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doi: 10.1097/ALN.0b013e31825943fb
This Month in Anesthesiology

THIS MONTH IN Anesthesiology

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Ventilator-induced Lung Injury Is Mediated by the NLRP3 Inflammasome 1104

The NLRP3 inflammasome is upregulated by mechanical ventilation in humans and is required for full expression of ventilator-induced lung injury in mice.
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Early Treatment with Risperidone for Subsyndromal Delirium after On-pump Cardiac Surgery in the Elderly: A Randomized Trial 987

Risperidone treatment of subsyndromal delirium was associated with reduced clinical delirium after cardiac surgery. See the accompanying Editorial View on page 975
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Active Emergence from Propofol General Anesthesia Is Induced by Methylphenidate 998

Methylphenidate induces emergence from propofol anesthesia; further study is warranted to test this in humans. See the accompanying Editorial View on page 977
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Cerebral Oxygen Saturation Measured by Near-infrared Spectroscopy and Jugular Venous Bulb Oxygen Saturation during Arthroscopic Shoulder Surgery in the Beach Chair Position under Sevoflurane–Nitrous Oxide or Propofol–Remifentanil Anesthesia 1047

Sevoflurane–nitrous oxide anesthesia may provide a wider margin of safety against impaired cerebral oxygenation in these patients.
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Acute Kidney Injury and Extrarenal Organ Dysfunction: New Concepts and Experimental Evidence (Review Article) 1139

Acute kidney injury leads to earlier onset of multiorgan dysfunction and increased mortality. Animal models suggest neutrophil migration, uncontrolled cytokine expression, and increased oxidative stress as factors in such organ dysfunction.
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Optic Nerve Sheath Diameter Used as Ultrasonographic Assessment of the Incidence of Raised Intracranial Pressure in Preeclampsia: A Pilot Study 1066

The incidence of elevated intracranial pressure in preeclampsia is not known. A study was conducted to measure optic nerve sheath diameter (ONSD) in 51 preeclamptic and healthy pregnant women using ocular ultrasonography. At delivery, preeclamptic patients had significantly higher median ONSD values, and 19% had ONSD greater than 5.8 mm. Values were similar between groups by postpartum Day 7. This study suggests the potential utility of ocular ultrasonography to monitor intracranial pressure in preeclamptic patients. See the accompanying Editorial View on page 983
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High Tidal Volumes in Mechanically Ventilated Patients Increase Organ Dysfunction after Cardiac Surgery 1072

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Mechanical ventilation using high tidal volumes is known to increase mortality in certain patients with comorbidities. The current study evaluated the impact of tidal volume on patients undergoing cardiac surgery. High, traditional, and low tidal volumes were used. Independent risk factors for high tidal volume included body mass index greater than 30 kg/m2, and female sex. Furthermore, high and traditional tidal volumes were found to be independent risk factors for poor outcomes including organ failure, multiple organ failure, and prolonged stay in the intensive care unit. This study confirmed the negative impact of mechanical ventilation with high tidal volumes on patients after cardiac surgery. See the accompanying Editorial View on page 985
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Noninvasive Continuous Arterial Blood Pressure Monitoring with Nexfin® 1092

Effective noninvasive and continuous blood pressure measurement using finger cuff technology would be beneficial in a multitude of surgeries. This study compared the precision of arterial pressure measured by Nexfin® (BMEYE, Amsterdam, The Netherlands), a noninvasive arterial pressure (NAP) device, with direct intraarterial pressure (IAP) in cardiothoracic surgery patients. Systolic, diastolic, mean arterial, and pulse pressure measurements all correlated between IAP and NAP techniques. NAP showed within-subject precision over a wide range of pressures. These results suggest that arterial blood pressure may be successfully measured noninvasively and continuously using such a device.

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