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doi: 10.1097/ALN.0b013e31826d7488
This Month in Anesthesiology

THIS MONTH IN Anesthesiology

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Developing Leaders in Anesthesiology: A Practical Framework (Clinical Concepts and Commentary) 651

A practical road map to develop effective leadership behaviors in clinicians is provided.
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The Quest for a Unified Model of Anesthetic Action: A Century in Claude Bernard's Shadow (Special Article) 465

The history of research in anesthetic mechanisms is examined. See the accompanying Editorial View on page 451
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Are Anesthesia and Surgery during Infancy Associated with Altered Academic Performance during Childhood? 494

Poor achievement test scores were more common in children who had undergone anesthesia and surgery during infancy than in a normative population. See the accompanying Editorial View on page 459
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Home Noninvasive Ventilation: What Does the Anesthesiologist Need to Know? (Review Article) 657

Noninvasive ventilation is now standard practice. Anesthesiologists need to understand the limitations of domiciliary noninvasive ventilation devices in the hospital environment.
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Perioperative Administration of Tocotrienols and Green Tea Extract in a Child with Familial Dysautonomia (Case Scenario) 639

Recent discoveries have led to improved treatments for familial dysautonomia patients, greatly reducing the incidence of dysautonomic crises and diminishing symptoms overall.
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Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients 531

Point-of-care (POC) measurements of hemostatic therapy algorithms have shown benefit in reducing coagulopathies in patients undergoing cardiac surgery. A prospective, randomized trial, comparing conventional coagulation analyses to POC assessment, was conducted in 100 patients undergoing complex cardiac surgery. The study was terminated after the interim analysis because a significantly lower rate of transfused units of packed erythrocytes was found in the POC group compared with the conventional group. Secondary outcomes also favored the POC group including decreased plasma and platelet transfusion rates, length of intensive care unit stay, and 6-month mortality. This study confirms that hemostatic therapy based on POC testing is beneficial to patients undergoing cardiac surgery.
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Who Is at Risk for Postdischarge Nausea and Vomiting after Ambulatory Surgery? 475

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In patients undergoing ambulatory surgery, postdischarge nausea and vomiting is a significant problem; however, there are no current methods for predicting risk. A large, prospective multicenter study was conducted in 2,170 patients undergoing general anesthesia at ambulatory surgery centers to assess risk factors for postdischarge nausea and vomiting. Overall, 37% of patients experienced postdischarge nausea and vomiting. Independent predictors of postdischarge nausea and vomiting included female sex, a history of nausea and vomiting after previous anesthesia exposure, opioid administration, or nausea in the postanesthesia care unit. This study suggests that at least one in three patients may suffer from postdischarge nausea and vomiting. Furthermore, this study developed and validated a simplified risk score for patients who would benefit from long-acting prophylactic antiemetics at discharge from ambulatory care centers. See the accompanying Editorial View on page 454
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Effects of Muscle Relaxants on Mask Ventilation in Anesthetized Persons with Normal Upper Airway Anatomy 487

Muscle relaxants are often used to achieve adequate face mask ventilation; however, previous studies have failed to show direct benefits. In this prospective study, 42 consecutive patients undergoing elective surgeries received either rocuronium or succinylcholine during general anesthesia. Succinylcholine significantly increased total tidal volumes; however, no significant effects were observed after rocuronium administration. Changes in face mask ventilation are specific to the particular muscle relaxant administered. See the accompanying Editorial View on page 456

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