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Journal Cover Anesthesiology
  [SJR: 2.162]   [H-I: 181]   [150 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 0003-3022 - ISSN (Online) 1528-1175
   Published by LWW Wolters Kluwer Homepage  [290 journals]
  • Do Anesthetic Choices Signal Quality'
    • Authors: Chen CL; Neuman MD.
      Abstract: “…measuring anesthesia care at the institutional level might offer insights as to other unmeasured aspects of an institution’s quality and performance.”
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Artificial Intelligence for Everyone
    • Authors: Gambus P; Shafer SL.
      Abstract: “…machine learning to model the interaction of remifentanil and propofol on processed electroencephalogram…. Is this the end of clinical pharmacology'”
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Advancing Patient Safety in Airway Management
    • Authors: Aziz MF.
      Abstract: “…[W]e are making airway management safer. What remains to be studied is which advances in airway management have an im pact on patient safety events.”
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture
           Surgery with Outcomes A Population-based Cohort Study
    • Authors: McIsaac DI; Wijeysundera DN, Huang A, et al.
      Abstract: Background There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes). Methods We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014. For each patient, we measured the proportion of hip fracture patients at their hospital who received neuraxial anesthesia in the year before their surgery. Multilevel, multivariable regression was used to measure the association of log-transformed hospital-level neuraxial anesthetic-use proportion with outcomes, controlling for patient-level anesthesia type and confounders. Results Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic; utilization varied from 0 to 100% between hospitals. In total, 9,122 (8.5%) of patients died within 30 days of surgery. Survival independently improved as hospital-level neuraxial use increased (P = 0.009). Primary and sensitivity analyses demonstrated that most of the survival benefit was realized with increase in hospital-level neuraxial use above 20 to 25%; there did not appear to be a substantial increase in survival above this point. No significant associations between hospital neuraxial anesthesia-use and other outcomes existed. Conclusions Hip fracture surgery patients at hospitals that use more than 20 to 25% neuraxial anesthesia have improved survival independent of patient-level anesthesia type and other confounders. The underlying causal mechanism for this association requires a prospective study to guide improvements in perioperative care and outcomes of hip fracture patients. Visual An online visual overview is available for this article at
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Prediction of Bispectral Index during Target-controlled Infusion of
           Propofol and Remifentanil A Deep Learning Approach
    • Authors: Lee H; Ryu H, Chung E, et al.
      Abstract: Background The discrepancy between predicted effect-site concentration and measured bispectral index is problematic during intravenous anesthesia with target-controlled infusion of propofol and remifentanil. We hypothesized that bispectral index during total intravenous anesthesia would be more accurately predicted by a deep learning approach. Methods Long short-term memory and the feed-forward neural network were sequenced to simulate the pharmacokinetic and pharmacodynamic parts of an empirical model, respectively, to predict intraoperative bispectral index during combined use of propofol and remifentanil. Inputs of long short-term memory were infusion histories of propofol and remifentanil, which were retrieved from target-controlled infusion pumps for 1,800 s at 10-s intervals. Inputs of the feed-forward network were the outputs of long short-term memory and demographic data such as age, sex, weight, and height. The final output of the feed-forward network was the bispectral index. The performance of bispectral index prediction was compared between the deep learning model and previously reported response surface model. Results The model hyperparameters comprised 8 memory cells in the long short-term memory layer and 16 nodes in the hidden layer of the feed-forward network. The model training and testing were performed with separate data sets of 131 and 100 cases. The concordance correlation coefficient (95% CI) were 0.561 (0.560 to 0.562) in the deep learning model, which was significantly larger than that in the response surface model (0.265 [0.263 to 0.266], P < 0.001). Conclusions The deep learning model–predicted bispectral index during target-controlled infusion of propofol and remifentanil more accurately compared to the traditional model. The deep learning approach in anesthetic pharmacology seems promising because of its excellent performance and extensibility.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Temporal Trends in Difficult and Failed Tracheal Intubation in a Regional
           Community Anesthetic Practice
    • Authors: Schroeder RA; Pollard R, Dhakal I, et al.
      Abstract: Background When tracheal intubation is difficult or unachievable before surgery or during an emergent resuscitation, this is a critical safety event. Consensus algorithms and airway devices have been introduced in hopes of reducing such occurrences. However, evidence of improved safety in clinical practice related to their introduction is lacking. Therefore, we selected a large perioperative database spanning 2002 to 2015 to look for changes in annual rates of difficult and failed tracheal intubation. Methods Difficult (more than three attempts) and failed (unsuccessful, requiring awakening or surgical tracheostomy) intubation rates in patients 18 yr and older were compared between the early and late periods (pre- vs. post-January 2009) and by annual rate join-point analysis. Primary findings from a large, urban hospital were compared with combined observations from 15 smaller facilities. Results Analysis of 421,581 procedures identified fourfold reductions in both event rates between the early and late periods (difficult: 6.6 of 1,000 vs. 1.6 of 1,000, P < 0.0001; failed: 0.2 of 1,000 vs. 0.06 of 1,000, P < 0.0001), with join-point analysis identifying two significant change points (2006, P = 0.02; 2010, P = 0.03) including a pre-2006 stable period, a steep drop between 2006 and 2010, and gradual decline after 2010. Data from 15 affiliated practices (442,428 procedures) demonstrated similar reductions. Conclusions In this retrospective assessment spanning 14 yr (2002 to 2015), difficult and failed intubation rates by skilled providers declined significantly at both an urban hospital and a network of smaller affiliated practices. Further investigations are required to validate these findings in other data sets and more clearly identify factors associated with their occurrence as clues to future airway management advancements. Visual An online visual overview is available for this article at
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Effect of Thoracic Epidural Ropivacaine versus Bupivacaine on Lower
           Urinary Tract Function A Randomized Clinical Trial
    • Authors: Girsberger SA; Schneider MP, Löffel LM, et al.
