Anesthesia and Analgesia

Hemodynamic instability during anesthesia and surgery is common and associated with cardiac morbidity and mortality. Information is needed regarding optimal blood pressure (BP) threshold in the perioperative period. Therefore, the effect of intraoperative hypotension (IOH) on risk of perioperative myocardial infarction (MI) was explored.

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Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018

Lam, Stephanie; Qu, Helena; Hannum, Margaret; Tan, Kay See; Afonso, Anoushka; Tokita, Hanae K.; McCormick, Patrick J

doi : 10.1213/ANE.0000000000005368

Anesthesia & Analgesia. 133(1):32-40, July 2021.

Compared to general anesthesia, regional anesthesia confers several benefits including improved pain control and decreased postoperative opioid consumption. While the benefits of peripheral nerve blocks (PNB) have been well studied, there are little epidemiological data on PNB usage in mastectomy and lumpectomy procedures. The primary objective of our study was to assess national trends of the annual proportion of PNB use in breast surgery from 2010 to 2018. We also identified factors associated with PNB use for breast surgery.

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Hemodynamic Changes via the Lung Recruitment Maneuver Can Predict Fluid Responsiveness in Stroke Volume and Arterial Pressure During One-Lung Ventilation

Kimura, Aya; Suehiro, Koichi; Juri, Takashi; Fujimoto, Yohei; Yoshida, Hisako; Tanaka, Katsuaki; Mori, Takashi; Nishikawa, Kiyonobu Less

doi : 10.1213/ANE.0000000000005375

Anesthesia & Analgesia. 133(1):44-52, July 2021.

We aimed to evaluate the ability of lung recruitment maneuver–induced hemodynamic changes to predict fluid responsiveness in patients undergoing lung-protective ventilation during one-lung ventilation (OLV).

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Pro-Con Debate: Fibrinogen Concentrate or Cryoprecipitate for Treatment of Acquired Hypofibrinogenemia in Cardiac Surgical Patients

Hensley, Nadia B.; Mazzeffi, Michael A.

doi : 10.1213/ANE.0000000000005513

Anesthesia & Analgesia. 133(1):19-28, July 2021.

Cryoprecipitate has been the gold standard for treating acquired hypofibrinogenemia in cardiac surgery for nearly 50 years. More recently, fibrinogen concentrate has been used off-label in the United States and is the standard in European countries and Canada to treat the acquired hypofibrinogenemia during cardiac surgery. Fibrinogen concentrate has multiple potential advantages including rapid reconstitution, greater dose predictability, viral inactivation during processing, and reduced transfusion-related adverse events. However, because fibrinogen concentrate lacks the other components contained in the cryoprecipitate, it may not be the “ideal” product for replacing fibrinogen in all cardiac surgical patients, particularly those with longer cardiopulmonary bypass duration. In this Pro-Con commentary article, we discuss the advantages and disadvantages of using fibrinogen concentrate and cryoprecipitate to treat acquired hypofibrinogenemia in cardiac surgical patients.

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A Short Course on the Teachings of Paul Barash

Perrino, Albert C. Jr; Holt, Natalie F.

doi : 10.1213/ANE.0000000000005466

Anesthesia & Analgesia. 133(1):55-57, July 2021.

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Comparative Efficacy of 6 Topical Pharmacological Agents for Preventive Interventions of Postoperative Sore Throat After Tracheal Intubation: A Systematic Review and Network Meta-analysis

Wang, Ge; Qi, Yang; Wu, LiNa; Jiang, GuiChun

doi : 10.1213/ANE.0000000000005521

Anesthesia & Analgesia. 133(1):58-67, July 2021.

Topical pharmacological agents typically used to treat postoperative sore throat (POST) after tracheal intubation include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, lidocaine, Glycyrrhiza (licorice), and N -methyl- d -aspartate (NMDA) receptor antagonists (including ketamine and magnesium). However, the optimal prophylactic drug remains elusive.

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Vasopressors in Trauma: A Never Event?

