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Got Oxygen? Hypoxia, Aging, and Its Contributions to POCD
Shah, Sonali; Weber, Garret; Nathan, Naveen
doi : 10.1213/ANE.0000000000005560
Anesthesia & Analgesia. 132(6):1501, June 2021.
Cerebral Hypoxia: Its Role in Age-Related Chronic and Acute Cognitive Dysfunction
Snyder, Brina; Simone, Stephanie M.; Giovannetti, Tania; Floyd, Thomas F
doi : 10.1213/ANE.0000000000005525
Anesthesia & Analgesia. 132(6):1502-1513, June 2021.
Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated. Herein, we discuss the various disease processes and forms in which hypoxia may contribute to POCD. Furthermore, we outline hypoxia-related mechanisms, such as hypoxia-inducible factor activation, cerebral ischemia, cerebrovascular reserve, excitotoxicity, and neuroinflammation, which may contribute to cognitive impairment and how these mechanisms interact with aging. Finally, we discuss opportunities to prevent and manage POCD related to hypoxia.
The Time to Seriously Reassess the Use and Misuse of Neuromuscular Blockade in Children Is Now
Renew, J. Ross; Tobias, Joseph D.; Brull, Sorin J.
doi : 10.1213/ANE.0000000000005488
Anesthesia & Analgesia. 132(6):1514-1517, June 2021.
Neuraxial Anesthesia and the Ubiquitous Platelet Count Question—How Low Is Too Low?
Scavone, Barbara M.; Wong, Cynthia A.
doi : 10.1213/ANE.0000000000005496
Anesthesia & Analgesia. 132(6):1527-1530, June 2021.
Biomarkers in Cardiac Surgery: Inch by Inch Toward Perioperative Organoprotection
Heinisch, Paul P.; Meineri, Massimiliano; Luedi, Markus M.
doi : 10.1213/ANE.0000000000005511
Anesthesia & Analgesia. 132(6):1545-1547, June 2021.
Toward a Blueprint for Perioperative Handoffs and Handoff Tools
Arriaga, Alexander F.; Chen, Yun-Yun K.; Kim, Jimin J.; Bader, Angela M
doi : 10.1213/ANE.0000000000005514
Anesthesia & Analgesia. 132(6):1559-1562, June 2021.
Entrustable Professional Activities: Base Hit or Homerun?
Kinney, Daniel A.; Gaiser, Robert R.
doi : 10.1213/ANE.0000000000005529
Anesthesia & Analgesia. 132(6):1576-1578, June 2021.
A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade
Faulk, Debra J.; Austin, Thomas M.; Thomas, James J.; Strupp, Kim; Macrae, Andrew W.; Yaster, Myron
doi : 10.1213/ANE.0000000000005386
Anesthesia & Analgesia. 132(6):1518-1526, June 2021.
Although the package insert clearly states that “the safety and efficacy of sugammadex in pediatric patients have not been established,” we hypothesized that sugammadex is used widely in pediatric anesthetic practice supplanting neostigmine as the primary drug for antagonizing neuromuscular blockade (NMB). Additionally, we sought to identify the determinants by which pediatric anesthesiologists choose reversal agents and if and how they assess NMB in their practice. Finally, because of sugammadex’s effects on hormonal contraception, we sought to determine whether pediatric anesthesiologists counseled postmenarchal patients on the need for additional or alternative forms of contraception and the risk of unintended pregnancy in the perioperative period.
Free Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury After On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled Trial
Hu, Jie; Rezoagli, Emanuele; Zadek, Francesco; Bittner, Edward A.; Lei, Chong; Berra, Lorenzo
doi : 10.1213/ANE.0000000000005381
Anesthesia & Analgesia. 132(6):1548-1558, June 2021.
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a high risk of postoperative acute kidney injury (AKI). Due to limitations of current diagnostic strategies, we sought to determine whether free hemoglobin (fHb) ratio (ie, levels of fHb at the end of CPB divided by baseline fHb) could predict AKI after on-pump cardiac surgery.
