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Acute Kidney Injury after Cardiac Surgery: The Effect of the KDIGO Bundle
Nathan, Naveen MD
doi : 10.1213/ANE.0000000000005647
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 291
Leveraging Machine Learning to Thwart the Opiate Crisis
Nathan, Naveen MD
doi : 10.1213/ANE.0000000000005648
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 303
Prevention of Cardiac Surgery–Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial
Zarbock, Alexander MD*; Küllmar, Mira MD*; Ostermann, Marlies MD†; Lucchese, Gianluca MD†; Baig, Kamran MD†; Cennamo, Armando MD†; Rajani, Ronak MD†; McCorkell, Stuart MD†; Arndt, Christian MD‡; Wulf, Hinnerk MD‡; Irqsusi, Marc MD§; Monaco, Fabrizio MD?; Di Prima, Ambra Licia MD?; Garc?a Alvarez, Mercedes MD¶; Italiano, Stefano MD¶; Miralles Bagan, Jordi MD¶; Kunst, Gudrun MD#; Nair, Shrijit MD#; L’Acqua, Camilla MD**; Hoste, Eric MD††; Vandenberghe, Wim MD††; Honore, Patrick M. MD‡‡; Kellum, John A. MD§§; Forni, Lui G. MD??; Grieshaber, Philippe MD¶¶; Massoth, Christina MD*; Weiss, Raphael MD*; Gerss, Joachim PhD##; Wempe, Carola PhD*; Meersch, Melanie MD*
doi : 10.1213/ANE.0000000000005458
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 292-302
Prospective, single-center trials have shown that the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations in high-risk patients significantly reduced the development of acute kidney injury (AKI) after surgery. We sought to evaluate the feasibility of implementing a bundle of supportive measures based on the KDIGO guideline in high-risk patients undergoing cardiac surgery in a multicenter setting in preparation for a large definitive trial.
Prediction of Prolonged Opioid Use After Surgery in Adolescents: Insights From Machine Learning
Ward, Andrew PhD*; Jani, Trisha MS†; De Souza, Elizabeth PhD‡; Scheinker, David PhD§; Bambos, Nicholas PhD*,§; Anderson, T. Anthony PhD, MD?
doi : 10.1213/ANE.0000000000005527
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 304-313
Long-term opioid use has negative health care consequences. Patients who undergo surgery are at risk for prolonged opioid use after surgery (POUS). While risk factors have been previously identified, no methods currently exist to determine higher-risk patients. We assessed the ability of a variety of machine-learning algorithms to predict adolescents at risk of POUS and to identify factors associated with this risk.
A Novel Perioperative Multidose Methadone-Based Multimodal Analgesic Strategy in Children Achieved Safe and Low Analgesic Blood Methadone Levels Enabling Opioid-Sparing Sustained Analgesia With Minimal Adverse Effects
Sadhasivam, Senthilkumar MD, MPH, MBA, FASA*; Aruldhas, Blessed W. MD*,†,‡; Packiasabapathy, Senthil MD*; Overholser, Brian R. PharmD, FCCP†,§; Zhang, Pengyue PhD?; Zang, Yong PhD?; Renschler, Janelle S. DVM, PhD*; Fitzgerald, Ryan E. MD¶; Quinney, Sara K. PharmD, PhD†,#,**
doi : 10.1213/ANE.0000000000005366
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 327-337
Intraoperative methadone, a long-acting opioid, is increasingly used for postoperative analgesia, although the optimal methadone dosing strategy in children is still unknown. The use of a single large dose of intraoperative methadone is controversial due to inconsistent reductions in total opioid use in children and adverse effects. We recently demonstrated that small, repeated doses of methadone intraoperatively and postoperatively provided sustained analgesia and reduced opioid use without respiratory depression. The aim of this study was to characterize pharmacokinetics, efficacy, and safety of a multiple small-dose methadone strategy.
The 2014 New York State Medicaid Expansion and Severe Maternal Morbidity During Delivery Hospitalizations
Guglielminotti, Jean MD, PhD*; Landau, Ruth MD*; Li, Guohua MD, DrPH*,†
doi : 10.1213/ANE.0000000000005371
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 340-348
Medicaid expansions under the Affordable Care Act have increased insurance coverage and prenatal care utilization in low-income women. However, it is not clear whether they are associated with any measurable improvement in maternal health outcomes. In this study, we compared the changes in the incidence of severe maternal morbidity (SMM) during delivery hospitalizations between low- and high-income women associated with the 2014 Medicaid expansion in New York State.