Richards, Justin E.; Harris, Tim; Dünser, Martin W.; Bouzat, Pierre; Gauss, Tobias

doi : 10.1213/ANE.0000000000005552

Anesthesia & Analgesia. 133(1):68-79, July 2021.

Vasopressor use in severely injured trauma patients is discouraged due to concerns that vasoconstriction will worsen organ perfusion and result in increased mortality and organ failure in hypotensive trauma patients. Hypotensive resuscitation is advocated based on limited data that lower systolic blood pressure and mean arterial pressure will result in improved mortality. It is classically taught that hypotension and hypovolemia in trauma are associated with peripheral vasoconstriction. However, the pathophysiology of traumatic shock is complex and involves multiple neurohormonal interactions that are ultimately manifested by an initial sympathoexcitatory phase that attempts to compensate for acute blood loss and is characterized by vasoconstriction, tachycardia, and preserved mean arterial blood pressure. The subsequent hypotension observed in hemorrhagic shock reflects a sympathoinhibitory vasodilation phase. The objectives of hemodynamic resuscitation in hypotensive trauma patients are restoring adequate intravascular volume with a balanced ratio of blood products, correcting pathologic coagulopathy, and maintaining organ perfusion. Persistent hypotension and hypoperfusion are associated with worse coagulopathy and organ function. The practice of hypotensive resuscitation would appear counterintuitive to the goals of traumatic shock resuscitation and is not supported by consistent clinical data. In addition, excessive volume resuscitation is associated with adverse clinical outcomes. Therefore, in the resuscitation of traumatic shock, it is necessary to target an appropriate balance with intravascular volume and vascular tone. It would appear logical that vasopressors may be useful in traumatic shock resuscitation to counteract vasodilation in hemorrhage as well as other clinical conditions such as traumatic brain injury, spinal cord injury, multiple organ dysfunction syndrome, and vasodilation of general anesthetics. The purpose of this article is to discuss the controversy of vasopressors in hypotensive trauma patients and advocate for a nuanced approach to vasopressor administration in the resuscitation of traumatic shock.

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Liver and Biliary Disease of Pregnancy and Anesthetic Implications: A Review

Hansen, Jennette D.; Perri, Roman E.; Riess, Matthias L.

doi : 10.1213/ANE.0000000000005433

Anesthesia & Analgesia. 133(1):80-92, July 2021.

Liver and biliary disease complicates pregnancy in varying degrees of severity to the mother and fetus, and anesthesiologists may be asked to assist in caring for these patients before, during, and after birth of the fetus. Therefore, it is important to be familiar with how different liver diseases impact the pregnancy state. In addition, knowing symptoms, signs, and laboratory markers in the context of a pregnant patient will lead to faster diagnosis and treatment of such patients. This review article discusses changes in physiology of parturients, patients with liver disease, and parturients with liver disease. Next, general treatment of parturients with acute and chronic liver dysfunction is presented. The article progresses to specific liver diseases with treatments as they relate to pregnancy. And finally, important aspects to consider when anesthetizing parturients with liver disease are discussed.

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Intermittent Hypoxia and Effects on Early Learning/Memory: Exploring the Hippocampal Cellular Effects of Pediatric Obstructive Sleep Apnea

Chandrakantan, Arvind; Adler, Adam C.; Tohsun, Mehmet; Kheradamand, Farrah; Ray, Russell S.; Roth, Steven

doi : 10.1213/ANE.0000000000005273

Anesthesia & Analgesia. 133(1):93-103, July 2021.

This review provides an update on the neurocognitive phenotype of pediatric obstructive sleep apnea (OSA). Pediatric OSA is associated with neurocognitive deficits involving memory, learning, and executive functioning. Adenotonsillectomy (AT) is presently accepted as the first-line surgical treatment for pediatric OSA, but the executive function deficits do not resolve postsurgery, and the timeline for recovery remains unknown. This finding suggests that pediatric OSA potentially causes irreversible damage to multiple areas of the brain. The focus of this review is the hippocampus, 1 of the 2 major sites of postnatal neurogenesis, where new neurons are formed and integrated into existing circuitry and the mammalian center of learning/memory functions. Here, we review the clinical phenotype of pediatric OSA, and then discuss existing studies of OSA on different cell types in the hippocampus during critical periods of development. This will set the stage for future study using preclinical models to understand the pathogenesis of persistent neurocognitive dysfunction in pediatric OSA.

