This Month In Anesthesiology
Front Teeth–to–Carina Distance in Children Undergoing Cardiac Catheterization 1004
To help prevent bronchial intubation, normal upper front teeth–to–carina distance was measured in 170 infants and children.
Volatile Anesthetic Effects on Midbrain-elicited Locomotion Suggest that the Locomotor Network in the Ventral Spinal Cord Is the Primary Site for Immobility 1016
Anesthetic effects on stimulation-elicited locomotion activity were measured. See the accompanying Editorial View on page 975
Vascular Remodeling Protects against Ventilator-induced Lung Injury in the In Vivo Rat 1047
Chronic pulmonary vascular remodeling reduces ventilator-induced lung injury in rats.
Acceleromyography for Use in Scientific and Clinical Practice: A Systematic Review of the Evidence (Review Article) 1117
Evidence that acceleromyography improves detection of postoperative residual neuromuscular blockade is reviewed.
Carbon Monoxide Inhalation Reduces Pulmonary Inflammatory Response during Cardiopulmonary Bypass in Pigs 1025
Cardiopulmonary bypass (CPB) is associated with pulmonary inflammation and dysfunction. This study examined if inhaled carbon monoxide (CO) before initiation of CPB would reduce the inflammatory response in the lungs in a porcine model. The animals were randomized either to standard CPB or to CPB while the lungs were ventilated with 250 ppm inhaled CO. Lung tissue samples were obtained at various time points and pulmonary cytokine levels determined. Compared with standard CPB animals, CO significantly suppressed inflammatory cytokines and induced the antiinflammatory cytokine interleukin 10. Inhaled CO could represent a potential new therapeutic modality for counteracting CPB-induced lung injury. See the accompanying Editorial View on page 977
Dobutamine: Too Dangerous for “Routine” Administration? (Editorial View) 973
Depending on personal and group practice pattern, positive inotropic drugs may be administered to as few as 5% or to as many as 100% of patients undergoing elective coronary artery bypass surgery. This editorial discusses the propensity analysis performed by Fellahi et al. that compared the outcome after coronary artery surgery in patients who did or did not receive positive inotropic drugs. In nearly all cases, the inotrope was dobutamine. After controlling for other factors, patients treated with positive inotropic drugs had worse outcomes. The editorialist suggests that patients should not receive dobutamine after heart surgery unless there is a clear indication. Furthermore, he recommends that there should be guidelines and protocols by which dobutamine should be administered after coronary artery bypass surgery.
Pregnancy Increases Excitability of Mechanosensitive Afferents Innervating the Uterine Cervix 1087
Labor pain derives primarily from stimulation of sensory afferents innervating the uterine cervix and lower uterine segment. This study examined the regulation of the excitability of cervical afferents by sex hormones and pregnancy. The hypogastric nerve was dissected and single-nerve fiber spontaneous activity and the response to graded distension were recorded. Pregnancy was associated with an increase in spontaneous activity compared with the nonpregnant state. More fibers responded to the weakest stimulus in the pregnant than in the nonpregnant animals. These data suggest that, at the onset of labor, there is an increased sensitivity of sensory fibers to cervical distension.
Statin Therapy within the Perioperative Period (Clinical Concepts and Commentary) 1141
Statins are highly effective in lowering serum cholesterol concentrations by inhibiting 3-hydroxy-3-methyl glutaryl coenzyme A reductase. Statins also exert numerous lipid-independent effects like their ability to inhibit the inflammatory response, reduce thrombosis, reduce ischemia–reperfusion injury, and restore endothelial function. There is evidence suggesting statins reduce the incidence of acute adverse cardiovascular outcomes. More recent data suggest that perioperative statin therapy, independent of its effects on serum cholesterol levels, is useful for the prevention of adverse postoperative outcomes.
© 2008 American Society of Anesthesiologists, Inc.