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Beyond the Smoke Screen: Vaping in Adolescents
Shah, Sonali; Weber, Garret MD; Nathan, Naveen MD
doi : 10.1213/ANE.0000000000005684
September 2021 - Volume 133 - Issue 3 - p 561
Biomarkers That Forecast Cardiac Surgery Associated Acute Kidney Injury
Nathan, Naveen MD
doi : 10.1213/ANE.0000000000005683
September 2021 - Volume 133 - Issue 3 - p 569
Vaping and E-Cigarette Use in Children and Adolescents: Implications on Perioperative Care From the American Society of Anesthesiologists Committee on Pediatric Anesthesia, Society for Pediatric Anesthesia, and American Academy of Pediatrics Section on Anesthesiology and Pain Medicine
Rusy, Deborah A. MD, MBA, FASA*; Honkanen, Anita MD†; Landrigan-Ossar, Mary F. MD, PhD, FASA, FAAP‡; Chatterjee, Debnath MD, FAAP, FASA§; Schwartz, Lawrence I. MD?; Lalwani, Kirk MBBS, FRCA, MCR¶; Dollar, Jennifer R. MD#; Clark, Randall MD, FASA?; Diaz, Christina D. MD, FASA, FAAP**; Deutsch, Nina MD††; Warner, David O. MD‡‡; Soriano, Sulpicio G. MD‡
doi : 10.1213/ANE.0000000000005519
September 2021 - Volume 133 - Issue 3 - p 562-568
Electronic cigarettes (e-cigarettes) or vaping use in adolescents has emerged as a public health crisis that impacts the perioperative care of this vulnerable population. E-cigarettes have become the most commonly used tobacco products among youth in the United States. Fruit and mint flavors and additives such as marijuana have enticed children and adolescents. E-cigarette, or vaping, product use–associated lung injury (EVALI) is a newly identified lung disease linked to vaping. Clinical presentation of EVALI can be varied, but most commonly includes the respiratory system, gastrointestinal (GI) tract, and constitutional symptoms. Clinical management of EVALI has consisted of vaping cessation and supportive therapy, including supplemental oxygen, noninvasive ventilation, mechanical ventilation, glucocorticoids, and empiric antibiotics, until infectious causes are eliminated, and in the most severe cases, extracorporeal membrane oxygenation (ECMO). Currently, although there is an insufficient evidence to determine the safety and the efficacy of e-cigarettes for perioperative smoking cessation, EVALI clearly places these patients at an increased risk of perioperative morbidity. Given the relatively recent introduction of e-cigarettes, the long-term impact on adolescent health is unknown. As a result, the paucity of postoperative outcomes in this potentially vulnerable population does not support evidence-based recommendations for the management of these patients. Clinicians should identify “at-risk” individuals during preanesthetic evaluations and adjust the risk stratification accordingly. Our societies encourage continued education of the public and health care providers of the risks associated with vaping and nicotine use and encourage regular preoperative screening and postoperative outcome studies of patients with regard to smoking and vaping use.
Associations Between Preoperative Biomarkers and Cardiac Surgery–Associated Acute Kidney Injury in Elderly Patients: A Cohort Study
Verwijmeren, Lisa MD, PhD*; Bosma, Madeleen MSc†; Vernooij, Lisette M. MSc, PhD*; Linde, Esther M. MD*; Dijkstra, Ineke M. MSc, PhD†; Daeter, Edgar J. MD‡; Van Dongen, Eric P. A. MD, PhD*; Van Klei, Wilton A. MD, PhD§; Noordzij, Peter G. MD, PhD*
doi : 10.1213/ANE.0000000000005650
September 2021 - Volume 133 - Issue 3 - p 570-577
Acute kidney injury (AKI) is associated with mortality after cardiac surgery. Novel risk factors may improve identification of patients at risk for renal injury. The authors evaluated the association between preoperative biomarkers that reflect cardiac, inflammatory, renal, and metabolic disorders and cardiac surgery–associated AKI (CSA-AKI) in elderly patients.
