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Reduce, Reuse… Reprocess? Strategies for Extended Use of N95 Masks
Wanderer, Jonathan P.; Nathan, Naveen
doi : 10.1213/ANE.0000000000005300
Anesthesia & Analgesia. 132(1):1, January 2021.
Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do We Stand?
Cassorla, Lydia
doi : 10.1213/ANE.0000000000005254
Anesthesia & Analgesia. 132(1):2-14, January 2021.
The coronavirus disease 2019 (COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remains unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.
A Developing Nation’s Experience in Using Simulation-Based Training as a Preparation Tool for the Coronavirus Disease 2019 Outbreak
Loh, P. S.; Chaw, Sook-Hui; Shariffuddin, Ina I.; Ng, Ching-Choe; Yim, Carolyn C.; Hashim, Noorjahan Haneem Md
doi : 10.1213/ANE.0000000000005264
Anesthesia & Analgesia. 132(1):15-24, January 2021.
The coronavirus disease 2019 (COVID-19) pandemic affected and overwhelmed many health care systems around the world at an unprecedented speed and magnitude with devastating effects. In developing nations, smaller hospitals were unprepared to face this outbreak nor had strategies in place to do so at the beginning. Here, we describe the preparation in an anesthetic department using simulation-based training over 2 weeks, as the number of cases rose rapidly.
Effectiveness of Prone Positioning in Nonintubated Intensive Care Unit Patients With Moderate to Severe Acute Respiratory Distress Syndrome by Coronavirus Disease 2019
Taboada, Manuel; Gonz?lez, Mariana; ?lvarez, Ant?a; Gonz?lez, Irene; Garc?a, Javier; Eiras, Mar?a; Vieito, Mar?a Diaz; Naveira, Alberto; Otero, Pablo; Campa?a, Olga; Muniategui, Ignacio; Tubio, Ana; Costa, Jose; Selas, Salomé; Cari?ena, Agust?n; Mart?nez, Adri?n; Veiras, Sonia; Aneiros, Francisco; Caruezo, Valent?n; Baluja, Aurora; Alvarez, Julian
doi : 10.1213/ANE.0000000000005239
Anesthesia & Analgesia. 132(1):25-30, January 2021.
In the treatment for severe acute respiratory distress syndrome (ARDS) from coronavirus disease 2019 (COVID-19), the World Health Organization (WHO) recommends prone positioning (PP) during mechanical ventilation for periods of 12–16 h/d to potentially improve oxygenation and survival. In this prospective observational study, we evaluated the ability of long PP sessions to improve oxygenation in awake intensive care unit (ICU) patients with moderate or severe ARDS due to COVID-19.
Adaptation of an Obstetric Anesthesia Service for the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists, Workflows, and Development Tools
Li, Yunping; Ciampa, Erin J.; Zucco, Liana; Levy, Nadav; Colella, Meredith; Golen, Toni; Shainker, Scott A.; Lunderberg, J. Mark; Ramachandran, Satya Krishna; Hess, Philip E
doi : 10.1213/ANE.0000000000005256
Anesthesia & Analgesia. 132(1):31-37, January 2021.
Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training.
Barrier Devices, Intubation, and Aerosol Mitigation Strategies: Personal Protective Equipment in the Time of Coronavirus Disease 2019
Fried, Eric A.; Zhou, George; Shah, Ronak; Shin, Da Wi; Shah, Anjan; Katz, Daniel; Burnett, Garrett W. Less
doi : 10.1213/ANE.0000000000005249
Anesthesia & Analgesia. 132(1):38-45, January 2021.
Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect health care workers (HCWs) from exposure to coronavirus disease 2019 (COVID-19) during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19.
Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit
Martinez, Rebecca; Bernstein, Kyra; Ring, Laurence; Ona, Samsiya; Baptiste, Caitlin; Syeda, Sbaa; Aziz, Aleha; Robinson, Kenya; Valderrama, Natali; Sheen, Jean-Ju; D’Alton, Mary; Goffman, Dena; Gyamfi-Bannerman, Cynthia; Moroz, Leslie; Landau, Ruth
doi : 10.1213/ANE.0000000000005253
Anesthesia & Analgesia. 132(1):46-51, January 2021.
