advancement of the science of anesthesiology.
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003536
      Issue No: Vol. 133, No. 4 (2020)
       
  • Robert D. Sanders, B.Sc., M.B.B.S., Ph.D., F.R.C.A., Recipient of the 2020
           James E. Cottrell, M.D., Presidential Scholar Award
    • Authors: Pearce RA; Maze M.
      Pages: 720 - 723
      Abstract: THE 2020 recipient of the James E. Cottrell, M.D., Presidential Scholar Award is Robert D. Sanders, B.Sc., M.B.B.S., Ph.D., F.R.C.A. We served as his department chairs and mentors during his clinical and research training at Imperial College London (M.M.) and when he was assistant professor of anesthesiology at the University of Wisconsin-Madison (R.A.P.). We had the good fortune of watching, from front-row seats, a meteoric progression from his medical school in London to his recent appointment as Nuffield Chair of Anaesthetics at the University of Sydney, Australia. What follows are personal reflections of time spent observing and collaborating with a rising star in our discipline.
      PubDate: Mon, 17 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003512
      Issue No: Vol. 133, No. 4 (2020)
       
  • Images from the Frontlines of the COVID-19 Pandemic
    • Pages: 724 - 739
      Abstract: As the COVID-19 pandemic has emerged, anesthesiologists have taken leading roles on the frontlines in operating rooms, ICUs, and on emergency response and institutional leadership teams around the world. This crisis abruptly changed our everyday practices, challenging us to contribute in unique ways. This photo essay combines images submitted by anesthesiologists from around the world to help tell the COVID-19 story through images captured on the frontlines of the pandemic.
      PubDate: Tue, 04 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003513
      Issue No: Vol. 133, No. 4 (2020)
       
  • Anesthetic and Analgesic Drug Products Advisory Committee Activity and
           Decisions in the Opioid-crisis Era
    • Authors: Litman RS.
      Pages: 740 - 749
      Abstract: The United States Food and Drug Administration is tasked with ensuring the efficacy and safety of medications marketed in the United States. One of their primary responsibilities is to approve the entry of new drugs into the marketplace, based on the drug’s perceived benefit–risk relationship. The Anesthetic and Analgesic Drug Product Advisory Committee is composed of experts in anesthesiology, pain management, and biostatistics, as well as consumer and industry representatives, who meet several times annually to review new anesthetic-related drugs, those seeking new indications, and nearly every opioid-related application for approval. The following report describes noteworthy activities of this committee since 2017, as it has grappled, along with the Food and Drug Administration, to balance the benefit–risk relationships for individual patients along with the overarching public health implications of bringing additional opioids to market. All anesthesia advisory committee meetings since 2017 will be described, and six will be highlighted, each with representative considerations for potential new opioid formulations or local anesthetics.
      PubDate: Mon, 03 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003485
      Issue No: Vol. 133, No. 4 (2020)
       
  • Body Habitus and Dynamic Surgical Conditions Independently Impair
           Pulmonary Mechanics during Robotic-assisted Laparoscopic Surgery A
           Cross-sectional Study
    • Authors: Tharp WG; Murphy S, Breidenstein MW, et al.
      Pages: 750 - 763
      Abstract: BackgroundBody habitus, pneumoperitoneum, and Trendelenburg positioning may each independently impair lung mechanics during robotic laparoscopic surgery. This study hypothesized that increasing body mass index is associated with more mechanical strain and alveolar collapse, and these impairments are exacerbated by pneumoperitoneum and Trendelenburg positioning.MethodsThis cross-sectional study measured respiratory flow, airway pressures, and esophageal pressures in 91 subjects with body mass index ranging from 18.3 to 60.6 kg/m2. Pulmonary mechanics were quantified at four stages: (1) supine and level after intubation, (2) with pneumoperitoneum, (3) in Trendelenburg docked with the surgical robot, and (4) level without pneumoperitoneum. Subjects were stratified into five body mass index categories (less than 25, 25 to 29.9, 30 to 34.9, 35 to 39.9, and 40 or higher), and respiratory mechanics were compared over surgical stages using generalized estimating equations. The optimal positive end-expiratory pressure settings needed to achieve positive end-expiratory transpulmonary pressures were calculated.ResultsAt baseline, transpulmonary driving pressures increased in each body mass index category (1.9 ± 0.5 cm H2O; mean difference ± SD; P < 0.006), and subjects with a body mass index of 40 or higher had decreased mean end-expiratory transpulmonary pressures compared with those with body mass index of less than 25 (–7.5 ± 6.3 vs. –1.3 ± 3.4 cm H2O; P < 0.001). Pneumoperitoneum and Trendelenburg each further elevated transpulmonary driving pressures (2.8 ± 0.7 and 4.7 ± 1.0 cm H2O, respectively; P < 0.001) and depressed end-expiratory transpulmonary pressures (–3.4 ± 1.3 and –4.5 ± 1.5 cm H2O, respectively; P < 0.001) compared with baseline. Optimal positive end-expiratory pressure was greater than set positive end-expiratory pressure in 79% of subjects at baseline, 88% with pneumoperitoneum, 95% in Trendelenburg, and ranged from 0 to 36.6 cm H2O depending on body mass index and surgical stage.ConclusionsIncreasing body mass index induces significant alterations in lung mechanics during robotic laparoscopic surgery, but there is a wide range in the degree of impairment. Positive end-expiratory pressure settings may need individualization based on body mass index and surgical conditions.Editor’s PerspectiveWhat We Already Know about This TopicPrior studies suggest that intraoperative use of standardized tidal volumes based on ideal body weight are beneficial. However, attempts to define optimal positive end-expiratory pressure levels remain elusive given varying effects of body habitus and dynamic surgical conditions (pneumoperitoneum and Trendelenberg positioning).Using esophageal manometry, the authors partitioned respiratory mechanical properties into lung and chest wall components in patients undergoing robotic laparoscopic surgery to assess the effects of obesity, pneumoperitoneum and Trendelenberg positioning on transpulmonary driving pressures and estimate optimal positive end-expiratory pressure for a given degree of obesity or surgical condition.What This Article Tells Us That Is NewObese patients demonstrated increased driving pressures and decreased mean end-expiratory transpulmonary pressures. Pneumoperitoneum and Trendelenberg position further accentuated these differences. The optimal positive end-expiratory pressure was greater than set positive end-expiratory pressure in most subjects at all stages, ranging from 0 to 36.6 cm H2O.Intraoperative positive end-expiratory pressure settings should account for dynamic changes in transpulmonary driving and end-expiratory pressures related to these factors. How best to accomplish this clinically remains uncertain.
      PubDate: Thu, 09 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003442
      Issue No: Vol. 133, No. 4 (2020)
       
  • Bailey’s Match Safe for Matchless Anesthesia and Dentistry
    • Pages: 763 - 763
      Abstract: In 1884, Rowland William Bailey, an Illinois native, earned his D.D.S. from the University of Michigan. By 1888, he had moved to Omaha, Nebraska, where he established a dental practice. To strike up business, he distributed a backplate (left) that advertised “Vitalized Air for Painless Extraction” and came with an attached container. Peering into the pouch (upper right) suggests what its underside (lower right) confirms. This was a wall-mounted match safe, with a rough base that was used to strike matches. Such hanging match holders were foolish furnishings for dental offices using flammable anesthetics. Vitalized Air—nitrous oxide mixed with alcohol and chloroform—was certainly combustible. In newspaper advertisements, the daring Dr. Bailey also claimed that his anesthetized treatments, by promoting “a clean mouth” and “healthy digestion,” would keep cholera away. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology, Schaumburg, Illinois.)
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003544
      Issue No: Vol. 133, No. 4 (2020)
       
  • Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in
           Patients Having Digestive Cancer Surgery A Nationwide Retrospective Cohort
           Study
    • Authors: Makito K; Matsui H, Fushimi K, et al.
      Pages: 764 - 773
      Abstract: BackgroundPrevious experimental and clinical studies have shown that anesthetic agents have varying effects on cancer prognosis; however, the results were inconsistent among these studies. The authors compared overall and recurrence-free survival in patients given volatile or intravenous anesthesia for digestive tract cancer surgery.MethodsThe authors selected patients who had elective esophagectomy, gastrectomy, hepatectomy, cholecystectomy, pancreatectomy, colectomy, and rectal cancer surgery from July 2010 to March 2018 using the Japanese Diagnosis Procedure Combination database. Patients were divided into a volatile anesthesia group (desflurane, sevoflurane, or isoflurane with/without nitrous oxide) and a propofol-based total intravenous anesthesia group. The authors hypothesized that total intravenous anesthesia is associated with greater overall and recurrence-free survival than volatile anesthesia. Subgroup analyses were performed for each type of surgery.ResultsThe authors identified 196,303 eligible patients (166,966 patients in the volatile anesthesia group and 29,337 patients in the propofol-based total intravenous anesthesia group). The numbers (proportions) of death in the volatile anesthesia and total intravenous anesthesia groups were 17,319 (10.4%) and 3,339 (11.4%), respectively. There were no significant differences between the two groups in overall survival (hazard ratio, 1.02; 95% CI, 0.98 to 1.07; P = 0.28) or recurrence-free survival (hazard ratio, 0.99; 95% CI, 0.96 to 1.03; P = 0.59), whereas instrumental variable analyses showed a slight difference in recurrence-free survival (hazard ratio, 0.92; 95% CI, 0.87 to 0.98; P = 0.01). Subgroup analyses showed no significant difference in overall or recurrence-free survival between the groups in any type of surgery.ConclusionsOverall and recurrence-free survival were similar between volatile and intravenous anesthesia in patients having digestive tract surgery. Selection of the anesthetic approach for these patients should be based on other factors.Editor’s PerspectiveWhat We Already Know about This TopicExperimental and clinical studies suggest that intravenous anesthesia may reduce cancer recurrence after potentially curative surgeryWhat This Article Tells Us That Is NewAmong more than 190,000 patients who had cancer surgery, overall and recurrence-free survival were comparable in patients who had propofol-based total intravenous and volatile anesthesiaSelection of anesthetic approach should be based on factors other than putative effects on cancer recurrence
      PubDate: Wed, 01 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003440
      Issue No: Vol. 133, No. 4 (2020)
       
  • Granger Causality of the Electroencephalogram Reveals Abrupt Global Loss
           of Cortical Information Flow during Propofol-induced Loss of
           Responsiveness
    • Authors: Pullon RM; Yan L, Sleigh JW, et al.
      Pages: 774 - 786
      Abstract: BackgroundIt is a commonly held view that information flow between widely separated regions of the cerebral cortex is a necessary component in the generation of wakefulness (also termed “connected” consciousness). This study therefore hypothesized that loss of wakefulness caused by propofol anesthesia should be associated with loss of information flow, as estimated by the effective connectivity in the scalp electroencephalogram (EEG) signal.MethodsEffective connectivity during anesthesia was quantified by applying bivariate Granger to multichannel EEG data recorded from 16 adult subjects undergoing a slow induction of, and emergence from, anesthesia with intravenous propofol. During wakefulness they were conducting various auditory and motor tasks. Functional connectivity using EEG coherence was also estimated.ResultsThere was an abrupt, substantial, and global decrease in effective connectivity around the point of loss of responsiveness. Recovery of behavioral responsiveness was associated with a comparable recovery in information flow pattern (expressed as normalized values). The median (interquartile range) change was greatest in the delta frequency band: decreasing from 0.15 (0.21) 2 min before loss of behavioral response, to 0.06 (0.04) 2 min after loss of behavioral response (P < 0.001). Regional decreases in information flow were maximal in a posteromedial direction from lateral frontal and prefrontal regions (0.82 [0.24] 2 min before loss of responsiveness, decreasing to 0.17 [0.05] 2 min after), and least for information flow from posterior channels. The widespread decrease in bivariate Granger causality reflects loss of cortical coordination. The relationship between functional connectivity (coherence) and effective connectivity (Granger causality) was inconsistent.ConclusionsPropofol-induced unresponsiveness is marked by a global decrease in information flow, greatest from the lateral frontal and prefrontal brain regions in a posterior and medial direction. Loss of information flow may be a useful measure of connected consciousness.Editor’s PerspectiveWhat We Already Know about This TopicInformation flow between brain regions is commonly hypothesized as a necessary component in the generation of wakefulnessThe issue of how loss of consciousness alters this information flow is incompletely understoodGranger causality analysis of multichannel electroencephalogram recordings may provide a useful approach to study connectivity in the cerebral cortexWhat This Article Tells Us That Is NewIn healthy adult volunteers, propofol anesthesia–induced loss of consciousness was associated with an abrupt, substantial, and global decrease in connectivityThese changes are comparably reversed at regain of consciousnessThese observations suggest that information flow is an important indicator of wakefulness
      PubDate: Wed, 01 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003398
      Issue No: Vol. 133, No. 4 (2020)
       
