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Anesthesia and Analgesia

Carlo Pancaro, Julie Boulanger-Bertolus, Scott Segal, Chris J Watson, Irene St Charles, George A Mashour, James E Marchand
BACKGROUND: Fever and increased maternal interleukin-6 (IL-6) plasma levels in labor are associated with an increased risk of adverse events in offspring, including neonatal seizures, cerebral palsy, and low intelligence scores at school age. However, the neural changes in the neonate that might mediate the adverse effects of maternal noninfectious fever are not fully characterized. This study was designed to test the hypothesis that induced maternal noninfectious fever alters neonatal neural progenitor cell proliferation and enhances microglial activation in the rat dentate gyrus of the hippocampus...
March 11, 2019: Anesthesia and Analgesia
Oluremi A Ojo, Jennifer E Mehdiratta, Brock H Gamez, John Hunting, Ashraf S Habib
BACKGROUND: Programmed intermittent epidural boluses may improve the spread of local anesthetics compared to continuous epidural infusion, improving labor analgesia and obstetric outcomes. However, there are limited data from studies using commercially available pumps capable of coadministering programmed intermittent epidural boluses or continuous epidural infusion with patient-controlled epidural analgesia. Therefore, we performed this prospective, randomized, double-blind study to compare the impact of programmed intermittent epidural boluses versus continuous epidural infusion on labor analgesia and maternal/neonatal outcomes...
March 11, 2019: Anesthesia and Analgesia
Andre Shomorony, Claudia M Santamaria, Chao Zhao, Alina Y Rwei, Manisha Mehta, David Zurakowski, Daniel S Kohane
BACKGROUND: Capsaicin, the active component of chili peppers, can produce sensory-selective peripheral nerve blockade. Coadministration of capsaicin and tetrodotoxin, a site-1 sodium channel blocker, can achieve a synergistic effect on duration of nerve blocks. However, capsaicin can be neurotoxic, and tetrodotoxin can cause systemic toxicity. We evaluated whether codelivery of capsaicin and tetrodotoxin liposomes can achieve prolonged local anesthesia without local or systemic toxicity...
March 11, 2019: Anesthesia and Analgesia
Vikas N O'Reilly-Shah, Salman Hemani, Paran Davari, Lena Glowka, Emily Gebhardt, Laureen Hill, Simon Lee, Viraj A Master, Amy D Rodriguez, Paul S García
BACKGROUND: Frailty is associated with adverse perioperative outcomes including major morbidity, mortality, and increased length of stay. We sought to elucidate the role that a preoperatively assessed Mini-Cog can play in assessing the risk of adverse perioperative outcomes in a population at high risk of frailty. METHODS: In this retrospective case-control study, patients who were >60 years of age, nonambulatory, or had >5 documented medications were preoperatively assessed for handgrip strength, walking speed, and Mini-Cog score...
March 11, 2019: Anesthesia and Analgesia
Guido Mazzinari, Lucas Rovira, Liliana Henao, Juan Ortega, Alma Casasempere, Yolanda Fernandez, Mariana Acosta, Moncef Belaouchi, José Miguel Esparza-Miñana
BACKGROUND: Tracheal intubation failure in patients with difficult airway is still not uncommon. While videolaryngoscopes such as the Glidescope offer better glottic vision due to an acute-angled blade, this advantage does not always lead to an increased success rate because successful insertion of the tube through the vocal cords may be the limiting factor. We hypothesize that combined use of Glidescope and fiberscope used only as a dynamic guide facilitates tracheal intubation compared to a conventional Glidescope technique with a preshaped nondynamic stylet...
March 7, 2019: Anesthesia and Analgesia
Kamal Maheshwari, Sanchit Ahuja, Edward J Mascha, Kenneth C Cummings, Praveen Chahar, Hesham Elsharkawy, Andrea Kurz, Alparslan Turan, Daniel I Sessler
BACKGROUND: We previously reported that the duration of hospitalization was not different between isoflurane and sevoflurane. But more plausible consequences of using soluble volatile anesthetics are delayed emergence from anesthesia and prolonged stays in the postanesthesia care unit (PACU). We therefore compared isoflurane and sevoflurane on emergence time and PACU duration. METHODS: We reanalyzed data from 1498 adults who participated in a previous alternating intervention trial comparing isoflurane and sevoflurane...
March 7, 2019: Anesthesia and Analgesia
Shelley Hershner, Yves Dauvilliers, Frances Chung, Mandeep Singh, Jean Wong, Bhargavi Gali, Rahul Kakkar, Emmanuel Mignot, Michael Thorpy, Dennis Auckley
There is increasing awareness that sleep disorders may be associated with increased perioperative risk. The Society of Anesthesia and Sleep Medicine created the Narcolepsy Perioperative Task Force: (1) to investigate the current state of knowledge of the perioperative risk for patients with narcolepsy, (2) to determine the viability of developing perioperative guidelines for the management of patients with narcolepsy, and (3) to delineate future research goals and clinically relevant outcomes. The Narcolepsy Perioperative Task Force established that there is evidence for increased perioperative risk in patients with narcolepsy; however, this evidence is sparse and based on case reviews, case series, and retrospective reviews...
March 7, 2019: Anesthesia and Analgesia
Jason K Panchamia, Adam W Amundson, Jashvant Poeran, Ngoc Tram V Nguyen, Sandra L Kopp, Rebecca L Johnson
No abstract text is available yet for this article.
March 7, 2019: Anesthesia and Analgesia
Raeford E Brown
No abstract text is available yet for this article.
March 7, 2019: 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
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