This Month In Anesthesiology
2007 in Review: A Dozen Steps Forward in Anesthesiology (Special Article) … 149
The editors highlight articles published in Anesthesiology that have advanced clinical care and science in the specialty.
On-demand Rather than Daily-routine Chest Radiography Prescription May Change Neither the Number Nor the Impact of Chest Computed Tomography and Ultrasound Studies in a Multidisciplinary Intensive Care Unit … 40
The effect of elimination of daily-routine chest radiographs on computed tomography studies and ultrasound studies was determined.
Equipment-related Electrocardiographic Artifacts: Causes, Characteristics, Consequences, and Correction (Review Article) … 138
Interference of the electrocardiogram within operating room and intensive care unit environments is reviewed.
Predictors of Cognitive Dysfunction after Major Noncardiac Surgery … 18
This article has been selected for the Anesthesiology CME Program. See the accompanying Editorial View on page 1
Does Intraoperative Hypothermia Increase Blood Loss and Transfusion Requirements? … 71
Rajagopalan et al. conducted a meta-analysis in an effort to resolve controversies regarding the effects of intraoperative hypothermia on coagulation. A systematic search of published randomized trials yielded 14 studies comparing blood loss and/or transfusion requirements in normothermic versus mildly hypothermic surgical patients. The meta-analysis revealed that even mild hypothermia significantly increases blood loss by approximately 16% and that the relative risk of transfusion is approximately 22% in patients who experience mild hypothermia during surgery. These results add to the evidence supporting perioperative maintenance of normothermia.
Anesthesiologists Positioned to Address Postoperative Cognitive Dysfunction (Editorial View) … 1
In this issue, Maze et al. expand upon the conclusions of the study of postoperative cognitive dysfunction (POCD) conducted by Monk et al., which identified risk factors and also found an increased risk of mortality in elderly patients who develop the syndrome. Maze and coauthors point out that further research will be needed to establish mechanisms for associations noted in the Monk studies. Whether due to global or specific regional neuroinflammation, POCD remains a significant risk in elderly patients. Maze and coauthors argue that anesthesiologists may be uniquely positioned to identify pathogenic mechanisms and institute appropriate protective and therapeutic interventions to target pathogenic processes that produce POCD.
Understanding Pharmacology of Drugs Used in Neonates … 122
GABAA receptors, which govern the majority of synaptic inhibition in the adult central nervous system, undergo significant postnatal changes in the brain and spinal cord regarding their expression levels, distribution, and subunit composition. For this reason, Koch et al. designed a series of experiments in neonate and young adult rats to analyze the effects of midazolam on nociceptive processing throughout the postnatal development period. They found that midazolam decreased mechanical reflex thresholds and increased mechanical and thermal reflex magnitudes in a dose-dependent fashion in neonate rats, but produced no sedative effect. In older rat pups and adults, midazolam produced the expected sedative effects without affecting reflex responses to nociceptive stimuli. See the accompanying Editorial View on page 6
Relationship of Blood Transfusions to Mortality Investigated … 31
Reporting on the multicenter observational study of adults admitted to 198 European intensive care units (the Sepsis Occurrence in Acutely Ill Patients Study), Vincent et al. found that 1,040 out of 3,147 patients received a blood transfusion between May 1–15, 2002. Patients who received blood transfusions were more likely to be older, have liver cirrhosis or hematological cancer, be surgical admissions, and have sepsis. However, subsequent multivariate analysis revealed that receiving a transfusion was not significantly associated with a worse mortality rate. See the accompanying Editorial View on page 3
© 2008 American Society of Anesthesiologists, Inc.