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Anesthesia & Analgesia
Journal Prestige (SJR): 1.472
Citation Impact (citeScore): 3
Number of Followers: 226  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-2999 - ISSN (Online) 1526-7598
Published by LWW Wolters Kluwer Homepage  [302 journals]
  • Regular Maintenance Is Strongly Recommended: The Road to Board
           Certification and Beyond
    • Authors: Nathan; Naveen
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Wet Tap, Worse Outcomes: Complications Following Post-Dural Puncture
           Headache
    • Authors: Wanderer; Jonathan P.; Nathan, Naveen
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Chi-square Tests in Medical Research
    • Authors: Schober; Patrick; Vetter, Thomas R.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • The Time to Address Curriculum and Evaluation for Nontechnical Skills Is
           Now
    • Authors: Abatzis; Vaia T.; Littlewood, Keith E.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Toward Transparency in Board Certification
    • Authors: Cloyd; Benjamin H.; Nemergut, Edward C.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Developing the Anesthesia Workforce: The Impact of Training Nurse
           Anesthetists
    • Authors: Vreede; Eric; Bulamba, Fred; Chikumba, Edson
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Is Insufficient Evidence Sufficient'
    • Authors: Leffert; Lisa R.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Characterization of the Rapid Drop in Pulse Oximetry Reading After
           Intraoperative Administration of Methylene Blue in Open Thoracoabdominal
           Aortic Repairs
    • Authors: Rong; Lisa Q.; Mauer, Elizabeth; Mustapich, Taylor L.; White, Robert S.; Di Franco, Antonino; Girardi, Leonard N.; Gaudino, Mario; Pryor, Kane O.
      Abstract: imageThis study evaluates the changes of oxygen saturation (Spo2) after intravenous administration of methylene blue in 103 patients undergoing open repair of thoracoabdominal aortic aneurysms. We found that Spo2 decreased by a median (interquartile range [IQR]) of 49% (37%–81%)
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Society of Cardiovascular Anesthesiologists Clinical Practice Improvement
           Advisory for Management of Perioperative Bleeding and Hemostasis in
           Cardiac Surgery Patients
    • Authors: Raphael; Jacob; Mazer, C. David; Subramani, Sudhakar; Schroeder, Andrew; Abdalla, Mohamed; Ferreira, Renata; Roman, Philip E.; Patel, Nichlesh; Welsby, Ian; Greilich, Philip E.; Harvey, Reed; Ranucci, Marco; Heller, Lori B.; Boer, Christa; Wilkey, Andrew; Hill, Steven E.; Nuttall, Gregory A.; Palvadi, Raja R.; Patel, Prakash A.; Wilkey, Barbara; Gaitan, Brantley; Hill, Shanna S.; Kwak, Jenny; Klick, John; Bollen, Bruce A.; Shore-Lesserson, Linda; Abernathy, James; Schwann, Nanette; Lau, W. Travis
      Abstract: imageBleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point-of-care (POC) coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, have increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has only modestly declined over the last decade, remaining at ≥50% in high-risk patients. Given these limitations, and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists (SCA) has formed the Blood Conservation in Cardiac Surgery Working Group to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Intravascular Cooling Device Versus Esophageal Heat Exchanger for Mild
           Therapeutic Hypothermia in an Experimental Setting
    • Authors: Schroeder; Daniel C.; Maul, Alexandra C.; Guschlbauer, Maria; Finke, Simon-Richard; de la Puente Bethencourt, David; Becker, Ingrid; Padosch, Stephan A.; Hohn, Andreas; Annecke, Thorsten; Böttiger, Bernd W.; Sterner-Kock, Anja; Herff, Holger
      Abstract: imageBACKGROUND: Targeted temperature management is a standard therapy for unconscious survivors of cardiac arrest. To date, multiple cooling methods are available including invasive intravascular cooling devices (IVDs), which are widely used in the clinical setting. Recently, esophageal heat exchangers (EHEs) have been developed providing cooling via the esophagus that is located close to the aorta and inferior vena cava. The objective was to compare mean cooling rates, as well as differences, to target temperature during maintenance and the rewarming period of IVD and EHE.METHODS: The study was conducted in 16 female domestic pigs. After randomization to either IVD or EHE (n = 8/group), core body temperature was reduced to 33°C. After 24 hours of maintenance (33°C), animals were rewarmed using a target rate of 0.25°C/h for 10 hours. All cooling phases were steered by a closed-loop feedback system between the internal jugular vein and the chiller. After euthanasia, laryngeal and esophageal tissue was harvested for histopathological examination.RESULTS: Mean cooling rates (4.0°C/h ± 0.4°C/h for IVD and 2.4°C/h ± 0.3°C/h for EHE; P < .0008) and time to target temperature (85.1 ± 9.2 minutes for IVD and 142.0 ± 21.2 minutes for EHE; P = .0008) were different. Mean difference to target temperature during maintenance (0.07°C ± 0.05°C for IVD and 0.08°C ± 0.10°C for EHE; P = .496) and mean rewarming rates (0.2°C/h ± 0.1°C/h for IVD and 0.3°C/h ± 0.2°C/h for EHE; P = .226) were similar. Relevant laryngeal or esophageal tissue damage could not be detected. There were no significant differences in undesired side effects (eg, bradycardia or tachycardia, hypokalemia or hyperkalemia, hypoglycemia or hyperglycemia, hypotension, overcooling, or shivering).CONCLUSIONS: After insertion, target temperatures could be reached faster by IVD compared to EHE. Cooling performance of IVD and EHE did not significantly differ in maintaining target temperature during a targeted temperature management process and in active rewarming protocols according to intensive care unit guidelines in this experimental setting.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Long Intravascular Persistence of 20% Albumin in Postoperative Patients
    • Authors: Hasselgren; Emma; Zdolsek, Markus; Zdolsek, Joachim H.; Björne, Håkan; Krizhanovskii, Camilla; Ntika, Stelia; Hahn, Robert G.
      Abstract: imageBACKGROUND: Albumin may persist intravascularly for a shorter time in patients after major surgery than in healthy volunteers due to a surgery-induced breakdown (shedding) of the endothelial glycocalyx layer.METHODS: In this nonrandomized clinical trial, an IV infusion of 3 mL/kg of 20% albumin was given at a constant rate during 30 minutes to 15 patients on the first day after major open abdominal surgery (mean operating time 5.9 h) and to 15 conscious volunteers. Blood samples and urine were collected during 5 h and mass balance calculations used to estimate the half-lives of the administered albumin molecules and the induced plasma volume expansion, based on measurements of hemodilution and the plasma albumin concentration.RESULTS: At the end of the infusions, albumin had diluted the plasma volume by 13.3% ± 4.9% (mean ± SD) in the postoperative patients and by 14.2% ± 4.8% in the volunteers (mean difference −0.9, 95% CI, −4.7 to 2.9; 1-way ANOVA P = .61), which amounted to twice the infused volume. The intravascular half-life of the infused albumin molecules was 9.1 (5.7–11.2) h in the surgical patients and 6.0 (5.1–9.0) h in the volunteers (Mann-Whitney U test, P = .26; geometric mean difference 1.2, 95% CI, 0.8–2.0). The half-life of the plasma volume expansion was 10.3 (5.3–17.6; median and interquartile range) h in the surgical patients and 7.6 (3.5–9.0) h in the volunteers (P = .10; geometric mean difference 1.5, 95% CI, 0.8–2.8). All of these parameters correlated positively with the body mass index (correlation coefficients being 0.42–0.47) while age and sex did not affect the results.CONCLUSIONS: Twenty percent albumin caused a long-lasting plasma volume expansion of similar magnitude in postoperative patients and volunteers.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • What Does a Red Meat Allergy Have to Do With Anesthesia' Perioperative
           Management of Alpha-Gal Syndrome
    • Authors: Dunkman; W. Jonathan; Rycek, Wendy; Manning, Michael W.