      Abstract: Background Thoracic epidural analgesia with bupivacaine resulted in clinically relevant postvoid residuals due to detrusor underactivity. This study aimed to compare the risk of bladder dysfunction with ropivacaine versus bupivacaine using postvoid residuals and maximum flow rates. Our hypothesis was that ropivacaine would result in lower postvoid residuals, because ropivacaine has been shown to have less effect on motor blockade. Methods In this single-center, parallel-group, randomized, double-blind superiority trial, 42 patients undergoing open renal surgery were equally allocated to receive epidural bupivacaine 0.125% or ropivacaine 0.2%, and 36 were finally included. Inclusion criterion was normal bladder function. Patients underwent urodynamic investigations preoperatively and during thoracic epidural analgesia. Primary outcome was the difference in postvoid residual preoperatively and during thoracic epidural analgesia postoperatively. Secondary outcomes were changes in maximum flow rate between and within the groups. Results Median difference in postvoid residual (ml) from baseline to postoperatively was 300 (range, 30 to 510; P < 0.001) for bupivacaine and 125 (range, −30 to 350; P = 0.011) for ropivacaine, with a significant mean difference between groups (−175; 95% CI, −295 to −40; P = 0.012). Median difference in maximum flow rate (ml/s) was more pronounced with bupivacaine (−12; range, −28 to 3; P < 0.001) than with ropivacaine (−4; range, −16 to 7; P = 0.025) with a significant mean difference between groups (7; 95% CI, 0 to 12; P = 0.028). Pain scores were similar. No adverse events occurred. Conclusions Postvoid residuals were significantly lower using ropivacaine compared to bupivacaine for thoracic epidural analgesia reflecting less impairment of detrusor function with ropivacaine.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Four Types of Pulse Oximeters Accurately Detect Hypoxia during Low
           Perfusion and Motion
    • Authors: Louie A; Feiner JR, Bickler PE, et al.
      Abstract: Background Pulse oximeter performance is degraded by motion artifacts and low perfusion. Manufacturers developed algorithms to improve instrument performance during these challenges. There have been no independent comparisons of these devices. Methods We evaluated the performance of four pulse oximeters (Masimo Radical-7, USA; Nihon Kohden OxyPal Neo, Japan; Nellcor N-600, USA; and Philips Intellivue MP5, USA) in 10 healthy adult volunteers. Three motions were evaluated: tapping, pseudorandom, and volunteer-generated rubbing, adjusted to produce photoplethsmogram disturbance similar to arterial pulsation amplitude. During motion, inspired gases were adjusted to achieve stable target plateaus of arterial oxygen saturation (SaO2) at 75%, 88%, and 100%. Pulse oximeter readings were compared with simultaneous arterial blood samples to calculate bias (oxygen saturation measured by pulse oximetry [SpO2] − SaO2), mean, SD, 95% limits of agreement, and root mean square error. Receiver operating characteristic curves were determined to detect mild (SaO2 < 90%) and severe (SaO2 < 80%) hypoxemia. Results Pulse oximeter readings corresponding to 190 blood samples were analyzed. All oximeters detected hypoxia but motion and low perfusion degraded performance. Three of four oximeters (Masimo, Nellcor, and Philips) had root mean square error greater than 3% for SaO2 70 to 100% during any motion, compared to a root mean square error of 1.8% for the stationary control. A low perfusion index increased error. Conclusions All oximeters detected hypoxemia during motion and low-perfusion conditions, but motion impaired performance at all ranges, with less accuracy at lower SaO2. Lower perfusion degraded performance in all but the Nihon Kohden instrument. We conclude that different types of pulse oximeters can be similarly effective in preserving sensitivity to clinically relevant hypoxia.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Physiologic Evaluation of Ventilation Perfusion Mismatch and Respiratory
           Mechanics at Different Positive End-expiratory Pressure in Patients
           Undergoing Protective One-lung Ventilation
    • Authors: Spadaro S; Grasso S, Karbing D, et al.
      Abstract: Background Arterial oxygenation is often impaired during one-lung ventilation, due to both pulmonary shunt and atelectasis. The use of low tidal volume (VT) (5 ml/kg predicted body weight) in the context of a lung-protective approach exacerbates atelectasis. This study sought to determine the combined physiologic effects of positive end-expiratory pressure and low VT during one-lung ventilation. Methods Data from 41 patients studied during general anesthesia for thoracic surgery were collected and analyzed. Shunt fraction, high V/Q and respiratory mechanics were measured at positive end-expiratory pressure 0 cm H2O during bilateral lung ventilation and one-lung ventilation and, subsequently, during one-lung ventilation at 5 or 10 cm H2O of positive end-expiratory pressure. Shunt fraction and high V/Q were measured using variation of inspired oxygen fraction and measurement of respiratory gas concentration and arterial blood gas. The level of positive end-expiratory pressure was applied in random order and maintained for 15 min before measurements. Results During one-lung ventilation, increasing positive end-expiratory pressure from 0 cm H2O to 5 cm H2O and 10 cm H2O resulted in a shunt fraction decrease of 5% (0 to 11) and 11% (5 to 16), respectively (P < 0.001). The Pao2/Fio2 ratio increased significantly only at a positive end-expiratory pressure of 10 cm H2O (P < 0.001). Driving pressure decreased from 16 ± 3 cm H2O at a positive end-expiratory pressure of 0 cm H2O to 12 ± 3 cm H2O at a positive end-expiratory pressure of 10 cm H2O (P < 0.001). The high V/Q ratio did not change. Conclusions During low VT one-lung ventilation, high positive end-expiratory pressure levels improve pulmonary function without increasing high V/Q and reduce driving pressure.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Bupivacaine Indirectly Potentiates Glutamate-induced Intracellular Calcium
           Signaling in Rat Hippocampal Neurons by Impairing Mitochondrial Function
           in Cocultured Astrocytes
    • Authors: Xing Y; Zhang N, Zhang W, et al.