Prenatal Exposure to General Anesthesia and Childhood Behavioral Deficit
Ing, Caleb MD, MS*; Landau, Ruth MD†; DeStephano, David MPH†; Miles, Caleb H. PhD‡; von Ungern-Sternberg, Britta S. MD, PhD§,?,¶; Li, Guohua MD, DrPH*; Whitehouse, Andrew J. O. PhD#
doi : 10.1213/ANE.0000000000005389
September 2021 - Volume 133 - Issue 3 - p 595-605
Exposure to surgery and anesthesia in early childhood has been found to be associated with an increased risk of behavioral deficits. While the US Food and Drug Administration (FDA) has warned against prenatal exposure to anesthetic drugs, little clinical evidence exists to support this recommendation. This study evaluates the association between prenatal exposure to general anesthesia due to maternal procedures during pregnancy and neuropsychological and behavioral outcome scores at age 10.
REsidual Neuromuscular Block Prediction Score Versus Train-of-Four Ratio and Respiratory Outcomes: A Retrospective Cohort Study
Patroc?nio, Maria D. MD*,†; Shay, Denys Cand Med*,†,‡; Rudolph, Ma?ra I. MD‡; Santer, Peter MD, DPhil*,†; Grabitz, Stephanie D. MD*,†; Xu, Xinling PhD*,†; Nabel, Sarah MSc*,†; Bose, Somnath MD*,†; Eikermann, Matthias MD, PhD*,†,§
doi : 10.1213/ANE.0000000000005363
September 2021 - Volume 133 - Issue 3 - p 610-619
Residual neuromuscular blockade is associated with an increased incidence of postoperative respiratory complications. The REsidual neuromuscular block Prediction Score (REPS) identifies patients at high risk for residual neuromuscular blockade after surgery.
The 1-Hour Versus 2-Hour Clear Liquid Fasting Pro-Con Debate: What Problem Are We Solving?
Nguyen, Khoa N. MD; Davis, Peter J. MD
doi : 10.1213/ANE.0000000000005658
September 2021 - Volume 133 - Issue 3 - p 578-580
Does Anesthesia and Surgery During Pregnancy Really Affect Learning and Behavior in the Offspring: The Holy Grail in Anesthesiology Research
Fardelmann, Kristen MD; Gaiser, Robert MD
doi : 10.1213/ANE.0000000000005486
September 2021 - Volume 133 - Issue 3 - p 592-594
Risk Scores to Improve Quality and Realize Health Economic Gains in Perioperative Care
Bartels, Karsten MD, PhD, MBA*,†,‡; Lobato, Robert L. MD, MS*; Bradley, Cathy J. PhD§
doi : 10.1213/ANE.0000000000005563
September 2021 - Volume 133 - Issue 3 - p 606-609
Pro-Con Debate: 1- vs 2-Hour Fast for Clear Liquids Before Anesthesia in Children
Disma, Nicola MD*; Frykholm, Peter MD†; Cook-Sather, Scott D. MD, FCPP‡; Lerman, Jerrold MD, FRCPC, FANZCA§
doi : 10.1213/ANE.0000000000005589
September 2021 - Volume 133 - Issue 3 - p 581-591
Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastrointestinal contents. The current recommendations from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC) are for a minimum 2-hour fast after ingestion of clear liquids before general anesthesia, regional anesthesia, or procedural sedation and analgesia. Nonetheless, in children, fasting guidelines also have consequences as regards to child and parent satisfaction, hemodynamic stability, the ability to achieve vascular access, and perioperative energy balance. Despite the fact that current guidelines recommend a relatively short fasting time for clear fluids of 2 hours, the actual duration of fasting time can be significantly longer. This may be the result of deficiencies in communication regarding the duration of the ongoing fasting interval as the schedule changes in a busy operating room as well as to poor parent and patient adherence to the 2-hour guidelines. Prolonged fasting can result in children arriving in the operating room for an elective procedure being thirsty, hungry, and generally in an uncomfortable state. Furthermore, prolonged fasting may adversely affect hemodynamic stability and can result in parental dissatisfaction with the perioperative experience. In this PRO and CON presentation, the authors debate the premise that reducing the nominal minimum fasting time from 2 hours to 1 hour can reduce the incidence of prolonged fasting and provide significant benefits to children, with no increased risks.
