Anesthesiology
@_Anesthesiology
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Anesthesiology leads the world in publication of peer-reviewed research that transforms clinical practice and fundamental understanding in #anesthesiology .
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A new journal opportunity is here! Anesthesiology is looking for two Associate Editors for CME who will work together to identify the monthly Journal CME article and draft quiz questions and associated learning objectives each month. Learn more:
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Alejandra Garza, M.D. — a first-year resident at the National Institute of Medical Sciences in Mexico City, a hospital transformed to exclusively treat patients infected with
#COVID19
— rests after a hard day with numerous intubations in May 2020.
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Images in
#Anesthesiology
- Dramatic Cervical Spine Injury Secondary to Videolaryngoscopy in a Patient Suffering from Ankylosing Spondylitis 📷
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Images in
#Anesthesiology
- Dramatic Cervical Spine Injury Secondary to Videolaryngoscopy in a Patient Suffering from Ankylosing Spondylitis 📷
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Images in
#Anesthesiology
- Intracranial Nasogastric Tube Placement in a Nontrauma Patient 📷
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Images in
#Anesthesiology
- Intracranial Nasogastric Tube Placement in a Nontrauma Patient 📷
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Tackling a topic relevant to all anesthesiologists, authors highlight the following aspects of perioperative point-of-care ultrasound: clinical utility, technology advancements, training/certification, education, reporting/billing, and limitations.
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#Infographic
in
#Anesthesiology
- Goldilocks and the Three Rocuronium Reversals: A Sugammadex Dose-finding Study 🎨
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#Infographic
in Anesthesiology - Optimizing Analgesia for Total Knee Arthroplasty: A Networked Comparison 🎨
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#Infographic
in
#Anesthesiology
- Chasing Unicorns: Debunking the Myths Around Reversal of Neuromuscular Blockade 🎨
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#Infographic
in
#Anesthesiology
- Optimizing Analgesia for Total Knee Arthroplasty: A Networked Comparison 🎨
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Happy
#WorldAnaesthesiaDay
2020.
@wfsaorg
is asking you to share your occupational wellbeing strategies at
#ourwellbeing
.
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#Infographic
in Anesthesiology - To Puncture or Not to Puncture: Dural Puncture Epidural vs. Standard Epidural 🎨
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Recent findings confirmed that intraoperative
#hypotension
during cardiac surgery, even if it occurs outside of cardiopulmonary bypass, is associated with an increased risk of acute kidney injury, mortality, or stroke. Read more:
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In a multicenter matched cohort analysis, sugammadex administration was associated with a 30% reduced risk of pulmonary complications, a 47% reduced risk of pneumonia, and a 55% reduced risk of respiratory failure compared to neostigmine.
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“Opioid-free anesthesia may be feasible. Nevertheless, it appears neither logical nor beneficial to patients," writes EIC Dr. Evan Kharasch
@Duke_Anesthesia
and Editor Dr. David Clark in newly published editorial discussing opioid-free anesthesia .
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#Infographic
in
#Anesthesiology
- To Puncture or Not to Puncture: Dural Puncture Epidural vs. Standard Epidural 🎨
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Images in
#Anesthesiology
- Labeled Surgical Caps: A Tool to Improve Perioperative Communication 📷
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A retrospective cohort analysis suggests that increasing familiarity between
#anesthesiologists
and
#surgeons
on a case basis was associated with greater short-term patient outcomes. Read the June 2023 Science, Medicine, and the Anesthesiologist:
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Authors discussed the definition of severe bleeding, how to identify procedures and patients with high bleeding risk, and perioperative considerations for the management of severely bleeding coagulopathic patients. Learn more:
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#Infographic
in
#Anesthesiology
- Under Pressure: More Evidence Supporting Increased PEEP in Obese Patients 🎨
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Understanding minimum alveolar concentration and fraction of minimum alveolar concentration helps clinicians titrate volatile
#anesthetics
. Authors explain the quantal and probabilistic nature of
#MAC
, semantics, drug interactions, and hysteresis:
1
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#Infographic
in
#Anesthesiology
- NPO! Ready to Go?: Do Current Fasting Guidelines Ensure Empty Stomach in Diabetic Patients? 🎨
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#Infographic
in Anesthesiology - A Calculated Risk: Comparing Perioperative Assessment Tools 🎨
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Authors review information on the pathophysiological mechanisms producing atelectasis and its functional, biologic, and biomechanical consequences. This mechanistic understanding aims to provide a solid basis for critical assessment of clinical management.