      Abstract: Background Bupivacaine induces central neurotoxicity at lower blood concentrations than cardiovascular toxicity. However, central sensitivity to bupivacaine is poorly understood. The toxicity mechanism might be related to glutamate-induced excitotoxicity in hippocampal cells. Methods The intracellular free Ca2+ concentration ([Ca2+]i), mitochondrial membrane potential, and reactive oxygen species generation were measured by fluorescence and two-photon laser scanning microscopy in fetal rat hippocampal neurons and astrocytes. Results In astrocyte/neuron cocultures, 300 μM bupivacaine inhibited glutamate-induced increases in [Ca2+]i in astrocytes by 40% (P < 0.0001; n = 20) but significantly potentiated glutamate-induced increases in [Ca2+]i in neurons by 102% (P = 0.0007; n = 10). Ropivacaine produced concentration-dependent effects similar to bupivacaine (0.3 to 300 μM). Tetrodotoxin did not mimic bupivacaine’s effects. In pure cell cultures, bupivacaine did not affect glutamate-induced increases in [Ca2+]i in neurons but did inhibit increased [Ca2+]i in astrocytes. Moreover, bupivacaine produced a 61% decrease in the mitochondrial membrane potential (n = 20) and a 130% increase in reactive oxygen species generation (n = 15) in astrocytes. Cyclosporin A treatment suppressed bupivacaine’s effects on [Ca2+]i, mitochondrial membrane potential, and reactive oxygen species generation. When astrocyte/neuron cocultures were incubated with 500 μM dihydrokainic acid (a specific glutamate transporter–1 inhibitor), bupivacaine did not potentiate glutamate-induced increases in [Ca2+]i in neurons but still inhibited glutamate-induced increases in [Ca2+]i in astrocytes. Conclusions In primary rat hippocampal astrocyte and neuron cocultures, clinically relevant concentrations of bupivacaine selectively impair astrocytic mitochondrial function, thereby suppressing glutamate uptake, which indirectly potentiates glutamate-induced increases in [Ca2+]i in neurons.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Sevoflurane Blocks the Induction of Long-term Potentiation When Present
           during, but Not When Present Only before, the High-frequency Stimulation
    • Authors: Liu J; Yang L, Lin D, et al.
      Abstract: Background This study tests the hypothesis that sevoflurane blocks long-term potentiation only if it is present during the high-frequency stimulation that induces long-term potentiation. Methods Long-term potentiation, an electrophysiologic correlate of memory, was induced by high-frequency stimulation and measured as a persistent increase in the field excitatory postsynaptic potential slope in the CA1 region. Results Long-term potentiation was induced in the no sevoflurane group (171 ± 58% vs. 96 ± 11%; n = 13, mean ± SD); when sevoflurane (4%) was present during the high-frequency stimulation, long-term potentiation was blocked (92 ± 22% vs. 99 ± 7%, n = 6). While sevoflurane reduced the size of the field excitatory postsynaptic potential to single test stimuli by 59 ± 17%, it did not significantly reduce the size of the field excitatory postsynaptic potentials during the 100 Hz high-frequency stimulation. If sevoflurane was removed from the artificial cerebrospinal fluid superfusing the slices 10 min before the high-frequency stimulation, then long-term potentiation was induced (185 ± 48%, n = 7); this was not different from long-term potentiation in the no sevoflurane slices (171 ± 58). Sevoflurane before, but not during, ⊖-burst stimulation, a physiologic stimulus, did not block the induction of long-term potentiation (151 ± 37% vs. 161 ± 34%, n = 7). Conclusions Sevoflurane blocks long-term potentiation formation if present during the high-frequency stimulation; this blockage of long-term potentiation does not persist if sevoflurane is discontinued before the high-frequency stimulation. These results may explain why short periods of insufficient sevoflurane anesthesia may lead to recall of painful or traumatic events during surgery.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • L-arginine and Arginase Products Potentiate Dexmedetomidine-induced
           Contractions in the Rat Aorta
    • Authors: Wong EW; Man RK, Ng KJ, et al.
      Abstract: Background The α2-adrenergic sedative/anesthetic agent dexmedetomidine exerts biphasic effects on isolated arteries, causing endothelium-dependent relaxations at concentrations at or below 30 nM, followed by contractions at higher concentrations. l-arginine is a common substrate of endothelial nitric oxide synthase and arginases. This study was designed to investigate the role of l-arginine in modulating the overall vascular response to dexmedetomidine. Methods Isometric tension was measured in isolated aortic rings of Sprague Dawley rats. Cumulative concentrations of dexmedetomidine (10 nM to 10 μM) were added to quiescent rings (with and without endothelium) after previous incubation with vehicle, Nω-nitro-l-arginine methyl ester hydrochloride (l-NAME; nitric oxide synthase inhibitor), prazosin (α1-adrenergic antagonist), rauwolscine (α2-adrenergic antagonist), l-arginine, (S)-(2-boronethyl)-l-cysteine hydrochloride (arginase inhibitor), NG-hydroxy-l-arginine (arginase inhibitor), urea and/or ornithine. In some preparations, immunofluorescent staining, immunoblotting, or measurement of urea content were performed. Results Dexmedetomidine did not contract control rings with endothelium but evoked concentration-dependent increases in tension in such rings treated with l-NAME (Emax 50 ± 4%) or after endothelium-removal (Emax 74 ± 5%; N = 7 to 12). Exogenous l-arginine augmented the dexmedetomidine-induced contractions in the presence of l-NAME (Emax 75 ± 3%). This potentiation was abolished by (S)-(2-boronethyl)-l-cysteine hydrochloride (Emax 16 ± 4%) and NG-hydroxy-l-arginine (Emax 18 ± 4%). Either urea or ornithine, the downstream arginase products, had a similar potentiating effect as l-arginine. Immunoassay measurements demonstrated an upregulation of arginase I by l-arginine treatment in the presence of l-NAME (N = 4). Conclusions These results suggest that when vascular nitric oxide homeostasis is impaired, the potentiation of the vasoconstrictor effect of dexmedetomidine by l-arginine depends on arginase activity and the production of urea and ornithine.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Astrocytic N-Myc Downstream-regulated Gene–2 Is Involved in Nuclear
           Transcription Factor κB–mediated Inflammation Induced by Global
           Cerebral Ischemia
    • Authors: Deng Y; Ma Y, Zhang Z, et al.
