This Month in Anesthesiology
Practice Advisory for Preanesthesia Evaluation: An Updated Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation (Special Article) 522
The preanesthetic evaluation may be used to educate the patient, organize resources, and formulate plans for perioperative care.
Practice Guidelines for Central Venous Access: A Report by the American Society of Anesthesiologists Task Force on Central Venous Access (Special Article) 539
Placement and management of central venous catheters is discussed.
Surgery and Brain Atrophy in Cognitively Normal Elderly Subjects and Subjects Diagnosed with Mild Cognitive Impairment 603
An increased rate of atrophy in surgical versus nonsurgical subjects occurred in hippocampus and cortical gray matter. See the accompanying Editorial View on page 510
Postoperative Liver Failure after Liver Resection in a Cirrhotic Patient (Case Scenario) 705
Management of postoperative liver failure after liver resection is discussed.
Prevalence of Survivor Bias in Observational Studies on Fresh Frozen Plasma:Erythrocyte Ratios in Trauma Requiring Massive Transfusion (Review Article) 716
Ten of the 26 studies reviewed probably contain survivor bias favoring increased use of plasma. See the accompanying Editorial View on page 518
Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics 683
Simulation studies have suggested that frequent supervision lapses may occur during critical portions of first cases. The current study evaluated timing and duration of critical portions of cases from 1 yr of data at a tertiary care hospital. At least one lapse in supervision occurred in 35% of days at a ratio of 1:2, and 99% of days at a ratio of 1:3. The average peak activity of providers needed was at the start of the day, and specifically during first case starts. These results were consistent with the theoretical results published previously and support either staggered starts or additional anesthesiologists at the beginning of the day.
Association between Anesthesiologist Age and Litigation 574
Threat of liability is a concern for clinicians; however, risk of liability may differ based on age and experience. A retrospective review of billing data and litigations handled by the Canadian Medical Protective Association was performed to determine whether age was associated with litigation against anesthesiologists. Compared with anesthesiologists younger than 51 yr of age, anesthesiologists 51–64 yr of age, and older than 65 yr of age had higher litigation rates. Furthermore, the two older age groups also had higher rates of disability compared with younger anesthesiologists. This discrepancy warrants further investigation. See the accompanying Editorial View on page 501
Advance Targeted Transfusion in Anemic Cardiac Surgical Patients for Kidney Protection: An Unblinded Randomized Pilot Clinical Trial 613
Acute kidney injury is associated with worse outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass. A parallel-group, randomized pilot trial analyzed the effects of prophylactic transfusion or standard of care for patients (n = 60) undergoing cardiac surgery with cardiopulmonary bypass. The proportions of patients with acute kidney injury were similar between groups. High transferrin saturation was associated with acute kidney injury. Perioperative anemia and erythrocyte transfusions were lower in the prophylactic group. Prophylactic erythrocyte transfusion did not reduce acute kidney injury in anemic patients undergoing cardiac surgery and high transferrin saturation implicates iron in transfusion-associated acute kidney injury in these patients. See the accompanying Editorial View on page 513
© 2012 American Society of Anesthesiologists, Inc.