Living Large: Insights into Managing the Obese Patient
Nathan, Naveen
doi : 10.1213/ANE.0000000000005299
Anesthesia & Analgesia. 132(1):52, January 2021.
The Obese Patient: Facts, Fables, and Best Practices
Moon, Tiffany S.; Van de Putte, Peter; De Baerdemaeker, Luc; Schumann, Roman Less
doi : 10.1213/ANE.0000000000004772
Anesthesia & Analgesia. 132(1):53-64, January 2021.
The prevalence of obesity continues to rise worldwide, and anesthesiologists must be aware of current best practices in the perioperative management of the patient with obesity. Obesity alters anatomy and physiology, which complicates the evaluation and management of obese patients in the perioperative setting. Gastric point-of-care ultrasound (PoCUS) is a noninvasive tool that can be used to assess aspiration risk in the obese patient by evaluating the quantity and quality of gastric contents. An important perioperative goal is adequate end-organ perfusion. Standard noninvasive blood pressure (NIBP) is our best available routine surrogate measurement, but is vulnerable to greater inaccuracy in patients with obesity compared to the nonobese population. Current NIBP methodologies are discussed. Obese patients are at risk for wound and surgical site infections, but few studies conclusively guide the exact dosing of intraoperative prophylactic antibiotics for them. We review evidence for low-molecular-weight heparins and weight-based versus nonweight-based administration of vasoactive medications. Finally, intubation and extubation of the patient with obesity can be complicated, and evidence-based strategies are discussed to mitigate danger during intubation and extubation.
Intraoperative Ketamine for the Opioid-Naïve Patients: Move Along Folks, Nothing to See Here?
Bhatia, Anuj; Orhurhu, Vwaire; Cohen, Steven P.
doi : 10.1213/ANE.0000000000004818
Anesthesia & Analgesia. 132(1):65-68, January 2021.
Inflammation After Surgical Trauma: Bleeding or Clotting?
Dutton, Richard P
doi : 10.1213/ANE.0000000000005095
Anesthesia & Analgesia. 132(1):80-81, January 2021.
Chasing Shadows, Catching Smoke, and Estimating Anaphylaxis to Sugammadex
Johnson, Ken B.; Dutton, Richard P .
doi : 10.1213/ANE.0000000000005192
Anesthesia & Analgesia. 132(1):89-92, January 2021.
To Retrograde Autologous Prime or Not?
Skubas, Nikolaos J.; Svensson, Lars G.; Bakaeen, Faisal
doi : 10.1213/ANE.0000000000005286
Anesthesia & Analgesia. 132(1):98-99, January 2021.
Analgesic Effect of Intraoperative Intravenous S-Ketamine in Opioid-Naïve Patients After Major Lumbar Fusion Surgery Is Temporary and Not Dose-Dependent: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
Brinck, Elina C. V.; Maisniemi, Kreu; Kankare, Jyrki; Tielinen, Laura; Tarkkila, Pekka; Kontinen, Vesa K
doi : 10.1213/ANE.0000000000004729
Anesthesia & Analgesia. 132(1):69-79, January 2021.
Severe pain often accompanies major spine surgery. Opioids are the cornerstone of postoperative pain management but their use can be limited by numerous side effects. Several studies claim that adjuvant treatment with intravenous (IV) ketamine reduces opioid consumption and pain after back surgery. However, the exact role of ketamine for this indication is yet to be elucidated. We compared 2 different doses of S-ketamine with placebo on postoperative analgesic consumption, pain, and adverse events in adult, opioid-naïve patients after lumbar fusion surgery.
The Attributable Mortality of Postoperative Bleeding Exceeds the Attributable Mortality of Postoperative Venous Thromboembolism
Bellomy, Melissa L.; Engoren, Milo C.; Martin, Barbara J.; Shi, Yaping; Shotwell, Matthew S.; Hughes, Christopher G.; Freundlich, Robert E
doi : 10.1213/ANE.0000000000004989
Anesthesia & Analgesia. 132(1):82-88, January 2021.
Bleeding and venous thromboembolic disease are considered important sources of postoperative morbidity and mortality. Clinically, treatment of these 2 disorders is often competing. We sought to better understand the relative contributions of bleeding and venous thromboembolic disease to postoperative attributable mortality in a national cohort.