A Bayesian Comparison of Frailty Instruments in Noncardiac Surgery: A Cohort Study
McIsaac, Daniel I. MD, MPH, FRCPC*,†,‡; Aucoin, Sylvie D. MD, MSc, FRCPC*; van Walraven, Carl MD, MSc, FRCPC†,‡,§
doi : 10.1213/ANE.0000000000005290
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 366-373
Frailty—a multidimensional syndrome related to age- and disease-related deficits—is a key risk factor for older surgical patients. However, it is unknown which frailty instrument most accurately predicts postoperative outcomes. Our objectives were to quantify the probability of association and relative predictive performance of 2 frailty instruments (ie, the risk analysis index-administrative [RAI-A] and 5-item modified frailty index [mFI-5]) with postoperative outcomes in National Surgical Quality Improvement Program (NSQIP) data.
The Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis
Gracie, Thomas J. BS*; Caufield-Noll, Christine MLIS†; Wang, Nae-Yuh PhD‡; Sieber, Frederick E. MD§
doi : 10.1213/ANE.0000000000005609
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 314-323
Both frailty and postoperative delirium (POD) are common in elective surgical patients 65 years of age and older. However, the association between preoperative frailty and POD remains difficult to characterize owing to the large number of frailty and POD assessment tools used in the literature, only a few of which are validated. Furthermore, some validated frailty tools fail to provide clear score cutoffs for distinguishing frail and nonfrail patients. We performed a meta-analysis to estimate the relationship between preoperative frailty and POD.
Pediatric Perioperative Methadone Dosing Trial: An Illustration of the Challenges in Conducting High-Quality Pediatric Anesthesia Research
De Souza, Elizabeth PhD; Anderson, T. Anthony PhD, MD
doi : 10.1213/ANE.0000000000005453
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 324-326
Evidence From New York: Perinatal Insurance Expansions as a Lever to Address Maternal Morbidity
Admon, Lindsay K. MD, MSc*,†; Daw, Jamie R. PhD‡
doi : 10.1213/ANE.0000000000005468
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 338-339
Another Milestone in Anesthesiology Education
Schartel, Scott A. DO
doi : 10.1213/ANE.0000000000005574
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 349-352
Multicollinearity in Logistic Regression Models
Bayman, Emine Ozgur PhD*; Dexter, Franklin MD, PhD, FASA†
doi : 10.1213/ANE.0000000000005593
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 362-365
The Anesthesiology Milestones 2.0: An Improved Competency-Based Assessment for Residency Training
Ambardekar, Aditee P. MD, MSEd*; Walker, K. Karisa MD, MEd†; McKenzie-Brown, Anne Marie MD‡; Brennan, Kaitlyn DO, MPH§; Jackson, Chelsia MD?; Edgar, Laura EdD, CAE¶; Ellinas, Herodotos MD, MHPE#; Long, Timothy R. MD**; Trombetta, Carlos E. MD††; Laskey, Martin G. DO‡‡; Wargo, Bradley W. DO§§; Dainer, Rupa J. MD??; Draconi, Crys S. BA¶¶; Mitchell, John D. MD##
doi : 10.1213/ANE.0000000000005499
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 353-361
The evolution of medical education, from a time-based to a competency-based platform, began nearly 30 years ago and continues to slowly take shape. The development of valid and reproducible assessment tools is the first step. Medical educators across specialties acknowledge the challenges and remain motivated to develop a relevant, generalizable, and measurable system. The Accreditation Council for Graduate Medical Education (ACGME) remains committed to its responsibility to the public by assuring that the process and outcome of graduate medical education in the nation’s residency programs produce competent, safe, and compassionate doctors. The Milestones Project is the ACGME’s current strategy in the evolution to a competency-based system, which allows each specialty to develop its own set of subcompetencies and 5-level progression, or milestones, along a continuum of novice to expert. The education community has now had nearly 5 years of experience with these rubrics. While not perfect, Milestones 1.0 provided important foundational information and insights. The first iteration of the Anesthesiology Milestones highlighted some mismatch between subcompetencies and current and future clinical practices. They have also highlighted challenges with assessment and evaluation of learners, and the need for faculty development tools. Committed to an iterative process, the ACGME assembled representatives from stakeholder groups within the Anesthesiology community to develop the second generation of Milestones. This special article describes the foundational data from Milestones 1.0 that was useful in the development process of Milestones 2.0, the rationale behind the important changes, and the additional tools made available with this iteration.
