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Aspirin in Coronavirus Disease 2019–Related Acute Respiratory Distress Syndrome: An Old, Low-Cost Therapy With a Strong Rationale
Coppola, Silvia; Chiumello, Davide
doi : 10.1213/ANE.0000000000005408
Anesthesia & Analgesia. 132(4):927-929, April 2021.
Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019
Chow, Jonathan H. MD*; Khanna, Ashish K. MD, FCCP, FCCM†,‡; Kethireddy, Shravan MD§; Yamane, David MD?; Levine, Andrea MD¶; Jackson, Amanda M. MD#; McCurdy, Michael T. MD¶; Tabatabai, Ali MD¶,**; Kumar, Gagan MD§; Park, Paul MD††; Benjenk, Ivy RN, MPH*; Menaker, Jay MD; Ahmed, Nayab MD§§; Glidewell, Evan MD??; Presutto, Elizabeth MD††; Cain, Shannon MD¶¶; Haridasa, Naeha BS*; Field, Wesley MD§§; Fowler, Jacob G. BS??; Trinh, Duy MD††; Johnson, Kathleen N. BS??; Kaur, Aman DO§§; Lee, Amanda BS††; Sebastian, Kyle MD??; Ulrich, Allison MD††; Pe?a, Salvador MD, PhD??; Carpenter, Ross MD††; Sudhakar, Shruti MD††; Uppal, Pushpinder MD††; Fedeles, Benjamin T. MD, Capt, USAF, MC††; Sachs, Aaron MD††; Dahbour, Layth MD††; Teeter, William MD**,##; Tanaka, Kenichi MD‡‡‡; Galvagno, Samuel M. DO, PhD**; Herr, Daniel L. MD**; Scalea, Thomas M. MD**,‡‡; Mazzeffi, Michael A. MD, MPH*
doi : 10.1213/ANE.0000000000005292
Anesthesia & Analgesia. 132(4):930-941, April 2021.
Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality.
Is a Mean Arterial Pressure Less Than 65 mm Hg an Appropriate Indicator of the Quality of Anesthesia Care?
Kamenetsky, Eric; Hogue, Charles W.
doi : 10.1213/ANE.0000000000005281
Anesthesia & Analgesia. 132(4):942-945, April 2021.
Myocardial Injury After Noncardiac Surgery—Slightly Heavier May Be Better
Khanna, Ashish K.; Gan, Tong J.
doi : 10.1213/ANE.0000000000005348
Anesthesia & Analgesia. 132(4):957-959, April 2021.
Blood Pressure Management by Anesthesia Professionals: Evaluating Clinician Skill From Electronic Medical Records
Sessler, Daniel I. MD*; Khan, Mohammad Z. MD*; Maheshwari, Kamal MD, MPH*,†; Liu, Liu MS*,‡; Adegboye, Janet BS§; Saugel, Bernd MD?,¶; Mascha, Edward J. PhD
doi : 10.1213/ANE.0000000000005198
Anesthesia & Analgesia. 132(4):946-956, April 2021.
Avoiding intraoperative hypotension might serve as a measure of clinician skill. We, therefore, estimated the range of hypotension in patients of nurse anesthetists, and whether observed differences were associated with a composite of serious complications.
Association Between High Body Mass Index and Mortality Following Myocardial Injury After Noncardiac Surgery
Lee, Seung-Hwa MD*; Yang, Kwangmo MD†; Park, Jungchan MD‡; Lee, Jong Hwan MD, PhD‡; Min, Jeong Jin MD, PhD‡; Kwon, Ji-hye MD†; Yeo, Junghyun MD‡; Kim, Jihoon MD*; Hyeon, Cheol Won MD*; Choi, Jin-ho MD, PhD*,§; Lee, Sang-Chol MD, PhD*; Gwon, Hyeon-Cheol MD, PhD*; Kim, Kyunga PhD?,¶; Ahn, Joonghyun MB§; Lee, Sangmin Maria MD, PhD
doi : 10.1213/ANE.0000000000005303
Anesthesia & Analgesia. 132(4):960-968, April 2021.
Despite an association between obesity and increased risks for various diseases, obesity has been paradoxically reported to correlate with improved mortality in patients with established cardiovascular disease. However, its effect has not been evaluated to date in patients with myocardial injury after noncardiac surgery (MINS).
