Anesthesiology

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Perioperative acute kidney injury is commonIt is unclear whether this merely represents a transient increase in creatinine or has prognostic value WHAT THIS ARTICLE TELLS US THAT IS NEW: Patients with mild postoperative kidney injury (stage I) after noncardiac surgery had an estimated 2.4 times higher odds of having long-term renal dysfunction compared with patients without postoperative kidney injuryA quarter of patients who had stage I acute kidney injury postoperatively still had stage I kidney injury 1 to 2 yr later, and an additional 11% had even worse renal function BACKGROUND:: Perioperative acute kidney injury is common...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Transthoracic ultrasound may be clinically useful, but training is not standardized, and it remains unclear when naïve trainees have sufficient competency to perform exams unsupervised WHAT THIS ARTICLE TELLS US THAT IS NEW: A multicenter, international study was conducted in 10 intensive care units among residents and staff in anesthesiology, critical care, emergency medicine, and internal medicine who underwent supervised training, to determine the number of exams required to achieve basic competenceAfter 25 supervised examinations, 80% of lung regions were adequately classified by traineesUltrasound exam average duration was 8 to 10 min in experts and decreased from 19 (after 5 exams) to 12 min (after 25 exams) in trainees BACKGROUND:: Lung ultrasound is increasingly used in critically ill patients as an alternative to bedside chest radiography, but the best training method remains uncertain...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Lesions of the mesopontine tegmental anesthesia area in the brainstem render rats strongly insensitive to pentobarbitalThe effects of mesopontine tegmental anesthesia area lesions on responses to other anesthetics have not been previously reported WHAT THIS ARTICLE TELLS US THAT IS NEW: Targeted microinjection of ibotenic acid into the mesopontine tegmental anesthesia area in adult rats led to an up to twofold loss in anesthetic potency of etomidate and propofolIn contrast, the potency of ketamine, medetomidine, and alfaxolone/alfadolone was unaffectedThese observations suggest that the mesopontine tegmental anesthesia area of the brainstem may serve as a key structure to selectively mediate transition from wakefulness into an anesthetic state in response to γ-aminobutyric acid-mediated anesthetics BACKGROUND:: The brainstem mesopontine tegmental anesthesia area is a key node in circuitry responsible for anesthetic induction and maintenance...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: β-blockers are usually stopped in cardiac surgical patientsWhen best to reintroduce them remains unknown, and is a trade-off between hemodynamic risk and development of atrial fibrillation WHAT THIS ARTICLE TELLS US THAT IS NEW: There was little advantage to reintroducing β-blockers within 48 hThe odds of atrial fibrillation were significantly reduced by restarting β-blockers between 72 and 96 h after surgery BACKGROUND:: For cardiac surgery patients under chronic β-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Measuring the effects of factor Xa inhibitor levels to guide the management of patients needing urgent surgery or procedural interventions is not readily available. Point-of-care testing would provide clinicians with the ability to determine functional factor Xa impairment to guide management strategies. WHAT THIS ARTICLE TELLS US THAT IS NEW: The use of a modified thromboelastography assay demonstrated significant correlations with rivaroxaban concentrations but values were within normal ranges, and therefore clinical utility is limited...