  • Cost-effectiveness Analysis of Preoperative Screening Strategies for
           Obstructive Sleep Apnea among Patients Undergoing Elective Inpatient
           Surgery
    • Authors: Sankar A; Dixon PR, Sivanathan L, et al.
      Pages: 787 - 800
      Abstract: BackgroundObstructive sleep apnea is underdiagnosed in surgical patients. The cost-effectiveness of obstructive sleep apnea screening is unknown. This study’s objective was to evaluate the cost-effectiveness of preoperative obstructive sleep apnea screening (1) perioperatively and (2) including patients’ remaining lifespans.MethodsAn individual-level Markov model was constructed to simulate the perioperative period and lifespan of patients undergoing inpatient elective surgery. Costs (2016 Canadian dollars) were calculated from the hospital perspective in a single-payer health system. Remaining model parameters were derived from a structured literature search. Candidate strategies included: (1) no screening; (2) STOP-Bang questionnaire alone; (3) STOP-Bang followed by polysomnography (STOP-Bang + polysomnography); and (4) STOP-Bang followed by portable monitor (STOP-Bang + portable monitor). Screen-positive patients (based on STOP-Bang cutoff of at least 3) received postoperative treatment modifications and expedited definitive testing. Effectiveness was expressed as quality-adjusted life month in the perioperative analyses and quality-adjusted life years in the lifetime analyses. The primary outcome was the incremental cost-effectiveness ratio.ResultsIn perioperative and lifetime analyses, no screening was least costly and least effective. STOP-Bang + polysomnography was the most effective strategy and was more cost-effective than both STOP-Bang + portable monitor and STOP-Bang alone in both analyses. In perioperative analyses, STOP-Bang + polysomnography was not cost-effective compared to no screening at the $4,167/quality-adjusted life month threshold (incremental cost-effectiveness ratio $52,888/quality-adjusted life month). No screening was favored in more than 90% of iterations in probabilistic sensitivity analyses. In contrast, in lifetime analyses, STOP-Bang + polysomnography was favored compared to no screening at the $50,000/quality-adjusted life year threshold (incremental cost-effectiveness ratio $2,044/quality-adjusted life year). STOP-Bang + polysomnography was favored in most iterations at thresholds above $2,000/quality-adjusted life year in probabilistic sensitivity analyses.ConclusionsThe cost-effectiveness of preoperative obstructive sleep apnea screening differs depending on time horizon. Preoperative screening with STOP-Bang followed by immediate confirmatory testing with polysomnography is cost-effective on the lifetime horizon but not the perioperative horizon. The integration of preoperative screening based on STOP-Bang and polysomnography is a cost-effective means of mitigating the long-term disease burden of obstructive sleep apnea.Editor’s PerspectiveWhat We Already Know about This TopicObstructive sleep apnea is common, frequently undiagnosed, and associated with increased risk of postoperative complications.This risk may be mitigated if obstructive sleep apnea is identified preoperatively.Several screening modalities are available. Polysomnography is the gold standard but expensive. The STOP-Bang questionnaire and portable monitors are cheaper but less accurate alternatives.What This Article Tells Us That Is NewIn a Canadian single healthcare payer model, the cost-effectiveness of preoperative obstructive sleep apnea screening differs depending on time horizon.Preoperative screening with STOP-Bang followed by immediate confirmatory testing with polysomnography is cost-effective on the lifetime horizon but not the perioperative horizon.
      PubDate: Fri, 26 Jun 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003429
      Issue No: Vol. 133, No. 4 (2020)
       
  • Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative
           Ambulation A Randomized Controlled Trial
    • Authors: Schwenk ES; Kasper VP, Smoker JD, et al.
      Pages: 801 - 811
      Abstract: BackgroundEarly ambulation after total hip arthroplasty predicts early discharge. Spinal anesthesia is preferred by many practices but can delay ambulation, especially with bupivacaine. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. This study was designed to test the hypothesis that patients who received mepivacaine would ambulate earlier than those who received hyperbaric or isobaric bupivacaine for primary total hip arthroplasty.MethodsThis randomized controlled trial included American Society of Anesthesiologists Physical Status I to III patients undergoing primary total hip arthroplasty. The patients were randomized 1:1:1 to 52.5 mg of mepivacaine, 11.25 mg of hyperbaric bupivacaine, or 12.5 mg of isobaric bupivacaine for spinal anesthesia. The primary outcome was ambulation between 3 and 3.5 h. Secondary outcomes included return of motor and sensory function, postoperative pain, opioid consumption, transient neurologic symptoms, urinary retention, intraoperative hypotension, intraoperative muscle tension, same-day discharge, length of stay, and 30-day readmissions.ResultsOf 154 patients, 50 received mepivacaine, 53 received hyperbaric bupivacaine, and 51 received isobaric bupivacaine. Patient characteristics were similar among groups. For ambulation at 3 to 3.5 h, 35 of 50 (70.0%) of patients met this endpoint in the mepivacaine group, followed by 20 of 53 (37.7%) in the hyperbaric bupivacaine group, and 9 of 51 (17.6%) in the isobaric bupivacaine group (P < 0.001). Return of motor function occurred earlier with mepivacaine. Pain and opioid consumption were higher for mepivacaine patients in the early postoperative period only. For ambulatory status, 23 of 50 (46.0%) of mepivacaine, 13 of 53 (24.5%) of hyperbaric bupivacaine, and 11 of 51 (21.5%) of isobaric bupivacaine patients had same-day discharge (P = 0.014). Length of stay was shortest in mepivacaine patients. There were no differences in transient neurologic symptoms, urinary retention, hypotension, muscle tension, or dizziness.ConclusionsMepivacaine patients ambulated earlier and were more likely to be discharged the same day than both hyperbaric bupivacaine and isobaric bupivacaine patients. Mepivacaine could be beneficial for outpatient total hip arthroplasty candidates if spinal is the preferred anesthesia type.Editor’s PerspectiveWhat We Already Know about This TopicEarly ambulation after total hip arthroplasty is key to achieving readiness for dischargeThe spinal anesthetic for total hip arthroplasty that balances pain control with timely resolution of motor block has not been identifiedWhat This Article Tells Us That Is NewIn this randomized, three-arm study involving 154 patients, more individuals in the mepivacaine spinal group ambulated 3 to 3.5 h after injection than did individuals in either the isobaric or hyperbaric bupivacaine groupLikewise, more patients in the mepivacaine group achieved same-day discharge than patients in the other experimental groups
      PubDate: Thu, 23 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003480
      Issue No: Vol. 133, No. 4 (2020)
       
  • Neonatal Isoflurane Anesthesia or Disruption of Postsynaptic Density-95
           Protein Interactions Change Dendritic Spine Densities and Cognitive
           Function in Juvenile Mice
    • Authors: Schaefer ML; Perez PJ, Wang M, et al.
      Pages: 812 - 823
      Abstract: BackgroundExperimental evidence shows postnatal exposure to anesthesia negatively affects brain development. The PDZ2 domain, mediating protein–protein interactions of the postsynaptic density-95 protein, serves as a molecular target for several inhaled anesthetics. The authors hypothesized that early postnatal disruption of postsynaptic density-95 PDZ2 domain interactions has persistent effects on dendritic spines and cognitive function.MethodsOne-week-old mice were exposed to 1.5% isoflurane for 4 h or injected with 8 mg/kg active postsynaptic density-95 wild-type PDZ2 peptide along with their respective controls. A subset of these mice also received 4 mg/kg of the nitric oxide donor molsidomine. Hippocampal spine density, long-term potentiation, novel object recognition memory, and fear learning and memory were evaluated in mice.ResultsExposure of 7-day-old mice to isoflurane or postsynaptic density-95 wild-type PDZ2 peptide relative to controls causes: (1) a long-term decrease in mushroom spines at 7 weeks (mean ± SD [spines per micrometer]): control (0.8 ± 0.2) versus isoflurane (0.4 ± 0.2), P < 0.0001, and PDZ2MUT (0.7 ± 0.2) versus PDZ2WT (0.4 ± 0.2), P < 0.001; (2) deficits in object recognition at 6 weeks (mean ± SD [recognition index]): naïve (70 ± 8) versus isoflurane (55 ± 14), P = 0.010, and control (65 ± 13) versus isoflurane (55 ± 14), P = 0.045, and PDZ2MUT (64 ±11) versus PDZ2WT (53 ± 18), P = 0.045; and (3) deficits in fear learning at 7 weeks and memory at 8 weeks (mean ± SD [% freezing duration]): Learning, control (69 ± 12) versus isoflurane (52 ± 13), P < 0.0001, and PDZ2MUT (65 ± 14) versus PDZ2WT (55 ± 14) P = 0.011, and Memory, control (80 ± 17) versus isoflurane (56 ± 23), P < 0.0001 and PDZ2MUT (73 ± 18) versus PDZ2WT (44 ± 19) P < 0.0001. Impairment in long-term potentiation has fully recovered here at 7 weeks (mean ± SD [% baseline]): control (140 ± 3) versus isoflurane (137 ± 8), P = 0.560, and PDZ2MUT (136 ± 17) versus PDZ2WT (128 ± 11), P = 0.512. The isoflurane induced decrease in mushroom spines was preventable by introduction of a nitric oxide donor.ConclusionsEarly disruption of PDZ2 domain-mediated protein–protein interactions mimics isoflurane in decreasing mushroom spine density and causing learning and memory deficits in mice. Prevention of the decrease in mushroom spine density with a nitric oxide donor supports a role for neuronal nitric oxide synthase pathway in mediating this cellular change associated with cognitive impairment.Editor’s PerspectiveWhat We Already Know about This TopicPDZ2 domains of postsynaptic density-95 proteins bind to the NR2 subunit of the N-methyl-d-aspartate (NMDA) receptor and promote synaptogenesisPDZ2 domains are molecular targets for inhalational anestheticsWhat This Article Tells Us That Is NewDisruption of PDZ2 domain-mediated protein–protein interactions or a 4-h-long isoflurane anesthesia in 7-day-old mice induced comparable lasting deficits in synaptogenesis and cognitive function, and these effects were prevented by administration of the nitric oxide donor molsidomineThese experimental observations suggest the involvement of a pathway involving the NMDA receptor, postsynaptic density protein-95, and nitric oxide signaling in isoflurane exposure-induced cognitive impairment in mice
      PubDate: Tue, 28 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003482
      Issue No: Vol. 133, No. 4 (2020)
       