Effect of Dural Puncture Epidural Technique Combined With Programmed Intermittent Epidural Bolus on Labor Analgesia Onset and Maintenance: A Randomized Controlled Trial
Song, Yujie MD; Du, Weijia MD; Zhou, Shuangqiong MD; Zhou, Yao MD; Yu, Yibing MD; Xu, Zhendong MD, PhD; Liu, Zhiqiang MD, PhD
doi : 10.1213/ANE.0000000000004768
Anesthesia & Analgesia. 132(4):971-978, April 2021.
The dural puncture epidural (DPE) technique is associated with faster onset than the conventional epidural (EP) technique for labor analgesia. The programmed intermittent epidural bolus (PIEB) mode for maintaining labor analgesia allows for lower anesthetic drug consumption than the continuous epidural infusion (CEI) mode. Whether DPE technique with PIEB mode offers additional benefits for analgesia onset, local anesthetic drug consumption, and side effects versus EP or DPE techniques with CEI mode remains unclear.
Kaplan-Meier Curves, Log-Rank Tests, and Cox Regression for Time-to-Event Data
Schober, Patrick; Vetter, Thomas R.
doi : 10.1213/ANE.0000000000005358
Anesthesia & Analgesia. 132(4):969-970, April 2021.
Safety and Efficacy of the Combination of Propofol and Ketamine for Procedural Sedation/Anesthesia in the Pediatric Population: A Systematic Review and Meta-analysis
Hayes, Jason A. MD*; Aljuhani, Talal MD†; De Oliveira, Kyle MD*; Johnston, Bradley C. PhD
doi : 10.1213/ANE.0000000000004967
Anesthesia & Analgesia. 132(4):979-992, April 2021.
Drugs such as propofol and ketamine are used alone or in combination to provide sedation for medical procedures in children. The purpose of this systematic review was to compare the safety and effectiveness of propofol and ketamine to other drug regimens.
Carbon Dioxide Absorption During Inhalation Anesthesia: A Modern Practice
Feldman, Jeffrey M.; Hendrickx, Jan; Kennedy, R. Ross
doi : 10.1213/ANE.0000000000005137
Anesthesia & Analgesia. 132(4):993-1002, April 2021.
CO2 absorbents were introduced into anesthesia practice in 1924 and are essential when using a circle system to minimize waste by reducing fresh gas flow to allow exhaled anesthetic agents to be rebreathed. For many years, absorbent formulations consisted of calcium hydroxide combined with strong bases like sodium and potassium hydroxide. When Sevoflurane and Desflurane were introduced, the potential for toxicity (compound A and CO, respectively) due to the interaction of these agents with absorbents became apparent. Studies demonstrated that strong bases added to calcium hydroxide were the cause of the toxicity, but that by eliminating potassium hydroxide and reducing the concentration of sodium hydroxide to <2%, compound A and CO production is no longer a concern. As a result, CO2 absorbents have been developed that contain little or no sodium hydroxide. These CO2 absorbent formulations can be used safely to minimize anesthetic waste by reducing fresh gas flow to approach closed-circuit conditions. Although absorbent formulations have been improved, practices persist that result in unnecessary waste of both anesthetic agents and absorbents. While CO2 absorbents may seem like a commodity item, differences in CO2 absorbent formulations can translate into significant performance differences, and the choice of absorbent should not be based on unit price alone. A modern practice of inhalation anesthesia utilizing a circle system to greatest effect requires reducing fresh gas flow to approach closed-circuit conditions, thoughtful selection of CO2 absorbent, and changing absorbents based on inspired CO2.
Intraoperative Airway Management Considerations for Adult Patients Presenting With Tracheostomy: A Narrative Review
Rosero, Eric B. MD, MSc*; Corbett, John PhD†; Mau, Ted MD, PhD‡; Joshi, Girish P. MBBS, MD, FFARCSI
doi : 10.1213/ANE.0000000000005330
Anesthesia & Analgesia. 132(4):1003-1011, April 2021.