      Abstract: Background Inflammation is a key element in the pathophysiology of cerebral ischemia. This study investigated the role of N-Myc downstream-regulated gene–2 in nuclear transcription factor κB–mediated inflammation in ischemia models. Methods Mice (n = 6 to 12) with or without nuclear transcription factor κB inhibitor pyrrolidinedithiocarbamate pretreatment were subjected to global cerebral ischemia for 20 min. Pure astrocyte cultures or astrocyte-neuron cocultures (n = 6) with or without pyrrolidinedithiocarbamate pretreatment were exposed to oxygen-glucose deprivation for 4 h or 2 h. Astrocytic nuclear transcription factor κB and N-Myc downstream-regulated gene–2 expression, proinflammatory cytokine secretion, neuronal apoptosis and survival, and memory function were analyzed at different time points after reperfusion or reoxygenation. Proinflammatory cytokine secretion was also studied in lentivirus-transfected astrocyte lines after reoxygenation. Results Astrocytic nuclear transcription factor κB and N-Myc downstream-regulated gene–2 expression and proinflammatory cytokine secretion increased after reperfusion or reoxygenation. Pyrrolidinedithiocarbamate pretreatment significantly reduced N-Myc downstream-regulated gene–2 expression and proinflammatory cytokine secretion in vivo and in vitro, reduced neuronal apoptosis induced by global cerebral ischemia/reperfusion (from 65 ± 4% to 47 ± 4%, P = 0.0375) and oxygen-glucose deprivation/reoxygenation (from 45.6 ± 0.2% to 22.0 ± 4.0%, P < 0.001), and improved memory function in comparison to vehicle-treated control animals subjected to global cerebral ischemia/reperfusion. N-Myc downstream-regulated gene–2 lentiviral knockdown reduced the oxygen-glucose deprivation-induced secretion of proinflammatory cytokines. Conclusions Astrocytic N-Myc downstream-regulated gene–2 is up-regulated after cerebral ischemia and is involved in nuclear transcription factor κB–mediated inflammation. Pyrrolidinedithiocarbamate alleviates ischemia-induced neuronal injury and hippocampal-dependent cognitive impairment by inhibiting increases in N-Myc downstream-regulated gene–2 expression and N-Myc downstream-regulated gene–2—mediated inflammation.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Targeted Genotyping Identifies Susceptibility Locus in Brain-derived
           Neurotrophic Factor Gene for Chronic Postsurgical Pain
    • Authors: Tian Y; Liu X, Jia M, et al.
      Abstract: Background The purpose of this study was to evaluate the association between single-nucleotide polymorphisms and chronic postsurgical pain. Methods Using GoldenGate genotyping assays, we genotyped 638 polymorphisms within 54 pain-related genes in 1,152 surgical patients who were enrolled in our Persistent Pain after Surgery Study. Patients were contacted by phone to determine whether they had chronic postsurgical pain at 12 months. Polymorphisms identified were validated in a matched cohort of 103 patients with chronic postsurgical pain and 103 patients who were pain free. The functions of targeted polymorphisms were tested in an experimental plantar incisional nociception model using knock-in mice. Results At 12 months after surgery, 246 (21.4%) patients reported chronic postsurgical pain. Forty-two polymorphisms were found to be associated with chronic postsurgical pain, 19 decreased the risk of pain, and 23 increased the risk of pain. Patients carrying allele A of rs6265 polymorphism in brain-derived neurotrophic factor (BDNF) had a lower risk of chronic postsurgical pain in the discovery and validation cohorts, with an adjusted odds ratio (95% CI) of 0.62 (0.43 to 0.90) and 0.57 (0.39 to 0.85), respectively. Age less than 65 yr, male sex, and prior history of pain syndrome were associated with an increased risk of pain. Genetic polymorphisms had higher population attributable risk (7.36 to 11.7%) compared with clinical risk factors (2.90 to 5.93%). Importantly, rs6265 is a substitution of valine by methionine at amino acid residue 66 (Val66Met) and was associated with less mechanical allodynia in BDNFMet/Met mice compared with BDNFVal/Val group after plantar incision. Conclusions This study demonstrated that genetic variation of BDNF is associated with an increased risk of chronic postsurgical pain.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Using Activity Trackers to Quantify Postpartum Ambulation A Prospective
           Observational Study of Ambulation after Regional Anesthesia and Analgesia
    • Authors: Ma J; Martin R, Chan B, et al.
      Abstract: Background Early postoperative ambulation is associated with enhanced functional recovery, particularly in the postpartum population, but ambulation questionnaires are limited by recall bias. This observational study aims to objectively quantify ambulation after neuraxial anesthesia and analgesia for cesarean delivery and vaginal delivery, respectively, by using activity tracker technology. The hypothesis was that vaginal delivery is associated with greater ambulation during the first 24 h postdelivery, compared to cesarean delivery. Methods Parturients having first/second cesarean delivery under spinal anesthesia or first/second vaginal delivery under epidural analgesia between July 2015 and December 2016 were recruited. Patients with significant comorbidities or postpartum complications were excluded, and participants received standard multimodal analgesia. Mothers were fitted with wrist-worn activity trackers immediately postdelivery, and the trackers were recollected 24 h later. Rest and dynamic postpartum pain scores at 2, 6, 12, 18, and 24 h and quality of recovery (QoR-15) at 12 and 24 h were assessed. Results The study analyzed 173 patients (cesarean delivery: 76; vaginal delivery: 97). Vaginal delivery was associated with greater postpartum ambulation (44%) compared to cesarean delivery, with means ± SD of 1,205 ± 422 and 835 ± 381 steps, respectively, and mean difference (95% CI) of 370 steps (250, 490; P < 0.0001). Although both groups had similar pain scores and opioid consumption (less than 1.0 mg of morphine), vaginal delivery was associated with superior QoR-15 scores, with 9.2 (0.6, 17.8; P = 0.02) and 8.2 (0.1, 16.3; P = 0.045) differences at 12 and 24 h, respectively. Conclusions This study objectively demonstrates that vaginal delivery is associated with greater early ambulation and functional recovery compared to cesarean delivery. It also establishes the feasibility of using activity trackers to evaluate early postoperative ambulation after neuraxial anesthesia and analgesia.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Pharmacodynamics and Pharmacokinetics of Lidocaine in a Rodent Model of
           Diabetic Neuropathy
    • Authors: ten Hoope W; Hollmann MW, de Bruin K, et al.
