Journal Cover Anesthesia & Analgesia
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   ISSN (Print) 0003-2999 - ISSN (Online) 1526-7598
   Published by LWW Wolters Kluwer Homepage  [289 journals]
  • The Eyes Have It: Factors that Influence Intraocular Pressure (IOP)
    • Authors: Nathan; Naveen
      Abstract: imageNo abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • A Pain in the Abs: Predicting Post-Cesarean Analgesia
    • Authors: Wanderer; Jonathan P.; Nathan, Naveen
      Abstract: imageNo abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Auditing Intraoperative Transfusions to Promote High-Value Perioperative
           Care
    • Authors: Sikorski; Robert A.; Hensley, Nadia B.; Frank, Steven M.
      Abstract: imageNo abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Postoperative Troponin Elevation, Myocardial Injury, and Pulmonary
           Embolism
    • Authors: Biccard; Bruce McClure
      Abstract: imageNo abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The American College of Surgeons Children’s Surgery Verification and
           Quality Improvement Program: Be Careful What You Wish For!
    • Authors: DiNardo; James A.; Davis, Peter J.
      Abstract: imageNo abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The Pros of Publishing Standalone Clinical Trial Protocols in
           Anesthesiology Journals
    • Authors: Whittington; Robert A.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Publishing Methods Without Results: A First That Hopefully Will Not Last
    • Authors: Crosby; Gregory
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The Eye: What You Don’t Know Can Hurt Your Patient
    • Authors: Gayer; Steven; Prielipp, Richard C.
      Abstract: imageNo abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Looking Beyond the Pain: Can Effective Labor Analgesia Prevent the
           Development of Postpartum Depression'
    • Authors: Toledo; Paloma; Miller, Emily S.; Wisner, Katherine L.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Testing Times: Routine to Indicated!
    • Authors: Kumar; Nishant
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Strain as an Outcome Predictor
    • Authors: Howard-Quijano; Kimberly; Zhang, Kan; Skubas, Nikolaos J.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Surveying the Literature: Synopsis of Recent Key Publications
    • Authors: Hessel; Eugene A. II
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Unexpected Cardiac Computed Tomography Findings in Patients With
           Postoperative Myocardial Injury
    • Authors: Grobben; Remco B.; van Waes, Judith A. R.; Leiner, Tim; Peelen, Linda M.; de Borst, Gert Jan; Vogely, Henri C.; Grobbee, Diederick E.; Doevendans, Pieter A.; van Klei, Wilton A.; Nathoe, Hendrik M.; on behalf of the CHASE Investigators
      Abstract: imageBACKGROUND: Postoperative myocardial injury (PMI) is a strong predictor of mortality after noncardiac surgery. PMI is believed to be attributable to coronary artery disease (CAD), yet its etiology is largely unclear. We aimed to quantify the prevalence of significant CAD in patients with and without PMI using coronary computed tomography angiography (CCTA).METHODS: This prospective cohort study included patients of 60 years or older without a history of cardiac disease and with and without PMI after intermediate- to high-risk noncardiac surgery. PMI was defined as any serum troponin I level ≥60 ng/L on the first 3 postoperative days. Main exclusion criteria were known cardiac disease and postoperative ischemic symptoms or electrocardiography abnormalities. Noninvasive imaging consisted of a postoperative CCTA. Main outcome was CAD defined as>50% coronary stenosis on CCTA.RESULTS: The analysis included 66 patients. Median peak troponin levels in the PMI (n = 46) and control group (n = 20) were 150 (interquartile range, 120–298) vs 15 (interquartile range, 10–31) ng/L (P < .01). CAD was found in 23 patients with PMI (50%) vs 3 without PMI (15%; relative risk, 3.3; 95% confidence interval, 1.1–9.8). Remarkably, pulmonary embolism was present in 15 patients with PMI (33%) versus in 4 without PMI (20%; relative risk, 1.6; 95% confidence interval, 0.6–4.3). None of the patients died within 30 days.CONCLUSIONS: In patients without a history of cardiac disease, PMI after noncardiac surgery was associated with CAD. In addition, a clinically silent pulmonary embolism was found in one-third of patients with PMI. This urges further research to improve clinical workup using imaging and may have important clinical implications.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • No Significant Association Between the Transfusion of Small Volumes of
           Leukocyte-Depleted Red Blood Cells and Mortality Over 7 Years of Follow-up
           in Patients Undergoing Cardiac Surgery: A Propensity Score Matched
           Analysis
    • Authors: Koster; Andreas; Zittermann, Armin; Börgermann, Jochen; Gummert, Jan F.
      Abstract: imageBACKGROUND: The impact of red blood cell (RBC) transfusion on long-term clinical outcome is controversial.METHODS: We prospectively recorded follow-up data of 6124 cardiac surgical patients who received no transfusion (RBC− group) or 1–2 units of leukocyte-depleted RBC (RBC+ group) at our institution. The primary end point was overall mortality up to 7 years after cardiac surgery; secondary end point was coronary artery revascularization during follow-up. To correct for nonrandomized group assignment, propensity score (PS) matching was performed. A subgroup analysis was also performed in patients with preoperative anemia.RESULTS: PS matching was possible in 4118 patients. During a mean follow-up of 4.05 years (range, 0.0–7.3 years), 140 patients (14.6%) died in the RBC− group and 173 (17.2%) died in the RBC+ group. The hazard ratio for the RBC+ group versus the RBC− group was 1.00 (95% confidence interval, 0.79–1.25; P = .969). The number of revascularizations was 96 (9.9%) and 125 (10.6%), respectively, with a hazard ratio of 1.21 (95% confidence interval, 0.92–1.58; P = .166) for the RBC+ group. Preoperative anemia was not a risk factor for postoperative mortality, even when patients were transfused.CONCLUSIONS: This PS-matched analysis does not provide evidence for an association of the transfusion of small volumes of leukocyte-depleted RBCs with an increased postoperative mortality in cardiac surgical patients. Moreover, preoperative anemia could not be identified as a risk factor for increased postoperative mortality.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Low Cardiac Output Syndrome After Adult Cardiac Surgery: Predictive Value
           of Peak Systolic Global Longitudinal Strain
    • Authors: Amabili; Philippe; Benbouchta, Sabeha; Roediger, Laurence; Senard, Marc; Hubert, Marie Bernard; Donneau, Anne-Françoise; Brichant, Jean-François; Hans, Gregory A.
      Abstract: imageBACKGROUND: Peak systolic global longitudinal strain (GLS) is increasingly used to quantify left ventricular systolic function. The primary objective of this study was to assess whether GLS obtained during intraoperative transesophageal echocardiogram, performed before cardiopulmonary bypass, improves the prediction of postoperative low cardiac output syndrome (LCOS) after adult cardiac surgery.METHODS: GLS from 275 patients undergoing on-pump cardiac surgery was calculated retrospectively using two-dimensional– speckle tracking echocardiography (aCMQ module from Qlab software version 10.5, Philips Medical, Brussels, Belgium). LCOS was defined as the need for inotropic or mechanical circulatory support for>24 hours postoperatively. Patient and procedure characteristics associated with LCOS at the univariable level (P ≤ .05) were entered into a forward stepwise logistic regression to create a first predictive model. A second model was created by adding GLS. The 2 models were compared using the likelihood-ratio test, the area under the receiver operating characteristic (ROC) curve, and the integrated discrimination index. The optimal cutoff value of GLS associated with LCOS was determined by maximizing the Youden index of the ROC curve. Secondary outcomes included time until complete weaning from inotropes, discharge from the intensive care unit and from the hospital, and 30-day mortality.RESULTS: GLS was significantly associated with LCOS (P < .001) at the univariable level. Predictors of LCOS retained in the first model were cardiopulmonary bypass duration, decreased left ventricular ejection fraction, mitral valve surgery, and New York Heart Association functional class III or IV. Adding the GLS value improved the prediction of LCOS (P = .02). However, the area under the ROC curve did not differ between the 2 models (0.83; 95% confidence interval [CI], 0.77–0.99 vs 0.84; 95% CI, 0.79–0.90; P = .15). The integrated discrimination index associated with addition of GLS was 0.02 (P = .046), meaning that the difference in predicted risk between patients with and without LCOS increased by 2% after adding GLS. A GLS cutoff value of −17% (95% CI, −18.8% to −15.3%) was found to best identify LCOS. After adjusting for covariates included in model 1, a lower GLS value was significantly associated with a lower cumulative probability of weaning from inotropes postoperatively (hazard ratio, 0.90; 95% CI, 0.82–0.97; P = .01). No association was found between GLS and other secondary outcome measures.CONCLUSIONS: GLS is an independent predictor of LCOS after on-pump cardiac surgery. Its incremental value over other established risk factors for postoperative LCOS is, however, limited.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Reduced Left Ventricular Global Longitudinal Strain Predicts Prolonged
           Hospitalization: A Cohort Analysis of Patients Having Aortic Valve
           Replacement Surgery
    • Authors: Sonny; Abraham; Alfirevic, Andrej; Sale, Shiva; Zimmerman, Nicole M.; You, Jing; Gillinov, A. Marc; Sessler, Daniel I.; Duncan, Andra E.