Tracheotomy is a surgical procedure through which a tracheostomy, an opening into the trachea, is created. Indications for tracheostomy include facilitation of airway management during prolonged mechanical ventilation, treatment of acute upper airway obstruction when tracheal intubation is unfeasible, management of chronic upper airway obstructive conditions, and planned airway management for major head and neck surgery. Patients who have a recent or long-term tracheostomy may present for a variety of surgical or diagnostic procedures performed under general anesthesia or sedation/analgesia. Airway management of these patients can be challenging and should be planned ahead of time. Anesthesia personnel should be familiar with the different components of cuffed and uncuffed tracheostomy devices and their connectivity to the anesthesia circuits. An appropriate airway management plan should take into account the indication of the tracheostomy, the maturity status of the stoma, the type and size of tracheostomy tube, the expected patient positioning, and presence of patient’s concurrent health conditions. Management of the patient with a T-tube is highlighted. Importantly, there is a need for multidisciplinary care involving anesthesiologists, surgical specialists, and perioperative nurses. The aim of this narrative review is to discuss the anesthesia care of patients with a tracheostomy. Key aspects on relevant tracheal anatomy, tracheostomy tubes/devices, alternatives of airway management, and possible complications related to tracheostomy are summarized with a recommendation for an algorithm to manage intraoperative tracheostomy tube dislodgement.
Overview and Limitations of Database Research in Anesthesiology: A Narrative Review
Abdel-Kader, Amir K.; Eisenkraft, James B.; Katz, Daniel J.
doi : 10.1213/ANE.0000000000005346
Anesthesia & Analgesia. 132(4):1023-1032, April 2021.
The utilization of large-scale databases for research in medical fields, including anesthesiology, has increased in popularity over the last decade, likely due to their structured content and relative ease of access. These databases have been used in a variety of perioperative studies, including analyses of risk stratification, preoperative testing, complications, and cost. While these databases contain a wealth of information that allows for an abundance of research opportunities, there are unique limitations to their use. A comprehensive understanding will afford the anesthesiology researcher the knowledge and tools to not only better interpret studies that utilized these databases, but also to conduct analyses of their own. This review details the content and composition of these databases, highlights the advantages of and limitations to their use, and offers information about their access and cost.
The Effect of Mechanical Ventilation With Low Tidal Volume on Blood Loss During Laparoscopic Liver Resection: A Randomized Controlled Trial
Gao, Xian MD*; Xiong, Ya MD*; Huang, Jian MSc*; Zhang, Ning MD*; Li, Jianwei MD, PhD†; Zheng, Shuguo MD, PhD†; Lu, Kaizhi MD, PhD*; Ma, Daqing MD, PhD, FRCA‡; Yang, Bin MD, PhD§; Ning, Jiaolin MD, PhD
doi : 10.1213/ANE.0000000000005242
Anesthesia & Analgesia. 132(4):1033-1041, April 2021.
Control of bleeding during laparoscopic liver resection (LLR) is important for patient safety. It remains unknown what the effects of mechanical ventilation with varying tidal volumes on bleeding during LLR. Thus, this study aims to investigate whether mechanical ventilation with low tidal volume (LTV) reduces surgical bleeding during LLR.
Reflection Versus Rebreathing for Administration of Sevoflurane During Minor Gynecological Surgery
Kermad, Azzeddine MD*; Appenzeller, Madeleine MS*; Morinello, Emanuela MD*; Schneider, Sven Oliver MD*; Kleinschmidt, Stefan MD*; O‘Gara, Brian MD, MPH†; Volk, Thomas MD*; Meiser, Andreas MD
doi : 10.1213/ANE.0000000000005074
Anesthesia & Analgesia. 132(4):1042-1050, April 2021.
Contemporary anesthetic circle systems, when used at low fresh gas flows (FGF) to allow rebreathing of anesthetic, lack the ability for rapid dose titration. The small-scale anesthetic reflection device Anaesthetic Conserving Device (50mL Version; AnaConDa-S) permits administration of volatile anesthetics with high-flow ventilators. We compared washin, washout, and sevoflurane consumption using AnaConDa-S versus a circle system with low and minimal FGF.
Neuromuscular Blockade Monitoring in Acute Respiratory Distress Syndrome: Randomized Controlled Trial of Clinical Assessment Alone or With Peripheral Nerve Stimulation
Rezaiguia-Delclaux, Saïda MD*; Laverdure, Florent MD*; Genty, Thibaut MD*; Imbert, Audrey MD*; Pilorge, Catherine MD, PhD*; Amaru, Priscilla MD*; Sarfati, Céline PT†; Stéphan, François MD, PhD
doi : 10.1213/ANE.0000000000005174
Anesthesia & Analgesia. 132(4):1051-1059, April 2021.
