2017 Covers & Artwork

Year < Previous Year

December 2017, Volume 125, Issue 6

When initiating a call for resources during massive, surgical hemorrhage, there is hardly a more apt analogy than actuating the lever of a fire alarm. The pull of this trigger is often a justifiably knee-jerk response as clinical crises rarely occur with subtlety. Once the deployment of personnel, equipment, and support systems have commenced, who then oversees deescalation? The arc of descent during the tapering of emergent transfusion therapy is as fraught with uncertainty as any other point in the management of massive hemorrhage. The reader is encouraged to ponder the article herein reviewing this question. The cover image partly utilized a stock image, copyright attributed as follows: 123RF Stock Photo (https://www.123rf.com/profile_skynavin).
Naveen Nathan, MD
Cover Editor and Illustrator

November 2017, Volume 125, Issue 5

It would have been too easy to take the surrealist's approach to the November cover and create a nightmarish dreamscape to represent the opiate crisis at the forefront of our attention. Instead, two distinctly separate photographs were digitally merged into one image. The human skulls, of course, convey the very real possibility of our mortality at the hands of an addictive and potentially lethal drug class. The unassuming prescription bottle, however, is meant to emphasize that in an ideal world, we assume some control and regulation of opiates. They will, for the foreseeable future, play a central role in pain management as our search continues for effective alternative and complementary strategies. Opiates will not disappear from our pharmacologic landscape and thus should not be overtly vilified. As much as our patients may develop a dependence on opiates, we should strive to avoid depending on them as our common denominator in ameliorating perioperative pain. Two stock images were used to create this month’s cover, copyrights attributed as follows: 123RF Stock Photo (https://www.123rf.com/profile_koya79 and https://www.123rf.com/profile_burlingham).
Naveen Nathan, MD
Cover Editor and Illustrator

October 2017, Volume 125, Issue 4

Though the story arc of the perioperative experience begins with an appraisal of one's health and constitution and ends with the ideal pain management pathway to facilitate recovery, the two spheres are intimately linked. The cover image conceptualizes the importance of this relationship. In it, we witness the perioperative surgical home annexed with an addition focused on optimal strategies to enhance pain control. A very special thanks to Niyati Naveen in the production of this month's illustration.
Naveen Nathan, MD
Cover Editor and Illustrator

September 2017, Volume 125, Issue 3

The stylized circulatory system depicted on this month's cover takes on a two-color format; bisecting the figure into a highly perfused upper half while relegating the trunk and lower extremities aerobically destitute. This may evoke the classic profile of circulatory redistribution during aortic cross-clamping during aneurysmal repair. However, the premise for this image evolves from the intentional circulatory blockade set forth through endovascular balloon occlusion of the aorta during traumatic hemorrhage. The dramatic physiologic repercussions of this intervention are highlighted in this issue.
Naveen Nathan, MD
Cover Editor and Illustrator

August 2017, Volume 125, Issue 2

This month's cover captures the instantaneous moment when a multitude of hematologic, inflammatory, and mechanical forces submit their allegiance toward a hypercoaguable state. An insidious process allows the machinery of death to crystallize despite our well-intentioned efforts to subdue it. A review of perioperative venous thromboembolism in this issue gathers our current understanding of its mechanisms and the most effective strategies to thwart its morbidity.
Naveen Nathan, MD
Cover Editor and Illustrator

July 2017, Volume 125, Issue 1

The cover artwork contains elements of the most basic conceptualizations of cardiac action potentials as well as the cardinal vectors of the electrocardiogram. Abruptly fading in and out are the real-world manifestations of these principles that we monitor every day. Despite our best efforts, we have yet to fully understand how and why nature's most elegant circuit board functions and, in some cases, ceases to do so.
Naveen Nathan, MD
Cover Editor and Illustrator

June 2017, Volume 124, Issue 6

This month the Aedes Aegypti mosquito takes the Journal's center stage. As frightful as its clandestine operations may be (due to the adaptive local anesthetic and anticoagulant qualities of its saliva), the more disquieting concern is that it is oblivious to its vectorial role in the advancement of disease. It is, after all, 'just the messenger.' The real aggressor is, of course, in the mosquito's sinister payload: the Zika virus. This month offers an insightful review on the anesthetic management of the growing population of patients infected with Zika.
Naveen Nathan, MD
Cover Editor and Illustrator

May 2017, Volume 124, Issue 5

Ask any patient who has endured the course of a successful oncologic surgery and they will yet attest to, at a minimum, a healthy state of paranoia. They are forever committed to looking over their shoulder in doubt, wondering if even a single rogue cell escaped surgical extradition. That our very choice of anesthetic drug may tip the balance in favor of or against the recurrence of microscopic disease should compel anyone to read the review contained in this month’s issue. Our pivotal role in cancer outcomes however is limited by some uncertainty and our choice of drug may essentially come down to an educated gamble.
Naveen Nathan, MD
Cover Editor and Illustrator

April 2017, Volume 124, Issue 4

There is hardly any biologic process that so evokes the dynamic of a factory line than the translation of an mRNA sequence into a functional peptide. So go thousands of patients every day into a realm where even the sanctity of the surgical process is protocol-driven. But where the stark, granular linearity of the patient's genome ends, begins the distinct expression of their code. So unique may this be that it manifests in nothing short of a pharmacodynamic response ranging from nearly non-existent pain relief to a lethal overdose, to use but one example.
Naveen Nathan, MD
Cover Editor and Illustrator

Photo Credit: RAJESH RAJENDRAN NAIR / 123RF

March 2017, Volume 124, Issue 3

If there was ever a time to revive this artist’s childhood wonder and admiration of classic superhero tales, then this issue presents just such an opportunity. Rarely does a clinical intervention enjoy the confluence of accessibility, safety, and diagnostic potential as does focused cardiovascular ultrasound, a modality that expands our monitoring arsenal to an impressive utility. We may not be genetically endowed to see through walls with x-ray vision, but this certainly brings us one step closer to that reality.
Naveen Nathan, MD
Cover Editor and Illustrator

February 2017, Volume 124, Issue 2

This month's cover image portrays classic neural architecture with telescoping and progressively distinct units of nerve elements. It culminates though with a disintegrating axon that succumbs to a triad of injurious forces characterized in this issue's cover article. The very real, but mercifully rare incidence of neurologic complications is often overcast by the sheer elegance of a regional anesthetic. This issue cuts further through the noise to define modifiable factors in the development of neurologic compromise, a bona fide needle amidst the haystack.
Naveen Nathan, MD
Cover Editor and Illustrator

January 2017, Volume 124, Issue 1

As this issue profiles the current utility and advances in monitoring, it seems appropriate to underscore the physiologic gas of life and death. Oxygen has enriched our atmosphere for roughly half of the Earth's existence. Arguably the most relevant and chemically unique agent that exerts a partial pressure within us all, everything from oxygen's electronegativity to its paramagnetic tendencies has been exploited by modern technology in the operating room. For all that we understand about the curious element that enjoys a seat on the upper tier of the periodic table, it is at its core a dual agent; orchestrating both the sustenance of cellular life as much as the path to its hyperoxidant demise.
Naveen Nathan, MD
Cover Editor and Illustrator
​​