Author: Uday Jain, MD, PhD, FASA ASA Monitor March 2021, Vol. 85, 23. As technology and its skillful use advance, older techniques fall into disuse. Over time, this leads to deskilling in older techniques. Newer technologies may not be as widely available as the older ones, even within the United States. Newer technologies are often unavailable […]
A New Eye for the Needle? Regional Anesthesia as a Case Study in Deskilling
Author: Zachary Deutch, MD, FASA ASA Monitor March 2021, Vol. 85, 25–26. The goal of postgraduate training is to assimilate as much clinical knowledge and expertise as possible in order to be maximally functional once the mythical day of July 1 comes around, when suddenly residents/fellows are autonomous, newly minted anesthesiology attendings. But what if some […]
Positive Regulatory Domain I–binding Factor 1 Mediates Peripheral Nerve Injury–induced Nociception in Mice by Repressing Kv4.3 Channel Expression
Authors: Cunjin Wang, M.D., Ph.D. et al Anesthesiology March 2021, Vol. 134, 435–456. Background The transcriptional repressor positive regulatory domain I–binding factor 1 (PRDM1) is expressed in adult mouse dorsal root ganglion and regulates the formation and function of peripheral sensory neurons. The authors hypothesized that PRDM1 in the dorsal root ganglion may contribute to peripheral […]
Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove Cytokines, Chemokines, and Cell-derived Microvesicles
Authors: Ian J. Welsby, B.Sc., M.B.B.S. et al Anesthesiology March 2021, Vol. 134, 395–404. Background Removal of cytokines, chemokines, and microvesicles from the supernatant of allogeneic erythrocytes may help mitigate adverse transfusion reactions. Blood bank–based washing procedures present logistical difficulties; therefore, we tested the hypothesis that on-demand bedside washing of allogeneic erythrocyte units is capable of […]
Patient and Procedural Determinants of Postoperative Pain Trajectories
Authors: Terrie Vasilopoulos, Ph.D. et al Anesthesiology March 2021, Vol. 134, 421–434. Background The primary goal of this study was to evaluate patterns in acute postoperative pain in a mixed surgical patient cohort with the hypothesis that there would be heterogeneity in these patterns. Methods This study included 360 patients from a mixed surgical cohort whose […]
Association between In-hospital Mortality and Low Cardiac Output Syndrome with Morning versus Afternoon Cardiac Surgery
Authors: Ryan M. Hijazi, D.O.et al Anesthesiology February 2021 Background Recent work suggests that having aortic valve surgery in the morning increases risk for cardiac-related complications. This study therefore explored whether mortality and cardiac complications, specifically low cardiac output syndrome, differ for morning and afternoon cardiac surgeries. Methods The study included adults who had aortic […]
Intravenous versus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery
Authors: Yujuan Li, M.D., Ph.D. et al Anesthesiology March 2021, Vol. 134, 381–394. Background Delayed neurocognitive recovery after surgery is associated with poor outcome. Most surgeries require general anesthesia, of which sevoflurane and propofol are the most commonly used inhalational and intravenous anesthetics. The authors tested the primary hypothesis that patients with laparoscopic abdominal surgery under […]
Restrictive Transfusion Strategy after Cardiac Surgery: Role of Central Venous Oxygen Saturation Trigger
Authors: Norddine Zeroual, M.D.et al Anesthesiology March 2021, Vol. 134, 370–380. Background Recent guidelines on transfusion in cardiac surgery suggest that hemoglobin might not be the only criterion to trigger transfusion. Central venous oxygen saturation (Svo2), which is related to the balance between tissue oxygen delivery and consumption, may help the decision process of transfusion. We […]
Greater Fibrinolysis Resistance but No Greater Platelet Aggregation in Critically Ill COVID-19 Patients
Authors: Christoph Heinz, M.D.et al Anesthesiology March 2021, Vol. 134, 457–467. Background The hemostatic balance in patients with coronavirus disease 2019 (COVID-19) seems to be shifted toward a hypercoagulable state. The aim of the current study was to assess the associated coagulation alterations by point-of-care-diagnostics, focusing on details of clot formation and lysis in these severely […]
Complications as a Mediator of the Perioperative Frailty–Mortality Association
Authors: Daniel I. McIsaac, M.D., M.P.H., F.R.C.P.C.et al Anesthesiology February 2021 Background Preoperative frailty is strongly associated with postoperative complications and mortality. However, the pathways between frailty, postoperative complications, and mortality are poorly described. The authors hypothesized that the occurrence of postoperative complications would mediate a substantial proportion of the total effect of frailty on […]