by: American Society of Anesthesiologists
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This Month In Anesthesiology
THIS MONTH IN Anesthesiology
Anesthesiology. 112(1):9A, January 2010.
doi: 10.1097/01.anes.0000365971.56342.1d
Anesthesiology CME Program
Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit
Anesthesiology. 112(1):A11, January 2010.
doi: 10.1097/01.anes.0000365969.71589.1f
Editorial Views
To Our Readers: An Experiment in Education
Eisenach, James C.
Anesthesiology. 112(1):1-2, January 2010.
doi: 10.1097/ALN.0b013e3181c5f88d
Education: An Essential Leg for Anesthesiology's Four-legged Stool!
Schwartz, Alan Jay
Anesthesiology. 112(1):3-5, January 2010.
doi: 10.1097/ALN.0b013e3181c60e4d
Predicting the Success of an Anesthesiology Trainee: Is There a Method to Our Madness?
Nagle, Pamela C.
Anesthesiology. 112(1):6-7, January 2010.
doi: 10.1097/ALN.0b013e3181c62f8c
Simulation Training and Assessment: A More Efficient Method to Develop Expertise than Apprenticeship
Cooper, Jeffrey B.; Murray, David
Anesthesiology. 112(1):8-9, January 2010.
doi: 10.1097/ALN.0b013e3181c62a1a
New Insights about an Old Foe
Nunnally, Mark E.; Apfelbaum, Jeffrey L.
Anesthesiology. 112(1):10-11, January 2010.
doi: 10.1097/01.anes.0000365962.59021.02
Perioperative Use of [beta]-Adrenergic Antagonists and Anemia: Known Knowns, Known Unknowns, Unknown Unknowns; and Unknown Knowns
Weiskopf, Richard B.
Anesthesiology. 112(1):12-15, January 2010.
doi: 10.1097/ALN.0b013e3181c5dc18
Neostigmine: How Much Is Necessary for Patients Who Receive a Nondepolarizing Neuromuscular Blocking Agent?
Lien, Cynthia A.
Anesthesiology. 112(1):16-18, January 2010.
doi: 10.1097/ALN.0b013e3181c5388f
Anesthesiology Reflections
PDF Only
The Final Dental and Surgical Microcosm
Bause, George S.
Anesthesiology. 112(1):5, January 2010.
doi: 10.1097/01.anes.0000365967.89515.62
Laennec's 1819 Stethoscope
Bause, George S.
Anesthesiology. 112(1):18, January 2010.
doi: 10.1097/01.anes.0000365966.81891.4d
Hales' 1733 Haemastaticks
Bause, George S.
Anesthesiology. 112(1):65, January 2010.
doi: 10.1097/01.anes.0000365965.04763.66
King's Oxygen Compound
Bause, George S.
Anesthesiology. 112(1):219, January 2010.
doi: 10.1097/01.anes.0000365968.71589.56
Perioperative Medicine
Effects of Dexmedetomidine and Propofol on Lower Esophageal Sphincter and Gastroesophageal Pressure Gradient in Healthy Volunteers
Turan, Alparslan; Wo, John; Kasuya, Yusuke; Govinda, Raghavendra; Akça, Ozan; Dalton, Jarrod E.; Sessler, Daniel I.; Rauch, Stefan
Anesthesiology. 112(1):19-24, January 2010.
doi: 10.1097/01.anes.0000365963.97138.54
Dexmedetomidine and propofol were found to have similar effects on lower esophageal sphincter pressure and gastroesophageal pressure gradient in healthy volunteers. Both of the drugs cause some decrease in lower esophageal sphincter pressure at high concentrations.
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Acute Surgical Anemia Influences the Cardioprotective Effects of [beta]-Blockade: A Single-center, Propensity-matched Cohort Study
Beattie, W Scott; Wijeysundera, Duminda N.; Karkouti, Keyvan; McCluskey, Stuart; Tait, Gordon; Mitsakakis, Nicholas; Hare, Gregory M. T.