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Blood Conservation and Hemostasis in Cardiac Surgery: A Survey of Practice Variation and Adoption of Evidence-Based Guidelines

Joshi, Ravi V.; Wilkey, Andrew L.; Blackwell, James-Michael; Kwak, Jenny; Raphael, Jacob; Shore-Lesserson, Linda; Greilich, Philip E.

doi : 10.1213/ANE.0000000000005553

Anesthesia & Analgesia. 133(1):104-114, July 2021.

Blood conservation and hemostasis are integral parts of reducing avoidable blood transfusions and the associated morbidity and mortality. Despite the publication of blood conservation guidelines for cardiac surgery, evidence suggests persistent variability in practice patterns. Members of the Society of Cardiovascular Anesthesiologists (SCA) created a survey to audit conformance to existing guidelines and use the results to help narrow the evidence-to-practice gap.

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Postoperative Morbidity and Mortality in Diabetic Patients After Fast-Track Hip and Knee Arthroplasty: A Prospective Follow-up Cohort of 36,762 Procedures

Ortved, Milla; Petersen, Pelle B.; J?rgensen, Christoffer C.; Kehlet, Henrik; on behalf of the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

doi : 10.1213/ANE.0000000000005248

Anesthesia & Analgesia. 133(1):115-122, July 2021.

Diabetes increases the risk of adverse outcomes in surgical procedures, including total hip and knee arthroplasty (THA/TKA), and the prevalence of diabetic patients undergoing these procedures is high, ranging from approximately 8% to 20%. However, there is still a need to clarify the role of diabetes and antihyperglycemic treatment in a fast-track THA/TKA setting, which otherwise may decrease morbidity. Consequently, we investigated the association between diabetes and antihyperglycemic treatment on length of stay (LOS) and complications following fast-track THA/TKA within a multicenter fast-track collaboration.

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Association Between Preoperative Statin Use and Respiratory Complications After Noncardiac Surgery: A Retrospective Cohort Analysis

Komatsu, Ryu; Yilmaz, Huseyin Oguz; Makarova, Natalya; Turan, Alparslan; Sessler, Daniel I.; Rajan, Shobana; Argalious, Maged

doi : 10.1213/ANE.0000000000005194

Anesthesia & Analgesia. 133(1):123-132, July 2021.

Statins possess pleiotropic effects, which potentially benefit noncardiovascular conditions. Previous work suggests that statins reduce inflammation and prevent acute respiratory distress syndrome and infections. However, there is a paucity of data regarding potential benefits of statins on respiratory and infectious complications, particularly after noncardiac surgery. We therefore evaluated respiratory and other complications in noncardiac surgery patients taking or not taking statins preoperatively.

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The Effect of High-Flow Nasal Oxygen on Carbon Dioxide Accumulation in Apneic or Spontaneously Breathing Adults During Airway Surgery: A Randomized-Controlled Trial

Booth, Anton W. G.; Vidhani, Kim; Lee, Phil K.; Coman, Scott H.; Pelecanos, Anita M.; Dimeski, Goce; Sturgess, David J.

doi : 10.1213/ANE.0000000000005002

Anesthesia & Analgesia. 133(1):133-141, July 2021.

High-flow nasal oxygen (HFNO) is an emerging technology that has generated interest in tubeless anesthesia for airway surgery. HFNO has been shown to maintain oxygenation and CO 2 clearance in spontaneously breathing patients and is an effective approach to apneic oxygenation. Although it has been suggested that HFNO can enhance CO 2 clearance during apnea, this has not been established. The true extent of CO 2 accumulation and resulting acidosis using HFNO during prolonged tubeless anesthesia remains undefined.

