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Pharmacological consequence of the A118G μ opioid receptor polymorphism on morphine-and fentanyl-mediated modulation of Ca2+ channels in humanized mouse sensory neurons | Background: The most common functional single nucleotide polymorphism of the human OPRM1 gene, A118G, has been shown to be associated with interindividual differences in opioid analgesic requirements, particularly with morphine, in patients with acute postoperative pain. The purpose of this study was to examine whether... |
Perioperative mortality, 2010 to 2014: A retrospective cohort study using the national anesthesia clinical outcomes registry | Background: The National Anesthesia Clinical Outcomes Registry collects demographic and outcome data from anesthesia cases, with the goal of improving safety and quality across the specialty. The authors present a preliminary analysis of the National Anesthesia Clinical Outcomes Registry database focusing on the rates ... |
Noxious stimulation response index: A novel anesthetic state index based on hypnotic-opioid interaction | Background: The noxious stimulation response index (NSRI) is a novel anesthetic depth index ranging between 100 and 0, computed from hypnotic and opioid effect-site concentrations using a hierarchical interaction model. The authors validated the NSRI on previously published data. METHODS:: The data encompassed 44 women... |
Norepinephrine infusion into nucleus basalis elicits microarousal in desflurane-anesthetized rats | Background: The nucleus basalis of Meynert of the basal forebrain has been implicated in the regulation of the state of consciousness across normal sleep-wake cycles. Its role in the modulation of general anesthesia was investigated. Methods: Rats were chronically implanted with bilateral infusion cannulae in the nucle... |
Unanticipated difficult airway in obstetric patients: Development of a new algorithm for formative assessment in high-fidelity simulation | Background: The objective of this study was to develop a consensus-based algorithm for the management of the unanticipated difficult airway in obstetrics, and to use this algorithm for the assessment of anesthesia residents' performance during high-fidelity simulation. Methods: An algorithm for unanticipated difficult ... |
Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents | Background: The perioperative surgical home model highlights the need for trainees to include modalities that are focused on the entire perioperative experience. The focus of this study was to design, introduce, and evaluate the integration of a wholebody point-of-care (POC) ultrasound curriculum (Focused periOperative... |
Chronic Pain Management: American Society of Anesthesiologists Closed Claims Project | Background: The practice of chronic pain management has grown steadily in recent years. The purpose of this study was to identify and describe issues and trends in liability related to chronic pain management by anesthesiologists. Methods: Data from 5,475 claims in the American Society of Anesthesiologists Closed Claim... |
Human alzheimer and inflammation biomarkers after anesthesia and surgery | Background: The prevalence of postoperative cognitive disturbance, coupled with growing in vitro, cell, and animal evidence suggesting anesthetic effects on neurodegeneration, calls for additional study of the interaction between surgical care and Alzheimer neuropathology. The authors studied human cerebrospinal fluid ... |
Impact of the prone position in an animal model of unilateral bacterial pneumonia undergoing mechanical ventilation | Background: The prone position (PP) has proven beneficial in patients with severe lung injury subjected to mechanical ventilation (MV), especially in those with lobar involvement. We assessed the impact of PP on unilateral pneumonia in rabbits subjected to MV. Methods: After endobronchial challenge with Enterobacter ae... |
Preoperative fasting practices in pediatrics | Background: The purpose of this study was to determine current practice patterns for preoperative fasting at major pediatric hospitals. Methods: Fasting guidelines for children at each of the hospitals listed in the second edition of the Directory of Pediatric Anesthesiology Fellowship Programs were solicited and analy... |
Autopsy utilization in medicolegal defense of anesthesiologists | Background: The rate of autopsy in hospital deaths has declined from more than 50% to 2.4% over the past 50 yr. To understand the role of autopsies in anesthesia malpractice claims, we examined 980 closed claims for deaths that occurred in 1990 or later in the American Society of Anesthesiologists Closed Claims Project... |
Prolonged central venous desaturation measured by continuous oximetry is associated with adverse outcomes in pediatric cardiac surgery | Background: The role of continuous central venous oxygen saturation (ScvO2) oximetry during pediatric cardiac surgery for predicting adverse outcomes is not known. Using a recently available continuous ScvO2 oximetry catheter, we examined the association between venous oxygen desaturations and patient outcomes. We hypo... |