Whether train-of-four (TOF) monitoring is more effective than clinical monitoring to guide neuromuscular blockade (NMB) in patients with acute respiratory distress syndrome (ARDS) is unclear. We compared clinical monitoring alone or with TOF monitoring to guide atracurium dosage adjustment with respect to drug dose and respiratory parameters.
Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury
Chen, Fangyu BA*,†; Komisarow, Jordan M. MD†,‡; Mills, Brianna PhD§; Vavilala, Monica MD§,?; Hernandez, Adrian MD¶; Laskowitz, Daniel T. MD#; Mathew, Joseph P. MD, MHSc, MBA, FASE**; James, Michael L. MD, FAHA†,**; Haines, Krista L. DO, MA†,††; Raghunathan, Karthik MBBS, MPH†,**; Fuller, Matt MS†,**; Bartz, Raquel R. MD†,**; Krishnamoorthy, Vijay MD, MPH, PhD
doi : 10.1213/ANE.0000000000005110
Anesthesia & Analgesia. 132(4):1060-1066, April 2021.
Severe traumatic brain injury (TBI) can result in left ventricular dysfunction, which can lead to hypotension and secondary brain injuries. Although echocardiography is often used to examine cardiovascular function in multiple clinical settings, its use and association with outcomes following severe TBI are not known. To address this gap, we used the National Trauma Data Bank (NTDB) to describe utilization patterns of echocardiography and examine its association with mortality following severe TBI.
A Qualitative Assessment of Factors That Children, Parents, and Clinicians Prioritize in the Setting of Elective Anesthesia and Surgery
Muhly, Wallis T. MD*; Wohler, Brittany BS†; Nelson, Maria N. MA‡; Tan, Jonathan M. MD, MPH, MBI*; Barg, Frances K. PhD, MEd§; England, William BBA†; Fazzini, Carolyn RN?; Sequera-Ramos, Luis MD*; Stricker, Paul A. MD
doi : 10.1213/ANE.0000000000004936
Anesthesia & Analgesia. 132(4):1067-1074, April 2021.
Assessing the postoperative recovery of pediatric patients is challenging as there is no validated comprehensive patient-centered recovery assessment tool for this population. A qualitative investigative approach with in-depth stakeholder interviews can provide insight into the recovery process and inform the development of a comprehensive patient-centered postoperative assessment tool for children.
Risk Factors for Intraoperative Hypoglycemia in Children: A Multicenter Retrospective Cohort Study
Riegger, Lori Q. MD; Leis, Aleda M. MS; Golmirzaie, Kristine H. MD; Malviya, Shobha MD
doi : 10.1213/ANE.0000000000004979
Anesthesia & Analgesia. 132(4):1075-1083, April 2021.
Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors in a multicenter cohort.
Predicting Perioperative Respiratory Adverse Events in Children With Sleep-Disordered Breathing
Pehora, Carolyne RN, MN*; Faraoni, David MD, PhD, FAHA*,†; Obara, Soichiro MD, MPH‡; Amin, Reshma MD, MSc§; Igbeyi, Brenda MD?; Al-Izzi, Adel MD¶; Sayal, Aman BMSc§; Sayal, Aarti BHSc§; Mc Donnell, Conor MD, MB
doi : 10.1213/ANE.0000000000005195
Anesthesia & Analgesia. 132(4):1084-1091, April 2021.
No evidence currently exists to quantify the risk and incidence of perioperative respiratory adverse events (PRAEs) in children with sleep-disordered breathing (SDB) undergoing all procedures requiring general anesthesia. Our objective was to determine the incidence of PRAEs and the risk factors in children with polysomnography-confirmed SDB undergoing procedures requiring general anesthesia.
Laryngeal Injury and Upper Airway Symptoms After Endotracheal Intubation During Surgery: A Systematic Review and Meta-analysis
Brodsky, Martin B. PhD, ScM, CCC-SLP*,†,‡; Akst, Lee M. MD§; Jedlanek, Erin MS?; Pandian, Vinciya PhD, MBA, MSN‡,¶; Blackford, Brendan MHS#; Price, Carrie MLS**; Cole, Gai DrPH, MBA, MHA††; Mendez-Tellez, Pedro A. MD‡,‡‡; Hillel, Alexander T. MD§; Best, Simon R. MD§; Levy, Matthew J. DO, MSc
doi : 10.1213/ANE.0000000000005276
Anesthesia & Analgesia.132(4):1023-1032, April 2021.
