Anesthesia and Analgesia

Elevated troponin levels within 3 days of surgery, independent of the presence of symptoms, are strongly linked to increased risk of short- and long-term morbidity and mortality. However, the value of screening with troponin measurements is controversial. The Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery recommends measuring daily troponin for 48 to 72 hours after surgery in high-risk patients. Nevertheless, others doubt this recommendation, in part because postoperative elevated levels of troponin describe very little in terms of disease or event-specific pathogenesis and etiology, and thus, tailoring an intervention remains a challenge. This Pro-Con debate offers evidence-based data to stimulate physician understanding of daily practice and its significance in this matter, and assist in determining whether to use (Pro) or not to use (Con) this surveillance.

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Opportunities Beyond the Anesthesiology Department: Broader Impact Through Broader Thinking

Mathis, Michael R. MD*; Schonberger, Robert B. MD, MHS†; Whitlock, Elizabeth L. MD, MSc‡; Vogt, Keith M. MD, PhD§; Lagorio, John E. MD, MBA?; Jones, Keith A. MD¶; Conroy, Joanne M. MD#; Kheterpal, Sachin MD, MBA*

doi : 10.1213/ANE.0000000000005428

February 2022 - Volume 134 - Issue 2 - p 242-252

Ensuring a productive clinical and research workforce requires bringing together physicians and communities to improve health, by strategic targeting of initiatives with clear and significant public health relevance. Within anesthesiology, the traditional perspective of the field’s health impact has focused on providing safe and effective intraoperative care, managing critical illness, and treating acute and chronic pain. However, there are limitations to such a framework for anesthesiology’s public health impact, including the transient nature of acute care episodes such as the intraoperative period and critical illness, and a historical focus on analgesia alone—rather than the complex psychosocial milieu—for pain management. Due to the often episodic nature of anesthesiologists’ interactions with patients, it remains challenging for anesthesiologists to achieve their full potential for broad impact and leadership within increasingly integrated health systems. To unlock this potential, anesthesiologists should cultivate new clinical, research, and administrative roles within the health system—transcending traditional missions, seeking interdepartmental collaborations, and taking measures to elevate anesthesiologists as dynamic and trusted leaders.

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Development, Validation, and Results of a Survey of Personal Electronic Device Use Among 299 Anesthesia Providers From a Single Institution

Porter, Steven B. MD, FASA*; Renew, J. Ross MD, FASA, FASE*; Paredes, Stephania MD*; Roscher, Christopher R. MD†; Plevak, Matthew F. BS‡; Yost, Kathleen J. PhD‡

doi : 10.1213/ANE.0000000000005708

February 2022 - Volume 134 - Issue 2 - p 269-275

The pattern of perioperative use of personal electronic devices (PEDs) among anesthesia providers in the United States is unknown.

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Multidimensional Perioperative Recovery Trajectories in a Mixed Surgical Cohort: A Longitudinal Cluster Analysis Utilizing National Institutes of Health Patient-Reported Outcome Measurement Information System Measures

Kent, Michael L. MD*; Giordano, Nicholas A. PhD, RN†; Rojas, Winifred BSN, RN, CCRP‡,§; Lindl, Mary Jo MS, RN‡,§,?; Lujan, Eugenio MD?; Buckenmaier, Chester C. III MD‡; Kroma, Raymond BS‡,§; Highland, Krista B. PhD‡,§

doi : 10.1213/ANE.0000000000005758

February 2022 - Volume 134 - Issue 2 - p 279-290

Pain trajectories have been described in numerous surgical settings where preoperative characteristics have been used to predict trajectory membership. Suboptimal pain intensity trajectories have been linked to poor longitudinal outcomes. However, numerous biopsychosocial modulators of postoperative pain may also have distinct longitudinal trajectories that may inform additional targets to improve postoperative recovery.