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#Propofol
is associated with green discoloration of urine. Lesser known: the same side effect can impact hair. This rare reaction occurred after an otherwise uneventful spinal anesthetic for a total hip replacement, lasting 1 to 2 months. Learn more:
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#Infographic
in Anesthesiology - Chasing Unicorns: Debunking the Myths Around Reversal of Neuromuscular Blockade 🎨
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#Infographic
in
#Anesthesiology
- The Great Fluid Debate: Normal Saline versus Balanced Crystalloid 🎨
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“High intraoperative oxygen administration has no clinically significant benefit on the incidence of postoperative nausea and vomiting.” Authors assert that intraoperative oxygen should be adjusted for oxygenation reasons only. See the editorial:
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Authors review information on the pathophysiological mechanisms producing atelectasis and its functional, biologic, and biomechanical consequences. This mechanistic understanding aims to provide a solid basis for critical assessment of clinical management.
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#Infographic
in Anesthesiology - Bringing Back the Balance: Opioid Reduction in Anesthesia 🎨
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72
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Understanding minimum alveolar concentration and fraction of minimum alveolar concentration helps clinicians titrate volatile
#anesthetics
. Authors explain the quantal and probabilistic nature of MAC, semantics, drug interactions, and hysteresis:
0
65
177
A new issue is hot off the press! Perineural
#dexamethasone
as an adjunct to
#bupivacaine
resulted in a greater duration of an ulnar nerve block compared to placebo. Systemic dexamethasone resulted in a similar duration as placebo. Read the cover study:
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“Low-dose tranexamic acid provides the best balance between reduction in postoperative blood loss and red blood cell transfusion and the risk of clinical seizure.” Read more on the optimal tranexamic acid dosing regimen in cardiac surgery:
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Authors discussed the definition of severe bleeding, how to identify procedures and patients with high bleeding risk, and perioperative considerations for the management of severely bleeding coagulopathic patients. Learn more:
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Images in
#Anesthesiology
- Intraoperative Trombone Playing during Awake Deep Brain Stimulator Placement 📷
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Forced air warming systems are used to maintain body temperature during surgery. Research shows airflow caused by forced air warming is well counteracted by downward laminar airflow from the ceiling, making it less likely to cause site contamination.
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"
#Ketamine
analgesia may consist of acute analgesic effects, antihyperalgesic effects, and modulation of opioid-mediated analgesia, each potentially mediated by a different set of peripheral and central nervous system circuits.” Read the editorial:
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Elevated lactate can result from many pathophysiologic processes. Understanding the mechanism of lactate production, metabolism, and the basics of lactic acidosis will enable the appropriate use of laboratory tests and interpretation.
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Tackling a topic relevant to all
#anesthesiologists
, authors highlighted the clinical utility, technology advancements, training/certification, education, reporting/billing, and limitations of perioperative point-of-care
#ultrasound
. Read more:
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In healthy unanesthetized volunteers, norepinephrine increased arterial pressure but decreased the cerebral blood flow. Cerebral blood flow was correlated with cardiac output, not arterial blood pressure. Read more:
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#Infographic
in
#Anesthesiology
- To Puncture or Not to Puncture: Dural Puncture Epidural vs. Standard Epidural 🎨
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“If ketamine works, who cares whether the analgesic and psychedelic effects are mechanistically distinct?” A recent study found that
#ketamine
psychedelic and antinociceptive effects are connected. Dr. Mashour delves deeper into these results:
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#Infographic
in
#Anesthesiology
- A Calculated Risk: Comparing Perioperative Assessment Tools 🎨
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Images in Anesthesiology: Too Much of a Good Thing: Iatrogenic Pediatric Pneumothorax from Engagement of the Oxygen Flush Valve
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“Low-dose tranexamic acid provides the best balance between reduction in postoperative blood loss and red blood cell transfusion and the risk of clinical seizure.” Read more on the optimal tranexamic acid dosing regimen in
#cardiac
surgery:
1
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135
#Infographic
in
#Anesthesiology
- To Puncture or Not to Puncture: Dural Puncture Epidural vs. Standard Epidural 🎨
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48
134
Communication in the operating room is a challenge. However, role clarity can improve teamwork, patient safety, and equality.