Laryngeal injury from intubation can substantially impact airway, voice, and swallowing, thus necessitating multidisciplinary interventions. The goals of this systematic review were (1) to review the types of laryngeal injuries and their patient-reported symptoms and clinical signs resulting from endotracheal intubation in patients intubated for surgeries and (2) to better understand the overall the frequency at which these injuries occur. We conducted a search of 4 online bibliographic databases (ie, PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and The Cochrane Library) and ProQuest and Open Access Thesis Dissertations (OPTD) from database inception to September 2019 without restrictions for language. Studies that completed postextubation laryngeal examinations with visualization in adult patients who were endotracheally intubated for surgeries were included. We excluded (1) retrospective studies, (2) case studies, (3) preexisting laryngeal injury/disease, (4) patients with histories of or surgical interventions that risk injury to the recurrent laryngeal nerve, (5) conference abstracts, and (6) patient populations with nonfocal, neurological impairments that may impact voice and swallowing function, thus making it difficult to identify isolated postextubation laryngeal injury. Independent, double-data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Collaboration’s criteria. Twenty-one articles (1 cross-sectional, 3 cohort, 5 case series, 12 randomized controlled trials) representing 21 surgical studies containing 6140 patients met eligibility criteria. The mean patient age across studies reporting age was 49 (95% confidence interval [CI], 45-53) years with a mean intubation duration of 132 (95% CI, 106-159) minutes. Studies reported no injuries in 80% (95% CI, 69-88) of patients. All 21 studies presented on type of injury. Edema was the most frequently reported mild injury, with a prevalence of 9%–84%. Vocal fold hematomas were the most frequently reported moderate injury, with a prevalence of 4% (95% CI, 2-10). Severe injuries that include subluxation of the arytenoids and vocal fold paralysis are rare (<1%) outcomes. The most prevalent patient complaints postextubation were dysphagia (43%), pain (38%), coughing (32%), a sore throat (27%), and hoarseness (27%). Overall, laryngeal injury from short-duration surgical intubation is common and is most often mild. No uniform guidelines for laryngeal assessment postextubation from surgery are available and hoarseness is neither a good indicator of laryngeal injury or dysphagia. Protocolized screening for dysphonia and dysphagia postextubation may lead to improved identification of injury and, therefore, improved patient outcomes and reduced health care utilization.
Epidural Administration of Ropivacaine Reduces the Amplitude of Transcranial Electrical Motor–Evoked Potentials: A Double-Blinded, Randomized, Controlled Trial
Furutani, Kenta MD, PhD*; Tobita, Toshiyuki MD, PhD†; Ishii, Hideaki MD, PhD‡; Deguchi, Hiroyuki MD*; Mitsuma, Yusuke MD*; Kamiya, Yoshinori MD, PhD*; Baba, Hiroshi MD, PhD
doi : 10.1213/ANE.0000000000005236
Anesthesia & Analgesia. 132(4):1092-1100, April 2021.
An epidurally administered local anesthetic acts primarily on the epidural nerve roots and can act directly on the spinal cord through the dural sleeve. We hypothesized that epidurally administered ropivacaine would reduce the amplitude of transcranial electrical motor–evoked potentials by blocking nerve conduction in the spinal cord. Therefore, we conducted a double-blind, randomized, controlled trial.
Sex-Specific Associations Between Preoperative Anemia and Postoperative Clinical Outcomes in Patients Undergoing Cardiac Surgery
Ripoll, Juan G. MD*; Smith, Mark M. MD†; Hanson, Andrew C. BS‡; Schulte, Phillip J. PhD‡; Portner, Erica R. RRT§; Kor, Daryl J. MD?; Warner, Matthew A. MD
doi : 10.1213/ANE.0000000000005392
Anesthesia & Analgesia. 132(4):1101-1111, April 2021.
Preoperative anemia is common in cardiac surgery, yet there were limited data describing the role of sex in the associations between anemia and clinical outcomes. Understanding these relationships may guide preoperative optimization efforts.