Effects of an Innovative Psychotherapy Program for Surgical Patients: Bridging Intervention in Anesthesiology - A Randomized Controlled Trial | Background: The stepped care program Bridging Intervention in Anesthesiology (BRIA) aims at motivating and supporting surgical patients with comorbid mental disorders to engage in psychosocial mental healthcare options. This study examined the efficacy of BRIA. Methods: This randomized, parallel-group, open-label, cont... |
Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period | Background: The subjective experience of residual neuromuscular blockade after emergence from anesthesia has not been examined systematically during postanesthesia care unit (PACU) stays. The authors hypothesized that acceleromyography monitoring would diminish unpleasant symptoms of residual paresis during recovery fr... |
Influence of the type of anesthesia provider on costs of labor analgesia to the Texas Medicaid Program | Background: The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. Methods: Under the Freedom of Inf... |
Association between anesthesiologist age and litigation | Background: The threat of being sued is a concern for many anesthesiologists. This paper asks whether litigation brought against anesthesiologists is associated with the age of the anesthesiologist. Methods: Institutional research ethics approval was granted. We obtained billing data for all procedures performed by spe... |
Evolution of the inflammatory and fibroproliferative responses during resolution and repair after ventilator-induced lung injury in the rat | Background: The time course and mechanisms of resolution and repair, and the potential for fibrosis following ventilation-induced lung injury (VILI), are unclear. We sought to examine the pattern of inflammation, injury, repair, and fibrosis following VILI. Methods: Sixty anesthetized rats were subject to high-stretch;... |
Detection of intraoperative incidents by electronic scanning of computerized anesthesia records: Comparison with voluntary reporting | Background: The use of a computerized anesthesia information management system provides an opportunity to scan case records electronically for deviations from specific limits for physiologic variables. Anesthesia department policy may define such deviations as intraoperative incidents and may require anesthesiologists ... |
An in vivo evaluation of the mycobacterial filtration efficacy of three breathing filters used in anesthesia | Background: The use of breathing filters (BFs) has been recommended to protect the anesthesia apparatus in proven or suspected cases of tuberculosis. Some investigators have also suggested the use of BF to alleviate the need to change anesthesia breathing circuits after each case. This study evaluated the filtration ef... |
A population-based analysis of outpatient colonoscopy in adults assisted by an anesthesiologist | BACKGROUND: The use of propofol to sedate patients for colonoscopy, generally administered by an anesthesiologist in North America, is increasingly popular. In the United States, regional use of anesthesiologist-assisted endoscopy appears to correlate with local payor policy. This study's objective was to identify nonp... |
Caffeine Accelerates Emergence from Isoflurane Anesthesia in Humans A Randomized, Double-blind, Crossover Study | Background: There are currently no drugs clinically available to reverse general anesthesia. We previously reported that caffeine is able to accelerate emergence from anesthesia in rodents. This study was carried out to test the hypothesis that caffeine accelerates emergence from anesthesia in humans. Methods: We condu... |
Fiberoptic Intubation Using Anesthetized, Paralyzed, Apneic Patients Results of a Resident Training Program | Background: There is no consensus about the best way to teach fiberoptic intubation. This study assesses the effectiveness of a training program in which novice anesthetic residents routinely were taught fiberoptic tracheal intubation of anesthetized, paralyzed, apneic patients. Methods: Eight inexperienced anesthetic ... |
Effect of Performance Deficiencies on Graduation and Board Certification Rates: A 10-yr Multicenter Study of Anesthesiology Residents | Background: This multicenter, retrospective study was conducted to determine how resident performance deficiencies affect graduation and board certification. Methods: Primary documents pertaining to resident performance were examined over a 10-yr period at four academic anesthesiology residencies. Residents entering tr... |
Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume | Background: This prospective observational study aimed to assess the feasibility and performance of the ultrasonographic measurement of antral cross-sectional area (CSA) for the preoperative assessment of gastric contents and volume in adult patients and for the diagnosis of risk stomach (defined by the presence of sol... |
A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block | BACKGROUND: This prospective, randomized, blinded study tested the hypothesis that ultrasound guidance can shorten the onset time of axillary brachial plexus block as compared with nerve stimulation guidance when using a multiple injection technique. METHODS: Sixty American Society of Anesthesiology physical status I-I... |
