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Global Impact: The Environmental Effects of Anesthetic Drugs
Nathan, Naveen MD
doi : 10.1213/ANE.0000000000005729
October 2021 - Volume 133 - Issue 4 - p 825
Man vs Machine: Closed Loop or Manual Intravenous Anesthesia?
Nathan, Naveen MD
doi : 10.1213/ANE.0000000000005731
October 2021 - Volume 133 - Issue 4 - p 836
Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update
Varughese, Shane MD; Ahmed, Raza MD
doi : 10.1213/ANE.0000000000005504
October 2021 - Volume 133 - Issue 4 - p 826-835
With an estimated worldwide volume of 266 million surgeries in 2015, the call for general inhalation anesthesia is considerable. However, widely used volatile anesthetics such as N2O and the highly fluorinated gases sevoflurane, desflurane, and isoflurane are greenhouse gases, ozone-depleting agents, or both. Because these agents undergo minimal metabolism in the body during clinical use and are primarily (?95%) eliminated unchanged via exhalation, waste anesthetic gases (WAGs) in operating rooms and postanesthesia care units can pose a challenge for overall elimination and occupational exposure. The chemical properties and global warming impacts of these gases vary, with atmospheric lifetimes of 1?5 years for sevoflurane, 3?6 years for isoflurane, 9?21 years for desflurane, and 114 years for N2O. Additionally, the use of N2O as a carrier gas for the inhalation anesthetics and as a supplement to intravenous (IV) anesthetics further contributes to these impacts. At the same time, unscavenged WAGs can result in chronic occupational exposure of health care workers to potential associated adverse health effects. Few adverse effects associated with WAGs have been documented, however, when workplace exposure limits are implemented. Specific measures that can help reduce occupational exposure and the environmental impact of inhaled anesthetics include efficient ventilation and scavenging systems, regular monitoring of airborne concentrations of waste gases to remain below recommended limits, ensuring that anesthesia equipment is well maintained, avoiding desflurane and N2O if possible, and minimizing fresh gas flow rates (eg, use of low-flow anesthesia). One alternative to volatile anesthetics may be total intravenous anesthesia (TIVA). While TIVA is not associated with the risks of occupational exposure or atmospheric pollution that are inherent to volatile anesthetic gases, clinical considerations should be weighed in the choice of agent. Appropriate procedures for the disposal of IV anesthetics must be followed to minimize any potential for negative environmental effects. Overall, although their contributions are relatively low compared with those of other human-produced substances, inhaled anesthetics are intrinsically potent greenhouse gases and pose a risk to operating-room personnel if not properly managed and scavenged. Factors to reduce waste and minimize the future impact of these substances should be considered.
Postoperative Neurocognitive Disorders After Closed-Loop Versus Manual Target Controlled-Infusion of Propofol and Remifentanil in Patients Undergoing Elective Major Noncardiac Surgery: The Randomized Controlled Postoperative Cognitive Dysfunction-Electroencephalographic-Guided Anesthetic Administration Trial
Mahr, Nicolas MD*; Bouhake, Yannis MD*; Chopard, Gilles PhD†; Liu, Ngai MD, PhD‡,§; Boichut, Nathalie MD*; Chazot, Thierry MD‡,§; Claveau, Melanie MD*; Vettoretti, Lucie PhD*; Tio, Gregory BSc?; Pili-Floury, Sebastien MD, PhD*,¶,#; Samain, Emmanuel MD, PhD*,¶,#; Besch, Guillaume MD, PhD*,¶
doi : 10.1213/ANE.0000000000005278
October 2021 - Volume 133 - Issue 4 - p 837-847
The aim of the study was to investigate whether closed-loop compared to manual bispectral index (BIS)–guided target-controlled infusion of propofol and remifentanil could decrease the incidence of postoperative neurocognitive disorders after elective major noncardiac surgery.
Determinants of Work-Related Quality of Life in French Anesthesiologists
Gafsou, Benjamin MD*,†; Becq, Marie-Christine MD*,‡; Michelet, Daphné MD, PhD*,§,?; Julien-Marsollier, Florence MD*,§,?; Brasher, Christopher MD¶,#,**; Dahmani, Souhayl MD, PhD*,§,?
doi : 10.1213/ANE.0000000000005397
October 2021 - Volume 133 - Issue 4 - p 863-872
Little evidence is available regarding work-related quality of life (WRQoL) for anesthesiologists. We aimed to explore factors associated with WRQoL among French anesthesiologists.