Agreement Between the Mini-Cog in the Preoperative Clinic and on the Day of Surgery and Association With Postanesthesia Care Unit Delirium: A Cohort Study of Cognitive Screening in Older Adults
Tiwary, Nayan BS*; Treggiari, Miriam M. MD, PhD, MPH†,‡; Yanez, N. David PhD†,‡; Kirsch, Jeffrey R. MD†,§; Tekkali, Praveen MS†; Taylor, Cornelia C. MD?; Schenning, Katie J. MD, MPH
doi : 10.1213/ANE.0000000000005197
Anesthesia & Analgesia. 132(4):1112-1119, April 2021.
Cognitive impairment is common in older surgical patients and is associated with postoperative delirium. However, cognitive function is inconsistently assessed preoperatively, leading to missed opportunities to recognize vulnerable patients. We designed a prospective cohort study to assess the agreement of the Mini-Cog screening tool administered in the preoperative clinic (clinic-day test) or immediately before surgery (surgery-day test) and to determine whether a positive screening for cognitive dysfunction in the surgery-day test is associated with postoperative delirium in the postanesthesia care unit (PACU).
Anesthesiology Residents’ Experiences and Perspectives of Residency Training
Sun, Huaping PhD*; Chen, Dandan PhD*; Warner, David O. MD†; Zhou, Yan PhD*; Nemergut, Edward C. MD‡; Macario, Alex MD, MBA§; Keegan, Mark T. MB, BCh
doi : 10.1213/ANE.0000000000005316
Anesthesia & Analgesia. 132(4):1120-1128, April 2021.
Anesthesiology residents’ experiences and perspectives about their programs may be helpful in improving training. The goals of this repeated cross-sectional survey study are to determine: (1) the most important factors residents consider in choosing an anesthesiology residency, (2) the aspects of the clinical base year that best prepare residents for anesthesia clinical training, and what could be improved, (3) whether residents are satisfied with their anesthesiology residency and what their primary struggles are, and (4) whether residents believe their residency prepares them for proficiency in the 6 Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and for independent practice.
Comparison of the Analgesic Duration of 0.5% Bupivacaine With 1:200,000 Epinephrine Versus 0.5% Ropivacaine Versus 1% Ropivacaine for Low-Volume Ultrasound-Guided Interscalene Brachial Plexus Block: A Randomized Controlled Trial
Safa, Ben MD*; Flynn, Brendan BSc*; McHardy, Paul G. MD*; Kiss, Alex PhD†; Haslam, Lynn RN (EC)*; Henry, Patrick D. MD‡; Kaustov, Lilia PhD*; Choi, Stephen MD, FRCPC, MSc
doi : 10.1213/ANE.0000000000005373
Anesthesia & Analgesia. 132(4):1129-1137, April 2021.
Bupivacaine and ropivacaine are the preferred long-acting local anesthetics for peripheral nerve blocks as they provide prolonged analgesia in the postoperative period. No studies have directly compared the analgesic duration of these commonly used local anesthetics in the setting of low-volume ultrasound-guided interscalene block (US-ISB). This study was designed to determine which local anesthetic and concentration provides superior analgesia (duration and quality) for low-volume US-ISB.
Subcostal Anterior Quadratus Lumborum Block Versus Epidural Block for Analgesia in Open Nephrectomy: A Randomized Clinical Trial
Elsharkawy, Hesham MD, MBA, MSc, FASA*,†; Ahuja, Sanchit MD†,‡; Sessler, Daniel I. MD†; Maheshwari, Kamal MD, MPH†,§; Mao, Guangmei PhD, MPH†,?; Sakr Esa, Wael Ali MD, MBA, PhD§; Soliman, Loran Mounir MD§; Ayad, Sabry MD, MBA, FASA†; Khoshknabi, Dilara MD†; Khan, Mohammad Zafeer MD¶; Raza, Syed BS†; DeGrande, Sean MD#; Turan, Alparslan MD
doi : 10.1213/ANE.0000000000005382
Anesthesia & Analgesia. 132(4):1138-1145, April 2021.
Epidural block are often used for analgesia after open nephrectomy surgery. Subcostal anterior quadratus lumborum block may be an alternative. We therefore tested the hypothesis that the continuous subcostal anterior quadratus lumborum block is noninferior to epidural block for analgesia in patients having open partial nephrectomies.
