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doi: 10.1097/ALN.0b013e318249fe1a
This Month in Anesthesiology

THIS MONTH IN Anesthesiology

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Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management (Special Article) 248

This article focuses on acute pain management that is present in a surgical patient after a procedure.
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Prognostic Implications of Preoperative E/e′ Ratio in Patients with Off-pump Coronary Artery Surgery 362

Preoperative noninvasive measure of left ventricular filling pressure predicts long-term adverse events.
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First Human Administration of MR04A3: A Novel Water Soluble Nonbenzodiazepine Sedative 385

MR04A3 is a novel intravenous drug that produces dose-related sedation in humans.
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Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss (Special Article) 274

This article focuses on the perioperative management of prone patients undergoing spine procedures and receiving general anesthesia.
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Perianesthetic Management of Laryngospasm in Children (Case Scenario) 458

The prevention, diagnosis, and treatment of laryngospasm occurring during anesthesia is reviewed.
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Peripartum Subarachnoid Hemorrhage: Nationwide Data and Institutional Experience 324

Subarachnoid hemorrhage (SAH) in pregnant women is attributed to multiple etiologies. In this retrospective analysis of the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality database, 639 cases of pregnancy-related SAH were identified. SAH was associated with 4.1% of all pregnancy-related in-hospital deaths and generally occurred postpartum. Pregnancy-related SAH was associated with independent risk factors such as age (see fig.), African-American race, Hispanic ethnicity, tobacco, drug or alcohol abuse, or comorbid disorders such as intracranial venous thrombosis, sickle cell, and hypercoagulability. See the accompanying Editorial View on page 242
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Mixed (Long- and Medium-chain) Triglyceride Lipid Emulsion Extracts Local Anesthetic from Human Serum In Vitro More Effectively than a Long-chain Emulsion 334

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Local anesthetic-associated cardiac toxicity may be reduced with lipid emulsion infusions. An in vitro study of two commercially available lipid emulsions, Lipofundin® (B. Braun Melsungen AG, Melsungen, Germany) and Intralipid® (Fresenius Kabi, Uppsala, Sweden), extracted local anesthetics from serum. Lipofundin® extracted bupivacaine, ropivacaine, and mepivacaine to a greater extent than Intralipid®. Extraction could be increased with increasing concentrations of bupivacaine or lipid. Changes in pH did not alter the sequestration of bupivacaine. Lipofundin®, an emulsion containing 50% each of medium- and long-chain triglycerides, extracted local anesthetics to a greater extent than Intralipid®, a long-chain triglyceride emulsion alone.
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Anesthetic Management and Outcome in Patients during Endovascular Therapy for Acute Stroke 396

General anesthesia is associated with poor outcomes in patients undergoing endovascular treatment for acute ischemic stroke. A retrospective chart review (N = 129) was conducted to assess potential modifiable factors associated with outcome when adjusting for stroke severity. Of 96 patients for whom data were available, half received general anesthesia. The proportion of “good” outcomes, identified by modified Rankin Score, was significantly lower (15% vs. 60%) in the general anesthesia group compared with the local anesthesia/sedation group. Independent predictors for good outcome included local anesthesia, systolic blood pressure greater than 140 mmHg, and low baseline stroke scores. This study confirmed that general anesthesia is associated with worse outcomes compared with local anesthesia/sedation, and is not associated with stroke severity. See the accompanying Editorial View on page 244

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