Focused Cardiac Ultrasound in the Operating Room—Another Important Tool for the Assessment of the Unstable Patient
Markin, Nicholas W. MD, FASE*; Coker, Bradley J. MD†; Tuck, Benjamin C. MD†; Chacon, M. Megan MD*
doi : 10.1213/ANE.0000000000005487
October 2021 - Volume 133 - Issue 4 - p 848-851
Home Is Where the Heart Is, but What About That Other Place You Spend Your Time?
Vinson, Amy E. MD
doi : 10.1213/ANE.0000000000005542
October 2021 - Volume 133 - Issue 4 - p 860-862
Guidance for a New Clinical Challenge
Joffe, Aaron M. DO*; Tung, Avery MD, FCCM†
doi : 10.1213/ANE.0000000000005703
October 2021 - Volume 133 - Issue 4 - p 873-875
Pediatric Airway Anatomy and Tracheal Tubes: It Is Not All About the Cuff
Peyton, James MBChB*,†; Foglia, Elizabeth MD‡,§; Lee, Gi Soo MD†,?
doi : 10.1213/ANE.0000000000005705
October 2021 - Volume 133 - Issue 4 - p 891-893
The International Anesthesia Research Society Coronavirus Disease 2019 Pandemic Scientific Advisory Board: Supporting a Pandemic of Positivity
Orser, Beverley A. MD, PhD, FRCPC, FCAHS, FRSC*,†; Jones, Keith A. MD‡,§
doi : 10.1213/ANE.0000000000005722
October 2021 - Volume 133 - Issue 4 - p 903-905
Intraoperative Focused Cardiac Ultrasound for Assessment of Hypotension: A Systematic Review
Navas-Blanco, Jose R. MD*; Louro, Jack MD*; Reynolds, John MLIS, AHIP†; Epstein, Richard H. MD, FASA*; Dudaryk, Roman MD*
doi : 10.1213/ANE.0000000000005336
October 2021 - Volume 133 - Issue 4 - p 852-859
Focused cardiac ultrasound (FoCUS) has become a valuable tool to assess unexplained hypotension in critically ill patients. Due to increasing availability of transthoracic echocardiography (TTE) equipment in the operating room, there is a widespread interest in its usefulness for intraoperative diagnosis of hypotension as an alternative to transesophageal echocardiography (TEE). The objective of this systematic review is to evaluate the utility of intraoperative FoCUS to assess patients experiencing unexplained hypotension while undergoing noncardiac surgery. We performed a systematic literature search of multiple publication databases for studies that evaluated the utility of intraoperative FoCUS for assessment and management of unexplained hypotension in patients undergoing noncardiac surgery, including retro- and prospective clinical studies. A summary of the study findings, study quality, and assessment of level of evidence is presented. We identified 2227 unique articles from the literature search, of which 27 were potentially relevant, and 9 were included in this review. The number of patients pooled from these studies was 255, of whom 228 had intraoperative diagnoses with the aid of intraoperative FoCUS. The level of evidence of all studies included was very low according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. This systematic review has demonstrated that FoCUS may be a useful, noninvasive method to differentiate causes of intraoperative hypotension and guide correcting interventions, although the quality of evidence is very low. Further prospective high-quality studies are needed to investigate whether intraoperative FoCUS has a diagnostic utility that is associated with improved outcomes.
Difficult Airway Management in Adult Coronavirus Disease 2019 Patients: Statement by the Society of Airway Management
Foley, Lorraine J. MD, MBA*; Urdaneta, Felipe MD†; Berkow, Lauren MD, FASA‡; Aziz, Michael F. MD§; Baker, Paul A. MBChB, MD, FANZCA?; Jagannathan, Narasimhan MD, MBA¶; Rosenblatt, William MD#; Straker, Tracey M. MD, MS, MPH, CBA**; Wong, David T. MD††; Hagberg, Carin A. MD‡‡
doi : 10.1213/ANE.0000000000005554
October 2021 - Volume 133 - Issue 4 - p 876-890
The coronavirus disease 2019 (COVID-19) disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often results in severe hypoxemia requiring airway management. Because SARS-CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue, the Society for Airway Management (SAM) created a task force to review existing literature and current practice guidelines for difficult airway management by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. The SAM task force created recommendations for the management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in the COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of Appraisal of Guidelines Research and Evaluation (AGREE) Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement.
