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In a soul-searching Emery A. Rovenstine Memorial Lecture on Monday, David Chestnut, M.D., examined the key attributes of professionalism and his own journey on the road to professionalism in anesthesiology. “Each of us helps shape the culture of professionalism in our practice environment. Professionalism is not something that we learn once. None of us is […]
Read MoreDavid J. Bjorkman, MD, MSPH (HSA), SM (Epid.) Reviewing Kumar NL et al., Gastrointest Endosc 2016 Sep 29; Earlier endoscopy — performed within 12 versus 24 hours of bleeding presentation — was associated with worse outcomes in low-risk patients. Most guidelines recommend that patients with nonvariceal upper gastrointestinal bleeding (UGIB) undergo endoscopy within 24 hours of presentation. But […]
Read MoreEdited by Susan Sadoughi, MD, and André Sofair, MD, MPH Elective sigmoidectomy is associated with improved quality of life for patients with recurrent and persistent symptoms after a diverticulitis episode, suggests an open-label trial in the Lancet Gastroenterology & Hepatology. Roughly 100 Dutch patients who’d had an episode of left-sided diverticulitis followed by either ongoing abdominal complaints lasting […]
Read MoreAuthors: Colin F. Royse, M.B.B.S., M.D., F.A.N.Z.C.A. et al Anesthesiology published on October 23, 2016 Background: Inflammation after cardiopulmonary bypass may contribute to postoperative delirium and cognitive dysfunction. The authors evaluated the effect of high-dose methylprednisolone to suppress inflammation on the incidence of delirium and postoperative quality of recovery after cardiac surgery. Methods: Five hundred fifty-five adults from […]
Read MoreAuthors: Lesley K. Rao, M.D. et al Anesthesiology published on October 23, 2016. Background: At therapeutic concentrations, cytochrome P4502B6 (CYP2B6) is the major P450 isoform catalyzing hepatic ketamine N-demethylation to norketamine in vitro. The CYP2B6 gene is highly polymorphic. The most common variant allele, CYP2B6*6, is associated with diminished hepatic CYP2B6 expression and catalytic activity compared with wild-type CYP2B6*1/*1. CYP2B6.6, […]
Read MoreAnesthesia & Analgesia: September 2016 – Volume 123 – Issue 3 – p 731–738 AUTHORS: Sigakis, Matthew J. G. MD et al BACKGROUND: Discharge diagnoses are used to track national trends and patterns of maternal morbidity. There are few data regarding the validity of the International Classification of Diseases (ICD) codes used for this purpose. The goal […]
Read MoreAnesthesia & Analgesia: September 2016 – Volume 123 – Issue 3 – p 715–721 AUTHORS: Schwartz, Lawrence I. MD et al BACKGROUND: Dexmedetomidine is a selective α-2 receptor agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic for pediatric patients with congenital heart disease (CHD). Although several smaller, single-center studies suggest […]
Read MoreAnesthesia & Analgesia: September 2016 – Volume 123 – Issue 3 – p 705–714 AUTHORS: Chau, Destiny F. MD et al BACKGROUND: Complex surgical and critically ill pediatric patients rely on syringe infusion pumps for precise delivery of IV medications. Low flow rates and in-line IV filter use may affect drug delivery. To determine the […]
Read MoreAnesthesia & Analgesia: September 2016 – Volume 123 – Issue 3 – p 698–702 AUTHORS: Downing, John W. MD et al BACKGROUND: Vasoactive agents administered to counter maternal hypotension at cesarean delivery may theoretically intensify the hypoxemic fetoplacental vasoconstrictor response and, hence, negatively impact transplacental oxygen delivery to the fetus. Yet, this aspect of their […]
Read MoreAnesthesia & Analgesia:September 2016 – Volume 123 – Issue 3 – p 690–697 AUTHORS: Sviggum, Hans P. MD et al BACKGROUND: Intrathecal (IT) morphine is considered the “gold standard” for analgesia after cesarean delivery under spinal anesthesia, most commonly administered at a dose of 100 to 200 μg. There is less experience with IT hydromorphone […]
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