Repeated cross-sectional surveys of burnout, distress, and depression among anesthesiology residents and first-year graduates | Background: This repeated cross-sectional survey study was conducted to determine the prevalence of, and factors associated with, burnout, distress, and depression among anesthesiology residents and first-year graduates. We hypothesized that heavy workload and student debt burden were associated with a higher risk of p... |
Practice Improvements Based on Participation in Simulation for the Maintenance of Certification in Anesthesiology Program | Background: This study describes anesthesiologists' practice improvements undertaken during the first 3 yr of simulation activities for the Maintenance of Certification in Anesthesiology Program. Methods: A stratified sampling of 3 yr (2010-2012) of participants' practice improvement plans was coded, categorized, and a... |
Toll-like receptor 4 inhibitor TAK-242 attenuates acute kidney injury in endotoxemic sheep | Background: This study was conducted to investigate the role of toll-like receptor 4 (TLR4) in mediating acute kidney injury in endotoxemic sheep using the selective TLR4 inhibitor TAK-242. Methods: A randomized, controlled, experimental study was performed with 20 adult Texel crossbred sheep. Before an Escherichia col... |
Magnetic resonance imaging analysis of the spread of local anesthetic solution after ultrasound-guided lateral thoracic paravertebral blockade: A volunteer study | Background: This study was designed to examine the spread of local anesthetic (LA) via magnetic resonance imaging after a standardized ultrasound-guided thoracic paravertebral blockade. Methods: Ten volunteers were enrolled in the study. We performed ultrasound-guided single-shot paravertebral blocks with 20 ml mepivac... |
Operating room fires: A closed claims analysis | Background: To assess patterns of injury and liability associated with operating room (OR) fires, closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985 were reviewed. Methods: All claims related to fires in the OR were compared with nonfire-related surgical anesthesia ... |
Injury and liability associated with monitored anesthesia care: A closed claims analysis | Background: To assess the patterns of injury and liability associated with monitored anesthesia care (MAC) compared with general and regional anesthesia, the authors reviewed closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1990. Methods: All surgical anesthesia claims... |
Development and validation of the questionnaire of satisfaction with perioperative anesthetic care for general and regional anesthesia in taiwanese patients | Background: To fulfill the increasing demand of service quality improvement in recent years, it is imperative to develop a proper instrument to evaluate patient satisfaction with perioperative anesthetic care for many institutes in Taiwan. Methods: We used a six-factor 32-item pilot questionnaire developed in our previ... |
French survey of anesthesia in 1996 | Background: To identify the growth in the number of anesthetic procedures since 1980 and the changes in the practice of anesthesia, the present survey was designed to collect and analyze the anesthetic activity performed in France in 1996, from a representative sample collected in all French hospitals and clinics. Meth... |
Retrograde light-guided laryngoscopy for tracheal intubation: Clinical practice and comparison with conventional direct laryngoscopy | Background: Tracheal intubation with conventional laryngoscopy requires many trials until beginners are sufficiently skilled in intubating patients safely. To facilitate intubation, the authors used retrograde light-guided laryngoscopy (RLGL) and compared its feasibility with conventional direct laryngoscopy (DL). Meth... |
Activation of triggering receptor expressed on myeloid cells-1 protects monocyte from apoptosis through regulation of myeloid cell leukemia-1 | Background: Triggering receptor expressed on myeloid cells-1 (TREM-1) can amplify the proinflammatory response and may contribute to the pathogenesis of inflammatory disease such as sepsis. However, the role of TREM-1 in monocyte fate and the detailed molecular mechanisms evoked by TREM-1 are unknown. Methods: Adenovir... |
Involvement of the tyr kinase/JNK pathway in carbachol-induced bronchial smooth muscle contraction in the rat | Background: Tyrosine (Tyr) kinases and mitogen-activated protein kinases have been thought to participate in the contractile response in various smooth muscles. The aim of the current study was to investigate the involvement of the Tyr kinase pathway in the contraction of bronchial smooth muscle. Methods: Ring preparat... |
Formal instruction in difficult airway management: A survey of anesthesiology residency programs | Background: Up to 30% of all deaths attributable to anesthesia are related to difficulties with airway management. The purpose of this study was to determine whether anesthesiology residents are receiving specialized instruction in the various techniques and mechanical devices currently recommended for airway managemen... |