Anatomical In Vitro Investigations of the Pediatric Larynx: A Call for Manufacturer Redesign of Tracheal Tube Cuff Location and Perhaps a Call to Reconsider the Use of Uncuffed Tracheal Tubes
Isa, Malaak MD*; Holzki, Josef MD, PhD†; Hagemeier, Anna MSc‡; Rothschild, Markus A. MD, PhD*; Coté, Charles J. MD§
doi : 10.1213/ANE.0000000000005565
October 2021 - Volume 133 - Issue 4 - p 894-902
Some in vivo studies question the traditional “funnel-shaped” infant larynx; further anatomic examinations were warranted. Examination of fixative free fresh autopsy laryngeal and upper tracheal specimens and multiple measurements was needed to determine consistency between current tracheal tube designs and anatomic observations.
Effect of 6% Hydroxyethyl Starch 130/0.4 on Inflammatory Response and Pulmonary Function in Patients Having Cardiac Surgery: A Randomized Clinical Trial
Lee, Mee Jee MD*; Tannenbaum, Charles PhD†; Mao, Guangmei PhD§; Jia, Yuan MD§; Leung, Steve MD§; Yilmaz, Hüseyin O?uz MD§; Ince, Ilker MD§; Soltesz, Edward MD, MPH?; Duncan, Andra E. MD, MS§,¶
doi : 10.1213/ANE.0000000000005664
October 2021 - Volume 133 - Issue 4 - p 906-914
Cardiac surgery with cardiopulmonary bypass induces a profound inflammatory response that, when severe, can lead to multiorgan system dysfunction. Preliminary data suggest that administration of hydroxyethyl starch (HES) solutions may mitigate an inflammatory response and improve pulmonary function. Our goal was to examine the effect of 6% HES 130/0.4 versus 5% human albumin given for intravascular plasma volume replacement on the perioperative inflammatory response and pulmonary function in patients undergoing cardiac surgery.
Association Between Short-, Intermediate-, and Long-term Mortality and Myocardial Injury After Noncardiac Surgery After Hip Fracture Surgery: A Retrospective Cohort
Vacheron, Charles-Hervé MD*,†,‡; Hentzen, Julie MD‡; Fauvernier, Mathieu PhD*,†; Fessy, Michel MD, PhD§; Chaudier, Philippe MD§; Landel, Verena PhD?; David, Jean Stephane MD, PhD‡,¶; Incagnoli, Pascal MD, PhD‡; Piriou, Vincent MD, PhD‡,¶; Friggeri, Arnaud MD, PhD‡,¶
doi : 10.1213/ANE.0000000000005528
October 2021 - Volume 133 - Issue 4 - p 915-923
For more than 20 years, hip fracture 1-year mortality has remained around 20%. An elevation of the postoperative troponin peak within 72 hours (myocardial injury after noncardiac surgery [MINS]) is associated with a greater risk of short-term mortality in the general population. However, there seem to be conflicting results in the specific population who undergo hip fracture surgery, with some studies finding an association between troponin and mortality and some not. The objective of the present study was to investigate the association of MINS and the short- (before 28th day), intermediate- (before 180th day), and long-term (before 365th day) mortality after hip fracture surgery.
Anesthetic Hypersensitivity in a Case-Controlled Series of Patients With Mitochondrial Disease
Hsieh, Vincent C. MD*; Niezgoda, Julie MD†; Sedensky, Margaret M. MD*; Hoppel, Charles L. MD‡; Morgan, Philip G. MD*
doi : 10.1213/ANE.0000000000005430
October 2021 - Volume 133 - Issue 4 - p 924-932
Children with mitochondrial disease undergo anesthesia for a wide array of surgical procedures. However, multiple medications used for their perioperative care can affect mitochondrial function. Defects in function of the mitochondrial electron transport chain (ETC) can lead to a profound hypersensitivity to sevoflurane in children. We studied the sensitivities to sevoflurane, during mask induction and maintenance of general anesthesia, in children presenting for muscle biopsies for diagnosis of mitochondrial disease.
