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doi: 10.1097/ALN.0b013e31825dd6fc
This Month in Anesthesiology

THIS MONTH IN Anesthesiology

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Respiratory Variations in Arterial Pressure for Guiding Fluid Management in Mechanically Ventilated Patients (Case Scenario) 1354

Dynamic indicators of preload can be obtained from the arterial pressure waveform.
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Autologous Transplantation of Peripheral Blood-derived Circulating Endothelial Progenitor Cells Attenuates Endotoxin-induced Acute Lung Injury in Rabbits by Direct Endothelial Repair and Indirect Immunomodulation 1278

Transplantation of circulating endothelial progenitor partly restored pulmonary endothelial function in acute lung injury. See the accompanying Editorial View on page 1189
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Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity: Systematic Review and Meta-analysis of Randomized Controlled Trials 1312

Perioperative systemic α2 agonists have a modest beneficial effect on postoperative morphine consumption, pain intensity, and nausea. See the accompanying Editorial View on page 1192
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Patient Blood Management (Clinical Concepts and Commentary) 1367

The goal of patient blood management is to optimize clinical management and minimize components' use.
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High-volume Hemofiltration in the Intensive Care Unit: A Blood Purification Therapy (Review Article) 1377

Recent improvements in high-volume hemofiltration have made its clinical application easier and safer.
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Hospital Stay and Mortality Are Increased in Patients Having a “Triple Low” of Low Blood Pressure, Low Bispectral Index, and Low Minimum Alveolar Concentration of Volatile Anesthesia 1195

Intraoperative anesthetic management may influence postoperative mortality. This retrospective cohort analysis evaluated the effect of the “triple low” state (low mean arterial pressure and low bispectral index during a low minimum alveolar concentration) on postoperative outcomes. The triple low state was associated with prolonged hospital length-of-stay, which increased with increasing duration of triple low state. Thirty-day mortality was quadrupled in patients with the triple low state. This study suggests that patients in the triple low state are at higher risk for postoperative morbidity and mortality. See the accompanying Editorial View on page 1176
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Awake Fiberoptic or Awake Video Laryngoscopic Intubation in Patients with Anticipated Difficult Airway Management: A Randomized Clinical Trial 1210

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Although awake tracheal intubation is considered the gold standard for patients with potentially difficult airways, improved technologies are required for this difficult procedure. In this multicenter trial, patients undergoing elective surgeries with anticipated difficult intubation were randomized to undergo either awake flexible fiberoptic intubation (FFI) or awake McGrath® video laryngoscope (MVL; Aircraft Medical, Edinburgh, Scotland, United Kingdom). Time to intubation (80 s vs. 62 s) and first-attempt intubation rates (79% vs. 71%) were similar in the FFI and MVL groups. Intubation discomfort, evaluated on a visual analog scale, was 2 for both groups. Awake MVL may be a valuable alternative to awake FFI. See the accompanying Editorial View on page 1181
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Predictors and Clinical Outcomes from Failed Laryngeal Mask Airway Unique™: A Study of 15,795 Patients 1217

Laryngeal mask airways (LMA) are commonly used during general anesthesia. However, the independent risk factors for device failure are not well known. A retrospective review was conducted of prospectively collected perioperative electronic clinical records of patients (N = 15,795) in whom a LMA Unique™ (uLMA™; LMA North America, Inc., San Diego, CA) was used in ambulatory and nonambulatory anesthesia. uLMA™ failure occurred in 1.1% of patients. Among those with failed uLMA™, patients developed significant hypoxia, hypercarbia, or airway obstruction (>60%) or inadequate ventilation related to leak (42%). Independent risk factors associated with failed uLMA™ included surgical table rotation, males, poor dentition, and high body mass index. Although the relatively low failure rate supports the use of uLMA™, steps should be taken to minimize the clinically relevant risks of uLMA™ failure. See the accompanying Editorial View on page 1183

© 2012 American Society of Anesthesiologists, Inc.

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