This Month in Anesthesiology
Early Exposure to Anesthesia and Learning Disabilities in a Population-based Birth Cohort 796
The investigators studied the association between anesthetic exposure before age 4 and the development of learning disabilities (LD) in reading, written language, and mathematics. Educational and medical records of all children born to mothers residing in five townships were examined. A single exposure to anesthesia (n = 449) was not associated with an increased risk of LD (hazard ratio = 1.0; 95% confidence interval, 0.79–1.27). However, children receiving two anesthetics (n = 100) or three or more anesthetics (n = 44) were at increased risk for LD (hazard ratio = 1.59; 95% confidence interval, 1.06–2.37, and hazard ratio = 2.60; 95% confidence interval 1.60–4.24, respectively). The authors noted they cannot determine whether anesthesia itself may contribute to LD, or whether the need for multiple anesthetics is a marker for other unidentified factors that contribute to LD.
Natriuretic Peptide System Gene Variants Are Associated with Ventricular Dysfunction after Coronary Artery Bypass Grafting 738
The authors hypothesized that natriuretic peptide system gene variants independently predict risk of ventricular dysfunction (VnD) after primary coronary artery bypass grafting. A total of 139 haplotype-tagging single nucleotide polymorphisms (SNPs) within 7 natriuretic peptide system genes were genotyped. Seven natriuretic SNPs were associated with decreased risk of postoperative VnD (odds ratios = 0.44–0.55; P = 0.010–0.036) and four natriuretic SNPs were associated with increased risk of postoperative VnD (odds ratios = 3.89–4.28; P = 0.007–0.034). Knowledge of natriuretic peptide system gene variants may result in a better understanding of postoperative VnD after primary coronary artery bypass grafting. These variants may also predict those patients at high risk for VnD so that preventative interventions can be explored. See the accompanying Editorial View on page 693
Inhibition of p75 Neurotrophin Receptor Attenuates Isoflurane-mediated Neuronal Apoptosis in the Neonatal Central Nervous System 813
Exposure to anesthetics administered to young animals causes neurohistopathologic changes including apoptosis, a form of programmed cell death. The investigators examined isoflurane-mediated apoptosis in isolated neuronal tissues in vitro. The authors focused their investigation on a precursor of mature brain-derived neurotrophic factor (BDNF), called proBDNF, and its receptor, the p75 neurotrophin receptor (p75NTR). Inhibition of the proBDNF–p75NTR signaling pathway blocked isoflurane-mediated neuronal apoptosis in cultured neurons from the developing rodent brain. If exposure to anesthesia and surgery in early life impairs neural development, the proBDNF–p75NTR signaling pathway may be a target for future therapeutic intervention. See the accompanying Editorial View on page 709
Executive Function and Depression as Independent Risk Factors for Postoperative Delirium 781
The authors examined the association between preoperative executive function, depression, and other established clinical predictors of postoperative delirium among 998 patients undergoing major noncardiac surgery. Patients were screened prospectively using the Confusion Assessment Method as well as by retrospective chart review. Thirty-five patients developed delirium postoperatively (3.5%). Preoperative executive dysfunction (P = 0.007) and greater levels of depression (P = 0.049) were associated with a greater incidence of postoperative delirium. Complex tests for executive function were more strongly associated with postoperative delirium than simpler tests. In the future, preoperative screening of patients at risk for delirium may facilitate testing of preventative interventions.
The Pursuit of Excellence: The 47th Annual Rovenstine Lecture (Special Article) 714
The pursuit of excellence should always be the number one agenda item for all anesthesiologists. See the accompanying Editorial View on page 712
Identification of Patients at Risk for Postoperative Respiratory Complications Using a Preoperative Obstructive Sleep Apnea Screening Tool and Postanesthesia Care Assessment 869
A preoperative screening tool for obstructive sleep apnea and postanesthesia care unit monitoring identified patients at risk for later adverse postoperative respiratory events.
Prediction and Outcomes of Impossible Mask Ventilation: A Review of 50,000 Anesthetics 891
Independent predictors of impossible mask ventilation were determined.
Obstructive Sleep Apnea of Obese Adults: Pathophysiology and Perioperative Airway Management (Review Article) 908
Keys for safe perioperative airway management of obese patients with obstructive sleep apnea are reviewed.
© 2009 American Society of Anesthesiologists, Inc.