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Competence in Decision Making: Setting Performance Standards for Critical Care

Murray, David J.; Boulet, John R.; Boyle, Walter A.; Beyatte, Mary Beth; Woodhouse, Julie

doi : 10.1213/ANE.0000000000005053

Anesthesia & Analgesia. 133(1):142-150, July 2021.

Health care professionals must be able to make frequent and timely decisions that can alter the illness trajectory of intensive care patients. A competence standard for this ability is difficult to establish yet assuring practitioners can make appropriate judgments is an important step in advancing patient safety. We hypothesized that simulation can be used effectively to assess decision-making competence. To test our hypothesis, we used a “standard-setting” method to derive cut scores (standards) for 16 simulated ICU scenarios targeted at decision-making skills and applied them to a cohort of critical care trainees.

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Difficulty in Advancing Flexible Epidural Catheters When Establishing Labor Analgesia: An Observational Open-Label Randomized Trial

Pancaro, Carlo; Purtell, Jasmine; LaBuda, Dana; Saager, Leif; Klumpner, Thomas T.; Dubovoy, Timur; Rajala, Baskar; Singh, Shubhangi; Cassidy, Ruth; Vahabzadeh, Christie; Maxwell, Sean; Manica, Virgil; Eckmann, David M.; Mhyre, Jill M.; Engoren, Milo C

doi : 10.1213/ANE.0000000000005526

Anesthesia & Analgesia. 133(1):151-159, July 2021.

While flexible epidural catheters reduce the risk of paresthesia and intravascular cannulation, they may be more challenging to advance beyond the tip of a Tuohy needle. This may increase placement time, number of attempts, and possibly complications when establishing labor analgesia. This study investigated the ability to advance flexible epidural catheters through different epidural needles from 2 commonly used, commercially available, epidural kits.

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Association Between Behavioral and Learning Outcomes and Single Exposures to Procedures Requiring General Anesthesia Before Age 3: Secondary Analysis of Data From Olmsted County, MN

Warner, David O.; Hu, Danqing; Zaccariello, Michael J.; Schroeder, Darrell R.; Hanson, Andrew C.; Wilder, Robert T.; Sprung, Juraj; Flick, Randall P.

doi : 10.1213/ANE.0000000000005180

Anesthesia & Analgesia. 133(1):160-167, July 2021.

Two prior population-based (children born in Olmsted County, MN), retrospective cohort studies both found that multiple exposures to anesthesia before age 3 were associated with a significant increase in the frequency of attention-deficit hyperactivity disorder (ADHD) and learning disabilities (LD) later in life. The primary purpose of this secondary analysis of these data was to test the hypothesis that a single exposure to anesthesia before age 3 was associated with an increased risk of ADHD. We also examined the association of single exposures with LD and the need for individualized educational plans as secondary outcomes.

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Comparison of Monotherapy Versus Combination of Intravenous Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial

Lee, Hye-Mi; Park, Ji-Hoon; Park, Su-Jung; Choi, Haegi; Lee, Jeong-Rim

doi : 10.1213/ANE.0000000000005284

Anesthesia & Analgesia. 133(1):168-175, July 2021.

Extensive efforts have been made toward reducing postoperative opioid use in children. In this study, we assessed whether propacetamol, or a nonsteroidal anti-inflammatory drug (NSAID), or their combination could effectively reduce opioid use in children after laparoscopic inguinal hernia repair.

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Association Between Cerebral Desaturation and Postoperative Delirium in Thoracotomy With One-Lung Ventilation: A Prospective Cohort Study

Cui, Fan; Zhao, Wei; Mu, Dong-Liang; Zhao, Xu; Li, Xue-Ying; Wang, Dong-Xin; Jia, Hui-Qun; Dai, Feng; Meng, Lingzhong

doi : 10.1213/ANE.0000000000005489

Anesthesia & Analgesia. 133(1):176-186, July 2021.

The association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation (OLV) has not been specifically studied.