Comparing Central Venous Blood Gas to Arterial Blood Gas and Determining Its Utility in Critically Ill Patients: Narrative Review
Chong, Woon H. MD*; Saha, Biplab K. MD†; Medarov, Boris I. MD*
doi : 10.1213/ANE.0000000000005501
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 374-378
Arterial blood gas (ABG) analysis is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body. However, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Central venous blood gas (VBG) is a potentially more accessible alternative to ABG sampling. Current evidence suggests that pH and Pco2 obtained via peripheral VBG correlate well with ABG measurement. Nevertheless, the value of using central VBG to guide clinical decisions or as a surrogate for ABG is unclear. The purpose of this review is to explore the relationship between ABGs and central VBGs in critically ill patients. We performed a MEDLINE search using the following search terms: venous blood gas, arterial blood gas, and central venous blood gas. We excluded studies that did not involve human subjects, and only pH and Pco2 values were reviewed and examined from the studies included. All cited references from included studies were also reviewed to identify relevant literature. We identified 7 studies that met our criteria. In studies of hemodynamically stable patients, the mean difference between arterial and central venous pH and Pco2 was 0.03 units and 4–6.5 mm Hg, respectively. However, in patients with circulatory failure, the difference between central venous and arterial pH/Pco2 was 4-fold greater. We concluded that central VBG parameters of pH and Pco2 are potentially good surrogates for determining arterial pH and Pco2 in a stable patient without severe acid-base disturbances. Furthermore, central VBG can be used as a useful screening tool for arterial hypercapnia. In addition, we derived an adjustment formula for ABG conversion from central VBG: (1) arterial pH = venous pH + 0.05 units and (2) arterial Pco2 = venous Pco2 ? 5 mm Hg.
Cerebral Emboli Monitoring Using Transcranial Doppler Ultrasonography in Adults and Children: A Review of the Current Technology and Clinical Applications in the Perioperative and Intensive Care Setting
Kussman, Barry D. MBBCh, FFA(SA)*,†; Imaduddin, Syed M. SM‡; Gharedaghi, Mohammad Hadi MD, MPH*,†; Heldt, Thomas PhD‡; LaRovere, Kerri MD§,?
doi : 10.1213/ANE.0000000000005417
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 379-392
Transcranial Doppler (TCD) ultrasonography is the only noninvasive bedside technology for the detection and monitoring of cerebral embolism. TCD may identify patients at risk of acute and chronic neurologic injury from gaseous or solid emboli. Importantly, a window of opportunity for intervention—to eliminate the source of the emboli and thereby prevent subsequent development of a clinical or subclinical stroke—may be identified using TCD. In this review, we discuss the application of TCD sonography in the perioperative and intensive care setting in adults and children known to be at increased risk of cerebral embolism. The major challenge for evaluation of emboli, especially in children, is the need to establish the ground truth and define true emboli identified by TCD. This requires the development and validation of a predictive TCD emboli monitoring technique so that appropriately designed clinical studies intended to identify specific modifiable factors and develop potential strategies to reduce pathologic cerebral embolic burden can be performed.
