Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2022
Keeping an Open Mind About Open Notes: Sharing Anesthesia Records With Patients.
Please note that in the interim since this paper was accepted for publication, new governmental regulations, pertinent to the topic, have been approved for implementation. The reader is thus directed to this online addendum for additional relevant information: http://links.lww.com/AA/E44.
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Anesthesia and analgesia · Oct 2022
Observational StudyCharacterizing the Heart Rate Effects From Administration of Sugammadex to Reverse Neuromuscular Blockade: An Observational Study in Patients.
Reversal of neuromuscular blockade (NMB) with sugammadex can cause marked bradycardia and asystole. Administration of sugammadex typically occurs in a dynamic period when anesthetic adjuvants and gas concentrations are being titrated to achieve emergence. This evaluation examined the heart rate (HR) responses to sugammadex to reverse moderate to deep NMB during a steady-state period and sought mechanisms for HR changes. ⋯ Sugammadex to reverse moderate and deep NMB resulted in a fast onset and variable magnitude of HR slowing in patients. A difference in HR slowing as a function of dose did not achieve statistical significance. The observational nature of the investigation prevented a full understanding of the mechanism(s) of the HR slowing.
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Anesthesia and analgesia · Oct 2022
Biography Historical ArticleThomas Drysdale Buchanan, MD, and the Birth of Academic Anesthesiology.
Thomas Drysdale Buchanan, MD (1876-1940), founding president of the American Board of Anesthesiology, was the first person in the United States to hold the title "Professor of Anesthesiology" in a medical school faculty position dedicated exclusively to the specialty. An 1897 graduate of New York Medical College, Dr Buchanan joined the faculty of his alma mater in 1902 in response to demands by medical students and recent graduates for a dedicated instructor in anesthesia. Within a decade, the instructorship had become a professorship, and Dr Buchanan was on his way to distinction as one of the founders of academic anesthesiology. This chapter in Dr Buchanan's early career illustrates how anesthesiology took shape as a distinct body of knowledge during the formative decades of modern medical education at the turn of the century, laying the groundwork for its recognition 30 years later as a specialty in its own right.
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Anesthesia and analgesia · Oct 2022
Pro-Con Debate: The Clinical (Ir)relevance of the Lower Limit of Cerebral Autoregulation for Anesthesiologists.
In this Pro-Con commentary article, we discuss whether the lower limit of cerebral autoregulation is clinically relevant for anesthesiologists. The central question regarding this issue is whether mean arterial blood pressure below the lower limit of autoregulation is detrimental for the brain. The Pro side argues that continuous monitoring of cerebral autoregulation has revealed an association between going below the lower limit and mortality in the critically ill patient. Conversely, the Con side argues that cerebral autoregulation is only one of various defense mechanisms of the brain that protect against cerebral hypoperfusion, and that cerebral autoregulation may be more important to protect against intracranial hypertension.
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Anesthesia and analgesia · Oct 2022
Observational StudyIntraoperative Blood Pressure and Long-Term Neurodevelopmental Function in Children Undergoing Ambulatory Surgery.
Some studies have found surgery and anesthesia in children to be associated with neurodevelopmental deficits, but specific reasons for this association have not been fully explored. This study evaluates intraoperative mean arterial pressure (MAP) during a single ambulatory procedure in children and subsequent mental disorder diagnoses. ⋯ Presence in a predefined mean intraoperative MAP category was not associated with subsequent mental disorder diagnoses within our follow-up period. However, the limitations of this study, including uncertainty regarding what constitutes an adequate blood pressure in children, may limit the ability to form definitive conclusions.