Anesthesiology. 112(1):25-33, January 2010.
doi: 10.1097/ALN.0b013e3181c5dd81
Perioperative β-blocker use reduces cardiac events, but increases stroke and overall mortality. The perioperative period is frequently associated with major blood loss and anemia; therefore, anemia may influence the risk-benefit profile of perioperative β-blocker use. In this retrospective observational study, the effects of anemia and β-blockade on adverse outcomes in propensity score-matched patients were compared. The primary outcome was the composite of myocardial infarction, nonfatal cardiac arrest, and in-hospital mortality (major acute cardiac events [MACE]). MACE occurred in 54 (6.5%) β-blocked patients and in 25 (3.0%) patients who did not receive β-blockers (relative risk 2.38; 95% confidence interval 1.43–3.96; P = 0.0009). Patients most at risk were those whose nadir hemoglobin was greater than 35% below the baseline value.
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Antagonism of Low Degrees of Atracurium-induced Neuromuscular Blockade: Dose-Effect Relationship for Neostigmine
Fuchs-Buder, Thomas; Meistelman, Claude; Alla, François; Grandjean, Arnaud; Wuthrich, Yann; Donati, François
Anesthesiology. 112(1):34-40, January 2010.
doi: 10.1097/ALN.0b013e3181c53863
Reduced doses (10–30 μg/kg) of neostigmine are effective in antagonizing shallow atracurium block (train-of-four ratio, 0.4–0.6). For successful reversal within 10 min, as little as 20 μg/kg neostigmine is sufficient.
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Predicting the Unpredictable: A New Prediction Model for Operating Room Times Using Individual Characteristics and the Surgeon's Estimate
Eijkemans, Marinus J. C.; van Houdenhoven, Mark; Nguyen, Tien; Boersma, Eric; Steyerberg, Ewout W.; Kazemier, Geert
Anesthesiology. 112(1):41-49, January 2010.
doi: 10.1097/ALN.0b013e3181c294c2
Characteristics of operative session, the team, the patient, and the surgeon's estimate predict the length of operative sessions and can readily be used in day-to-day planning of operating room capacity for a general surgery department.
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Cerebral Blood Flow, Blood Volume, and Mean Transit Time Responses to Propofol and Indomethacin in Peritumor and Contralateral Brain Regions: Perioperative Perfusion-weighted Magnetic Resonance Imaging in Patients with Brain Tumors
Rasmussen, Mads; Juul, Niels; Christensen, Søren M.; Jónsdóttir, Kristjana Y.; Gyldensted, Carsten; Vestergaard-Poulsen, Peter; Cold, Georg E.; Østergaard, Leif
Anesthesiology. 112(1):50-56, January 2010.
doi: 10.1097/ALN.0b013e3181c38bd3
Propofol and indomethacin are not associated with different perfusion in the peritumoral and contralateral brain regions in patients with cerebral tumors
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Effects of Prone and Reverse Trendelenburg Positioning on Ocular Parameters
Grant, Geordie P.; Szirth, Bernard C.; Bennett, Henry L.; Huang, Sophia S.; Thaker, Rajesh S.; Heary, Robert F.; Turbin, Roger E.
Anesthesiology. 112(1):57-65, January 2010.
doi: 10.1097/ALN.0b013e3181c294e1
Prolonged prone positioning increases intraocular pressure, choroid layer thickness, and optic nerve diameter independent of anesthetics and intravenous fluid infusion. A small degree of reverse Trendelenburg may not be useful in attenuating these effects for over 5 h.
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Improving Efficiency and Patient Satisfaction in a Tertiary Teaching Hospital Preoperative Clinic
Harnett, Miriam J. P.; Correll, Darin J.; Hurwitz, Shelley; Bader, Angela M.; Hepner, David L.
Anesthesiology. 112(1):66-72, January 2010.
doi: 10.1097/ALN.0b013e3181c617cb
By instituting operational changes in our Center for Preoperative Evaluation, waiting time was reduced, and patient satisfaction was improved with a minimal impact on cost per visit.