A Remote Surveillance Platform to Monitor General Care Ward Surgical Patients for Acute Physiologic Deterioration
Safavi, Kyan C. MD, MBA*; Deng, Hao PhD*,†; Driscoll, William MA*; Nikolov, Milcho MA*; Tolia, Kalpan MA*; Wiener-Kronish, Jeanine P. MD*
doi : 10.1213/ANE.0000000000005530
October 2021 - Volume 133 - Issue 4 - p 933-939
The traditional paradigm of hospital surgical ward care consists of episodic bedside visits by providers with periodic perusals of the patient’s electronic health record (EHR). Vital signs and laboratory results are directly pushed to the EHR but not to providers themselves. Results that require intervention may not be recognized for hours. Remote surveillance programs continuously monitor electronic data and provide automatic alerts that can be routed to multidisciplinary providers. Such programs have not been explored in surgical general care wards.
Patient Satisfaction Through an Immersive Experience Using a Mobile Phone–Based Head-Mounted Display During Arthroscopic Knee Surgery Under Spinal Anesthesia: A Randomized Clinical Trial
Tharion, Joseph G. DA; Kale, Suniti MD
doi : 10.1213/ANE.0000000000005666
October 2021 - Volume 133 - Issue 4 - p 940-948
Patient satisfaction is an important element of high-quality health care. Virtual reality has been studied for its sedative and analgesic effects, as it immerses the patient into an artificial interactive environment. Deriving from this concept, we hypothesized that an immersive experience that engulfs the senses with noninteractive visual and auditory stimuli would have a positive effect on satisfaction and anxiety in patients undergoing spinal anesthesia.
Comparative Effect of Propofol and Volatile Anesthetics on Postoperative Pulmonary Complications After Lung Resection Surgery: A Randomized Clinical Trial
Li, Xue-Fei MD*; Hu, Jian-Rong BN†; Wu, Yan MD*; Chen, Ying MD*; Zhang, Meng-Qiu MD*; Yu, Hai MD, PhD*
doi : 10.1213/ANE.0000000000005334
October 2021 - Volume 133 - Issue 4 - p 949-957
The effect of general anesthetics (propofol and volatile anesthetics) on pulmonary outcome after lung resection surgery with one-lung ventilation (OLV) is yet undetermined. We evaluated the effect of intravenous anesthesia (propofol) and volatile anesthesia (sevoflurane or desflurane) regimens on postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery.
Unanticipated Consequences of Switching to Sugammadex: Anesthesia Provider Survey on the Hormone Contraceptive Drug Interaction
Dwan, Robyn L. DO; Raymond, Britany L. MD; Richardson, Michael G. MD
doi : 10.1213/ANE.0000000000005465
October 2021 - Volume 133 - Issue 4 - p 958-966
Sugammadex binds progesterone with high affinity and may interfere with hormonal contraceptive effectiveness. The clinical, economical, and ethical implications of unintended pregnancy should prompt anesthesiologists to actively consider and manage this pharmacologic interaction. We surveyed anesthesiology providers at our institution about knowledge of this potential adverse drug interaction, how they manage it clinically, and the extent to which they involve patients in shared decision-making regarding choice of neuromuscular blocker antagonist.
Association Between Hyperbaric Bupivacaine Dose and Maternal Hypotension: Retrospective Database Study of 8226 Women Undergoing Cesarean Delivery Under Spinal Anesthesia
Weiniger, Carolyn F. MB, ChB*; Heesen, Michael MD†; Knigin, David MD‡; Deutsch, Frederic BSc§; Hilber, Nicole MD†; Avidan, Alexander MD?,¶
doi : 10.1213/ANE.0000000000005518
October 2021 - Volume 133 - Issue 4 - p 967-975
Low-dose (?8 mg) hyperbaric bupivacaine for spinal anesthesia during cesarean delivery results in reduced efficacy, yet as a secondary outcome was associated with reduced frequency of spinal-induced hypotension. Our primary aim was to investigate the relationship between hyperbaric bupivacaine dose and the occurrence of spinal-induced hypotension for cesarean delivery.