  • Volatile Anesthetics Activate a Leak Sodium Conductance in Retrotrapezoid
           Nucleus Neurons to Maintain Breathing during Anesthesia in Mice
    • Authors: Yang Y; Ou M, Liu J, et al.
      Pages: 824 - 838
      Abstract: BackgroundVolatile anesthetics moderately depress respiratory function at clinically relevant concentrations. Phox2b-expressing chemosensitive neurons in the retrotrapezoid nucleus, a respiratory control center, are activated by isoflurane, but the underlying mechanisms remain unclear. The hypothesis of this study was that the sodium leak channel contributes to the volatile anesthetics-induced modulation of retrotrapezoid nucleus neurons and to respiratory output.MethodsThe contribution of sodium leak channels to isoflurane-, sevoflurane-, and propofol-evoked activity of Phox2b-expressing retrotrapezoid nucleus neurons and respiratory output were evaluated in wild-type and genetically modified mice lacking sodium leak channels (both sexes). Patch-clamp recordings were performed in acute brain slices. Whole-body plethysmography was used to measure the respiratory activity.ResultsIsoflurane at 0.42 to 0.50 mM (~1.5 minimum alveolar concentration) increased the sodium leak channel–mediated holding currents and conductance from −75.0 ± 12.9 to −130.1 ± 34.9 pA (mean ± SD, P = 0.002, n = 6) and 1.8 ± 0.5 to 3.6 ± 1.0 nS (P = 0.001, n = 6), respectively. At these concentrations, isoflurane increased activity of Phox2b-expressing retrotrapezoid nucleus neurons from 1.1 ± 0.2 to 2.8 ± 0.2 Hz (P < 0.001, n = 5), which was eliminated by bath application of gadolinium or genetic silencing of sodium leak channel. Genetic silencing of sodium leak channel in the retrotrapezoid nucleus resulted in a diminished ventilatory response to carbon dioxide in mice under control conditions and during isoflurane anesthesia. Sevoflurane produced an effect comparable to that of isoflurane, whereas propofol did not activate sodium leak channel–mediated holding conductance.ConclusionsIsoflurane and sevoflurane increase neuronal excitability of chemosensitive retrotrapezoid nucleus neurons partly by enhancing sodium leak channel conductance. Sodium leak channel expression in the retrotrapezoid nucleus is required for the ventilatory response to carbon dioxide during anesthesia by isoflurane and sevoflurane, thus identifying sodium leak channel as a requisite determinant of respiratory output during anesthesia of volatile anesthetics.Editor’s PerspectiveWhat We Already Know about This TopicThe voltage-independent sodium leak channel is expressed in chemosensitive retrotrapezoid nucleus neurons of the rostral medulla and is required for physiologic respiratory activityWhether sodium leak channel in retrotrapezoid nucleus neurons contributes to the effects of volatile anesthetics on breathing under general anesthesia has not been previously investigatedWhat This Article Tells Us That Is NewIsoflurane increased neuronal activity of chemosensitive retrotrapezoid nucleus neurons in brain slices of neonatal miceGenetic ablation of the voltage-independent sodium leak channel from retrotrapezoid nucleus neurons decreased respiratory rate and ventilatory response to carbon dioxide upon isoflurane and sevoflurane but not after propofol exposureThese observations suggest that the voltage-independent sodium leak channel in retrotrapezoid nucleus neurons of the medulla is a target of volatile anesthetics to activate respiratory activity
      PubDate: Tue, 04 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003493
      Issue No: Vol. 133, No. 4 (2020)
       
  • Mitochondrial Complex I Mutations Predispose Drosophila to Isoflurane
           Neurotoxicity
    • Authors: Olufs ZG; Ganetzky B, Wassarman DA, et al.
      Pages: 839 - 851
      Abstract: BackgroundGeneral anesthetics influence mitochondrial homeostasis, placing individuals with mitochondrial disorders and possibly carriers of recessive mitochondrial mutations at increased risk of perioperative complications. In Drosophila, mutations in the ND23 subunit of complex I of the mitochondrial electron transport chain–analogous to mammalian NDUFS8–replicate key characteristics of Leigh syndrome, an inherited mitochondrial disorder. The authors used the ND23 mutant for testing the hypothesis that anesthetics have toxic potential in carriers of mitochondrial mutations.MethodsThe authors exposed wild-type flies and ND23 mutant flies to behaviorally equivalent doses of isoflurane or sevoflurane in 5%, 21%, or 75% oxygen. The authors used percent mortality (mean ± SD, n ≥ 3) at 24 h after exposure as a readout of toxicity and changes in gene expression to investigate toxicity mechanisms.ResultsExposure of 10- to 13-day-old male ND23 flies to isoflurane in 5%, 21%, or 75% oxygen resulted in 16.0 ± 14.9% (n = 10), 48.2 ± 16.1% (n = 9), and 99.2 ± 2.0% (n = 10) mortality, respectively. Comparable mortality was observed in females. In contrast, under the same conditions, mortality was less than 5% for all male and female groups exposed to sevoflurane, except 10- to 13-day-old male ND23 flies with 9.6 ± 8.9% (n = 16) mortality. The mortality of 10- to 13-day-old ND23 flies exposed to isoflurane was rescued by neuron- or glia-specific expression of wild-type ND23. Isoflurane and sevoflurane differentially affected expression of antioxidant genes in 10- to 13-day-old ND23 flies. ND23 flies had elevated mortality from paraquat-induced oxidative stress compared with wild-type flies. The mortality of heterozygous ND23 flies exposed to isoflurane in 75% oxygen increased with age, resulting in 54.0 ± 19.6% (n = 4) mortality at 33 to 39 days old, and the percent mortality varied in different genetic backgrounds.ConclusionsMutations in the mitochondrial complex I subunit ND23 increase susceptibility to isoflurane-induced toxicity and to oxidative stress in Drosophila. Asymptomatic flies that carry ND23 mutations are sensitized to hyperoxic isoflurane toxicity by age and genetic background.Editor’s PerspectiveWhat We Already Know about This TopicMitochondrial proteins are targets of general anestheticsThe extent to which pathogenic mutations in mitochondrial proteins increase the risk of adverse reactions from anesthetics has not been previously exploredWhat This Article Tells Us That Is NewIsoflurane but not sevoflurane exposure increased mortality in Drosophila carrying homozygous mutations in mitochondrial complex I, and hyperoxia increased mortality associated with isoflurane administrationIn heterozygous flies, carrying mutations in mitochondrial complex I, age, and hyperoxia rendered flies susceptible to mortality after exposure to isofluraneThese observations raise the possibility that heterozygous carriers of mitochondrial mutations may be more susceptible to perioperative complications after isoflurane exposure
      PubDate: Tue, 28 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003486
      Issue No: Vol. 133, No. 4 (2020)
       