@BeckyWongMD
and colleagues suggest a labeled scrub cap to make names and roles more readable, thus preventing confusion.
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#Infographic
in Anesthesiology - Bringing Back the Balance: Opioid Reduction in Anesthesia 🎨
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“Low-dose tranexamic acid provides the best balance between reduction in postoperative blood loss and red blood cell transfusion and the risk of clinical seizure.” Read more on the optimal tranexamic acid dosing regimen in cardiac surgery:
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#Infographic
in Anesthesiology - Time for a New Monitor? Urine Oxygenation Is Associated with Acute Kidney Injury 🎨
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Among 14,000+ women receiving general anesthetics for cesarean delivery, the risk of difficult intubation was 1 in 49, and failed intubation was 1 in 808. Risk factors included increased BMI, limited jaw protrusion, cervical spine limitations, and more:
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Newly published Practice Guidelines for Management of the Difficult Airway from
@ASALifeline
@ESAIC_org
@shanasociety
@PediAnesthesia
@SOCCA_CritCare
@theTASHQ
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The story of pulse oximetry, its inventor, and how this landmark technology revolutionized healthcare and touched the lives of billions. Read more from
@Alex_Hannenberg
:
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Images in
#Anesthesiology
- Transient Reactive Phlebitis Induced during Anesthesia Induction 📷
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Images in Anesthesiology - Difficult Airway Management in Neonates: Fiberoptic Intubation via Laryngeal Mask Airway 📷
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Understanding minimum alveolar concentration and fraction of minimum alveolar concentration helps clinicians titrate volatile anesthetics. Authors explain the quantal and probabilistic nature of
#MAC
, semantics, drug interactions, and hysteresis:
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122
Lung
#ultrasound
permits reliable assessment and
#monitoring
of lung aeration, and multiple scoring systems have been developed recently with specific technical aspects. Authors described how to apply this technique in the appropriate clinical context:
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Continuous adductor canal block, but not single-injection adductor canal block or single-injection iPACK, provided statistically superior
#analgesia
when added to local infiltration analgesia for total knee arthroplasty. Learn more:
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#Infographic
in
#Anesthesiology
- Dueling Diagnostics for Acid–Base Derangements: Bicarbonate-centered Approach versus Base Excess and Stewart Approaches 🎨
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Patients receiving
#neuromuscular
blocking medications in their
#anesthetic
regimen should be carefully monitored to ensure the best care, according to new—and independently developed—guidelines from
@ASALifeline
and
@ESAIC_org
. Read the joint letter:
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“Anesthesiologists have an important potential role in preventing delayed graft function and thereby optimizing the function of transplanted kidneys.” When it comes to normal saline for kidney transplant, less is more. Read the editorial:
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“It is time to call a MAC (minimum alveolar concentration) a MAC (median alveolar concentration).” Anesthesiology Editor-In-Chief, Dr. Evan Kharasch, revisits the origin, utility, and nomenclature of
#anesthetic
MAC:
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#Infographic
in
#Anesthesiology
- Debunking Developmental Delay: Assessing Associations between Anesthesia in Infancy and Neurodevelopmental Outcomes 🎨
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“Postoperative atrial fibrillation is not a transient benign phenomenon, but rather an ominous postoperative complication associated with increased risk of thromboembolism, stroke, and mortality.” Authors discuss
#inflammation
and atrial fibrillation:
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In a large observational cohort, the use of NSAIDs in the early postoperative period after major gastrointestinal
#surgery
was not associated with a greater risk of either acute kidney injury or anastomotic leak. Learn more:
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Images in
#Anesthesiology
- Radiographic Demonstration of Hypoxic Pulmonary Vasoconstriction during One-lung Ventilation 📷
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In a prospective randomized study, researchers found no differences in postoperative neurocognitive disorder between older patients anesthetized with a propofol-based compared to a sevoflurane-based
#anesthetic
. Learn more:
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#Infographic
in
#Anesthesiology
- Continuous Postoperative Monitoring: Validation of the Next Frontier 🎨
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“Pulmonary aspiration of gastric contents continues to be a significant source of morbidity and mortality in modern
#anesthesiology
.” Can we improve patient outcomes? Read the editorial by Drs. Anahi Perlas and Cristian Arzola:
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Images in
#Anesthesiology
- Radiographic Demonstration of Hypoxic Pulmonary Vasoconstriction during One-lung Ventilation 📷
1
36
109
