Goodbye
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Today’s post is sadly the last. We’ve been around for almost two years and our family has grown more than we ever thought it would. Thank you for your support. Our efforts will be directed toward making the Journal website reflect the excitement that’s been generated here. Page2Anesthesiology’s name will continue. As we gear up the Anesthesiology site, some posts intended for the Anesthesiology site might actually come from here.
Let us know how you liked what we did (email: alnwebeditor@asahq.org).
— J. Lance Lichtor, M.D. and the Page2Anesthesiology gang
Anesthesia-related cardiac arrest in a child with Timothy syndrome: an anesthesiology case scenario with something for everyone
Knowing which patients have long QT syndrome and are therefore at risk, is an essential step in providing safer anesthesia for this patient population. (Image source: Thinkstock)
Knowing which patients have long QT syndrome and are therefore at risk, is an essential step in providing safer anesthesia for this patient population.
According to a recent summary, long QT syndrome is the cause of 3,000 to 4,000 pediatric and young adult deaths each year in the U.S. The public’s level of awareness of long QT syndrome as a cause of sudden death in apparently healthy young people has increased dramatically in recent years. A similar, heightened recognition among anesthesiologists about long QT syndrome as a risk factor for young patients receiving anesthesia care has also surged in recent years.
Continue Reading →
Are there any postoperative problems when intermediate-acting, non-depolarizing neuromuscular blocking agents are used?
Use of non-depolarizing blocking agents was associated with an increased risk of oxygen desaturation and postoperative reintubation that required admission to an intensive care unit. In addition, the use of neostigmine for reversal did not decrease but even increased the risk of severe postoperative respiratory complications (Image source: Thinkstock)
Anesthesia helps ensure that a patient does not respond to a stimulus. Components of the anesthesia state include hypnosis and analgesia. Neuromuscular blocking agents are used in part to help minimize a patient’s response to the stimulus of surgery. If the neuromuscular agents are not adequately reversed, patients may feel weak after surgery.
In addition, because of inadequate reversal, other less frequent, but more serious side effects may occur, such as impaired breathing or respiratory arrest. Of course, use of these drugs are not the only reason such side effects occur. Longer-acting neuromuscular blocking agents, e.g., pancuronium, have been replaced with intermediate acting agents.
In the study “Intermediate Acting Non-depolarizing Neuromuscular Blocking Agents and Risk of Postoperative Respiratory Complications: Prospective Propensity Score Matched Cohort Study,” first author Martina Grosse-Sundrup (Research Fellow Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA), corresponding author Matthias Eikermann, (Associate Professor, Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, and Universitaetsklinikum Essen, Klinik fuer Anaesthesie und Intensivmedizin, Essen, Germany), and coauthors determined whether postoperative respiratory complications were greater when intermediate-acting neuromuscular blocking agents were used. Continue Reading →
Mind-to-mind: Author describes and reads “A Boring Thanksgiving”
Dr. Ian H. Black reads and describes “A Boring Thanksgiving” (Image source: Thinkstock)
Author describes his essay
Author reads his essay
Mineralocorticoid receptors and back pain: a new era for the local use of steroids?
Targeting the mineralocorticoid receptor at the DRG level may offer a credible, alternative, working hypothesis for treating back pain in millions of patients. (Image Source: Thinkstock)
Inflammatory processes are key components of the pathophysiology of low back pain. The local use of glucocorticoids as a therapeutic strategy to decrease painful radicular symptoms, presumably by reducing inflammation, is considered a milestone in treatment of back pain. However, restricting the action of steroids to a local anti-inflammatory process is probably erroneous, and the reality may be much more complex. Dr. Fei Dong (Research Fellow, Department of Anesthesiology, Pain Research Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, and Research Fellow, Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China) and colleagues in their article, “Mineralocorticoid Receptor Blocker Eplerenone Reduces Pain Behaviors In Vivo and Decreases Excitability in Small-diameter Sensory Neurons from Local Inflamed Dorsal Root Ganglia In Vitro,” used an elegant experimental combination of a pain behavior model (local inflammation of L5 dorsal root ganglion [DRG] with the immune activator zymosan) and electrophysiological techniques (patch clamp) to produce evidence for mechanical hypersensitivity and increased excitability of sensory neurons. Continue Reading →
Anesthetic preconditioning: Notch signaling pathways
Notch may activate the endogenous neuroprotective components and reduce ischemic brain injury at the early phase after stroke. (Image source: Thinkstock)
Exposure to a sublethal period of ischemia, i.e., ischemic preconditioning, can increase the tolerance of the brain to the more injurious ischemia that could be encountered in the future. The protective effects of ischemic preconditioning can be reproduced in many other ways, thus avoiding the necessity and damage of ischemic periods. The neuroprotective effects of anesthetic preconditioning have been manifested. Use of anesthetics may prevent or delay neurological complications like perioperative stroke, which is a serious complication that can occur during or following surgical procedures such as carotid endarterectomy and aortic repair.