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Isoflurane Postconditioning Protects against Reperfusion Injury by Preventing Mitochondrial Permeability Transition by an Endothelial Nitric Oxide Synthase-dependent Mechanism
Ge, Zhi-Dong; Pravdic, Danijel; Bienengraeber, Martin; Pratt, Phillip F. Jr; Auchampach, John A.; Gross, Garrett J.; Kersten, Judy R.; Warltier, David C.
Anesthesiology. 112(1):73-85, January 2010.
doi: 10.1097/ALN.0b013e3181c4a607
Isoflurane postconditioning protects mouse hearts from reperfusion injury by preventing mitochondrial permeability transition in an endothelial nitric oxide synthase–dependent manner. Nitric oxide functions as both a trigger and a mediator of cardioprotection produced by isoflurane postconditioning.
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No Association between Intraoperative Hypothermia or Supplemental Protective Drug and Neurologic Outcomes in Patients Undergoing Temporary Clipping during Cerebral Aneurysm Surgery: Findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial
Hindman, Bradley J.; Bayman, Emine O.; Pfisterer, Wolfgang K.; Torner, James C.; Todd, Michael M.; on behalf of the IHAST Investigators
Anesthesiology. 112(1):86-101, January 2010.
doi: 10.1097/ALN.0b013e3181c5e28f
In 441 patients undergoing temporary clipping during cerebral aneurysm surgery, neither intraoperative hypothermia nor supplemental protective drug had any clinically demonstrable effect on short- or long-term neurologic outcomes.
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Surgery as a Teachable Moment for Smoking Cessation
Shi, Yu; Warner, David O.
Anesthesiology. 112(1):102-107, January 2010.
doi: 10.1097/ALN.0b013e3181c61cf9
Surgery is a significant independent factor associated with smoking cessation in older Americans and thus serves as a “teachable moment.” Approximately 1 in 10 of all successful quit attempts in this population are associated with surgery.
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Propofol Depresses Angiotensin II-induced Cell Proliferation in Rat Cardiac Fibroblasts
Cheng, Tzu-Hurng; Leung, Yuk-Man; Cheung, Chi-Wai; Chen, Cheng-Hsien; Chen, Yen-Ling; Wong, Kar-Lok
Anesthesiology. 112(1):108-118, January 2010.
doi: 10.1097/01.anes.0000365960.74268.21
Propofol prevents cardiac fibroblast proliferation by interfering with the generation of reactive oxygen species and involves the activation of the Akt–endothelial nitric oxide synthase–nitric oxide pathway.
Critical Care Medicine
Fluid Resuscitation Does Not Improve Renal Oxygenation during Hemorrhagic Shock in Rats
Legrand, Matthieu; Mik, Egbert G.; Balestra, Gianmarco M.; Lutter, Rene; Pirracchio, Romain; Payen, Didier; Ince, Can
Anesthesiology. 112(1):119-127, January 2010.
doi: 10.1097/ALN.0b013e3181c4a5e2
The fluid resuscitation strategy for hemorrhagic shock remains controversial. The kidney is prone to hypoxia during shock. The authors show that fluid resuscitation does not result in improvement of renal oxygenation during hemorrhagic shock in rats.
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Perioperative Intravenous Amiodarone Does Not Reduce the Burden of Atrial Fibrillation in Patients Undergoing Cardiac Valvular Surgery
Beaulieu, Yanick; Denault, André Y.; Couture, Pierre; Roy, Denis; Talajic, Mario; O'Meara, Eileen; Carrier, Michel; Pagé, Pierre; Levesque, Sylvie; Lambert, Jean; Tardif, Jean-Claude
Anesthesiology. 112(1):128-137, January 2010.
doi: 10.1097/ALN.0b013e3181c61b28
Patients undergoing valvular surgery were randomly assigned to intravenous amiodarone for 48 h starting intraoperatively or placebo in the prevention of postoperative atrial fibrillation. Atrial fibrillation occurred more frequently in the amiodarone group (P = 0.035).