      Abstract: imageBACKGROUND: Left ventricular ejection fraction (LVEF) is often preserved in patients with aortic stenosis and thus cannot distinguish between normal myocardial contractile function and subclinical dysfunction. Global longitudinal strain and strain rate (SR), which measure myocardial deformation, are robust indicators of myocardial function and can detect subtle myocardial dysfunction that is not apparent with conventional echocardiographic measures. Strain and SR may better predict postoperative outcomes than LVEF. The primary aim of our investigation was to assess the association between global longitudinal strain and serious postoperative outcomes in patients with aortic stenosis having aortic valve replacement. Secondarily, we also assessed the associations between global longitudinal SR and LVEF and the outcomes.METHODS: In this post hoc analysis of data from a randomized clinical trial (NCT01187329), we examined the association between measures of myocardial function and the following outcomes: (1) need for postoperative inotropic/vasopressor support; (2) prolonged hospitalization (>7 days); and (3) postoperative atrial fibrillation. Standardized transesophageal echocardiographic examinations were performed after anesthetic induction. Myocardial deformation was measured using speckle-tracking echocardiography. Multivariable logistic regression was used to assess associations between measures of myocardial function and outcomes, adjusted for potential confounding factors. The predictive ability of global longitudinal strain, SR, and LVEF was assessed as area under receiver operating characteristics curves (AUCs).RESULTS: Of 100 patients enrolled in the clinical trial, 86 patients with aortic stenosis had acceptable images for global longitudinal strain analysis. Primarily, worse intraoperative global longitudinal strain was associated with prolonged hospitalization (odds ratio [98.3% confidence interval], 1.22 [1.01–1.47] per 1% decrease [absolute value] in strain; P = .012), but not with other outcomes. Secondarily, worse global longitudinal SR was associated with prolonged hospitalization (odds ratio [99.7% confidence interval], 1.68 [1.01–2.79] per 0.1 second−1 decrease [absolute value] in SR; P = .003), but not other outcomes. LVEF was not associated with any outcomes. Global longitudinal SR was the best predictor for prolonged hospitalization (AUC, 0.72), followed by global longitudinal strain (AUC, 0.67) and LVEF (AUC, 0.62).CONCLUSIONS: Global longitudinal strain and SR are useful predictors of prolonged hospitalization in patients with aortic stenosis having an aortic valve replacement.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Intensive Care Unit Enhanced Recovery Pathway for Patients Undergoing
           Orthotopic Liver Transplants Recipients: A Prospective, Observational
           Study
    • Authors: King; Adam B.; Kensinger, Clark D.; Shi, Yaping; Shotwell, Matthew S.; Karp, Seth J.; Pandharipande, Pratik P.; Wright, J. Kelly; Weavind, Liza M.
      Abstract: imageBACKGROUND: Liver transplant recipients continue to have high perioperative resource utilization and prolonged length of stay despite improvements in perioperative care. Enhanced recovery pathways have been shown in other surgical populations to produce reductions in hospital resource utilization.METHODS: A prospective, observational study was performed to examine the effect of an enhanced recovery pathway for postoperative care after liver transplantation. Outcomes from patients undergoing liver transplantation from November 1, 2013, to October 31, 2014, managed by the pathway were compared to transplant recipients from the year before pathway implementation. Multivariable regression analysis was used to assess the association of the clinical pathway on clinical outcomes.RESULTS: The intervention and control groups included 141 and 106 patients, respectively. There were no demographic differences between the control and intervention group including no differences between the length of surgery and cold ischemic time. Median intensive care unit length of stay was reduced from 4.4 to 2.6 days (P < .001). The intervention group had a higher likelihood of earlier discharge (hazard ratio [95% CI], 2.01 [1.55–2.62]; P < .001), and a 69% and 65% lower odds of receiving a plasma (P < .001) or packed red blood cell (P < .001) transfusion. There was no significant effect on hospital mortality (P = .40), intensive care unit readmission rates (P = .75), or postoperative infections (urinary traction infections: P = .09; pneumonia: P = .27).CONCLUSIONS: An enhanced recovery pathway focused on milestone-based elements of intensive care unit management and predetermined management triggers including hemodynamic goals, fluid therapy, perioperative antibiotics, glycemic control, and standardized transfusion triggers led to reductions in intensive care unit length of stay without an increase in perioperative complications.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Incidence of Anaphylaxis Associated With Sugammadex
    • Authors: Miyazaki; Yusuke; Sunaga, Hiroshi; Kida, Kotaro; Hobo, Shotaro; Inoue, Nobuyoshi; Muto, Masayuki; Uezono, Shoichi
      Abstract: imageWe retrospectively investigated the incidence of potential sugammadex-induced anaphylaxis at a single center in Japan over a period of 3 years. The overall incidence of intraoperative hypersensitivity reaction was 0.22% (95% confidence interval [CI], 0.17%–0.29%), and the incidence of anaphylaxis was 0.059% (95% CI, 0.032%–0.10%). The total number of patients who received sugammadex during the study period was 15,479, and the incidence of anaphylaxis associated with sugammadex was 0.039% (n = 6; 95% CI, 0.014%–0.084%). This result implies that the incidence of sugammadex-associated anaphylaxis could be as high as that for succinylcholine or rocuronium. A prospective study, including testing for identification of cause, is necessary to confirm the exact incidence of sugammadex-induced anaphylaxis; however, the present finding calls attention to this potential.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Usefulness of Basophil Activation Tests for Diagnosis of
           Sugammadex-Induced Anaphylaxis
    • Authors: Horiuchi; Tatsuo; Yokohama, Akihiko; Orihara, Masaki; Tomita, Yukinari; Tomioka, Akihiro; Yoshida, Nagahide; Takahashi, Kenichiro; Saito, Shigeru; Takazawa, Tomonori
      Abstract: imageBACKGROUND: Sugammadex is used to reverse the effects of neuromuscular blocking agents in many cases of general anesthesia. However, there are several reports of anaphylaxis after its use. Skin testing is the gold standard for detecting the causative agent of anaphylaxis. However, due to the lack of validated protocols for skin testing with sugammadex, the diagnostic accuracy might be inadequate. Recently, the basophil activation test (BAT) has been established as a tool to detect the causative agent of anaphylaxis with high sensitivity and specificity. However, few studies have investigated the utility of the BAT for sugammadex-induced anaphylaxis.METHODS: Eight patients who presented with immediate hypersensitivity to sugammadex during general anesthesia were included in this study. We conducted skin tests to confirm the diagnosis of sugammadex-induced anaphylaxis. Twenty-one sugammadex-naive individuals who had a negative skin test for allergy to this drug were enrolled as controls. Basophils were selected on a CD3−/CRTH2+ gate and labeled with CD63 and CD203c.RESULTS: The ratios of activated basophils in the patients were much higher than those in controls: the median values of areas under the curves in the patients and controls for CD203c were 1,265,985 (95% confidence interval [CI], 77,580–5,040,270) and 116,325 (95% CI, −268,605 to 232,690), respectively (Mann-Whitney U test, P < .01), and the areas under the curves in the patients and controls for CD63 were 788,647 (95% CI, 120,285–3,523,410) and 220,005 (95% CI, −50,346 to 404,680), respectively (Mann-Whitney U test, P < .01). The patients, but not controls, demonstrated clear dose-dependent CD203c upregulation. This was also true for CD63. In the case of CD203c, the sensitivity of the BAT for sugammadex was 88% (95% CI, 47%–100%), and specificity was 100% (95% CI, 84%–100%), while sensitivity and specificity for CD63 were 75% (95% CI, 35%–97%) and 100% (95% CI, 84%–100%), respectively.CONCLUSIONS: The BAT seems to have comparable accuracy to skin tests for the diagnosis of sugammadex-induced anaphylaxis. For this purpose, both CD203c and CD63 can be used to detect activated basophils.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The Clinical Utility of Noninvasive Pulse Co-oximetry Hemoglobin
           Measurements in Dark-Skinned Critically Ill Patients
    • Authors: Murphy; Susan M.; Omar, Shahed
      Abstract: imageBACKGROUND: The primary objective of this study was to assess the clinical usefulness of a point-of-care device which measures hemoglobin noninvasively (SpHb) in a group of critically ill participants with dark skin pigmentation.METHODS: One hundred forty-six adult and pediatric participants from a multidisciplinary intensive care unit had intermittent readings of noninvasive hemoglobin measurements performed at a minimum of 4 hourly intervals. A total of 371 readings were analyzed. Concurrent blood samples were taken to assess hemoglobin levels using point-of-care blood gas analyzer, as well as sent to a central laboratory where hemoglobin was measured using the sodium lauryl sulfate method. Bland-Altman plots were constructed to assess the agreement between results from the 2 point-of-care devices with the reference standard (laboratory hemoglobin).RESULTS: SpHb exhibited significant bias when compared to laboratory hemoglobin, while blood gas hemoglobin did not. Mean bias for SpHb was +1.64 with limits of agreement of −1.03 to 4.31 compared to blood gas hemoglobin which showed a bias of 0.26 and limits of agreement of −0.84 to 1.37. The magnitude of the bias for SpHb increased with increasing mean hemoglobin levels. Of all the additional study variables assessed for effect on the bias, only Acute Physiology and Chronic Health Evaluation II score in adult patients (P < .0001) and mean arterial blood pressure (P = .001) had an effect. Skin pigmentation did not have any effect on the magnitude of bias.CONCLUSIONS: Noninvasive Hemoglobin measurement is a promising tool in dark-skinned critically ill patients with low hemoglobin levels, but requires further refinements for it to have clinical usefulness.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The Technology of Video Laryngoscopy
    • Authors: Berkow; Lauren C.; Morey, Timothy E.; Urdaneta, Felipe
      Abstract: imageTracheal intubation via laryngeal exposure has evolved over the past 150 years and has greatly expanded in the last decade with the introduction and development of newer, more sophisticated optical airway devices. The introduction of indirect and video-assisted laryngoscopes has significantly impacted airway management as evidenced by the presence of these devices in the majority of published difficult airway algorithms. However, it is quite possible that many airway managers do not have a thorough comprehension of how these devices actually function, an understanding that is vital not only for their use but also for assessing the devices’ limitations. This article discusses the development of video laryngoscopy, how the video laryngoscope works, and the impact of video laryngoscopy on difficult airway management.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Preventing Adverse Events in Cataract Surgery: Recommendations From a
           Massachusetts Expert Panel
    • Authors: Nanji; Karen C.; Roberto, Sarah A.; Morley, Michael G.; Bayes, Joseph