Outcome of Organ Dysfunction in the Perioperative Period
Thiele, Robert H. MD*; Theodore, Danny J. MD*; Gan, Tong J. MD, MBA, MHS, FRCA†
doi : 10.1213/ANE.0000000000005603
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 393-405
While intraoperative mortality has diminished greatly over the last several decades, the risk of death within 30 days of surgery remains stubbornly high and is ultimately related to perioperative organ failure. Perioperative strokes, while rare (<2% in noncardiac surgery), are associated with a more than 10-fold increase in mortality. Rapid identification and treatment are key to maximizing long-term outcomes. Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are separate but related perioperative neurological disorders, both of which are associated with poor long-term outcomes. To date, there are few known interventions that can ameliorate the risk of perioperative central nervous system dysfunction. Major adverse cardiac events (MACE) are a major contributor to adverse clinical outcomes following surgical procedures. Recently, advances in diagnostic strategies (eg, high-sensitivity cardiac troponin [hs-cTn] assays) have improved our understanding of MACE. Recently, the dabigatran in patients with myocardial injury after noncardiac surgery (MINS; Management of myocardial injury After NoncArdiac surGEry) trial demonstrated that a direct thrombin inhibitor could improve outcomes following MINS. While the risk of acute respiratory distress syndrome (ARDS) after surgery is approximately 0.2%, other less severe complications (eg, pneumonia, reintubation) are closer to 2%. While intensive care unit (ICU) concepts related to ARDS have migrated into the operating room, whether or not adverse pulmonary outcomes impact long-term outcomes in surgical patients remains a matter of debate. The standardization of acute kidney injury (AKI) definition has improved the ability of clinicians to measure and study the incidence of this important source of perioperative morbidity. AKI is associated with increased mortality as well as nonrenal morbidity (eg, myocardial infarction) after major surgery. Gastrointestinal complications after surgery range from ileus (common in abdominal procedures and associated with an increased length of stay) to less common complications such as mesenteric ischemia and gastrointestinal bleeding, both of which are associated with very high mortality. Outside of cardiothoracic surgery, the incidence of perioperative hepatic injury is not well described but, in this population, is associated with worsened long-term outcomes. Hyperglycemia is a common perioperative complication and occurs in patients undergoing both cardiac and noncardiac surgery. Both hyper- and hypoglycemia are associated with worsened long-term outcomes in cardiac and noncardiac surgery. Better diagnosis and increased understanding of perioperative organ injury has led to an increased appreciation for the specific role that particular organ systems play in poor long-term outcomes and has set the stage for targeted therapeutic interventions.
Relationship Between Intraoperative and Preoperative Ambulatory Nighttime Heart Rates: A Secondary Analysis of a Prospective Observational Study
Kouz, Karim MD*; Hoppe, Phillip MD*; Reese, Philip MD*; Burfeindt, Christian MD*; Flick, Moritz MD*; Briesenick, Luisa MD*; Nitzschke, Rainer MD*; Pinnschmidt, Hans PhD†; Saugel, Bernd MD*,‡
doi : 10.1213/ANE.0000000000005625
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 406-412
It remains unknown what constitutes physiologically relevant intraoperative bradycardia. Intraoperative bradycardia is usually defined using absolute heart rate thresholds, ignoring preoperative baseline heart rates. In contrast, we considered defining intraoperative bradycardia relative to preoperative ambulatory nighttime heart rate. Specifically, we hypothesized that the individual mean intraoperative heart rate is lower than the mean preoperative ambulatory nighttime heart rate. We, therefore, sought to investigate the relationship between the intraoperative and preoperative ambulatory nighttime heart rates in adults having noncardiac surgery with general anesthesia. Additionally, we sought to investigate the incidence of intraoperative bradycardia using relative versus absolute heart rate thresholds.
Intraoperative Intravascular Effect of Lactated Ringer’s Solution and Hyperoncotic Albumin During Hemorrhage in Cystectomy Patients
L?ffel, Lukas M. MD*; Hahn, Robert G. MD, PhD†; Engel, Dominique MD*; Wuethrich, Patrick Y MD*
doi : 10.1213/ANE.0000000000005173
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 413-422
The intraoperative effect of 20% albumin on plasma volume during surgery involving major blood loss has not been explored extensively due to methodological difficulties. Crystalloids poorly expand the plasma volume, and using a colloid might then be a way to avoid fluid overload. As doubts have been raised about synthetic colloids, albumin solutions are currently used more extensively. This study presents a methodological development showing how plasma volume expansion can be studied in surgical settings with the coinfusion of 20% albumin and lactated Ringer’s solution.
