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Erratum: Protamine-induced cardiotoxicity is prevented by anti-TNF-α antibodies and heparin (Anesthesiology (2001) 95 (1389-1395) DOI: 10.1097/00000542-200112000-00018) | In the article beginning on page 1389 in the December 2001 issue, Dr. Loker's name was listed incorrectly in the byline. It should have appeared as Chaim Locker, M.D. © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Current status of neuromuscular reversal and monitoring: Challenges and opportunities (Anesthesiology (2017) 126 (173-190)) | In the article beginning on page 173 of the January 2017 issue, the sentence, It is less effective as a reversal agent, as the bonds it forms with NMBA molecules are ionic and much weaker than the covalent bonds of neostigmine and NMBA, is incorrect. Te correct sentence is, It is less effective as a reversal agent, as the bonds it forms with acetylcholinesterases are ionic and much weaker than the covalent bonds of neostigmine and acetylcholinesterases. Tis error has been corrected in the online version of the article. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Impact of methylprednisolone on postoperative quality of recovery and delirium in the steroids in cardiac surgery trial: A randomized, double-blind, placebo-controlled substudy (Anesthesiology (2017) 126 (223-233) DOI: 10.1097/ALN.0000000000001433) | In the article beginning on page 223 in the February 2017 issue, there is an error in the sentence, "The incidence of delirium for the control group was 10%, which was similar to that in patients given methylprednisolone (8%; OR, 0.31; 95% CI, 0.73 to 2.48; P = 0.357; table 3)." The correct sentence is, "The incidence of delirium for the control group was 10%, which was similar to that in patients given methylprednisolone (8%; OR, 0.74; 95% CI, 0.40 to 1.37; P = 0.357; table 3)." The authors regret this error. The online version and PDF of the article have been corrected. Copyright © 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Complications as a Mediator of the Perioperative Frailty-Mortality Association: Mediation Analysis of a Retrospective Cohort (Anesthesiology (2021) 134 (577–587) DOI: 10.1097/ALN.0000000000003699) | In the article beginning on page 577 in the April 2021 issue, several instances of the word "prior"were incorrectly changed to "previous." © 2021, the American Society of Anesthesiologists, Inc. |
Erratum: Presidential scholar award (Anesthesiology (2017) 127 (611-613) DOI: 10.1097/ALN.0000000000001825) | In the article beginning on page 611 in the October 2017 issue, the middle initial of Dr. Cottrell is listed incorrectly in the title and text. The correct name of the award is "2017 James E. Cottrell, M.D., Presidential Scholar Award." The Journal apologizes for this error. The online version and PDF of the article have been corrected. © 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: No Differences in renal function between balanced 6% hydroxyethyl starch (130/0.4) and 5% albumin for volume replacement therapy in patients undergoing cystectomy: A randomized controlled trial (Anesthesiology (2018) 128 (67-78) DOI: 10.1097/ALN.0000000000001927) | In the article beginning on page 67 in the January 2018 issue, Dr. Pagel's name was listed incorrectly in the byline. It should have appeared as Judith-Irina Pagel, M.D. The authors regret this error. The online version and PDF of the article have been corrected. © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Sedation with Dexmedetomidine or Propofol Impairs Hypoxic Control of Breathing in Healthy Male Volunteers: A Nonblinded, Randomized Crossover Study (Anesthesiology (2016); 125 (700-15)) | In the article beginning on page 700 of the October 2016 issue, the phrase, "concentrations in plasma at the sedation target were 0.66 ± 0.14 and 1.26 ± 0.36 μg/ml for dexmedetomidine and propofol, respectively" is incorrect due to a publisher error. The correct phrase is "concentrations in plasma at the sedation target were 0.66 ± 0.14 ng/ml and 1.26 ± 0.36 μg/ml for dexmedetomidine and propofol, respectively.". © Copyright 2016, the American Society of Anesthesiologists Inc Wolters Kluwer Health Inc. Unauthorized reproduction of this article is prohibited. |
Erratum: Neuraxial anesthesia in parturients with intracranial pathology: A comprehensive review and reassessment of risk (Anesthesiology (2013) 119 (703-718)) | In the article beginning on page 703 of the September 2013 issue, on page 706, in the δIntracranial Complianceδ section, the variables are inverted in the compliance ratio equation. The correct definition should have been presented as follows: δIntracranial compliance (C) is defined as the change in volume (δV) for any given change in pressure (δP), or C = δV/δP.". The authors regret this error. |
Erratum: Anticoagulation monitoring for perioperative physicians (Anesthesiology (2021) 135 (738-748) DOI: 10.1097/ALN.0000000000003903) | In the article beginning on page 738 in the October 2021 issue, the green-shaded area in figure 1 should be labeled Intrinsic and the yellow-shaded area should be labeled Extrinsic. (Figure Presented). The authors regret this error. The online version and PDF of the article have been corrected. © 2022 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Anesthetic and Analgesic Drug Products Advisory Committee Activity and Decisions in the Opioid-crisis Era (Anesthesiology (2020) 133 (740–749) DOI: 10.1097/ALN.0000000000003485) | In the article beginning on page 740 in the October 2020 issue, there is an error in the “Oliceridine” section and in Table 2. In the third paragraph of the “Oliceridine” section on page 745, “… (at the time of this writing, the Food and Drug Administration has not publicly responded to the resubmission)” should be replaced by “Oliceridine has now been approved by the Food and Drug administration in adults for the management of acute pain severe enough to require an intravenous opioid analgesic and for whom alternative treatments are inadequate.” Additionally, in the first “October 2018” row in Table 2 on page 742, “Not approved” should be replaced by “Approved after resubmission.” The online version and PDF of the article have been corrected. © 2020 American Medical Association. All rights reserved. |
Erratum: Volatile Anesthetics Activate a Leak Sodium Conductance in Retrotrapezoid Nucleus Neurons to Maintain Breathing during Anesthesia in Mice (Anesthesiology (2020) 133 (824–838) DOI: 10.1097/ALN.0000000000003493) | In the article beginning on page 824 in the August 2020 issue, there are errors in the author affiliations and in the corresponding author's address. © 2020, the American Society of Anesthesiologists, Inc. |
Erratum: Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: The VANCS randomized controlled trial (Anesthesiology (2017) 126 (85-93)) | In the article beginning on page 85 of the January 2017 issue, the nomenclature, 2.2 l min-2 m-2 is incorrect due to a publisher error. Te correct nomenclature is 2.2 l min-1 m-2. Tis error has been corrected in the online version of the article. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Vasopressin, norepinephrine, and vasodilatory shock after cardiac surgery: Another "VASST" difference (Anesthesiology (2017) 126 (9-11)) | In the article beginning on page 9 of the January 2017 issue, the nomenclature, "2.2 l min m-2" is incorrect due to a publisher error. Te correct nomenclature is 2.2 l min-1 m-2. Tis error has been corrected in the online version of the article. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Deep Spinal Infection after Outpatient Epidural Injections for Pain: A Retrospective Sample Cohort Study Using a Claims Database in South Korea (Anesthesiology (2021) 134 (925–936) DOI: 10.1097/ALN.0000000000003770) | In the article beginning on page 925 in the June 2021 issue, the second point in the “What This Article Tells Us That Is New” section should read “... (1.0 infections per 10,000 injections)” rather than “... (1.0 infections per 100,000 injections)” as originally published. We regret this error.The online version and PDF of the article have been corrected. © 2021, the American Society of Anesthesiologists. All Rights Reserved. |
Erratum: Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function: A Randomized Clinical Trial (Anesthesiology (2018) 128 (710-717) DOI: 10.1097/ALN.0000000000002104) | In the article Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function: A Randomized Clinical Trial (Ederoth P, Dardashti A, Grins E, Bronden B, Metzsch C, Erdling A, Nozohoor S, Mokhtari A, Hansson MJ, Elmer E, Algotsson L, Jovinge S, Bjursten H: ANESTHESIOLOGY 2018; 128:710-7), there is an error in figures 3 and 4. The figure 3 legend refers to a dashed line that is missing in the figure. The upper line has been changed to a dashed line to match the figure legend: "Fig. 3. Mean values with 95% CI for plasma creatinine in the cyclosporine (dashed line) and placebo (solid line) groups. The broken axis denotes that a post hoc analysis was performed in the period 1 to 6 months after operation. Preop = preoperative sampling, usually the day of admission. Days 1 to 4 = days after surgery." Figure 4 and its legend have been updated so that the lines are consistent with figure 3. The dashed line denotes the cyclosporine group and the solid line, the placebo group. The authors regret these errors. The article has been corrected online and in the PDF. © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery (Anesthesiology (2018) 129 (440-447) DOI: 10.1097/ALN.0000000000002298) | In the article Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery (Sun LY, Chung AM, Farkouh ME, van Diepen S, Weinberger J, Bourke M, Ruel M: Anesthesiology 2018; 129:440-7), errors were discovered in two references. On page 445 in the first paragraph in the first line, the sentence starting with "In a randomized control study," was incorrectly attributed to reference number 8 when it should have been attributed to reference number 9. Also on page 445 the sentence starting with "Subsequently a MAP of no less" that starts at the bottom of the first column and continues into the second column was attributed to reference number 7 when it should have been attributed to reference number 8. The authors regret the error. The article has been corrected online and in the PDF. © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Olanzapine for the Prevention of Postdischarge Nausea and Vomiting after Ambulatory Surgery: A Randomized Controlled Trial (ANESTHESIOLOGY (2020) 132 (1419–1428) DOI: 10.1097/ALN.0000000000003286) | In the article in the June issue, "Olanzapine for the Prevention of Postdischarge Nausea and Vomiting after Ambulatory Surgery: A Randomized Controlled Trial,"a space was missing between the words "24 h"and "after"in the Conclusions section of the Abstract. The correct sentence is: "When combined with ondansetron and dexamethasone, the addition of olanzapine relative to placebo decreased the risk of nausea and/or vomiting in the 24 h after discharge from ambulatory surgery by about 60% with a slight increase in reported sedation." The publisher regrets the error. The online version and PDF of the article have been corrected. Copyright © 2020, the American Society of Anesthesiologists, Inc. |