      Abstract: imageMassachusetts health care facilities reported a series of cataract surgery–related adverse events (AEs) to the state in recent years, including 5 globe perforations during eye blocks performed by 1 anesthesiologist in a single day. The Betsy Lehman Center for Patient Safety, a nonregulatory Massachusetts state agency, responded by convening an expert panel of frontline providers, patient safety experts, and patients to recommend strategies for mitigating patient harm during cataract surgery. The purpose of this article is to identify contributing factors to the cataract surgery AEs reported in Massachusetts and present the panel’s recommended strategies to prevent them. Data from state-mandated serious reportable event reports were supplemented by online surveys of Massachusetts cataract surgery providers and semistructured interviews with key stakeholders and frontline staff. The panel identified 2 principal categories of contributing factors to the state’s cataract surgery–related AEs: systems failures and choice of anesthesia technique. Systems failures included inadequate safety protocols (48.7% of contributing factors), communication challenges (18.4%), insufficient provider training (17.1%), and lack of standardization (15.8%). Choice of anesthesia technique involved the increased relative risk of needle-based eye blocks. The panel’s surveys of Massachusetts cataract surgery providers show wide variation in anesthesia practices. While 45.5% of surgeons and 69.6% of facilities reported increased use of topical anesthesia compared to 10 years earlier, needle-based blocks were still used in 47.0% of cataract surgeries performed by surgeon respondents and 40.9% of those performed at respondent facilities. Using a modified Delphi approach, the panel recommended several strategies to prevent AEs during cataract surgery, including performing a distinct time-out with at least 2 care-team members before block administration; implementing standardized, facility-wide safety protocols, including a uniform site-marking policy; strengthening the credentialing and orientation of new, contracted and locum tenens anesthesia staff; ensuring adequate and documented training in block administration for any provider who is new to a facility, including at least 10 supervised blocks before practicing independently; using the least invasive form of anesthesia appropriate to the patient; and finally, adjusting anesthesia practices, including preferred techniques, as evidence-based best practices evolve. Future research should focus on evaluating the impact of these recommendations on patient outcomes.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Patient Harm in Cataract Surgery: A Series of Adverse Events in
           Massachusetts
    • Authors: Roberto; Sarah A.; Bayes, Joseph; Karner, Paul E.; Morley, Michael G.; Nanji, Karen C.
      Abstract: imageMassachusetts state agencies received reports of 37 adverse events (AEs) involving cataract surgery from 2011 to 2015. Fifteen were anesthesia related, including 5 wrong eye blocks, 3 cases of hemodynamic instability, 2 retrobulbar hematoma/hemorrhages, and 5 globe perforations resulting in permanent loss of vision. While Massachusetts’ reported AEs likely underrepresent the true number of AEs that occur during cataract surgery, they do offer useful signal data to indicate the types of patient harm occurring during these procedures.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Physiology and Role of Intraocular Pressure in Contemporary Anesthesia
    • Authors: Kelly; Dermot J.; Farrell, Sinéad M.
      Abstract: imageMore than 26 million Americans suffer with cataracts, and with 3.6 million cataract extractions performed annually in the United States, it is the most common surgical procedure. The integrity of the delicate structures of the eye that mediate vision is dependent on the intraocular pressure (IOP). Yet, IOP acts to compress the vessels within the globe—akin to a Starling resistor—and is a key component that determines the ocular perfusion pressure, defined as the difference between arterial pressure and IOP. The retina is one of the most metabolically active tissues in the body, and its functional integrity is dependent on an adequate blood supply, with retinal function linearly related to the ocular perfusion pressure. Retinal cell death has been demonstrated at low perfusion pressures (below 50 mm Hg). Modern ophthalmic surgery involves globe irrigation, manipulation, and instrumentation, resulting in dynamic pressure fluxes within the eye. Marked elevations of IOP (up to 4–5 times the normal value) with consequent borderline retinal and optic disk perfusion pressures occur for prolonged periods during many ophthalmic procedures. General surgeries, including laparoscopic, spinal, and cardiac procedures, especially, with their demand for steep Trendelenburg or prolonged prone positioning and/or hypotensive anesthesia, can induce IOP changes and ocular perfusion imbalance. These rapid fluctuations in IOP, and so in perfusion, play a role in the pathogenesis of the visual field defects and associated ocular morbidity that frequently complicate otherwise uneventful surgeries. The exact etiology of such outcomes is multifactorial, but ocular hypoperfusion plays a significant and frequently avoidable role. Those with preexisting compromised ocular blood flow are especially vulnerable to intraoperative ischemia, including those with hypertension, diabetes, atherosclerosis, or glaucoma. However, overly aggressive management of arterial pressure and IOP may not be possible given a patient’s comorbidity status, and it potentially exposes the patient to risk of catastrophic choroidal hemorrhage. Anesthetic management significantly influences the pressure changes in the eye throughout the perioperative period. Strategies to safeguard retinal perfusion, reduce the ischemic risk, and minimize the potential for expulsive bleeding must be central to the anesthetic techniques selected. This review outlines: important physiological principles; ophthalmic and general procedures most likely to develop damaging IOP levels and their causative factors; the effect of anesthetic agents and techniques on IOP; recent scientific evidence highlighting the significance of perfusion changes during surgery; and key aspects of postoperative visual loss and management approaches for high-risk patients presenting for surgery.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Videolaryngoscopy for Physician-Based, Prehospital Emergency Intubation: A
           Prospective, Randomized, Multicenter Comparison of Different Blade Types
           Using A.P. Advance, C-MAC System, and KingVision
    • Authors: Cavus; Erol; Janssen, Sebastian; Reifferscheid, Florian; Caliebe, Amke; Callies, Andreas; von der Heyden, Martin; Knacke, Peer G.; Doerges, Volker
      Abstract: imageBACKGROUND: Videolaryngoscopy is a valuable technique for endotracheal intubation. When used in the perioperative period, different videolaryngoscopes vary both in terms of technical use and intubation success rates. However, in the prehospital environment, the relative performance of different videolaryngoscopic systems is less well studied.METHODS: We conducted this prospective, randomized, multicenter study at 4 German prehospital emergency medicine centers. One hundred sixty-eight adult patients requiring prehospital emergency intubation were treated by an emergency physician and randomized to 1 of 3 portable videolaryngoscopes (A.P. Advance, C-MAC PM, and channeled blade KingVision) with different blade types. The primary outcome variable was overall intubation success and secondary outcomes included first-attempt intubation success, glottis visualization, and difficulty with handling the devices. P values for pairwise comparisons are corrected by the Bonferroni method for 3 tests (P[BF]). All presented P values are adjusted for center.RESULTS: Glottis visualization was comparable with all 3 devices. Overall intubation success for A.P. Advance, C-MAC, and KingVision was 96%, 97%, and 61%, respectively (overall: P < .001, A.P. Advance versus C-MAC: odds ratio [OR], 0.97, 95% confidence interval [CI], 0.13–7.42, P[BF]> 0.99; A.P. Advance versus KingVision: OR, 0.043, 95% CI, 0.0088–0.21, P[BF] < 0.001; C-MAC versus KingVision: OR, 0.043, 95% CI, 0.0088–0.21, P[BF] < 0.001). Intubation success on the first attempt with A.P. Advance, C-MAC, and KingVision was 86%, 85%, and 48%, respectively (overall: P < .001, A.P. Advance versus C-MAC: OR, 0.89, 95% CI, 0.31–2.53, P[BF]> 0.99; A.P. Advance versus KingVision: OR, 0.24, 95% CI, 0.055–0.38, P[BF] = 0.0054; C-MAC versus KingVision: OR, 0.21, 95% CI, 0.043–.34, P[BF] < 0.003). Direct laryngoscopy for successful intubation with the videolaryngoscopic device was necessary with the A.P. Advance in 5 patients, and with the C-MAC in 4 patients. In the KingVision group, 21 patients were intubated with an alternative device.CONCLUSIONS: During prehospital emergency endotracheal intubation performed by emergency physicians, success rates of 3 commercially available videolaryngoscopes A.P. Advance, C-MAC PM, and KingVision varied markedly. We also found that although any of the videolaryngoscopes provided an adequate view, actual intubation was more difficult with the channeled blade KingVision.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Anesthetic Considerations for Patients Undergoing Bronchial Thermoplasty
    • Authors: Saran; Jagroop S.; Kreso, Melissa; Khurana, Sandhya; Nead, Michael; Larj, Michael; Karan, Suzanne
      Abstract: imageBronchial thermoplasty (BT) is a novel, Food and Drug Administration–approved nondrug treatment for patients whose asthma remains uncontrolled despite traditional pharmacotherapy. BT involves application of controlled radiofrequency energy to reduce airway smooth muscle in large- and medium-sized airways. Although BT is often performed under general anesthesia, anesthetic management strategies for BT are poorly described. We describe the anesthetic management of 7 patients who underwent 19 BT treatments in a tertiary academic medical center.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Use of Survey and Delphi Process to Understand Trauma Anesthesia Care
           Practices
    • Authors: Kuza; Catherine M.; Vavilala, Monica S.; Speck, Rebecca M.; Dutton, Richard P.; McCunn, Maureen
      Abstract: imageBACKGROUND: Few trauma guidelines evaluate and recommend anesthesiology practices and there are no trauma anesthesia-specific guidelines. There is no information on how anesthesiologists perceive clinical practice patterns. Our objective was to understand the perceptions of anesthesiologists regarding trauma anesthesia practices.METHODS: A survey assessing anesthesia management of trauma patients was distributed to 21,491 anesthesiologists. A subset of 10 of these questions was subsequently reviewed by a trauma anesthesiology focus group through a 3-round web-based Delphi process. A question was deemed to have respondent consensus if the response with the highest percentage of agreement was unchanged between rounds 1 and 2.RESULTS: A total of 2360 anesthesiologists (11% response rate) responded to the survey. Results demonstrated that the practitioners’ answers conflicted with existing surgical trauma society recommendations (ie, when to transfuse component therapy), and several areas that lacked any guidelines, resulted in response variability among anesthesiologists where not 1 answer achieved>75% agreement (ie, intubation technique of choice for patients with uncleared cervical spine). Thirteen trauma anesthesiologists participated in round 1 (response rate 100%), and 12 responded in rounds 2 and 3 (response rate 92%) of the Delphi process. None of the questions received 100% agreement. Consensus was achieved on 9 of 10 statements pertaining to trauma anesthesia care. Consensus was not reached on the intubating technique in a hemodynamically unstable patient with an uncleared cervical spine with deficits. Delphi participant opinion conflicted with existing guidelines on 2 statements: the use of cricoid pressure, and when to begin blood component therapy.CONCLUSIONS: There are several important areas of trauma anesthesia practice where guidelines do not exist and several where existing guidelines are not endorsed by the majority of practitioners who completed our survey. The lack of consensus on trauma anesthesia management and the variation in survey responses demonstrate a need to develop evidence-based trauma anesthesia guidelines.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The Relationship Between Women’s Intention to Request a Labor Epidural
           Analgesia, Actually Delivering With Labor Epidural Analgesia, and
           Postpartum Depression at 6 Weeks: A Prospective Observational Study
    • Authors: Orbach-Zinger; Sharon; Landau, Ruth; Harousch, Avi Ben; Ovad, Oren; Caspi, Liron; Kornilov, Evgeniya; Ioscovich, Alexander; Bracco, Danielle; Davis, Atara; Fireman, Shlomo; Hoshen, Moshe; Eidelman, Leonid A.