Effect of Permissive Mild Hypercapnia on Cerebral Vasoreactivity in Infants: A Randomized Controlled Crossover Trial
Schopfer, Leonore MMSc*; Habre, Walid MD, PhD*,†; Pichon, Isabelle CRNA*,†; Fodor, Gergely H. MD, PhD†,‡
doi : 10.1213/ANE.0000000000005325
October 2021 - Volume 133 - Issue 4 - p 976-983
Mechanical ventilation interferes with cerebral perfusion via changes in intrathoracic pressure and/or as a consequence of alterations in CO2. Cerebral vascular vasoreactivity is dependent on CO2, and hypocapnia can potentially lead to vasoconstriction and subsequent decrease in cerebral blood flow. Thus, we aimed at characterizing whether protective ventilation with mild permissive hypercapnia improves cerebral perfusion in infants.
Association Between Intraoperative Remifentanil Dosage and Postoperative Opioid Consumption in Adolescent Idiopathic Spine Surgery: A Retrospective Cohort Study
Lo, Calvin MD, MSc*; Schwindt, Stephanie BSc†; Sharma, Richa MD*; Dubé, Rebecca MD‡,§; Faraoni, David MD, PhD*; Steinberg, Benjamin E. MD, PhD*,†; Brown, Stephen MD*,†
doi : 10.1213/ANE.0000000000005395
October 2021 - Volume 133 - Issue 4 - p 984-990
Adolescent idiopathic scoliosis (AIS) surgery is associated with significant postoperative pain. Remifentanil is a short-acting opioid that is often used as a component of total intravenous anesthesia. Remifentanil has been implicated in acute opioid tolerance and opioid-induced hyperalgesia, resulting in increased postoperative pain and opioid consumption. This retrospective study sought to investigate the relationship between the dose of intraoperative remifentanil and cumulative postoperative opioid consumption through 72 hours following surgery for pediatric AIS patients.
Quantitative Pupillometry as a Predictor of Pediatric Postoperative Opioid–Induced Respiratory Depression
Packiasabapathy, Senthil MD*; Zhang, Xue PhD†; Ding, Lili PhD†,‡; Aruldhas, Blessed W. MD*,§,?; Pawale, Dhanashri MS*; Sadhasivam, Senthilkumar MD, MPH, MBA*
doi : 10.1213/ANE.0000000000005579
October 2021 - Volume 133 - Issue 4 - p 991-999
Safe postoperative pain relief with opioids is an unmet critical medical need in children. There is a lack of objective, noninvasive bedside tool to assess central nervous system (CNS) effects of intraoperative opioids. Proactive identification of children at risk for postoperative respiratory depression (RD) will help tailor analgesic therapy and significantly improve the safety of opioids in children. Quantitative pupillometry (QP) is a noninvasive, objective, and real-time tool for monitoring CNS effect-time relationship of opioids. This exploratory study aimed to determine the association of QP measures with postoperative RD, as well as to identify the best intraoperative QP measures predictive of postoperative RD in children.
Effect of Intraoperative Arterial Hypotension on the Risk of Perioperative Stroke After Noncardiac Surgery: A Retrospective Multicenter Cohort Study
Wongtangman, Karuna MD*,†,‡; Wachtendorf, Luca J. cand.med*,‡; Blank, Michael cand.med*,‡; Grabitz, Stephanie D. MD*; Linhardt, Felix C. cand.med*,‡; Azimaraghi, Omid MD*,‡; Raub, Dana cand.med*; Pham, Stephanie BS*; Kendale, Samir M. MD*; Low, Ying H. MD§; Houle, Timothy T. PhD§; Eikermann, Matthias MD, PhD‡,?; Pollard, Richard J. MD*
doi : 10.1213/ANE.0000000000005604
October 2021 - Volume 133 - Issue 4 - p 1000-1008
Intraoperative cerebral blood flow is mainly determined by cerebral perfusion pressure and cerebral autoregulation of vasomotor tone. About 1% of patients undergoing noncardiac surgery develop ischemic stroke. We hypothesized that intraoperative hypotension within a range frequently observed in clinical practice is associated with an increased risk of perioperative ischemic stroke within 7 days after surgery.