Development and evaluation of a graphical anesthesia drug display | Background: Usable real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical decision-making. Pharmacokinetic models are available to estimate past, present, and future drug effectsite concentrations, and pharmacodynamic models are available to predict t... |
Postoperative recovery with bispectral index versus anesthetic concentration-guided protocols | Background: Use of the bispectral index (BIS) monitor has been suggested to decrease excessive anesthetic drug administration, leading to improved recovery from general anesthesia. The purpose of this substudy of the B-Unawareand BAG-RECALL trials was to assess whether a BIS-based anesthetic protocol was superior to an... |
Determining resident clinical performance: Getting beyond the noise | Background: Valid and reliable (dependable) assessment of resident clinical skills is essential for learning, promotion, and remediation. Competency is defined as what a physician can do, whereas performance is what a physician does in everyday practice. There is an ongoing need for valid and reliable measures of resid... |
Simulation-based assessment to identify critical gaps in safe anesthesia resident performance | Background: Valid methods are needed to identify anesthesia resident performance gaps early in training. However, many assessment tools in medicine have not been properly validated. The authors designed and tested use of a behaviorally anchored scale, as part of a multiscenario simulation-based assessment system, to id... |
Multimodal Analgesic Regimen for Spine Surgery A Randomized Placebo-controlled Trial | Background: Various multimodal analgesic approaches have been proposed for spine surgery. The authors evaluated the effect of using a combination of four nonopioid analgesics versus placebo on Quality of Recovery, postoperative opioid consumption, and pain scores. Methods: Adults having multilevel spine surgery who wer... |
Isoflurane regulates atypical type-a γ-aminobutyric acid receptors in alveolar type II epithelial cells | Background: Volatile anesthetics act primarily through upregulating the activity of γ-aminobutyric acid type A (GABAA) receptors. They also exhibit antiinflammatory actions in the lung. Rodent alveolar type II (ATII) epithelial cells express GABAA receptors and the inflammatory factor cyclooxygenase-2 (COX-2). The goal... |
Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists | Background: We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. Methods: A total of 263 co... |
Mandibular Advancement Improves the Laryngeal View during Direct Laryngoscopy Performed by Inexperienced Physicians | Background: When oral or nasal fiberoptic laryngoscopy is attempted, mandibular advancement has been reported to improve the laryngeal view. The authors hypothesized that mandibular advancement may also improve the laryngeal view during direct laryngoscopy. Methods: Forty patients undergoing elective surgery under gene... |
Continuous femoral nerve blocks: Varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block | Background: Whether the method of local anesthetic administration for continuous femoral nerve blocks-basal infusion versus repeated hourly bolus doses-influences block effects remains unknown. Methods: Bilateral femoral perineural catheters were inserted in volunteers (n = 11). Ropivacaine 0.1% was concurrently admini... |
A systems theoretic process analysis of the medication use process in the operating room | Background: While 4 to 10% of medications administered in the operating room may involve an error, few investigations have prospectively modeled how these errors might occur. Systems theoretic process analysis is a prospective risk analysis technique that uses systems theory to identify hazards. The purpose of this stu... |
Adaptive support ventilation may deliver unwanted respiratory rate-tidal volume combinations in patients with acute lung injury ventilated according to an open lung concept | Background: With adaptive support ventilation, respiratory rate and tidal volume (VT) are a function of the Otis least work of breathing formula. We hypothesized that adaptive support ventilation in an open lung ventilator strategy would deliver higher VTs to patients with acute lung injury. Methods: Patients with acut... |
Fiberoptic orotracheal intubation on anesthetized patients: Do manipulation skills learned on a simple model transfer into the operating room? | Background: With increasing pressure to use operating room time efficiently, opportunities for residents to learn fiberoptic orotracheal intubation in the operating room have declined. The purpose of this study was to determine whether fiberoptic orotracheal intubation skills learned outside the operating room on a sim... |
Hearing acuity of anesthesiologists and alarm detection | Background: With rapid technological advances in anesthesiology, we are acquiring an ever increasing number of auditory alarm systems in the operating room the value of which depend on the hearing acuity of the anesthesiologist monitoring the patient. Presbycusis, the effect of aging on the auditory system, characteris... |
Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use | Background: Zygapophyseal (facet) joint interventions are the second most common interventional procedure in pain medicine. Opioid exposure after surgery is a significant risk factor for chronic opioid use. The aim of this study was to determine the incidence of new persistent use of opioids after lumbar facet radiofre... |
Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation | BACKGROUND:: Emergent intubation is associated with a high complication rate. These intubations are often performed by resident physicians in teaching hospitals. The authors evaluated whether supervision by an anesthesia-trained intensivist decreases complications of emergent intubations. METHODS:: The authors performe... |
Spontaneous breathing with biphasic positive airway pressure attenuates lung injury in hydrochloric acid-induced acute respiratory distress syndrome | BACKGROUND:: It has been proved that spontaneous breathing (SB) with biphasic positive airway pressure (BIPAP) can improve lung aeration in acute respiratory distress syndrome compared with controlled mechanical ventilation. The authors hypothesized that SB with BIPAP would attenuate lung injury in acute respiratory di... |
Should anesthesia groups advocate funding of clinics and scheduling systems to increase operating room workload? | BACKGROUND:: Knowledge of patterns related to patient visits in a multispecialty group is important for helping anesthesia groups make strategic and tactical decisions relevant to increasing anesthesia workload. METHODS:: The authors studied surgery at an outpatient surgery center over 6 months and analyzed every clini... |
Comparison of the effects of 0.03 and 0.05 mg/kg midazolam with placebo on prevention of emergence agitation in children having strabismus surgery | BACKGROUND:: Midazolam has been widely studied for preventing emergence agitation. The authors previously reported that in children with sevoflurane anesthesia, intravenous administration of midazolam (0.05 mg/kg) before the end of surgery reduced the incidence of emergence agitation but prolonged the emergence time. T... |
Reversal of monoarthritis-induced affective disorders by diclofenac in rats | BACKGROUND:: Nonsteroidal anti-inflammatory drugs are effective for arthritic pain, but it is unknown whether they also benefit anxiety and depression that frequently coexist with pain. Using the monoarthritis model, the authors evaluated the activation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) in stru... |
Characterization of acute and chronic neuropathies induced by oxaliplatin in mice and differential effects of a novel mitochondria-targeted antioxidant on the neuropathies | BACKGROUND:: Oxaliplatin, a chemotherapeutic agent used for the treatment of colorectal cancer, induces dose-limiting neuropathy that compromises quality of life. This study aimed to reproduce, in mice, patients' symptoms of oxaliplatin-induced neuropathy and to observe effects of SS-31, a mitochondria-targeted antioxi... |
Phase 1 safety assessment of intrathecal oxytocin | BACKGROUND:: Preclinical data suggest that oxytocin reduces hypersensitivity by actions in the spinal cord, but whether it produces antinociception to acute stimuli is unclear. In this article, the authors examined the safety of intrathecal oxytocin and screened its effects on acute noxious stimuli. METHODS:: After ins... |
Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients | BACKGROUND:: The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown that residents and anesthesiologists do not apply these guidelines when tested. Th... |
Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children | BACKGROUND:: The aim of this study was to test the accuracy of lung sonography (LUS) to diagnose anesthesia-induced atelectasis in children undergoing magnetic resonance imaging (MRI). METHODS:: Fifteen children with American Society of Anesthesiology's physical status classification I and aged 1 to 7 yr old were studi... |
Real-time detection of gastric insufflation related to facemask pressure-controlled ventilation using ultrasonography of the antrum and epigastric auscultation in nonparalyzed patients | BACKGROUND:: The authors sought to determine the level of inspiratory pressure minimizing the risk of gastric insufflation while providing adequate pulmonary ventilation. The primary endpoint was the increase in incidence of gastric insufflation detected by ultrasonography of the antrum while inspiratory pressure for f... |
A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: Quantifying the pharmacodynamic shift evoked by stimulation | BACKGROUND:: The authors studied the interaction between sevoflurane and remifentanil on bispectral index (BIS), state entropy (SE), response entropy (RE), Composite Variability Index, and Surgical Pleth Index, by using a response surface methodology. The authors also studied the influence of stimulation on this intera... |