      Abstract: imageBACKGROUND: Postpartum depression (PPD) is associated with pain during and after delivery, with studies showing reduced rates among women delivering with labor epidural analgesia (LEA). We hypothesized that women who intend to deliver with LEA but do not receive it are at higher risk for PPD at 6 weeks due to the combined experience of untreated labor pain and unmatched expectations during labor, and evaluated the interaction between labor plans related to LEA, satisfaction with pain control when actually delivering with LEA, and PPD at 6 weeks after delivery.METHODS: A total of 1497 women with a vaginal delivery were enrolled into this prospective longitudinal study. Women’s initial intention to deliver with or without LEA, how they subsequently delivered, and satisfaction with pain relief were recorded on postpartum day 1. Primary aim was selected as PPD at 6 weeks among women intending to deliver with but subsequently delivering without LEA compared with the rest of the cohort. Primary outcome was PPD at 6 weeks using the Edinburgh Postnatal Depression Scale; PPD was defined with a score ≥10 (scale from 0 to 30). Demographic and obstetric data were recorded. Fisher exact test was used for comparisons between groups. The interaction between intention and actual delivery with regard to LEA and PPD was tested.RESULTS: Overall, 87 of 1326 women completing the study at 6 weeks had PPD (6.6%). For the primary aim, 439 (29.3%) delivered without LEA, of which 193 (12.9%) had intended to deliver with LEA; the PPD rate among these women was 8.1%, which was not statistically different from the rest of the cohort (6.3%; odds ratio [OR], 1.30; 95% confidence interval [CI], 0.72–2.38; P = .41). A total of 1058 women (70.7%) delivered with LEA and 439 (29.3%) delivered without; therefore, 1169 (78.1%) delivered as intended and 328 (21.9%) did not (unmatched expectations). Evaluating the interaction between effects, there was a strong negative additive interaction between intending to deliver without LEA and actually delivering with LEA (risk difference = −8.6%, 95% CI, 16.2%–1.6%; P = .014) suggesting that unmatched intention effect is significantly associated with negative outcome. In multiple regression analysis, while intending to deliver with LEA (OR, 1.06; 95% CI, 1.01–1.11; P = .029) and actually delivering with LEA (OR, 1.07; 95% CI, 1.01–1.13; P = .018) both increased the odds for PPD, the multiplicative interaction was protective (OR, 0.92; 95% CI, 0.86–0.99; P = .022), after adjusting for cofactors.CONCLUSIONS: Our study results did not demonstrate a significant increase in the odds for PPD at 6 weeks among women who intended to deliver with LEA but subsequently delivered without. However, we identified a protective interaction between intended LEA use and actual use on the incidence of PPD. Our data suggest an increased risk when women do not deliver as intended, particularly when not initially intending to deliver with LEA. The relationship between unplanned LEA and PPD may be mediated by a physically difficult delivery rather than or in addition to negative emotions related to unmet expectations or a sense of personal failure; therefore, counseling women after delivery to address any negative perceptions may be useful.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A
           Retrospective Observational Study
    • Authors: Lim; Grace; Farrell, Lia M.; Facco, Francesca L.; Gold, Michael S.; Wasan, Ajay D.
      Abstract: imageBACKGROUND: Using labor, epidural analgesia has been linked to a reduced risk of postpartum depression, but the role of labor pain relief in this association remains unclear. The goal of this study was to test the hypothesis that effective epidural analgesia during labor is associated with reduced postpartum depression symptomatology.METHODS: A single, institutional, retrospective, observational cohort design was chosen. The primary outcome was Edinburgh postnatal depression scale (EPDS) score, measured at the 6-week postpartum visit. Subjects included in the final analysis had (1) received labor epidural analgesia; (2) pain assessed during labor both before and during initiation of labor epidural analgesia by 0–10 numeric rating scores; and (3) depression risk assessed by the EPDS and documented at their 6-week postpartum visit. Simple and multiple linear regression was used to identify the best model for assessing the association between pain improvement, defined as percent improvement in pain (PIP), and depression, after adjusting for a history of anxiety or depression, other psychiatric history, abuse, trauma, mode of delivery, and other maternal or fetal comorbid diseases.RESULTS: Two hundred one patients were included in the final analysis. Women with higher improvements in pain were associated with lower EPDS scores (r = 0.025; P = .002). Variables known to be associated with depression (body mass index, anxiety and/or depression, third- and fourth-degree perineal lacerations, and anemia) were significantly correlated with EPDS score and included in the final model. After we adjusted for these covariates, PIP remained a significant predictor of EPDS score (r = 0.49; P = .008), accounting for 6.6% of the variability in postpartum depression scores. The full model including pain, body mass index, anxiety and/or depression, perineal lacerations, and anemia explained 24% of the variability in postpartum depression scores.CONCLUSIONS: Although the extent of labor pain relief by epidural analgesia predicts lower postpartum depression scores, the relative contribution of PIP to risk for postpartum depression symptoms may be less than other established risk factors for depression. These data support that the clinical significance of labor analgesia in the development of postpartum depression needs to be more clearly defined.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative
           Review
    • Authors: Gamez; Brock H.; Habib, Ashraf S.
      Abstract: imageCesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools. For this review, we searched MEDLINE, the Cochrane database, and Google Scholar to identify articles that evaluated the utility of various tools to predict severe pain and/or opioid consumption in the first 48 hours after cesarean delivery. Thirteen articles were included in the final review: 5 utilizing quantitative sensory testing, including patient responses to pressure, electrical, and thermal stimuli; 1 utilizing hyperalgesia testing; 1 using response to local anesthetic wound infiltration; 4 utilizing preoperative psychometric evaluations including the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires; and 2 utilizing a combination of quantitative sensory tests and psychometric evaluations. A number of modalities demonstrated statistically significant correlations with pain outcomes after cesarean delivery, but most correlations were weak to modest, and many modalities might not be clinically feasible. Response to local anesthetic infiltration and a tool using 3 simple questions enquiring about anxiety and anticipated pain and analgesic needs show potential for clinical use, but further studies are needed to evaluate the utility of these predictive tests in clinical practice.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Predicting Heparin Responsiveness in Children Before Cardiopulmonary
           Bypass: A Retrospective Cohort Study
    • Authors: Nakamura; Sayaka; Honjo, Osami; Crawford-Lean, Lynn; Foreman, Celeste; Sano, Minako; O’Leary, James D.