Pain Medicine
Bupivacaine Inhibits Glutamatergic Transmission in Spinal Dorsal Horn Neurons
Furutani, Kenta; Ikoma, Miho; Ishii, Hideaki; Baba, Hiroshi; Kohno, Tatsuro
Anesthesiology. 112(1):138-143, January 2010.
doi: 10.1097/01.anes.0000365964.97138.9a
Bupivacaine inhibited N-methyl-d-aspartate–induced currents in rat dorsal horn neurons. This inhibitory effect is not likely to block sodium channels.
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Randomized Study Assessing the Accuracy of Cervical Facet Joint Nerve (Medial Branch) Blocks Using Different Injectate Volumes
Cohen, Steven P.; Strassels, Scott A.; Kurihara, Connie; Forsythe, Akara; Buckenmaier, Chester C. III; McLean, Brian; Riedy, Gerard; Seltzer, Sharon
Anesthesiology. 112(1):144-152, January 2010.
doi: 10.1097/ALN.0b013e3181c38a82
Reducing the volume for cervical facet nerve blocks from 0.5 to 0.25 ml is likely to increase specificity without affecting sensitivity.
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Guarding Pain and Spontaneous Activity of Nociceptors after Skin versus Skin Plus Deep Tissue Incision
Xu, Jun; Brennan, Timothy J.
Anesthesiology. 112(1):153-164, January 2010.
doi: 10.1097/ALN.0b013e3181c2952e
Incised deep tissue rather than skin caused guarding behavior and spontaneous activity of nociceptors. Skin and skin plus deep tissue incision caused similar mechanical and heat hyperalgesia.
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Cerebrospinal Fluid and Spinal Cord Distribution of Hyperbaric Bupivacaine and Baclofen during Slow Intrathecal Infusion in Pigs
Flack, Sean H.; Bernards, Christopher M.
Anesthesiology. 112(1):165-173, January 2010.
doi: 10.1097/ALN.0b013e3181c38da5
During slow intrathecal infusions such as those used for chronic intrathecal drug delivery, solution baricity has a significant effect on drug distribution in both cerebrospinal fluid and spinal cord.
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Blood Pressure, but Not Cerebrospinal Fluid Fentanyl Concentration, Predicts Duration of Labor Analgesia from Spinal Fentanyl
Nelson, Kenneth E.; Houle, Timothy T.; Eisenach, James C.
Anesthesiology. 112(1):174-180, January 2010.
doi: 10.1097/ALN.0b013e3181c38c0b
Acute mixing of fentanyl in cerebrospinal fluid after spinal injection, as measured by fentanyl concentration 1 min later, did not predict speed of onset or duration of labor analgesia, whereas preinjection blood pressure did.
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Sex-specific Mediation of Opioid-induced Hyperalgesia by the Melanocortin-1 Receptor
Juni, Aaron; Cai, Minying; Stankova, Magda; Waxman, Amanda R.; Arout, Caroline; Klein, Gad; Dahan, Albert; Hruby, Victor J.; Mogil, Jeffrey S.; Kest, Benjamin
Anesthesiology. 112(1):181-188, January 2010.
doi: 10.1097/ALN.0b013e3181c53849
Morphine hyperalgesia is sex-dependently mediated by N-methyl-d-aspartate receptors in male mice and by melanocortin-1 receptors in female mice. This sex dependency is absent at a lower morphine infusion dose.
Education
Case Scenarios
Case Scenario: Postoperative Delirium in Elderly Surgical Patients
Mantz, Jean; Hemmings, Hugh C. Jr; Boddaert, Jacques
Anesthesiology. 112(1):189-195, January 2010.
doi: 10.1097/ALN.0b013e3181c2d661
Postoperative delirium is a frequent and serious complication occurring in older surgical patients. The use of diagnostic scales and the identification of risk factors can help to reduce morbidity and mortality in this growing patient subpopulation.