      Abstract: Background Clinical and experimental data show that peripheral nerve blocks last longer in the presence of diabetic neuropathy. This may occur because diabetic nerve fibers are more sensitive to local anesthetics or because the local anesthetic concentration decreases more slowly in the diabetic nerve. The aim of this study was to investigate both hypotheses in a rodent model of neuropathy secondary to type 2 diabetes. Methods We performed a series of sciatic nerve block experiments in 25 Zucker Diabetic Fatty rats aged 20 weeks with a neuropathy component confirmed by neurophysiology and control rats. We determined in vivo the minimum local anesthetic dose of lidocaine for sciatic nerve block. To investigate the pharmacokinetic hypothesis, we determined concentrations of radiolabeled (14C) lidocaine up to 90 min after administration. Last, dorsal root ganglia were excised for patch clamp measurements of sodium channel activity. Results First, in vivo minimum local anesthetic dose of lidocaine for sciatic nerve motor block was significantly lower in diabetic (0.9%) as compared to control rats (1.4%). Second, at 60 min after nerve block, intraneural lidocaine was higher in the diabetic animals. Third, single cell measurements showed a lower inhibitory concentration of lidocaine for blocking sodium currents in neuropathic as compared to control neurons. Conclusions We demonstrate increased sensitivity of the diabetic neuropathic nerve toward local anesthetics, and prolonged residence time of local anesthetics in the diabetic neuropathic nerve. In this rodent model of neuropathy, both pharmacodynamic and pharmacokinetic mechanisms contribute to prolonged nerve block duration.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Transcriptional Changes in Dorsal Spinal Cord Persist after Surgical
           Incision Despite Preemptive Analgesia with Peripheral Resiniferatoxin
    • Authors: Raithel SJ; Sapio MR, LaPaglia DM, et al.
      Abstract: Background Peripheral nociceptors expressing the ion channel transient receptor potential cation channel, subfamily V, member 1, play an important role in mediating postoperative pain. Signaling from these nociceptors in the peri- and postoperative period can lead to plastic changes in the spinal cord and, when controlled, can yield analgesia. The transcriptomic changes in the dorsal spinal cord after surgery, and potential coupling to transient receptor potential cation channel, subfamily V, member 1–positive nociceptor signaling, remain poorly studied. Methods Resiniferatoxin was injected subcutaneously into rat hind paw several minutes before surgical incision to inactivate transient receptor potential cation channel, subfamily V, member 1–positive nerve terminals. The effects of resiniferatoxin on postincisional measures of pain were assessed through postoperative day 10 (n = 51). Transcriptomic changes in the dorsal spinal cord, with and without peripheral transient receptor potential cation channel, subfamily V, member 1–positive nerve terminal inactivation, were assessed by RNA sequencing (n = 22). Results Peripherally administered resiniferatoxin increased thermal withdrawal latency by at least twofold through postoperative day 4, increased mechanical withdrawal threshold by at least sevenfold through postoperative day 2, and decreased guarding score by 90% relative to vehicle control (P < 0.05). Surgical incision induced 70 genes in the dorsal horn, and these changes were specific to the ipsilateral dorsal horn. Gene induction with surgical incision persisted despite robust analgesia from resiniferatoxin pretreatment. Many of the genes induced were related to microglial activation, such as Cd11b and Iba1. Conclusions A single subcutaneous injection of resiniferatoxin before incision attenuated both evoked and nonevoked measures of postoperative pain. Surgical incision induced transcriptomic changes in the dorsal horn that persisted despite analgesia with resiniferatoxin, suggesting that postsurgical pain signals can be blocked without preventing transcription changes in the dorsal horn.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Does the Brachial Artery Lack Effective Collaterals'
    • Authors: Bowdle T; Sheu R.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • In Reply
    • Authors: Singh A; Wakefield BJ, Duncan AE.
      Abstract: We thank Drs. Bowdle and Sheu for their interest and thoughtful comments on our recent article,1 which reported a low risk of complications from intraarterial brachial pressure monitoring during cardiac surgery.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Effect of Spinal versus General Anesthesia in Study Comparing Three
           Methods of Using Local Anesthetics to Achieve Post–knee Arthroplasty
    • Authors: Riopelle J.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • In Reply
    • Authors: Amundson AW; Johnson RL, Schroeder DR, et al.
      Abstract: We thank Dr. Riopelle for his question. In the article,1 table 2 contains the results of unadjusted comparisons across study arms for all pain endpoints. In addition to these unadjusted comparisons, for the study’s primary endpoint an analysis was performed to assess differences across study arms after adjusting for sex, American Society of Anesthesiologists status, and type of anesthesia. In all cases, the results of the unadjusted and adjusted comparisons across treatment groups were consistent.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • “A Message in the Bottle”
    • Authors: Vetrugno L; Brogi E, Barbariol F, et al.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Impact of Weaning from Mechanical Ventilation: The Importance of Pleural
           Effusions and Their Effect on Pulmonary Vascular Resistance
    • Authors: Jacobsohn E; Grocott HP.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Accurate Quantification of Pleural Effusion and Cofactors Affecting
           Weaning Failure
    • Authors: Iwasaki Y; Ohshimo S, Shime N.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • In Reply
    • Authors: Dres M; Demoule A.