Rifampin Reduces the Plasma Concentrations of Oral and Intravenous Hydromorphone in Healthy Volunteers
Lohela, Terhi J. MD, PhD*,†,‡; Poikola, Satu MD†,‡; Neuvonen, Mikko MSc*,‡; Niemi, Mikko MD, PhD*,‡; Backman, Janne T. MD, PhD*,‡; Olkkola, Klaus T. MD, PhD†,‡; Lilius, Tuomas O. MD, PhD*,‡
doi : 10.1213/ANE.0000000000005229
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 423-434
Several opioids are metabolized by the inducible cytochrome P450 (CYP) 3A isozymes. Coadministration with strong inducers of drug metabolism, such as rifampin, can dramatically reduce systemic exposure to these opioids. As the CYP metabolism of hydromorphone is of minor importance, we studied in healthy volunteers whether hydromorphone would be an effective analgesic for patients who concomitantly receive the prototypical enzyme inducer rifampin.
Neuromuscular and Clinical Recovery in Thoracic Surgical Patients Reversed With Neostigmine or Sugammadex
Murphy, Glenn S. MD*; Avram, Michael J. PhD†; Greenberg, Steven B. MD*; Bilimoria, Sara BS*; Benson, Jessica BS*; Maher, Colleen E. BS*; Teister, Kevin J. BS*; Szokol, Joseph W. MD*
doi : 10.1213/ANE.0000000000005294
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 435-444
Patients undergoing thoracoscopic procedures may be at high-risk for incomplete neuromuscular recovery and associated complications. The aim of this clinical investigation was to assess the incidence of postoperative residual neuromuscular blockade in adult thoracic surgical patients administered neostigmine or sugammadex when optimal dosing and reversal strategies for these agents were used. The effect of choice of reversal agent on hypoxemic events and signs and symptoms of muscle weakness were also determined. Additionally, operative conditions in each group were graded by surgeons performing the procedures.
Development and Evaluation of a Risk-Adjusted Measure of Intraoperative Hypotension in Patients Having Nonemergent, Noncardiac Surgery
Christensen, Anna L. PhD*; Jacobs, Ethan MPP†; Maheshwari, Kamal MD, MPH‡; Xing, Fei PhD*; Zhao, Xiaohong PhD§; Simon, Samuel E. PhD†; Domino, Karen B. MD, MPH?; Posner, Karen L. PhD?; Stewart, Alvin F. MD¶; Sanford, Joseph A. MD¶; Sessler, Daniel I. MD#
doi : 10.1213/ANE.0000000000005287
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 445-454
Intraoperative hypotension is common and associated with organ injury and death, although randomized data showing a causal relationship remain sparse. A risk-adjusted measure of intraoperative hypotension may therefore contribute to quality improvement efforts.
The Bitter and the Sweet: Relationship of Lactate, Glucose, and Mortality After Severe Blunt Trauma
Richards, Justin E. MD*,†,‡; Mazzeffi, Michael A. MD, MPH*; Massey, Michael S. MD*; Rock, Peter MD, MBA*,‡; Galvagno, Samuel M. Jr, DO, PhD*,†,§; Scalea, Thomas M. MD‡,§
doi : 10.1213/ANE.0000000000005335
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 455-461
Hyperglycemia is associated with mortality after trauma; however, few studies have simultaneously investigated the association of depth of shock and acute hyperglycemia. We evaluated lactate, as a surrogate measure for depth of shock, and glucose levels on mortality following severe blunt trauma. We hypothesize that measurements of both lactate and glucose are associated with mortality when considered simultaneously.
The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States
Katz, Daniel MD*; Bateman, Brian T. MD, MSc†; Kjaer, Klaus MD‡; Turner, Dana P. PhD§; Spence, Nicole Z. MD?; Habib, Ashraf S. MBBCh¶; George, Ronald B. MD#; Toledano, Roulhac D. MD, PhD**; Grant, Gilbert MD**; Madden, Hannah E. BS§; Butwick, Alex J. MBBS, MS††; Lynde, Grant MD‡‡; Minehart, Rebecca D. MD, MSHPEd§; Beilin, Yaakov MD§§; Houle, Timothy T. PhD§; Sharpe, Emily E. MD??; Kodali, Bhavani MD¶¶; Bharadwaj, Shobana MBBS¶¶; Farber, Michaela K. MD, MS†; Palanisamy, Arvind MD##; Prabhu, Malavika MD***; Gonzales, Nikolai Y. MD†††; Landau, Ruth MD‡‡‡; Leffert, Lisa MD§
doi : 10.1213/ANE.0000000000005592
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 462-473
Early reports associating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with adverse pregnancy outcomes were biased by including only women with severe disease without controls. The Society for Obstetric Anesthesia and Perinatology (SOAP) coronavirus disease 2019 (COVID-19) registry was created to compare peripartum outcomes and anesthetic utilization in women with and without SARS-CoV-2 infection delivering at institutions with widespread testing.
