Author: Dr Clemens

Uncategorized Published - 17 November, 2016    By - Dr Clemens
Complications of One-lung Ventilation: Is It the Blood Flow or the Ventilation?

Author: Jonathan V. Roth, M.D. Anesthesiology 12 2016, Vol.125, 1253-1254. The results of the study of management of one-lung ventilation by Blank et al. suggest that adequate positive end-expiratory pressure (PEEP) is an important factor in reducing pulmonary complications. Blank et al.1  provide an excellent discussion of the mechanical mechanisms and implications. I suggest an alternative or additional possible explanation […]

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Uncategorized Published - 16 November, 2016    By - Dr Clemens
Distinct Cortical Signatures Associated with Sedation and Respiratory Rate Depression by Morphine in a Pediatric Population

Authors: Gaspard Montandon, Ph.D. et al Anesthesiology 11 2016, Vol.125, 889-903. Background: Opioid analgesia is an essential component of perioperative care, but effective analgesia can be limited by excessive sedation and respiratory depression. The cortical signatures associated with sedation by opioids and the relationship between changes in cortical activity and respiratory function are not well understood. The […]

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Uncategorized Published - 16 November, 2016    By - Dr Clemens
Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis

Authors: Vafi Salmasi, M.D. et al    Anesthesiology published on November 3, 2016. Background: How best to characterize intraoperative hypotension remains unclear. Thus, the authors assessed the relationship between myocardial and kidney injury and intraoperative absolute (intraoperative mean arterial pressure [MAP]) and relative (reduction from preoperative pressure) MAP thresholds. Methods: The authors characterized hypotension by the lowest MAP […]

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Uncategorized Published - 16 November, 2016    By - Dr Clemens
A Case Report From the Anesthesia Incident Reporting System

ASA Monitor 11 2016, Vol.80, 50-51. Review of unusual patient care experiences is a cornerstone of medical education. Each month, the AQI-AIRS Steering Committee abstracts a patient history submitted to the Anesthesia Incident Reporting System (AIRS) and authors a discussion of the safety and human factors challenges involved. Real-life case histories often include multiple clinical decisions, […]

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Uncategorized Published - 16 November, 2016    By - Dr Clemens
Opioid Use in Pediatric Patients – Time to Reassess

Authors: Joseph P. Cravero, M.D., FAAP et al ASA Monitor 11 2016, Vol.80, 28-30. Opioids represent one of the time-honored tools for pediatric anesthesiologists in treating the most significant pain and suffering that confront our patients. While we continue to seek adequate pain treatment and avoid the consequences of inadequately treated pain, the reality of the ongoing […]

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Uncategorized Published - 16 November, 2016    By - Dr Clemens
Anesthetic-Related Neurotoxicity – Current State of the Art

Authors: Caleb H. Ing, M.D., M.S. et al ASA Monitor 11 2016, Vol.80, 16-18. The possibility of anesthetic neurotoxicity was first suggested more than 15 years ago with findings of apoptosis in the brains of rodents after ethanol exposure during critical periods of neurodevelopment. A similar neuroapoptotic effect was soon identified in anesthetic agents and linked to […]

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Uncategorized Published - 15 November, 2016    By - Dr Clemens
Selecting the Level of Positive End-expiratory Pressure for One-lung Ventilation: “By Formula” or “By Feel”?

Author: John Pfitzner, M.B.B.S., F.R.C.A. Anesthesiology 12 2016, Vol.125, 1254-1255. Blank et al  confirm that one-lung ventilation (OLV) is not without risk, but I have grave doubts about whether it is reasonable to conclude that “advances in our understanding of protective ventilation during OLV are likely to derive from well-designed randomized trials controlling for variables of inherent pathophysiologic […]

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Uncategorized Published - 15 November, 2016    By - Dr Clemens
High versus Low Technology in Assessment of Endotracheal Tube Position

Author: Hans-Joachim Priebe, M.D. Anesthesiology 12 2016, Vol.125, 1246-1247. I read with great interest the publication by Ramsingh et al. which elegantly shows that point-of-care ultrasound examination is considerably more accurate than chest auscultation in discriminating between endotracheal and endobronchial intubation. However, several factors limit the practicality of this technique in routine clinical practice. It requires unrestricted access […]

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Uncategorized Published - 15 November, 2016    By - Dr Clemens
Detection of Inadvertent Endobronchial Intubation

Authors: Mohammad El-Orbany, M.D. Anesthesiology 12 2016, Vol.125, 1248 I read with interest the article by Ramsingh et al regarding point-of-care ultrasound verification of endotracheal tube (ETT) insertion depth. Numerous tests had been previously utilized to prevent and/or detect inadvertent endobronchial (main stem) intubation. Each one of these tests has its own advantages and limitations. Undoubtedly, the use […]

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Uncategorized Published - 15 November, 2016    By - Dr Clemens
Portal Catheter Fracture in a Pediatric Patient

Authors: Antoinette Van Meter, M.D. et al    Anesthesiology 12 2016, Vol.125, 1220. IMPLANTED vascular access devices enable patients to receive long-term therapy, including chemotherapy, parenteral nutrition, and blood transfusions. While portal cathethers (PACs) rarely fracture (incidence, 0.4 to 1.8%), the most common location of fractures is at the space between the clavicle and the first […]

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