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Rapid Infusion of Hydroxyethyl Starch 70/0.5 but not Acetate Ringer’s Solution Decreases the Plasma Concentration of Propofol during Target-controlled Infusion

Authors: Sayako Itakura, M.D. et al Anesthesiology 8 2016, Vol.125, 304-312. Background: Rapid fluid infusion resulting in increased hepatic blood flow may decrease the propofol plasma concentration (Cp) because propofol is a high hepatic extraction drug. The authors investigated the effects of rapid colloid and crystalloid infusions on the propofol Cp during target-controlled infusion. Methods: Thirty-six patients were […]

Preoperative Evaluation Clinic Visit Is Associated with Decreased Risk of In-hospital Postoperative Mortality

Authors: Jeanna D. Blitz, M.D. et al Anesthesiology 8 2016, Vol.125, 280-294. Background: As specialists in perioperative medicine, anesthesiologists are well equipped to design and oversee the preoperative patient preparation process; however, the impact of an anesthesiologist-led preoperative evaluation clinic (PEC) on clinical outcomes has yet to be fully elucidated. The authors compared the incidence of in-hospital […]

Anesthetic Neurotoxicity Meets Big Data: Reasons to Be Cheerful?

Authors: Cor J. Kalkman, M.D., Ph.D. et al Commentary: A Population-based Study Evaluating the Association between Surgery in Early Life and Child Development at Primary School Entry Anesthesiology 8 2016, Vol.125, 263-265 FOR more than a decade, the possibility that exposure to anesthetics may be harmful to the developing human brain has intrigued anesthesiologists and the public […]

Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury

Authors: Pierre Bouzat, M.D., Ph.D. et al     Anesthesiology 8 2016, Vol.125, 346-354.: Background: To assess the performance of transcranial Doppler (TCD) in predicting neurologic worsening after mild to moderate traumatic brain injury. Methods: The authors conducted a prospective observational study across 17 sites. TCD was performed upon admission in 356 patients (Glasgow Coma Score [GCS], 9 to […]

Emergency Cricothyrotomy Performed by Surgical Airway–naive Medical Personnel: A Randomized Crossover Study in Cadavers Comparing Three Commonly Used Techniques

Authors: Frédéric Heymans, M.D. et al        Commentary: Surgical Cricothyrotomy, Rather than Percutaneous Cricothyrotomy, in “Cannot Intubate, Cannot Oxygenate” Situation Anesthesiology 8 2016, Vol.125, 295-303. Background: When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it […]

Anesthesia Alert: Reduce PONV by “Bookending” Propofol

The key is to get gas out of the patient’s system. Michael Reines, MD Take advantage of propofol’s antiemetic properties by reintroducing it toward the end of the procedure. I‘ve developed an anesthetic technique that significantly reduces PONV and costs, and improves patient, surgeon and nurse satisfaction. I call it “bookending,” because it involves using […]

The Impact of Surgery and Stored Red Blood Cell Transfusions on Nitric Oxide Homeostasis

Anesthesia & Analgesia: August 2016 – Volume 123 – Issue 2 – p 274–282 AUTHORS: Nagababu, Enika PhD et al BACKGROUND: Cell-free hemoglobin (Hb) forms in stored red blood cells (RBCs) as a result of hemolysis. Studies suggest that this cell-free Hb may decrease nitric oxide (NO) bioavailability, potentially leading to endothelial dysfunction, vascular injury, […]

The Use of Ultrasound Guidance for Perioperative Neuraxial and Peripheral Nerve Blocks in Children: A Cochrane Review.

Anesthesia & Analgesia: June 15, 2016 AUTHORS: Guay, Joanne MD et BACKGROUND: Objectives were to determine whether the use of ultrasound guidance offers any clinical advantage in the performance of neuraxial or peripheral nerve blocks in children in terms of increasing the success rate or decreasing the rate of complications. METHODS: We searched the following […]

Researchers Surprised by Opioid Scripts for Low-Risk Surgical Procedures

Tissue Oximetry and Clinical Outcomes.

Anesthesia & Analgesia: June 15, 2016 AUTHORS: Bickler, Philip MD, PhD et al A number of different technologies have been developed to measure tissue oxygenation, with the goal of identifying tissue hypoxia and guiding therapy to prevent patient harm. In specific cases, tissue oximetry may provide clear indications of decreases in tissue oxygenation such as […]