Erratum: Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain (Anesthesiology (2020) 133 (265-279) DOI: 10.1097/ALN.0000000000003428) | In the article Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-Analysis (Anesthesiology 2020; 133:265-79; doi: 10.1097/ALN.0000000000003428), the mean dose of intravenous morphine equivalent in the control group must be corrected in the Results section. In the Cumulative Dose of Opioids Administered within 24, 48, and 72h after Surgery subsection within the Results section on page 270, the mean dose of intravenous morphine in the control group should be 32.6 mg not 38.7 mg. The correct sentence should read: The mean dose of intravenous morphine equivalent administered in the gabapentinoids group was 25.3 mg compared with 32.6 mg in the control group. . © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Perioperative Management of Patients Infected with the Novel Coronavirus: Recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists (ANESTHESIOLOGY (2020) 132 (1307–1316) DOI: 10.1097/ALN.0000000000003301) | In the article published in the June 2020 issue entitled "Perioperative Management of Patients Infected with the Novel Coronavirus: Recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists,"a funder was omitted from the Research Support section, which currently states: "Support was provided solely from institutional and/or departmental sources."This section should instead state: "Support was provided by the National Key Research and Development Program of China grant No. 2018YFC2001900 (Beijing, China)." The authors regret the error. The online version and PDF of the article have been corrected. Copyright © 2020, the American Society of Anesthesiologists, Inc. |
Erratum: Preoperative evaluation clinic visit is associated with decreased risk of in-hospital postoperative mortality (Anesthesiology (2016) 125 (280-294)) | In the August 2016 issue, the article beginning on page 280 included errors in the tallies in the column headings and in the row categories of table 4. The numbers within the table body below the column headings are and were correct. There were no errors in the actual numbers reported or analyzed, but rather an error with the way the columns and rows were totaled. The corrected table is included below, with the corrected numbers in red. (Table Presented). Copyright © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: Icteric vocal cords recorded during video laryngoscopy (Anesthesiology (2013) 119 (1469) DOI: 10.1097/01.anes.0000438160.96877.dd) | In the December 2013 issue, the article on page 188 published Online First (Publish Ahead-of-Print) using an incorrect DOI. The DOI used when the article published in the issue (10.1097/01.anes.0000438160.96877.dd) is the correct one. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: A before-and-after concurrence study (Anesthesiology (2010) 112 (282-7) doi: 10.1097/ALN.0b013e3181ca7a9b) | In the February 2010 issue, the article “Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: A before-and-after concurrence study” (Taenzer AH, Pyke JB, McGrath SP, Blike GT: Anesthesiology 2010; 112:282-7. doi: 10.1097/ALN.0b013e3181ca7a9b) contains an error in the denominator label for rates of rescue events presented.The correct denominator label is patient days, not discharges.This error does not alter the findings of the study. Clarification of the terminology, however, will allow other organizations implementing the same or similar technology to improve understanding of their comparative performance. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: CASQ1 gene is an unlikely candidate for malignant hyperthermia susceptibility in the North American Population (Anesthesiology (2013) 118 (344-9) DOI: 10.1097/01.anes.0000530185.78660.d) | In the February 2013 issue, the article on page 344 published with an incorrect DOI. The correct DOI for this article is 10.1097/01.anes.0000530185.78660.da. |
Erratum: Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: Pacemakers and implantable cardioverter-defibrillators 2020: An updated report by the American Society of Anesthesiologists Task Force on perioperative management of patients with cardiac implantable electronic devices (Journal of Physical Chemistry (2020) 132 (225-252) DOI: 10.1097/ALN.0000000000002821) | In the February 2020 issue, the article "Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices" (Anesthesiology 2020; 132:225-52. doi: 10.1097/ALN.0000000000002821) contains the wrong short title. The correct short title is "Cardiac Implantable Electronic Device Management." The online version and PDF of the article have been corrected. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Machine Learning for Anesthesiologists: A Primer (Anesthesiology (2018) 129 (A29) DOI: 10.1097/ALN.0000000000002444) | In the infographic "Machine Learning for Anesthesiologists: A Primer" (Wanderer JP, Rathmell JP: Anesthesiology 2018; 129:A29) from the October 2018 issue of Anesthesiology, references 3 and 4 should be switched. The authors regret this error. The article has been corrected online and in the PDF. © 2019, the American Society of Anesthesiologists, Inc. |
Erratum: Radial artery pseudoaneurysm: A rare complication with serious risk to life and limb (Anesthesiology (2013) 118 (188) DOI: 10.1097/ALN.0b013e318279f925) | In the January 2013 issue, the article on page 188 published Online First (Publish Ahead-of-Print) using an incorrect DOI. The DOI used when the article published in the issue (10.1097/ALN.0b013e318279f925) is the correct one. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: Simulator Training Enhances Resident Performance in Transesophageal Echocardiography (Anesthesiology (2014) 120 (149-159) DOI: 10.1097/ALN.0000000000000063) | In the January 2014 issue, the article "Simulator Training Enhances Resident Performance in Transesophageal Echocardiography" (Ferrero NA, Bortsov AV, Arora H, Martinelli SM, Kolarczyk LM, Teeter EC, Zvara DA, Kumar PA: Anesthesiology 2014; 120:149-59) lists an incorrect middle initial for coauthor Emily Teeter. Dr. Teeter's middle initial should have been listed as "G," not "C." The authors regret the error. Copyright © 2019, the American Society of Anesthesiologists, Inc. Unauthorized reproduction of this article is prohibited. |
Erratum: Fresh Frozen Plasma versus crystalloid priming of cardiopulmonary bypass circuit in pediatric surgery: A randomized clinical trial (Journal of Physical Chemistry (2020) 132 (95-106) DOI: 10.1097/ALN.0000000000003017) | In the January 2020 issue, the article "Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery: A Randomized Clinical Trial" (Dieu A, Rosal Martins M, Eeckhoudt S, Matta A, Kahn D, Khalifa C, Rubay J, Poncelet A, Haenecour A, Derycke E, Thiry D, Gregoire A, Momeni M. Anesthesiology 2020; 132:95-106. doi: 10.1097/ALN.0000000000003017) contains an error. A sentence on page 5 states "The maximum clot firmness and the clot formation time of the EXTEM test and the maximum clot firmness of the FIBTEM test were significantly lower in the crystalloid group upon weaning from CBP," but in table 4 the EXTEM clot formation time at end of CPB is lower in the FFP group (149 ± 52 v s. 216 ± 98 s). Table 4 and the data represented in the table are correct. The sentence on page 5 should read as follows: "The maximum clot firmness of the EXTEM test and the maximum clot firmness of the FIBTEM test were significantly lower in the crystalloid group upon weaning from CPB." The authors regret the error. The online version and PDF of the article have been corrected. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Venovenous extracorporeal membrane oxygenation for rigid bronchoscopy and carinal tumor resection in decompensating patients (Journal of Physical Chemistry (2020) 132 (156) DOI: 10.1097/ALN.0000000000002967) | In the January 2020 issue, the article "Venovenous Extracorporeal Membrane Oxygenation for Rigid Bronchoscopy and Carinal Tumor Resection in Decompensating Patients" (Hang D, Tawil JN, Fierro MA. Anesthesiology 2020; 132:156. doi: 10.1097/ALN.0000000000002967) failed to include an acknowledgment to a colleague who assisted with Panel B of the image, which gives important context to the CT image. The Acknowledgment should read: "The authors would like to acknowledge Jonathan S. Kurman, M.D., M.B.A., Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin (Milwaukee, Wisconsin), for capturing and providing Panel B of the image." The authors regret the error. The online version and PDF of the article have been corrected. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Personalizing the definition of hypotension to protect the brain (Journal of Physical Chemistry (2020) 132 (170-179) DOI: 10.1097/ALN.0000000000003005) | In the January 2020 issue, the Clinical Focus Review article “Personalizing the Definition of Hypotension to Protect the Brain” (Brady KM, Hudson A, Hood R, DeCaria B, Lewis C, Hogue CW. Anesthesiology 2020; 132:170–9. doi: 10.1097/ ALN.0000000000003005) contains an error in the next to last paragraph. The authors erroneously stated that 1.35 mmHg should be subtracted from blood pressure measured at the heart level for each 1 cm of head elevation such as with “beach chair” patient positioning. The aim of that subtraction is to obtain an estimate of the blood pressure at the Circle of Willis as widely discussed. This sentence should read 1 mmHg should be subtracted from the blood pressure measured at heart level for each 1.35 cm of head elevation. The corrected sentence reads: “Our findings are further consistent with the conclusion in a recent review by Drummond,47 who emphasized the need to consider the projected blood pressure at the circle of Willis when the head is elevated above the horizontal as for surgery in the beach chair position (i.e., subtract 1 mmHg per 1.35 cm of head elevation from blood pressure measured from arm or leg).” The authors regret the error. The online version and PDF of the article have been corrected. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Effects of volatile anesthetics on mortality and postoperative pulmonary and other complications in patients undergoing surgery: A systematic review and meta-analysis (Anesthesiology (2016) 124 (1230-1245)) | In the June 2016 issue, the article beginning on page 1230 included errors in the number of patients corresponding to the respective circles in figure 2A. The circle sizes, however, were correct. The corrected figure is included below. We thank the unknown reader who called our attention to this error. (Figure Presented). Copyright © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: Cerebral autoregulation-oriented therapy at the bedside: A comprehensive review (Anesthesiology (2017) 126 (1187-1199) DOI: 10.1097/ALN.0000000000001625) | In the June 2017 issue, for the article beginning on page 1187, the authors wish to add that this paper was funded in part by a grant from the National Institutes of Health (Bethesda, Maryland; grant Number R01HL092259 to Dr. Charles W. Hogue, M.D.). Dr. Hogue provided mentorship on this project, including the writing of the manuscript, but recused authorship. © Copyright 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: COVID-19 Infection: Implications for Perioperative and Critical Care Physicians (ANESTHESIOLOGY (2020) 132 (1346–1361) DOI: 10.1097/ALN.0000000000003303) | In the June 2020 issue, the article "COVID-19 Infection: Implications for Perioperative and Critical Care Physicians"(Greenland JR, Michelow MD, Wang L, London MJ. Anesthesiology 2020; 132: 1346-61. doi: 10.1097/ALN.0000000000003303) contains an error in table 1. In the fifth row describing 52 cases, the Cardiac Injury column should be "23%,"not "12%." The authors regret the error. The online version and PDF of the article have been corrected. Copyright © 2020, the American Society of Anesthesiologists, Inc. |
Erratum: Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study (Anesthesiology (2021) 135 (621-632) DOI: 10.1097/ALN.0000000000003887) | In the last sentence of the article beginning on page 621 in the October 2021 issue, early graft function should be delayed graft function. The revised sentence is as follows: In conclusion, our study demonstrated an association of high percentages of normal saline with delayed graft function in patients undergoing kidney transplantation. © 2022 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: In Reply (Comment on: Academic anesthesia: Innovate to avoid extinction) (Anesthesiology (2014) 121 (428-429)) | In the letter beginning on page 428 of the August 2014 issue, the second author's name should have included a middle initial and should have been presented as "Lee A. Fleisher. |
Erratum: All Valve Functions Are Not the Same (Anesthesiology (2010) 113 (758)) | In the letter beginning on page 758 of the September 2010 issue, the first author's surname was spelled incorrectly. It should have appeared as "Giordano.". © Copyright 2016, the American Society of Anesthesiologists Inc Wolters Kluwer Health Inc. Unauthorized reproduction of this article is prohibited. |
Erratum: Preoperative Score to Predict Postoperative Mortality (POSPOM): Derivation and validation (Anesthesiology (2016) 124 (570-579)) | In the March 2016 issue, the article beginning on page 570 included errors in the last paragraph of the Results section. The published paragraph and the corrected paragraph are included below, with the corrections in red. Last paragraph of the Results section (published version): In the validation cohort, POSPOM score equal to 30 (i.e., predicted in-hospital mortality = 5.65%) was associated with an observed in-hospital mortality of 6.74% (95% CI, 6.40 to 7.08%). The distribution of POSPOM and the associated observed in-hospital mortality in the validation cohort are shown in figure 3. POSPOM values less than or equal to 20 were associated with a probability of in-hospital mortality less than or equal to 0.32% (i.e., less than the in-hospital mortality observed in the full population-the average risk); a POSPOM value of 25 equates to a probability of in-hospital mortality of 1.37% (i.e., about three times the average risk), and POSPOM values of 30 and 40 equate to probabilities of in-hospital mortality of, respectively, 5.65 and 20.51% (i.e., 10 and 40 times the average risk). Corrected version: In the validation cohort, POSPOM score equal to 30 (i.e., predicted in-hospital mortality = 7.40%) was associated with an observed in-hospital mortality of 6.74% (95% CI, 6.40 to 7.08%). The distribution of POSPOM and the associated observed in-hospital mortality in the validation cohort are shown in figure 3. POSPOM values less than or equal to 20 were associated with a probability of in-hospital mortality less than or equal to 0.04% (i.e., less than the in-hospital mortality observed in the full population-the average risk); a POSPOM value of 25 equates to a probability of in-hospital mortality of 1.73% (i.e., about three times the average risk), and POSPOM values between 30 and 40 equate to a probability of in-hospital mortality of 11.77% (i.e., 20 times the average risk). Copyright © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: B-lines Visualization and Lung Aeration Assessment: Mind the Ultrasound Machine Setting (Anesthesiology (2019) 130: 444 DOI: 10.1097/ALN.0000000000002522) | In the March 2019 issue, the article “B-lines Visualization and Lung Aeration Assessment: Mind the Ultrasound Machine Setting” (Anesthesiology 2019; 130:444. doi: 10.1097/ALN.0000000000002522) contains an error in the Competing Interests section, which reads “The authors declare no competing interests.” This section should have read as follows: “Dr. Mongodi received fees for lectures from General Electric (Boston, Massachusetts). Dr. Mojoli received fees for lectures from General Electric and Hamilton Medical (Bonaduz, Switzerland). The other authors declare no competing interests.” The authors deeply regret this error. The online version and PDF of the article have been corrected. © 2005 IEEE Computer Society. All rights reserved. |
Erratum: Preoperative risk and the association between hypotension and postoperative acute kidney injury (Journal of Physical Chemistry (2020) 132 (461-475) DOI: 10.1097/ALN.0000000000003063) | In the March 2020 issue, the article "Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury" (Mathis MR, Naik BI, Freundlich RE, Shanks AM, Heung M, Kim M, Burns ML, Colquhoun DA, Rangrass G, Janda A, Engoren MC, Saager L, Tremper KK, Kheterpal S; Multicenter Perioperative Outcomes Group Investigators. Anesthesiology 2020; 132:461-75. doi: 10.1097/ALN.0000000000003063), the figure labels for Supplemental Digital Content 8A and 8B (http://links.lww.com/ALN/C123) were reversed. Specifically, the absolute mean arterial pressure ranges were labelled in decreasing order (>64 mmHg, 60-64 mmHg, 55-59 mmHg, 50-54 mmHg, <50 mmHg) from top to bottom within each figure. The absolute mean arterial pressure ranges should have been labelled in increasing order from top to bottom within each figure. The authors regret the error. The Supplemental Digital Content has been corrected. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Perioperative comparative effectiveness of anesthetic technique in orthopedic patients (Anesthesiology (2013) 118 (1046-1058)) | In the May 2013 issue, the article beginning on page 1046 included an error in the Materials and Methods section, Complication Variables subsection, first paragraph. The authors note that a mistake was made in the description of one of the 14 outcome variables. They have incorrectly stated in this paragraph that "The incidence of 30-day mortality was directly provided from Premier." The statement should read "The incidence of in-hospital mortality was directly provided from Premier." The authors mistakenly overlooked that 30-day mortality was a variable created by their study team. The authors believe that this mistake does not alter the conclusions of their study significantly, but they believe that this information is important for the accurate interpretation of their data by readers. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: Fibrin network changes in neonates after cardiopulmonary bypass (Anesthesiology (2016) 124 (1021-1031)) | In the May 2016 issue, the article beginning on page 1021 included an error in the second author's middle initial. The correct presentation of this author's name is "Riley T. Hannan." © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Erratum: A slick way volatile anesthetics reduce myocardial injury (Anesthesiology (2016) 124 (986-988)) | In the May 2016 issue, the article beginning on page 986 included the following comment in the first paragraph: "Numerous animal studies from canines to nematodes provided evidence for volatile anesthetic protection against myocardial ischemia-reperfusion injury." It was brought to the authors' attention that nematodes do not have a circulatory system or a myocardium, making the original wording confusing. The sentence should read: "Numerous animal studies from canines to nematodes provided evidence for volatile anesthetic protection against ischemia-reperfusion (hypoxia-reoxygenation) injury.". |