      Abstract: imageOver the past decade, there has been a growing awareness of a new allergic syndrome known as alpha-gal allergy or alpha-gal syndrome, commonly recognized as a red meat allergy. We performed a review of the literature to identify articles that provide both background on this syndrome in general and any reports of reactions to medications or medical devices related to alpha-gal syndrome. Alpha-gal syndrome results from IgE to the oligosaccharide galactose-α-1,3-galactose, expressed in the meat and tissues of noncatarrhine mammals. It is triggered by the bite of the lone star tick and has been implicated in immediate-onset hypersensitivity to the monoclonal antibody cetuximab and delayed-onset hypersensitivity reactions after the consumption of red meat. There is growing recognition of allergic reactions in these patients to other drugs and medical devices that contain alpha-gal. Many of these reactions result from inactive substances that are part of the manufacturing or preparation process such as gelatin or stearic acid. This allergy may be documented in a variety of ways or informally reported by the patient, requiring vigilance on the part of the anesthesiologist to detect this syndrome, given its serious implications. This allergy presents a number of unique challenges to the anesthesiologist, including proper identification of a patient with alpha-gal syndrome and selection of anesthetic and adjunctive medications that will not trigger this allergy.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Intravenous Lidocaine for the Prevention of Cough: Systematic Review and
           Meta-analysis of Randomized Controlled Trials
    • Authors: Clivio; Sara; Putzu, Alessandro; Tramèr, Martin R.
      Abstract: imageBACKGROUND: It remains unclear to what extent intravenous lidocaine prevents cough and whether there is dose-responsiveness and risk of harm.METHODS: We searched electronic databases to January 1, 2017 for randomized trials comparing intravenous lidocaine with placebo for the prevention of cough in surgical patients. Primary outcome was the incidence of cough. Data were analyzed using a random-effects model and were expressed as risk ratio (RR) and number needed to treat (NNT) with 95% confidence interval.RESULTS: In 20 trials in adults (n = 3062) and 5 trials in children (n = 445), intravenous lidocaine 0.5–2 mg·kg−1 was tested for the prevention of intubation-, extubation-, or opioid-induced cough. Twenty-two trials included only American Society of Anesthesiologists I or II patients; 3 trials (n = 99) also included American Society of Anesthesiologists III patients. Lidocaine was associated with a lower incidence of cough compared to placebo in adults and children, irrespective of dosage and cough etiology. Data from adults suggested dose-responsiveness; with 0.5 mg·kg−1, RR was 0.66 (0.50–0.88) and NNT was 8 (5.4–14.3); with 1 mg·kg−1, RR was 0.58 (0.49–0.69) and NNT was 7 (4.6–8.9); with 1.5 mg·kg−1, RR was 0.44 (0.33–0.58) and NNT was 5 (3.3–5.2); and with 2 mg·kg−1, RR was 0.39 (0.24–0.62) and NNT was 3 (2.0–3.4). Adverse effect reporting was sparse.CONCLUSIONS: Within a range of 0.5–2 mg·kg−1, intravenous lidocaine dose dependently prevents intubation-, extubation-, and opioid-induced cough in adults and children with NNTs ranging from 8 to 3. The risk of harm in high-risk patients remains unknown.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Development and Initial Evaluation of a Novel, Ultraportable, Virtual
           Reality Bronchoscopy Simulator: The Computer Airway Simulation System
    • Authors: Casso; Gabriele; Schoettker, Patrick; Savoldelli, Georges L.; Azzola, Andrea; Cassina, Tiziano
      Abstract: imageBACKGROUND: Virtual reality (VR) simulation is an effective and safe method of teaching bronchoscopic skills. Few VR bronchoscopy simulators exist; all are expensive. The present study aimed to describe the design, development, and evaluation of a new, affordable, VR bronchoscopy simulator.METHODS: Anesthesiologists and engineers collaborated to design and develop the Computer Airway Simulation System (CASS), an iPad-based, high-fidelity, VR bronchoscopy simulator. We describe hardware and software development, as well as the technical and teaching features of the CASS. Twenty-two senior anesthesiologists evaluated various aspects of the simulator (using a 5-point Likert scale) to assess its face validity.RESULTS: Anesthesiologists performed a simulated bronchoscopy (mouth to carina) with a median (range) procedural time of 66 seconds (30–96). The simulator’s ease of use was rated 4.3 ± 0.8 and the bronchoscope proxy’s handling 4.0 ± 0.7. Criticisms included that excessive system reactivity created handling difficulties. Anatomical accuracy, 3-dimensional bronchial segmentation, and mucosal texture were judged to be very realistic. The simulator’s usefulness for teaching and its educational value were highly rated (4.9 ± 0.3 and 4.8 ± 0.4, respectively).CONCLUSIONS: We describe the design, development, and initial evaluation of the CASS—a new, ultraportable, affordable, VR bronchoscopy simulator. The simulator’s face validity was supported by excellent assessments from senior anesthesiologists with regard to anatomical realism, quality of graphics, and handling performance, even though some future refinements are required. All the practitioners agreed on the significant educational potential of the CASS.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Determination of Geolocations for Anesthesia Specialty Coverage and
           Standby Call Allowing Return to the Hospital Within a Specified Amount of
           Time
    • Authors: Epstein; Richard H.; Dexter, Franklin; Diez, Christian; Potnuru, Paul