The Facilitatory Effects of Adjuvant Pharmaceutics to Prolong the Duration of Local Anesthetic for Peripheral Nerve Block: A Systematic Review and Network Meta-analysis
Xuan, Chengluan MD, PhD*; Yan, Wen MD, PhD†; Wang, Dan MD, PhD*; Li, Cong MD*; Ma, Haichun MD, PhD*; Mueller, Ariel MA‡; Wang, Jingping MD, PhD‡
doi : 10.1213/ANE.0000000000005640
September 2021 - Volume 133 - Issue 3 - p 620-629
Peripheral nerve block (PNB) with perineural local anesthetic is used for anesthesia or analgesia with many benefits. To extend these benefits, various adjuvant drugs have been used to prolong the duration of analgesia. We aimed to evaluate the effectiveness of various adjuvants at prolonging the duration of sensory and motor blockade for PNB.
Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach
Denault, André Y. MD, PhD, ABIM-CCM, FRCPC, FASE, FCCS*; Roberts, Michael DO, FASE†; Cios, Theodore MD, MPH, FASE†; Malhotra, Anita MD†; Paquin, Sarto C. MD‡; Tan, Stéphanie MD§; Cavayas, Yiorgos Alexandros MD, MSc, FRCPC?; Desjardins, Georges MD, FRCPC, FASE*; Klick, John MD, FCCP, FASE, FCCM¶
doi : 10.1213/ANE.0000000000005537
September 2021 - Volume 133 - Issue 3 - p 630-647
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies
Karamchandani, Kunal MD, FCCP, FCCM*; Wheelwright, Jonathan DO†; Yang, Ae Lim BS‡; Westphal, Nathaniel D. MD§; Khanna, Ashish K. MD, FCCP, FCCM§,?; Myatra, Sheila N. MD, FCCM, FICCM¶
doi : 10.1213/ANE.0000000000005644
September 2021 - Volume 133 - Issue 3 - p 648-662
Emergency airway management outside the operating room (OR) is often associated with an increased risk of airway related, as well as cardiopulmonary, complications which can impact morbidity and mortality. These emergent airways may take place in the intensive care unit (ICU), where patients are critically ill with minimal physiological reserve, or other areas of the hospital where advanced equipment and personnel are often unavailable. As such, emergency airway management outside the OR requires expertise at manipulation of not only the anatomically difficult airway but also the physiologically and situationally difficult airway. Adequate preparation and appropriate use of airway management techniques are important to prevent complications. Judicious utilization of pre- and apneic oxygenation is important as is the choice of medications to facilitate intubation in this at-risk population. Recent study in critically ill patients has shown that postintubation hemodynamic and respiratory compromise is common, independently associated with poor outcomes and can be impacted by the choice of drugs and techniques used. In addition to adequately preparing for a physiologically difficult airway, enhancing the ability to predict an anatomically difficult airway is essential in reducing complication rates. The use of artificial intelligence in the identification of difficult airways has shown promising results and could be of significant advantage in uncooperative patients as well as those with a questionable airway examination. Incorporating this technology and understanding the physiological, anatomical, and logistical challenges may help providers better prepare for managing such precarious airways and lead to successful outcomes. This review discusses the various challenges associated with airway management outside the OR, provides guidance on appropriate preparation, airway management skills, medication use, and highlights the role of a coordinated multidisciplinary approach to out-of-OR airway management.