Erratum: Major Adverse Events and Relationship to Nil per Os Status in Pediatric Sedation/Anesthesia outside the Operating Room: A Report of the Pediatric Sedation Research Consortium (Anesthesiology (2016) 124 (1202) DOI: 10.1097/01.anes.0000481945.07566.3c) | In the May 2016 issue, the erratum on page 1202 published Online First (Publish Ahead-of-Print) using an incorrect DOI. The DOI used when the erratum published in the issue (10.1097/01.anes.0000481945.07566.3c) is the correct one. © 2019, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Residual Neuromuscular Block in the Elderly: Incidence and Clinical Implications (Anesthesiology (2016) 124 (1201) DOI: 10.1097/01.anes.0000481944.99941.7e) | In the May 2016 issue, the erratum on page 1202 published Online First (Publish Ahead-of-Print) using an incorrect DOI. The DOI used when the erratum published in the issue (10.1097/01.anes.0000481945.07566.3c) is the correct one. © 2019, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Perioperative fluid therapy for major surgery (Journal of Physical Chemistry (2019) 130 (825–32) DOI: 10.1097/ALN.0000000000002603) | In the May 2019 issue, the article “Perioperative Fluid Therapy for Major Surgery” (Miller TE, Myles PS:Anesthesiology 2019; 130:825–32. doi: 10.1097/ALN.0000000000002603) contains an error. In the following sentence on page 828, “If a patient is volume-optimized (not fluid responsive) and remains hypotensive (mean blood pressure greater than 65mm Hg and possibly higher in patients with preexisting hypertension), a vasopressor infusion should be considered,” the words “greater than” should be “less than.”The full, corrected sentence reads:“If a patient is volume-optimized (not fluid responsive) and remains hypotensive (mean blood pressure less than 65mm Hg and possibly higher in patients with preexisting hypertension), a vasopressor infusion should be considered.” The authors regret the error.The online version and PDF of the article have been corrected. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: A population-based comparative effectiveness study of peripheral nerve blocks for hip fracture surgery (Anesthesiology (2019) 131 (1025-1035) DOI: 10.1097/ALN.0000000000002947) | In the November 2019 issue, the article "A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery" (Hamilton GM, Lalu MM, Ramlogan R, Bryson GL, Abdallah FW, McCartney CJL, McIsaac DI: Anesthesiology 2019; 131:1025-35. doi: 10.1097/ALN.0000000000002947), costs reported in the results section of the abstract were incorrect. In the sentence "Costs were lower with a nerve block (adjusted difference, ?1,421; 95% CI, ?11,579 to ?11,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed" the costs "?11,579 to ?11,289" should read "?1,579 to ?1,289." The correct sentence reads: "Costs were lower with a nerve block (adjusted difference, ?1,421; 95% CI, ?1,579 to ?1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed.". Copyright © 2019, the American Society of Anesthesiologists, Inc. All Rights Reserved. |
Erratum: Upper airway collapsibility during dexmedetomidine and propofol sedation in healthy volunteers: A nonblinded randomized crossover study (Journal of Physical Chemistry (2019) 131 (962-973) DOI: 10.1097/ALN.0000000000002883) | In the November 2019 issue, the article “Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in HealthyVolunteers” (Lodenius Å, Maddison KJ, Lawther BK, Scheinin M, Eriksson LI, Eastwood PR, Hillman DR, Fagerlund MJ,Walsh JH: Anesthesiology 2019; 131:962-73. doi: 10.1097/ALN.0000000000002883) contains an error. In the Results section of the Abstract, median (interquartile range) pharyngeal critical pressure “0.3 (−9.2 to 1.4)” should be “−0.3 (−9.2 to 1.4).”The corrected sentence reads: “Median (interquartile range) pharyngeal critical pressure was −2.0 (less than −15 to 2.3) and 0.9 (less than −15 to 1.5) cm H2O (mean difference, 0.9; 95% CI, −4.7 to 3.1) during low infusion rates (P = 0.595) versus −0.3 (−9.2 to 1.4) and −0.6 (−7.7 to 1.3) cm H2O (mean difference, 0.0; 95% CI, −2.1 to 2.1; P = 0.980) during moderate infusion of dexmedetomidine and propofol, respectively.”The same error was repeated in the Primary Outcome: Upper Airway Collapsibility, Pharyngeal Critical Pressure, during Sedation with Dexmedetomidine or Propofol section on page 968. The authors regret the error. The online version and PDF of the article have been corrected. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Hypoxemia, Bradycardia, and multiple laryngoscopy attempts during anesthetic induction in infants (Anesthesiology (2019) 131 (830-839) DOI: 10.1097/ALN.0000000000002847) | In the October 2019 issue, the article "Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants" (Gálvez JA, Acquah S, Ahumada L, Cai L, Polanski M, Wu L, Simpao AF, Tan JM, Wasey J, Fiadjoe JE: Anesthesiology 2019; 131:830-9. doi: 10.1097/ALN.0000000000002847) contains an error in table 1. In the first row of the first column, the unit for "Age (yr)" should be "Age (months).". Copyright © 2019, the American Society of Anesthesiologists, Inc. All Rights Reserved. |
Erratum: A tale of different populations: Disparities in obstetric anesthesia (Journal of Physical Chemistry (2019) 131 (A23) DOI: 10.1097/ALN.0000000000002979) | In the October 2019 issue, there are two errors in the Infographics in Anesthesiology image entitled "A Tale of Different Populations: Disparities in Obstetric Anesthesia." (1) The patient demographic icons and labels "Hispanic" and "African- American" should be switched. (2) "General anesthesia for c-sections, national cohort, 2016" should be "General anesthesia for c-sections, national cohort, 1999-2002," reflecting the years of the cohort rather than year of publication. The authors regret the errors. The online version and PDF of the article have been corrected. © 2020 SAE International. All rights reserved. |
Erratum: Complications as a Mediator of the Perioperative Frailty-Mortality Association: Mediation Analysis of a Retrospective Cohort (Anesthesiology (2021) DOI: 10.1097/ALN.0000000000003699) | In the Online First article by McIsaac et al., modifications were made to reflect issues of precision missed during the proof process. Frailty scores were adjusted to avoid any false precision, and language was adjusted to properly reflect between-group comparisons (increase was changed to greater). © 2021, the American Society of Anesthesiologists, Inc. |
Erratum: Controversies in perioperative antimicrobial prophylaxis (Anesthesiology (2020) 132 (586-597) DOI: 10.1097/ALN.0000000000003075) | In the Online First article published on December 4, 2019,“Controversies in Perioperative Antimicrobial Prophylaxis” (Decker BK, Nagrebetsky A, Lipsett PA, Wiener-Kronish JP, O'Grady NP: Controversies in Perioperative Antimicrobial Prophylaxis, Anesthesiology 2019; doi: 10.1097/ALN.0000000000003075. [Epub ahead of print]) there are two errors. On page 2, the sentence “Although vancomycin provides appropriate antimicrobial coverage for Gram-positive flora (the predominant cause of surgical site infections in clean procedures) from a microbiologic standpoint, the increased administration time of 1 to 2 h and time before incision (within 120 min) has lead centers to try to time incision for 60 to 120 min after start of infection” should read: “Although vancomycin provides appropriate antimicrobial coverage for Gram-positive flora (the predominant cause of surgical site infections in clean procedures) from a microbiologic standpoint, the increased administration time of 1 to 2 h and time before incision (within 120 min) has led centers to try to time incision for 60 to 120 min after start of infusion.” On page 4, the first sentence in the Controversies in Selected Cardiac Procedures section, “The use of implantable cardiac electronic device infections continues to rise,” should read:“Implantable cardiac electronic device infections continue to rise. © 2020 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Inhalational versus intravenous induction of anesthesia in children with a high risk of perioperative respiratory adverse events: A randomized controlled trial (Anesthesiology (2018) 128 (1065-1074) DOI: 10.1097/ALN.0000000000002152) | In the Online First article published on March 2, 2018, there were several errors in the article's abstract. Te frst sentence of the Methods paragraph should read: "Children (N = 300; 0 to 8 yr) with at least two clinically relevant risk factors for perioperative respiratory adverse events and deemed suitable for either technique of anesthesia induction were recruited and randomized to either intravenous propofol or inhalational sevoflurane. © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Erratum: Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during Noncardiac Surgery (Anesthesiology (2022) 136 (127-137) DOI: 10.1097/ALN.0000000000004040) | In the online first article that published on November 1, 2021, the unit of measure in figure 1 was mislabeled as mmHg. The correct label is l min 1 m 2. The corrected figure and legend appear below. (Figrue Presented). The authors regret this error. The online version and PDF of the article have been corrected. © 2022 Lippincott Williams and Wilkins. All rights reserved. |
