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Science, Medicine, and the Anesthesiologist  |   January 2015
Science, Medicine, and the Anesthesiologist
Article Information
Science, Medicine, and the Anesthesiologist
Science, Medicine, and the Anesthesiologist   |   January 2015
Science, Medicine, and the Anesthesiologist
Anesthesiology 01 2015, Vol.122, A21-A22. doi:10.1097/01.anes.0000457226.87496.81
Anesthesiology 01 2015, Vol.122, A21-A22. doi:10.1097/01.anes.0000457226.87496.81
Key Papers from the Most Recent Literature Relevant to Anesthesiologists
Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384:980–1004.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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This worldwide survey used robust methodology to analyze trends in all-cause maternal mortality ratio (MMR) between 1990 and 2013. The total annual number of maternal deaths decreased from 376,034 (95% uncertainty interval 343,483–407,574) in 1990 to 292,982 (261,017–327,792) in 2013. Between 2003 and 2013, the annual rate of change in MMR was greater than –1%, reaching –3.3% for 2012–13. The most likely underlying etiologies are complications of anesthesia, embolism (air, amniotic fluid, and blood clot). Global rates of change suggest that only 16 countries will achieve the fifth Millennium Development Goal target by 2015, which requires careful consideration for regions that are making slow progress, such as west and central Africa.
Effect of fenoldopam and use of renal replacement therapy among patients with acute kidney injury after cardiac surgery: A randomized clinical trial. JAMA 2014; doi: 10.1001/jama.2014.13573 [Epub ahead of print].
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Acute kidney injury is one of the most frequent complications of cardiac surgery and is associated with morbidity and mortality. In this multicenter randomized controlled trial, the effect of fenoldopam (a selective dopamine receptor D1 agonist that induces vasodilation of the renal, mesenteric, and coronary arteries) via continuous infusion for 4 days was compared with placebo in 667 cardiac surgical patients with early postoperative acute kidney injury admitted to the intensive care unit. The need for renal replacement therapy was the primary outcome. Fenoldopam infusion did not reduce the need for renal replacement therapy or 30-day mortality among patients with acute kidney injury after cardiac surgery. However, fenoldopam was associated with an increased rate of hypotension.
Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med 2014; 371:1111–20.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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The use of intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains a matter of debate. In this randomized, registry base trial, 7,244 patients with STEMI were allocated to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone. It was found that a strategy of routine manual thrombus aspiration before PCI, as compared with PCI alone, did not reduce all-cause mortality or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis up to 1 yr.
Shattuck lecture. A molecular basis for nicotine as a gateway drug. N Engl J Med 2014; 371:932–43.
Summary: J. Mantz. Image: Nicotinic channel-receptor, ©Nature Publishing Group. Used with permission.
Summary: J. Mantz. Image: Nicotinic channel-receptor, ©Nature Publishing Group. Used with permission.
Summary: J. Mantz. Image: Nicotinic channel-receptor, ©Nature Publishing Group. Used with permission.
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Epidemiologic studies have suggested that nicotine use is a gateway to the use of marijuana and cocaine in human populations, but the mechanisms of this phenomenon are unclear. In this illuminating article written by prestigious authors in the domain of molecular neuroscience and medicine, the reader will find a description of how nicotine produces its effects in the brain of mice. The conclusions are applied to public health concerns that are being raised as the popularity of electronic cigarettes rises, with emphasis of the potential benefits to society of translating epidemiologic findings into public health policy.
Sepsis Severity Score: An internationally derived scoring system from the surviving sepsis campaign database. Crit Care Med 2014; 42:1969–76.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Sepsis remains a major perioperative public health challenge. A better understanding of the risk factors predicting mortality can help to improve the level of care in severe sepsis. In this study including a database of 23,482 observations, a 34-item Sepsis Severity Score was generated and exhibited an excellent ability to discriminate between survivors and nonsurvivors. The most significant limitation is that of age and comorbidity. As with all severity scoring models, the probabilities generated in these models should be used for gaining further understanding of populations, not for decision making with regard to individual patients.
Impact of closure at the first take back: Complication burden and potential overutilization of damage control laparotomy. J Trauma 2011; 71:1503–11.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Damage control laparotomy (DCL) has been used as a lifesaving technique that minimizes coagulopathy, hypothermia, and acidosis. However, the morbidity carried by overutilization of this technique remains unknown. In this retrospective cohort including 925 trauma patients who underwent immediate DCL, early fascial closure was found to be an independent predictor of reduced complications in DCL patients. This may represent an overutilization of this valuable technique, exposing patients to increased complications.
Acupuncture for chronic knee pain: A randomized clinical trial. JAMA 2014; 312:1313–22.
Summary: J.D. Clark. Image: ©Thinkstock.
Summary: J.D. Clark. Image: ©Thinkstock.
Summary: J.D. Clark. Image: ©Thinkstock.
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Acupuncture is a popular approach to pain control. However, few studies in this area have been well powered, and adequate control groups have often not been included. In their recent randomized trial involving 282 patients, Hinman et al. evaluated acupuncture on chronic knee pain at the end of treatment (12 weeks) and at 1 yr. The study was remarkable for its use of a control (no treatment) and sham treatment group as well as groups receiving each of two alternative forms of acupuncture. The investigators found that compared with sham treatment the traditionally and laser acupuncture–treated patients did not achieve significant improvement in average knee pain or function, the primary outcomes in this trial. This study does not support the use of acupuncture for knee pain, and demonstrates the need for powerful study designs to be applied to alternative as well as allopathic pain therapies.
Doing today’s work superbly well—treating Ebola with current tools. N Engl J Med 2014; 371:1565–6.
Summary: J. Mantz. Image: Colorized transmission electron micrograph of the Ebola virus, Centers for Disease Control and Prevention.
Summary: J. Mantz. Image: Colorized transmission electron micrograph of the Ebola virus, Centers for Disease Control and Prevention.
Summary: J. Mantz. Image: Colorized transmission electron micrograph of the Ebola virus, Centers for Disease Control and Prevention.
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News of the Ebola outbreak across West Africa is taking over the lay press and scholarly medical publications. Articles describing this disease evoke fear among the public and clinicians as well as a concern that, if there is no treatment, nothing can be done. In this superb perspective, the authors point out a most important educational message for every care provider: reduction of mortality does not only rely on new high-tech antiviral drugs, but also on excellent routine clinical care with simple interventions (i.e., fluid loading to prevent deaths attributable to hypovolemia, rational use of basic routine biology, strict isolation measures of suspect cases) that will help to break transmission chains.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Summary: J. Mantz. Image: Nicotinic channel-receptor, ©Nature Publishing Group. Used with permission.
Summary: J. Mantz. Image: Nicotinic channel-receptor, ©Nature Publishing Group. Used with permission.
Summary: J. Mantz. Image: Nicotinic channel-receptor, ©Nature Publishing Group. Used with permission.
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Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
Summary: J. Mantz. Image: J.P. Rathmell.
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Summary: J.D. Clark. Image: ©Thinkstock.
Summary: J.D. Clark. Image: ©Thinkstock.
Summary: J.D. Clark. Image: ©Thinkstock.
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Summary: J. Mantz. Image: Colorized transmission electron micrograph of the Ebola virus, Centers for Disease Control and Prevention.
Summary: J. Mantz. Image: Colorized transmission electron micrograph of the Ebola virus, Centers for Disease Control and Prevention.
Summary: J. Mantz. Image: Colorized transmission electron micrograph of the Ebola virus, Centers for Disease Control and Prevention.
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