      Abstract: imageBACKGROUND: For emergent procedures, in-house teams are required for immediate patient care. However, for many procedures, there is time to bring in a call team from home without increasing patient morbidity. Anesthesia providers taking subspecialty or backup call from home are required to return to the hospital within a designated number of minutes. Driving times to the hospital during the hours of call need to be considered when deciding where to live or to visit during such calls. Distance alone is an insufficient criterion because of variable traffic congestion and differences in highway access. We desired to develop a simple, inexpensive method to determine postal codes surrounding hospitals allowing a timely return during the hours of standby call.METHODS: Pessimistic travel times and driving distances were calculated using the Google distance matrix application programming interface for all N = 136 postal codes within 60 great circle (“straight line”) miles of the University of Miami Hospital (Miami, FL) during all 108 weekly standby call hours. A postal code was acceptable if the estimated longest driving time to return to the hospital was ≤60 minutes (the anesthesia department’s service commitment to start an urgent case during standby call). Linear regression (with intercept = 0) minimizing the mean absolute percentage difference between the distances (great circle and driving) and the pessimistic driving times to return to the hospital was performed among all 136 postal codes. Implementation software written in Python is provided.RESULTS: Postal codes allowing return to the studied hospital within the specified interval were identified. The linear regression showed that driving distances correlated poorly with the longest driving time to return to the hospital among the 108 weekly call hours (mean absolute percentage error = 25.1% ± 1.7% standard error [SE]; N = 136 postal codes). Great circle distances also correlated poorly (mean absolute percentage error = 28.3% ± 1.9% SE; N = 136). Generalizability of the method was determined by successful application to a different hospital in a rural state (University of Iowa Hospital).CONCLUSIONS: The described method allows identification of postal codes surrounding a hospital in which personnel taking standby call could be located and be able to return to the hospital during call hours on every day of the week within any specified amount of time. For areas at the perimeter of the acceptability, online distance mapping applications can be used to check driving times during the hours of standby call.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Comparison of Broadband and Discrete Wavelength Near-Infrared Spectroscopy
           Algorithms for the Detection of Cytochrome aa3 Reduction
    • Authors: Thiele; Robert H.; Ikeda, Keita; Osuru, Hari P.; Zuo, Zhiyi
      Abstract: imageBACKGROUND: Cytochrome aa3, the terminal component of the electron transport chain, absorbs near-infrared radiation (NIR) differentially depending on its oxidation state (Cytox), which can in theory be measured using near-infrared spectroscopy (NIRS) by relating light absorption at specific wavelengths to chromophore concentrations. Some NIRS algorithms use discrete wavelengths, while others analyze a band of NIR (broadband NIRS). The purpose of this study was to test the ability of discrete wavelength and broadband algorithms to measure changes in Cytox (primary outcome), and to determine whether or not a discreet wavelength NIRS algorithm could perform similarly to a broadband NIRS algorithm for the measurement of Cytox in a staged hypoxia–cyanide model (hypoxia and cyanide have oppositional effects on tissue saturation, but both cause cytochrome reduction).METHODS: Twenty Sprague-Dawley rats were anesthetized with isoflurane, intubated, and instrumented. Blood pressure, end-tidal carbon dioxide, and arterial oxygen saturation were measured. A halogen light source transmitted NIR transcranially. NIR from the light source and the skull was transmitted to 2 cooled charge-coupled device spectrometers. Rats were subjected to anoxia (fraction of inspired oxygen, 0.0) until arterial oxygen saturation decreased to 70%. After recovery, 5 mg/kg sodium cyanide was injected intravenously. The cycle was repeated until cardiac arrest occurred. Relative concentrations of hemoglobin and cytochrome aa3 were calculated using discreet wavelength and broadband NIRS algorithms.RESULTS: Hypoxia led to an increase in calculated deoxyhemoglobin (0.20 arbitrary units [AUs]; 95% confidence interval [CI], 0.17–0.22; P < .0001), a decrease in calculated oxyhemoglobin (−0.16 AUs; 95% CI, −0.19 to −0.14; P < .0001), and a decrease in calculated Cytox (−0.057 AUs; 95% CI, −0.073 to 0.0040; P < .001). Cyanide led to a decrease in calculated deoxyhemoglobin (−0.037 AUs; 95% CI, 0.046 to −0.029; P < .001), an increase in calculated oxyhemoglobin (0.053 AUs; 95% CI, 0.040–0.065; P < .001), and a decrease in calculated Cytox (−0.056 AUs; 95% CI, −0.064 to −0.048; P < .001). The correlations between “discreet” wavelength algorithms (using 4, 6, 8, and 10 wavelengths) and the broadband algorithm for the measurement of calculated Cytox were 0.54 (95% CI, 0.52–0.56), 0.87 (0.87–0.88), 0.88 (0.88–0.89), and 0.95 (0.95–0.95), respectively.CONCLUSIONS: The broadband and 10 wavelength algorithm were able to accurately track changes in Cytox for all experiments.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • A Preoperative Cognitive Screening Test Predicts Increased Length of Stay
           in a Frail Population: A Retrospective Case–Control Study
    • Authors: O’Reilly-Shah; Vikas N.; Hemani, Salman; Davari, Paran; Glowka, Lena; Gebhardt, Emily; Hill, Laureen; Lee, Simon; Master, Viraj A.; Rodriguez, Amy D.; García, Paul S.
      Abstract: imageBACKGROUND: Frailty is associated with adverse perioperative outcomes including major morbidity, mortality, and increased length of stay. We sought to elucidate the role that a preoperatively assessed Mini-Cog can play in assessing the risk of adverse perioperative outcomes in a population at high risk of frailty.METHODS: In this retrospective case–control study, patients who were>60 years of age, nonambulatory, or had>5 documented medications were preoperatively assessed for handgrip strength, walking speed, and Mini-Cog score. The Emory University Clinical Data Warehouse was then used to extract this information and other perioperative data elements and outcomes data.RESULTS: Data were available for 1132 patients undergoing a wide variety of surgical procedures. For the subset of 747 patients with data for observed-to-expected length of stay, an abnormal Mini-Cog was associated with an increased odds of observed-to-expected>1 (odds ratio, 1.52; 95% CI, 1.05–2.19; P = .025). There was no association of abnormal Mini-Cog with intensive care unit length of stay>3 days (P = .182) discharge to home with self-care (P = .873) or risk of readmission (P = .104). Decreased baseline hemoglobin was associated with increased risk of 2 of the 4 outcomes studied.CONCLUSIONS: In a high-risk pool of patients, Mini-Cog may not be sensitive enough to detect significant differences for most adverse outcomes. Further work is needed to assess whether cognitive screens with greater resolution are of value in this context and to compare tools for assessing overall frailty status.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Intraoperative Awareness With Recall: A Descriptive, Survey-Based, Cohort
           Study
    • Authors: Bombardieri; Anna Maria; Mathur, Shagun; Soares, Andrea; Sharma, Anshuman; Ben Abdallah, Arbi; Wildes, Troy S.; Avidan, Michael S.