Simulator-based transesophageal echocardiographic training with motion analysis: A curriculum-based approach | BACKGROUND:: Transesophageal echocardiography (TEE) is a complex endeavor involving both motor and cognitive skills. Current training requires extended time in the clinical setting. Application of an integrated approach for TEE training including simulation could facilitate acquisition of skills and knowledge. METHODS:... |
Adverse anesthetic outcomes arising from gas delivery equipment: A closed claims analysis | Background. Anesthesia gas delivery equipment is a potentially important source of patient injury. To better define the contribution of gas delivery equipment to professional liability in anesthesia, the authors conducted an in-depth analysis of cases from the database of the American Society of Anesthesiologists Close... |
Target-Controlled Drug Delivery: Progress Toward an Intravenous "Vaporizer" and Automated Anesthetic Administration | Based on a drug's typical pharmacokinetic behavior, target-controlled infusion systems calculate and deliver the infusion rate that is necessary to achieve and maintain a user-designated drug concentration in the blood or theoretical effect site. Employed in both clinical and research settings, target-controlled infusi... |
An Anesthesiologist's Perspective on the History of Basic Airway Management: The "preanesthetic" Era-1700 to 1846 | Basic airway management modern history starts in the early 18th century in the context of resuscitation of the apparently dead. History saw the rise and fall of the mouth-to-mouth and then of the instrumental positive-pressure ventilation generated by bellows. Pulmonary ventilation had a secondary role to external and ... |
Measuring Clinical Productivity of Anesthesiology Groups: Surgical Anesthesia at the Facility Level | Benchmarking and comparing group productivity is an essential activity of data-driven management. For clinical anesthesiology, accomplishing this task is a daunting effort if meaningful conclusions are to be made. For anesthesiology groups, productivity must be done at the facility level in order to reduce some of the ... |
Succinylcholine and intracranial pressure | Bolus injections of succinylcholine (1.5mg/kg) signifcantly increased intracranial pressure (ICP) in cats under normal conditions from control levels of 8 +/-1 mmHg to 16 +/-3 mmHg (+/-SEM, P less than 0.01), and in the presence of artifcially increased ICP from control levels of 27 +/-1 mmHg to 47 +/-4 mmHg (P less th... |
Modulation of Cerebral Function by Muscle Afferent Activity, with Reference to Intravenous Succinylcholine | Cerebral Function and Muscle Afferent Activity Following Intravenous Succinylcholine in Dogs Anesthetized with Halothane: The Effects of Pretreatment with a Defasciculating Dose of Pancuronium. By WL Lanier, PA Iaizzo, and JH Milde. Anesthesiology 1989; 71:87-95. Reprinted with permission. By the mid-1980s, it was wide... |
Smoking and pain : Pathophysiology and clinical implications | Cigarette smoke, which serves as a nicotine delivery vehicle in humans, produces profound changes in physiology. Experimental studies suggest that nicotine has analgesic properties. However, epidemiologic evidence shows that smoking is a risk factor for chronic pain. The complex relationship between smoking and pain no... |
Artificial Intelligence and Machine Learning in Anesthesiology | Commercial applications of artificial intelligence and machine learning have made remarkable progress recently, particularly in areas such as image recognition, natural speech processing, language translation, textual analysis, and self-learning. Progress had historically languished in these areas, such that these skil... |
Controlled substance dispensing and accountability in United States anesthesiology residency programs | Controlled substance dependence (CSD) among anesthesiology personnel, particularly residents, has become a matter of increasing concern. Opinions vary as to the effectiveness of controlled substances (CS) accountability in deterring, identifying, or confirming CSD. A survey of program directors of American anesthesiolo... |
Addiction and substance abuse in anesthesiology | Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace, and outcomes have not appreciably changed. Although alcoholism and other forms of impairment, such as addiction to o... |
Myocardial ischemia revisited. | Does perioperative myocardial ischemia lead to postoperative myocardial infarction? By Stephen Slogoff and Arthur S. Keats. Anesthesiology 1985; 62:107-14. Reprinted with permission.To determine if a relationship exists between perioperative myocardial ischemia (ST segment depression greater than or equal to 0.1 mV) an... |
Muscarinic signaling in the central nervous system: Recent developments and anesthetic implications | During the last decade, major advances have been made in our understanding of the physiology and pharmacology of CNS muscarinic signaling. It is time to emphasize that the well-known peripheral parasympathetic and cardiovascular actions represent only one component of muscarinic signaling. Interestingly, many new findi... |
