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This Month in Anesthesiology  |   January 2015
This Month in: Anesthesiology
Article Information
This Month in Anesthesiology
This Month in Anesthesiology   |   January 2015
This Month in: Anesthesiology
Anesthesiology 01 2015, Vol.122, A1-A2. doi:10.1097/01.anes.0000457222.63732.53
Anesthesiology 01 2015, Vol.122, A1-A2. doi:10.1097/01.anes.0000457222.63732.53
29 Transfusion Requirements in Surgical Oncology Patients: A Prospective, Randomized Controlled Trial
Summary: M.J. Avram. Image: A. Johnson/Vivo Visuals.
Summary: M.J. Avram. Image: A. Johnson/Vivo Visuals.
Summary: M.J. Avram. Image: A. Johnson/Vivo Visuals.
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The decision to transfuse patients having surgery for cancer should take into account risks of anemia and adverse effects of blood transfusion. A composite primary outcome of death from all causes or severe clinical complications within 30 days of randomization was compared in 198 high-risk abdominal oncological surgery patients randomly assigned to a restrictive or a liberal transfusion strategy, who received an erythrocyte unit when their hemoglobin concentration decreased to less than 7 g/dl or 9 g/dl, respectively, during their intensive care unit stay. The composite primary outcome occurred in 19.6% of the liberal strategy patients and in 35.6% of the restrictive strategy patients. See the accompanying Editorial View on page 3.
21 Characterizing the Epidemiology of Perioperative Transfusion-associated Circulatory Overload
Summary: M.J. Avram. Image: ©Shutterstock.
Summary: M.J. Avram. Image: ©Shutterstock.
Summary: M.J. Avram. Image: ©Shutterstock.
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Transfusion-associated circulatory overload (TACO) is the second leading cause of transfusion-related death, but its perioperative epidemiology is poorly understood. Perioperative TACO incidence was determined by analyzing data abstracted from electronic medical records of 4,070 adults who underwent noncardiac surgery under general anesthesia and received intraoperative blood product transfusions in 2004 or 2011. TACO occurred within 6 h of the last intraoperative blood product transfusion at rates of 5.5% in 2004 and 3.0% in 2011. Although increased rates of TACO were associated with surgical specialty, patient age, transfusion volume, and total operative fluid balance, no patient or transfusion characteristic could fully account for the decreased incidence between 2004 and 2011. See the accompanying Editorial View on page 1.
12 Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related death, but its perioperative epidemiology is poorly understood. The combined incidence of perioperative TRALI/possible TRALI was determined by analyzing data abstracted from electronic medical records of 3,379 adults who underwent noncardiac surgery under general anesthesia and received intraoperative blood product transfusions in 2004 or 2011, before and after introduction of TRALI mitigation strategies. TRALI/possible TRALI occurred within 6 h of the last intraoperative blood product transfusion at rates of 1.3% in 2004 and 1.4% in 2011. Increased rates were associated with increased volumes of transfused blood product. See the accompanying Editorial View on page 1.
172 A Randomized Control Trial of Bupivacaine and Fentanyl versus Fentanyl-only for Epidural Analgesia during the Second Stage of Labor
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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Although epidural analgesia for pain relief during childbirth may not increase cesarean delivery rates, it can slightly prolong first and second stages of labor. In order to determine whether eliminating local anesthetic from epidural analgesia during the second stage would reduce its length, 310 nulliparous women with labor epidurals were randomly assigned to receive either 0.125% bupivacaine and 2 µg/ml fentanyl or 10 µg/ml fentanyl alone via the epidural catheter. The groups did not differ in duration of the second stage of labor, degree of motor blockade, mode of delivery, relief of labor pain, or maternal and neonatal outcomes.
46 Postoperative Bladder Catheterization Based on Individual Bladder Capacity: A Randomized Trial
Summary: M.J. Avram. Image: Hellerhoff [own work] [CC-BY-SA-3.0] [http://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons].
Summary: M.J. Avram. Image: Hellerhoff [own work] [CC-BY-SA-3.0] [http://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons].