      Abstract: imageBACKGROUND: Inadequate or excess administration of unfractionated heparin for cardiopulmonary bypass (CPB) can cause significant harm. Age-dependent differences in the pharmacodynamics and pharmacokinetics of heparin contribute to increased variability of heparin responsiveness in children. The aims of the current study were to (1) examine the correlation between predicted and observed heparin responsiveness in children before CPB measured using the Hemostasis Management System (HMS) Plus (Medtronic, Minneapolis, MN), (2) describe age-specific reference intervals for heparin sensitivity index (HSI) observed in children, and (3) test predictive models of HSI using preoperative clinical and laboratory data.METHODS: In this retrospective cohort study, children (ages ≤17 years) who required therapeutic heparinization for CPB in a 40-month period between September 2010 and December 2013 were investigated. Children weighing ≥45 kg or with a height ≥142 cm were excluded. HSI was defined as the difference between activated clotting time after heparin administration and the baseline activated clotting time divided by the heparin-loading dose (IU) per kilogram. Lin’s concordance correlation coefficient was used for the primary analysis of the relationship between predicted and observed HSI. Reference intervals were calculated for HSI using medians and 2.5% and 97.5% percentiles according to established guidelines for clinical and laboratory standards. Nonparametric regression analyses were used to model the relationship between HSI (dependent variable) and preoperative covariates (independent variables).RESULTS: A total of 1281 eligible children were included in the final analysis. Overall, there was a moderate correlation between predicted and observed HSI measured using HMS Plus System (rho_c = 0.46; 95% confidence interval, 0.41–0.50; P < .001). Sixty-five percent (829 of 1281) of predicted HSI values were less than observed. From adjusted regression models, HSI was best predicted by preoperative international normalized ratio, platelet count, and weight, but this model accounted for only 25% of the variance in HSI.CONCLUSIONS: In a large cohort of children, heparin responsiveness before CPB was not reliably predicted by either in vitro measurement using the HMS Plus System or commonly available preoperative clinical and laboratory data. We describe age-specific reference intervals for HSI in children, and we anticipate that these data will aid the identification of heparin resistance in this population.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • American College of Surgeons Children’s Surgery Verification Quality
           Improvement Program: What Anesthesiologists Need to Know Now
    • Authors: Brooks Peterson; Melissa; Houck, Constance S.; Deshpande, Jayant K.; Flick, Randall P.
      Abstract: imageA task force of pediatric surgical specialists with the support of The American College of Surgeons recently launched a verification program for pediatric surgery, the Children’s Surgery Verification quality improvement program, with the goal of improving pediatric surgical, procedural, and perioperative care. Included in this program are specific standards for the delivery of pediatric anesthesia care across a variety of practice settings. We review the background, available evidence, requirements for verification, and verification process and its implications for the practice of pediatric anesthesia across the country. In addition, we have included a special roundtable interview of 3 recently Children’s Surgery Verification–verified program directors to provide an up-to-date real-world perspective of this children’s surgery quality improvement program.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Preoperative Blood Tests Conducted Before Low-Risk Surgery in Japan: A
           Retrospective Observational Study Using a Nationwide Insurance Claims
           Database
    • Authors: Yonekura; Hiroshi; Seto, Kahori; Ide, Kazuki; Kawasaki, Yohei; Tanaka, Shiro; Nahara, Isao; Takeda, Chikashi; Kawakami, Koji
      Abstract: imageBACKGROUND: Routine preoperative testing is discouraged before low-risk surgery because testing does not provide any beneficial effect in terms of patient outcome. However, few studies have assessed the utilization of hospital health care resources in terms of preoperative tests in a real-world setting. Here, we aimed to assess the prevalence and factors associated with preoperative blood tests before low-risk surgery in Japan.METHODS: In this retrospective observational study, we used the nationwide insurance claims data of Japan. Patients who underwent low-risk surgeries between April 1, 2012 and March 31, 2016, were included. Our primary outcome was the receipt of any preoperative tests within 60 days before an index procedure: complete blood count, basic metabolic panel, coagulation tests, and liver function tests. We performed a descriptive analysis to estimate the proportions of preoperative blood tests, and examined the associations between patient-level and institutional-level factors and preoperative blood tests, using multilevel logistic regression analysis. Interinstitutional variation in the utilization of preoperative tests was summarized using the median odds ratio (OR).RESULTS: The study sample included 59,818 patients (mean [standard deviation] age, 44.0 [11.3] years; 33,574 [56.1%] women) from 9746 institutions. The overall proportion of each test was: complete blood count, 58.7%; metabolic panel, 47.8%; coagulation tests, 36.6%; and liver function tests, 48.5%. The proportion receiving any preoperative tests in the overall sample was 59.5%. Multilevel logistic regression analysis indicated that preoperative blood tests were associated with the Charlson comorbidity index score (score ≥3: adjusted OR, 4.21; 95% confidence interval [CI], 3.69–4.80), anticoagulant use (adjusted OR, 4.12; 95% CI, 2.35–7.22), type of anesthesia (general anesthesia: adjusted OR, 5.69; 95% CI, 4.85–6.68; regional anesthesia: adjusted OR, 3.76; 95% CI, 3.28–4.30), surgical setting (inpatient procedure: adjusted OR, 3.64; 95% CI, 3.30–4.00), and number of beds (≥100 beds: adjusted OR, 3.61; 95% CI, 3.19–4.08). The median institutional-specific proportion of preoperative tests was 40.0% (interquartile range, 0%–100%). The median OR for interinstitutional variation in ordering preoperative tests was 4.34. These findings were consistent across a sensitivity analysis.CONCLUSIONS: Preoperative blood tests were performed before 59.5% of low-risk surgeries. Preoperative tests were associated with the type of anesthesia, patient characteristics, and medical facility status. There was a substantial interinstitutional variation in the utilization of preoperative tests.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Comparison of Nasal Intubations by GlideScope With and Without a Bougie
           Guide in Patients Who Underwent Maxillofacial Surgeries: Randomized
           Clinical Trial
    • Authors: Pourfakhr; Pejman; Ahangari, Ailar; Etezadi, Farhad; Moharari, Reza Shariat; Ahmadi, Ayat; Saeedi, Negin; Najafi, Atabak
      Abstract: imageBACKGROUND: Nasotracheal intubation is commonly performed to provide a secure airway for the maintenance of general anesthesia in maxillofacial surgeries. Routine nasotracheal intubation is performed under general anesthesia by direct laryngoscopy, frequently with the aid of Magill forceps. This method can be time-consuming and may cause bleeding in the field of view. A gum elastic bougie (GEB) is a cheap, slender, and flexible device that could expedite nasotracheal intubation. The aim of this study was to evaluate the use of a GEB during nasotracheal intubation to facilitate the procedure and reduce the rate of complications.METHODS: In this randomized clinical trial study, 110 patients with American Society of Anesthesiologists (ASA) physical status I–II from 15 to 65 years of age were randomized into 2 equal groups. In both groups, a GlideScope and armored tube were used. In the GEB group, GEB was used to facilitate nasal intubation while the nasal intubation was performed without the aid of GEB in the routine group. The difficult intubation (defined as>1 attempt for intubation) was the primary outcome, and the duration of the intubation, the presence of traces of bleeding, the need for a tube replacement, and the usage of Magill forceps were the secondary outcomes.RESULTS: The incidence of bleeding in the GEB group was 1.81% vs 43.63% in the routine group (P < .001). In 5.5% of the GEB group, Magill forceps were used to advance the tube versus 67.3% in the routine group (P < .001). The mean time for intubation in GEB group was 48.63 ± 8.53 vs 55.9 ± 10.76 seconds in the routine group (P < .001).CONCLUSIONS: The GEB is a useful aid to nasotracheal intubation, reducing bleeding, the requirement for Magill forceps and, to a small degree, intubation time. A case exists for its routine use for this purpose.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Utilizing Patient E-learning in an Intervention Study on Preoperative
           Smoking Cessation
    • Authors: Wong; Jean; Raveendran, Raviraj; Chuang, Junior; Friedman, Zeev; Singh, Mandeep; Patras, Jayadeep; Wong, David T.; Chung, Frances
      Abstract: imageBACKGROUND: Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence.METHODS: In this prospective multicenter study, smokers undergoing elective noncardiac surgery participated in a preoperative smoking cessation program consisting of a patient e-learning program, brief advice, educational pamphlet, tobacco quitline referral, letter to the primary care physician, and pharmacotherapy. The patient e-learning program described (1) the benefits of quitting smoking before surgery; (2) how to quit smoking; and (3) how to cope while quitting. The 7-day point prevalence (PP) abstinence on the day of surgery and at 1, 3 and 6 six months after surgery was separately assessed, and factors most associated with abstinence were identified using multivariable logistic regression analysis. Generalized estimating equation methods were used to estimate effect of the factors associated with abstinence longitudinally. The reach of the program was assessed with the number of smokers who participated in the program versus the number of patients who were referred to the program.RESULTS: A total of 459 patients (68.9% of eligible patients) participated. The 7-day PP abstinence at day of surgery, 1 month, 3 months, and 6 months was 22%, 29%, 25%, and 22%, respectively. The variables predicting abstinence at 6 months were use of pharmacotherapy (odds ratio [OR], 7.32; 95% confidence interval [CI], 3.71–14.44; P < .0001) and number of contacts with a tobacco quitline (OR, 1.60; 95% CI, 1.35–1.90; P < .0001). Presence of other smokers in the household (OR, 0.39; 95% CI, 0.21–0.72; P = .0030) and amount spent on cigarettes weekly at baseline (per $10 increase) (OR, 0.73; 95% CI, 0.61–0.87; P = .0004) were barriers to abstinence.CONCLUSIONS: Our preoperative smoking cessation program resulted in a 7-day PP abstinence of 22% at 6 months. A multifaceted intervention including a patient e-learning program may be a valuable tool to overcome some of the barriers to help surgical patients quit smoking.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Validation of a New Method to Automatically Select Cases With
           Intraoperative Red Blood Cell Transfusion for Audit
    • Authors: Dexter; Franklin; Epstein, Richard H.; Ledolter, Johannes; Dasovich, Susan M.; Herman, Jay H.; Maga, Joni M.; Schwenk, Eric S.