Incidence of Anaphylaxis to Sugammadex in a Single-Center Cohort of 19,821 Patients
Burbridge, Mark A.
doi : 10.1213/ANE.0000000000004752
Anesthesia & Analgesia. 132(1):93-97, January 2021.
Sugammadex is a modified cyclodextrin that is being increasingly used in anesthetic practice worldwide for the reversal of the aminosteroid neuromuscular blockers rocuronium and vecuronium. Its safety profile, however, is incompletely understood. One such aspect is the incidence of anaphylactic reactions that occur after its administration. While several case reports exist in the literature, there is a paucity of information on the actual incidence of anaphylactic reactions.
Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis
Hensley, Nadia B.; Gyi, Richard; Zorrilla-Vaca, Andres; Choi, Chun W.; Lawton, Jennifer S.; Brown, Charles H. IV; Frank, Steve M.; Grant, Michael C.; Cho, Brian C
doi : 10.1213/ANE.0000000000005151
Anesthesia & Analgesia. 132(1):100-107, January 2021.
Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP on perioperative allogeneic red cell transfusions in cardiac surgical patients.
Linear Regression in Medical Research
Schober, Patrick; Vetter, Thomas R.
doi : 10.1213/ANE.0000000000005206
Anesthesia & Analgesia. 132(1):108-109, January 2021.
No Abstract
Exhaled Propofol Concentrations Correlate With Plasma and Brain Tissue Concentrations in Rats
Müller-Wirtz, Lukas M.; Maurer, Felix; Brausch, Timo; Kiefer, Daniel; Floss, Maximilian; Doneit, Jonas; Volk, Thomas; Sessler, Daniel I.; Fink, Tobias; Lehr, Thorsten; Kreuer, Sascha
doi : 10.1213/ANE.0000000000004701
Anesthesia & Analgesia. 132(1):110-118, January 2021.
Propofol can be measured in exhaled gas. Exhaled and plasma propofol concentrations correlate well, but the relationship with tissue concentrations remains unknown. We thus evaluated the relationship between exhaled, plasma, and various tissue propofol concentrations. Because the drug acts in the brain, we focused on the relationship between exhaled and brain tissue propofol concentrations.
Blood Substitutes and Oxygen Therapeutics: A Review
Jahr, Jonathan S.; Guinn, Nicole R; Lowery, David R.; Shore-Lesserson, Linda; Shander, Aryeh Less
doi : 10.1213/ANE.0000000000003957
Anesthesia & Analgesia. 132(1):119-129, January 2021.
Despite the exhaustive search for an acceptable substitute to erythrocyte transfusion, neither chemical-based products such as perfluorocarbons nor hemoglobin-based oxygen carriers have succeeded in providing a reasonable alternative to allogeneic blood transfusion. However, there remain scenarios in which blood transfusion is not an option, due to patient’s religious beliefs, inability to find adequately cross-matched erythrocytes, or in remote locations. In these situations, artificial oxygen carriers may provide a mortality benefit for patients with severe, life-threatening anemia. This article provides an up-to-date review of the history and development, clinical trials, new technology, and current standing of artificial oxygen carriers as an alternative to transfusion when blood is not an option.
Intraoperative Cardiac Arrest During Adult Liver Transplantation: Incidence and Risk Factor Analysis From 7 Academic Centers in the United States
Smith, Natalie K; Zerillo, Jeron; Kim, Sang Jo; Efune, Guy E.; Wang, Cynthia; Pai, Sher-Lu; Chadha, Ryan; Kor, Todd M.; Wetzel, David R.; Hall, Michael A.; Burton, Kristen K.; Fukazawa, Kyota; Hill, Bryan; Spad, Mia-Ashley; Wax, David B.; Lin, Hung-Mo; Liu, Xiaoyu; Odeh, Jaffer; Torsher, Laurence; Kindscher, James D.; Mandell, M. Susan; Sakai, Tetsuro; DeMaria, Samuel Jr Less
doi : 10.1213/ANE.0000000000004734
Anesthesia & Analgesia. 132(1):130-139, January 2021.
Intraoperative cardiac arrest (ICA) has a reported frequency of 1 in 10,000 anesthetics but has a much higher estimated incidence in orthotopic liver transplantation (OLT). Single-center studies of ICA in OLT are limited by small sample size that prohibits multivariable regression analysis of risks.