In the article “Activation of Canonical Notch Signaling Pathway Is Involved in the Ischemic Tolerance Induced by Sevoflurane Preconditioning in Mice,” first author Dr. Qianzi Yang (Ph.D. Candidate), corresponding author Dr. Lize Xiong (Professor, Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China), and coauthors explored the mechanisms of anesthetic preconditioning by studying the role of Notch signaling pathways in the neuroprotection induced by sevoflurane preconditioning in a middle cerebral artery occlusion model in mice. Continue Reading →
When we retire, how, and why
So why do we retire? Predictive factors for a decision to discontinue patient care were career dissatisfaction and higher financial status. (Image source: Thinkstock)
We all have mentors. They are those who have gone before us and whose examples we look to when making major decisions. As I approach my 60th birthday, I am looking to my own mentors, especially those 5 to 10 years older than myself, to understand why and how they retire. I suppose it’s not surprising to find that, like many major life decisions, it’s not that easy.
Fred Orkin (Adjunct Professor of Anesthesiology [proposed]) and colleagues on the Task Force on the Aging Anesthesiologist, Committee on Occupational Health, American Society of Anesthesiologists, Park Ridge, Illinois, in their article “United States Anesthesiologists over 50: Retirement Decision Making and Workforce Implications,” while not giving us personal advice, do provide a fascinating snapshot of how, when, and why anesthesiologists retire. Using a large survey developed by national medical societies to examine these questions in older physicians practicing in the U.S., the authors were able to compare the characteristics of our anesthesiology colleagues to others in the broader family of medicine. Continue Reading →
Practice guideline: registered nurses who are not licensed anesthesia providers who care for women with epidural catheters
During labor, only qualified, credentialed anesthesia care providers should insert, or inject, through epidural catheters. (Image source: Thinkstock)
This summer, the Association of Women’s Health, Obstetric and Neonatal Nurses reapproved the “Role of the Registered Nurse in the Care of the Pregnant Woman Receiving Analgesia and Anesthesia by Catheter Techniques.” Registered nurses who are practicing within the scope of practice for the state in which they are practicing, coordinate and document care for women in labor. The nurse will implement, monitor, and evaluate the effectiveness of different non-pharmacologic and pharmacologic medications. If the registered nurse is not a licensed anesthesia provider, in the case of regional or intrathecal medications, the nurse cannot administer medications into the catheter, change doses when delivered by continuous infusion, change dosing intervals, re-initiate an infusion if it is stopped, or get informed consent for the procedure. In terms of consent, however, the nurse can witness consent. The nurse should assess and monitor patients as to the effectiveness of different medications, including their possible side effects. Continue Reading →
Anesthesiology November 2012 highlights: Editor-in-Chief
The November 2012 issue of Anesthesiology has posted. Specific articles I have discussed:
“United States Anesthesiologists over 50: Retirement Decision Making and Workforce Implications” with the editorial, “Baby Boom or Bust . . . Is 64 the New 57?”
“Mineralocorticoid Receptor Blocker Eplerenone Reduces Pain Behaviors In Vivo and Decreases Excitability in Small Diameter Sensory Neurons from Local Inflamed Dorsal Root Ganglia In Vitro” and the editorial “Back Pain and the Mineralocorticoid Receptor: Is There a Connection?”
Classic Paper Revisited: “Avoiding Subarachnoid or Intravascular Injection of Local Anesthetics: A Single Test Dose”
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Continuous arterial spin labeling as a technique to measure blood flow after exposure to different kinds of pain
For different pain tasks, most consistent changes were in the supplemental motor cortex (Brodmann area 6) as opposed to regions associated with somatosensory brain areas. (Image source: Thinkstock)
The advantages of MRI are known to most and in part include the fact that there isn’t any ionizing radiation, it is sensitive to blood flow, and images can be oriented in any plane. Measures of perfusion can serve as biomarkers of different physiologic functions. Continuous arterial spin-labeled perfusion MRI manipulates blood water so that perfusion distribution of individual arteries can be measured. In the article “Quantitative Changes in Regional Cerebral Blood Flow Induced by Cold, Heat and Ischemic Pain: A Continuous Arterial Spin Labeling Study” that was published in the October 2012 issue of Anesthesiology, Dr. Michael A. Frölich (Associate Professor, Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama) and colleagues used continuous arterial spin labeling to measure regional blood flow when five male and female volunteers were exposed to conditions of heat, cold and ischemic pain. Continue Reading →