Anesthesiology

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Hispanic women choose epidural labor analgesia less commonly than non-Hispanic women. The causes of the healthcare disparity are unknown, and effective interventions are to be established. WHAT THIS ARTICLE TELLS US THAT IS NEW: A language-concordant, educational program regarding labor epidurals during the first stage of labor, in addition to the routine prenatal education, is feasible and does not cause any negative effect...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Interscalene nerve block is commonly used for shoulder surgery for anesthesia and postoperative analgesiaUnfortunately, interscalene blocks commonly result in hemidiaphragmatic paralysis WHAT THIS ARTICLE TELLS US THAT IS NEW: When interscalene block was compared with superior trunk block, less frequent hemidiaphragmatic paralysis was seen in the superior trunk block groupSuperior trunk block was noninferior to interscalene block in terms of worst pain scores in the recovery room, and superior trunk block patients were more satisfied BACKGROUND:: Interscalene nerve blockade remains one of the most commonly used anesthetic and analgesic approaches for shoulder surgery...

In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks.Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach)...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: In the United States, anesthesia groups derive revenue from insurers and "direct payments" or "institutional support" from hospitalsDirect payments can represent a significant portion of group revenue and may enable the provision of services to patients covered by public insurers, which disproportionately represent low-resource and underserved populationsThe magnitude or characteristics of direct hospital payments to nonacademic private practice anesthesia groups is not well understood WHAT THIS ARTICLE TELLS US THAT IS NEW: Among 240 nonacademic California hospitals analyzed between 2002 and 2014, more hospitals made direct payments to an anesthesia group in 2014 than in 2002 and the median payment increasedHospitals where public insurers accounted for a larger fraction of anesthesia revenues were increasingly more likely to make direct payments to private anesthesia groupsDirect payments to private anesthesia groups are becoming increasingly important, particularly for hospitals providing care to underserved populations BACKGROUND:: In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Cardiac output is an independent regulator of cerebral blood flow in healthy awake humansThe relationship between cardiac output and cerebral blood flow in anesthetized patients undergoing laparoscopy has not been previously characterized WHAT THIS ARTICLE TELLS US THAT IS NEW: At steady-state depth of anesthesia, in patients undergoing laparoscopic cholecystectomy, creation of pneumoperitoneum decreased cardiac output and internal carotid artery blood flow while mean arterial pressure and end-tidal carbon dioxide levels remained unchanged BACKGROUND:: Little is known about how implementation of pneumoperitoneum and head-up tilt position contributes to general anesthesia-induced decrease in cerebral blood flow in humans...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Among patients with sepsis or septic shock, a variety of extracorporeal blood purification techniques are availableIndividual existing trials evaluating these options are underpowered to provide clear evidence WHAT THIS PAPER TELLS US THAT IS NEW: Meta-analysis of very low-quality randomized controlled trial evidence demonstrates a potential benefit of hemoperfusion, hemofiltration, or plasmapheresisAdditional high-quality trials demonstrating benefit in modern clinical practice are needed before recommending these therapies BACKGROUND:: Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Volume kinetic modeling is an adaptation of pharmacokinetic modeling that characterizes the disposition of intravenously administered fluids using hemoglobin concentration as a natural tracerPopulation-based pharmacokinetic analysis enables assessment of variability between individuals and across populations and permits inclusion of covariates such as the presence or absence of anesthetization, body weight, and sex in the data analysis WHAT THIS ARTICLE TELLS US THAT IS NEW: The distribution of infused fluid after hemorrhage (7 ml/kg during 20 min) in a randomized crossover study of 12 healthy volunteers while awake and while isoflurane-anesthetized was described by a two-fluid space model that included study arm, body weight, and sex as covariatesOnly sex had a statistically significant effect on the area under the plasma dilution curve and maximum plasma dilution, both of which were increased by a median of 17% in females (95% CIs, 1...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Delirium is a frequently occurring disorder in intensive care unit patients associated with impaired short-term and long-term outcomesProphylactic haloperidol neither reduces delirium incidence nor its short-term clinical consequencesMany intensive care unit survivors suffer from long-term impairment of physical, cognitive, or mental health status, but there is a gap in knowledge regarding which factors are associated with such a change in quality of life in the post-intensive care unit period WHAT THIS ARTICLE TELLS US THAT IS NEW: Prophylactic haloperidol does not affect long-term outcome of critically ill patients at high risk for deliriumEvery additional day of sedation-induced coma is associated with further decline of long-term physical and mental function BACKGROUND:: Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Randomized controlled trials evaluating the potential value of statin administration for intensive care unit patients have not observed a benefitHowever, the chronic preadmission use of statins among patients admitted to the intensive care unit has not been robustly studied WHAT THIS ARTICLE TELLS US THAT IS NEW: Single-center retrospective data suggest that preadmission statin use may be associated with decreased 90-day mortality among some intensive care unit patientsSpecific statin agents and noncardiovascular mortality may demonstrate a stronger signal for further study BACKGROUND:: This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose...

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