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Anesthesiology:
doi: 10.1097/01.anes.0000367886.73836.e3
This Month In Anesthesiology

THIS MONTH IN Anesthesiology

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Postoperative Noninvasive Ventilation (Clinical Concepts and Commentary) 453

Postoperative noninvasive ventilation can help prevent postoperative hypoxemia and acute respiratory failure.
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Perioperative Tobacco Interventions by Chinese Anesthesiologists: Practices and Attitudes 338

Chinese anesthesiologists are poised to play a significant role in tobacco control in China.
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Hypercapnia and Acidosis in Sepsis: A Double-edged Sword? (Review Article) 462

Hypercapnia may be beneficial in early sepsis, but potentially deleterious in prolonged sepsis. See the accompanying Editorial View on page 269
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Continuous Peripheral Nerve Blocks: Is Local Anesthetic Dose the Only Factor, or Do Concentration and Volume Influence Infusion Effects as Well? 347

Dose of local anesthetic but not concentration and volume influence nerve block characteristics.
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Ultrasound Imaging for Regional Anesthesia in Infants, Children, and Adolescents: A Review of Current Literature and Its Application in the Practice of Extremity and Trunk Blocks (Review Article) 473

Techniques on ultrasound-guided peripheral nerve blocks of the extremities and trunk are discussed.
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Impact of Pulse Oximetry Surveillance on Rescue Events and Intensive Care Unit Transfers: A Before-and-After Concurrence Study 282

Unrecognized patient deterioration in the postoperative period may lead to increased intensive care unit (ICU) admission rates or even death. A patient surveillance system based on pulse oximetry and wireless pagers was used for nursing notification of violation of alarm limits. Data were collected on a postoperative orthopedic ward for 11 months before and 10 months after implementation of the system and compared with matched outcome data on two other postoperative units. Rescue events decreased by 2.2 per 1,000 patient discharges and ICU transfers by 1.7 per 1,000 patient days while the comparison units had no change. Rescue events and ICU transfers were decreased after implementation of this patient surveillance system on a postoperative orthopedic ward. See the accompanying Editorial View on page 272
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Factor VII Levels and International Normalized Ratios in the Early Phase of Warfarin Therapy 298

Factor VII is affected during the early phase of warfarin therapy and high international normalized ratios (INR > 1.4) are considered unsafe for epidural catheter placement or removal by the American Society of Regional Anesthesia. Data from 121 patients who took warfarin after undergoing total joint surgery and had INRs and factor VII levels determined were reviewed. Patients had INR > 1.4 on postoperative days (POD) 1 (n = 11), POD 2 (n = 78), and POD 3 (n = 84) and mean factor VII activities were 60 ± 28%, 32 ± 15%, and 44 ± 19%, respectively. Predictors of INR > 1.4 on POD 2 were warfarin dose on POD 1 and factor VII activity on POD 2. The range of factor VII activities in the patients with INR > 1.4 within 12 h of warfarin therapy was compatible with adequate hemostasis. Based on factor VII activity levels, the authors found no evidence that epidural catheters should not be removed even with INR up to 1.9, the highest INR on POD 1 noted in their study. See the accompanying Editorial View on page 277
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Comparison of Single-use and Reusable Metal Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia 325

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Intubation efficiency varies depending on the type of laryngoscope blade used. In a multicenter cluster randomized trial, 1,072 adult patients undergoing general anesthesia under emergency conditions and requiring rapid sequence induction were randomly assigned on a weekly basis to either single-use or reusable metal blades. The rate of failed intubation was significantly decreased with metal single-use blade at the first attempt compared with the reusable blade (2.8% vs. 5.4%). The proportion of grades 3 and 4 in Cormack and Lehane score were also significantly decreased with single-use metal blade (6% vs. 10%). The global complication rate tended to be lower in the single-use group (6.8% vs. 11.5%). The single-use metal blade was more efficient than a reusable metal blade in rapid sequence induction of anesthesia for emergency surgery.

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