Gut Microbiota Influences Neuropathic Pain Through Modulating Proinflammatory and Anti-inflammatory T Cells
Ding, Weihua MM*; You, Zerong PhD*; Chen, Qian PhD†; Yang, Liuyue MM*; Doheny, Jason MS*; Zhou, Xue MD‡; Li, Na MD§; Wang, Shiyu MD*; Hu, Kun MD?; Chen, Lucy MD*; Xia, Suyun MD¶; Wu, Xinbo MM#; Wang, Changning PhD**; Zhang, Can PhD††; Chen, Liang PhD‡‡; Ritchie, Christine MD§§; Huang, Peigen MD??; Mao, Jianren MD, PhD*; Shen, Shiqian MD
doi : 10.1213/ANE.0000000000005155
Anesthesia & Analgesia. 132(4):1146-1155, April 2021.
Gut microbiota, a consortium of diverse microorganisms residing in the gastrointestinal tract, has emerged as a key player in neuroinflammatory responses, supporting the functional relevance of the “gut–brain axis.” Chronic-constriction injury of the sciatic nerve (CCI) is a commonly used animal model of neuropathic pain with a major input from T cell–mediated immune responses. In this article, we sought to examine whether gut microbiota influences CCI neuropathic pain, and, if so, whether T-cell immune responses are implicated.
A Novel Syngeneic Immunocompetent Mouse Model of Head and Neck Cancer Pain Independent of Interleukin-1 Signaling
Heussner, Matthew J. BS*,†; Folger, Joseph K. PhD*; Dias, Christina BS‡; Massri, Noura BS*; Dahdah, Albert PhD§; Vermeer, Paola D. PhD?; Laumet, Geoffroy PhD
doi : 10.1213/ANE.0000000000005302
Anesthesia & Analgesia. 132(4):1156-1163, April 2021.
Pain is one of the first presenting symptoms in patients with head and neck cancer, who often develop chronic and debilitating pain as the disease progresses. Pain is also an important prognostic marker for survival. Unfortunately, patients rarely receive effective pain treatment due to our limited knowledge of the mechanisms underlying head and neck cancer pain (HNCP). Pain is often associated with neuroinflammation and particularly interleukin (IL)-1 signaling. The purpose of this study is to develop a novel syngeneic model of HNCP in immunocompetent mice to examine the contribution of IL-1 signaling.
Anesthesia for Maternal–Fetal Interventions: A Consensus Statement From the American Society of Anesthesiologists Committees on Obstetric and Pediatric Anesthesiology and the North American Fetal Therapy Network
Chatterjee, Debnath MD, FAAP*; Arendt, Katherine W. MD†; Moldenhauer, Julie S. MD‡; Olutoye, Olutoyin A. MD, MSc§; Parikh, Jagroop Mavi MD?; Tran, Kha M. MD¶; Zaretsky, Michael V. MD#; Zhou, Jie MD, MS, MBA**; Rollins, Mark D. MD, PhD
doi : 10.1213/ANE.0000000000005177
Anesthesia & Analgesia. 132(4):1164-1173, April 2021.
Maternal–fetal surgery is a rapidly evolving specialty, and significant progress has been made over the last 3 decades. A wide range of maternal–fetal interventions are being performed at different stages of pregnancy across multiple fetal therapy centers worldwide, and the anesthetic technique has evolved over the years. The American Society of Anesthesiologists (ASA) recognizes the important role of the anesthesiologist in the multidisciplinary approach to these maternal–fetal interventions and convened a collaborative workgroup with representatives from the ASA Committees of Obstetric and Pediatric Anesthesia and the Board of Directors of the North American Fetal Therapy Network. This consensus statement describes the comprehensive preoperative evaluation, intraoperative anesthetic management, and postoperative care for the different types of maternal–fetal interventions.
Preoperative Intravenous Iron in Anemic Patients Undergoing Major Abdominal Surgery May Not PREVENTT Blood Transfusions But Still Contribute to the Objectives of Patient Blood Management
Hardy, Jean-François MD*,†; Farmer, Shannon L. DHSc, PhD‡; Auerbach, Michael MD§; Frank, Steven M. MD?; Javidroozi, Mazyar MD, PhD¶; Leahy, Michael F. MBBS#; Meier, Jens MD†,**; Ozawa, Sherri RN††; Shander, Aryeh MD
doi : 10.1213/ANE.0000000000005409
Anesthesia & Analgesia. 132(4):1174-1177, April 2021.