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Emergency Front-of-Neck Airway Rescue Via the Cricothyroid Membrane: A High-Resolution Computed Tomography Study of Airway Anatomy in Adults

Fennessy, Paul; Greco, Eugene; Gelber, Nicholas; Brewster, David J.; Reeves, John H. Less

doi : 10.1213/ANE.0000000000005583

Anesthesia & Analgesia. 133(1):187-195, July 2021.

Emergency front-of-neck airway rescue is recommended in a can’t intubate, can’t oxygenate clinical scenario. Cannula cricothyroidotomy has been reported as having a high failure rate. Our primary aim was to estimate the angle of the trachea in relation to the horizontal axis in a simulated emergency front-of-neck airway rescue position. Our secondary aims were to estimate the optimal cannula angle of approach and evaluate the anatomical relationship of the cricothyroid membrane (CTM) to adjacent structures. We also assessed whether the CTM lies above or below the neck midpoint, a point equidistant from the suprasternal notch (SSN), and the chin surface landmarks. All measurements were compared between the male and female subjects.

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Association of Obstructive Sleep Apnea With Difficult Intubation: Prospective Multicenter Observational Cohort Study

Seet, Edwin; Chung, Frances; Wang, Chew Yin; Tam, Stanley; Kumar, Chandra M.; Ubeynarayana, Chalani U.; Yim, Carolyn C.; Chew, Eleanor F. F.; Lam, Carmen K. M.; Cheng, Benny C. P.; Chan, Matthew T. V.

doi : 10.1213/ANE.0000000000005479

Anesthesia & Analgesia. 133(1):196-204, July 2021.

Obstructive sleep apnea (OSA) has been found to be associated with difficult airway, although there is a paucity of prospective studies investigating thresholds of OSA severity with difficult airway outcomes. The aim of this study was to examine the association between OSA and difficult intubation or difficult mask ventilation. We also explored the utility of the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-Bang) score for difficult airway prediction.

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Association Between Lower Preoperative Cognition With Intraoperative Electroencephalographic Features Consistent With Deep States of Anesthesia in Older Patients: An Observational Cohort Study

Gutiérrez, Rodrigo G.; Ega?a, José I.; Maldonado, Felipe A.; S?ez, Iv?n A.; Reyes, Fernando I.; Soulat, Hugo; Purdon, Patrick L.; Penna, Antonello

doi : 10.1213/ANE.0000000000005262

Anesthesia & Analgesia. 133(1):205-214, July 2021.

Patients with low cognitive performance are thought to have a higher risk of postoperative neurocognitive disorders. Here we analyzed the relationship between preoperative cognition and anesthesia-induced brain dynamics. We hypothesized that patients with low cognitive performance would be more sensitive to anesthetics and would show differences in electroencephalogram (EEG) activity consistent with a brain anesthesia overdose.

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Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings

Mossenson, Adam I.; Bailey, Jonathan G.; Whynot, Sara; Livingston, Patricia

doi : 10.1213/ANE.0000000000005584

Anesthesia & Analgesia. 133(1):215-225, July 2021.

Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST) aims to overcome barriers limiting widespread application of simulation-based education (SBE) in resource-limited environments, providing immersive, low-cost, multidisciplinary SBE and simulation facilitator training. There is a dearth of knowledge regarding the factors supporting effective simulation facilitation in resource-limited environments. Frameworks evaluating simulation facilitation in high-income countries (HICs) are unlikely to fully assess the range of skills required by simulation facilitators working in resource-limited environments. This study explores the qualities of effective VAST facilitators; knowledge gained will inform the design of a framework for assessing simulation facilitators working in resource-limited contexts and promote more effective simulation faculty development.

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Construct Validation of the American Board of Anesthesiology’s APPLIED Examination for Initial Certification

Wang, Ting; Sun, Huaping; Zhou, Yan; Chen, Dandan; Harman, Ann E.; Isaak, Robert S.; Peterson-Layne, Cathleen; Macario, Alex; Fahy, Brenda G.; Warner, David O.

doi : 10.1213/ANE.0000000000005364

Anesthesia & Analgesia. 133(1):226-232, July 2021.

