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doi: 10.1097/01.anes.0000368874.10683.7e
This Month in Anesthesiology

THIS MONTH IN Anesthesiology

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Role of Transient Receptor Potential and Acid-sensing Ion Channels in Peripheral Inflammatory Pain (Review Article) 729

The role of these receptors in mediating peripheral pain in response to inflammation is reviewed.
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Family-centered Pediatric Perioperative Care (Clinical Concepts and Commentary) 751

Family-centered care partners patients, families, health care providers, and hospitals.
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Preoperative C-reactive Protein Predicts Long-term Mortality and Hospital Length of Stay after Primary, Nonemergent Coronary Artery Bypass Grafting 607

Preoperative C-reactive protein levels as low as 3 mg/l are associated with increased long-term mortality and extended length of stay.
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Practice Advisory for Infectious Complications Associated with Neuraxial Techniques (Special Article) 530

The goal of this Advisory is to reduce the risk of infectious complications associated with neuraxial techniques.
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Ultrasound Imaging for Regional Anesthesia in Infants, Children, and Adolescents (Review Article) 719

Ultrasound imaging for pediatric neuraxial anesthesia is reviewed.
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Bumetanide Alleviates Epileptogenic and Neurotoxic Effects of Sevoflurane in Neonatal Rat Brain 567

General anesthetics have been reported to cause epileptiform electroencephalographic activity and seizure-like movements. Such events in neonates and infants are of concern as they may potentially result in neurologic and cognitive defects. The current study evaluated the effects of the Na+-K+-2Cl- cotransporter 1 inhibitor, bumetanide, in neonatal rats exposed to sevoflurane at postnatal days 4-17 (P4-P17). During anesthesia maintenance, epileptic seizures occurred in P4-P8 rats but not in P10-P17 rats. Bumetanide (5 μmol/kg, intraperitoneally) significantly decreased seizures in P4-P9 rats, but did not affect P10-P17 rats. A significant increase in activated caspase-3 and impairment of long-term potentiation induction occurred after 6 h of sevoflurane that was inhibited by bumetanide. The excitatory output of sevoflurane-potentiated γ-aminobutyric acid type A/glycine systems may contribute to epileptogenic and neurotoxic effects in early postnatal rats, and bumetanide is a possible therapy for these putative adverse effects of anesthetics. See the accompanying Editorial View on page 527
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Endothelial Dysfunction Enhances Vasoconstriction Due to Scavenging of Nitric Oxide by a Hemoglobin-based Oxygen Carrier 586

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A safer and more effective hemoglobin-based oxygen carrier (HBOC) to substitute for red blood cell transfusion is needed. HBOC-induced vasoconstriction caused by scavenging of endothelium-derived nitric oxide appears to be responsible for the adverse effects of cell-free hemoglobin. In this study, the hemodynamic effects of infusion of PolyHeme (1.08 g hemoglobin/kg; Northfield Laboratories, Evanston, IL) or murine tetrameric hemoglobin (0.48 g hemoglobin/kg) were determined. In normal lambs and mice, infusion of HBOCs did not cause systemic hypertension, but produced acute systemic and pulmonary vasoconstriction. Mice with endothelial dysfunction were more sensitive to systemic vasoconstriction after infusion of either tetrameric hemoglobin or PolyHeme. This study suggests that reduced vascular nitric oxide levels associated with endothelial dysfunction contribute to adverse effects of HBOCs. These findings suggest that testing HBOCs in animals with endothelial dysfunction can provide a more sensitive indication of their potential adverse vasoconstrictor effects.
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Use of Manometry for Laryngeal Mask Airway Reduces Postoperative Pharyngolaryngeal Adverse Events: A Prospective, Randomized Trial 652

Although use of manometry to limit laryngeal mask airway (LMA) intracuff pressure is not current practice, it may reduce adverse pharyngolaryngeal events. This double-blind randomized trial compared pharyngolaryngeal complications in ambulatory surgery patients (N=200) managed with manometers to limit LMA intracuff pressure (less than 44 mmHg) versus patients under routine care. Mean LMA intracuff pressure was less in the pressure-limiting group versus the routine care group. The incidence of composite pharyngolaryngeal complications was significantly lower in the pressure-limiting group versus the routine care group with a relative risk reduction of 70.6%, and a number-needed-to-treat of 3. Reduction of LMA intracuff pressure to less than 44 mmHg lowered the incidence of postoperative pharyngolaryngeal complications.

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