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Multicenter Study Evaluating Nitrous Oxide Use for Labor Analgesia at High- and Low-Altitude Institutions

Wood, Cristina MD*; Arbet, Jaron PhD†; Amura, Claudia R. PhD, MPH‡; Nodine, Priscilla PhD, CNM‡; Collins, Michelle R. CNM, PhD§; Orlando, Barbara S. MD?; Mayer, David C. MD¶; Stein, Deborah MD?; Anderson, Jessica DNP, CNM, WHNP‡

doi : 10.1213/ANE.0000000000005712

February 2022 - Volume 134 - Issue 2 - p 294-302

Nitrous oxide (N2O) has been used nationally as an analgesic in many clinical settings. While neuraxial analgesia is still the most commonly used labor analgesic in the United States, there is increasing use of N2O in labor. Given the reduction in the partial pressure of gases at a higher altitude, N2O has been reported to have reduced analgesic properties. However, there is no study to date evaluating the impact of altitude on labor analgesia and N2O.

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Effective Dose of Prophylactic Oxytocin Infusion During Cesarean Delivery in 90% Population of Nonlaboring Patients With Preeclampsia Receiving Magnesium Sulfate Therapy and Normotensives: An Up-Down Sequential Allocation Dose-Response Study

Tyagi, Asha MD*; Mohan, Aparna MBBS*; Singh, Yuvraj MD*; Luthra, Ankit MD*; Garg, Devansh MD*; Malhotra, Rajeev Kumar PhD†

doi : 10.1213/ANE.0000000000005701

February 2022 - Volume 134 - Issue 2 - p 303-311

Oxytocin administration during cesarean delivery is the first-line therapy for the prevention of uterine atony. Patients with preeclampsia may receive magnesium sulfate, a drug with known tocolytic effects, for seizure prophylaxis. However, no study has evaluated the minimum effective dose of oxytocin during cesarean delivery in women with preeclampsia.

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In Vitro Comparison of Recombinant and Plasma-Derived von Willebrand Factor Concentrate for Treatment of Acquired von Willebrand Syndrome in Adult Extracorporeal Membrane Oxygenation Patients

Mazzeffi, Michael MD, MPH, MSc*; Henderson, Reney MD†; Krause, Eric MD†; Rabin, Joseph MD†; Madathil, Ronson MD†; Chow, Jonathan MD*; Grazioli, Alison MD‡; Meyer, Michael MS§; Wu, Zhongjun PhD†; Tanaka, Kenichi MD?

doi : 10.1213/ANE.0000000000005831

February 2022 - Volume 134 - Issue 2 - p 312-321

Coagulopathic bleeding is common during adult extracorporeal membrane oxygenation (ECMO), and acquired von Willebrand syndrome is a contributing factor. We compared ECMO patient blood samples that were treated in vitro with recombinant von Willebrand Factor concentrate and plasma-derived von Willebrand Factor concentrate. Our hypothesis was that recombinant von Willebrand Factor (vWF) would have greater efficacy in increasing vWF function. Secondarily, we hypothesized that recombinant vWF would have less impact on thrombin generation.

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The Relation Between Mean Arterial Pressure and Cardiac Index in Major Abdominal Surgery Patients: A Prospective Observational Cohort Study

Kouz, Karim MD*; Bergholz, Alina*; Timmermann, Lea M.*; Brockmann, Lennart*; Flick, Moritz MD*; Hoppe, Phillip MD*; Briesenick, Luisa MD*; Schulte-Uentrop, Leonie MD*; Krause, Linda PhD†; Maheshwari, Kamal MD‡,§; Sessler, Daniel I. MD‡; Saugel, Bernd MD*,?

doi : 10.1213/ANE.0000000000005805

February 2022 - Volume 134 - Issue 2 - p 322-329

Cardiac output is an important hemodynamic variable and determines oxygen delivery. In contrast to blood pressure, cardiac output is rarely measured even in high-risk surgical patients, suggesting that clinicians consider blood pressure to be a reasonable indicator of systemic blood flow. However, the relationship depends on constant vascular tone and volume, both of which routinely vary during anesthesia and surgery. We therefore tested the hypothesis that there is no clinically meaningful correlation between mean arterial pressure and cardiac index in major abdominal surgery patients.