      Abstract: imageBACKGROUND: Unintended intraoperative awareness with recall (AWR) is a potential complication of general anesthesia. Patients typically report recollections of (1) hearing sounds or conversations, (2) being unable to breathe or move, (3), feeling pain, and/or (4) experiencing emotional distress. The purpose of the current study was to identify and further characterize AWR experiences identified through postoperative surveys of a large unselected adult surgical cohort.METHODS: This is a substudy of a prospective registry study, which surveys patients on their health and well-being after surgery. Responses to 4 questions focusing on AWR were analyzed. Patients who reported AWR with pain, paralysis, and/or distress were contacted by telephone to obtain more information about their AWR experience. The interview results for patients who received general anesthesia were sent to 3 anesthesiologists, who adjudicated the reported AWR episodes.RESULTS: Of 48,151 surveys sent, 17,875 patient responses were received. Of these respondents, 622 reported a specific memory from the period between going to sleep and waking up from perceived general anesthesia and 282 of these reported related pain, paralysis, and/or distress. An attempt was made to contact these 282 patients, and 149 participated in a telephone survey. Among the 149 participants, 87 endorsed their prior report of AWR. However, only 22 of these patients had received general anesthesia, while 51 received only sedation and 14 received regional anesthesia. Three anesthesiologists independently adjudicated the survey results of the 22 general anesthesia cases and assigned 6 as definite AWR, 8 as possible AWR, and 8 as not AWR episodes. Of the 65 patients who confirmed their report of AWR after regional or sedation anesthesia, 37 (31 with sedation and 6 with regional anesthesia) had not expected to be conscious during surgery.CONCLUSIONS: The complication of AWR continues to occur during intended general anesthesia. Many reports of AWR episodes occur in patients receiving sedation or regional anesthesia and relate to incorrect expectations regarding anesthetic techniques and conscious experiences, representing a potential target for intervention.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Culture-Negative and Culture-Positive Sepsis: A Comparison of
           Characteristics and Outcomes
    • Authors: Sigakis; Matthew J. G.; Jewell, Elizabeth; Maile, Michael D.; Cinti, Sandro K.; Bateman, Brian T.; Engoren, Milo
      Abstract: imageBACKGROUND: The primary objective of this study was to compare the characteristics of culture-positive and culture-negative status in septic patients. We also determined whether culture status is associated with mortality and whether unique variables are associated with mortality in culture-positive and culture-negative patients separately.METHODS: Utilizing patient records from intensive care units, emergency department, and general care wards in a large academic medical center, we identified adult patients with suspected infection and ≥2 systemic inflammatory response syndrome criteria between January 1, 2007, and May 31, 2014. We compared the characteristics between culture-positive and culture-negative patients and used binary logistic regression to identify variables independently associated with culture status and mortality. We also did sensitivity analyses using patients with Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria for sepsis.RESULTS: The study population included 9288 culture-negative patients (89%) and 1105 culture-positive patients (11%). Culture-negative patients received more antibiotics during the 48 hours preceding diagnosis but otherwise demonstrated similar characteristics as culture-positive patients. After adjusting for illness severity, a positive culture was not independently associated with mortality (odds ratio = 1.01 [95% CI, 0.81–1.26]; P = .945). The models predicting mortality separately in culture-negative and culture-positive patients demonstrated very good and excellent discrimination (C-statistic ± SD, 0.87 ± 0.01 and 0.92 ± 0.01), respectively. In the sensitivity analyses using patients with sepsis by Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria, after adjustments for illness severity, positive cultures were still not associated with mortality (odds ratio = 1.13 [95% CI, 0.86–1.43]; P = .303; and odds ratio = 1.05 [95% CI, 0.83–1.33]; P = .665), respectively. In all models, physiological derangements were associated with mortality.CONCLUSIONS: While culture status is important for tailoring antibiotics, culture-negative and culture-positive patients with sepsis demonstrate similar characteristics and, after adjusting for severity of illness, similar mortality. The most important factor associated with negative cultures is receipt of antibiotics during the preceding 48 hours. The risk of death in patients suspected of having an infection is most associated with severity of illness. This is aligned with the Sepsis-3 definition using Sequential Organ Failure Assessment score to better identify those suspected of infection at highest risk of a poor outcome.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Anesthetic Management of Patients After Traumatic Injury With
           Resuscitative Endovascular Balloon Occlusion of the Aorta
    • Authors: Engdahl; Ashton J.; Parrino, Christopher R.; Wasicek, Philip J.; Galvagno, Samuel M. Jr; Brenner, Megan L.; Anders, Megan G.; Conti, Bianca; Rock, Peter; McCunn, Maureen
      Abstract: imageResuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing maneuver for noncompressible torso hemorrhage. To our knowledge, this single-center brief report provides the most extensive anesthetic data published to date on patients who received REBOA. As anticipated, patients were critically ill, exhibiting lactic acidosis, hypotension, hyperglycemia, hypothermia, and coagulopathy. All patients received blood products during their index operations and received less inhaled anesthetic gas than normally required for healthy patients of the same age. This study serves as an important starting point for clinician education and research into anesthetic management of patients undergoing REBOA.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Comparison of Intermittent Intravenous Boluses of Phenylephrine and
           Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean
           Deliveries: Randomized Controlled Trial
    • Authors: Sharkey; Aidan M.; Siddiqui, Naveed; Downey, Kristi; Ye, Xiang Y.; Guevara, Jennifer; Carvalho, Jose C. A.
      Abstract: imageBACKGROUND: Phenylephrine (PE) is currently the vasopressor of choice to prevent and treat spinal-induced hypotension at cesarean delivery (CD). However, its use is often associated with reflex bradycardia. Norepinephrine (NE) has been put forward as an alternative vasopressor during CD due to its ability to treat hypotension while maintaining heart rate (HR). Recent studies have focused on the role of NE used as an infusion with favorable results compared to PE. No studies have compared equipotent bolus doses of PE and NE at CD. We hypothesized that when used in equipotent doses as an intermittent bolus regimen to prevent and treat spinal-induced hypotension, NE would result in a reduction in the incidence of bradycardia compared to PE.METHODS: This was a double-blind, randomized clinical trial of women undergoing elective CD under spinal anesthesia. Women were randomized to receive either PE 100 µg or NE 6 µg when the systolic blood pressure (SBP) was below baseline. In addition to the randomized treatment, ephedrine was given intravenously to both groups if the SBP was below baseline and the HR
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Objective Epidural Space Identification Using Continuous Real-Time
           Pressure Sensing Technology: A Randomized Controlled Comparison With
           Fluoroscopy and Traditional Loss of Resistance
    • Authors: Gebhard; Ralf E.; Moeller-Bertram, Tobias; Dobecki, Douglas; Peralta, Feyce; Pivalizza, Evan G.; Rupasinghe, Madhumani; Ilic, Sanja; Hochman, Mark