Education
Images in Anesthesiology
Camera Phone as the Medium
Lichtor, J Lance
Anesthesiology. 112(1):196, January 2010.
doi: 10.1097/ALN.0b013e3181c2954b
Education
Anesthesia Literature Review
Critical Care Medicine
Mantz, Jean
Anesthesiology. 112(1):197-198, January 2010.
doi: 10.1097/ALN.0b013e3181c683c8
Perioperative Medicine
Lichtor, J Lance; Antognini, Joseph F.
Anesthesiology. 112(1):198-200, January 2010.
doi: 10.1097/01.anes.0000365972.63966.e7
Pain Medicine
Brennan, Timothy J.
Anesthesiology. 112(1):200-201, January 2010.
doi: 10.1097/01.anes.0000365973.02084.17
Education
Original Investigations in Education
Acquisition of Critical Intraoperative Event Management Skills in Novice Anesthesiology Residents by Using High-fidelity Simulation-based Training
Park, Christine S.; Rochlen, Lauryn R.; Yaghmour, Edward; Higgins, Nicole; Bauchat, Jeanette R.; Wojciechowski, Kyle G.; Sullivan, John T.; McCarthy, Robert J.
Anesthesiology. 112(1):202-211, January 2010.
doi: 10.1097/ALN.0b013e3181c62d43
Event-specific simulation-based training improved novice anesthesiology residents' competence in the initial management of a critical intraoperative event compared with routine clinical exposure and simulation-based training in an alternate event.
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Predicting Success on the Certification Examinations of the American Board of Anesthesiology
McClintock, Joseph C.; Gravlee, Glenn P.
Anesthesiology. 112(1):212-219, January 2010.
doi: 10.1097/ALN.0b013e3181c62e2f
In-training examination scores and three other factors were found to predict success in completing the American Board of Anesthesiology certification process within 1 yr of graduation from residency training.
Education
Clinical Concepts and Commentary
Improving Postoperative Pain Management: What Are the Unresolved Issues?
White, Paul F.; Kehlet, Henrik
Anesthesiology. 112(1):220-225, January 2010.
doi: 10.1097/ALN.0b013e3181c6316e
Improving pain management has proven to be a major challenge despite the more widespread use of multimodal analgesic regimens. In facilitating the recovery process after surgery, an increased reliance on nonopioid analgesic drugs and procedure-specific analgesic regimens are of critical importance.
Education
Review Article
Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression
Dahan, Albert; Aarts, Leon; Smith, Terry W.
Anesthesiology. 112(1):226-238, January 2010.
doi: 10.1097/ALN.0b013e3181c38c25
Naloxone reversal of opioid-induced respiratory depression is effective although its efficacy depends on many factors including the pharmacokinetics and pharmacodynamics (including receptor kinetics) of naloxone and the opioid that requires antagonism. Alternative nonopioid antagonists are discussed.
Education
Case Report
Exertional Rhabdomyolysis and Malignant Hyperthermia in a Patient with Ryanodine Receptor Type 1 Gene, L-type Calcium Channel [alpha]-1 Subunit Gene, and Calsequestrin-1 Gene Polymorphisms
Capacchione, John F.; Sambuughin, Nyamkhishig; Bina, Saiid; Mulligan, Lisa P.; Lawson, Tamara D.; Muldoon, Sheila M.
Anesthesiology. 112(1):239-244, January 2010.
doi: 10.1097/ALN.0b013e3181c29504
Correspondence
Drowning: Lifeguard Rescue and Resuscitation
Culp, William C. Jr; Brewster, B Chris; Wernicki, Peter
Anesthesiology. 112(1):245, January 2010.
doi: 10.1097/ALN.0b013e3181c2951b
Drowning: Lifeguard Rescue and Resuscitation
Modell, Jerome H.; Layon, A Joseph
Anesthesiology. 112(1):246, January 2010.
doi: 10.1097/ALN.0b013e3181c3ca9f
Residual Neuromuscular Blockade and Upper Airway Muscles
Duvaldestin, Philippe
Anesthesiology. 112(1):246, January 2010.