Development and Pilot Testing of Entrustable Professional Activities for US Anesthesiology Residency Training
Woodworth, Glenn E.; Marty, Adrian P.; Tanaka, Pedro P.; Ambardekar, Aditee P.; Chen, Fei; Duncan, Michael J.; Fromer, Ilana R.; Hallman, Matthew R.; Klesius, Lisa L.; Ladlie, Beth L.; Mitchell, Sally Ann; Miller Juve, Amy K.; McGrath, Brian J.; Shepler, John A.; Sims, Charles III; Spofford, Christina M.; Van Cleve, Wil; Maniker, Robert B
doi : 10.1213/ANE.0000000000005434
Anesthesia & Analgesia. 132(6):1579-1591, June 2021.
Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of competencies and milestones but does not provide standardized instruments to assess and track trainee competency over time. Entrustable professional activities (EPAs) represent a workplace-based method to assess the achievement of competency milestones at the point-of-care that can be applied to anesthesiology training in the United States.
Phrenic Nerve Block at the Azygos Vein Level Versus Sham Block for Ipsilateral Shoulder Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial
Kimura Kuroiwa, Kaori; Shiko, Yuki; Kawasaki, Yohei; Aoki, Yoshitaka; Nishizawa, Masaaki; Ide, Susumu; Miura, Kentaro; Kobayashi, Nobutaka; Sehmbi, Herman Less
doi : 10.1213/ANE.0000000000005305
Anesthesia & Analgesia. 132(6):1594-1602, June 2021.
Ipsilateral shoulder pain (ISP) is a common problem after pulmonary surgery. We hypothesized that phrenic nerve block (PNB) at the azygos vein level, near the location of the surgical operation, would be effective for reducing ISP. Our primary aim was to assess the effect of PNB on postoperative ISP, following video-assisted thoracic surgery (VATS).
The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia
Bauer, Melissa E; Arendt, Katherine; Beilin, Yaakov; Gernsheimer, Terry; Perez Botero, Juliana; James, Andra H.; Yaghmour, Edward; Toledano, Roulhac D.; Turrentine, Mark; Houle, Timothy; MacEachern, Mark; Madden, Hannah; Rajasekhar, Anita; Segal, Scott; Wu, Christopher; Cooper, Jason P.; Landau, Ruth; Leffert, Lisa
doi : 10.1213/ANE.0000000000005355
Anesthesia & Analgesia. 132(6):1531-1544, June 2021.
Because up to 12% of obstetric patients meet criteria for the diagnosis of thrombocytopenia in pregnancy, it is not infrequent that the anesthesiologist must decide whether to proceed with a neuraxial procedure in an affected patient. Given the potential morbidity associated with general anesthesia for cesarean delivery, thoughtful consideration of which patients with thrombocytopenia are likely to have an increased risk of spinal epidural hematoma with neuraxial procedures, and when these risks outweigh the relative benefits is important to consider and to inform shared decision making with patients. Because there are substantial risks associated with withholding a neuraxial analgesic/anesthetic procedure in obstetric patients, every effort should be made to perform a bleeding history assessment and determine the thrombocytopenia etiology before admission for delivery. Whereas multiple other professional societies (obstetric, interventional pain, and hematologic) have published guidelines addressing platelet thresholds for safe neuraxial procedures, the US anesthesia professional societies have been silent on this topic. Despite a paucity of high-quality data, there are now meta-analyses that provide better estimations of risks. An interdisciplinary taskforce was convened to unite the relevant professional societies, synthesize the data, and provide a practical decision algorithm to help inform risk-benefit discussions and shared decision making with patients. Through a systematic review and modified Delphi process, the taskforce concluded that the best available evidence indicates the risk of spinal epidural hematoma associated with a platelet count ?70,000 × 10 6 /L is likely to be very low in obstetric patients with thrombocytopenia secondary to gestational thrombocytopenia, immune thrombocytopenia (ITP), and hypertensive disorders of pregnancy in the absence of other risk factors. Ultimately, the decision of whether to proceed with a neuraxial procedure in an obstetric patient with thrombocytopenia occurs within a clinical context. Potentially relevant factors include, but are not limited to, patient comorbidities, obstetric risk factors, airway examination, available airway equipment, risk of general anesthesia, and patient preference.
Systematic Review of Intraoperative Anesthesia Handoffs and Handoff Tools
Abraham, Joanna; Pfeifer, Ethan; Doering, Michelle; Avidan, Michael S.; Kannampallil, Thomas
doi : 10.1213/ANE.0000000000005367
Anesthesia & Analgesia. 132(6):1563-1575, June 2021.
