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Anesthesia and Analgesia

Beverley A Orser, C Ruth Wilson, Alexandra J Rotstein, Stuart J Iglesias, Brian T Spain, Pavithra Ranganathan, William A MacDonald, Victor Ng, Susan O'Leary, Alika Lafontaine
Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries...
March 4, 2019: Anesthesia and Analgesia
Gunnar Lachmann, Rudolf Mörgeli, Sophia Kuenz, Sophie K Piper, Claudia Spies, Maryam Kurpanik, Steffen Weber-Carstens, Tobias Wollersheim
BACKGROUND: Skeletal muscle failure in critical illness (intensive care unit-acquired weakness) is a well-known complication developing early during intensive care unit stay. However, muscle weakness during the perioperative setting has not yet been investigated. METHODS: We performed a subgroup investigation of a prospective observational trial to investigate perioperative muscle weakness. Eighty-nine patients aged 65 years or older were assessed for handgrip strength preoperatively, on the first postoperative day, at intensive care unit discharge, at hospital discharge, and at 3-month follow-up...
March 4, 2019: Anesthesia and Analgesia
Jiajia Dai, Zhuofeng Ding, Jie Zhang, Wei Xu, Qulian Guo, Wangyuan Zou, Yunchuan Xiong, Yingqi Weng, Yong Yang, Sisi Chen, Jun-Ming Zhang, Zongbin Song
BACKGROUND: Pain and depression are highly prevalent symptoms in cancer patients. They tend to occur simultaneously and affect each other and share biological pathways and neurotransmitters. In this study, we investigated the roles of microglia in the hippocampus in the comorbidity of bone cancer pain and depressive-like behaviors in an animal model of bone cancer pain. METHODS: Bone cancer pain was induced by injection of Walker 256 mammary gland carcinoma cells into the tibia of rats...
February 27, 2019: Anesthesia and Analgesia
Diana N Romano, Jaime Hyman, Daniel Katz, Nakiyah Knibbs, Sharon Einav, Ortal Resnick, Yaakov Beilin
BACKGROUND: The use of in vitro fertilization is increasing. The incidence of adverse outcomes is greater for women who undergo in vitro fertilization, potentially leading to intensive care unit admission. This study aimed to assess the etiology and course of intensive care unit admission in women who underwent in vitro fertilization compared to those who did not, with specific focus on intensive care unit admission due to postpartum hemorrhage. METHODS: In this retrospective study, medical records of patients admitted to the intensive care unit during pregnancy or the peripartum period at 2 medical centers (2005-2016 at Mount Sinai Hospital, New York, NY, and 2005-2013 at Shaare Zedek Medical Center, Jerusalem, Israel) were analyzed...
February 27, 2019: Anesthesia and Analgesia
Jiamin Miao, Xue Zhou, Weihua Ding, Zerong You, Jason Doheny, Wei Mei, Qian Chen, Jianren Mao, Shiqian Shen
BACKGROUND: Tissue injuries such as surgery and trauma are usually accompanied by simultaneous development of acute pain, which typically resolves along with tissue healing. However, in many cases, acute pain does not resolve despite proper tissue repair; rather, it transitions to chronic pain. In this study, we examined whether proliferator-activated receptor-gamma coactivator-1α (PGC-1α), a master regulator of mitochondria biogenesis, is implicated in pain chronification after burn injury in mice...
February 27, 2019: Anesthesia and Analgesia
Monica A Hoagland, Richard J Ing, Kris R Jatana, Ian N Jacobs, Debnath Chatterjee
Button battery ingestions result in significant morbidity and mortality in children-before, during, and even after removal. The injuries created by a button battery lodged in the esophagus develop rapidly and can be severe. The current of the button battery, conducted through saliva and the tissue drives a highly alkaline caustic injury, leading to liquefactive tissue necrosis. In June 2018, new guidelines were released from the National Capital Poison Center, which include the use of preoperative protective, pH-neutralizing and viscous barrier interventions with honey and/or sucralfate administered within 12 h of ingestion...
February 27, 2019: Anesthesia and Analgesia
John D Mitchell, Cindy Ku, Brendan Lutz, Sajid Shahul, Vanessa Wong, Stephanie B Jones
Communication remains challenging to teach and evaluate. We designed an online patient survey to assess anesthesia residents' communication skills from August 2014 to July 2015. In December 2014, we implemented a customized, simulation-based curriculum. We calculated an overall rating for each survey by averaging the ratings for the individual questions. Based on the Hodges-Lehmann 2-sample aligned rank-sum test, overall ratings, reported as the median (interquartile range) of residents' average overall ratings, differed significantly between the preintervention (3...
February 27, 2019: Anesthesia and Analgesia
Matthew J G Sigakis, Elizabeth Jewell, Michael D Maile, Sandro K Cinti, Brian T Bateman, Milo Engoren
BACKGROUND: The primary objective of this study was to compare the characteristics of culture-positive and culture-negative status in septic patients. We also determined whether culture status is associated with mortality and whether unique variables are associated with mortality in culture-positive and culture-negative patients separately. METHODS: Utilizing patient records from intensive care units, emergency department, and general care wards in a large academic medical center, we identified adult patients with suspected infection and ≥2 systemic inflammatory response syndrome criteria between January 1, 2007, and May 31, 2014...
February 27, 2019: Anesthesia and Analgesia
Tianlong Wang, Xiaoming Deng, Yuguang Huang, Lee A Fleisher, Lize Xiong
With the development of anesthesiology, patient safety has been remarkably improved, but the postoperative mortality rate at 30 days is still as high as 0.56%-4%, and the morbidity is even higher. Three years ago, the Chinese Society of Anesthesiology proposed that the direction of the anesthesiology development should be changed to perioperative medicine in China. Anesthesiologists should pay more attention to the long-term outcome. In this article, we introduced what we have done, what the challenges are, and what we should do in the future with regard to the practice of perioperative medicine in China...