  • Boston Skulling, Not Sculling: Anesthetic Advertising by Daring Dentists
    • Pages: 851 - 851
      Abstract: Because this month is one in which Americans celebrate the haunting holiday of Halloween, this October Anesthesiology Reflection presents one of the more ghoulish trade cards used in advertising anesthesia. From their State Street office in Rochester, New York, the Boston Dental Association used a grinning skull on the obverse of their ill-advised advertisement to promote both pure and adulterated nitrous-oxide (“vitalized air”) anesthetics for dental surgery. The association boasted that their anesthetic gases were “made fresh every day” and that “any one can take it with perfect safety, young or old” (right, extracted from the card’s reverse). To underscore their claim, the association issued this trade card (left) as a “treat” depicting a “trick” image that symbolized Life (two young girls playing with a puppy) when viewed from “one foot away” and, in an optical illusion, depicted Death (a grinning skull) from 20 feet away. Ironically, the skull, advertising “the beginning and the end of life” on this 1890 trade card, may have foreshadowed the association’s demise…that same year. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology, Schaumburg, Illinois.)
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003545
      Issue No: Vol. 133, No. 4 (2020)
       
  • Androgenic Modulation of the Chloride Transporter NKCC1 Contributes to
           Age-dependent Isoflurane Neurotoxicity in Male Rats
    • Authors: Chinn GA; Sasaki Russell JM, Yabut NA, et al.
      Pages: 852 - 866
      Abstract: BackgroundCognitive deficits after perinatal anesthetic exposure are well established outcomes in animal models. This vulnerability is sex-dependent and associated with expression levels of the chloride transporters NKCC1 and KCC2. The hypothesis was that androgen signaling, NKCC1 function, and the age of isoflurane exposure are critical for the manifestation of anesthetic neurotoxicity in male rats.MethodsFlutamide, an androgen receptor antagonist, was administered to male rats on postnatal days 2, 4, and 6 before 6 h of isoflurane on postnatal day 7 (ntotal = 26). Spatial and recognition memory were subsequently tested in adulthood. NKCC1 and KCC2 protein levels were measured from cortical lysates by Western blot on postnatal day 7 (ntotal = 20). Bumetanide, an NKCC1 antagonist, was injected immediately before isoflurane exposure (postnatal day 7) to study the effect of NKCC1 inhibition (ntotal = 48). To determine whether male rats remain vulnerable to anesthetic neurotoxicity as juveniles, postnatal day 14 animals were exposed to isoflurane and assessed as adults (ntotal = 30).ResultsFlutamide-treated male rats exposed to isoflurane successfully navigated the spatial (Barnes maze probe trial F[1, 151] = 78; P < 0.001; mean goal exploration ± SD, 6.4 ± 3.9 s) and recognition memory tasks (mean discrimination index ± SD, 0.09 ± 0.14; P = 0.003), unlike isoflurane-exposed controls. Flutamide changed expression patterns of NKCC1 (mean density ± SD: control, 1.49 ± 0.69; flutamide, 0.47 ± 0.11; P < 0.001) and KCC2 (median density [25th percentile, 75th percentile]: control, 0.23 [0.13, 0.49]; flutamide, 1.47 [1.18,1.62]; P < 0.001). Inhibiting NKCC1 with bumetanide was protective for spatial memory (probe trial F[1, 162] = 6.6; P = 0.011; mean goal time, 4.6 [7.4] s). Delaying isoflurane exposure until postnatal day 14 in males preserved spatial memory (probe trial F[1, 140] = 28; P < 0.001; mean goal time, 6.1 [7.0] s).ConclusionsVulnerability to isoflurane neurotoxicity is abolished by blocking the androgen receptor, disrupting the function of NKCC1, or delaying the time of exposure to at least 2 weeks of age in male rats. These results support a dynamic role for androgens and chloride transporter proteins in perinatal anesthetic neurotoxicity.Editor’s PerspectiveWhat We Already Know about This TopicExperimental data in laboratory animals suggest sex-dependent differences in neurocognitive and behavioral vulnerability to early life anesthesia exposureSteroid sex hormones play an important role in guiding sex-specific brain developmentThe relationship between steroid sex hormones and developmental anesthesia neurotoxicity is incompletely understoodWhat This Article Tells Us That Is NewBlockade of androgen receptors in 7-day-old male rats protects against isoflurane anesthesia-induced behavioral deficitsAndrogen receptor blockade results in a premature transition in the developmental expression profiles of chloride transporters NKCC1 and KCC2These observations suggest that regulation of specific chloride transporters, determining functional modalities of γ-aminobutyric acid–mediated neurotransmission, by androgens is a critical component for developmental anesthetic neurotoxicity
      PubDate: Thu, 25 Jun 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003437
      Issue No: Vol. 133, No. 4 (2020)
       
  • Byline Backstory No. 9: Hanging Sir Humphry—the Davy Oil at Hopkins,
           Yale, and then the Wood Library-Museum
    • Pages: 866 - 866
      Abstract: As a Johns Hopkins anesthesiology preceptee, I met a brilliant, plucky pediatric intensivist, Mark C. Rogers, M.D. (upper left, image credit: Johns Hopkins Department of Anesthesiology and Critical Care Medicine or ACCM). Named chair of the department he had rebranded “ACCM,” Rogers tapped me to be one of his first interns. After setting up the departmental museum, we drafted the nation’s first geriatric anesthesiology fellowship, a 1984 to 1985 Hopkins–National Institute on Aging collaboration. (Yes, Rogers pioneered innovations for both pediatric and geriatric patients!) Following my move to Connecticut, Yale’s charismatic chair of anesthesiology, Paul G Barash, M.D. (1942 to 2020, lower left) encouraged my geriatric anesthesia lecturing nationwide. After I founded Yale’s departmental museum, Barash blessed my long-distance curating for the Wood Library-Museum of Anesthesiology. So, after hanging at Hopkins and then Yale, my family’s oil portrait of Sir Humphry Davy (right) ended up hanging at the Wood Library-Museum before gracing a 2011 cover of Anesthesiology. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology, Schaumburg, Illinois.)
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003546
      Issue No: Vol. 133, No. 4 (2020)
       