Intraoperative handoffs between anesthesia clinicians are critical for care continuity. However, such handoffs pose a significant threat to patient safety. This systematic review synthesizes the empirical evidence on the (a) effect of intraoperative handoffs on outcomes and (b) effect of intraoperative handoff tools on outcomes. All studies on intraoperative handoffs and handoff tools published until September 2019, in any study setting and population, and with no prespecified criteria on the type of comparison and outcome were included. Data extracted from the included studies were aggregated to identify common patterns related to the type of surgery, clinician(s) involved, patient population, handoff tool, the tool design approach (where relevant), tool implementation strategies, and finally, all reported clinical and process outcomes. Quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). Fourteen studies met the inclusion criteria. All included studies used adult patients. Eight studies were retrospective cohort studies that used administrative or electronic health record (EHR)–based databases to investigate the effects of intraoperative handoffs on morbidity and mortality. These studies included a total of 680,855 surgeries, with 139,426 of these surgeries having at least 1 handoff (20.47%). Seven of the studies found a positive association between intraoperative handoffs and considered outcomes. However, a pooled meta-analysis across these studies was not feasible across the retrospective studies due to differing surgical populations and varying definitions of the considered outcomes. Six studies used a nonrandomized prospective design to evaluate the effects of handoff tools on process-based outcomes such as clinician satisfaction, information transfer, handoff duration, and adherence. Five of the 6 handoff tools were checklist based. All prospective tool-based studies relied on small samples and reported a significant improvement on the considered process-based outcomes. The median quality score among retrospective (median [interquartile range {IQR}] = 9 [1]) was significantly higher than that of prospective (median [IQR] = 5 [1.5]) studies ( U = 21, P = .0017). This systematic review provides a unique appraisal of the current state of intraoperative handoff research. To improve the quality and outcomes of handoffs, future efforts should focus on design and implementation of standardized handoff tools integrated within EHR systems, consider the use of similar metrics for evaluating handoff process and clinical outcomes, and improve the execution and reporting of studies using standard protocols and guidelines.
Linear Mixed-Effects Models in Medical Research
Schober, Patrick; Vetter, Thomas R.
doi : 10.1213/ANE.0000000000005541
Anesthesia & Analgesia. 132(6):1592-1593, June 2021.
Developing a Clinical Prediction Score: Comparing Prediction Accuracy of Integer Scores to Statistical Regression Models
Subramanian, Vigneshwar; Mascha, Edward J.; Kattan, Michael W.
doi : 10.1213/ANE.0000000000005362
Anesthesia & Analgesia. 132(6):1603-1613, June 2021.
Researchers often convert prediction tools built on statistical regression models into integer scores and risk classification systems in the name of simplicity. However, this workflow discards useful information and reduces prediction accuracy. We, therefore, investigated the impact on prediction accuracy when researchers simplify a regression model into an integer score using a simulation study and an example clinical data set. Simulated independent training and test sets (n = 1000) were randomly generated such that a logistic regression model would perform at a specified target area under the receiver operating characteristic curve (AUC) of 0.7, 0.8, or 0.9. After fitting a logistic regression with continuous covariates to each data set, continuous variables were dichotomized using data-dependent cut points. A logistic regression was refit, and the coefficients were scaled and rounded to create an integer score. A risk classification system was built by stratifying integer scores into low-, intermediate-, and high-risk tertiles. Discrimination and calibration were assessed by calculating the AUC and index of prediction accuracy (IPA) for each model. The optimism in performance between the training set and test set was calculated for both AUC and IPA. The logistic regression model using the continuous form of covariates outperformed all other models. In the simulation study, converting the logistic regression model to an integer score and subsequent risk classification system incurred an average decrease of 0.057–0.094 in AUC, and an absolute 6.2%–17.5% in IPA. The largest decrease in both AUC and IPA occurred in the dichotomization step. The dichotomization and risk stratification steps also increased the optimism of the resulting models, such that they appeared to be able to predict better than they actually would on new data. In the clinical data set, converting the logistic regression with continuous covariates to an integer score incurred a decrease in externally validated AUC of 0.06 and a decrease in externally validated IPA of 13%. Converting a regression model to an integer score decreases model performance considerably. Therefore, we recommend developing a regression model that incorporates all available information to make the most accurate predictions possible, and using the unaltered regression model when making predictions for individual patients. In all cases, researchers should be mindful that they correctly validate the specific model that is intended for clinical use.