      Abstract: imageBACKGROUND: Performance of epidural anesthesia and analgesia depends on successful identification of the epidural space (ES). While multiple investigations have described objective and alternative methodologies to identify the ES, traditional loss of resistance (LOR) and fluoroscopy (FC) are currently standard of care in labor and delivery (L&D) and chronic pain (CP) management, respectively. While FC is associated with high success, it exposes patients to radiation and requires appropriate radiological equipment. LOR is simple but subjective and consequently associated with higher failure rates. The purpose of this investigation was to compare continuous, quantitative, real-time, needle-tip pressure sensing using a novel computer-controlled ES identification technology to FC and LOR for lumbar ES identification.METHODS: A total of 400 patients were enrolled in this prospective randomized controlled noninferiority trial. In the CP management arm, 240 patients scheduled to receive a lumbar epidural steroid injection had their ES identified either with FC or with needle-tip pressure measurement. In the L&D arm, 160 female patients undergoing lumbar epidural catheter placements were randomized to either LOR or needle-tip pressure measurement. Blinded observers determined successful ES identification in both arms. A modified intention-to-treat protocol was implemented, with patients not having the procedure for reasons preceding the intervention excluded. Noninferiority of needle-tip pressure measurement regarding the incidence of successful ES identification was claimed when the lower limit of the 97.27% confidence interval (CI) for the odds ratio (OR) was above 0.50 (50% less likely to identify the ES) and P value for noninferioirty
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Major Neurologic Complications Associated With Postdural Puncture Headache
           in Obstetrics: A Retrospective Cohort Study
    • Authors: Guglielminotti; Jean; Landau, Ruth; Li, Guohua
      Abstract: imageBACKGROUND: Increased risks of cerebral venous thrombosis or subdural hematoma, bacterial meningitis, persistent headache, and persistent low back pain are suggested in obstetric patients with postdural puncture headache (PDPH). Acute postpartum pain such as PDPH may also lead to postpartum depression. This study tested the hypothesis that PDPH in obstetric patients is associated with significantly increased postpartum risks of major neurologic and other maternal complications.METHODS: This retrospective cohort study consisted of 1,003,803 women who received neuraxial anesthesia for childbirth in New York State hospitals between January 2005 and September 2014. The primary outcome was the composite of cerebral venous thrombosis and subdural hematoma. The 4 secondary outcomes were bacterial meningitis, depression, headache, and low back pain. PDPH and complications were identified during the delivery hospitalization and up to 1 year postdelivery. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using the inverse probability of treatment weighting approach.RESULTS: Of the women studied, 4808 (0.48%; 95% CI, 0.47–0.49) developed PDPH, including 264 cases (5.2%) identified during a readmission with a median time to readmission of 4 days. The incidence of cerebral venous thrombosis and subdural hematoma was significantly higher in women with PDPH than in women without PDPH (3.12 per 1000 neuraxial or 1:320 vs 0.16 per 1000 or 1:6250, respectively; P < .001). The incidence of the 4 secondary outcomes was also significantly higher in women with PDPH than in women without PDPH. The aORs associated with PDPH were 19.0 (95% CI, 11.2–32.1) for the composite of cerebral venous thrombosis and subdural hematoma, 39.7 (95% CI, 13.6–115.5) for bacterial meningitis, 1.9 (95% CI, 1.4–2.6) for depression, 7.7 (95% CI, 6.5–9.0) for headache, and 4.6 (95% CI, 3.3–6.3) for low back pain. Seventy percent of cerebral venous thrombosis and subdural hematoma were identified during a readmission with a median time to readmission of 5 days.CONCLUSIONS: PDPH is associated with substantially increased postpartum risks of major neurologic and other maternal complications, underscoring the importance of early recognition and treatment of anesthesia-related complications in obstetrics.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Perioperative Management of the Pediatric Patient on Medicinal Marijuana:
           What Anesthesiologists Should Know
    • Authors: Flannery; Kaitlin M.; D’Souza, Genevieve; Agarwal, Rita
      Abstract: imageIn 2018, 29 states allow the use of medicinal marijuana. In these states, minors, with parental permission, are granted access. Use has increased in some states, although there remains a paucity of clear evidence regarding usefulness and dosing. There are 2 Food and Drug Administration–approved synthetic derivatives. One purified compound was just approved by the Food and Drug Administration, and another is undergoing Food and Drug Administration review. This article will review the literature regarding the use of each of these compounds in the literature, with particular attention to data in children. The history, known pharmacology, data from nonmedicinal use, current evidence, and anesthetic considerations will be described.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Systematic Review and Meta-analysis of Virtual Reality in Pediatrics:
           Effects on Pain and Anxiety
    • Authors: Eijlers; Robin; Utens, Elisabeth M. W. J.; Staals, Lonneke M.; de Nijs, Pieter F. A.; Berghmans, Johan M.; Wijnen, René M. H.; Hillegers, Manon H. J.; Dierckx, Bram; Legerstee, Jeroen S.
      Abstract: imageBACKGROUND: Medical procedures often evoke pain and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide distraction during, or to prepare patients for, medical procedures. This meta-analysis is the first to collate evidence on the effectiveness of VR on reducing pain and anxiety in pediatric patients undergoing medical procedures.METHODS: On April 25, 2018, we searched EMBASE, MEDLINE, CENTRAL, PubMed, Web of Science, and PsycINFO with the keywords “VR,” “children,” and “adolescents.” Studies that applied VR in a somatic setting with participants ≤21 years of age were included. VR was defined as a fully immersive 3-dimensional environment displayed in surround stereoscopic vision on a head-mounted display (HMD). We evaluated pain and anxiety outcomes during medical procedures in VR and standard care conditions.RESULTS: We identified 2889 citations, of which 17 met our inclusion criteria. VR was applied as distraction (n = 16) during venous access, dental, burn, or oncological care or as exposure (n = 1) before elective surgery under general anesthesia. The effect of VR was mostly studied in patients receiving burn care (n = 6). The overall weighted standardized mean difference (SMD) for VR was 1.30 (95% CI, 0.68–1.91) on patient-reported pain (based on 14 studies) and 1.32 (95% CI, 0.21–2.44) on patient-reported anxiety (based on 7 studies). The effect of VR on pediatric pain was also significant when observed by caregivers (SMD = 2.08; 95% CI, 0.55–3.61) or professionals (SMD = 3.02; 95% CI, 0.79–2.25). For anxiety, limited observer data were available.CONCLUSIONS: VR research in pediatrics has mainly focused on distraction. Large effect sizes indicate that VR is an effective distraction intervention to reduce pain and anxiety in pediatric patients undergoing a wide variety of medical procedures. However, further research on the effect of VR exposure as a preparation tool for medical procedures is needed because of the paucity of research into this field.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Beyond Anesthesia Toxicity: Anesthetic Considerations to Lessen the Risk
           of Neonatal Neurological Injury
    • Authors: McCann; Mary Ellen; Lee, Jennifer K.; Inder, Terrie
      Abstract: imageInfants who undergo surgical procedures in the first few months of life are at a higher risk of death or subsequent neurodevelopmental abnormalities. Although the pathogenesis of these outcomes is multifactorial, an understanding of the nature and pathogenesis of brain injury in these infants may assist the anesthesiologist in consideration of their day-to-day practice to minimize such risks. This review will summarize the main types of brain injury in preterm and term infants and their key pathways. In addition, the review will address key potential pathogenic pathways that may be modifiable including intraoperative hypotension, hypocapnia, hyperoxia or hypoxia, hypoglycemia, and hyperthermia. Each of these conditions may increase the risk of perioperative neurological injury, but their long-term ramifications are unclear.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Voluntary Exercise Rescues the Spatial Memory Deficit Associated With
           Early Life Isoflurane Exposure in Male Rats
    • Authors: Chinn; Gregory A.; Sasaki Russell, Jennifer M.; Banh, Esther T.; Lee, Saehee C.; Sall, Jeffrey W.