The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective
Cushman, Tera MD, MPH*; Waisel, David B. MD†; Treggiari, Miriam M. MD, PhD, MPH†
doi : 10.1213/ANE.0000000000005559
September 2021 - Volume 133 - Issue 3 - p 663-675
No patient arrives at the hospital to undergo general anesthesia for its own sake. Anesthesiology is a symbiont specialty, with the primary mission of preventing physical and psychological pain, easing anxiety, and shepherding physiologic homeostasis so that other care may safely progress. For most elective surgeries, the patient-anesthesiologist relationship begins shortly before and ends after the immediate perioperative period. While this may tempt anesthesiologists to defer goals of care discussions to our surgical or primary care colleagues, we have both an ethical and a practical imperative to share this responsibility. Since the early 1990s, the American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), and the Association of Perioperative Registered Nurses (AORN) have mandated a “required reconsideration” of do-not-resuscitate (DNR) orders. Key ethical considerations and guiding principles informing this “required reconsideration” have been extensively discussed in the literature and include respect for patient autonomy, beneficence, and nonmaleficence. In this article, we address how well these principles and guidelines are translated into daily clinical practice and how often anesthesiologists actually discuss goals of care or potential limitations to life-sustaining medical treatments (LSMTs) before administering anesthesia or sedation. Having done so, we review how often providers implement goal-concordant care, that is, care that reflects and adheres to the stated patient wishes. We conclude with describing several key gaps in the literature on goal-concordance of perioperative care for patients with limitations on LSMT and summarize novel strategies and promising efforts described in recent literature to improve goal-concordance of perioperative care.
The Effects of Anesthetics and Perioperative Medications on Immune Function: A Narrative Review
Ackerman, Robert S. MD*; Luddy, Kimberly A. MS†; Icard, Benjamin E. BS?; Pi?eiro Fern?ndez, Juli?n MS†; Gatenby, Robert A. MD†,‡; Muncey, Aaron R. MD§
doi : 10.1213/ANE.0000000000005607
September 2021 - Volume 133 - Issue 3 - p 676-689
Preclinical and clinical studies have sought to better understand the effect of anesthetic agents, both volatile and intravenous, and perioperative adjuvant medications on immune function. The immune system has evolved to incorporate both innate and adaptive components, which are delicately interwoven and essential for host defense from pathogens and malignancy. This review summarizes the complex and nuanced relationship that exists between each anesthetic agent or perioperative adjuvant medication studied and innate and adaptive immune function with resultant clinical implications. The most commonly used anesthetic agents were chosen for review including volatile agents (sevoflurane, isoflurane, desflurane, and halothane), intravenous agents (propofol, ketamine, etomidate, and dexmedetomidine), and perioperative adjuvant medications (benzodiazepines, opioids, nonsteroidal anti-inflammatory drugs [NSAIDs], and local anesthetic agents). Patients who undergo surgery experience varying combinations of the aforementioned anesthetic agents and adjuncts, depending on the type of surgery and their comorbidities. Each has unique effects on immunity, which may be more or less ideal depending on the clinical situation. Further study is needed to better understand the clinical effects of these relationships so that patient-specific strategies can be developed to improve surgical outcomes.
Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study
Cho, Eun-Ah PhD*,†; Huh, Jin PhD*; Lee, Sung Hyun MD, PhD†; Ryu, Kyoung-Ho PhD†; Shim, Jae-Geum MD†; Cha, Yun-Byeong MD†; Kim, Mi Sung PhD‡; Song, Taejong PhD§
doi : 10.1213/ANE.0000000000005411
September 2021 - Volume 133 - Issue 3 - p 690-697
Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group.