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Association Between Health Literacy and Enhanced Recovery After Surgery Protocol Adherence and Postoperative Outcomes Among Patients Undergoing Colorectal Cancer Surgery: A Prospective Cohort Study

Qin, Pei-Pei MD; Jin, Ju-Ying MD; Min, Su MD; Wang, Wen-Jian MD; Shen, Yi-Wei MD

doi : 10.1213/ANE.0000000000005829

February 2022 - Volume 134 - Issue 2 - p 330-340

Low health literacy (HL) adversely affects medical adherence and health outcomes in patients with chronic diseases. However, the association between HL and enhanced recovery after surgery (ERAS) adherence and postoperative outcomes has not been investigated in patients undergoing colorectal surgery.

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Association Between Body Mass Index and Outcomes in Venoarterial Extracorporeal Membrane Oxygenation

Lu, Shu Yang MD*; Ortoleva, Jamel MD†; Colon, Katia BS*; Mueller, Ariel MA*; Laflam, Andrew MD*; Shelton, Kenneth MD*; Dalia, Adam A. MD, MBA, FASE*

doi : 10.1213/ANE.0000000000005689

February 2022 - Volume 134 - Issue 2 - p 341-347

The association between obesity, or elevated body mass index (BMI), and outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) has not been well established. Recent studies in patients receiving venovenous ECMO did not detect an association between obesity and increased mortality. The purpose of this retrospective observational study is to evaluate the association between BMI and survival in patients receiving VA-ECMO for cardiogenic shock.

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The Effects of Coronavirus Disease 2019 on Pediatric Anesthesiologists: A Survey of the Members of the Society for Pediatric Anesthesia

Margolis, Rebecca D. DO, FAOCA*; Strupp, Kim M. MD†; Beacham, Abbie O. PhD‡; Yaster, Myron MD†; Austin, Thomas M. MD, MS§; Macrae, Andrew W. BS§; Diaz-Berenstain, Laura MD?; Janosy, Norah R. MD†

doi : 10.1213/ANE.0000000000005422

February 2022 - Volume 134 - Issue 2 - p 348-356

The coronavirus disease 2019 (COVID-19) pandemic has affected the personal and professional lives of all health care workers. Anesthesiologists frequently perform virus-aerosolizing procedures (eg, intubation and extubation) that place them at increased risk of infection. We sought to determine how the initial COVID-19 outbreak affected members of the Society for Pediatric Anesthesia (SPA) on both personal and professional levels. Specifically, we examined the potential effects of gender and age on personal stress, burnout, sleep deprivation, anxiety, depression, assessed job satisfaction, and explored financial impact.

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The Association Between Race and Adverse Postoperative Outcomes in Children With Congenital Heart Disease Undergoing Noncardiac Surgery

Nasr, Viviane G. MD*; Staffa, Steven J. MS†; DiNardo, James A. MD, FAAP*; Faraoni, David MD, PhD, FAHA‡

doi : 10.1213/ANE.0000000000005571

February 2022 - Volume 134 - Issue 2 - p 357-368

The association between race and perioperative outcomes has been evaluated in adult cardiac surgical and in healthy pediatric patients but has not been evaluated in children with congenital heart disease (CHD) presenting for noncardiac procedures. This study compares the incidence of the primary outcome of 30-day mortality and adverse postoperative outcomes following noncardiac surgery between Black and White children with CHD, stratified by severity.

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Oxygen Saturation and Postoperative Mortality in Patients With Acute Ischemic Stroke Treated by Endovascular Thrombectomy

Farag, Ehab MD, FRCA, FASA*,†; Liang, Chen MS†,‡; Mascha, Edward J. PhD†,‡; Toth, Gabor MD§; Argalious, Maged MD, MSc, MBA, MEd, FASE, FASA*; Manlapaz, Mariel MD*; Gomes, Joao MD?; Ebrahim, Zeyd MD*; Hussain, Muhammad Shazam MD§

doi : 10.1213/ANE.0000000000005763

February 2022 - Volume 134 - Issue 2 - p 369-379

Monitored anesthesia care (MAC) and general anesthesia (GA) with endotracheal intubation are the 2 most used techniques for patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy. We aimed to test the hypothesis that increased arterial oxygen concentration during reperfusion period is a mechanism underlying the association between use of GA (versus MAC) and increased risk of in-hospital mortality.

