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doi: 10.1097/ALN.0b013e3182232502
This Month in Anesthesiology

This Month In Anesthesiology

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Ultrasonography of the Adult Thoracic and Lumbar Spine for Central Neuraxial Blockade (Review Article) 1459

Anatomy and sonoanatomy of the adult thoracic and lumbar spine are reviewed.
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Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients: A Subgroup Analysis of the PROXI Trial 1313

When 80% oxygen was given during and after abdominal surgery, no difference in complications was noted. See the accompanying Editorial View on page 1271
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Development and Validation of a Risk Quantification Index for 30-day Postoperative Mortality and Morbidity in Noncardiac Surgical Patients 1336

Risk adjustment models were developed to improve monitoring quality of care.
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Propofol Enhances Memory Formation via an Interaction with the Endocannabinoid System 1380

Propofol but not benzodiazepines or barbiturates increased memory consolidation in rats. See the accompanying Editorial View on page 1277
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Anesthesia for Maternal–Fetal Surgery: The Ex Utero Intrapartum Therapy Procedure (Case Scenario) 1446

Issues and concerns in the care of a pregnant mother whose child may need surgery before delivery are discussed.
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Expansion of the Surgical Apgar Score across All Surgical Subspecialties as a Means to Predict Postoperative Mortality 1305

In an attempt to externally validate the intraoperative surgical Apgar scoring system across multiple surgical subspecialties, this study reviewed 123,684 procedures and corresponding patient death records. Lower scores were associated with an increased risk of death, but varied by subspecialty. The strongest associations occurred with ophthalmology, otolaryngology, plastics, orthopedics sports/hand, and gynecology. In the majority of subspecialties the predictive ability decreased over time after surgery. The Surgical Apgar Score may be successfully applied across multiple surgical subtypes to predict surgical outcomes. See the accompanying Editorial View on page 1269
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Preexisting Cognitive Impairment and Mild Cognitive Impairment in Subjects Presenting for Total Hip Joint Replacement 1297

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The prevalence of mild cognitive impairment in patients undergoing noncardiac surgery is unknown. Patients (N = 150) undergoing total hip joint replacement underwent neuropsychologic testing 1 week before surgery, and the results were compared with published data. Twenty percent of patients had preexisting cognitive impairments, 22% had amnestic mild cognitive impairment, and 7% had both. These results were lower than those reported for patients undergoing cardiac surgery, but similar to the general population. Because amnestic mild cognitive impairment progresses to Alzheimer disease, future studies should evaluate amnestic mild cognitive impairment, to understand the relationship between anesthesia, surgery, and Alzheimer disease. See the accompanying Editorial View on page 1265
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Moderate-dose Vasopressin Therapy May Impair Gastric Mucosal Perfusion in Severe Sepsis: A Pilot Study 1396

Vasopressor therapy is often used to manage patients with sepsis; yet, vasopressor agents may impair tissue oxygenation. Tissue oxygenation and blood flow parameters were assessed in patients (N = 12) with severe sepsis who received vasopressin (0.04 IU · kg–1 · h–1 over 4 h). Vasopressin treatment was associated with minimal changes in global hemodynamics. Changes included slightly decreased heart rate, significantly decreased global oxygen delivery, and significantly increased gastric mucosal carbon dioxide–gap pressure. This pilot study demonstrates that even moderate doses of vasopressin in septic patients may decrease gastric mucosal perfusion.

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