The American Board of Anesthesiology administers the APPLIED Examination as a part of initial certification, which as of 2018 includes 2 components—the Standardized Oral Examination (SOE) and the Objective Structured Clinical Examination (OSCE). The goal of this study is to investigate the measurement construct(s) of the APPLIED Examination to assess whether the SOE and the OSCE measure distinct constructs (ie, factors).

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The Effects of Intraoperative Caffeine on Postoperative Opioid Consumption and Related Outcomes After Laparoscopic Surgery: A Randomized Controlled Trial

Vlisides, Phillip E.; Li, Duan; McKinney, Amy; Brooks, Joseph; Leis, Aleda M.; Mentz, Graciela; Tsodikov, Alexander; Zierau, Mackenzie; Ragheb, Jacqueline; Clauw, Daniel J.; Avidan, Michael S.; Vanini, Giancarlo; Mashour, George A.

doi : 10.1213/ANE.0000000000005532

Anesthesia & Analgesia. 133(1):233-242, July 2021.

Surgical patients are vulnerable to opioid dependency and related risks. Clinical-translational data suggest that caffeine may enhance postoperative analgesia. This trial tested the hypothesis that intraoperative caffeine would reduce postoperative opioid consumption. The secondary objective was to assess whether caffeine improves neuropsychological recovery postoperatively.

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Controlling Anesthesia Hardware With Simple Hand Gestures: Thumbs Up or Thumbs Down?

Owens, Gwen E.; Connor, Christopher W.

doi : 10.1213/ANE.0000000000005071

Anesthesia & Analgesia. 133(1):243-250, July 2021.

Modern consumer electronic devices and automobiles are often controlled by interfaces that sense physical gestures and spoken commands. In contrast, patient monitors and anesthesia devices are typically equipped with panel-mounted buttons, dials, and keyboards. The increased use of noncontact gesture-based interfaces in anesthesia may improve patient safety through more intuitive and prompter control of equipment and also through reduced rates of surface contamination. A novel gesture-based controller was designed and retrofitted to a standard GE Solar 8000M patient monitor. This type of technical innovation is rare, due to closely held proprietary input control systems on commercially produced clinical equipment. Nevertheless, we hypothesized that anesthesiologists would find a contactless gesture interface straightforward to use.

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Cannabinoid Receptor-2 Activation in Keratinocytes Contributes to Elevated Peripheral ?-Endorphin Levels in Patients With Obstructive Jaundice

Tao, Kunming; Zhu, Jiao; Wei, Kai; Meng, Xiaoyan; Zhu, Mei; Tao, Yong; Lu, Zhijie; Yu, Weifeng

doi : 10.1213/ANE.0000000000005405

Anesthesia & Analgesia. 133(1):251-262, July 2021.

Cholestatic diseases are often accompanied by elevated plasma levels of endogenous opioid peptides, but it is still unclear whether central or peripheral mechanisms are involved in this process, and little is known about the change of pain threshold in these patients. The purpose of this study was to determine the preoperative pain threshold, postoperative morphine consumption, and central and peripheral ?-endorphin levels in patients with obstructive jaundice. This study also tests the hypothesis that activation of the cannabinoid receptor-2 (CB2R) in skin keratinocytes by endocannabinoids is the mechanism underlying circulating ?-endorphin elevation in patients with obstructive jaundice.

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Volutrauma Increases Exhaled Pentanal in Rats: A Potential Breath Biomarker for Ventilator-Induced Lung Injury

Müller-Wirtz, Lukas Martin; Kiefer, Daniel; Maurer, Felix; Floss, Maximilian Alexander; Doneit, Jonas; Hüppe, Tobias; Shopova, Theodora; Wolf, Beate; Sessler, Daniel I.; Volk, Thomas; Kreuer, Sascha; Fink, Tobias

doi : 10.1213/ANE.0000000000005576

Anesthesia & Analgesia. 133(1):263-273, July 2021.

Mechanical ventilation injures lungs, but there are currently no reliable methods for detecting early injury. We therefore evaluated whether exhaled pentanal, a lipid peroxidation product, might be a useful breath biomarker for stretch-induced lung injury in rats.