Erratum: Modeling the Effect of Excitation on Depth of Anesthesia Monitoring in γ-Aminobutyric Acid Type A Receptor Agonist ABP-700 (Anesthesiology (2021) 134 (35–51) DOI: 10.1097/ALN.0000000000003590) | In the Online First article that published on October 16, 2020, figure 8 was incorrect due to an author error. One of the lines in figure 8, panels C and E, was black instead of red. © 2020, the American Society of Anesthesiologists, Inc. |
Erratum: Emergency Airway Management in Patients with COVID-19: A Prospective International Multicenter Cohort Study (Anesthesiology (2021) 135 (292–303) DOI: 10.1097/ALN.0000000000003791) | In the Online First article that was published on April 29, 2021, there was a transcription error in table 3 that resulted in incorrect data. This error has no impact on the results of the study. The correct table is listed below and appears in this issue. © 2021, the American Society of Anesthesiologists, Inc. |
Erratum: Science, medicine, and the anesthesiologist: Trial of pregabalin for acute and chronic sciatica (Anesthesiology (2017) 127 (A13-A14) DOI: 10.1097/ALN.0000000000001741) | In the Science, Medicine, and the Anesthesiologist section starting on page A13 of the July 2017 issue, the summary for "Trial of pregabalin for acute and chronic sciatica" includes a misstatement in the take home message, which reads: "Pregabalin may not be effective in treating sciatic pain and may result in more adverse events, although the study may have been underpowered to detect a difference." The last part of the sentence, "although the study may have been underpowered to detect a difference" © 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
A Historical Perspective on Use of the Laryngoscope as a Tool in Anesthesiology | Interest in visualizing the larynx for medical purposes dates back to at least the 18th century. The adoption of the laryngoscope as a tool used in the practice of anesthesia played a significant role in the development of the specialty. |
Intraoperative awareness: From neurobiology to clinical practice | Intraoperative awareness is defined by both consciousness and explicit memory of surgical events. Although electroencephalographic techniques to detect and prevent awareness are being investigated, no method has proven uniformly reliable. The lack of a standard intraoperative monitor for the brain likely reflects our insufficient understanding of consciousness and memory. In this review, the authors discuss the neurobiology of consciousness and memory, as well as the incidence, risk factors, sequelae, and prevention of intraoperative awareness. Copyright © 2011, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology. |
Anesthetic preconditioning: An anesthesiologist's tale | Isoflurane Mimics Ischemic Preconditioning via Activation of KATP Channels: Reduction of Myocardial Infarct Size with an Acute Memory Phase. By J. R. Kersten, T. J. Schmeling, P. S. Pagel, G. J. Gross, and D. C. Warltier. Anesthesiology 1997; 87:361-70. Reprinted with permission. Background: The hypotheses that isoflurane directly preconditions myocardium against infarction via activation of adenosine triphosphate-regulated potassium channels and that the protection afforded by isoflurane is associated with a short-term memory phase similar to that of ischemic preconditioning were tested. Methods: Barbiturate-anesthetized dogs (n = 71) underwent measurement of systemic hemodynamics. Myocardial infarct size was assessed by triphenyltetrazolium chloride staining. All dogs were subjected to a single prolonged (60-min) left anterior descending (LAD) coronary artery occlusion, followed by 3 h of reperfusion. Ischemic preconditioning was produced by four 5-min LAD coronary artery occlusions interspersed with 5-min periods of reperfusion before the prolonged LAD coronary artery occlusion and reperfusion. The actions of isoflurane to decrease infarct size were examined in dogs receiving one minimum alveolar concentration of isoflurane that was discontinued 5 min before prolonged LAD coronary artery occlusion. The interaction between isoflurane and ischemic preconditioning on infarct size was evaluated in dogs receiving isoflurane before and during preconditioning LAD coronary artery occlusions and reperfusions. To test whether the cardioprotection produced by isoflurane can mimic the short-term memory of ischemic preconditioning, isoflurane was discontinued 30 min before prolonged LAD coronary artery occlusion and reperfusion. The mechanism of isoflurane-induced cardioprotection was evaluated in two final groups of dogs pretreated with glyburide in the presence or absence of isoflurane. Results: Myocardial infarct size was 25.3 ± 2.9% (mean ± SEM) of the area at risk during control conditions. Isoflurane and ischemic preconditioning produced significant (P < 0.05) and equivalent reductions in infarct size (ischemic preconditioning alone, 9.6 ± 2.0%; isoflurane alone, 11.8 ± 2.7%; isoflurane and ischemic preconditioning, 5.1 ± 1.9%). Isoflurane-induced reduction of infarct size also persisted 30 min after discontinuation of the anesthetic (13.9 ± 1.5%), independent of hemodynamic effects during LAD coronary artery occlusion. Glyburide alone had no effect on infarct size (28.3 ± 3.9%), but it abolished the protective effects of isoflurane (27.1 ± 4.6%). Conclusions: Isoflurane directly preconditions myocardium against infarction via activation of adenosine triphosphate-regulated potassium channels in the absence of hemodynamic effects and exhibits short-term memory of preconditioning in vivo. © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. |
Succinylcholine and the open globe: Tracing the teaching | It is a commonly held belief that the use of succinylcholine for induction in cases with open globe injuries is contraindicated. Having found no evidence for extrusion of vitreous with the use of succinylcholine in open globe injuries in recent medical literature, the authors have traced the origins of this teaching in anesthesia. |
History of the development of anesthesia for the dolphin a quest to study a brain as large as man’s | It is important for academic-minded human anesthesiologists to have an interdisciplinary perspective when engaging in cutting-edge research as well as the practice of human anesthesiology. This was a philosophy promoted by Dr. Robert Dripps, former pioneering Chairman of the Anesthesiology Department at the University of Pennsylvania (Philadelphia, Pennsylvania). Many human and veterinary anesthesiologists as well as biomedical engineers and neuroscientists benefited from Dr. Dripps’s constructive outlook personified in the quest to develop dolphin anesthesiology. The motivation to anesthetize dolphins came from the fact that scientists and physicians wanted to study the brain of the dolphin, a brain as large as man’s. Also, investigators wanted to develop anesthesia for the dolphin in order to study the electrophysiology of the dolphin’s highly sophisticated auditory system, which facilitates the dolphin’s amazing echolocation capability. Dolphin anesthesia involves a complex matter of unique neural control, airway anatomy, neuromuscular control of respiration, and sleep behavior. Copyright © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
The registry imperative | Like it or not - agree or disagree - the federal government and other payers, ostensibly to promote high-quality patient care, will demand that individual anesthesiologists or groups of anesthesiologists in the United States document their performance metrics and outcomes against benchmark data. They will use reimbursement to prod anesthesiologists to develop the benchmark data and to carefully assess and improve their practices. All physicians involved in maintenance of certification from member boards of the American Board of Medical Specialties, including the American Board of Anesthesiology, will require similar information Thus, strong and validated anesthesia process and outcome databases, such as the Anesthesia Quality Institute database, will become a necessity for future practice. It is an imperative that hopefully will improve patient safety and the quality of care that we provide. © 2009, the American Society of Anesthesiologists, Inc. |
Ultrasonic localization of the lumbar epidural space | Lumbar epidural anesthesia was performed in 26 patients by an anesthesiology resident at either the L2-L3 or L3-L4 interspace using the loss-of-resistance technique. Measurements obtained ultrasonically the night before were not available to this resident. In the 22 successful epidural anesthetics, a good correlation between predicted distance (ultrasound) and measured needle distance occurred (r=0.99, p<0.0001). Average distance to the epidural space was 4.6 cm by both a priori ultrasound and a posteriori needle measurements. Among the 26 lumbar epidural anesthetics, four blocks were unsuccessful. Two unsuccessful blocks were characterized by a centimeter difference between the ultrasound measured distance and the needle measured distance. The other two unsuccessful blocks were due to accidental dislodgement of the catheter from the epidural space with removal of the needle. |
An Introduction to Causal Diagrams for Anesthesiology Research | Making good decisions in the era of Big Data requires a sophisticated approach to causality. We are acutely aware that association ≠ causation, yet untangling the two remains one of our greatest challenges. This realization has stimulated a Causal Revolution in epidemiology, and the lessons learned are highly relevant to anesthesia research. This article introduces readers to directed acyclic graphs; a cornerstone of modern causal inference techniques. These diagrams provide a robust framework to address sources of bias and discover causal effects. We use the topical question of whether anesthetic technique (total intravenous anesthesia vs. volatile) affects outcome after cancer surgery as a basis for a series of example directed acyclic graphs, which demonstrate how variables can be chosen to statistically control confounding and other sources of bias. We also illustrate how controlling for the wrong variables can introduce, rather than eliminate, bias; and how directed acyclic graphs can help us diagnose this problem. This is a rapidly evolving field, and we cover only the most basic elements. The true promise of these techniques is that it may become possible to make robust statements about causation from observational studies-without the expense and artificiality of randomized controlled trials. (ANESTHESIOLOGY 2020; 132:951-67). © 2020, the American Society of Anesthesiologists, Inc. All Rights Reserved. |