Activation of GABAergic Neurons in the Rostromedial Tegmental Nucleus and Other Brainstem Regions Promotes Sedation and Facilitates Sevoflurane Anesthesia in Mice
Vlasov, Ksenia BA*,†; Pei, JunZhu BS*,†; Nehs, Christa J. PhD*,†,‡; Guidera, Jennifer A. AB*; Zhang, Edlyn R. BSc*; Kenny, Jonathan D. BS§; Houle, Timothy T. PhD*,‡; Brenner, Gary J. MD, PhD*,‡; Taylor, Norman E. MD, PhD?; Solt, Ken MD
doi : 10.1213/ANE.0000000000005387
Anesthesia & Analgesia. 132(4):e50-e55, April 2021.
Many general anesthetics potentiate gamma-aminobutyric acid (GABA) A receptors but their neuroanatomic sites of action are less clear. GABAergic neurons in the rostromedial tegmental nucleus (RMTg) send inhibitory projections to multiple arousal-promoting nuclei, but the role of these neurons in modulating consciousness is unknown. In this study, designer receptors exclusively activated by designer drugs (DREADDs) were targeted to RMTg GABAergic neurons of Vgat-ires-Cre mice. DREADDs expression was found in the RMTg and other brainstem regions. Activation of these neurons decreased movement and exploratory behavior, impaired motor coordination, induced electroencephalogram (EEG) oscillations resembling nonrapid eye movement (NREM) sleep without loss of righting and reduced the dose requirement for sevoflurane-induced unconsciousness. These results suggest that GABAergic neurons in the RMTg and other brainstem regions promote sedation and facilitate sevoflurane-induced unconsciousness.
Artificial Ventilation: A Basic Clinical Guide
Bello, Corina MD; Luedi, Markus M. MD, MBA
doi : 10.1213/ANE.0000000000005403
Anesthesia & Analgesia. 132(4):e56-e57, April 2021.
Is Surgical Tracheostomy Better Than Percutaneous Tracheostomy in Coronavirus Disease 2019–Positive Patients?
Amaya, Oswaldo MD; Arango, Enrique MD; Pab?n, Stefanie MD; Mej?a, Sara MD; Montoya, Mar?a C. MD; Madrid, Guillermo MD
doi : 10.1213/ANE.0000000000005376
Anesthesia & Analgesia. 132(4):e58, April 2021.
In Response
Bassi, Massimiliano MD; Ruberto, Franco MD; Poggi, Camilla MD; Diso, Daniele MD; Anile, Marco MD; De Giacomo, Tiziano MD; Pecoraro, Ylenia MD; Carillo, Carolina MD; Pugliese, Francesco MD; Venuta, Federico MD; Vannucci, Jacopo MD
doi : 10.1213/ANE.0000000000005377
Anesthesia & Analgesia. 132(4):e58-e59, April 2021.
Extending Our Role as Perioperative Physician in the Care of Undiagnosed Hypertensive Patients
Nwokolo, Omonele O. MD; Patterson, Velvet MD; Liang, Yafen MD
doi : 10.1213/ANE.0000000000005400
Anesthesia & Analgesia. 132(4):e59-e60, April 2021.
Opioid-Induced Respiratory Depression: Is Hydromorphone Safer Than Morphine?
Roth, Jonathan V. MD
doi : 10.1213/ANE.0000000000005413
Anesthesia & Analgesia. 132(4):e60, April 2021.
In Response
Khanna, Ashish K. MD, FCCP, FCCM; Urman, Richard D. MD, MBA; Overdyk, Frank J. MD
doi : 10.1213/ANE.0000000000005415
Anesthesia & Analgesia. 132(4):e61, April 2021.
In Response
Prielipp, Richard C. MD, MBA, FCCM; Fulesdi, Bela MD, PhD; Brull, Sorin J. MD, FCARCSI (Hon)
doi : 10.1213/ANE.0000000000005414
Anesthesia & Analgesia. 132(4):e61-e63, April 2021.