Emerging Role of Long Noncoding RNAs in Perioperative Neurocognitive Disorders and Anesthetic-Induced Developmental Neurotoxicity
Pant, Tarun; DiStefano, Johanna K.; Logan, Sara; Bosnjak, Zeljko J. Less
doi : 10.1213/ANE.0000000000005317
Anesthesia & Analgesia. 132(6):1614-1625, June 2021.
Preclinical investigations in animal models have consistently demonstrated neurobiological changes and life-long cognitive deficits following exposure to widely used anesthetics early in life. However, the mechanisms by which these exposures affect brain function remain poorly understood, therefore, limiting the efficacy of current diagnostic and therapeutic options in human studies. The human brain exhibits an abundant expression of long noncoding RNAs (lncRNAs). These biologically active transcripts play critical roles in a diverse array of functions, including epigenetic regulation. Changes in lncRNA expression have been linked with brain development, normal CNS processes, brain injuries, and the development of neurodegenerative diseases, and many lncRNAs are known to have brain-specific expression. Aberrant lncRNA expression has also been implicated in areas of growing importance in anesthesia-related research, including anesthetic-induced developmental neurotoxicity (AIDN), a condition defined by neurological changes occurring in patients repeatedly exposed to anesthesia, and the related condition of perioperative neurocognitive disorder (PND). In this review, we detail recent advances in PND and AIDN research and summarize the evidence supporting roles for lncRNAs in the brain under both normal and pathologic conditions. We also discuss lncRNAs that have been linked with PND and AIDN, and conclude with a discussion of the clinical potential for lncRNAs to serve as diagnostic and therapeutic targets for the prevention of these neurocognitive disorders and the challenges facing the identification and characterization of associated lncRNAs.
Comparison of Liposomal Bupivacaine and Conventional Local Anesthetic Agents in Regional Anesthesia: A Systematic Review
Jin, Zhaosheng; Ding, Olivia; Islam, Ali; More
doi : 10.1213/ANE.0000000000005406
Anesthesia & Analgesia. 132(6):1626-1634, June 2021.
Pain is one of the most common adverse events after surgery. Regional anesthesia techniques are effective for pain control but have limited duration of action. Liposomal bupivacaine is a long-acting formulation of bupivacaine. We conduct this systematic review to assess whether liposomal bupivacaine may prolong the analgesic duration of regional anesthesia compared to conventional local anesthetic agents.
Association Between Antifibrinolytic Therapy and Perioperative Outcomes in Patients With Coronary Artery Stents Undergoing Noncardiac Surgery
Boswell, Michael R.; Smith, Mark M.; Frank, Ryan D.; Brown, Michael J.; Abcejo, Arnoley S.; Kor, Todd M.; Gulati, Rajiv; Smith, Bradford B
doi : 10.1213/ANE.0000000000005522
Anesthesia & Analgesia. 132(6):1635-1644, June 2021.
Patients with existing coronary artery stents are at an increased risk for major adverse cardiac events (MACEs) when undergoing noncardiac surgery (NCS). Although the use of antifibrinolytic (AF) therapy in NCS has significantly increased in the past decade, the relationship between perioperative AF use and its association with MACEs among patients with existing coronary artery stents has yet to be assessed. In this study, we aim to evaluate the association of MACEs in patients with existing coronary artery stents who receive perioperative AF therapy during orthopedic surgery.
Propofol for Induction and Maintenance of Anesthesia in Patients With Brugada Syndrome: A Single-Center, 25-Year, Retrospective Cohort Analysis
Flamée, Panagiotis; Viaene, Kea; Tosi, Maurizio; Nogueira Carvalho, Hugo; de Asmundis, Carlo; Forget, Patrice; Poelaert, Jan
doi : 10.1213/ANE.0000000000005540
Anesthesia & Analgesia. 132(6):1645-1653, June 2021.