  • Prevalence of Complete Airway Closure According to Body Mass Index in
           Acute Respiratory Distress Syndrome Pooled Cohort Analysis
    • Authors: Coudroy R; Vimpere D, Aissaoui N, et al.
      Pages: 867 - 878
      Abstract: BackgroundComplete airway closure during expiration may underestimate alveolar pressure. It has been reported in cases of acute respiratory distress syndrome (ARDS), as well as in morbidly obese patients with healthy lungs. The authors hypothesized that complete airway closure was highly prevalent in obese ARDS and influenced the calculation of respiratory mechanics.MethodsIn a post hoc pooled analysis of two cohorts, ARDS patients were classified according to body mass index (BMI) terciles. Low-flow inflation pressure–volume curve and partitioned respiratory mechanics using esophageal manometry were recorded. The authors’ primary aim was to compare the prevalence of complete airway closure according to BMI terciles. Secondary aims were to compare (1) respiratory system mechanics considering or not considering complete airway closure in their calculation, and (2) and partitioned respiratory mechanics according to BMI.ResultsAmong the 51 patients analyzed, BMI was less than 30 kg/m2 in 18, from 30 to less than 40 in 16, and greater than or equal to 40 in 17. Prevalence of complete airway closure was 41% overall (95% CI, 28 to 55; 21 of 51 patients), and was lower in the lowest (22% [3 to 41]; 4 of 18 patients) than in the highest BMI tercile (65% [42 to 87]; 11 of 17 patients). Driving pressure and elastances of the respiratory system and of the lung were higher when complete airway closure was not taken into account in their calculation. End-expiratory esophageal pressure (ρ = 0.69 [95% CI, 0.48 to 0.82]; P < 0.001), but not chest wall elastance, was associated with BMI, whereas elastance of the lung was negatively correlated with BMI (ρ = −0.27 [95% CI, −0.56 to −0.10]; P = 0.014).ConclusionsPrevalence of complete airway closure was high in ARDS and should be taken into account when calculating respiratory mechanics, especially in the most morbidly obese patients.Editor’s PerspectiveWhat We Already Know about This TopicPlateau and driving pressures have been shown to correlate with mortality in adult respiratory distress syndrome (ARDS). However, these static airway pressures may not always accurately reflect alveolar pressure.It has recently been recognized that in ARDS, airway closure may occur while some alveoli are still inflated. This may result in a biased estimate of mean alveolar pressure.Complete airway closure can only be measured by the inflection point on the initial portion of a low-flow inflation pressure–volume or pressure–time curve with the absence of cardiac oscillations and very low compliance, most likely in the terminal bronchioles.In 25 to 33% of patients with ARDS, airway opening pressure (the inflection point value) is greater than the total positive end-expiratory pressure measured by an end-expiratory maneuver.What This Article Tells Us That Is NewIn a post hoc analysis of two cohort studies of respiratory mechanics in ARDS, the authors compared the prevalence of complete airway closure stratified by body mass index and its effects on respiratory mechanics.Complete airway closure was present in 41% of patients, increasing with body mass index tercile (65% in the highest).Driving pressure and respiratory system elastances (lung, chest wall) were higher when complete airway closure was not adjusted for.
      PubDate: Tue, 14 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003444
      Issue No: Vol. 133, No. 4 (2020)
       
  • Assessment of Right Heart Function during Extracorporeal Therapy by
           Modified Thermodilution in a Porcine Model
    • Authors: Bachmann KF; Zwicker L, Nettelbeck K, et al.
      Pages: 879 - 891
      Abstract: BackgroundVeno-arterial extracorporeal membrane oxygenation therapy is a growing treatment modality for acute cardiorespiratory failure. Cardiac output monitoring during veno-arterial extracorporeal membrane oxygenation therapy remains challenging. This study aims to validate a new thermodilution technique during veno-arterial extracorporeal membrane oxygenation therapy using a pig model.MethodsSixteen healthy pigs were centrally cannulated for veno-arterial extracorporeal membrane oxygenation, and precision flow probes for blood flow assessment were placed on the pulmonary artery. After chest closure, cold boluses of 0.9% saline solution were injected into the extracorporeal membrane oxygenation circuit, right atrium, and right ventricle at different extracorporeal membrane oxygenation flows (4, 3, 2, 1 l/min). Rapid response thermistors in the extracorporeal membrane oxygenation circuit and pulmonary artery recorded the temperature change. After calculating catheter constants, the distributions of injection volumes passing each circuit were assessed and enabled calculation of pulmonary blood flow. Analysis of the exponential temperature decay allowed assessment of right ventricular function.ResultsCalculated blood flow correlated well with measured blood flow (r2 = 0.74, P < 0.001). Bias was −6 ml/min [95% CI ± 48 ml/min] with clinically acceptable limits of agreement (668 ml/min [95% CI ± 166 ml/min]). Percentage error varied with extracorporeal membrane oxygenation blood flow reductions, yielding an overall percentage error of 32.1% and a percentage error of 24.3% at low extracorporeal membrane oxygenation blood flows. Right ventricular ejection fraction was 17 [14 to 20.0]%. Extracorporeal membrane oxygenation flow reductions increased end-diastolic and end-systolic volumes with reductions in pulmonary vascular resistance. Central venous pressure and right ventricular ejection fractions remained unchanged. End-diastolic and end-systolic volumes correlated highly (r2 = 0.98, P < 0.001).ConclusionsAdapted thermodilution allows reliable assessment of cardiac output and right ventricular behavior. During veno-arterial extracorporeal membrane oxygenation weaning, the right ventricle dilates even with stable function, possibly because of increased venous return.Editor’s PerspectiveWhat We Already Know about This TopicVeno-arterial extracorporeal membrane oxygenation is an accepted rescue therapy for patients experiencing severe cardiac or pulmonary failure.Weaning from veno-arterial extracorporeal membrane oxygenation is important for determining next steps in patients’ cardiopulmonary care. Assessment of right ventricular function during veno-arterial extracorporeal membrane oxygenation support and weaning is often done using echocardiography, but echocardiographic guidance provides challenges because right ventricular dimensions change with ventricular loading and may not be related to intrinsic right ventricular function.What This Article Tells Us That Is NewIn 16 healthy pigs that received veno-arterial extracorporeal membrane oxygenation support via central cannulation, a novel adaptation of thermodilution cardiac output assessment provided reliable estimation of right ventricular cardiac output and right ventricular function.Future studies appear warranted to determine whether this method of modified thermodilution can be used to accurately assess right ventricular output and function during veno-arterial extracorporeal membrane oxygenation support.
      PubDate: Wed, 08 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003443
      Issue No: Vol. 133, No. 4 (2020)
       