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Raspberry Pi-Based Data Archival System for Electroencephalogram Signals From the SedLine Root Device

Suresha, Pradyumna B. MS*; Robichaux, Chad J. MPH†; Cassim, Tuan Z. MS‡; García, Paul S. MD, PhD‡; Clifford, Gari D. DPhil†

doi : 10.1213/ANE.0000000000005774

February 2022 - Volume 134 - Issue 2 - p 380-388

The retrospective analysis of electroencephalogram (EEG) signals acquired from patients under general anesthesia is crucial in understanding the patient’s unconscious brain’s state. However, the creation of such database is often tedious and cumbersome and involves human labor. Hence, we developed a Raspberry Pi-based system for archiving EEG signals recorded from patients under anesthesia in operating rooms (ORs) with minimal human involvement.

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Cognitive Recovery by Decade in Healthy 40- to 80-Year-Old Volunteers After Anesthesia Without Surgery

Baxter, Mark G. PhD*,†; Mincer, Joshua S. MD, PhD‡; Brallier, Jess W. MD‡; Schwartz, Arthur MD†; Ahn, Helen MD†; Nir, Tommer MD, PhD†; McCormick, Patrick J. MD, MEng‡; Ismail, Mohammed BS†; Sewell, Margaret PhD§; Allore, Heather G. PhD?,¶; Ramsey, Christine M. PhD#,**; Sano, Mary PhD§,††; Deiner, Stacie G. MD†,‡‡,§§

doi : 10.1213/ANE.0000000000005824

February 2022 - Volume 134 - Issue 2 - p 389-399

Postoperative delirium and postoperative cognitive dysfunction are the most common complications for older surgical patients. General anesthesia may contribute to the development of these conditions, but there are little data on the association of age with cognitive recovery from anesthesia in the absence of surgery or underlying medical condition.

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Real-Time Ultrasound–Guided Versus Ultrasound-Assisted Spinal Anesthesia in Elderly Patients With Hip Fractures: A Randomized Controlled Trial

Chen, Luying MD*; Huang, Jieling MD*; Zhang, Yuling MD*; Qu, Bo MD†; Wu, Xinyuan MD‡; Ma, Wuhua MD, PhD‡; Li, Yuhui MD‡

doi : 10.1213/ANE.0000000000005778

February 2022 - Volume 134 - Issue 2 - p 400-409

Traditional landmark-guided spinal anesthesia can be challenging in elderly patients with hip fractures. Ultrasound assistance (USAS) and real-time ultrasound guidance (USRTG) techniques can facilitate lumbar neuraxial blocks. However, it remains undetermined which method is optimal for use in elderly patients. This study aimed to evaluate which technique was associated with a higher success rate of spinal anesthesia in elderly patients with hip fractures: USAS or USRTG technique.

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Low-Concentration Norepinephrine Infusion for Major Surgery: A Safety and Feasibility Pilot Randomized Controlled Trial

Aykanat, Verna M. FANZCA, MBBS, BMedSci (Hons)*; Myles, Paul S. MD, DSc, MBBS*; Weinberg, Laurence MD, MBBCh†; Burrell, Aidan PhD, MBBS‡,§; Bellomo, Rinaldo PhD, MBBS§,?,¶

doi : 10.1213/ANE.0000000000005811

February 2022 - Volume 134 - Issue 2 - p 410-418

Prevention of hypotension during the intra- and postoperative period is an important goal. Peripheral administration of low-concentration norepinephrine may be a safe and effective strategy to reduce the risk of hypotension.

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Dexmedetomidine Alleviates Gut-Vascular Barrier Damage and Distant Hepatic Injury Following Intestinal Ischemia/Reperfusion Injury in Mice

Zhang, Yi-Nan MD*; Chang, Ze-Nan MD†; Liu, Zi-Meng MD, PhD†; Wen, Shi-Hong MD, PhD*; Zhan, Ya-Qing MD*; Lai, Han-Jin MD†; Zhang, Hu-Fei MD*; Guo, Yi MD*; Zhang, Xu-Yu MD, PhD*

doi : 10.1213/ANE.0000000000005810

February 2022 - Volume 134 - Issue 2 - p 419-431

Intestinal ischemia/reperfusion (I/R) challenge often results in gut barrier dysfunction and induces distant organ injury. Dexmedetomidine has been shown to protect intestinal epithelial barrier against I/R attack. The present study aims to investigate the degree to which intestinal I/R attack will contribute to gut-vascular barrier (GVB) damage, and to examine the ability of dexmedetomidine to minimize GVB and liver injuries in mice.