A Retrospective Analysis Demonstrates That a Failure to Document Key Comorbid Diseases in the Anesthesia Preoperative Evaluation Associates With Increased Length of Stay and Mortality
Hofer, Ira S. MD; Cheng, Drew MD; Grogan, Tristan MS
doi : 10.1213/ANE.0000000000005393
September 2021 - Volume 133 - Issue 3 - p 698-706
The introduction of electronic health records (EHRs) has helped physicians access relevant medical information on their patients. However, the design of EHRs can make it hard for clinicians to easily find, review, and document all of the relevant data, leading to documentation that is not fully reflective of the complete history. We hypothesized that the incidence of undocumented key comorbid diseases (atrial fibrillation [afib], congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], diabetes, and chronic kidney disease [CKD]) in the anesthesia preoperative evaluation was associated with increased postoperative length of stay (LOS) and mortality.
Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients
Naranjo, Julian DO*; Portner, Erica R. RRT, LRT*; Jakub, James W. MD†; Cheville, Andrea L. MD‡; Nuttall, Gregory A. MD§
doi : 10.1213/ANE.0000000000005597
September 2021 - Volume 133 - Issue 3 - p 707-712
There is a continued perception that intravenous line (IV) placement is contraindicated in the arm ipsilateral to prior breast cancer surgery to avoid breast cancer–related lymphedema (BCRL). The aim of this retrospective study was to determine the risk for development of BCRL in ipsilateral arm IV placement compared to contralateral arm IV placement to prior breast cancer surgery.
Pharmacologic Management of Intensive Care Unit Delirium: Clinical Prescribing Practices and Outcomes in More Than 8500 Patient Encounters
Boncyk, Christina S. MD*,†; Farrin, Emily MD*; Stollings, Joanna L. PharmD†,‡; Rumbaugh, Kelli PharmD‡; Wilson, Jo Ellen MD, MPH†,§; Marshall, Matt PharmD‡; Feng, Xiaoke MS?; Shotwell, Matthew S. PhD?; Pandharipande, Pratik P. MD, MSCI*,†; Hughes, Christopher G. MD, MS*,†
doi : 10.1213/ANE.0000000000005365
September 2021 - Volume 133 - Issue 3 - p 713-722
Pharmacologic agents are frequently utilized for management of intensive care unit (ICU) delirium, yet prescribing patterns and impact of medication choices on patient outcomes are poorly described. We sought to describe prescribing practices for management of ICU delirium and investigate the independent association of medication choice on key in-hospital outcomes including delirium resolution, in-hospital mortality, and days alive and free of the ICU or hospital.
Blunt Chest Trauma and Regional Anesthesia for Analgesia of Multitrauma Patients in French Intensive Care Units: A National Survey
Blondonnet, Raiko MD, MSc*,†; Begard, Marc MD*; Jabaudon, Matthieu MD, PhD*,†; Godet, Thomas MD, PhD*; Rieu, Benjamin MD*; Audard, Jules MD, MSc*,†; Lagarde, Kevin MD*; Futier, Emmanuel MD, PhD*,†; Pereira, Bruno PhD‡; Bouzat, Pierre MD, PhD§; Constantin, Jean-Michel MD, PhD?
doi : 10.1213/ANE.0000000000005442
September 2021 - Volume 133 - Issue 3 - p 723-730
Chest injuries are associated with mortality among patients admitted to the intensive care unit (ICU) and require multimodal pain management strategies, including regional anesthesia (RA). We conducted a survey to determine the current practices of physicians working in ICUs regarding RA for the management of chest trauma in patients with multiple traumas.
Effect of Preoperative Oral Carbohydrate Loading on Body Temperature During Combined Spinal-Epidural Anesthesia for Elective Cesarean Delivery
Yang, Chen MD*; Cheng, Yan NP*; Liu, Shuangping MD†; Huang, Shaoqiang PhD*; Yu, Xinhua PhD‡
doi : 10.1213/ANE.0000000000005447
September 2021 - Volume 133 - Issue 3 - p 731-738
Intraoperative hypothermia is a common complication after neuraxial block in cesarean delivery. At least 1 animal study has found that carbohydrate loading can maintain the body temperature of rats during general anesthesia, but it is unclear whether carbohydrate loading is beneficial for body temperature maintenance in parturient women during combined spinal-epidural anesthesia (CSEA) for elective cesarean delivery.