      Abstract: imageBACKGROUND: Hospitals review allogeneic red blood cell (RBC) transfusions for appropriateness. Audit criteria have been published that apply to 5 common procedures. We expanded on this work to study the management decision of selecting which cases involving transfusion of at least 1 RBC unit to audit (review) among all surgical procedures, including those previously studied.METHODS: This retrospective, observational study included 400,000 cases among 1891 different procedures over an 11-year period. There were 12,616 cases with RBC transfusion. We studied the proportions of cases that would be audited based on criteria of nadir hemoglobin (Hb) greater than the hospital’s selected transfusion threshold, or absent Hb or missing estimated blood loss (EBL) among procedures with median EBL 50%) with transfusion were among procedures with median EBL 9 g/dL, the procedure’s median EBL was 9 g/dL and median EBL for the procedure ≥500 mL.CONCLUSIONS: An automated process to select cases for audit of intraoperative transfusion of RBC needs to consider the median EBL of the procedure, whether the nadir Hb is below the hospital’s Hb transfusion threshold for surgical cases, and the absence of either a Hb or entry of the EBL for the case. This conclusion applies to all surgical cases and procedures.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Reduction in Operating Room Plasma Waste After Evidence-Based Quality
           Improvement Initiative
    • Authors: Meyer; Matthew J.; Dzik, Walter H.; Levine, Wilton C.
      Abstract: imageAnesthesiologists request units of plasma in anticipation of transfusion. The amount of plasma transfused intraoperatively is less than that issued (requested, thawed, and sent). We presented institutional-specific data on plasma usage including anesthesiologist-specific ratios of plasma issued-to-transfused. In month-to-month comparisons from the year before the presentation (June–December 2015) to 7 months after (June–December 2016), plasma issued to the operating room was reduced from 434.9 ± 81 to 327.3 ± 65 units, a change of 107.6 units per month (95% confidence interval [CI], 22–193); plasma discarded by the blood bank was reduced from 109.7 ± 48 units to 69.1 ± 9 units, a change of 40.6 units per month (95% CI, 0.2–81); and plasma transfused went from 188.4 ± 42 units to 160.7 ± 52 units, a nonsignificant change of 27.7 units per month (95% CI, −27 to 83).
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Perioperative Management May Improve Long-term Survival in Patients After
           Lung Cancer Surgery: A Retrospective Cohort Study
    • Authors: Huang; Wen-Wen; Zhu, Wen-Zhi; Mu, Dong-Liang; Ji, Xin-Qiang; Nie, Xiao-Lu; Li, Xue-Ying; Wang, Dong-Xin; Ma, Daqing
      Abstract: imageBACKGROUND: Surgical resection is the main treatment for patients with non–small-cell lung cancer (NSCLC), but patients’ long-term outcome is still challenging. The purpose of this study was to identify predictors of long-term survival in patients after lung cancer surgery.METHODS: Patients who underwent surgery for NSCLC from January 1, 2006, to December 31, 2009, were enrolled into this retrospective cohort study. The primary outcome was the survival length after surgery. Predictors of long-term survival were screened with the multivariable Cox proportional hazard model.RESULTS: Postoperative follow-up was completed in 588 patients with a median follow-up duration of 5.2 years (interquartile range, 2.0–6.8). Two hundred ninety-one patients (49.5%) survived at the end of follow-up with median survival duration of 64.3 months (interquartile range, 28.5–81.6). The overall survival rates were 90.8%, 70.0%, and 57.1% at the end of the first, third, and fifth year after surgery, respectively. Limited resection (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.08–1.98; P = .013) and large tumor size (HR, 1.29; 95% CI, 1.17–1.42; P < .001) were associated with short survival; whereas high body mass index grade (HR, 0.82; 95% CI, 0.69–0.97; P = .021), highly differentiated tumor (HR, 0.59; 95% CI, 0.37–0.93; P = .024), dissection of mediastinal lymph node during surgery (HR, 0.45; 95% CI, 0.30–0.67; P < .001), and perioperative use of dexamethasone (HR, 0.70; 95% CI, 0.54–0.90; P = .006) were associated with long survival. No association was found between perioperative use of flurbiprofen axetil and long survival (HR, 0.80; 95% CI, 0.62–1.03; P = .086). However, combined administration of dexamethasone and flurbiprofen axetil was associated with longer survival (compared to no use of both: adjusted HR, 0.57; 95% CI, 0.38–0.84; P = .005).CONCLUSIONS: Certain factors in particular perioperative dexamethasone and flurbiprofen axetil therapy may improve patients’ long-term survival after surgery for NSCLC. Given the small sample size, these findings should be interpreted with caution, and randomized clinical trials are needed for further clarification.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Delineating the Trajectory of Cognitive Recovery From General Anesthesia
           in Older Adults: Design and Rationale of the TORIE (Trajectory of Recovery
           in the Elderly) Project
    • Authors: Mincer; Joshua S.; Baxter, Mark G.; McCormick, Patrick J.; Sano, Mary; Schwartz, Arthur E.; Brallier, Jess W.; Allore, Heather G.; Delman, Bradley N.; Sewell, Margaret C.; Kundu, Prantik; Tang, Cheuk Ying; Sanchez, Angela; Deiner, Stacie G.
      Abstract: imageBACKGROUND: Mechanistic aspects of cognitive recovery after anesthesia and surgery are not yet well characterized, but may be vital to distinguishing the contributions of anesthesia and surgery in cognitive complications common in the elderly such as delirium and postoperative cognitive dysfunction. This article describes the aims and methodological approach to the ongoing study, Trajectory of Recovery in the Elderly (TORIE), which focuses on the trajectory of cognitive recovery from general anesthesia.METHODS: The study design employs cognitive testing coupled with neuroimaging techniques such as functional magnetic resonance imaging, diffusion tensor imaging, and arterial spin labeling to characterize cognitive recovery from anesthesia and its biological correlates. Applying these techniques to a cohort of age-specified healthy volunteers 40–80 years of age, who are exposed to general anesthesia alone, in the absence of surgery, will assess cognitive and functional neural network recovery after anesthesia. Imaging data are acquired before, during, and immediately after anesthesia, as well as 1 and 7 days after. Detailed cognitive data are captured at the same time points as well as 30 days after anesthesia, and brief cognitive assessments are repeated at 6 and 12 months after anesthesia.RESULTS: The study is underway. Our primary hypothesis is that older adults may require significantly longer to achieve cognitive recovery, measured by Postoperative Quality of Recovery Scale cognitive domain, than younger adults in the immediate postanesthesia period, but all will fully recover to baseline levels within 30 days of anesthesia exposure. Imaging data will address systems neuroscience correlates of cognitive recovery from general anesthesia.CONCLUSIONS: The data acquired in this project will have both clinical and theoretical relevance regardless of the outcome by delineating the mechanism behind short-term recovery across the adult age lifespan, which will have major implications for our understanding of the effects of anesthetic drugs.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Treatment Patterns and Clinical Outcomes in Neonates Diagnosed With
           Respiratory Distress Syndrome in a Low-Income Country: A Report From
           Bangladesh
    • Authors: Hubbard; Richard M.; Choudhury, Kamal M.; Lim, Grace
      Abstract: imageRespiratory distress syndrome remains a leading cause of neonatal mortality worldwide. This retrospective study describes practice patterns for respiratory distress syndrome in a resource-limited setting and seeks to identify both risk factors for mortality and beneficial treatment modalities. Health, demographic, and treatment data were collected. Potential associations were analyzed using univariable and multivariable logistic regression. Of 104 children included for analysis, 38 died. Although most children were initially treated with noninvasive respiratory support, 59 progressed to invasive ventilation. Requirement for invasive ventilation was associated with death. A clear trend toward improved survival in mechanically ventilated patients was seen with surfactant administration.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Teaching Medical Students Clinical Anesthesia
    • Authors: Curry; Saundra E.
      Abstract: imageThere are many reasons for evaluating our approach and improving our teaching of America’s future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Peripheral Nerve Blocks for Hip Fractures: A Cochrane Review
    • Authors: Guay; Joanne; Parker, Martyn J.; Griffiths, Richard; Kopp, Sandra L.