Propofol administration in patients with Brugada syndrome (BrS) is still a matter of debate. Despite lacking evidence for its feared arrhythmogenicity, up to date, expert cardiologists recommend avoiding propofol. The main aim of this study is to assess the occurrence of malignant arrhythmias or defibrillations in patients with BrS, during and 30 days after propofol administration. The secondary aim is to investigate the occurrence of adverse events during propofol administration and hospitalization, as the 30-day readmission and 30-day mortality rate.
Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery
Gregory, Anne; Stapelfeldt, Wolf H.; Khanna, Ashish K.; Smischney, Nathan J.; Boero, Isabel J.; Chen, Qinyu; Stevens, Mitali; Shaw, Andrew D
doi : 10.1213/ANE.0000000000005250
Anesthesia & Analgesia. 132(6):1654-1665, June 2021.
Intraoperative hypotension (IOH) occurs frequently during surgery and may be associated with organ ischemia; however, few multicenter studies report data regarding its associations with adverse postoperative outcomes across varying hemodynamic thresholds. Additionally, no study has evaluated the association between IOH exposure and adverse outcomes among patients by various age groups.
Sugammadex Versus Neostigmine for Reversal of Rocuronium Neuromuscular Block in Patients Having Catheter-Based Neurointerventional Procedures: A Randomized Trial
Farag, Ehab; Rivas, Eva; Bravo, Mauro; Hussain, Shazam; Argalious, Maged; Khanna, Sandeep; Seif, John; Pu, Xuan; Mao, Guangmei; Bain, Mark; Elgabaly, Mohamed; Esa, Wael Ali Sakr; Sessler, Daniel I
doi : 10.1213/ANE.0000000000005533
Anesthesia & Analgesia. 132(6):1666-1676, June 2021.
Catheter-based endovascular neurointerventions require deep neuromuscular blocks during the procedure and rapid subsequent recovery of strength to facilitate neurological evaluation. We tested the primary hypothesis that sugammadex reverses deep neuromuscular blocks faster than neostigmine reverses moderate neuromuscular blocks.
Invasiveness of Treatment Is Gender Dependent in Intensive Care: Results From a Retrospective Analysis of 26,711 Cases
Blecha, Sebastian; Zeman, Florian; Specht, Simon; Lydia Pfefferle, Anna; Placek, Sabine; Karagiannidis, Christian; Bein, Thomas
doi : 10.1213/ANE.0000000000005082
Anesthesia & Analgesia. 132(6):1677-1683, June 2021.
Health care and outcome of critically ill patients are marked by gender-related differences. Several studies have shown that male patients in intensive care units (ICU) more often receive mechanical ventilation, dialysis, pulmonary arterial catheterization (PAC), and central venous catheterization (CVC). We investigated gender-related differences in ICU treatment and mortality.
Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma
Chanthima, Phuriphong; Yuwapattanawong, Kornkamon; Thamjamrassri, Thanyalak; Nathwani, Rajen; Stansbury, Lynn G.; Vavilala, Monica S.; Arbabi, Saman; Hess, John R. Less
doi : 10.1213/ANE.0000000000005431
Anesthesia & Analgesia. 132(6):1684-1691, June 2021.
Transfusion of citrated blood products may worsen resuscitation-induced hypocalcemia and trauma outcomes, suggesting the need for protocolized early calcium replacement in major trauma. However, the dynamics of ionized calcium during hemostatic resuscitation of severe injury are not well studied. We determined the frequency of hypocalcemia and quantified the association between the first measured ionized calcium concentration [iCa] and calcium administration early during hemostatic resuscitation and in-hospital mortality.
Attenuation of Muscle Mass and Density Is Associated With Poor Outcomes Among Patients Undergoing Major Gynecologic Surgery: A Retrospective Cohort Study
Che, Lu; Zhang, Yan; Yu, Jiawen; Xu, Li; Huang, Yuguang
doi : 10.1213/ANE.0000000000005380
Anesthesia & Analgesia. 132(6):1692-1699, June 2021.
The aim of this study was to explore the associations of preoperative sarcopenia (muscle mass depletion) and myosteatosis (muscle quality attenuation) with the incidence of postinduction hypotension (PIH) and postoperative complications among patients undergoing major gynecologic surgery.
Factors Associated With Postadenotonsillectomy Unexpected Admissions in Children
Subramanyam, Rajeev; Willging, Paul; Ding, Lili; Yang, Gang; Varughese, Anna
doi : 10.1213/ANE.0000000000005123
Anesthesia & Analgesia. 132(6):1700-1709, June 2021.