Dynamic Cortical Connectivity during General Anesthesia in Surgical Patients | Editor's Perspective What We Already Know about This Topic Animal data, along with recent human observations (in this issue of Anesthesiology∗), suggest that cortical oscillations and connectivity shift dynamically during what appears to be stable general anesthesia Clinical evidence in the perioperative setting to sup... |
Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event | Editor's Perspective What We Already Know about This Topic Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. What This Article Tells Us That Is New Failure to debrief after critical events is common among anesthesia trainees and... |
Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia: A Prospective Observational Study | Editor's Perspective What We Already Know about This Topic Intraoperative hypotension is associated with significant postoperative complications Intraoperative hypotension has been defined relative to preinduction blood pressure Blood pressure varies during the day, and the relationship between preinduction blood press... |
The Evolution of the Anesthesia Patient Safety Movement in America: Lessons Learned and Considerations to Promote Further Improvement in Patient Safety | Ellison C. Pierce, Jr., M.D., and a small number of specialty leaders and scientists formed a remarkable, diverse team in the mid-1980s to address a dual crisis: a safety crisis for anesthetized patients and a medical malpractice insurance crisis for anesthesiologists. This cohesive team's efforts led to the formation ... |
Fatigue in anesthesia: Implications and strategies for patient and provider safety | Fatigue is commonplace in contemporary society and is especially likely in individuals working in industries that must be in continuous operation. This article reviews the physiological challenges that face anesthesia care providers and the safety risks of working while fatigued. Data-based strategies are suggested for... |
49 Mathoura road: Geoffrey kaye's letters to Paul M. Wood, 1939-1955 | From 1930 to 1955, Geoffrey Kaye, M.B.B.S., was one of the most influential anesthetists in Australia. In 1951, he opened a center of excellence for Australian anesthesia at 49 Mathoura Road, Toorak, Melbourne, which Kaye affectionately called "The Anaesthestists' Castle" and "49." "49" was designed to foster the educa... |
How Can Anesthesiologists Influence Policymaking? Reflections from a Year at the Council of Economic Advisers | From September 2019 to August 2020, the author served as a senior economist on the Council of Economic Advisers, a government agency charged with providing economic analysis and advice to the President of the United States and senior government officials. Working with the Council yielded many useful lessons on how anes... |
49 Mathoura Road: Geoffrey Kaye's center of excellence for the Australian Society of Anaesthetists | Geoffrey Kaye, M.B.B.S. (1903 to 1986), was a prominent Australian anesthetist, researcher, and educator who envisioned that anesthesia practice in Australia would be comparable to European and American anesthesia practice during the 1940s and 1950s. Kaye's close relationship with Francis Hoeffer McMechan, M.D., F.I.C.... |
Anesthesiologists' Role in Value-based Perioperative Care and Healthcare Transformation | Health care is undergoing major transformation with a shift from fee-for-service care to fee-for-value. The advent of new care delivery and payment models is serving as a driver for value-based care. Hospitals, payors, and patients increasingly expect physicians and healthcare systems to improve outcomes and manage cos... |
COVID-19 Infection: Implications for Perioperative and Critical Care Physicians | Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem orga... |
High-volume hemofiltration in the intensive care unit: A blood purification therapy | High-volume hemofiltration is an extracorporeal therapy that has been available in the intensive care unit for more than 10 yr. Recent improvements in technology have made its clinical application easier and safer. However, the definition, indications, and management of this technique are still unclear, and considerabl... |
The Apgar score has survived the test of time. | In 1953, Virginia Apgar, M.D. published her proposal for a new method of evaluation of the newborn infant. The avowed purpose of this paper was to establish a simple and clear classification of newborn infants which can be used to compare the results of obstetric practices, types of maternal pain relief and the results... |
A modification in the training requirements in anesthesiology: Requirements for the third clinical anesthesia year | In order to continue to enhance the educational quality of residency training in anesthesiology and ultimately to improve patient care, the American Board of Anesthesiology has adopted a modification in the curriculum for the 4-year Continuum of Education in Anesthesiology to provide for a CA-3 year replacing the Speci... |
Development of an anesthesiology-based postoperative pain management service | In recent years, two new therapeutic modalities for treatment of postoperative pain have become available: epidural opiate analgesia (EOA) and patient-controlled analgesia (PCA). Several factors have limited the wide-spread use of these techniques: the cost of PCA machines, the time required by anesthesiologists to man... |