Relationship between malpractice litigation and human errors | Malpractice litigation is unrelated to human errors as determined by structured peer review. Practitioners may face malpractice claims in the absence of deviations from the standard of care, and patients who suffer disabling injuries caused by human error may remain uncompensated. |
On the Road to Professionalism | Many observers have concluded that we have a crisis of professionalism in the practice of medicine. In this essay, the author identifies and discusses personal attributes and commitments important in the development and maintenance of physician professionalism: humility, servant leadership, self-awareness, kindness, altruism, attention to personal well-being, responsibility and concern for patient safety, lifelong learning, self-regulation, and honesty and integrity. Professionalism requires character, but character alone is not enough. We need others to help and encourage us. And in turn, as physician leaders, we help shape the culture of professionalism in our practice environment. Professionalism is not something we learn once, and no physician is perfectly professional at all times, in all circumstances. Professionalism is both a commitment and a skill - a competency - that we practice over a lifetime. Copyright © 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Obstetric Anesthesia and Heart Disease: Practical Clinical Considerations | Maternal morbidity and mortality as a result of cardiac disease is increasing in the United States. Safe management of pregnancy in women with heart disease requires appropriate anesthetic, cardiac, and obstetric care. The anesthesiologist should risk stratify pregnant patients based upon cardiac disease etiology and severity in order to determine the appropriate type of hospital and location within the hospital for delivery and anesthetic management. Increased intrapartum hemodynamic monitoring may be necessary and neuraxial analgesia and anesthesia is typically appropriate. The anesthesiologist should anticipate obstetric and cardiac emergencies such as emergency cesarean delivery, postpartum hemorrhage, and peripartum arrhythmias. This clinical review answers practical questions for the obstetric anesthesiologist and the nonsubspecialist anesthesiologist who regularly practices obstetric anesthesiology. © 2021, the American Society of Anesthesiologists. All Rights Reserved. |
Receptors, G proteins, and their interactions | Membrane receptors coupling to intracellular G proteins (G protein-coupled receptors) form one of the major classes of membrane signaling proteins. They are of great importance to the practice of anesthesiology because they are involved in many systems of relevance to the specialty (cardiovascular and respiratory control, pain transmission, and others) and many drugs target these systems. In recent years, understanding of these signaling systems has grown. The structure of receptors and G proteins has been elucidated in more detail, their regulation is better understood, and the complexity of interactions between the various parts of the system (receptors, G proteins, effectors, and regulatory molecules) has become clear. These findings may help explain both actions and side effects of drugs. In addition, these newly discovered targets are likely to play important roles in disease states of relevance to anesthesiologists. © 2005 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. |
The responsibility of the specialty of anesthesiology to the profession of dentistry | Methods and equipment of at least the non specialist dentist administering general anesthesia are questioned. A training programme in anesthesia for dentists is proposed. |
Methoxyflurane revisited: Tale of an anesthetic from cradle to grave | Methoxyflurane metabolism and renal dysfunction: Clinical correlation in man. By Richard I. Mazze, James R. Trudell, and Michael J. Cousins. Anesthesiology 1971; 35:247-52. Reprinted with permission. Serum inorganic fluoride concentration and urinary inorganic fluoride excretion were found to be markedly elevated in ten patients previously shown to have methoxyflurane induced renal dysfunction. Five patients with clinically evident renal dysfunction had a mean peak serum inorganic fluoride level (190 ± 21 μm) significantly higher (P < 0.02) than that of thosewith abnormalities in laboratory tests only (106 ± 17μm). Similarly, patients withclinically evident renal dysfunction had a mean peak oxalic acid excretion (286 ± 39 mg/24 h) significantly greater (P < 0.05) than that of those with laboratory abnormalities only (130 ± 51 mg/24 h). That patients anesthetized with halothane had insignificant changes in serum inorganic fluoride concentration and oxalic acid excretion indicates that these substances are products of methoxyflurane metabolism. A proposed metabolic pathway to support this hypothesis is presented, as well as evidence to suggest that inorganic fluoride is the substance responsible for methoxyflurane renal dysfunction. Copyright © 2006, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. |
Michael Faraday and his contribution to anesthesia. | Michael Faraday (1791-1867) was a protégé of Humphry Davy. He became one of Davy's successors as Professor of Chemistry at the Royal Institution of Great Britain. Of Faraday's many brilliant discoveries in chemistry and physics, probably the best remembered today is his work on electromagnetic induction. Faraday's contribution to introduction of anesthesia was his published announcement in 1818 that inhalation of the vapor of ether produced the same effects on mentation and consciousness as the breathing of nitrous oxide. He most likely became familiar with the central nervous system effects of nitrous oxide through his association with Davy, an avid user of the gas. Sulfuric ether was a common, convenient, cheap, and easily available substance, in contrast to nitrous oxide, which required expensive, cumbersome, and probably not widely available apparatus for its production and administration. The capability for inhaling intoxicating vapors eventually became commonly available with the use of ether instead of the gas. The first surgical anesthetics were a consequence of the resulting student "ether frolics." The 1818 announcement on breathing ether vapor was published anonymously; however, notations in Faraday's handwriting in some of his personal books clearly establish Michael Faraday as the author of this brief communication. |
Emerging Roles for MicroRNAs in Perioperative Medicine | MicroRNAs (miRNAs) are small, non-protein-coding, single-stranded RNAs. They function as posttranscriptional regulators of gene expression by interacting with target mRNAs. This process prevents translation of target mRNAs into a functional protein. miRNAs are considered to be functionally involved in virtually all physiologic processes, including differentiation and proliferation, metabolism, hemostasis, apoptosis, and inflammation. Many of these functions have important implications for anesthesiology and critical care medicine. Studies indicate that miRNA expression levels can be used to predict the risk for eminent organ injury or sepsis. Pharmacologic approaches targeting miRNAs for the treatment of human diseases are currently being tested in clinical trials. The present review highlights the important biological functions of miRNAs and their usefulness as perioperative biomarkers and discusses the pharmacologic approaches that modulate miRNA functions for disease treatment. In addition, the authors discuss the pharmacologic interactions of miRNAs with currently used anesthetics and their potential to impact anesthetic toxicity and side effects. © 2015 The American Society of Anesthesiologists, Inc. |
The 31st Rovenstine lecture: The changing horizons in anesthesiology | Modern anesthesiology differs widely from what it was 40-50 years ago, not only because of what anesthesiology now involves in the operating room, but also because anesthesiology has expanded its horizons and activities above and beyond the provision of surgical anesthesia. These changes and the identity of modern anesthesiology are, however, but poorly understood, if understood at all, by the majority of laity and physicians alike. Such lack of identity, especially in the minds of those at the policy- and decision- making level, can only endanger the vitality and future of anesthesiology in an era of sweeping changes in health care-delivery systems. The problem of public identity of our specialty includes the historically correct, but, contemporaneously, all too often misleading name of our specialty. It is suggested that it is appropriate, at this time, to at least consider the potential advantages of changing the name of our specialty to, say, metesthesiology and metesthesiologist, to indicate that while, today, our specialty continues to involve operative anesthesia, it extends above and beyond to include a wide variety of professional activities outside the operating room richly rewarding to patient and practitioner alike. |