  • Differential Ventilation Using Flow Control Valves as a Potential Bridge
           to Full Ventilatory Support during the COVID-19 Crisis From Bench to
           Bedside
    • Authors: Levin MA; Shah A, Shah R, et al.
      Pages: 892 - 904
      Abstract: BackgroundDuring the COVID-19 pandemic, ventilator sharing was suggested to increase availability of mechanical ventilation. The safety and feasibility of ventilator sharing is unknown.MethodsA single ventilator in pressure control mode was used with flow control valves to simultaneously ventilate two patients with different lung compliances. The system was first evaluated using high-fidelity human patient simulator mannequins and then tested for 1 h in two pairs of COVID-19 patients with acute respiratory failure. Patients were matched on positive end-expiratory pressure, fractional inspired oxygen tension, and respiratory rate. Tidal volume and peak airway pressure (PMAX) were recorded from each patient using separate independent spirometers and arterial blood gas samples drawn at 0, 30, and 60 min. The authors assessed acid-base status, oxygenation, tidal volume, and PMAX for each patient. Stability was assessed by calculating the coefficient of variation.ResultsThe valves performed as expected in simulation, providing a stable tidal volume of 400 ml each to two mannequins with compliance ratios varying from 20:20 to 20:90 ml/cm H2O. The system was then tested in two pairs of patients. Pair 1 was a 49-yr-old woman, ideal body weight 46 kg, and a 55-yr-old man, ideal body weight 64 kg, with lung compliance 27 ml/cm H2O versus 35 ml/cm H2O. The coefficient of variation for tidal volume was 0.2 to 1.7%, and for PMAX 0 to 1.1%. Pair 2 was a 32-yr-old man, ideal body weight 62 kg, and a 56-yr-old woman, ideal body weight 46 kg, with lung compliance 12 ml/cm H2O versus 21 ml/cm H2O. The coefficient of variation for tidal volume was 0.4 to 5.6%, and for PMAX 0 to 2.1%.ConclusionsDifferential ventilation using a single ventilator is feasible. Flow control valves enable delivery of stable tidal volume and PMAX similar to those provided by individual ventilators.Editor’s PerspectiveWhat We Already Know about This TopicIn previous mass casualty situations that have resulted in intensive care unit or emergency room surge conditions, the use of ventilator splitting to ventilate two or more patients has been proposed.The concept has received renewed attention with the global COVID-19 pandemic.The impaired respiratory mechanics similar to the acute respiratory distress syndrome seen in COVID-19 patients pose significant engineering challenges to optimally ventilate one patient while preventing damage to a paired patient.What This Article Tells Us That Is NewCustom three-dimensional printed inspiratory flow control valves designed to allow individualized setting of tidal volume and airway pressure were evaluated using high-fidelity simulator mannequins with similar or different lung compliance and were found to perform as expected with stable tidal volumes delivered to each mannequin.The system demonstrated stable performance when tested for 1 h in two pairs of volunteer COVID-19 patients with acute respiratory failure. Continuous assessment of tidal volume and peak airway pressure in each patient during the study allowed for dynamic alteration of tidal volume in response to respiratory acidosis.This study suggests that custom-designed flow control valves may facilitate the use of split ventilation techniques in a surge setting.
      PubDate: Thu, 02 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003473
      Issue No: Vol. 133, No. 4 (2020)
       
  • Death-associated Protein Kinase 1 Mediates Ventilator-induced Lung Injury
           in Mice by Promoting Alveolar Epithelial Cell Apoptosis
    • Authors: Wang Y; Yang Y, Chen L, et al.
      Pages: 905 - 918
      Abstract: BackgroundAlveolar epithelial cell apoptosis is implicated in the onset of ventilator-induced lung injury. Death-associated protein kinase 1 (DAPK1) is associated with cell apoptosis. The hypothesis was that DAPK1 participates in ventilator-induced lung injury through promoting alveolar epithelial cell apoptosis.MethodsApoptosis of mouse alveolar epithelial cell was induced by cyclic stretch. DAPK1 expression was altered (knockdown or overexpressed) in vitro by using a small interfering RNA or a plasmid, respectively. C57/BL6 male mice (n = 6) received high tidal volume ventilation to establish a lung injury model. Adeno-associated virus transfection of short hairpin RNA and DAPK1 inhibitor repressed DAPK1 expression and activation in lungs, respectively. The primary outcomes were alveolar epithelial cell apoptosis and lung injury.ResultsCompared with the control group, the 24-h cyclic stretch group showed significantly higher alveolar epithelial cell apoptotic percentage (45 ± 4% fold vs. 6 ± 1% fold; P < 0.0001) and relative DAPK1 expression, and this group also demonstrated a reduced apoptotic percentage after DAPK1 knockdown (27 ± 5% fold vs. 53 ± 8% fold; P < 0.0001). A promoted apoptotic percentage in DAPK1 overexpression was observed without stretching (49 ± 6% fold vs. 14 ± 3% fold; P < 0.0001). Alterations in B-cell lymphoma 2 and B-cell lymphoma 2–associated X are associated with DAPK1 expression. The mice subjected to high tidal volume had higher DAPK1 expression and alveolar epithelial cell apoptotic percentage in lungs compared with the low tidal volume group (43 ± 6% fold vs. 4 ± 2% fold; P < 0.0001). Inhibition of DAPK1 through adeno-associated virus infection or DAPK1 inhibitor treatment appeared to be protective against lung injury with reduced lung injury score, resolved pulmonary inflammation, and repressed alveolar epithelial cell apoptotic percentage (47 ± 4% fold and 48 ± 6% fold; 35 ± 5% fold and 34 ± 4% fold; P < 0.0001, respectively).ConclusionsDAPK1 promotes the onset of ventilator-induced lung injury by triggering alveolar epithelial cell apoptosis through intrinsic apoptosis pathway in mice.Editor’s PerspectiveWhat We Already Know about This TopicVentilator-related lung injury may be related to stretch-induced apoptosisDAPK1 is involved in various apoptotic signal transduction pathwaysThe role of DAPK1 in ventilator-related lung injury is not well understoodWhat This Article Tells Us That Is NewIn mice, high tidal volumes increased cyclic stretch, DAPK1 expression, and epithelial cell apoptosisInhibition of DAPK1 appeared to be protective against lung injury, reducing lung injury, inflammation, and apoptosisDAPK1 triggers alveolar epithelial cell apoptosis and mediates ventilator-induced lung injury in mice
      PubDate: Thu, 23 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003464
      Issue No: Vol. 133, No. 4 (2020)
       
  • Mandibular and Maxillary Cysts in a Pediatric Patient with Pierre Robin
           Sequence and Ullrich Congenital Muscular Dystrophy
    • Authors: Duong K; Reddy S, Buchanan EP, et al.
      Pages: 919 - 920
      PubDate: Fri, 07 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003503
      Issue No: Vol. 133, No. 4 (2020)
       
  • Technological Assessment and Objective Evaluation of Minimally Invasive
           and Noninvasive Cardiac Output Monitoring Systems
    • Authors: Saugel B; Thiele RH, Hapfelmeier A, et al.
      Pages: 921 - 928
      Abstract: The authors discuss minimally invasive and noninvasive cardiac output monitoring technologies available in the clinical practice and how to evaluate these systems objectively.
      PubDate: Wed, 05 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003483
      Issue No: Vol. 133, No. 4 (2020)
       
  • Using Dynamic Variables to Guide Perioperative Fluid Management
    • Authors: Perel A.
      Pages: 929 - 935
      Abstract: Dynamic variables that quantify the variations in the arterial pressure and plethysmographic waveforms during mechanical ventilation reflect fluid responsiveness. These variables may be helpful in identifying occult hypovolemia and in preventing unnecessary fluid administration.
      PubDate: Mon, 08 Jun 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003408
      Issue No: Vol. 133, No. 4 (2020)
       
  • Boring Holes
    • Authors: Simon S.
      Pages: 936 - 937
      Abstract: how far will we go away from ourselvesto reach into them'
      PubDate: Thu, 27 Feb 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003226
      Issue No: Vol. 133, No. 4 (2020)
       