Postadenotonsillectomy unexpected admission remains an important challenge. Unexpected admissions can be quite frightening, increase health care burden, and cause unnecessary suffering in children and families. Identifying factors associated with postadenotonsillectomy unexpected admissions using a pragmatic approach could lead to a shift in the assessment and management of children presenting for adenotonsillectomy.
Parental Psychosocial Factors Moderate Opioid Administration Following Children’s Surgery
Kain, Alexandra S.; Fortier, Michelle A.; Donaldson, Candice D.; Tomaszewski, Daniel; Phan, Michael; Jenkins, Brooke N. Less
doi : 10.1213/ANE.0000000000005255
Anesthesia & Analgesia. 132(6):1710-1719, June 2021.
This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain.
Influence of Different Measurements on the Ability of P-SAP and DES-OSA Scores to Detect Severe Obstructive Sleep Apnea
Deflandre, Eric P.; Cester, Luca; Degey, Stephanie V.
doi : 10.1213/ANE.0000000000005412
Anesthesia & Analgesia. 132(6):1720-1726, June 2021.
Severe obstructive sleep apnea (sOSA) represents a risk factor of postoperative complications. Perioperative sleep apnea prediction (P-SAP) and DES-obstructive sleep apnea (DES-OSA) (DES being the acronym for 2 of the participating investigators and OSA for obstructive sleep apnea) scores were validated in the detection of such patients. They include the measurement of neck circumference (NC) and distance between thyroid and chin (DTC). The aim of this study was to evaluate the influence of the measurement method of NC and DTC on the ability of the 2 scores to detect sOSA.
An Assessment of Anesthesia Capacity in Liberia: Opportunities for Rebuilding Post-Ebola
Odinkemelu, Didi S.; Sonah, Aaron K.; Nsereko, Etienne T.; Dahn, Bernice T.; Martin, Marie H.; Moon, Troy D.; Niconchuk, Jonathan A.; Walters, Camila B.; Kynes, J. Matthew
doi : 10.1213/ANE.0000000000005456
Anesthesia & Analgesia. 132(6):1727-1737, June 2021.
The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014–2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country’s maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).
Efficacy of an Online Curriculum for Perioperative Goals of Care and Code Status Discussions: A Randomized Controlled Trial
Robertson, Amy C.; Fowler, Leslie C.; Kimball, Thomas S.; Niconchuk, Jonathan A.; Kreger, Michael T.; Brovman, Ethan Y.; Rickerson, Elizabeth; Sadovnikoff, Nicholas; Hepner, David L.; McEvoy, Matthew D.; Bader, Angela M.; Urman, Richard D. Less
doi : 10.1213/ANE.0000000000005548
Anesthesia & Analgesia. 132(6):1738-1747, June 2021.
Preoperative goals of care (GOC) and code status (CS) discussions are important in achieving an in-depth understanding of the patient’s care goals in the setting of a serious illness, enabling the clinician to ensure patient autonomy and shared decision making. Past studies have shown that anesthesiologists are not formally trained in leading these discussions and may lack the necessary skill set. We created an innovative online video curriculum designed to teach these skills. This curriculum was compared to a traditional method of learning from reading the medical literature.
Opioid Prescriptions by Pain Medicine Physicians in the Medicare Part D Program: A Cross-Sectional Study
Goel, Vasudha; Moran, Benedict; Kaizer, Alexander M.; Sivanesan, Eellan; Patwardhan, Amol M.; Ibrahim, Mohab; DeWeerth, Jacob C.; Shannon, Clarence IV; Shankar, Hariharan
doi : 10.1213/ANE.0000000000005399
Anesthesia & Analgesia. 132(6):1748-1755, June 2021.
Pain medicine physicians (PMP) are a group of physicians with background training in various primary specialties with interest and expertise in managing chronic pain disorders. Our objective is to analyze prescription drug (PD) claims from the Medicare Part D program associated with PMP to gain insights into patterns, associated costs, and potential cost savings areas.