Nonselective Compared With Selective ?-Blockade Is Associated With Less Intraoperative Hypertension in Patients With Pheochromocytomas and Paragangliomas: A Retrospective Cohort Study With Propensity Score Matching
Kong, Hao; Li, Nan; Yang, Xi-Chun; Nie, Xiao-Lu; Tian, Jie; Wang, Dong-Xin Less
doi : 10.1213/ANE.0000000000005070
Anesthesia & Analgesia. 132(1):140-149, January 2021.
Both selective and nonselective ?-blockade are used for preoperative preparation in patients with pheochromocytomas and paragangliomas (PPGLs). However, the effects of different types of ?-blockade on perioperative outcomes remain inconclusive. This study was designed to assess the association between the choice of ?-blockade and the amount of intraoperative hypertension in patients undergoing surgery for PPGLs.
Intravenous Amisulpride Does Not Meaningfully Prolong the QTc Interval at Doses Effective for the Management of Postoperative Nausea and Vomiting
Fox, Gabriel M.; Albayaty, Muna; Walker, Joanna L.; Xue, Hongqi; Darpo, Borje Less
doi : 10.1213/ANE.0000000000004538
Anesthesia & Analgesia. 132(1):150-159, January 2021.
Postoperative nausea and vomiting (PONV) are significant issues in surgical patients, and additional treatment options are needed. Dopaminergic antiemetics have been popular for their efficacy, but their use has been limited by safety concerns, especially the potential for torsade de pointes arising from QT interval prolongation. Intravenous (IV) amisulpride, a dopamine D2 and D3 antagonist shown to be effective at preventing and treating PONV at doses of 5 and 10 mg, respectively, has a dose-dependent effect on QT but at 5 mg is not associated with clinically meaningful prolongation of the heart rate-corrected QT (QTc) interval. This study was designed to evaluate the QT effect of a 10-mg dose of amisulpride, alone and when simultaneously coadministered with ondansetron, an antiemetic of a different class, also known to prolong the QT interval.
Machine Learning Applied to Registry Data: Development of a Patient-Specific Prediction Model for Blood Transfusion Requirements During Craniofacial Surgery Using the Pediatric Craniofacial Perioperative Registry Dataset
Jalali, Ali; Lonsdale, Hannah; Zamora, Lillian V.; Ahumada, Luis; Nguyen, Anh Thy H.; Rehman, Mohamed; Fackler, James; Stricker, Paul A.; Fernandez, Allison M.; Pediatric Craniofacial Collaborative Group Less
doi : 10.1213/ANE.0000000000004988
Anesthesia & Analgesia. 132(1):160-171, January 2021.
Craniosynostosis is the premature fusion of ?1 cranial sutures and often requires surgical intervention. Surgery may involve extensive osteotomies, which can lead to substantial blood loss. Currently, there are no consensus recommendations for guiding blood conservation or transfusion in this patient population. The aim of this study is to develop a machine-learning model to predict blood product transfusion requirements for individual pediatric patients undergoing craniofacial surgery.
Lung Ultrasound Findings in the Postanesthesia Care Unit Are Associated With Outcome After Major Surgery: A Prospective Observational Study in a High-Risk Cohort
Zieleskiewicz, Laurent; Papinko, Mickael; Lopez, Alexandre; Baldovini, Alice; Fiocchi, David; Meresse, Zoe; Boussuges, Alain; Thomas, Pascal Alexandre; Berdah, Stephane; Creagh-Brown, Ben; Bouhemad, Belaid; Futier, Emmanuel; Resseguier, Noémie; Antonini, François; Duclos, Gary; Leone, Marc
doi : 10.1213/ANE.0000000000004755
Anesthesia & Analgesia. 132(1):172-181, January 2021.
Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment.
Financial and Clinical Ramifications of Introducing a Novel Pediatric Enhanced Recovery After Surgery Pathway for Pediatric Complex Hip Reconstructive Surgery
Franklin, Andrew D.; Sobey, Jenna H.; Brenn, B. Randall; Johnson, Samuel R.; Schoenecker, Jonathan G.; Gartley, Alison C.; Shotwell, Matthew S.; Gay, James C.; Wanderer, Jonathan P
doi : 10.1213/ANE.0000000000004980
Anesthesia & Analgesia. 132(1):182-193, January 2021.