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A Round Trip: The Japanese Contribution to the Development of Sevoflurane

Ikeda, Shigemasa MD*; Makino, Hiroshi MD, PhD†

doi : 10.1213/ANE.0000000000005384

February 2022 - Volume 134 - Issue 2 - p 432-439

Sevoflurane was first synthesized independently by Richard Wallin and Bernard Regan at Travenol Laboratories Incorporated and Ross Terrell and Louise Croix at Airco, Inc in the late 1960s, and subsequent animal studies and a phase-1 human trial of the agent published in 1981 showed promising results. Further research in the United States was halted, however, because of concerns regarding potential nephrotoxicity and the introduction of less degradable alternatives. Interest in sevoflurane resumed in Japan when Maruishi Pharmaceutical Company, Limited (Ltd) (Maruishi) decided to continue its development in 1982. They secured approval by the Japanese Ministry of Health, Labor and Welfare for its clinical use in January 1990. Because of its low blood:gas partition coefficient and resulting rapid action, sevoflurane quickly became the anesthetic of choice of Japanese anesthesiologists. In 1992 Abbott Laboratories, now AbbVie, Inc (Abbott, North Chicago, IL) finalized a licensing agreement with Maruishi to seek the US Food and Drug Administration approval for sevoflurane sales in the United States. Approved in June 1995, sevoflurane is now marketed by Abbott in 120 countries and has been administered >120 million times. This report details the Japanese contribution to the development of sevoflurane.

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Suicidal Ideation (for Paul Scott)

Hess, Aaron Stansbury MD, PhD*,†

doi : 10.1213/ANE.0000000000005808

February 2022 - Volume 134 - Issue 2 - p 440

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Moving Toward Competency-Based Training

DiBiase, Jillian A. DO; Ballard, Heather A. MD

doi : 10.1213/ANE.0000000000005719

February 2022 - Volume 134 - Issue 2 - p e6

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In Response

Quraishi, Ibrahim MD; Mufarrih, Syed Hamza MD; Mahmood, Feroze MD; Matyal, Robina MD; Mitchell, John D. MD

doi : 10.1213/ANE.0000000000005720

February 2022 - Volume 134 - Issue 2 - p e6-e7

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Pharmacokinetics Police

Fisher, Dennis M. MD; Shafer, Steven L. MD

doi : 10.1213/ANE.0000000000005813

February 2022 - Volume 134 - Issue 2 - p e7-e8

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In Response

Dalesio, Nicholas M. MD, MPH; Lee, Carlton K. K. PharmD, MPH; Hendrix, Craig W. MD

doi : 10.1213/ANE.0000000000005814

February 2022 - Volume 134 - Issue 2 - p e8-e9

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In Response

Mohamed, Sahar Abdel-Baky MD; Abdel-Ghaffar, Hala Saad MD; Hassan, Nivin Abdel-Azim MD; El Sherif, Fatma Adel MD; Shouman, Samia Abdelsamie PhD; Omran, Mervat Mostafa MD; Hassan, Sahar Badr PhD; Allam, Ayat Ahmed Abd EL-Monsef PhD,,

doi : 10.1213/ANE.0000000000005815

February 2022 - Volume 134 - Issue 2 - p e9-e11

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Effects of Obstructive Sleep Apnea and Obesity on Morphine Pharmacokinetics in Children: Erratum

doi : 10.1213/ANE.0000000000005820

February 2022 - Volume 134 - Issue 2 - p e12

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Effects of an Intraoperative Intravenous Bolus Dose of Dexmedetomidine on Remifentanil-Induced Postinfusion Hyperalgesia in Patients Undergoing Thyroidectomy: A Double-Blind Randomized Controlled Trial: Erratum

doi : 10.1213/ANE.0000000000005834

February 2022 - Volume 134 - Issue 2 - p e13

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