2018 Covers & Artwork

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July 2018, Volume 127, Issue 1

As the story arc of blood transfusion practice began in the 19th century and subsequently evolved into the component therapy we are now familiar with, it closes in on what appears to be a circular path. This issue reconsiders the merits of whole blood transfusion as informed by the logistics of the austere military environment, a clinical sphere that has kept the use of whole blood alive and well. A review this month compels the idea that whole blood may in fact harbor a value greater than the sum of its component parts.
Naveen Nathan, MD
Cover Editor and Illustrator

June 2018, Volume 126, Issue 6

As we march into new frontiers of outcome-focused health care, a new uncertainty emerges: what outcomes are, in fact, relevant? The answer ostensibly depends on who you ask. A review in this month's journal on patient-reported outcomes after surgery underscores a concerning thought; that the individual spheres of priority and definitions of success according to a surgeon, an anesthesiologist, and the patient, may not overlap as much as we like. Our perspective on clinical management as anesthesiologists demands that we now open the aperture and take in the full story arc of the perioperative experience. Short of being a patient ourselves, we may do well to entertain walking in their shoes (or hospital-issued gown) for a change.
Naveen Nathan, MD
Cover Editor and Illustrator

May 2018, Volume 126, Issue 5

Articles in this month's issue address perioperative ocular complications. A review contained herein as well discusses the dynamic influences of surgical and anesthetic interventions and intraocular pressure, a major determinant of ocular perfusion pressure. The cover image is meant to address the uncertainty of perioperative concerns that extends beyond the cardinal goals of preserving cardiorespiratory and neurophysiologic homeostasis. Unlike basic physiologic measurements of pulmonary and cardiovascular indices, the eye enjoys no such scrutiny. There is no monitor to continuously assess its integrity. Ergo, that which cannot be measured, cannot be known. The original cover image, which has been modified and retouched, was acquired through pixabay.com at https://pixabay.com/en/eye-pupil-iris-see-close-brown-1392209/.
Naveen Nathan, MD
Cover Editor and Illustrator

April 2018, Volume 126, Issue 4

This month's cover image portrays the transformation of an antiquated, old-world map into the recognizable geography of modern times. Regrettably, only the richest countries have enjoyed the metamorphosis at the hands of the two physicians tasked with modernizing this mural. There is no intended subtlety in the metaphor at play here. Much like the fragile, oxidized parchment on which loosely identifiable continents were rendered centuries ago, so too suffers the majority of the world's population who endure the prison of need and deprivation. The articles contained herein offer us an aerial perspective on the roles, needs, and considerable disparity of anesthesia services across the globe.
Naveen Nathan, MD
Cover Editor and Illustrator

March 2018, Volume 126, Issue 3

This month's issue offers an instructive pair of narrative review articles on cardiac arrest, specifically in the perioperative setting. On the cover, we see a rhythm devolve into dis-coordinated fibrillation. As it is devoured into the black hole of uncertainty, what emerges on the other end is a reasoned, contextual decision tree that guides our management of the likeliest etiologies of cardiac arrest that occur perioperatively. The complete demise of hemodynamic stability in any patient rattles the psyche of even the most steadfast clinician. Despite the horror of such events, we may exploit our knowledge of the unique setting in which they occur to arrive at the most appropriate treatment algorithms expediently. A background stock image of a mathematical grid was used in developing this month's cover, copyright attributed as follows: 123RF Stock Photo (https://www.123rf.com/profile_studiom1).
Naveen Nathan, MD
Cover Editor and Illustrator

February 2018, Volume 126, Issue 2

As anesthesiologists, we are somewhat handicapped in that our interventions eliminate the ability to finely discriminate the dose-response relationship of our anesthetic drugs, at least in any way beyond the dichotomy of 'asleep' versus 'light'. Once we pass the threshold of the general anesthetic state, our understanding of the patient's instantaneous depth of anesthesia disappears into the dark matter of the unknowable. Although brain function monitors offer the temptation of using a digital depth gauge to reflect our imposed drug burden, they are defined as much by their limitations as their utility.
Naveen Nathan, MD
Cover Editor and Illustrator

January 2018, Volume 126, Issue 1

As medicine continues to reach greater depths of specialization, it has become clear that no one conventional pathway can prepare tomorrow's physicians for the entire bandwidth of specialty care. That has become most evident with the notions of focused training in pediatric cardiac anesthesia. The cover image incorporates the concept of the modified Penrose triangle, popularized by the likes of M. C. Escher, to convey the sheer complexity of congenital heart disease. His 1961 work entitled Waterfall has been assumed as the construct of the pathway of blood flow in the transposition of the great vessels. Here, we see elements that represent heart valves, a ductus arteriosus, and a ventricular septal defect that allows for mixing of blood.
Naveen Nathan, MD
Cover Editor and Illustrator