Enhanced recovery after surgery pathways confer significant perioperative benefits to patients and are currently well described for adult patients undergoing a variety of surgical procedures. Robust data to support enhanced recovery pathway use in children are relatively lacking in the medical literature, though clinical benefits are reported in targeted pediatric surgical populations. Surgery for complex hip pathology in the adolescent patient is painful, often requiring prolonged courses of opioid analgesia. Postoperative opioid-related side effects may lead to prolonged recovery periods and suboptimal postoperative physical function. Excessive opioid use in the perioperative period is also a major risk factor for the development of opioid misuse in adolescents. Perioperative opioid reduction strategies in this vulnerable population will help to mitigate this risk.
The Current State of Combined Pediatric Anesthesiology–Critical Care Practice: A Survey of Dual-Trained Practitioners in the United States
Welch, Timothy P.; Kilbaugh, Todd J.; McCloskey, John J.; Juriga, Lindsay L.; Abdallah, Arbi Ben; Fehr, James J. Less
doi : 10.1213/ANE.0000000000005024
Anesthesia & Analgesia. 132(1):194-201, January 2021.
Combined practice in pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM) was historically common but has declined markedly with time. The reasons for this temporal shift are unclear, but existing evidence suggests that length of training is a barrier to contemporary trainees. Among current practitioners, restriction in dual-specialty practice also occurs, for reasons that are unknown at present. We sought to describe the demographics of this population, investigate their perceptions about the field, and consider factors that lead to attrition.
Stickler Syndrome: Airway Complications in a Case Series of 502 Patients
Zimmermann, Julia; Stubbs, Daniel J.; Richards, Allan J.; Alexander, Philip; McNinch, Annie M.; Matta, Basil; Snead, Martin P. Less
doi : 10.1213/ANE.0000000000004582
Anesthesia & Analgesia. 132(1):202-209, January 2021.
Patients with Stickler syndrome often require emergency surgery and are often anesthetized in nonspecialist units, typically for retinal detachment repair. Despite the occurrence of cleft palate and Pierre-Robin sequence, there is little published literature on airway complications. Our aim was to describe anesthetic practice and complications in a nonselected series of Stickler syndrome cases. To our knowledge, this is the largest such series in the published literature.
Variation in Patient-Reported Advance Care Preferences in the Preoperative Setting
Udelsman, Brooks V.; Govea, Nicolas; Cooper, Zara; Chang, David C.; Bader, Angela; Meyer, Matthew J. Less
doi : 10.1213/ANE.0000000000004617
Anesthesia & Analgesia. 132(1):210-216, January 2021.
High-quality shared decision-making for patients undergoing elective surgical procedures includes eliciting patient goals and treatment preferences. This is particularly important, should complications occur and life-sustaining therapies be considered. Our objective was to determine the preoperative care preferences of older higher-risk patients undergoing elective procedures and to determine any factors associated with a preference for limitations to life-sustaining treatments.
Pediatric Anesthesia Severe Adverse Events Leading to Anesthetic Morbidity and Mortality in a Tertiary Care Center in a Low- and Middle-Income Country: A 25-Year Audit
Khoso, Nasir; Ghaffar, Waleed B.; Abassi, Shemila; Khan, Fauzia A
doi : 10.1213/ANE.0000000000005162
Anesthesia & Analgesia. 132(1):217-222, January 2021.
The analysis of adverse events, including morbidity and mortality (M&M), helps to identify subgroups of children at risk and to modify clinical practice. There are scant data available from low- and middle-income countries. Our aim was to estimate the proportion of pediatric patients with various severe adverse events in the perioperative period extending to 48 hours and to describe the clinical situations and causes of those events.
Interview Data Highlight Importance of “Same-State” on Anesthesiology Residency Match
Love, Ephy R.; Dexter, Franklin; Reminick, Jason I.; Sanford, Joseph A.; Karan, Suzanne
doi : 10.1213/ANE.0000000000005058
Anesthesia & Analgesia. 132(1):223-230, January 2021.
The US residency application, interview, and match processes are costly and time-intensive. We sought to quantify the importance of an applicant being from the same-state as a residency program in terms of how this impacted the number of interviews needed to match.