      Abstract: imageBACKGROUND: Early life anesthesia exposure results in long-term cognitive deficits in rats. Environmental enrichment consisting of social housing, a stimulating environment, and voluntary exercise can rescue this deficit. We hypothesized that exercise alone is sufficient to rescue the cognitive deficit associated with perinatal anesthesia.METHODS: Postnatal day 7 male rats (P7) underwent isoflurane (Iso) or sham exposure and were subsequently weaned at P21. They were then singly housed in a cage with a running wheel or a fixed wheel. After 3 weeks of exercise, animals underwent behavioral testing for spatial and recognition memory assessments. Animals were killed at various time points to accomplish either bromodeoxyuridine (BrdU) labeling or quantitative real-time polymerase chain reaction (qRT-PCR) to quantify brain-derived neurotrophic factor (BDNF) messenger ribonucleic acid (mRNA) levels.RESULTS: Postweaning voluntary exercise rescued the long-term spatial memory deficit associated with perinatal Iso exposure. Iso-sedentary animals did not discriminate the goal quadrant, spending no more time than chance during the Barnes maze probe trial (1-sample t test, P = .524) while all other groups did (1-sample t test, PIso-exercise = .033; Pcontrol [Con]-sedentary = .004). We did not find a deficit in recognition memory tasks after Iso exposure as we observed previously. BrdU incorporation in the adult hippocampus of Iso-sedentary animals was decreased compared to sedentary controls (Tukey P = .005). Exercise prevented this decrease, with Iso-exercise animals having more proliferation than Iso-sedentary (Tukey P < .001). There was no effect of exercise or Iso on BDNF mRNA in either the cortex or hippocampus (cortex: FExercise[1,32] = 0.236, P = .631; FIso [1,32] = 0.038, P = .847; FInteraction [1,32] = 1.543, P = .223; and hippocampus: FExercise[1,33] = 1.186, P = .284; FIso [1,33] = 1.46, P = .236; FInteraction[1,33] = 1.78, P = .191).CONCLUSIONS: Exercise restores BrdU incorporation and rescues a spatial memory deficit after early life anesthesia exposure. This demonstrates sufficiency of exercise alone in the context of environmental enrichment to recover a behavioral phenotype after a perinatal insult.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Narcolepsy, Anesthesia, and Sedation: A Survey of the Perioperative
           Experience of Patients With Narcolepsy
    • Authors: Hershner; Shelley; Kakkar, Rahul; Chung, Frances; Singh, Mandeep; Wong, Jean; Auckley, Dennis
      Abstract: imageBACKGROUND: Patients with narcolepsy may be at increased perioperative risk due to the interactions among anesthesia, narcolepsy, and narcolepsy medications. This study sought to determine the perioperative experience of narcoleptic patients undergoing anesthesia or sedation, the frequency of perioperative counseling, and self-reported surgical complications.METHODS: A 22-question survey was developed by expert consensus and distributed by the Narcolepsy Network. Recruitment was via the Narcolepsy Network’s list-serve and a Facebook link to the survey. One thousand and twenty respondents reported a diagnosis of narcolepsy and 1 or more procedures under anesthesia or sedation. Descriptive, comparative statistics and logistic regression were utilized.RESULTS: Respondents were mostly women (79.5%) and Caucasian (84.9%), with a mean age of 45 ± 16 years. Most respondents did not receive counseling regarding the possibility of increased sleepiness (70%), cataplexy (90%), or drowsy driving (59%) postanesthesia. More than half of respondents reported adverse events (medication withdrawal symptoms, inadequate pain relief, increased cataplexy). Subjects with cataplexy more frequently reported surgical complications (70% vs 31%; P = .03) and medication withdrawal symptoms (stimulant medications: odds ratio, 3.0 [95% CI, 1.9, 3.06]; P> .001 and antidepressant medications: odds ratio, 6.5 [95% CI, 2.1–19.5]; P = .001). Of the total sample, 18% indicated surgical complications. Undergoing 5 or more separate surgeries or procedures was associated with a 2-fold increase in self-reported complications (odds ratio, 2.2 [95% CI, 1.3–3.4]; P = .001), difficulty waking (odds ratio, 2.1 [95% CI, 1.45–3.06]; P = .001), and inadequate pain relief (odds ratio, 1.77 [95% CI, 1.01–3.13]; P < .05).CONCLUSIONS: Most narcoleptic patients report not receiving counseling regarding potential worsening of narcolepsy symptoms postanesthesia or an increased risk of drowsy driving. Enhanced education of perioperative providers about potential narcolepsy-related issues is essential. Respondents frequently self-report adverse events in the perioperative period. Future studies should clarify the perioperative risk associated with narcolepsy to optimize the care and safety of narcoleptic patients.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Special Report From the Society for the Advancement of Blood Management:
           The Choosing Wisely Campaign
    • Authors: Burns; Carolyn D.; Brown, James P.; Corwin, Howard L.; Gross, Irwin; Ozawa, Sherri J.; Shander, Aryeh
      Abstract: imageOver 7 years ago, the American Board of Internal Medicine Foundation (ABIM) created the national Choosing Wisely campaign with the purpose of encouraging active dialogue between health care providers and patients, focusing on appropriateness, quality care, and resource management. This special communication from the Society for the Advancement of Blood Management (SABM) serves to highlight the society’s recent participation in the Choosing Wisely campaign, encouraging sensible dialogue between clinicians and our patients with the intent to promote patient-centered, evidence-based care. The article addresses the rationale and supportive data for the 5 SABM Choosing Wisely recommendations.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in
           Patients With Postoperative Cognitive Dysfunction: A Pilot Study
    • Authors: Berger; Miles; Murdoch, David M.; Staats, Janet S.; Chan, Cliburn; Thomas, Jake P.; Garrigues, Grant E.; Browndyke, Jeffrey N.; Cooter, Mary; Quinones, Quintin J.; Mathew, Joseph P.; Weinhold, Kent J.; Amundsen, Cindy L.; Bengali, Shahrukh; Brigman, Brian E.; Bullock, W. Michael; Carter, Jessica; Chapman, Joseph; Cheong Yee Ching, Vanessa; Cohen, Harvey J.; Colin, Brian; D’Amico, Thomas A.; Devinney, Michael J.; DeOrio, James K.; Ellet, Tressa; Esclamado, Ramon M.; Ferrandino, Michael N.; Gadsden, Jeffrey; Guercio, Jason; Habib, Ashraf; Harpole, David H.; Hartwig, Mathew G.; Iboaya, Ehimemen; Inman, Brant A.; Khan, Anver; Lagoo-Deenadayalan, Sandhya; Lee, Paula S.; Lee, Walter T.; Lemm, John; Levinson, Howard; Mantyh, Christopher; McDonagh, David L.; Migaly, John; Mithani, Suhail K.; Moretti, Eugene; Moul, Judd W.; Newman, Mark F.; Ni, Katherine; Ohlendorf, Brian; Perez, Alexander; Peterson, Andrew C.; Ponussamy, Vikram; Preminger, Glenn M.; Robertson, Cary N.; Roman, Sanziana A.; Runyon, Scott; Sandler, Aaron; Scheri, Randall P.; Smith, S. Kendall; Talbot, Leonard; Thacker, Julie K. M.; Tong, Betty C.; Tu, Alexander; Vaslef, Steven N.; Waldron, Nathan; Wang, Xueyuan; Whitson, Heather; Wickenheisser, Victoria; Young, Christopher; for the MADCO-PC Study TeamThe Markers of Alzheimer’s Disease neuroCognitive Outcomes after Perioperative Care (MADCO-PC study team members also
      Abstract: imageAnimal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery in 5 patients ≥60 years of age who developed postoperative cognitive dysfunction and 5 matched controls who did not. We detected 12,654 ± 4895 cells/10 mL of CSF sample (mean ± SD). Patients who developed postoperative cognitive dysfunction showed an increased CSF monocyte/lymphocyte ratio and monocyte chemoattractant protein 1 receptor downregulation on CSF monocytes 24 hours after surgery. These pilot data demonstrate that CSF flow cytometry can be used to study mechanisms of postoperative neurocognitive dysfunction.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Safe Anesthesia Care in Western Kenya: A Preliminary Assessment of the
           Impact of Nurse Anesthetists at Multiple Levels of Government Hospitals
    • Authors: Umutesi; Grace; McEvoy, Matthew D.; Starnes, Joseph R.; Sileshi, Bantayehu; Atieli, Harrysone E.; Onyango, Kennedy; Newton, Mark W.