  • I Remember
    • Authors: Sharda S.
      Pages: 938 - 939
      Abstract: I look up. I see her, racing toward me, baby in arms. Her face is beaming. The unmistakable glow of a proud new parent.
      PubDate: Thu, 09 Apr 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003277
      Issue No: Vol. 133, No. 4 (2020)
       
  • Rational Perioperative Opioid Management in the Era of the Opioid Crisis:
           Comment
    • Authors: Gupta D; Chakrabortty S.
      Pages: 940 - 941
      PubDate: Tue, 04 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003495
      Issue No: Vol. 133, No. 4 (2020)
       
  • Rational Perioperative Opioid Management in the Era of the Opioid Crisis:
           Comment
    • Authors: Shishido S; Bowdle A.
      Pages: 941 - 942
      PubDate: Tue, 04 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003496
      Issue No: Vol. 133, No. 4 (2020)
       
  • Rational Perioperative Opioid Management in the Era of the Opioid Crisis:
           Reply
    • Authors: Kharasch ED; Avram MJ, Clark J.
      Pages: 942 - 943
      PubDate: Tue, 04 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003497
      Issue No: Vol. 133, No. 4 (2020)
       
  • Implications of Practice Variability: Comment
    • Authors: Magoon R.
      Pages: 943 - 944
      PubDate: Mon, 13 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003465
      Issue No: Vol. 133, No. 4 (2020)
       
  • Implications of Practice Variability: Comment
    • Authors: Prielipp RC; Rice MJ.
      Pages: 944 - 945
      PubDate: Mon, 13 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003466
      Issue No: Vol. 133, No. 4 (2020)
       
  • Impact of Closed-loop Anesthesia on Cognitive Function: Comment
    • Authors: Sneyd J; Evered LA.
      Pages: 945 - 946
      PubDate: Mon, 13 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003468
      Issue No: Vol. 133, No. 4 (2020)
       
  • Impact of Closed-loop Anesthesia on Cognitive Function: Reply
    • Authors: Joosten A; Van der Linden P, Rinehart J, et al.
      Pages: 946 - 948
      PubDate: Thu, 01 Oct 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003469
      Issue No: Vol. 133, No. 4 (2020)
       
  • Subomohyoid–Suprascapular versus Interscalene Block: Comment
    • Authors: Muggleton E; Muggleton T.
      Pages: 948 - 948
      PubDate: Mon, 20 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003467
      Issue No: Vol. 133, No. 4 (2020)
       
  • Sparking the Discussion about Vaping and Anesthesia: Comment
    • Authors: Oyston J.
      Pages: 948 - 949
      PubDate: Mon, 13 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003476
      Issue No: Vol. 133, No. 4 (2020)
       
  • Sparking the Discussion about Vaping and Anesthesia: Reply
    • Authors: Feinstein MM; Katz D.
      Pages: 949 - 950
      PubDate: Mon, 13 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003477
      Issue No: Vol. 133, No. 4 (2020)
       
  • Distribution of Ventilation in Pneumoperitoneum: Comment
    • Authors: Sahay N; Kumar R, Naaz S.
      Pages: 950 - 951
      PubDate: Mon, 13 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003474
      Issue No: Vol. 133, No. 4 (2020)
       
  • Suture-catheters Compared with Traditional Catheters: Comment
    • Authors: Wardhan R; Nimma SR.
      Pages: 951 - 952
      PubDate: Tue, 28 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003471
      Issue No: Vol. 133, No. 4 (2020)
       
  • Suture-catheters Compared with Traditional Catheters: Reply
    • Authors: Finneran JJ; IV, Ilfeld BM.
      Pages: 952 - 953
      PubDate: Tue, 28 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003470
      Issue No: Vol. 133, No. 4 (2020)
       
  • Multimodal Analgesia for Spine Surgery: Reply
    • Authors: Maheshwari K; Sessler DI.
      Pages: 953 - 954
      PubDate: Thu, 06 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003499
      Issue No: Vol. 133, No. 4 (2020)
       
  • Multimodal Analgesia for Spine Surgery: Comment
    • Authors: Meier AW; Buys MJ, Johnson KB.
      Pages: 953 - 953
      PubDate: Thu, 06 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003498
      Issue No: Vol. 133, No. 4 (2020)
       
  • Lung Ultrasound Training in the Critically Ill: Comment
    • Authors: Bronshteyn YS; Fox WC, Hashmi N, et al.
      Pages: 954 - 955
      PubDate: Tue, 04 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003506
      Issue No: Vol. 133, No. 4 (2020)
       
  • Lung Ultrasound Training in the Critically Ill: Reply
    • Authors: Rouby J; Dexheimer Neto F, Zhang M, et al.
      Pages: 955 - 958
      PubDate: Tue, 04 Aug 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003507
      Issue No: Vol. 133, No. 4 (2020)
       
  • Getting to a New Normal: Mandating That Patients Wear Masks as Hospitals
           Fully Reopen during the Coronavirus Pandemic: Comment
    • Authors: Wang H; Cain JG, Uraco A, et al.
      Pages: 958 - 959
      PubDate: Tue, 21 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003505
      Issue No: Vol. 133, No. 4 (2020)
       
  • Instructions for Obtaining Anesthesiology Continuing Medical Education
           (CME) Credit: Erratum
    • Pages: 960 - 960
      Abstract: On the CME pages of the July and August 2020 issues, the AMA PRA Category 1 Credits™ were incorrectly listed as 1.5. The American Society of Anesthesiologists designated the journal-based activity in both issues for a maximum of 1.0 AMA PRA Category 1 Credits™.
      PubDate: Mon, 27 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003494
      Issue No: Vol. 133, No. 4 (2020)
       
  • Lung Ultrasound in Emergency and Critically Ill Patients: Number of
           Supervised Exams to Reach Basic Competence: Erratum
    • Pages: 960 - 960
      Abstract: In the article “Lung Ultrasound in Emergency and Critically Ill Patients: Number of Supervised Exams to Reach Basic Competence” published in the April 2020 issue, there is an error in the Methods section. In the third paragraph under “Lung Ultrasound Curriculum and the APECHO Study” on page 902, the sentence “… (3) interstitial syndrome, defined as the presence of more than two spaced B lines or coalescent B lines, detected in a limited portion of the intercostal space and issued from the pleural line or subpleural consolidations of at least 5 mm;…” should be replaced by “… (3) interstitial syndrome, defined as the presence of more than two spaced B lines;…”.
      PubDate: Thu, 23 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003508
      Issue No: Vol. 133, No. 4 (2020)
       
  • A Tale of Different Populations: Disparities in Obstetric Anesthesia:
           Erratum
    • Pages: 960 - 960
      Abstract: In the October 2019 issue, there are two errors in the Infographics in Anesthesiology image entitled “A Tale of Different Populations: Disparities in Obstetric Anesthesia.” (1) The patient demographic icons and labels “Hispanic” and “African-American” should be switched. (2) “General anesthesia for c-sections, national cohort, 2016” should be “General anesthesia for c-sections, national cohort, 1999-2002,” reflecting the years of the cohort rather than year of publication.
      PubDate: Wed, 15 Jul 2020 00:00:00 GMT
      DOI: 10.1097/ALN.0000000000003475
      Issue No: Vol. 133, No. 4 (2020)
       
 
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