The Effects of Nitroglycerin on the Oxytocin Dose–Response Profile in Oxytocin-Desensitized and Naïve Human Myometrium: An In Vitro Study
Jayasooriya, Gayani S.; Carvalho, Jose C. A.; Luca, Alice; Balki, Mrinalini Less
doi : 10.1213/ANE.0000000000005055
Anesthesia & Analgesia. 132(1):231-239, January 2021.
Nitroglycerin is used for acute reduction in uterine tone. Prolonged oxytocin exposure causes desensitization of oxytocin receptors. It is unknown if nitroglycerin exposure impacts the subsequent action of oxytocin in the setting of oxytocin receptor desensitization. This study investigated the effects of nitroglycerin on oxytocin-desensitized and oxytocin-naïve human myometrium and the subsequent response to oxytocin dose–response testing in vitro.
Nonopioid GTS-21 Mitigates Burn Injury Pain in Rats by Decreasing Spinal Cord Inflammatory Responses
Zhou, Yinhui; Leung-Pitt, Yiuka; Deng, Hao; Ren, Yang; You, Zerong; Kem, William R.; Shen, Shiqian; Zhang, Wei; Mao, Jianren; Martyn, J. A. Jeevendra
doi : 10.1213/ANE.0000000000005274
Anesthesia & Analgesia. 132(1):240-252, January 2021.
Burn injury (BI) pain consists of inflammatory and neuropathic components and activates microglia. Nicotinic alpha 7 acetylcholine receptors (?7AChRs) expressed in microglia exhibit immunomodulatory activity during agonist stimulation. Efficacy of selective ?7AChR agonist GTS-21 to mitigate BI pain and spinal pain-mediators was tested.
Dexmedetomidine Provides Cardioprotection During Early or Late Reperfusion Mediated by Different Mitochondrial K+-Channels
Raupach, Annika; Karakurt, Elif; Torregroza, Carolin; Bunte, Sebastian; Feige, Katharina; Stroethoff, Martin; Brandenburger, Timo; Heinen, André; Hollmann, Markus W.; Huhn, Ragnar
doi : 10.1213/ANE.0000000000005148
Anesthesia & Analgesia. 132(1):253-260, January 2021.
Cardioprotective interventions—such as pharmacological postconditioning—are a promising strategy to reduce deleterious consequences of ischemia and reperfusion injury (I/RI) in the heart, especially as timing and onset of myocardial infarction are unpredictable. Pharmacological postconditioning by treatment with dexmedetomidine (Dex), an ?2-adrenoreceptor agonist, during reperfusion protects hearts from I/RI, independently of time point and duration of application during the reperfusion phase. The mitochondrial ATP-sensitive K+ (mKATP) and mitochondrial large-conductance calcium-sensitive potassium channel (mBKCa) play a pivotal role in mediating this cardioprotective effect. Therefore, we investigated whether Dex-induced cardioprotection during early or late reperfusion is mediated variously by these mitochondrial K+-channels.
The Clinical Use of Cricoid Pressure: First, Do No Harm
Zdravkovic, Marko; Rice, Mark J.; Brull, Sorin J.
doi : 10.1213/ANE.0000000000004360
Anesthesia & Analgesia. 132(1):261-267, January 2021.
Application of cricoid pressure (CP) during rapid sequence induction and intubation sequence has been a “standard” of care for many decades, despite limited scientific proof of its efficacy in preventing pulmonary aspiration of gastric contents. While some of the current rapid sequence induction and intubation guidelines recommend its use, other international guidelines do not, and many clinicians argue that there is insufficient evidence to either continue or abandon its use. Recently published articles and accompanying editorials have reignited the debate on the efficacy and safety of CP application and have generated multiple responses that pointed out the various (and significant) limitations of the available evidence. Thus, a critical discussion of available data must be undertaken before making a final clinical decision on such an important patient safety issue. In this review, the authors will take an objective look at the available scientific evidence about the effectiveness and safety of CP in patients at risk of pulmonary aspiration of gastric contents. We suggest that current data are inadequate to impose clinical guidelines on the use of CP because we acknowledge that currently there is not, and there may never be, a method to prevent aspiration in all patients. In addition, we reiterate that a universally accepted medical-legal standard for approaching the high-risk aspiration patient does not exist, discuss the differences in practice between the US and international practitioners regarding use of CP, and propose 5 recommendations on how future studies might be designed to obtain optimal scientific evidence about the effectiveness and safety of CP in patients at risk for pulmonary aspiration.