      Abstract: imageBACKGROUND: Only 20% of the surgical burden in eastern sub-Saharan Africa is currently met, leaving>17 million surgical cases annually in need of safe surgery and anesthesia. Similarly, there is an extreme shortage of anesthesia providers in East Africa, with just 0.44 anesthesiologists per 100,000 people in Kenya compared to 20.82 per 100,000 in the United States. Additionally, surgical access is not equally distributed within countries, with rural settings often having the greatest unmet need. We developed and tested a set of tools to assess if graduates of the Kenya registered nurse anesthetist (KRNA) training program, who were placed in rural hospitals in Kenya, would have any impact on surgical numbers, referral patterns, and economics of these hospitals.METHODS: Cross-sectional data were collected from facility assessments in 9 referral hospitals to evaluate the possible impact of the KRNAs on anesthesia care. The hospitals were grouped based on both the number of beds and the assigned national hospital level. At each level, a hospital that had KRNA graduates (intervention) was matched with comparison hospitals in the same category with no KRNA graduates (control). The facility assessment survey included questions capturing data on personnel, infrastructure, supplies, medications, procedures, and outcomes. At the intervention sites, the medical directors of the hospitals and the KRNAs were interviewed. Descriptive statistics were used to present the findings.RESULTS: Intervention sites had a density of anesthesia providers that was 43% higher compared to the control sites. Intervention sites performed at least twice as many surgical cases compared to the control sites. Most KRNAs stated that the anesthesia training program had given them sufficient training and leadership skills to perform safe anesthesia in their clinical practice setting. Medical directors at the intervention sites reported increased surgical volumes and fewer referrals to larger hospitals due to the anesthesia gaps that had been addressed.CONCLUSIONS: Our findings from this study suggest that KRNAs may be associated with an increased volume of surgical cases completed in these rural Kenyan hospitals and may therefore be filling a known anesthetic void. The presence of skilled anesthesia providers is a first step toward providing safe surgery and anesthesia care for all; however, significant gaps still remain. Future analysis will focus on surgical outcomes, the appropriate anesthesia delivery model for a rural population, and how the availability of anesthesia infrastructure impacts referral patterns and safe surgery capacity.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Customizable Curriculum to Enhance Resident Communication Skills
    • Authors: Mitchell; John D.; Ku, Cindy; Lutz, Brendan; Shahul, Sajid; Wong, Vanessa; Jones, Stephanie B.
      Abstract: imageCommunication remains challenging to teach and evaluate. We designed an online patient survey to assess anesthesia residents’ communication skills from August 2014 to July 2015. In December 2014, we implemented a customized, simulation-based curriculum. We calculated an overall rating for each survey by averaging the ratings for the individual questions. Based on the Hodges–Lehmann 2-sample aligned rank-sum test, overall ratings, reported as the median (interquartile range) of residents’ average overall ratings, differed significantly between the preintervention (3.86 [3.76–3.94]) and postintervention (3.91 [3.84–3.95]) periods (P = .025). Future studies should assess the intervention’s effectiveness and generalizability.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • The American Board of Anesthesiology’s Standardized Oral Examination for
           Initial Board Certification
    • Authors: Sun; Huaping; Warner, David O.; Patterson, Andrew J.; Harman, Ann E.; Rathmell, James P.; Keegan, Mark T.; Dainer, Rupa J.; McLoughlin, Thomas M. Jr; Fahy, Brenda G.; Macario, Alex
      Abstract: imageThe American Board of Anesthesiology (ABA) has been administering an oral examination as part of its initial certification process since 1939. Among the 24 member boards of the American Board of Medical Specialties, 13 other boards also require passing an oral examination for physicians to become certified in their specialties. However, the methods used to develop, administer, and score these examinations have not been published. The purpose of this report is to describe the history and evolution of the anesthesiology Standardized Oral Examination, its current examination development and administration, the psychometric model and scoring, physician examiner training and auditing, and validity evidence. The many-facet Rasch model is the analytic method used to convert examiner ratings into scaled scores for candidates and takes into account how difficult grader examiners are and the difficulty of the examination tasks. Validity evidence of the oral examination includes that it measures aspects of clinical performance not accounted for by written certifying examinations, and that passing the oral examination is associated with a decreased risk of subsequent license actions against the anesthesiologist. Explaining the details of the Standardized Oral Examination provides transparency about this component of initial certification in anesthesiology.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Association Between Participation and Performance in MOCA Minute and
           Actions Against the Medical Licenses of Anesthesiologists
    • Authors: Zhou; Yan; Sun, Huaping; Macario, Alex; Keegan, Mark T.; Patterson, Andrew J.; Minhaj, Mohammed M.; Wang, Ting; Harman, Ann E.; Warner, David O.
      Abstract: imageBACKGROUND: In January 2016, as part of the Maintenance of Certification in Anesthesiology (MOCA) program, the American Board of Anesthesiology launched MOCA Minute, a web-based longitudinal assessment, to supplant the former cognitive examination. We investigated the association between participation and performance in MOCA Minute and disciplinary actions against medical licenses of anesthesiologists.METHODS: All anesthesiologists with time-limited certificates (ie, certified in 2000 or after) who were required to register for MOCA Minute in 2016 were followed up through December 31, 2016. The incidence of postcertification prejudicial license actions was compared between those who did and did not register and compared between registrants who did and did not meet the MOCA Minute performance standard.RESULTS: The cumulative incidence of license actions was 1.2% (245/20,006) in anesthesiologists required to register for MOCA Minute. Nonregistration was associated with a higher incidence of license actions (hazard ratio, 2.93 [95% confidence interval {CI}, 2.15–4.00]). For the 18,534 (92.6%) who registered, later registration (after June 30, 2016) was associated with a higher incidence of license actions. In 2016, 16,308 (88.0%) anesthesiologists met the MOCA Minute performance standard. Of those not meeting the standard (n = 2226), most (n = 2093, 94.0%) failed because they did not complete the required 120 questions. Not meeting the standard was associated with a higher incidence of license actions (hazard ratio, 1.92 [95% CI, 1.36–2.72]).CONCLUSIONS: Both timely participation and meeting performance standard in MOCA Minute are associated with a lower likelihood of being disciplined by a state medical board.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • The American Board of Anesthesiology’s Staged Examination System and
           Performance on the Written Certification Examination After Residency
    • Authors: Zhou; Yan; Sun, Huaping; Macario, Alex; Martin, Donald E.; Rathmell, James P.; Warner, David O.
      Abstract: imageThis study compared anesthesiology residency graduates’ written certification examination performance before and after the American Board of Anesthesiology (ABA) introduced the staged examination system. After equating test scores using common test items, the first 2 cohorts (2013, 2014) in the staged system scored 7.1 points and 8.3 points higher than the 2011 baseline cohort in the former examination system. The 2013 and 2014 cohorts’ pass rates (94.2% and 95.9%) were also higher than the 2011 and 2012 cohorts (91.9% and 92.6%) if a common standard had been applied. The staged examination system may be associated with improved knowledge of anesthesiology graduates.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Unpredictable Injectate Spread of the Erector Spinae Plane Block in Human
           Cadavers
    • Authors: Dautzenberg; Karin H. W.; Zegers, Marissa J.; Bleeker, Chris P.; Tan, Edward C. T. H.; Vissers, Kris C. P.; van Geffen, Geert-Jan; van der Wal, Selina E. I.
      Abstract: imageWe performed bilateral ultrasound-guided erector spinae plane blocks at the second and eighth thoracic vertebrae in 11 fresh frozen cadavers. Methylene blue dye spread variably and extensively deep to the erector spinae muscles fascia with involvement of the spinal rami and paravertebral space in 1 of 11 cadavers when injected at the eighth thoracic vertebra, and in 4 of 11 cadavers at the second thoracic vertebra, with crossover to the contralateral side of the spine. Our study demonstrates that in cadavers, an erector spinae plane block follows the fascial planes with unpredictable spread, which might explain its varying clinical efficacy.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Family Caregiving and Cancer Pain Management
    • Authors: Ferrell; Betty R.