Application of a High-Flow Nasal Cannula for Prevention of Postextubation Atelectasis in Children Undergoing Surgery: A Randomized Controlled Trial
Lee, Ji-Hyun MD, PhD; Ji, Sang-Hwan MD; Jang, Young-Eun MD; Kim, Eun-Hee MD; Kim, Jin-Tae MD, PhD; Kim, Hee-Soo MD, PhD
doi : 10.1213/ANE.0000000000005285
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 474-482
General anesthesia-induced atelectasis is common, and persistent postoperative atelectasis is associated with pulmonary complications. We aimed to evaluate the preventive effects of a high-flow nasal cannula (HFNC) on postoperative atelectasis and respiratory complications in infants and small children.
Anesthetic Complications Associated With Severe Acute Respiratory Syndrome Coronavirus 2 in Pediatric Patients
Saynhalath, Rita MD*,†; Alex, Gijo MD*; Efune, Proshad N. MD*,†; Szmuk, Peter MD*,†; Zhu, Hong PhD†,‡; Sanford, Ethan L. MD*,†
doi : 10.1213/ANE.0000000000005606
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 483-490
Coronavirus disease 2019 (COVID-19) is associated with high perioperative morbidity and mortality among adults. The incidence and severity of anesthetic complications in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We hypothesized that there would be an increased incidence of intra- and postoperative complications in children with SARS-CoV-2 infection as compared to those with negative testing.
Effect of Paratracheal Pressure on the Glottic View During Direct Laryngoscopy: A Randomized Double-Blind, Noninferiority Trial
Won, Dongwook MD*; Kim, Hyerim MD*; Chang, Jee-Eun MD*; Lee, Jung-Man MD, PhD*; Min, Seong-Won MD, PhD*; Ma, Seoyoung MD†; Kim, Chanho MD†; Hwang, Jin-Young MD, PhD*; Kim, Tae Kyong MD, PhD*
doi : 10.1213/ANE.0000000000005620
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 491-499
Cricoid pressure has been used as a component of the rapid sequence induction and intubation technique. However, concerns have been raised regarding the effectiveness and safety of cricoid pressure. Paratracheal pressure, a potential alternative to cricoid pressure to prevent regurgitation of gastric contents or aspiration, has been studied to be more effective to cricoid pressure in preventing gastric insufflation during positive pressure ventilation. However, to adopt paratracheal compression into our practice, adverse effects including its effect on the glottic view during direct laryngoscopy should be studied. We conducted a randomized, double-blind, noninferiority trial comparing paratracheal and cricoid pressures for any adverse effects on the view during direct laryngoscopy, together with other secondary outcome measures.
Predictive Performance of Oximetry to Detect Sleep Apnea in Patients Taking Opioids
Waseem, Rida MA*; Wong, Jean MD*,†; Ryan, Clodagh MD, MB BCh‡; Chung, Frances MBBS, MD*
doi : 10.1213/ANE.0000000000005545
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 500-506
Long-term use of opioids for treatment of chronic pain is associated with significant risks including worsening unrecognized or untreated sleep apnea that may increase morbidity and mortality. Overnight oximetry has been validated for predicting sleep apnea in surgical and sleep clinic patients. The objective of the study was to assess the predictive accuracy of oxygen desaturation index (ODI 4%) from home overnight oximetry when compared to apnea hypopnea index (AHI) from polysomnography for predicting sleep apnea in patients taking opioids for chronic pain.
Quality of Recovery Following Orthopedic Surgery in Patients at an Academic Hospital in South Africa
Wessels, Erica MBChB; Perrie, Helen MSc; Scribante, Juan PhD; Jooma, Zainub FCA (SA)
doi : 10.1213/ANE.0000000000005594
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 507-514
Measurement of perioperative quality of recovery (QoR) is an important tool in improving the patient’s perioperative experience. By making use of the Quality of Recovery-15 (QoR-15) questionnaire, this study aimed to measure the QoR on day 1 in patients following elective and semiurgent orthopedic surgery at an academic hospital. A secondary aim was to determine factors that may influence the QoR.