      Abstract: We thank Dr. Vetrugno et al., Drs. Jacobsohn and Grocott, and Dr. Iwasaki et al. for their interest and positive appreciations of our study, “Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study,” recently published in Anesthesiology.1
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • One Size Fits All for Stress-dose Steroids
    • Authors: Wax DB.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • In Reply
    • Authors: Liu MM; Reidy AB, Saatee S, et al.
      Abstract: We thank Dr. Wax for his response to our recent article on perioperative steroid management.1 Since the publication of our article, we have received several queries regarding the use of dexamethasone as a perioperative stress-dose steroid and appreciate the opportunity to further address this topic. As Dr. Wax aptly notes, dexamethasone has significantly more glucocorticoid potency than hydrocortisone, has no mineralocorticoid effect, and can be clinically effective in the prevention of postoperative nausea and vomiting. Indeed, the recommended antiemetic dose of dexamethasone (4 mg) has at least the same glucocorticoid equivalence as the recommended intraoperative stress dose of hydrocortisone (100 mg) for patients at risk for adrenal insufficiency undergoing major surgery.1 The available literature on perioperative steroid supplementation provides dosing guidelines based on hydrocortisone, which has a shorter, more predictable half life compared to dexamethasone and is thus more easily tapered to the usual daily dose in patients requiring continued postoperative supplementation based on surgical stress. However, the literature on patients with secondary adrenal insufficiency does not make any specific recommendation as to what is the “best” stress-dose steroid to administer. Dexamethasone is not appropriate for patients with primary adrenal insufficiency or critically ill patients, both of whom require mineralocorticoid supplementation.2,3 While we agree that the use of dexamethasone may be a reasonable approach for many patients with secondary adrenal insufficiency, with additional benefit in the prevention of postoperative nausea and vomiting, we caution against a “one-size-fits-all algorithm,” especially in critically ill patients.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Volume Responsiveness Alone Is Not an Indication for Volume
    • Authors: Bloomstone JA; Navarro e Lima L, Kramer G.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Goal-directed Hemodynamic Therapy: Neither for Anyone, Neither the Same
           for Everyone
    • Authors: Ripollés-Melchor J; Aldecoa C.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • In Reply
    • Authors: Gómez-Izquierdo JC; Trainito A, Mirzakandov D, et al.
      Abstract: We would like to thank Bloomstone et al. for their important comments on our study.1 We certainly agree with Bloomstone et al. that fluid responsiveness should not be confused with hypovolemia. Being a fluid responder does not necessarily mean requiring additional intravenous fluids. Vice versa, fluid responsiveness should be determined before volume expansion, when clinical signs of hypovolemia suggest that patients might require additional intravenous fluids. Identifying hypovolemic patients might be challenging, however, given that standard hemodynamic parameters or biologic markers used during surgery may not be specific enough, or may fail to identify hypovolemic patients in a timely fashion. Furthermore, the majority of studies evaluating the effectiveness of goal-directed fluid therapy on postoperative outcomes, including ours, include protocols that preemptively maximize stroke volume by administering bolus of fluids based on dynamic indices or on the stroke volume response to a fluid challenge, independent of the presence of clinical signs of hypovolemia. As Bloomstone et al. also reported in their referenced and important consensus statement, stroke volume maximization has been considered “the cornerstone of most goal-directed therapy protocols.”2
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Statin Therapy before Cardiac Surgery: Neutral or Detrimental Effects'
    • Authors: Putzu A; Gallo M, Ferrari E, et al.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Neurocritical Care Needs Predictive Scores That Succeed at Predicting
           Failure as Well as They Predict Success
    • Authors: Patlak J; Shaefi S, Buhl L, et al.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • In Reply
    • Authors: Cinotti R; Roquilly A, Asehnoune K.
      Abstract: We gratefully acknowledge Dr. Patlak et al. for his constructive comments on our article.1 We fully agree with our colleague when he states that protracted ventilation is the main issue in brain-injured patients,2 because delaying extubation promotes morbidity and healthcare costs. The VISAGE (visual pursuit, swallowing, age, Glasgow coma scale for extubation) score1 was developed to help the physician in securing the challenging extubation process in neurocritical care patients. The fear of extubation failure is due to the lack of guidelines for extubation in neurologic patients, and there is a clear need for new clinical evidence to help the attending physician. If the VISAGE score performs well at predicting extubation success based on favorable neurologic clinical signs, it is true that its performance is less accurate in patients with a low score. One obvious explanation stems from the fact that neurologic examination varies considerably within the same day in a single patient. Thus, the VISAGE score, as well as the other prediction score recently published in Anesthesiology,3 add a lot to the field by showing for the first time that a suboptimal level of consciousness and one or two functional aspects of the airway may predict a successful extubation. However, as mentioned by Patlak et al., we need other information for guiding extubation when the value of the VISAGE score is low. Finally, we truly believe that this score is a first step toward improvement of global respiratory management of neurocritical care patients.4 Even if it is likely that extubation failure rate, as well as delayed extubation, will remain elevated in these patients over the next few years, this should not be considered a fatal flaw.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Oh Excellent Air Bag: Under the Influence of Nitrous Oxide,
    • Authors: Waisel DB.