Gender Differences in Compensation in Anesthesiology in the United States: Results of a National Survey of Anesthesiologists
Hertzberg, Linda B. MD*; Miller, Thomas R. PhD, MBA†; Byerly, Stephanie MD‡; Rebello, Elizabeth MD§; Flood, Pamela MD*; Malinzak, Elizabeth B. MD?; Doyle, Christine A. MD¶; Pease, Sonya MD, MBA#; Rock-Klotz, Jennifer A. MBA†; Kraus, Molly B. MD**; Pai, Sher-Lu MD††
doi : 10.1213/ANE.0000000000005676
October 2021 - Volume 133 - Issue 4 - p 1009-1018
A gender-based compensation gap among physicians is well documented. Even after adjusting for age, experience, work hours, productivity, and academic rank, the gender gap remained and widened over the course of a physician’s career. This study aimed to examine if a significant gender pay gap still existed for anesthesiologists in the United States.
Immediate Effects of a Continuous Peripheral Nerve Block on Postamputation Phantom and Residual Limb Pain: Secondary Outcomes From a Multicenter Randomized Controlled Clinical Trial
Ilfeld, Brian M. MD, MS*,†; Khatibi, Bahareh MD*; Maheshwari, Kamal MD, MPH‡,§; Madison, Sarah J. MD, MS*; Ali Sakr Esa, Wael MD, PhD, MBA‡,§; Mariano, Edward R. MD, MAS?; Kent, Michael L. MD¶; Hanling, Steven MD#; Sessler, Daniel I. MD**,††; Eisenach, James C. MD†,‡‡; Cohen, Steven P. MD§§; Mascha, Edward J. PhD??,¶¶; Yang, Dongsheng MS??; Padwal, Jennifer A. MD, MAS##,***; Turan, Alparslan MD‡,§; the PAINfRE Investigators
doi : 10.1213/ANE.0000000000005673
October 2021 - Volume 133 - Issue 4 - p 1019-1027
We recently reported that a 6-day continuous peripheral nerve block reduced established postamputation phantom pain 3 weeks after treatment ended. However, the immediate effects of perineural infusion (secondary outcomes) have yet to be reported.
Effects of the ABCB1 c.3435C>T (rs1045642) Polymorphism on Heat Pain Perception in Opioid-Free Adults With Chronic Pain
Hooten, W. Michael MD*; Hu, Danqing MD, PhD†; Cunningham, Julie M. PhD‡
doi : 10.1213/ANE.0000000000005629
October 2021 - Volume 133 - Issue 4 - p 1028-1035
The adenosine triphosphate-binding cassette, subfamily B, member 1 gene (ABCB1) encodes P-glycoprotein (P-gp) that influences the intracellular transport of solutes including endogenous opioid peptides. The primary objective of this study was to determine the effects of the ABCB1 polymorphism c.3435C>T (rs10454642) on heat pain (HP) perception in a group of opioid-free adults with chronic pain.
A Randomized, Multicenter, Open-Label, Blinded End Point, Phase 2, Feasibility, Efficacy, and Safety Trial of Preoperative Microvascular Protection in Patients Undergoing Major Abdominal Surgery
Yanase, Fumitaka MD*,†; Tosif, Shervin H. MBBS, MPH‡; Churilov, Leonid BSc, PhD§; Yee, Ken MD?; Bellomo, Rinaldo MD, PhD*,†; Gunn, Kerry MD?; Kim, Chang MD?; Krizhanovskii, Camilla PhD¶,#; Hahn, Robert G. MD, PhD**; Riedel, Bernhard MD, MBA, PhD††; Weinberg, Laurence MD§§
doi : 10.1213/ANE.0000000000005667
October 2021 - Volume 133 - Issue 4 - p 1036-1047
The endothelial glycocalyx, a carbohydrate-rich layer coating all endothelial surfaces, plays a fundamental role in the function of microcirculation. The primary aim of this study was to evaluate the feasibility of using dexamethasone and albumin to protect the endothelial glycocalyx in patients undergoing abdominal surgery. Secondary and exploratory outcomes included efficacy and safety.