Local Anesthetics Inhibit Transient Receptor Potential Vanilloid Subtype 3 Channel Function in Xenopus Oocytes
Horishita, Reiko; Ogata, Yuichi; Fukui, Ryo; Yamazaki, Ryo; Moriwaki, Kuniaki; Ueno, Susumu; Yanagihara, Nobuyuki; Uezono, Yasuhito; Yokoyama, Yuka; Minami, Kouichiro; Horishita, Takafumi
doi : 10.1213/ANE.0000000000005546
Anesthesia & Analgesia. 132(6):1756-1767, June 2021.
The transient receptor potential vanilloid subtype 3 (TRPV3) channel is activated by innocuous temperature and several chemical stimuli. It is proposed to be involved in pathological pain development and is therefore considered a potential target for treating pain. Local anesthetics have been used for patients with both acute and chronic pain. Although blockage of the voltage-gated sodium channel is the primary mechanism by which local anesthetics exert their effects, they cannot be explained by this mechanism alone, especially in pathologic states such as chronic pain. Indeed, the effects of local anesthetics on multiple targets involved in the pain pathway have been reported. It has also been suggested that modulating the function of transient receptor potential (TRP) channels (eg, TRPV1 and transient receptor potential ankyrin 1 [TRPA1]) is one of the mechanisms of action of local anesthetics. However, the effects of local anesthetics on TRPV3 have not been reported.
A Continuous Noninvasive Method to Assess Mixed Venous Oxygen Saturation: A Proof-of-Concept Study in Pigs
Karlsson, Jacob; L?nnqvist, Per-Arne; Wallin, Mats; Hallb?ck, Magnus
doi : 10.1213/ANE.0000000000005188
Anesthesia & Analgesia. 132(6):1768-1776, June 2021.
Mixed venous oxygen saturation (Sv o 2 ) is important when evaluating the balance between oxygen delivery and whole-body oxygen consumption. Monitoring Sv o 2 has so far required blood samples from a pulmonary artery catheter. By combining volumetric capnography, for measurement of effective pulmonary blood flow, with the Fick principle for oxygen consumption, we have developed a continuous noninvasive method, capnodynamic Sv o 2 , for assessment of Sv o 2 . The objective of this study was to validate this new technique against the gold standard cardiac output (CO)-oximetry Sv o 2 measurement of blood samples obtained from a pulmonary artery catheter and to assess the potential influence of intrapulmonary shunting.
Black Box, Gray Box, Clear Box? How Well Must We Understand Monitoring Devices?
Feldman, Jeffrey M.; Kuck, Kai; Hemmerling, Thomas
doi : 10.1213/ANE.0000000000005500
Anesthesia & Analgesia. 132(6):1777-1780, June 2021.
Anesthesia in the Postgenomic Era: Commercial Polymorphism Screening in a Cardiac Surgery Patient
Sankova, Susan K.; Deshpande, Seema; Miller, Steve P.; Tanaka, Kenichi
doi : 10.1213/ANE.0000000000005512
Anesthesia & Analgesia. 132(6):1781-1785, June 2021.
Cardiothoracic Critical Care
Liebold, Felix; Hinkelbein, Jochen
doi : 10.1213/ANE.0000000000005523
Anesthesia & Analgesia. 132(6):e96-e97, June 2021.
Interventional Management of Chronic Visceral Pain Syndrome
Hamada, Hiroshi
doi : 10.1213/ANE.0000000000005524
Anesthesia & Analgesia. 132(6):e98, June 2021.
Textbook of Ventilation, Fluids, Electrolytes and Blood Gases, 1st ed
Curtis, Michael; Bartels, Karsten
doi : 10.1213/ANE.0000000000005531
Anesthesia & Analgesia. 132(6):e99, June 2021.
Trauma Induced Coagulopathy, 2nd ed
Chaudhry, Rabail; Stephens, Christopher; Cattano, Davide
doi : 10.1213/ANE.0000000000005538
Anesthesia & Analgesia. 132(6):e100-e101, June 2021.
Sedation and Analgesia for the Pediatric Intensivist
Dajani, Khaled A.; DeYoung, Henry; Zweig, Aaron
doi : 10.1213/ANE.0000000000005539
Anesthesia & Analgesia. 132(6):e102, June 2021.
Perioperative Fluid Management, 2nd ed
Nyshadham, Soumya; Austin, Thomas M.
doi : 10.1213/ANE.0000000000005547
Anesthesia & Analgesia. 132(6):e103, June 2021.