      Abstract: Oh Excellent Air Bag presents a curated collection of 12 scientific and popular works about nitrous oxide, spanning 1799 to 1920. Voyeuristic readers will enjoy reading the frequently explicit experiences of inhaling nobles. Readers who prefer a coherent history with a focus on characters, causes, and effects may be less satisfied. That reader will savor the historian Mike Jay’s engaging introduction, but will be disappointed that each work does not have its own commentary.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Lyin’ with a Lion: Deceptive Advertising for “Vitalized
           Air” Anesthetics
    • Abstract: Soon after earning his D.D.S. in 1891 from the Ohio College of Dental Surgery, Dr. Charley D. Richey set up practice in York, Pennsylvania. From Ohio dentists, Richey had mastered how to extend nitrous oxide’s anesthetic duration by supplementing it with trace amounts of alcohol and chloroform. By concealing his anesthetic’s identity as “vitalized air” (bottom), he could reassure patients that they were not receiving nitrous oxide—the gas that many feared after reading press reports about laughing gas mishaps. “Vitalized air” reigned as a king of American dental anesthetics in the 1890s, so perhaps it made sense that Richey used the “king of beasts” (above) on one of his trade cards advertising the gas mixture. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.)
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Eucaine Lactate from H. K. Mulford Company of Philadelphia
    • Abstract: Using a pharmacy schoolmate’s financing and presidential leadership, Henry K. Mulford (1866 to 1937) reorganized his own namesake corporation in 1891 with himself as vice president. Soon “H. K. Mulford Company of Philadelphia” began synthesizing and compounding an astonishing array of pharmaceuticals, including (beta-)eucaine lactate. Less toxic than alpha-eucaine, beta-eucaine had the additional advantage of stability in aqueous solutions sterilized by prolonged boiling. Sold by Mulford as “one-quarter grain” hypodermic tablets (above), the lactate formulation of eucaine was less irritating to patients than was the hydrochlorate one. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.)
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Slocum’s Cocaine “Surprise” for Johnson Pillmore, M.D.
    • Abstract: From the Wood Library-Museum’s Ben Z. Swanson Collection, this illegibly postmarked cover (above) was sent to Johnson Pillmore, M.D., of Delta, New York. Fortunately, the “Columbus in Sight of Land” 1-cent stamp from the Columbian Issue assists us in dating this item. From Holly, Michigan, the Slocum Manufacturing Company was taking advantage of the 1893 World’s Columbian Exposition to advertise “Dental Surprise,” their new (') “local anesthetic for painless extraction of teeth.” Suspicious of the novelty of Slocum’s wares, the journal editor of the Dental Cosmos forwarded a sample of “Dental Surprise” in 1893 to S. P. Sadtler, Ph.D., a professor at the Philadelphia College of Pharmacy. Sadtler’s chemical analysis unmasked “Dental Surprise” as merely carbolic acid fortified with 1.46% “Anhydrous Cocain Hydrochlorate.” (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.)
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • From Malaysia and Spain: The Liebig Company Peppers the World with
    • Abstract: A discoverer of chloroform, Professor Justus von Liebig inspired the Liebig Extract of Beef Company, which collected many herbs and spices, including chili peppers from around the world. One of the company’s French-language trade cards depicted Malaysian workers on a spice plantation (upper left) and a Spanish lady collecting peppers in her Andalusian basket (lower right). Not lost on the Liebig Company was the fact that many early liniments, including snake oils, frequently provided topical pain relief by including capsaicin-spiced ingredients, courtesy of the chili pepper. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.)
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • “Frozen Air” Anesthetics in St. Louis by Columbia Dental
    • Abstract: In the wake of the 1893 World Columbian Exposition, a number of “Columbia” Dental Parlors sprung up around the United States. The trade card from one of these parlors depicts four frogs assisting a fifth in rowing a single scull (top). The back of the card locates the parlors in the “Trust Building” at “4th and Locust” Streets, which apparently references a former St. Louis Trust Company Building in St. Louis, Missouri. Also on the reverse of this card is a reference to anesthesia with “Frozen Air” (bottom). From ether spray to ethyl chloride (and eventually to Somnoform), a variety of vapocoolant sprays were used topically to provide chilling anesthesia for dental and minor surgical cases. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.)
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Science, Medicine, and the Anesthesiologist
    • Abstract: Key Papers from the Most Recent Literature Relevant to Anesthesiologists
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Searching for Quality: Hip Fractures and Type of Anesthesia
    • Authors: Wanderer JP; Rathmell JP.
      Abstract: Complex Information for Anesthesiologists Presented Quickly and Clearly
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • This Month in: Anesthesiology
    • PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Images in Anesthesiology: Intraoral Lipomas
    • Authors: Nguyen E; Sarah G, Ferschl MB.
      Abstract: INTRAORAL lipomas can cause significant airway obstruction and lead to respiratory compromise. Additionally, they can grossly alter airway anatomy, making direct laryngoscopy challenging.1 Oropharyngeal lipomas arising from the posterior pharynx or supraglottic region may present particular challenges for the anesthesiologist, given that they are not always obvious on preoperative evaluation.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • A Large Anterior Mediastinal Mass
    • Authors: Stubblefield J; Moon T, Griffin J.
      Abstract: A LARGE anterior mediastinal mass (AMM) poses significant challenges for hemodynamic and airway management. This image demonstrates a 19 x 11 x 10 cm B-cell lymphoma compressing the tracheobronchial tree and pulmonary arterial vasculature. AMMs are predominantly malignancies such as lymphomas or thymomas.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Relaxation before Debriefing during High-fidelity Simulation Improves
           Memory Retention of Residents at Three Months A Prospective Randomized
           Controlled Study
    • Authors: Lilot M; Evain J, Bauer C, et al.