Apelin-13 Reverses Bupivacaine-Induced Cardiotoxicity via the Adenosine Monophosphate–Activated Protein Kinase Pathway
Ye, Yingchao MD*; Cai, Yaoyao MD*; Xia, Erjie MD†; Shi, Kejian MD*; Jin, Zhousheng MD*; Chen, Hongfei MD*; Xia, Fangfang MD*; Xia, Yun MD‡; Papadimos, Thomas J. MD, MPH‡; Xu, Xuzhong MD; Liu, Le MD*; Wang, Quanguang MD*
doi : 10.1213/ANE.0000000000005692
October 2021 - Volume 133 - Issue 4 - p 1048-1059
Cardiotoxicity can be induced by the commonly used amide local anesthetic, bupivacaine. Bupivacaine can inhibit protein kinase B (AKT) phosphorylation and activated adenosine monophosphate–activated protein kinase alpha (AMPK?). It can decouple mitochondrial oxidative phosphorylation and enhance reactive oxygen species (ROS) production. Apelin enhances the phosphatidylinositol 3-kinase (PI3K)/AKT and AMPK/acetyl-CoA carboxylase (ACC) pathways, promotes the complete fatty acid oxidation in the heart, and reduces the release of ROS. In this study, we examined whether exogenous (Pyr1) apelin-13 could reverse bupivacaine-induced cardiotoxicity.
Hemodynamic and Intestinal Microcirculatory Changes in a Phenylephrine Corrected Porcine Model of Hemorrhage
Davies, Simon J. MD*,†; Mythen, Monty MD‡,§
doi : 10.1213/ANE.0000000000005388
October 2021 - Volume 133 - Issue 4 - p 1060-1069
Intraoperative hypotension is a common event, and a recent study suggests that maintenance of blood pressure may reduce complications. The splanchnic circulation provides a reservoir of blood that can be mobilized during hemorrhage; hence, intestinal microcirculation is sensitive to volume changes. The aim of this study was to assess the impact of hemorrhage on intestinal microcirculation and hemodynamics, and the effects of phenylephrine on these parameters.
Perspectives on Pain: A Visual Interpretation of Chronic Headaches
Rasmussen, Hannah K. MD
doi : 10.1213/ANE.0000000000005622
October 2021 - Volume 133 - Issue 4 - p 1070
Pick a Nice Dream
Camann, William MD
doi : 10.1213/ANE.0000000000005691
October 2021 - Volume 133 - Issue 4 - p 1071
Anesthesia Equipment: Principles and Applications, 3rd ed
Williams, Murray MBChB, FRCA; Davies, Simon J. MB, ChB, FRCA, MD
doi : 10.1213/ANE.0000000000005685
October 2021 - Volume 133 - Issue 4 - p e47
Resources for Optimal Care of Emergency Surgery
Heilbronner Samuel, Anna R. MD; Steiner, Luzius A. MD, PhD
doi : 10.1213/ANE.0000000000005686
October 2021 - Volume 133 - Issue 4 - p e48
Tracheostomy in Patients With Acute Traumatic Spinal Cord Injury: Is It Really a Matter of Timing?
Pozzi, Federico MD; Palazzo, Nadia MD; Veronese, Giacomo MD; Stagni, Giuliana PT; Sattin, Luca RN; Bastia, Luca MD; Curto, Francesco MD; Chieregato, Arturo MD
doi : 10.1213/ANE.0000000000005669
October 2021 - Volume 133 - Issue 4 - p e49-e50
In Response
Mubashir, Talha MD; Arif, Abdul A. BSc; Ernest, Prince MD; Maroufy, Vahed PhD; Chaudhry, Rabail MD; Balogh, Julius MD; Suen, Colin MD, PhD; Reskallah, Alexander MD; Williams, George W. MD
doi : 10.1213/ANE.0000000000005670
October 2021 - Volume 133 - Issue 4 - p e50-e51
Transfusion Thresholds in Cardiac Surgery
Schonberger, Robert B. MD, MHS
doi : 10.1213/ANE.0000000000005674
October 2021 - Volume 133 - Issue 4 - p e51-e52
In Response
Joshi, Ravi V. MD, FASE; Wilkey, Andrew L. MD, FASA; Greilich, Philip E. MD, MSc, FASE, FAHA
doi : 10.1213/ANE.0000000000005675
October 2021 - Volume 133 - Issue 4 - p e52-e53
Sarcopenia After Sleeve Gastrectomy: A Concern of Anesthesiologists
Tabboush, Zafer S. MD
doi : 10.1213/ANE.0000000000005687
October 2021 - Volume 133 - Issue 4 - p e53-e54
In Response
Yu, Jiawen MD; Che, Lu MD; Xu, Li MD
doi : 10.1213/ANE.0000000000005688
October 2021 - Volume 133 - Issue 4 - p e54