      Abstract: imageBACKGROUND: This review focuses on the use of peripheral nerve blocks as preoperative analgesia, as postoperative analgesia, or as a supplement to general anesthesia for hip fracture surgery and tries to determine if they offer any benefit in terms of pain on movement at 30 minutes after block placement, acute confusional state, myocardial infarction/ischemia, pneumonia, mortality, time to first mobilization, and cost of analgesic.METHODS: Trials were identified by computerized searches of Cochrane Central Register of Controlled Trials (2016, Issue 8), MEDLINE (Ovid SP, 1966 to 2016 August week 1), Embase (Ovid SP, 1988 to 2016 August week 1), and the Cumulative Index to Nursing and Allied Health Literature (EBSCO, 1982 to 2016 August week 1), trials registers, and reference lists of relevant articles. Randomized controlled trials involving the use of nerve blocks as part of the care for hip fractures in adults aged 16 years and older were included. The quality of the studies was rated according to the Cochrane tool. Two authors independently extracted the data. The quality of evidence was judged according to the Grading of Recommendations, Assessment, Development, and Evaluations Working Group scale.RESULTS: Based on 8 trials with 373 participants, peripheral nerve blocks reduced pain on movement within 30 minutes of block placement: standardized mean difference, −1.41 (95% confidence interval [CI], −2.14 to −0.67; equivalent to −3.4 on a scale from 0 to 10; I2 statistic = 90%; high quality of evidence). The effect size was proportional to the concentration of local anesthetic used (P < .00001). Based on 7 trials with 676 participants, no difference was found in the risk of acute confusional state: risk ratio, 0.69 (95% CI, 0.38–1.27; I2 statistic = 48%; very low quality of evidence). Based on 3 trials with 131 participants, the risk for pneumonia was decreased: risk ratio, 0.41 (95% CI, 0.19–0.89; I2 statistic = 3%; number needed-to-treat for additional beneficial outcome, 7 [95% CI, 5–72]; moderate quality of evidence). No difference was found for the risk of myocardial ischemia or death within 6 months but the number of participants included was well below the optimum information size for these 2 outcomes. Based on 2 trials with 155 participants, peripheral nerve blocks also reduced the time to first mobilization after surgery: mean difference, −11.25 hours (95% CI, −14.34 to −8.15 hours; I2 statistic = 52%; moderate quality of evidence). From 1 trial with 75 participants, the cost of analgesic drugs when used as a single-shot block was lower: standardized mean difference, −3.48 (95% CI, −4.23 to −2.74; moderate quality of evidence).CONCLUSIONS: There is high-quality evidence that regional blockade reduces pain on movement within 30 minutes after block placement. There is moderate quality of evidence for a decreased risk of pneumonia, reduced time to first mobilization, and reduced cost of analgesic regimen (single-shot blocks).
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Effect of Stellate Ganglion Block on the Regional Hemodynamics of the
           Upper Extremity: A Randomized Controlled Trial
    • Authors: Kim; Min Kyoung; Yi, Myung Sub; Park, Pyung Gul; Kang, Hyun; Lee, Jae Sung; Shin, Hwa Yong
      Abstract: imageBACKGROUND: The success of stellate ganglion block (SGB) is traditionally determined on the basis of findings such as Horner’s syndrome, temperature rise in the face, hyperemia of the tympanic membrane, and nasal congestion. However, decreases in vascular resistance and increases in blood flow in the arm may be more meaningful findings. To date, the effect of SGB on the regional hemodynamics of the arm has not been evaluated using pulsed-wave Doppler ultrasound.METHODS: A total of 52 patients who were to undergo orthopedic surgery of the forearm were randomly assigned to either the mepivacaine group (SGB with 5 mL of 0.5% mepivacaine) or the saline group (SGB with 5 mL of normal saline). Before surgery, a single anesthesiologist performed a SGB under ultrasound guidance. The temperature of the upper extremity and the resistance index and blood flow in the brachial artery were measured before SGB, 15 and 30 minutes after SGB, and 1 hour after surgery. The severity of pain, requirement for rescue analgesics, and side effects of the local anesthetic agent were all documented.RESULTS: After SGB, the resistance index decreased significantly and the blood flow increased significantly in the brachial artery of members of the mepivacaine group (15 minutes: P = .004 and P < .001, respectively; 30 minutes: P < .001 and P < .001, respectively). However, these values normalized after surgery. The severity of pain, need for rescue analgesics, and incidence of adverse effects were not significantly different between the 2 groups.CONCLUSIONS: Although SGB did not decrease the pain associated with forearm surgery, ultrasound-guided SGB did increase blood flow and decrease vascular resistance in the arm. Therefore, pulsed-wave Doppler may be used to monitor the success of SGB.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Randomized Clinical Trial of Preoperative High-Dose Methylprednisolone on
           Postoperative Pain at Rest After Laparoscopic Appendectomy
    • Authors: Kleif; Jakob; Hauge, Camilla I.; Vilandt, Jesper; Gögenur, Ismail
      Abstract: imageBACKGROUND: Methylprednisolone administered intravenously preoperatively has been shown to reduce pain, nausea, and fatigue after elective surgery. We aimed to show that 125 mg of methylprednisolone given intravenously 30 minutes before laparoscopic surgery for suspected appendicitis would reduce pain at rest during the first 3 postoperative days.METHODS: A multicenter, parallel-group, double-blind, placebo-controlled study was conducted including patients 18 years of age and older with an American Society of Anesthesiologist class of I–III undergoing laparoscopic surgery for suspected appendicitis. The primary outcome was pain at rest measured on the 11-point numerical rating scale 5 times during the first 3 days after surgery. The effect of 125 mg of methylprednisolone on postoperative pain at rest during the first 3 days was assessed using a mixed-effects model with time and intervention as main effects.RESULTS: From April 2016 to August 2016, 78 patients were included, and all were eligible for analysis of the primary outcome. The estimated effect of 125 mg of methylprednisolone on pain at rest during the first 3 days after surgery was a nonsignificant increase of 0.2 (95% confidence interval, −0.5 to 0.9; P = .571) on the 11-point numerical rating scale. There was no difference between the 2 groups regarding the need for opioid agonists during hospital stay on the first postoperative day (P = .381).CONCLUSIONS: A 125-mg dose of methylprednisolone given intravenously 30 minutes before laparoscopic surgery for appendicitis seemed no better than placebo at providing a clinical meaningful reduction in postoperative pain at rest.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Adding Dopamine to Proxymetacaine or Oxybuprocaine Solutions Potentiates
           and Prolongs the Cutaneous Antinociception in Rats
    • Authors: Chen; Yu-Wen; Chiu, Chong-Chi; Lin, Heng-Teng; Wang, Jhi-Joung; Hung, Ching-Hsia
      Abstract: imageBACKGROUND: We evaluated the interaction of dopamine–proxymetacaine and dopamine– oxybuprocaine antinociception using isobolograms.METHODS: This experiment uses subcutaneous drug (proxymetacaine, oxybuprocaine, and dopamine) injections under the skin of the rat’s back, thus simulating infiltration blocks. The dose-related antinociceptive curves of proxymetacaine and oxybuprocaine alone and in combination with dopamine were constructed, and then the antinociceptive interactions between the local anesthetic and dopamine were analyzed using isobolograms.RESULTS: Subcutaneous proxymetacaine, oxybuprocaine, and dopamine produced a sensory block to local skin pinpricks in a dose-dependent fashion. The rank order of potency was proxymetacaine (0.57 [0.52–0.63] μmol/kg)> oxybuprocaine (1.05 [0.96–1.15] μmol/kg)> dopamine (165 [154–177] μmol/kg; P < .01 for each comparison) based on the 50% effective dose values. On the equianesthetic basis (25% effective dose, 50% effective dose, and 75% effective dose), the nociceptive block duration of proxymetacaine or oxybuprocaine was shorter than that of dopamine (P < .01). Oxybuprocaine or proxymetacaine coinjected with dopamine elicited a synergistic antinociceptive effect and extended the duration of action.CONCLUSIONS: Oxybuprocaine and proxymetacaine had a higher potency and provoked a shorter duration of sensory block compared with dopamine. The use of dopamine increased the quality and duration of skin antinociception caused by oxybuprocaine and proxymetacaine.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Neural Invasion Spreads Macrophage-Related Allodynia via Neural Root in
           Pancreatic Cancer
    • Authors: Miura; Tomofumi; Mitsunaga, Shuichi; Ikeda, Masafumi; Ohno, Izumi; Takahashi, Hideaki; Kuwata, Takeshi; Ochiai, Atsushi
      Abstract: imageBACKGROUND: Neural invasion (N-inv) induces the neural damage and pain in pancreatic cancer (PCa). Benign nerve injury evokes allodynia through neuroinflammation in the neural root, which might be seen in PCa. Macrophages have the potential to release excitatory cytokines after nerve injury and so may play a role in the generation of chronic neuropathic pain. The aim of this study is to represent N-inv–induced allodynia in patients with PCa and to characterize allodynia-related neuroinflammation as macrophage accumulation on dorsal root ganglion (DRG) in the N-inv animal model (N-inv model).METHODS: Treatment-naïve patients with advanced PCa with no opioid use were enrolled in the clinical study. To evaluate allodynia, the current perception threshold on epigastric skin and pain score from questionnaire were measured. The association between the degrees of radiological N-inv and allodynia was evaluated. In the animal experiments, we used the N-inv model, which is established by the inoculation of the human PCa cell line into the left sciatic nerve of mice and mimics the invasion behavior of human PCa. The change of sensation was weekly measured at right hind paw, and the expressions of mRNA and protein were investigated on DRG at 6 weeks in the N-inv and sham models. The effect of macrophage depletion using liposome-encapsulated clodronate (Lp-CLD) was evaluated in the N-inv model. Tumor size and the degree of macrophage accumulation on DRG or around the tumor were investigated.RESULTS: In the clinical study, 43 patients were analyzed. The threshold of epigastric skin at 2000 Hz touch and pressure sensation was decreased in patients with severe N-inv, compared to patients without severe N-inv. Patients with severe N-inv showed a high pain score. In the animal experiments, the N-inv model decreased the threshold of right hind paw at 5 and 6 weeks. The macrophage-related gene expression and F4/80-positive macrophages were increased in the left DRG. Lp-CLD–induced macrophage depletion induced an increase of the threshold in the right hind paw and a decrease of CD206-positive macrophages accumulation in the left DRG. Lp-CLD had no effect for tumor size.CONCLUSIONS: The present study first showed that the N-inv–induced allodynia was spread in patients with PCa and in the N-inv model. Allodynia was related to the amount of macrophages at DRG in the N-inv model. The neuroinflammation may be a target for researching the N-inv-induced pain mechanism and developing novel analgesics.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Differential Effects of Anesthetics and Opioid Receptor Activation on