Creating a Residency Program for Years to Come: An Exceptional Experience
Mukhdomi, Taif J.
doi : 10.1213/ANE.0000000000005199
Anesthesia & Analgesia. 132(1):268-269, January 2021.
Gender Balance in Anesthesiology: Is a Change of Societal Mindset Needed?
von Ungern-Sternberg, Britta S.; Sommerfield, Aine
doi : 10.1213/ANE.0000000000005207
Anesthesia & Analgesia. 132(1):270-274, January 2021.
Potential Harm of Elimination of Score Reporting for the United States Medical Licensing Examination Step 1 Examination to Anesthesiology Residency Selection
Markham, Travis H.; de Haan, Johanna B.; Guzman-Reyes, Sara; Brollier, Lauren D.; Campbell, Amber N.; Pivalizza, Evan G. Less
doi : 10.1213/ANE.0000000000005235
Anesthesia & Analgesia. 132(1):275-279, January 2021.
Macrocirculation and Microcirculation: The “Batman and Superman” Story of Critical Care Resuscitation
Khanna, Ashish K.; Karamchandani, Kunal
doi : 10.1213/ANE.0000000000005272
Anesthesia & Analgesia. 132(1):280-283, January 2021.
Observation of Complement Protein Gene Expression Before and After Surgery in Opioid-Consuming and Opioid-Naive Patients
Johnson, Ken B.; Light, Alan R.; Odell, Daniel W.; Stuart, Ami R.; Radtke, Jacob; Light, Kathleen C. Less
doi : 10.1213/ANE.0000000000003722
Anesthesia & Analgesia. 132(1):e1-e5, January 2021.
Opioids may influence inflammation. We compared genes associated with pain and inflammation in patients who consumed opioids (3–120 mg of oral morphine equivalents per day) with those who did not for differential expression. White blood cells were assayed in 20 patients presenting for total lower extremity joint replacement. We focused on messenger ribonucleic acid expression of complement proteins. We report that the expression of a complement inhibitor, complement 4 binding protein A, was reduced, and the expression of a complement activator, complement factor D, was increased in opioid-consuming patients. We conclude that opioid consumption may influence expression of complement activators and inhibitors.
Daily Caffeine Consumption Does Not Influence Acupuncture Analgesia in Healthy Individuals: A Preliminary Study
Cao, Jin; Tu, Yiheng; Lang, Courtney; Vangel, Mark; Park, Joel; Liu, Jiao; Wilson, Georgia; Gollub, Randy; Orr, Scott; Kong, Jian Less
doi : 10.1213/ANE.0000000000003989
Anesthesia & Analgesia. 132(1):e6-e9, January 2021.
Animal studies suggest that caffeine may interfere with acupuncture analgesia. This study investigated the modulation effect of daily caffeine intake on acupuncture analgesia in 27 healthy subjects using a crossover design. We found that real acupuncture increased pain thresholds compared to sham acupuncture. Further, there was no association between caffeine intake measurements of daily caffeine use, duration of caffeine consumption, or their interaction and preacupuncture and postacupuncture pain threshold changes. Our findings suggest that daily caffeine intake may not influence acupuncture analgesia in the cohort of healthy subjects who participated in study.
Critical Care Medicine Review: 1000 Questions and Answers
?ribar, Andrej
doi : 10.1213/ANE.0000000000005240
Anesthesia & Analgesia. 132(1):e10, January 2021.
Practical Chronic Pain Management
Forget, Patrice
doi : 10.1213/ANE.0000000000005261
Anesthesia & Analgesia. 132(1):e11, January 2021.
Improving the Utility of Electroencephalogram-Guided Anesthesia for Prevention of Postoperative Delirium
Reis, Katherine; Clebone, Anna
doi : 10.1213/ANE.0000000000005251
Anesthesia & Analgesia. 132(1):e12, January 2021.
CO2 is Good for You!
Yaster, Myron; Gross, Jeffrey B.
doi : 10.1213/ANE.0000000000005270
Anesthesia & Analgesia. 132(1):e13, January 2021.
In Response
Gilbertson, Laura E.; Fiedorek, Michael C.; Lam, Humphrey; Austin, Thomas M
doi : 10.1213/ANE.0000000000005271
Anesthesia & Analgesia. 132(1):e13-e14, January 2021.