      Abstract: imageFamily caregivers are centrally involved in cancer pain management, especially for patients with advanced disease. This issue is becoming ever more important as care shifts to the outpatient setting and home care and as the aging population creates more patients who have multiple illnesses and family caregivers who often live with serious illnesses. This narrative review evaluated current knowledge and literature regarding family caregivers’ involvement in cancer pain management and identified areas for future research and clinical practice. There is a need for additional research in this area and for clinical models of support for family caregivers as they provide pain management for patients with cancer.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Pharmacological Characters of Oliceridine, a μ-Opioid Receptor
           G-Protein–Biased Ligand in Mice
    • Authors: Liang; De-Yong; Li, Wen-Wu; Nwaneshiudu, Chinwe; Irvine, Karen-Amanda; Clark, J. David
      Abstract: imageBACKGROUND: A major advancement in the field of analgesic pharmacology has been the development of G-protein–biased opioid agonists that display less respiratory depression than conventional drugs. It is uncertain, however, whether these new drugs cause less tolerance, hyperalgesia, and other maladaptations when administered repeatedly.METHODS: The archetypical µ-opioid receptor agonist morphine and, separately, the G-protein–biased µ-opioid receptor agonist oliceridine were administered to mice. These drugs were used in models of acute analgesia, analgesic tolerance, opioid-induced hyperalgesia, reward, and physical dependence. In addition, morphine and oliceridine were administered for 7 days after tibia fracture and pinning; mechanical allodynia and gait were followed for 3 weeks. Finally, the expression of toll-like receptor-4 and nacht domain-, leucine-rich repeat-, and pyrin domain-containing protein 3 (NALP3) and interleukin-1β mRNA were quantified in spinal tissue to measure surgical and drug effects on glia-related gene expression.RESULTS: We observed using the tail flick assay that oliceridine was a 4-fold more potent analgesic than morphine, but that oliceridine treatment caused less tolerance and opioid-induced hyperalgesia than morphine after 4 days of ascending-dose administration. Using similar analgesic doses, morphine caused reward behavior in the conditioned place preference assay while oliceridine did not. Physical dependence was, however, similar for the 2 drugs. Likewise, morphine appeared to more significantly impair the recovery of nociceptive sensitization and gait after tibial fracture and pinning than oliceridine. Furthermore, spinal cord toll-like receptor-4 levels 3 weeks after fracture were higher in fracture mice given morphine than those given oliceridine.CONCLUSIONS: Aside from reduced respiratory depression, G-protein–biased agonists such as oliceridine may reduce opioid maladaptations and enhance the quality of surgical recovery.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Epigenetics Mechanisms in Multiorgan Dysfunction Syndrome
    • Authors: Crimi; Ettore; Cirri, Silvia; Benincasa, Giuditta; Napoli, Claudio
      Abstract: imageEpigenetic mechanisms including deoxyribonucleic acid (DNA) methylation, histone modifications (eg, histone acetylation), and microribonucleic acids (miRNAs) have gained much scientific interest in the last decade as regulators of genes expression and cellular function. Epigenetic control is involved in the modulation of inflammation and immunity, and its dysregulation can contribute to cell damage and organ dysfunction. There is growing evidence that epigenetic changes can contribute to the development of multiorgan dysfunction syndrome (MODS), a leading cause of mortality in the intensive care unit (ICU). DNA hypermethylation, histone deacetylation, and miRNA dysregulation can influence cytokine and immune cell expression and promote endothelial dysfunction, apoptosis, and end-organ injury, contributing to the development of MODS after a critical injury. Epigenetics processes, particularly miRNAs, are emerging as potential biomarkers of severity of disease, organ damage, and prognostic factors in critical illness. Targeting epigenetics modifications can represent a novel therapeutic approach in critical care. Inhibitors of histone deacetylases (HDCAIs) with anti-inflammatory and antiapoptotic activities represent the first class of drugs that reverse epigenetics modifications with human application. Further studies are required to acquire a complete knowledge of epigenetics processes, full understanding of their individual variability, to expand their use as accurate and reliable biomarkers and as safe target to prevent or attenuate MODS in critical disease.
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • When Less Is More: Why Extubation With Less Than Routine 100% Oxygen May
           Be a Reasonable Strategy
    • Authors: Gerber; Daniel; Guensch, Dominik P.; Theiler, Lorenz; Erdoes, Gabor
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Ventilation Is an Important Confounding Variable When End-Tidal Carbon
           Dioxide Is Used to Help Guide Cardiopulmonary Resuscitation
    • Authors: Leinonen; Maria; Gravenstein, Nikolaus; Giordano, Christopher
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Equipment Problems. Preventable Anesthetic Deaths: Is “PaF”
           the Magic Dragon'
    • Authors: Prien; Thomas; Brinker, Andrea; Pfeiffer, Kathrin; Van Aken, Hugo K.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Hemodynamic Monitoring
    • Authors: de Oliveira Filho; Getúlio R.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Analgesia in Major Abdominal Surgery
    • Authors: Kumar; Nishant
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • The Pediatric Procedural Sedation Handbook
    • Authors: Banik; Sujoy
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Chestnut’s Obstetric Anesthesia: Principles and Practice, 6th ed
    • Authors: Tawfik; Mohamed Mohamed; Tolba, Mohamed Ahmed
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Scholarly Activity of Anesthesiology Residents
    • Authors: Benumof; Jonathan L.; Manecke, Gerard R.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Bartels; Karsten; Pagel, Paul S.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Heuristics, Overconfidence, and Experience With Management of
           Neuromuscular Block: Self-Correction Is Unlikely
    • Authors: Naguib; Mohamed; Brull, Sorin J.; Hunter, Jennifer M.; Kopman, Aaron F.; Fülesdi, Béla; Johnson, Ken B.; Arkes, Hal R.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Tung; Avery; Harman, Ann; Lien, Cynthia A.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Misinterpretation of USP 797 Continues
    • Authors: Brock-Utne; John G.; Jaffe, Richard A.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Baronos; Stamatis; Yarmush, Joel M.; Stedman, Jennifer L.; Kamath, Sangeetha; Xavier, Camilla; Ahmed, Khaja
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Dantrolene Should Be Readily Available Wherever Malignant Hyperthermia
           Triggering Drugs Are Stocked
    • Authors: Larach; Marilyn Green; Riazi, Sheila; Rosenberg, Henry
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Decoupling Complexity in Perioperative Systems
    • Authors: Tsai; Mitchell H.; Mangar, Devanand
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Revisiting the Classification of Neuromuscular Blockade, Aligning Clinical
           Practice and Research
    • Authors: Albers; Kim I.; Diaz-Cambronero, Oscar; Keijzer, Christiaan; Snoeck, Marc M. J.; Warlé, Michiel C.; Fuchs-Buder, Thomas
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Gender Distribution in Professional Anesthesiology Activities
    • Authors: Guzman-Reyes; Sara; Pivalizza, Evan G.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Anesthesiology’s Contribution to Environmental Preservation
    • Authors: Fink; Ryan J.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Zuegge; Karin L.; Bunsen, Shannon K.; Ward, Russel C.
      Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • What’s New in Obstetric Anesthesia' The 2017 Gerard W. Ostheimer
           Lecture: Erratum
    • Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
  • Enough But Not Too Much: Monitoring for Neuraxial Morphine-Associated
           Respiratory Depression in Obstetric Patients: Erratum
    • Abstract: No abstract available
      PubDate: Fri, 01 Nov 2019 00:00:00 GMT-
       
 
 
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