           Cardioprotection Elicited by Reactive Oxygen Species–Mediated
           Postconditioning in Sprague-Dawley Rat Hearts
    • Authors: Lucchinetti; Eliana; Lou, Phing-How; Gandhi, Manoj; Clanachan, Alexander S.; Zaugg, Michael
      Abstract: imageBACKGROUND: Despite an array of cardioprotective interventions identified in preclinical models of ischemia–reperfusion (IR) injury, successful clinical translation has not been achieved. This study investigated whether drugs routinely used in clinical anesthesia influence cardioprotective effectiveness by reducing effects of reactive oxygen species (ROS), upstream triggers of cardioprotective signaling. Effects of propofol, sevoflurane, or remifentanil were compared on postischemic functional recovery induced by ROS-mediated postconditioning with Intralipid.METHODS: Recovery of left ventricular (LV) work, an index of IR injury, was measured in isolated Sprague-Dawley rat hearts subjected to global ischemia (20 minutes) and reperfusion (30 minutes). Hearts were either untreated or were treated with postconditioning with Intralipid (1%, throughout reperfusion). Propofol (10 μM), sevoflurane (2 vol%), remifentanil (3 nM), or combinations thereof were administered peri-ischemically (before and during IR). The effects of anesthetics on ROS production were measured in LV cardiac fibers by Amplex Red assay under phosphorylating and nonphosphorylating conditions.RESULTS: Recovery of LV work (expressed as percentage of the preischemic value ± standard deviation) in untreated hearts was poor (20% ± 7%) and was improved by Intralipid postconditioning (58% ± 8%, P = .001). In the absence of Intralipid postconditioning, recovery of LV work was enhanced by propofol (28% ± 9%, P = .049), sevoflurane (49% ± 5%, P < .001), and remifentanil (51% ± 6%, P < .001). The benefit of Intralipid postconditioning was abolished by propofol (33% ± 10%, P < .001), but enhanced by sevoflurane (80% ± 7%, P < .001) or remifentanil (80% ± 9%, P < .001). ROS signaling in LV fibers was abolished by propofol, but unaffected by sevoflurane or remifentanil. We conclude that propofol abolishes ROS-mediated Intralipid postconditioning by acting as a ROS scavenger. Sevoflurane and remifentanil are protective per se and provide additive cardioprotection to ROS-mediated cardioprotection.CONCLUSIONS: These divergent effects of routinely used drugs in clinical anesthesia may influence the translatability of cardioprotective therapies such as Intralipid postconditioning.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Colloids and the Microcirculation
    • Authors: He; Huaiwu; Liu, Dawei; Ince, Can
      Abstract: imageColloid solutions have been advocated for use in treating hypovolemia due to their expected effect on improving intravascular retention compared with crystalloid solutions. Because the ultimate desired effect of fluid resuscitation is the improvement of microcirculatory perfusion and tissue oxygenation, it is of interest to study the effects of colloids and crystalloids at the level of microcirculation under conditions of shock and fluid resuscitation, and to explore the potential benefits of using colloids in terms of recruiting the microcirculation under conditions of hypovolemia. This article reviews the physiochemical properties of the various types of colloid solutions (eg, gelatin, dextrans, hydroxyethyl starches, and albumin) and the effects that they have under various conditions of hypovolemia in experimental and clinical scenarios.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Bias in Before–After Studies: Narrative Overview for
           Anesthesiologists
    • Authors: Ho; Anthony M. H.; Phelan, Rachel; Mizubuti, Glenio B.; Murdoch, John A. C.; Wickett, Sarah; Ho, Adrienne K.; Shyam, Vidur; Gilron, Ian
      Abstract: imageBefore–after study designs are effective research tools and in some cases, have changed practice. These designs, however, are inherently susceptible to bias (ie, systematic errors) that are sometimes subtle but can invalidate their conclusions. This overview provides examples of before–after studies relevant to anesthesiologists to illustrate potential sources of bias, including selection/assignment, history, regression to the mean, test–retest, maturation, observer, retrospective, Hawthorne, instrumentation, attrition, and reporting/publication bias. Mitigating strategies include using a control group, blinding, matching before and after cohorts, minimizing the time lag between cohorts, using prospective data collection with consistent measuring/reporting criteria, time series data collection, and/or alternative study designs, when possible. Improved reporting with enforcement of the Enhancing Quality and Transparency of Health Research (EQUATOR) checklists will serve to increase transparency and aid in interpretation. By highlighting the potential types of bias and strategies to improve transparency and mitigate flaws, this overview aims to better equip anesthesiologists in designing and/or critically appraising before–after studies.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Correlation Coefficients: Appropriate Use and Interpretation
    • Authors: Schober; Patrick; Boer, Christa; Schwarte, Lothar A.
      Abstract: imageCorrelation in the broadest sense is a measure of an association between variables. In correlated data, the change in the magnitude of 1 variable is associated with a change in the magnitude of another variable, either in the same (positive correlation) or in the opposite (negative correlation) direction. Most often, the term correlation is used in the context of a linear relationship between 2 continuous variables and expressed as Pearson product-moment correlation. The Pearson correlation coefficient is typically used for jointly normally distributed data (data that follow a bivariate normal distribution). For nonnormally distributed continuous data, for ordinal data, or for data with relevant outliers, a Spearman rank correlation can be used as a measure of a monotonic association. Both correlation coefficients are scaled such that they range from –1 to +1, where 0 indicates that there is no linear or monotonic association, and the relationship gets stronger and ultimately approaches a straight line (Pearson correlation) or a constantly increasing or decreasing curve (Spearman correlation) as the coefficient approaches an absolute value of 1. Hypothesis tests and confidence intervals can be used to address the statistical significance of the results and to estimate the strength of the relationship in the population from which the data were sampled. The aim of this tutorial is to guide researchers and clinicians in the appropriate use and interpretation of correlation coefficients.
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Can Lung Ultrasound Be the First-Line Tool for Evaluation of
           Intraoperative Hypoxemia'
    • Authors: Díaz-Gómez; José L.; Renew, J. Ross; Ratzlaff, Robert A.; Ramakrishna, Harish; Via, Gabriele; Torp, Klaus
      Abstract: imageNo abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The Expected Role of the Anesthesiologist in Delivering Bad News
    • Authors: Viswanath; Omar; Simpao, Allan F.; Garcia, Guillermo
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • How to Implement Evidence-Based Healthcare
    • Authors: Nguyen-Buckley; Christine; Steadman, Randolph
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Painless Evidence-Based Medicine, 2nd ed
    • Authors: Clark; Stephanie; Campbell, Douglas
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Treatment of Chronic Pain Conditions: A Comprehensive Handbook
    • Authors: Watanabe; Kazuhiro
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Perioperative Temperature Management
    • Authors: Argalious; Maged Y.; Jamroz, Tatiana
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Acute Respiratory Distress Syndrome
    • Authors: Regli; Adrian; von Ungern-Sternberg, Britta
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • The Amazing Language of Medicine: Understanding Medical Terms and Their
           Backstories
    • Authors: Melkonian; Arek V.; Shafer, Audrey
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Pain Medicine: An Essential Review
    • Authors: Jellish; W. Scott
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Monitoring the Nervous System for Anesthesiologists and Other Health Care
           Professionals, 2nd ed
    • Authors: Ansermino; J. Mark
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Complications of Regional Anesthesia, 3rd ed
    • Authors: Zink; Wolfgang
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Approaches to Patient Counseling Regarding Effectiveness of Oral
           Contraceptives
    • Authors: DeAndrade; Diana S.; Berman, Julie R.; Boisen, Michael L.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Corda; David M.; Robards, Christopher B.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Opioid Omission Is Not Opioid Sparing. Response to “Surgery-Induced
           Opioid Dependence: Adding Fuel to the Fire'”
    • Authors: Moore; David L.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Pupillary Dilation Reflex Measurement: Ideal Time—Pre- or
           Postsurgery'
    • Authors: Paliwal; Bharat; Bhatia, Pradeep; Kaloria, Narender; Chopra, Komal
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Duceau; Baptiste; Jayr, Christian
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Renal Interstitial Exhaustion and SGLT2 Blockers
    • Authors: Ardalan; Mohammadreza; Golzari, Samad E. J.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Peacock; Sharon C.; Lovshin, Julie A.; Cherney, David Z. I.
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Inflammation Triggered by the Use of Blood Products
    • Authors: Iner; Hasan; Gokalp, Orhan; Besir, Yuksel; Gokalp, Gamze; Yilik, Levent; Gurbuz, Ali
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Questions Regarding Perioperative Surgical Home by Kim et al
    • Authors: Oetgen; Matthew E.; Patel, Janish Jay; Heitmiller, Eugenie; Pestieau, Sophie
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • In Response
    • Authors: Kim; Eugene; Cucchiaro, Giovanni
      Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Perioperative Surgical Home: Evaluation of a New Protocol Focused on a
           Multidisciplinary Approach to Manage Children Undergoing Posterior Spinal
           Fusion Operation Erratum
    • Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Perioperative Cardiac Arrest: Focus on Malignant Hyperthermia (MH) Erratum
           
    • Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Cardiac Arrest in the Operating Room: Part 2—Special Situations in the
           Perioperative Period Erratum
    • Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Perioperative Cardiac Arrest: Focus on Local Anesthetic Systemic Toxicity
           (LAST) Erratum
    • Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
  • Research Productivity and Rankings of Anesthesiology Departments in Canada
           and the United States: The Relationship Between the h-Index and Other
           Common Metrics Retraction Notice
    • Abstract: No abstract available
      PubDate: Tue, 01 May 2018 00:00:00 GMT-
       
 
 
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