      Abstract: Background High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months when a relaxation break was performed before debriefing of critical event scenarios. Methods Each resident actively participated in one scenario and observed another. Residents were randomized in two parallel-arms. The intervention was a 5-min standardized relaxation break immediately before debriefing; controls had no break before debriefing. Five scenario-specific messages were read aloud by instructors during debriefings. Residents were asked by telephone three months later to recall the five messages from their two scenarios, and were scored for each scenario by blinded investigators. The primary endpoint was the number of residents participating actively who recalled three or more messages. Secondary endpoints included: number of residents observing who recalled three or more messages, anxiety level, and debriefing quality. Results In total, 149 residents were randomized and included. There were 52 of 73 (71%) residents participating actively who recalled three or more messages at three months in the intervention group versus 35 of 76 (46%) among controls (difference: 25% [95% CI, 10 to 40%], P = 0.004). No significant difference was found between groups for observers, anxiety or debriefing quality. Conclusions There was an additional 25% of active participants who recalled the critical messages at three months when a relaxation break was performed before debriefing of scenarios. Benefits of relaxation to enhance learning should be considered for medical education.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Use of Uncrossmatched Erythrocytes in Emergency Bleeding Situations
    • Authors: Yazer MH; Waters JH, Spinella PC, et al.
      Abstract: UNCROSSMATCHED erythrocytes are a lifesaving bridge between a hemorrhaging patient of unknown ABO blood group not receiving erythrocyte transfusions and the provision of crossmatched units. Unless the recipient’s ABO group is known, group O uncrossmatched erythrocytes will be issued, which are compatible with the preformed anti-A and/or anti-B (hemagglutinins) that are present in all recipients who are not blood group AB (table 1). Issuing group O erythrocyte units prevents acute, intravascular hemolytic reactions from occurring when uncrossmatched erythrocytes are transfused to a recipient of unknown ABO group. An acute (occurring within 24 h of the transfusion) intravascular reaction occurs when complement-fixing antibodies, such as the naturally occurring IgM isotype anti-A and/or anti-B found in all recipients who are not blood group AB, bind to their target antigen and fix complement, thereby causing the destruction of the erythrocytes inside the vascular system.1 These reactions can be life threatening because of the nature of the substances released from the lysed erythrocytes. In contrast, an extravascular hemolytic reaction is caused by IgG antibodies and tends to be less life threatening because the erythrocytes are destroyed in a contained manner in the liver and spleen, thereby not releasing intra-erythrocyte substances directly into the bloodstream. Thus, uncrossmatched erythrocytes can be administered to any patient with severe anemia or acute hemorrhage whose life would be compromised by waiting for crossmatched erythrocytes to become available. This Clinical Focus Review will briefly discuss how the blood bank performs pretransfusion testing, review the safety of using uncrossmatched erythrocytes in patients requiring urgent transfusions, and examine some newly emerging trends in the kinds of blood products that are used in the resuscitation of trauma patients.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Antifibrinolytic Therapy and Perioperative Considerations
    • Authors: Levy JH; Koster A, Quinones QJ, et al.
      Abstract: Fibrinolysis is a physiologic component of hemostasis that functions to limit clot formation. However, after trauma or surgery, excessive fibrinolysis may contribute to coagulopathy, bleeding, and inflammatory responses. Antifibrinolytic agents are increasingly used to reduce bleeding, allogeneic blood administration, and adverse clinical outcomes. Tranexamic acid is the agent most extensively studied and used in most countries. This review will explore the role of fibrinolysis as a pathologic mechanism, review the different pharmacologic agents used to inhibit fibrinolysis, and focus on the role of tranexamic acid as a therapeutic agent to reduce bleeding in patients after surgery and trauma.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Hospital Waiting Room
    • Authors: Chenevert A.
      Abstract: A celebrity’s polished face assures great care is taken to protect those inside the magazine. Anyone can forgive the discoloration on the floor, or a distant flat note breaking through a door in the pleasant yellows of the family room. Here magazines serve two functions, the first purely aesthetic: to hide the chipping paint on tables. The second is to muffle the hours of uncertainty entombed inside the hospital. When you get out, and your mother is cured, you will remember the ad for new lipstick, rush to the store, and thank it for showing mercy.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Then It Was Dark and Cold
    • Authors: Harnden J.
      Abstract: It was a sunny, warm, clear day until brute celestial geometry choked off standard photon dissemination. Then it was dark and cold.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • CASQ1 Gene Is an Unlikely Candidate for Malignant Hyperthermia
           Susceptibility in the North American Population: Erratum
    • Abstract: In the February 2013 issue, the article on page 344 published with an incorrect
      DOI . The correct
      DOI for this article is 10.1097/01.anes.0000530185.78660.da.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Anesthesiology
    • PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Anesthesiology
    • PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Instructions for Obtaining A nesthesiology Continuing Medical Education
           (CME) Credit
    • PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Call for Papers Point of Care Ultrasound in Perioperative, Critical Care,
           and Pain Medicine
    • PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Announcements
    • PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018 A
           Report by the American Society of Anesthesiologists Task Force on Moderate
           Procedural Sedation and Analgesia, the American Association of Oral and
           Maxillofacial Surgeons, American College of Radiology, American Dental
           Association, American Society of Dentist Anesthesiologists, and Society of
           Interventional Radiology *
    • Abstract: Update Highlights In October 2014, the American Society of Anesthesiologists Committee on Standards and Practice Parameters recommended that new practice guidelines addressing moderate procedural sedation and analgesia be developed. These new guidelines: Replace the “Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists: An Updated Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists,” published in 2002.1Specifically address moderate sedation. They do not address mild or deep sedation and do not address the educational, training, or certification requirements for providers of moderate procedural sedation. (Separate Practice Guidelines are under development that will address deep procedural sedation.)Differ from previous guidelines in that they were developed by a multidisciplinary task force of physicians from several medical and dental specialty organizations with the intent of specifically addressing moderate procedural sedation provided by any medical specialty in any location. New recommendations include: Patient evaluation and preparation.Continual monitoring of ventilatory function with capnography to supplement standard monitoring by observation and pulse oximetry.The presence of an individual in the procedure room with the knowledge and skills to recognize and treat airway complications.Sedatives and analgesics not intended for general anesthesia (e.g., benzodiazepines and dexmedetomidine).Sedatives and analgesics intended for general anesthesia (e.g., propofol, ketamine, and etomidate).Recovery care.Creation and implementation of quality improvement processes.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
School of Mathematical and Computer Sciences
Heriot-Watt University
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