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Expert Consensus Statement on the Perioperative Management of Adult Patients Undergoing Head and Neck Surgery and Free Tissue Reconstruction From the Society for Head and Neck Anesthesia

Healy, David W.; Cloyd, Benjamin H.; Straker, Tracey; Brenner, Michael J.; Damrose, Edward J.; Spector, Matthew E.; Saxena, Amit; Atkins, Joshua H.; Ramamurthi, Radhamangalam J.; Mehta, Arpan; Aziz, Michael F.; Cattano, Davide; Levine, Adam I.; Schechtman, Samuel A.; Cavallone, Laura F.; Abdelmalak, Basem B.

doi : 10.1213/ANE.0000000000005564

Anesthesia & Analgesia. 133(1):274-283, July 2021.

The perioperative care of adult patients undergoing free tissue transfer during head and neck surgical (microvascular) reconstruction is inconsistent across practitioners and institutions. The executive board of the Society for Head and Neck Anesthesia (SHANA) nominated specialized anesthesiologists and head and neck surgeons to an expert group, to develop expert consensus statements. The group conducted an extensive review of the literature to identify evidence and gaps and to prioritize quality improvement opportunities. This report of expert consensus statements aims to improve and standardize perioperative care in this setting. The Modified Delphi method was used to evaluate the degree of agreement with draft consensus statements. Additional discussion and collaboration was performed via video conference and electronic communication to refine expert opinions and to achieve consensus on key statements. Thirty-one statements were initially formulated, 14 statements met criteria for consensus, 9 were near consensus, and 8 did not reach criteria for consensus. The expert statements reaching consensus described considerations for preoperative assessment and optimization, airway management, perioperative monitoring, fluid management, blood management, tracheal extubation, and postoperative care. This group also examined the role for vasopressors, communication, and other quality improvement efforts. This report provides the priorities and perspectives of a group of clinical experts to help guide perioperative care and provides actionable guidance for and opportunities for improvement in the care of patients undergoing free tissue transfer for head and neck reconstruction. The lack of consensus for some areas likely reflects differing clinical experiences and a limited available evidence base.

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Time to Use Peripheral Norepinephrine in the Operating Room

French, W. Brenton; Rothstein, William B.; Scott, Michael J.

doi : 10.1213/ANE.0000000000005558

Anesthesia & Analgesia. 133(1):284-288, July 2021.

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Grief, What Is Your Name?

Boateng, Adjoa A.

doi : 10.1213/ANE.0000000000005596

Anesthesia & Analgesia. 133(1):289, July 2021.

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Musings From a Musician Anesthesiologist

Gerber, Lynn Ngai

doi : 10.1213/ANE.0000000000005598

Anesthesia & Analgesia. 133(1):290, July 2021.

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Evidence-Based Practice of Critical Care, 3rd ed

Kuhlmann, Henning; Herbstreit, Frank

doi : 10.1213/ANE.0000000000005557

Anesthesia & Analgesia. 133(1):e1-e2, July 2021.

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Just One?

Turkstra, Timothy P.

doi : 10.1213/ANE.0000000000005436

Anesthesia & Analgesia. 133(1):e3, July 2021.

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Objective Structured Clinical Examination—Are They Truly Objective?

Goudra, Basavana

doi : 10.1213/ANE.0000000000005555

Anesthesia & Analgesia. 133(1):e3-e5, July 2021.

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In Response

Warner, David O.; Lien, Cynthia A.; Wang, Ting; Zhou, Yan; Isaak, Robert S.; Peterson-Layne, Cathleen; Harman, Ann E.; Macario, Alex; Gaiser, Robert R.; Suresh, Santhanam; Rathmell, James P.; Keegan, Mark T.; Cole, Daniel J.; Fahy, Brenda G.; Dainer, Rupa J.; Sun, Huaping

doi : 10.1213/ANE.0000000000005556

Anesthesia & Analgesia. 133(1):e5-e7, July 2021.

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