2019 Covers & Artwork

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June 2019, Volume 128, Issue 6

On its face, we have yet one more play on Michelangelo's Creation of Adam, an installment amidst countless others over time that variably twist the contours of the source material: that of a greater power imbuing life to another. Dive beneath the surface and we understand the frightening limit of this analogy. As anesthesiologists, we return that which we stole in the first place. One perspective might be that our craft is a restorative effort to mitigate its own risk. And no risk would seem greater than that of the drug class which earns the right to sport a fluorescent red-orange label. The reader is strongly encouraged to read this issue's submissions and their accompanying editorials on our current understanding and management of postoperative residual neuromuscular blockade.
Naveen Nathan, MD
Cover Editor and Illustrator

May 2019, Volume 128, Issue 5

The cover artwork for this issue enters a dreamscape steeped in symbolism though it accommodates a simple concept: the question of benefit from preoperative erythropoietin treatment. The image primarily conveys time and patience, requisite elements of managing anemia thoughtfully prior to surgery. Droplets of a liquid drug slowly transition into blood across the timepiece as well as in decorative motifs within the composition. The clock hands, anchored by a porphyrin ring, embody the 2 most significant events that are inextricably bound to each other: the initial injection of an ostensibly protective drug and its effect on the day of incision. Interposed along the clock face are design elements that could as easily evoke sigmoidal oxy-hemoglobin dissociation curves as much as surgical wounds. The shadowy tone and illusory style of this month's cover may at first seem curious if not unjustified, especially when illustrating on behalf of such an objective analysis. Consider the gravity though of enacting an intervention well in advance of entering the operating room that could impact nothing short of the decision to administer allogeneic blood to our patients. How confident would you desire to be to this end? Our very future as perioperative physicians compels us not to simply accept what we think we know. It obliges us to reach the perimeter of all doubt.
This is dedicated as a long overdue thanks to my colleagues, without whom I would be as apparitional as this submission.
Naveen Nathan, MD
Cover Editor and Illustrator

April 2019, Volume 128, Issue 4

Thematically, this month's issue explores the concept of neuroinflammation, both in a broad sense as well as at cellular and bio-molecular levels. One article herein steers toward the implications of perinatal events that forecast downstream neurodevelopment. Another ranges into the realm of perioperative neurocognitive dysfunction. Given the obvious temporal spectrum of patients for which this topic becomes relevant, it seemed logical to design a cover that itself reflects a sense of time's passage. The reader may recognize some of the earliest woodcuts derived from the dissections of Vesalius which transition into more contemporaneous imagery, all of which either fade or pass out of focus. The latter effects are meant to signal just how much more we have yet to ascertain.
Naveen Nathan, MD
Cover Editor and Illustrator

March 2019, Volume 128, Issue 3

This month's cover art style deliberately applies fanciful strokes to a contemplative scene to accentuate uncertainty. As the accompanying article regards an almost geometric structure in the palette of options for decision-making in critical care medicine, there can be no doubt that the clinical considerations entertained have enormous stakes.
Naveen Nathan, MD
Cover Editor and Illustrator

February 2019, Volume 128, Issue 2

This month's cover art finds the human heart enveloped in currency. Arguably, medical economics finds itself the least prioritized element of medical education and yet, impacts our day-to-day practice as much or more than anything rooted in science. An article and its attendant editorial in this issue aim to define the cost of preoperative cardiovascular testing. In and of itself, this is a question worth answering. A far more frightening indulgence asks whether, despite the exorbitant cost of preoperative testing, does it actually produce a real outcome benefit to anyone?
Naveen Nathan, MD
Cover Editor and Illustrator

January 2019, Volume 128, Issue 1

As the executor of allogeneic blood transfusion in the operating room, anesthesiologists often interpret the action as part of a life-saving strategy. It goes against our very instinct to withhold treatment when it is truly indicated. In fact, questions that challenge nothing less than the Hippocratic oath emerge when confronted with patients who refuse blood products. To make matters more complicated, as alternative strategies come to mind to preserve the integrity of oxygen carrying capacity, so too does the logistical baggage attached to these methods. The reader is encouraged to observe the review of blood transfusion alternatives contained in this month's journal as a reflection of their own practice during times of such dilemmas.
Naveen Nathan, MD
Cover Editor and Illustrator