February 27, 2019: Anesthesia and Analgesia
Fei Xiao, Bei Shen, Wen-Ping Xu, Ying Feng, Warwick D Ngan Kee, Xin-Zhong Chen
BACKGROUND: Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight. METHODS: Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0...
February 27, 2019: Anesthesia and Analgesia
Diego Orbegozo, Jean-Louis Vincent, Jacques Creteur, Fuhong Su
The role of hypertonic saline in sepsis remains unclear because clinical data are limited and the balance between beneficial and adverse effects is not well defined. In this systematic literature review, we searched PubMed and Embase to identify all randomized controlled trials up until January 31, 2018 in which hypertonic saline solutions of any concentration were used in patients of all ages with sepsis and compared to a cohort of patients receiving an isotonic fluid. We identified 8 randomized controlled trials with 381 patients who had received hypertonic saline...
February 27, 2019: Anesthesia and Analgesia
Adam C Adler, Craig A Belon, Danielle M Guffey, Charles G Minard, Nihar V Patel, Arvind Chandrakantan
BACKGROUND: Caudal block, the most common regional anesthetic in children, is predominantly performed using palpation to determine placement. The efficacy of the palpation technique is unknown with respect to block success. While ultrasound has been suggested for use during caudal block, its use is infrequent. METHODS: A single-blinded prospective observational trial was performed evaluating provider success rate of caudal blocks placed by palpation alone. After needle insertion and partial local anesthetic injection, an ultrasound was performed to confirm correct location...
February 27, 2019: Anesthesia and Analgesia
Fu Shan Xue, Liu Jia Zi Shao, Rui Juan Guo
No abstract text is available yet for this article.
February 18, 2019: Anesthesia and Analgesia
Leslie A James, Matthew A Levin, Hung-Mo Lin, Stacie G Deiner
BACKGROUND: Frailty, a state of decreased physiological reserve, is strongly associated with perioperative mortality in older adults. However, the mechanism by which frailty is associated with mortality is not yet understood. Autonomic dysfunction in the form of decreased intraoperative hemodynamic variability has been shown to be associated with increased mortality. We aimed to see whether frail patients have less hemodynamic variability under anesthesia and whether variability mediates the relationship between frailty and 30-day mortality...
February 18, 2019: Anesthesia and Analgesia
Yuan Han, Abdul Mannan, Liu Han, Jun-Li Cao
No abstract text is available yet for this article.
February 18, 2019: Anesthesia and Analgesia
Mohamed M Abu Elyazed, Shaimaa F Mostafa, Mohamed S Abdelghany, Gehan M Eid
BACKGROUND: Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6-T9). METHODS: Sixty patients 18-65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block at the level of T7 transverse process using 20 mL of bupivacaine 0...
February 18, 2019: Anesthesia and Analgesia
Dermot P Maher, Deepa Walia, Nicola M Heller
BACKGROUND: The use of regional and other opioid-sparing forms of anesthesia has been associated with a decrease in the recurrence of certain malignancies. Direct suppression of human natural killer cells by opioids has been postulated to explain this observation. However, the effect of different classes of opioids on suppression of natural killer cell cytotoxicity has not been systematically characterized. METHODS: After confirming that freshly isolated natural killer cells from peripheral human blood express opioid receptors, cells were incubated with increasing concentrations of clinically used or receptor-specific opioid agonists...
February 18, 2019: Anesthesia and Analgesia
Vaskar Das, Jeffrey S Kroin, Mario Moric, Robert J McCarthy, Asokumar Buvanendran
BACKGROUND: Metformin, an adenosine monophosphate (AMP)-activated protein kinase activator, as well as a common drug for type 2 diabetes, has previously been shown to decrease mechanical allodynia in mice with neuropathic pain. The objective of this study is to determine if treatment with metformin during the first 3 weeks after fracture would produce a long-term decrease in mechanical allodynia and improve a complex behavioral task (burrowing) in a mouse tibia fracture model with signs of complex regional pain syndrome...
February 18, 2019: Anesthesia and Analgesia
Alparslan Turan, Barak Cohen, Richard P Whitlock, Hani Essber, Azfar Niazi, Natalya Makarova, Wael Saasouh, Andrej Alfirevic, Donn Marciniak, Daniel I Sessler
BACKGROUND: Pain after cardiac surgery is largely treated with opioids, but their poor safety profile makes nonopioid medications attractive as part of multimodal pathways. Anti-inflammatory drugs reduce acute postoperative pain, but the role of steroids in reducing acute poststernotomy pain is unclear. We evaluated the association between the intraoperative administration of methylprednisolone and postoperative analgesia, defined as a composite of pain scores and opioid consumption, during the initial 24 hours after cardiac surgery...
February 18, 2019: Anesthesia and Analgesia
Se-Hee Min, Hyunjae Im, Bo Rim Kim, Susie Yoon, Jae-Hyon Bahk, Jeong-Hwa Seo
BACKGROUND: During induction of general anesthesia, it is common practice to delay neuromuscular blockade until the ability to deliver mask ventilation has been confirmed. However, the benefits of this approach have never been scientifically validated. We thus compared the early and late administration of rocuronium before and after checking mask ventilation to investigate the efficiency of mask ventilation and the time to tracheal intubation in patients with normal airways. METHODS: Patients (n = 114) were randomized to receive IV rocuronium either before (early rocuronium group, n = 58) or after (late rocuronium group, n = 56) checking mask ventilation...
February 12, 2019: Anesthesia and Analgesia
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