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doi: 10.1097/ALN.0b013e318268891f
This Month in Anesthesiology

THIS MONTH IN Anesthesiology

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Innate Immune Dysfunction in Trauma Patients: From Pathophysiology to Treatment (Clinical Concepts and Commentary) 411

Recent insights into posttraumatic immune dysfunction have defined new targets for immunointervention that hold promise for improving outcomes in such critically ill patients.
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High Intraoperative Inspired Oxygen Does Not Increase Postoperative Supplemental Oxygen Requirements 271

High inspired oxygen may be reasonable in lower risk surgery to improve wound oxygenation.
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Accuracy of Ultrasound-guided Nerve Blocks of the Cervical Zygapophysial Joints 347

Ultrasound imaging was an accurate technique for cervical zygapophysial joint nerve blocks in volunteers. See the accompanying Editorial View on page 236.
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Estimation of the Contribution of Norketamine to Ketamine-induced Acute Pain Relief and Neurocognitive Impairment in Healthy Volunteers 353

Norketamine has an effect opposite to that of ketamine on pain relief.
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Severe Emergence Agitation after Myringotomy in a 3-yr-old Child (Case Scenario) 399

Emergence agitation, the associated risk factors, and its prevention and treatment are discussed.
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Factors Affecting Admission to Anesthesiology Residency in the United States: Choosing the Future of Our Specialty 243

The proportion of anesthesiology residents from U.S. medical schools has more than doubled since 1995. This retrospective cohort study evaluated the 2010 and 2011 residency applicants to determine the factors associated with a successful admission to residency training programs. The sample represented 58% of the total national applicant pool; 66% of the applicants successfully matched to anesthesiology. The odds for a successful match were higher for applicants from U.S. medical schools, those with United States Medical Licensing Examination scores greater than 210, younger applicants, and females. Prior graduate education or peer-reviewed publications did not offer any advantage. This study suggests the potential for age and gender bias in the selection process. See the accompanying Editorial View on page 230.
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What Factors Affect Intrapartum Maternal Temperature? A Prospective Cohort Study: Maternal Intrapartum Temperature 302

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The cause of rises in intrapartum maternal temperature is not known. In this prospective study of 81 women scheduled for labor induction, hourly oral temperatures were recorded and analyzed based on race, body mass index, duration of labor, and time to epidural. Overall, temperature rose in a significant linear trend over time. Positive temperature trends were associated with significantly longer time from membrane rupture to delivery and higher body mass index. Temperature slopes did not differ before compared with after epidural analgesia. This study suggests that epidural analgesia alone does not increase the risk of high temperatures in intrapartum women.
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Postoperative QT Interval Prolongation in Patients Undergoing Noncardiac Surgery under General Anesthesia 321

Electrocardiograms (ECG) can identify abnormal cardiac repolarization by observation of a prolonged QT interval. QT interval prolongation is often caused by drugs and can result in sudden cardiac death. In this ancillary study to the Vitamins in Nitrous Oxide trial, serial postoperative 12-lead ECG were obtained from 469 patients undergoing major noncardiac surgery under general anesthesia. Eighty percent of patients experienced a significant QT interval prolongation, and approximately half had increases greater than 440 ms at the end of surgery. One patient developed torsade de pointes. Drugs associated with prolonged QT interval included isoflurane, methadone, ketorolac, cefoxitin, zosyn, unasyn, epinephrine, ephedrine, and calcium. Although the exact cause of the association between perioperatively administered drugs and QT interval prolongation is not known, further study is warranted to determine the clinical relevance.

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