Anesthesiology

WHAT WE ALREADY KNOW: Days alive and out of hospital is an easily obtained patient-centered outcome WHAT THIS ARTICLE TELLS US THAT IS NEW: Days alive and out of hospital was associated with patient-level factors including comorbidities, advanced age, and complications, but not less relevant hospital-level factorsIt appears to be a useful measure of surgical impact BACKGROUND:: Days alive and out of hospital is a potentially useful patient-centered quality measure for perioperative care in adult surgical patients...

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No abstract text is available yet for this article.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Muscle atrophy is common in the critically ill, and diaphragm atrophy occurs during mechanical ventilation. It is not known whether wasting of diaphragm and nondiaphragm muscle is related. WHAT THIS ARTICLE TELLS US THAT IS NEW: Ultrasound was used for serial assessment of diaphragm and pectoral muscle in 97 critically ill patients. Diaphragm and pectoral atrophy occurred in 48% and 29%, respectively, and was associated with septic shock (diaphragm) and steroid use (pectoral); atrophy of the two muscle types appears unrelated...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: After pulmonary artery occlusion (mimicking a pulmonary embolism), perfusion is redistributed to the rest of the lung tissue, but the distribution of ventilation is uncertain. WHAT THIS ARTICLE TELLS US THAT IS NEW: Data from anesthetized pigs (uninjured lungs) indicates that the perfusion is redistributed as suspected. Similarly, ventilation is redistributed from nonperfused to perfused lung tissue. This limits the increase in dead space and is accompanied by less density in the occluded lung...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Sedation is known to unmask focal neurologic deficits in patients with supratentorial brain tumors but the mechanism is unclear WHAT THIS ARTICLE TELLS US THAT IS NEW: When induced with midazolam, these deficits can be reversed by flumazenil, suggesting a γ-aminobutyric acid-mediated mechanism BACKGROUND:: Midazolam has been found to exacerbate or unmask limb motor dysfunction in patients with brain tumors. This study aimed to determine whether the exacerbated upper limb motor-sensory deficits are mediated through benzodiazepine sites by demonstrating reversibility by flumazenil in patients with gliomas in eloquent areas...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Maternal complications during and after childbirth demonstrate wide variation across hospitalsNational reporting systems do not integrate maternal and newborn outcomes when defining hospital obstetric care quality WHAT THIS ARTICLE TELLS US THAT IS NEW: Administrative data can be used to calculate hospital-level risk-adjusted maternal, newborn, and composite maternal-newborn performanceMaternal and newborn hospital performance were poorly correlated, suggesting that composite performance measures must also report underlying maternal and newborn performance separately BACKGROUND:: The number of pregnancy-related deaths and severe maternal complications continues to rise in the United States, and the quality of obstetrical care across U...

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No abstract text is available yet for this article.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Neuropathic pain, which presents abnormal pain manifestations including allodynia and hyperalgesia, is associated with central sensitization involving N-methyl-D-aspartate receptorsIn the freeze-injury hyperalgesia model, a cold burn leads to development of both primary hyperalgesia and secondary hyperalgesia, which develops away from the site of injury without apparent tissue modification, and is associated with central sensitization and activation of N-methyl-D-aspartate receptors in the spinal cordDextromethorphan, which is an N-methyl-D-aspartate receptor antagonist, is antihyperalgesic in preclinical pain models WHAT THIS ARTICLE TELLS US THAT IS NEW: Using the freeze-injury pain model in a randomized, double-blind, placebo-controlled crossover trial of 30-mg doses of oral dextromethorphan in 20 male volunteers, dextromethorphan was antihyperalgesic and reversed peripheral and central neuronal sensitizationBecause dextromethorphan had no intrinsic antinociceptive effect in acute pain on healthy skin, N-methyl-D-aspartate receptors may need to be sensitized by pain for dextromethorphan to be effective BACKGROUND:: Central pain sensitization is often refractory to drug treatment...

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No abstract text is available yet for this article.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: The ventilatory response to hypoxia is a critical reflex that is impaired by neuromuscular blocking drugs. However, the degree to which this reflex is restored after reversal of blockade is unknown. WHAT THIS ARTICLE TELLS US THAT IS NEW: Despite full reversal of neuromuscular blockade at the thumb using different drug classes, this hypoxic chemoreflex is not fully restored. BACKGROUND: The ventilatory response to hypoxia is a life-saving chemoreflex originating at the carotid bodies that is impaired by nondepolarizing neuromuscular blocking agents...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Toll-like receptor 7 responds to elevated single-stranded RNA by increasing cytokine production. Sepsis is characterized by elevated plasma levels of tissue damage (and pathogen)-associated molecular patterns, including RNA. WHAT THIS ARTICLE TELLS US THAT IS NEW: Using murine models of bacterial sepsis, knockout of the Toll-like receptor 7 resulted in lower mortality and cytokine levels and less end-organ injury. Therefore, Toll-like receptor 7, which mediates innate immune response, contributes to harm in experimental sepsis...

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