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Anesthesiology:
doi: 10.1097/ALN.0b013e3182401eae
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Table of Contents

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ON THE COVER:

This issue is the 2nd annual special issue featuring research from a pioneering institution in our field. The cover is a compilation of images presented in Washington University research published in this issue.
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THIS MONTH IN ANESTHESIOLOGY 9A

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EDITORIAL VIEWS

Washington University and the Why of Anesthesiology 1145
James C. Eisenach
Memories and Dreams: Building an Academic Department at Washington University in St. Louis 1147
Alex S. Evers and William D. Owens
Depth of Anesthesia: Perhaps the Patient Isn’t a Submarine 1149
Jamie W. Sleigh
From Bedside to Bench and Back: Perfecting Lipid Emulsion Therapy for Local Anesthetic Toxicity 1151
Peter V. Killoran and Davide Cattano
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PERIOPERATIVE MEDICINE

Perioperative Pharmacokinetics of Methadone in Adolescents 1153
Anshuman Sharma, Danielle Tallchief, Jane Blood, Thomas Kim, Amy London, and Evan D. Kharasch
This investigation determined the pharmacokinetics of intravenous methadone in adolescents undergoing surgery. Methadone disposition was similar to that in healthy adults
A Gain-of-function Mutation in Adenylate Cyclase Confers Isoflurane Resistance in Caenorhabditis elegans 1162
Owais Saifee, Laura B. Metz, Michael L. Nonet, and C. Michael Crowder
A gain-of-function mutation in an adenylate cyclase gene was discovered in the nematode Caenorhabditis elegans that strongly reduces the potency of isoflurane. This mutation acts in neurons to regulate neurotransmitter release and isoflurane sensitivity
Perioperative Nerve Injury after Total Hip Arthroplasty: Regional Anesthesia Risk during a 20-year Cohort Study 1172
Adam K. Jacob, Carlos B. Mantilla, Hans P. Sviggum, Darrell R. Schroeder, Mark W. Pagnano, and James R. Hebl
This cohort study determined the overall incidence of perioperative nerve injury after total hip arthroplasty to be 0.72. Use of neuraxial or peripheral regional anesthesia techniques did not increase the risk for perioperative nerve injury
First-line Therapy with Coagulation Factor Concentrates Combined with Point-of-Care Coagulation Testing Is Associated with Decreased Allogeneic Blood Transfusion in Cardiovascular Surgery: A Retrospective, Single-center Cohort Study 1179
Klaus Görlinger, Daniel Dirkmann, Alexander A. Hanke, Markus Kamler, Eva Kottenberg, Matthias Thielmann, Heinz Jakob, and Jürgen Peters
First-line fibrinogen and/or prothrombin complex concentrate administration combined with point-of-care testing (thromboelastometry, impedance aggregometry) was associated with a markedly decreased incidence of allogeneic blood transfusion and of thrombotic/thromboembolic events in cardiovascular surgery
Pharmacogenomic Strain Differences in Cardiovascular Sensitivity to Propofol 1192
Thomas A. Stekiel, Stephen J. Contney, Richard J. Roman, Craig A. Weber, Anna Stadnicka, Zeljko J. Bosnjak, Andrew S. Greene, and Carol Moreno
There is a pharmacogenomic difference in Dahl Salt Sensitive rats compared with Brown Norway control rats manifesting as enhanced cardiovascular sensitivity to propofol. This is attributable to altered renin gene function in the Dahl strain
Use of Recombinant Factor VIIa in Patients with Amniotic Fluid Embolism: A Systematic Review of Case Reports 1201
Barbara L. Leighton, Michael H. Wall, Ellen M. Lockhart, Louise E. Phillips, and Amanda J. Zatta
Amniotic fluid embolism patients who received recombinant factor VIIa had significantly worse outcomes than cohorts who did not receive recombinant factor VIIa. Death and major organ thrombosis were common in patients receiving recombinant factor VIIa
Relationship between Bispectral Index Values and Volatile Anesthetic Concentrations during the Maintenance Phase of Anesthesia in the B-Unaware Trial 1209
Elizabeth L. Whitlock, Alexander J. Villafranca, Nan Lin, Ben J. Palanca, Eric Jacobsohn, Kevin J. Finkel, Lini Zhang, Beth A. Burnside, Heiko A. Kaiser, Alex S. Evers, and Michael S. Avidan
Individual and population concentration response characteristics limit the feasibility of titrating volatile anesthetic administration against processed electroencephalographic indices such as the Bispectral Index
Lipid Resuscitation of Bupivacaine Toxicity: Long-chain Triglyceride Emulsion Provides Benefits over Long- and Medium-chain Triglyceride Emulsion 1219
Zhengqian Li, Yun Xia, Xiaoxi Dong, Hongfei Chen, Fangfang Xia, Xianqin Wang, Huimin Dong, Zhousheng Jin, Xili Ding, Thomas J. Papadimos, and Xuzhong Xu
The results of resuscitation effects of two commercially available lipid emulsions of different compositions on the recovery from bupivacaine toxicity in rats displayed long-chain triglyceride emulsion’s superiorities over long- and medium-chain triglyceride emulsion
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CRITICAL CARE MEDICINE