Dissemination of Anesthesia Information During the Coronavirus Disease 2019 Pandemic Through Twitter: An Infodemiology Study
Gai, Nan MD*; So, Delvin MSc†; Siddiqui, Asad MD*; Steinberg, Benjamin E. MD, PhD*,‡
doi : 10.1213/ANE.0000000000005602
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 515-525
Twitter is a web-based social media platform that allows instantaneous sharing of user-generated messages (tweets). We performed an infodemiology study of the coronavirus disease 2019 (COVID-19) Twitter conversation related to anesthesiology to describe how Twitter has been used during the pandemic and ways to optimize Twitter use by anesthesiologists.
Fiber-Needle Swept-Source Optical Coherence Tomography for the Real-Time Visualization of the Transversus Abdominis Plane Block Procedure in a Swine Model
Teng, Wei-Nung MD, PhD*; Kao, Meng-Chun PhD†; Ting, Chien-Kun MD, PhD*; Kuo, Wen-Chuan PhD†
doi : 10.1213/ANE.0000000000005288
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 526-534
Fascia blocks (eg, the transversus abdominis plane [TAP] block) target the intermuscular fascia layers. Ultrasound techniques have allowed peripheral blocks to be performed with accuracy and safety, however, with limitations. Optical coherence tomography (OCT) is based on low-coherence interferometry. In this study, we examined the ability of OCT to identify the TAP.
The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions
Benzon, Honorio T. MD*; Maus, Timothy P. MD†; Kang, Hye-Ryun MD‡; Provenzano, David A. MD§; Bhatia, Anuj MD?; Diehn, Felix MD†; Nelson, Ariana MD¶; McCormick, Zachary L. MD#; Liu, Benjamin P. MD**; de Andres Ares, Javier MD††; Anitescu, Magdalena MD‡‡; Blackham, Kristine MD§§; Bhaskar, Arun MD??; Brill, Silviu MD¶¶; Collins, Jeremy MD†; Gulve, Ashish MD##; Hurley, Robert W. MD***; Jeon, Young Hoon MD†††; Moon, Jee Youn MD‡‡‡; Rauck, Richard L. MD§§§; Rodes, Meghan MD*; Lee, Ryan K. MD???; Shah, Vinil MD¶¶¶; Shanthanna, Harsha MD###; van Zundert, Jan MD, PhD****; Huntoon, Marc MD††††; Rathmell, James P. MD‡‡‡‡; Borges, Mario Sanchez MD§§§§; Cohen, Steven P. MD????; Greenberger, Paul A. MD¶¶¶¶
doi : 10.1213/ANE.0000000000005443
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 535-552
This Practice Advisory presents a comprehensive and evidence-based set of position statements and recommendations for the use of contrast media in interventional pain procedures. The advisory was established by an international panel of experts under the auspices of 11 multinational and multispecialty organizations based on a comprehensive review of the literature up to December 31, 2019. The advisory discusses the risks of using gadolinium-based contrast agents. These include nephrogenic systemic fibrosis, gadolinium brain deposition/retention, and encephalopathy and death after an unintentional intrathecal gadolinium injection. The advisory provides recommendations on the selection of a specific gadolinium-based contrast agent in patients with renal insufficiency, those who had multiple gadolinium-enhanced magnetic resonance imaging examinations, and in cases of paraspinal injections. Additionally, recommendations are made for patients who have a history of mild, moderate, or severe hypersensitivity reactions to contrast medium.