The foregger midget: A machine that traveled | Next year marks the 100th anniversary of the founding of the Foregger Company, an important manufacturer of anesthetic equipment in the first half of the 20th century. Founded by Richard von Foregger in a barn in Long Island, New York in 1914, the Foregger Company developed equipment in collaboration with anesthesiologists. Their first product was the Gwathmey machine, built around the rudimentary flowmeter designed by the anesthesiologist, James Tayloe Gwathmey. This machine was the cornerstone of future anesthetic machine development. As the company grew, von Foregger formed other liaisons, joining forces with Ralph Waters to create the Waters to-and-fro canister for carbon dioxide absorption, and with Arthur Guedel, a variety of nontraumatic airways. The combined creativity of these three men ultimately led to the Foregger Midget. This portable machine extended the reach of the Foregger Company well beyond the shores of America, as far away as the isolated west coast of Australia. © 2013, the American Society of Anesthesiologists. |
A public speaking course for foreign medical graduates | Nine residents in anesthesiology, all graduates of foreign medical schools, were given a 6 wk intensive course in public speaking in an attempt to improve their communication skills in the English language. Test audio and videotapes of each resident were made before and after the course, numbered randomly, and graded by independent observers. A statistically significant improvement in the performance of the participants was found. |
Effects of information feedback and pulse oximetry on the incidence of anesthesia complications. | No standard outcome measures exist to evaluate the effect of interventions intended to improve the quality of anesthesia care. The authors established a clinically practical definition of outcome, and used it to assess the effect of feedback of information about complications and the effect of pulse oximetry on the rate and severity of important anesthesia-related problems encountered in the operating room (OR) and recovery room (RR). On admission to the RR, the patient's anesthetist documented Recovery-Room-Impact Events (RRIE), defined as an "unanticipated, undesirable, possibly anesthesia-related effect that required intervention, was pertinent to recovery-room care, and did or could cause at least moderate morbidity." Following a control period with no feedback of data, intense feedback of grouped (anonymous) RRIE rates was provided. Later, pulse oximeters were introduced to all anesthetizing locations. Among 12,088 patients (71% of all RR admissions), 18% had at least one RRIE in the OR or RR. The most common RRIEs were hypotension (4.4%), arrhythmia (3.9%), hypertension (1.5%), intubation difficulties (0.8%), hypoventilation (0.8%), and hypovolemia (0.6%). Feedback of information produced no demonstrable change in the rate of RRIEs. Although significantly fewer patients experienced RRIEs (15.6% vs. 12.4%, P less than 0.0001), hypotensive RRIEs (5.2% vs. 3.8%, P = 0.0003), and hypovolemic RRIEs (0.88% vs. 0.42%, P = 0.0017) following the introduction of pulse oximetry in the OR, confounding factors prevent establishment of a cause-and-effect relationship. Quality assurance may require more direct intervention and individual feedback to be effective. Still, the RRIE measure requires minimal effort at low cost and encourages improved transmission of information at the time of admission to recovery-room care. |
Obesity hypoventilation syndrome: A review of epidemiology, pathophysiology, and perioperative considerations | Obesity hypoventilation syndrome (OHS) is defined by the triad of obesity, daytime hypoventilation, and sleep-disordered breathing without an alternative neuromuscular, mechanical, or metabolic cause of hypoventilation. It is a disease entity distinct from simple obesity and obstructive sleep apnea. OHS is often undiagnosed but its prevalence is estimated to be 10-20% in obese patients with obstructive sleep apnea and 0.15-0.3% in the general adult population. Compared with eucapnic obese patients, those with OHS present with severe upper airway obstruction, restrictive chest physiology, blunted central respiratory drive, pulmonary hypertension, and increased mortality. The mainstay of therapy is noninvasive positive airway pressure. Currently, information regarding OHS is extremely limited in the anesthesiology literature. This review will examine the epidemiology, pathophysiology, clinical characteristics, screening, and treatment of OHS. Perioperative management of OHS will be discussed last. © 2012 the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. |
A review of the impact of obstetric anesthesia on maternal and neonatal outcomes | Obstetric anesthesia has evolved over the course of its history to encompass comprehensive aspects of maternal care, ranging from cesarean delivery anesthesia and labor analgesia to maternal resuscitation and patient safety. Anesthesiologists are concerned with maternal and neonatal outcomes, and with preventing and managing complications that may present during childbirth. The current review will focus on recent advances in obstetric anesthesia, including labor anesthesia and analgesia, cesarean delivery anesthesia and analgesia, the effects of maternal anesthesia on breastfeeding and fever, and maternal safety. The impact of these advances on maternal and neonatal outcomes is discussed. Past and future progress in this field will continue to have significant implications on the health of women and children. Copyright © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Specialty choices of medical graduates taking anesthesiology preceptorships: a follow up study | Of the 26,662 graduates from 1967 to 1970 who did not take an anesthesiology preceptorship, 2.3% entered anesthesiology. In contrast, of the 868 graduates who took an anesthesiology preceptorship, 11.5% entered anesthesiology. |
Erratum: Instructions for obtaining anesthesiology continuing medical education (CME) credit (Journal of Physical Chemistry (2020) 133 (A12) DOI: 10.1097/ALN.0000000000003426) | On the CME pages of the July and August 2020 issues, the AMA PRA Category 1 Credits™were incorrectly listed as 1.5. The American Society of Anesthesiologists designated the journal-based activity in both issues for a maximum of 1.0 AMA PRA Category 1 Credits™. The online versions and PDFs have been corrected. © 2020 SAE International. All rights reserved. |
The McGill pain questionnaire: from description to measurement. | On the language of pain. By Ronald Melzack, Warren S. Torgerson. Anesthesiology 1971; 34:50-9. Reprinted with permission. The purpose of this study was to develop new approaches to the problem of describing and measuring pain in human subjects. Words used to describe pain were brought together and categorized, and an attempt was made to scale them on a common intensity dimension. The data show that: 1) there are many words in the English language to describe the varieties of pain experience; 2) there is a high level of agreement that the words fall into classes and subclasses that represent particular dimensions or properties of pain experience; 3) substantial portions of the words have approximately the same relative positions on a common intensity scale for people who have widely divergent backgrounds. The word lists provide a basis for a questionnaire to study the effects of anesthetic and analgesic agents on the experience of pain. |
Adenosine: An old drug newly discovered | Over decades, anesthesiologists have used intravenous adenosine as mainstay therapy for diagnosing or treating supraventricular tachycardia in the perioperative setting. More recently, specific adenosine receptor therapeutics or gene-targeted mice deficient in extracellular adenosine production or individual adenosine receptors became available. These models enabled physicians and scientists to learn more about the biologic functions of extracellular nucleotide metabolism and adenosine signaling. Such functions include specific signaling effects through adenosine receptors expressed by many mammalian tissues; for example, vascular endothelia, myocytes, heptocytes, intestinal epithelia, or immune cells. At present, pharmacological approaches to modulate extracellular adenosine signaling are evaluated for their potential use in perioperative medicine, including attenuation of acute lung injury; renal, intestinal, hepatic and myocardial ischemia; or vascular leakage. If these laboratory studies can be translated into clinical practice, adenosine receptor-based therapeutics may become an integral pharmacological component of daily anesthesiology practice. © 2009, the American Society of Anesthesiologists, Inc. |
Preoperative pain sensitivity and its correlation with postoperative pain and analgesic consumption: A qualitative systematic review | Pain perception to minor physical stimuli has been hypothesized to be related to subsequent pain ratings after surgery. The objective of this systematic review was to evaluate the correlation between preoperative pain sensitivity and postoperative pain intensity. After a literature search of MEDLINE, EMBASE, and meeting abstracts, we identified 15 studies (n = 948 patients) with univariate and/or multivariate analysis on the topic. In these studies, three types of pain stimuli were applied: thermal, pressure, and electrical pain. The intensity of suprathreshold heat pain (i.e., pain beyond patient threshold) was most consistently shown to correlate with postoperative pain. The most common limitation of the included studies was the method of statistical analysis and lack of multivariate analysis. More research is required to establish the correlation of other pain sensitivity variables with postoperative pain outcomes. © 2011, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology. |