Neuroprotective Effect of Curcumin in an Experimental Rat Model of Subarachnoid Hemorrhage 1229
Chang-Po Kuo, Chueng-He Lu, Li-Li Wen, Chen-Hwan Cherng, Chih-Shung Wong, Cecil O. Borel, Da-Tong Ju, Chun-Mei Chen, and Ching-Tang Wu
Treatment with multiple doses of curcumin after subarachnoid hemorrhage reduced mortality rate and improved functional and histological outcomes. Possible mechanisms include attenuation of glutamate level by preservation of glutamate transporter-1 protein expression and attenuation of oxidant stress
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PAIN MEDICINE

Metabotropic Glutamate Receptor 5 Antagonism with Fenobam: Examination of Analgesic Tolerance and Side Effect Profile in Mice 1239
Michael C. Montana, Beth A. Conrardy, Laura F. Cavallone, Benedict J. Kolber, Lesley K. Rao, Suellen C. Greco, and Robert W. Gereau IV
Daily administration of the mGlu5 antagonist fenobam for up to 2 weeks does not result in tolerance to fenobam’s analgesic effects and is well tolerated in mice
Buprenorphine Metabolites, Buprenorphine-3-glucuronide and Norbuprenorphine-3-glucuronide, Are Biologically Active 1251
Sarah M. Brown, Michael Holtzman, Thomas Kim, and Evan D. Kharasch
Buprenorphine-3-glucuronide and norbuprenorphine-3-glucuronide had moderate to high affinity for human μ, δ, and/or nociceptin receptors, and elicited mild analgesic responses. Norbuprenorphine-3-glucuronide but not buprenorphine-3-glucuronide caused sedation and decreased tidal volume. Glucuronide metabolites may contribute to buprenorphine effects
Isozyme-specific Effects of Protein Kinase C in Pain Modulation 1261
Chengshui Zhao, Michael Leitges, and Robert W. Gereau IV
This study utilizes a panel of genetically modified mice to demonstrate the diverse roles of the α, β, γ, and δ isoforms of protein kinase C in mediating hypersensitivity after inflammation or nerve injury
Rewarding Electrical Brain Stimulation in Rats after Peripheral Nerve Injury: Decreased Facilitation by Commonly Abused Prescription Opioids 1271
Eric E. Ewan and Thomas J. Martin
Spinal nerve ligation in rats suppresses opioid facilitation of rewarding brain stimulation in a manner that is distinct from analgesia-related manipulations
Shifts in Cell-type Expression Accompany a Diminishing Role of Spinal P38-Mapkinase Activation over Time during Prolonged Postoperative Pain 1281
Liang Huang, Yong-Jing Gao, Jeffrey Wang, and Gary Strichartz
During prolonged, postoperative pain, expression of activated mitogen-activated protein kinase p38 shifts from microglia to neurons. Inhibition of P-p38 at early times prevents later postoperative pain, but later inhibition causes only transient pain relief
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EDUCATION