Point-of-Care Lung Ultrasound Pattern in Healthy Parturients: Prevalence of Pulmonary Interstitial Syndrome Following Vaginal Delivery, Elective and Unplanned Intrapartum Cesarean Delivery
Macias, Paul MD, MS, RD*; Wilson, Jennifer G. MD†; Austin, Naola S. MD*; Guo, Nan PhD*; Carvalho, Brendan MD*; Ortner, Clemens M. MD, MSc, DESA*
doi : 10.1213/ANE.0000000000005464
September 2021 - Volume 133 - Issue 3 - p 739-746
Pregnancy-related cardiovascular physiologic changes increase the likelihood of pulmonary edema, with the risk of fluid extravasating into the pulmonary interstitium being potentially at a maximum during the early postpartum period. Data on the impact of labor and peripartum hemodynamic strain on lung ultrasound (LUS) are limited, and the prevalence of subclinical pulmonary interstitial syndrome in peripartum women is poorly described. The primary aim of this exploratory study was to estimate the prevalence of pulmonary interstitial syndrome in healthy term parturients undergoing vaginal (VD), elective (eCD), and unplanned intrapartum cesarean deliveries (uCD). Secondary aims were to estimate the prevalence of positive lung regions (?3 B-lines on LUS per region) and to assess the associations between positive lung regions and possible contributing factors.
Incidence, Mortality, and Characteristics of 18 Pediatric Perioperative Cardiac Arrests: An Observational Trial From 22,650 Pediatric Anesthesias in a German Tertiary Care Hospital
Jansen, Gerrit Dr med; Borgstedt, Rainer Dr med; Irmscher, Linda; Popp, Jakob; Schmidt, Benjamin Dr med; Lang, Eric Dr med; Rehberg, Sebastian W. Prof Dr med
doi : 10.1213/ANE.0000000000005296
September 2021 - Volume 133 - Issue 3 - p 747-754
Recently, a very low incidence of 3 per 10,000 and a mortality of 30% were reported for pediatric perioperative cardiac arrest (POCA). However, high-risk patients, namely children already anesthetized on the intensive care unit (ICU), were excluded. This study investigates the incidence and mortality of POCA in children in whom anesthesia was induced in the ICU or in the operating room using real-world data. In addition, different classifications of POCA were compared with respect to outcome relevance.
Differential Perioperative Outcomes in Patients With Obstructive Sleep Apnea, Obesity, or a Combination of Both Undergoing Open Colectomy: A Population-Based Observational Study
Stundner, Ottokar MD, MBA*,†; Zubizarreta, Nicole MPH‡; Mazumdar, Madhu PhD‡; Memtsoudis, Stavros G. MD, PhD, MBA*,§,?; Wilson, Lauren A. MPH?; Ladenhauf, Hannah N. MD¶; Poeran, Jashvant MD, PhD#
doi : 10.1213/ANE.0000000000005638
September 2021 - Volume 133 - Issue 3 - p 755-764
An increasing body of evidence demonstrates an association between obstructive sleep apnea (OSA) and adverse perioperative outcomes. However, large-scale data on open colectomies are lacking. Moreover, the interaction of obesity with OSA is unknown. This study examines the impact of OSA, obesity, or a combination of both, on perioperative complications in patients undergoing open colectomy. We hypothesized that while both obesity and OSA individually increase the likelihood for perioperative complications, the overlap of the 2 conditions is associated with the highest risk.