Summary: M.J. Avram. Image: Hellerhoff [own work] [CC-BY-SA-3.0] [http://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons].
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Untreated postoperative urinary retention can lead to bladder wall overdistention and damage to the detrusor muscle. Nonetheless, most patients prefer to avoid bladder catheterization, which has its own risks. Eighteen hundred forty patients undergoing operations with general or spinal anesthesia were randomly assigned to have 500 ml or their maximum bladder capacity (MBC) as the threshold for catheterization if the patient was unable to void spontaneously. MBC was the maximum voided volume at home plus the residual volume measured by ultrasound at preoperative assessment. The incidence of catheterization was 11.8% in the control group and 8.6% in the MBC group. The average MBC in all patients was approximately 600 ml.
140 Disruption of Cortical Connectivity during Remifentanil Administration Is Associated with Cognitive Impairment but Not with Analgesia
Summary: M.J. Avram. Image: ©Thinkstock.
Summary: M.J. Avram. Image: ©Thinkstock.
Summary: M.J. Avram. Image: ©Thinkstock.
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Electroencephalographic graph theory decomposes the multiple cortical connectivity features extracted from multichannel electroencephalography into composite measures of the overall brain network performance and functionality: characteristic path length, measuring functional integration; mean clustering coefficient, measuring functional segregation; and relative small-worldness, reflecting the balance of local segregation and global integration. These graph-theoretical measures were obtained from functional connectivity network measures in resting state electroencephalographic data from 21 volunteers in a double-blind, placebo-controlled, crossover study of remifentanil. Remifentanil reduced overall efficiencies of cortical networks in α and β1 frequency ranges. Disruptions of the complex cortical networks subserving normal brain function were associated with loss of stability of sustained attention but not with analgesic effect. See the accompanying Editorial View on page 8.
196 Regulation of Cerebral Autoregulation by Carbon Dioxide (Review Article)
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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Cerebral autoregulation protects the brain from ischemia and overperfusion in the face of fluctuating perfusion pressure. Cerebral blood flow remains stable between the lower and the upper cerebral perfusion pressure limits and is pressure passive at the cerebral perfusion pressures below the lower limit and above the upper limit. The integrated effect of carbon dioxide and perfusion pressure on cerebral circulation is discussed on the basis of published large animal data as well as human data, with speculation on the aspects for which there are no supportive data.
191 Pretransfusion Testing and Transfusion of Uncrossmatched Erythrocytes (Clinical Concepts and Commentary)
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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The level of pretransfusion testing ordered can be based on a variety of considerations, including an institution’s maximum surgical blood order schedule, which recommends the extent of pretransfusion testing for common surgical procedures that will reduce unnecessary testing and costs. Pretransfusion testing aimed at avoiding potentially fatal hemolytic transfusion reactions is reviewed, including computer or electronic crossmatching, on the basis of which any ABO and RhD type-specific unit can be issued to a patient with a negative antibody screen and no historical antibodies. Indications for the emergency release of uncrossmatched group O erythrocytes and risks and special considerations associated with their use are reviewed.
Summary: M.J. Avram. Image: A. Johnson/Vivo Visuals.
Summary: M.J. Avram. Image: A. Johnson/Vivo Visuals.
Summary: M.J. Avram. Image: A. Johnson/Vivo Visuals.
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Summary: M.J. Avram. Image: ©Shutterstock.
Summary: M.J. Avram. Image: ©Shutterstock.
Summary: M.J. Avram. Image: ©Shutterstock.
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Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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Summary: M.J. Avram. Image: Hellerhoff [own work] [CC-BY-SA-3.0] [http://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons].
Summary: M.J. Avram. Image: Hellerhoff [own work] [CC-BY-SA-3.0] [http://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons].
Summary: M.J. Avram. Image: Hellerhoff [own work] [CC-BY-SA-3.0] [http://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons].
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Summary: M.J. Avram. Image: ©Thinkstock.
Summary: M.J. Avram. Image: ©Thinkstock.
Summary: M.J. Avram. Image: ©Thinkstock.
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Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
Summary: M.J. Avram. Image: J.P. Rathmell.
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