Perioperative Health Services Research: Far Better Played as a Team Sport
Peden, Carol J. MB ChB, MD, MPH*,†; Ghaferi, Amir A. MD, MS‡; Vetter, Thomas R. MD, MPH§; Kain, Zeev N. MD, MBA?,¶,#
doi : 10.1213/ANE.0000000000005590
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 553-557
Remembering the Brachial Plexus: A Hand Mnemonic, Illustrated
Love, Nick MD, PhD*,†
doi : 10.1213/ANE.0000000000005618
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 558-559
Vigil
Kopp, Vincent J. MD
doi : 10.1213/ANE.0000000000005619
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p 560
Emergencies in Anaesthesia, 3rd ed
Mucci, Joti Juneja MD; Argalious, Maged Y. MD, MSc, MBA, MEd, FASE, FASA
doi : 10.1213/ANE.0000000000005591
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e17
Pulmonary Hypertension: Controversial and Emerging Topics
Charnin, Jonathan E. MD
doi : 10.1213/ANE.0000000000005616
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e18-e19
Can High-Flow Nasal Cannula Oxygen Enhance Patient Safety During Anesthesia for Advanced Esophagogastroduodenoscopy?
Xue, Fu-Shan MD; Shao, Liu-Jia-Zi MD; Hu, Bin MD
doi : 10.1213/ANE.0000000000005588
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e20
Influence of Levobupivacaine Regional Scalp Block on Hemodynamic Stability, and Intra- and Postoperative Opioid Consumption in Supratentorial Craniotomies: Increasing Security
Ni?o, Mar?a Claudia MD; Mej?a, Juan Armando MD; Cohen, Darwin MD; Mojica, Viviana MD; Rojas, Mar?a Fernanda MD; Mercado, José Dar?o MD; Gonz?lez, Mariana MD; Madrid, Guillermo MD, MSc
doi : 10.1213/ANE.0000000000005610
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e20-e22
In Response
Carella, Michele MD; Tran, Gabriel MD; Bonhomme, Vincent MD, PhD; Franssen, Colette MD, PhD
doi : 10.1213/ANE.0000000000005611
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e22-e23
Treating Increased Inspired Carbon Dioxide
Dosch, Michael P. PhD, CRNA
doi : 10.1213/ANE.0000000000005614
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e23-e24
In Response
Feldman, Jeffrey M. MSE, MD; Hendrickx, Jan MD, PhD; Kennedy, R. Ross MB, ChB, PhD
doi : 10.1213/ANE.0000000000005615
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e24-e25
Appropriate Inspired Carbon Dioxide Percentage for Absorber Replacement
Gross, Jeffrey B. MD
doi : 10.1213/ANE.0000000000005623
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e25
In Response
Feldman, Jeffrey M. MSE, MD; Hendrickx, Jan MD, PhD; Kennedy, R. Ross MB, ChB, PhD
doi : 10.1213/ANE.0000000000005624
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e25-e26
Intravenous versus Volatile Anesthesia and Cancer Outcomes: The Value of Precise Definitions and Pitfalls of Multivariate Analysis
Ackerman, Robert S. MD; Aldawoodi, Nasrin N. MD; Muncey, Aaron R. MD; Patel, Sephalie Y. MD; Coughlin, Emily C. MPH; Mhaskar, Rahul S. MPH, PhD
doi : 10.1213/ANE.0000000000005626
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e26-e27
In Response
Chang, Chun-Yu MD; Wu, Meng-Yu MD; Chien, Yung-Jiun MD; Su, I-Min MD; Wang, Shih-Ching MD; Kao, Ming-Chang MD, PhD
doi : 10.1213/ANE.0000000000005627
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e27-e29
A Practical Guide for Anesthesia Providers in the Endoscopy Suite During the Coronavirus Disease 2019 Pandemic: Unmitigated Coughing and Aerosol Generation During Open-Face Endoscopies
Gonzalez, René Miguel MD
doi : 10.1213/ANE.0000000000005612
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e29-e30
In Response
Abola, Ramon E. MD; Schwartz, Jonathon MD; Beg, Tazeen MD; Gan, Tong J. MD, MBA, MHS; Forrester, Joseph MD, MSc
doi : 10.1213/ANE.0000000000005613
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e30-e31
Aspirin Use, Mechanical Ventilation, and Inhospital Mortality in Coronavirus Disease 2019: Are We Missing Something?
Senthilnathan, Muthapillai MD; Ravi, Ramya MD; Sivakumar, Ranjith Kumar MD; Majella, Marie Gilbert MD; Chidambaram, Vignesh MD
doi : 10.1213/ANE.0000000000005621
Anesthesia & Analgesia: August 2021 - Volume 133 - Issue 2 - p e31-e33