Erratum: Nebulization of antiinfective agents in invasively mechanically ventilated adults: A systematic review and meta-analysis (Anesthesiology (2017) 126 (890-908) DOI: 10.1097/ALN.0000000000001570) | In th article beginning on page 890 in the May 2017 issue, the first sentence of the Competing Interests section is incorrect due to a publisher error. The correct sentence is "Dr. Rello received research grants and consulting fees from Bayer (Leverkusen, Germany) and Genentech (San Francisco, California)." This error ... |
Survey of residency training in preoperative evaluation | In the academic year 1998 to 1999, the majority of accredited anesthesiology residency training programs did not have a formal curriculum addressing preoperative assessment, and nearly 40% provided no clinical training in preoperative evaluation. |
Erratum: Comparison of tracheal intubation conditions in operating room and intensive care unit: A prospective, observational study (Anesthesiology (2018) 129 (321–328) DOI: 10.1097/ALN.0000000000002269) | In the article "Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study" (Taboada M, Doldan P, Calvo A, Almeida X, Ferreiroa E, Baluja A, Cariñena A, Otero P, Caruezo V, Naveira A, Otero P, Alvarez J: Anesthesiology 2018; 129:321-8), there was a mistake... |
Erratum: Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia (Anesthesiology (2019) 130 (981-194) DOI: 10.1097/ALN.0000000000002660) | In the article "Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia" (Lunardi N, Sica R, Atluri N, Salvati KA, Keller C, Beenhakker MP, Goodkin HP, Zuo Z: Anesthesiology 2019; 130:981-94), the figure 2 image and legend were incorrect. They should have appeared as follows. The... |
Erratum: Limb remote ischemic preconditioning attenuates lung injury after pulmonary resection under propofol-remifentanil anesthesia: A randomized controlled study (Anesthesiology (2014) 121 (249-259) DOI: 10.1097/ALN.0000000000000266) | In the article "Limb Remote Ischemic Preconditioning Attenuates Lung Injury after Pulmonary Resection under PropofolRemifentanil Anesthesia: A Randomized Controlled Study" (Li C, Xu M, Wu Y, Li YS, Huang WQ, Liu KX: Anesthesiology 2014; 121:249-59), the P values in tables 1 and 2 are systematically incorrect, given the... |
Erratum: Limb remote ischemic preconditioning for intestinal and pulmonary protection during elective open infrarenal abdominal aortic aneurysm repair: A randomized controlled trial (Anesthesiology (2013) 118 (842–852) DOI: 10.1097/ALN.0b013e3182850da5) | In the article "Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial" (Li C, Li YS, Xu M, Wen SH, Yao X, Wu Y, Huang CY, Huang WQ, Liu KX: Anesthesiology 2013; 118:842-52), the P values in table 2 are... |
Erratum: Lung ultrasound in emergency and critically ill patients: Number of supervised exams to reach basic competence (Anesthesiology (2020) 132 (899−907) DOI: 10.1097/ALN.0000000000003096) | In the article "Lung Ultrasound in Emergency and Critically Ill Patients: Number of Supervised Exams to Reach Basic Competence" published in the April 2020 issue, there is an error in the Methods section. In the third paragraph under "Lung Ultrasound Curriculum and the APECHO Study" on page 902, the sentence "⋯ (3) int... |
Erratum: Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center: A study of 92,881 patients (Anesthesiology (2007) 106 (226-237)) | In the article "Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center" (Flick RP, Sprung J, Harrison TE, Gleich SJ, Schroeder DR, Hanson AC, Buenvenida SL, Warner DO: Anesthesiology 2007; 106:226-37) there is an error in the following sentence: "Of the 26 noncardiac patients who ... |
Erratum: Prophylactic intrathecal morphine and prevention of post-dural puncture headache: A randomized double-blind trial (Anesthesiology (2020) 132 (1045−1052) DOI: 10.1097/ALN.0000000000003206) | In the article "Prophylactic Intrathecal Morphine and Prevention of Post-Dural Puncture Headache: A Randomized Double-blind Trial" published in the May 2020 issue, the terms intrathecal morphine and intrathecal saline are reversed in the Abstract and Results section. The results section of the Abstract currently reads:... |
Erratum: "Protective Ventilation" during Anesthesia: Is It Meaningful? (Anesthesiology (2016) 125 (1079-82)) | In the article beginning on page 1079 of the December 2016 issue, an incorrect reference appears in the References list. Reference 25 is incorrect, and should instead be listed as: "Edmark L, Auner U, Hallen J, Lassinantti-Olowsson L, Hedenstierna G, Enlund M: A ventilation strategy during general anaesthesia to reduce... |
Erratum: Nitrous oxide-related postoperative nausea and vomiting depends on duration of exposure (Anesthesiology (2014) 120 (1137-1145)) | In the article beginning on page 1137 of the May 2014 issue, typographic data errors exist in table 1, in the two right-most columns. The correct data are as follows: (Table presented). |
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