Anesthesia for Hepatico-Pancreatic-Biliary Surgery and Transplantation
Weston, Nicholas; Hewson, David W.
doi : 10.1213/ANE.0000000000005550
Anesthesia & Analgesia. 132(6):e104-e105, June 2021.
Core Topics in Airway Management
Hinkelbein, Jochen; Yücetepe, Sirin
doi : 10.1213/ANE.0000000000005551
Anesthesia & Analgesia. 132(6):e106-e107, June 2021.
Potential Role of Reticulocyte Hemoglobin in Facilitating Patient Blood Management
H?nemann, Christian; Doll, Dietrich; Luedi, Markus M.; Zimmermann, Mathias
doi : 10.1213/ANE.0000000000005491
Anesthesia & Analgesia. 132(6):e108-e109, June 2021.
In Response
Shander, Aryeh
doi : 10.1213/ANE.0000000000005492
Anesthesia & Analgesia. 132(6):e109, June 2021.
In Response
Warner, Matthew A.; Guinn, Nicole R.
doi : 10.1213/ANE.0000000000005493
Anesthesia & Analgesia. 132(6):e109-e110, June 2021.
Pheochromocytoma and Paraganglioma and Choice of Perioperative ?-Blockade
Schumann, Roman; Groeben, Harald Thomas
doi : 10.1213/ANE.0000000000005494
Anesthesia & Analgesia. 132(6):e110-e111, June 2021.
In Response
Kong, Hao; Li, Nan; Wang, Dong-Xin
doi : 10.1213/ANE.0000000000005495
Anesthesia & Analgesia. 132(6):e111-e112, June 2021.
Pediatric One-Lung Ventilation: Additional Considerations When Using Bronchial Blockers for Lung Isolation
Kapoor, Ravish; Singh Heir, Jagtar
doi : 10.1213/ANE.0000000000005505
Anesthesia & Analgesia. 132(6):e112-e113, June 2021.
Ketamine and Perioperative Analgesia: A Predictable Outcome?
White, Paul F.
doi : 10.1213/ANE.0000000000005506
Anesthesia & Analgesia. 132(6):e113-e114, June 2021.
Ketamine Analgesia: Not All Patients or Surgeries Seem to Be Equal
Mion, Georges
doi : 10.1213/ANE.0000000000005507
Anesthesia & Analgesia. 132(6):e114-e116, June 2021.
In Response
Brinck, Elina C. V.; Kontinen, Vesa K.
doi : 10.1213/ANE.0000000000005508
Anesthesia & Analgesia. 132(6):e116-e117, June 2021.
The Obese Patient: Facts, Fables, and Best Practices: Comment
Gross, Jeffrey B.; Flores, Mario
doi : 10.1213/ANE.0000000000005515
Anesthesia & Analgesia. 132(6):e117, June 2021.
In Response
Moon, Tiffany S.; Van de Putte, Peter; De Baerdmaeker, Luc; Schumann, Roman
doi : 10.1213/ANE.0000000000005516
Anesthesia & Analgesia. 132(6):e117, June 2021.
On the Importance of Language in Reports Discussing Racial Inequities
Armstead, Valerie; Bucklin, Brenda; Bustillo, Maria; Hastie, Maya Jalbout; Lane-Fall, Meghan; Lee, Allison; Leffert, Lisa; Mackensen, G. Burkhard; Minhaj, Mohammed; Sakai, Tetsuro; Straker, Tracey; Thenuwara, Kokila; Whitlock, Elizabeth; Whittington, Robert; Wiener-Kronish, Jeanine; Wong, Cynthia
doi : 10.1213/ANE.0000000000005534
Anesthesia & Analgesia. 132(6):e117-e118, June 2021.
In Response
Willer, Brittany L.; Mpody, Christian; Tobias, Joseph D.; Nafiu, Olubukola O
doi : 10.1213/ANE.0000000000005535
Anesthesia & Analgesia. 132(6):e118-e119, June 2021.
Anesthesia-Related Oncological Outcomes: Beyond Volatiles and Total Intravenous Anesthesia
Andereggen, Lukas; Zinn, Pascal O.; Luedi, Markus M.
doi : 10.1213/ANE.0000000000005549
Anesthesia & Analgesia. 132(6):e119-e120, June 2021.