Midazolam Premedication Immediately Before Surgery Is Not Associated With Early Postoperative Delirium
Wang, Man-Ling MD*; Min, Jie MS†; Sands, Laura P. PhD†; Leung, Jacqueline M. MD, MPH‡; the Perioperative Medicine Research Group‡
doi : 10.1213/ANE.0000000000005482
September 2021 - Volume 133 - Issue 3 - p 765-771
Postoperative delirium is common among older surgical patients and may be associated with anesthetic management during the perioperative period. The aim of this study is to assess whether intravenous midazolam, a short-acting benzodiazepine used frequently as premedication, increased the incidence of postoperative delirium.
Breast Regional Anesthesia Practice in the Italian Public Health System (BRA-SURVEY): A Survey-Based National Study
Bonvicini, Daniele MD*; De Cassai, Alessandro MD*; Andreatta, Giulio MD†; Salvagno, Michele MD†; Carbonari, Ilaria MD†; Carere, Anna MD†; Fornasier, Marcello MD†; Iori, Davide MD†; Negrello, Michele MD*; Grutta, Giuseppe MD*; Navalesi, Paolo MD*,†
doi : 10.1213/ANE.0000000000005649
September 2021 - Volume 133 - Issue 3 - p 772-780
Breast cancer is the most common malignancy in women. Surgery is a mainstay therapy unfortunately burdened by complications as severe postoperative pain. Regional anesthesia may play a role in a multimodal strategy for prevention and treatment of postoperative pain. The main purpose of this survey was to investigate the rate of use of regional anesthesia techniques in patients undergoing breast surgery in the Italian public hospital system.
Activation of Orexinergic Neurons Inhibits the Anesthetic Effect of Desflurane on Consciousness State via Paraventricular Thalamic Nucleus in Rats
Zhao, Shiyi MD; Wang, Sa MD; Li, Huiming MD; Guo, Juan MD; Li, Jiannan PhD; Wang, Dan MD; Zhang, Xinxin MD; Yin, Lu MD; Li, Rui MD; Li, Ao MD; Li, Huihui MD; Fan, Ze PhD; Yang, Qianzi PhD; Zhong, Haixing PhD; Dong, Hailong PhD
doi : 10.1213/ANE.0000000000005651
September 2021 - Volume 133 - Issue 3 - p 781-793
Orexin, a neuropeptide derived from the perifornical area of the hypothalamus (PeFLH), promotes the recovery of propofol, isoflurane, and sevoflurane anesthesias, without influencing the induction time. However, whether the orexinergic system also plays a similar role in desflurane anesthesia, which is widely applied in clinical practice owing to its most rapid onset and offset time among all volatile anesthetics, has not yet been studied. In the present study, we explored the effect of the orexinergic system on the consciousness state induced by desflurane anesthesia.
P2Y1 Purinergic Receptor Contributes to Remifentanil-Induced Cold Hyperalgesia via Transient Receptor Potential Melastatin 8–Dependent Regulation of N-methyl-d-aspartate Receptor Phosphorylation in Dorsal Root Ganglion
Su, Lin MD, PhD*,†; Bai, Xiaoqing MD‡; Niu, Tongxiang MD†,§; Zhuang, Xinqi MD†,?; Dong, Beibei MD, PhD*,†; Li, Yize MD, PhD*,†; Yu, Yonghao MD, PhD*,†; Wang, Guolin MD*,†
doi : 10.1213/ANE.0000000000005617
September 2021 - Volume 133 - Issue 3 - p 794-810
Remifentanil can induce postinfusion cold hyperalgesia. N-methyl-d-aspartate receptor (NMDAR) activation and upregulation of transient receptor potential melastatin 8 (TRPM8) membrane trafficking in dorsal root ganglion (DRG) are critical to cold hyperalgesia derived from neuropathic pain, and TRPM8 activation causes NMDAR-dependent cold response. Contribution of P2Y1 purinergic receptor (P2Y1R) activation in DRG to cold pain hypersensitivity and NMDAR activation induced by P2Y1R upregulation in neurons are also unraveled. This study explores whether P2Y1R contributes to remifentanil-induced cold hyperalgesia via TRPM8-dependent regulation of NMDAR phosphorylation in DRG.