doi: 10.1097/ALN.0b013e3181c5da8b
Residual Neuromuscular Blockade and Upper Airway Muscles
Herbstreit, Frank; Peters, Jürgen; Eikermann, Matthias
Anesthesiology. 112(1):246-247, January 2010.
doi: 10.1097/ALN.0b013e3181c65f45
Inhibition of Muscle Acetylcholine Receptors by Nondepolarizing Drugs: Humans Are Not Unique
Dilger, James P.; Steinbach, Joe Henry
Anesthesiology. 112(1):247-249, January 2010.
doi: 10.1097/ALN.0b013e3181c5dbbc
Inhibition of Muscle Acetylcholine Receptors by Nondepolarizing Drugs: Humans Are Not Unique
Fagerlund, Malin Jonsson; Dabrowski, Michael A.; Eriksson, Lars I.
Anesthesiology. 112(1):249-250, January 2010.
doi: 10.1097/ALN.0b013e3181c6611b
Ultrasound-guided Supraclavicular Block: What Is Intraneural?
Morfey, Dorothea; Brull, Richard
Anesthesiology. 112(1):250-251, January 2010.
doi: 10.1097/ALN.0b013e3181c5d943
Ultrasound-guided Supraclavicular Block: What Is Intraneural?
Bigeleisen, Paul E.; Groen, Gerbrand; Moayeri, Nizar
Anesthesiology. 112(1):251-252, January 2010.
doi: 10.1097/ALN.0b013e3181c63023
A Case of Accidental Hypotension Caused by Drug Leakage through the Rubber Piston in a Prefilled Inovan Injection 0.3% Syringe
Amagasa, Sumio; Igarashi, Ayuko; Sato, Masayoshi; Suzuki, Junichi; Kishi, Takayuki
Anesthesiology. 112(1):252-254, January 2010.
doi: 10.1097/01.anes.0000365961.51397.b9
A Case of Accidental Hypotension Caused by Drug Leakage through the Rubber Piston in a Prefilled Inovan Injection 0.3% Syringe
Pulsford, A Hugh
Anesthesiology. 112(1):254-255, January 2010.
doi: 10.1097/ALN.0b013e3181c5bbb1
Preoperative Electrocardiograms
Alexoudis, Apostolos; Spyridonidou, Aliki; Vogiatzaki, Theodosia; Iatrou, Christos
Anesthesiology. 112(1):255, January 2010.
doi: 10.1097/ALN.0b013e3181c38dc9
Reviews of Educational Material
A Practice of Anesthesia for Infants and Children, 4th Edition
Bielsky, Alan R.
Anesthesiology. 112(1):256-257, January 2010.
doi: 10.1097/ALN.0b013e3181c2d67b
Raj's Practical Management of Pain, Fourth Edition
Boyle, Patrick K.
Anesthesiology. 112(1):257-258, January 2010.
doi: 10.1097/ALN.0b013e3181c2d68d
Civetta, Taylor, and Kirby's Critical Care, 4th Edition
Jensen, Jeff
Anesthesiology. 112(1):258-259, January 2010.
doi: 10.1097/ALN.0b013e3181c5dbdc
The Soul of Medicine: Tales From the Bedside
McGoldrick, Kathryn E.
Anesthesiology. 112(1):259-260, January 2010.
doi: 10.1097/ALN.0b013e3181c5dbee
Miller's Anesthesia, Volumes 1 and 2, 7th Edition
Kalra, Praveen
Anesthesiology. 112(1):260-261, January 2010.
doi: 10.1097/ALN.0b013e3181c5dc06
Erratum
Erratum
Anesthesiology. 112(1):262, January 2010.
doi: 10.1097/ALN.0b013e3181c8371c
Announcements
Announcement and Call for Abstracts
Anesthesiology. 112(1):263-265, January 2010.
doi: 10.1097/01.anes.0000365970.79213.9f