Case Scenario
Opioid Association with Serotonin Syndrome: Implications to the Practitioners 1291
Rahul Rastogi, Robert A. Swarm, and Trusharth A. Patel
Serotonin syndrome is an uncommon but potentially life-threatening drug-induced toxicity, from interaction of opioids to other serotonergic agents. This toxic reaction can either be avoided, through knowing a patient’s detailed medicinal history, or be diagnosed early to prevent severe morbidity and mortality. It is even more critical for a practicing anesthesiologist to understand this entity, as the syndrome will be even more difficult to diagnose if secondary to overlapping symptoms from anesthetic. This case scenario focused on serotonin syndrome pathophysiology and management, and its association to routinely used opioids
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Images in Anesthesiology
Inflammatory Myofibroblastic Tumor within Intrahepatic Inferior Vena Cava 1299
Andrea Vannucci, Lan Chi Tran, and Ivan M. Kangrga
Subglottic Airway Foreign Body: A Near Miss 1300
Jacob AuBuchon, Catherine Krucylak, and David J. Murray
Necrotizing Fasciitis after Cesarean Delivery 1301
Kathleen W. Nissman, Daniel B. Nissman, Barbara L. Leighton, Swarup S. Varaday, and Ellen M. Lockhart
Pus in the Ventricles of a Patient with a Lumbar Cerebrospinal Fluid Drain for a Thoracoabdominal Aneurysm Repair 1302
Jonathan E. Charnin, Brian T. Bateman, and Edward A. Bittner
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Anesthesia Literature Review 1303
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Original Investigations in Education
Simulation-based Assessment of Pediatric Anesthesia Skills 1308
James J. Fehr, John R. Boulet, William B. Waldrop, Rebecca Snider, Megan Brockel, and David J. Murray
A multiple scenario simulation-based assessment of pediatric perioperative care demonstrated that anesthesia residents with more training achieved higher scores, with a wide range of ability among subjects
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Review Articles
Genetic Variation, β-blockers, and Perioperative Myocardial Infarction 1316
Peter Nagele and Stephen B. Liggett
Perioperative myocardial infarction (MI) is a common and potentially fatal complication after noncardiac surgery. The use of β-adrenergic receptor blocking drugs for prevention and treatment of perioperative MI has become controversial. Interindividual genetic variation may determine the clinical response to β-blocker therapy. This article reviews the molecular, cellular, and physiologic consequences of polymorphisms in the adrenergic signaling pathway and CYP2D6 gene, and shows that these are likely relevant factors influencing efficacy, safety, and toxicity of β-blocker therapy in prevention and treatment of perioperative MI
Use of Concatemers of Ligand-Gated Ion Channel Subunits to Study Mechanisms of Steroid Potentiation 1328
Joe Henry Steinbach and Gustav Akk
Neurosteroids potentiate responses to neurotransmitter at multiple sites on receptors. The authors review the use of covalently linked channel subunits to characterize the sites individually and provide insights into the mechanisms of neurosteroid potentiation
Structural Studies of the Actions of Anesthetic Drugs on the γ-Aminobutyric Acid Type A Receptor 1338
Gustav Akk and Joe Henry Steinbach
The γ-aminobutyric acid type A receptor is the major target for many clinically used anesthetic drugs. The authors describe the current state of knowledge of the structural rearrangements taking place during receptor activation and modulation
Advances in the Management of Sepsis and the Understanding of Key Immunologic Defects 1349
Lee P. Skrupky, Paul W. Kerby, and Richard S. Hotchkiss
Anesthesiologists increasingly face the difficult challenge of managing patients with sepsis both in the operating room and intensive care unit. This review discusses advances in current therapy and an evolving immunologic understanding of sepsis.
Molecular Mechanisms of Opioid Receptor-dependent Signaling and Behavior 1363
Ream Al-Hasani and Michael R. Bruchas
This review highlights the recent advances in opioid receptor signaling and discusses their potential for the development of novel opioids in the treatment of pain and neurologic disorders
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Mind To Mind
“… And I Was Born” 1382
Ezzat I. Abouleish
Blue Baby 1385
Thomas W. Quigley
The Sea Politic 1386
Jennifer Root
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CORRESPONDENCE

Hernia Repair, Anesthetic Exposure, and Academic Performance in Children 1387
Randall P. Flick and David O. Warner
In Reply
Tom G. Hansen, Steen W. Henneberg, Jacob K. Pedersen, and Kaare Christensen
New Dreams: Back to the Future 1388
Louis Jacobson and Anthony J. Mariano
Pain Treatment and Opioids 1389
Rosemary J. Orr
Intraoperative Transesophageal Echocardiography Guides Liver Transplant Surgery in a Patient with Thrombosed Transjugular Intrahepatic Portosystemic Shunt 1389
Andrea Vannucci, Joshua Johnston, Truman M. Earl, Majella Doyle, and Ivan M. Kangraga
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REVIEWS OF EDUCATIONAL MATERIAL 1392

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Announcements 1396

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Acknowledgment 1398

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Classified ADS 25A

INSTRUCTIONS FOR AUTHORS
The most recently updated version of the Instructions for Authors is available at www.anesthesiology.org. Please refer to the Instructions for the preparation of any material for submission to ANESTHESIOLOGY.

© 2011 American Society of Anesthesiologists, Inc.

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