Lean Six Sigma Methodology and the Future of Quality Improvement Education in Anesthesiology
Shah, Neal K. MD; Emerick, Trent D. MD, MBA
doi : 10.1213/ANE.0000000000005636
September 2021 - Volume 133 - Issue 3 - p 811-815
The Successful Anesthesia Patient Safety Officer
Cohen, Jonathan B. MD; Patel, Sephalie Y. MD
doi : 10.1213/ANE.0000000000005637
September 2021 - Volume 133 - Issue 3 - p 816-820
The Infinite Braid
Loeliger, Erin M. MD, PhD
doi : 10.1213/ANE.0000000000005643
September 2021 - Volume 133 - Issue 3 - p 821-822
On Ischemic Time
Kallina, Kayli BS
doi : 10.1213/ANE.0000000000005680
September 2021 - Volume 133 - Issue 3 - p 823
Operational and Medical Management of Explosive and Blast Incidents
Agarwal, Munisha MD
doi : 10.1213/ANE.0000000000005628
September 2021 - Volume 133 - Issue 3 - p e34-e35
Misconceptions About the Starling Principle as Applied to Fluid Therapy
Woodcock, Thomas Edward MBBS
doi : 10.1213/ANE.0000000000005327
September 2021 - Volume 133 - Issue 3 - p e19
In Response
Hahn, Robert G. MD, PhD; Wuethrich, Patrick Y. MD
doi : 10.1213/ANE.0000000000005328
September 2021 - Volume 133 - Issue 3 - p e36-e37
Macrocirculation and Microcirculation in Septic Shock
Furst, Branko MD, FFARCSI; Bughrara, Nibras MD; Musuku, Sridhar R. MD, FRCA
doi : 10.1213/ANE.0000000000005630
September 2021 - Volume 133 - Issue 3 - p e37-e38
In Response
Karamchandani, Kunal MD, FCCP, FCCM
doi : 10.1213/ANE.0000000000005631
September 2021 - Volume 133 - Issue 3 - p e38-e39
Routine Dural Puncture Epidural Technique; Caution is in Order
Kodali, Bhavani Shankar MD; Wong, Michael MD
doi : 10.1213/ANE.0000000000005632
September 2021 - Volume 133 - Issue 3 - p e39-e40
In Response
Xu, Zhendong MD; Liu, Zhiqiang MD
doi : 10.1213/ANE.0000000000005633
September 2021 - Volume 133 - Issue 3 - p e40-e41
Is Aspirin the True Protective Therapy in Coronavirus Disease 2019 Patients?
Mourad, Jean-Jacques MD, PhD; Suhl, Jaehyo MD
doi : 10.1213/ANE.0000000000005635
September 2021 - Volume 133 - Issue 3 - p e41
Intraoperative Airway Management Considerations for Adult Patients Presenting With Tracheostomy: Alternate Techniques
Rewari, Vimi MD
doi : 10.1213/ANE.0000000000005641
September 2021 - Volume 133 - Issue 3 - p e41-e42
In Response
Rosero, Eric B. MD, Msc; Corbett, John PhD; Mau, Ted MD, PhD; Joshi, Girish P. MBBS, MD, FFARCSI
doi : 10.1213/ANE.0000000000005642
September 2021 - Volume 133 - Issue 3 - p e42-e43
Reporting Response Entropy Along With State Entropy Would Enhance Differentiating Nociception
Ozcan, Mehmet S. MD; Charchaflieh, Jean G. MD, DrPH
doi : 10.1213/ANE.0000000000005645
September 2021 - Volume 133 - Issue 3 - p e43
In Response
Carella, Michele MD; Beck, Florian MD; Tran, Gabriel MD; Bonhomme, Vincent MD, PhD; Franssen, Colette MD, PhD
doi : 10.1213/ANE.0000000000005646
September 2021 - Volume 133 - Issue 3 - p e43-e46