Perioperative stroke in noncardiac, nonneurosurgical surgery | Perioperative stroke after noncardiac, nonneurosurgical procedures is more common than generally acknowledged. It is reported to have an incidence of 0.05-7% of patients. Most are thrombotic in origin and are noted after discharge from the postanesthetic care unit. Common predisposing factors include age, a previous stroke, atrial fibrillation, and vascular and metabolic diseases. The mortality is more than two times greater than in strokes occurring outside the hospital. Delayed diagnosis and a synergistic interaction between the inflammatory changes normally associated with stroke, and those normally occurring after surgery, may explain this increase.Intraoperative hypotension is an infrequent direct cause of stroke. Hypotension will augment the injury produced by embolism or other causes, and this may be especially important in the postoperative period, during which monitoring is not nearly as attentive as in the operating room. Increased awareness and management of predisposing risk factors with early detection should result in improved outcomes. © 2011, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology. |
Propofol: Its role in changing the practice of anesthesia | Pharmacokinetics and pharmacodynamics of propofol infusions during general anesthesia. By Audrey Shafer, Van A. Doze, Steven L. Shafer, and Paul F. White. Anesthesiology 1988; 69:348-56. Reprinted with permission.The pharmacokinetic and pharmacodynamic properties of propofol (Diprivan™) were studied in 50 elective surgical patients. Propofol was administered as a bolus dose, 2 mg/kg iv, followed by a variable-rate infusion, 0-20 mg/min, and intermittent supplemental boluses, 10-20 mg iv, as part of a general anesthetic technique that included nitrous oxide, meperidine, and muscle relaxants. For a majority of the patients (n = 30), the pharmacokinetics of propofol were best described by a two-compartment model. The propofol mean total body clearance rate was 2.09 ± 0.65 l/min (mean ± SD), the volume of distribution at steady state was 159 ± 57 l, and the elimination half-life was 116 ± 34 min. Elderly patients (patients older than 60 yr vs. those younger than 60 yr) had significantly decreased clearance rates (1.58 ± 0.42 vs. 2.19 ± 0.64 l/min), whereas women (vs. men) had greater clearance rates (33 ± 8 vs. 26 ± 7 ml • kg • min ) and volumes of distribution (2.50 ± 0.81 vs. 2.05 ± 0.65 l/kg). Patients undergoing major (intraabdominal) surgery had longer elimination half-life values (136 ± 40 vs. 108 ± 29 min). Patients required an average blood propofol concentration of 4.05 ± 1.01 micrograms/ml for major surgery and 2.97 ± 1.07 micrograms/ml for nonmajor surgery. Blood propofol concentrations at which 50% of patients (EC50) were awake and oriented after surgery were 1.07 and 0.95 microgram/ml, respectively. Psychomotor performance returned to baseline at blood propofol concentrations of 0.38-0.43 microgram/ml (EC50). This clinical study demonstrates the feasibility of performing pharmacokinetic and pharmacodynamic analyses when complex infusion and bolus regimens are used for administering iv anesthetics. © 2008, the American Society of Anesthesiologists, Inc. |
Wood's and Guedel's Legacies Return to the Heartland: Reflections from Coleman and Moon | Pioneering anesthesiologists Paul Wood, M.D., and Arthur Guedel, M.D., were Hoosiers who migrated from America's Heartland to opposite coasts. Dr. Wood moved east to New York in 1913; Dr. Guedel, west to California in 1928. By 1962, each pioneer had been honored with a namesake anesthesia museum. Fast-forwarding 55 yr, two young anesthesia historians, California's Jane Moon, M.D., and Pennsylvania's Melissa Coleman, M.D., met at the 2017 International Symposium of the History of Anesthesia in Boston. Today, these women are chairs of the Wood Library-Museum's Archives and Museum Committees, respectively. As the newest authors of "Anesthesiology Reflections," Drs. Coleman and Moon leave their coastal states semiannually for board meetings at the Wood Library-Museum of Anesthesiology, returning as legacies of Drs. Wood and Guedel.back to the American Heartland. © 2021 Lippincott Williams and Wilkins. All rights reserved. |
Eliminating blood transfusions: New aspects and perspectives | Preoperative autologous blood donation and the use of erythropoietin are efficacious preoperative strategies. Intraoperatively, ANH, cell salvage, pharmacologic treatment with antifibrinolytics, specific anesthesiology and surgical techniques, coagulation monitoring-based transfusion algorithms, acceptance of minimal hemoglobin values, and soon artificial oxygen carriers may be used to avoid allogeneic RBC transfusions. Cell salvage, antifibrinolytics, and accepted minimal hemoglobin values may also be used in the postoperative period. All of these techniques have been used efficaciously in certain situations and form the basis of an integral concept to avoid allogeneic RBC transfusions. Two major goals remain: (1) these strategies have to be implemented in general clinical practice; and (2) the most efficacious techniques and combinations thereof need to be defined for individual patients. |
Quality anesthesia medicine measures, patients decide | Quality has been defned by six domains: effective, equitable, timely, efcient, safe, and patient centered. Quality of anesthesia care can be improved through measurement, either through local measures in quality improvement or through national measures in value-based purchasing programs. Death directly related to anesthesia care has been reduced, but must be measured beyond simple mortality. To improve perioperative care for our patients, we must take shared accountability for all surgical outcomes including complications, which has traditionally been viewed as being surgically related. Anesthesiologists can also impact public health by being engaged in improving cognitive recovery after surgery and addressing the opiate crisis. Going forward, we must focus on what patients want and deserve: improved patient-oriented outcomes and satisfaction with our care. By listening to our patients and being engaged in the entire perioperative process, we can make the greatest impact on perioperative care. © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
Anesthesia for in utero repair of myelomeningocele | Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia, are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States. © 2013 the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology. |
Classic papers revisited: An early study of cardioprotection by volatile anesthetics. A behind-the-scenes look | Recovery of Contractile Function of Stunned Myocardium in Chronically Instrumented Dogs Is Enhanced by Halothane or Isoflurane. By Warltier DC, al-Wathiqui MH, Kampine JP, and Schmeling WT. Anesthesiology 1988; 69:552–65. Reprinted with permission. Abstract: Following brief periods (5–15 min) of total coronary artery occlusion and subsequent reperfusion, despite an absence of tissue necrosis, a decrement in contractile function of the postischemic myocardium may nevertheless be present for prolonged periods. This has been termed “stunned” myocardium to differentiate the condition from ischemia or infarction. Because the influence of volatile anesthetics on the recovery of postischemic, reperfused myocardium has yet to be studied, the purpose of this investigation was to compare the effects of halothane and isoflurane on systemic and regional hemodynamics following a brief coronary artery occlusion and reperfusion. Nine groups comprising 79 experiments were completed in 42 chronically instrumented dogs. In awake, unsedated dogs a 15-min coronary artery occlusion resulted in paradoxical systolic lengthening in the ischemic zone. Following reperfusion active systolic shortening slowly returned toward control levels but remained approximately 50% depressed from control at 5 h. In contrast, dogs anesthetized with halothane or isoflurane (2% inspired concentration) demonstrated complete recovery of function 3–5 h following reperfusion. Because the anesthetics directly depressed contractile function, additional experiments were conducted in which a 15-minute coronary artery occlusion was produced during volatile anesthesia; however, each animal was allowed to emerge from the anesthetized state at the onset of reperfusion. Similar results were obtained in these experiments, demonstrating total recovery of contractile function within 3–5 h following reperfusion. Thus, despite comparable degrees of contractile dysfunction during coronary artery occlusion in awake and anesthetized dogs, the present results demonstrate that halothane and isoflurane produce marked improvement in the recovery of segment function following a transient ischemic episode. Therefore, volatile anesthetics may attenuate postischemic left ventricular dysfunction occurring intraoperatively and enhance recovery of regional wall motion abnormalities during reperfusion. Copyright © 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. |
A 1966 anesthetic administered by Robert D. Dripps, M.D., demonstrated his experimental style of clinical care | Robert D. Dripps, M.D. (1911 to 1973), helped found academic anesthesiology. Newly reviewed teaching slides from the University of Pennsylvania (Philadelphia, Pennsylvania) contain six anesthesia records from 1965 to 1967 that involved Dripps. They illustrate the clinical philosophy he taught - to consider administration of each anesthetic a research study. Intense public criticism in 1967 for improper experimentation on patients during anesthesia changed his clinical and research philosophies and teaching. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. |
Sperm studies in anesthesiologists | Semen samples were collected from 46 anesthesiologists each of whom had worked a minimum of one year in hospital operating rooms ventilated with modern gas-scavenging devices. Samples collected from 26 beginning residents in anesthesiology served as controls. Concentrations of sperm and percentages of sperm having abnormal head shapes were determined for each sample. No significant differences were found between anesthesiologists and beginning residents. Limiting the analyses to men having no confounding factors (varicocele, recent illness, medications, heavy smoking, frequent sauna use) did not change the results. The sperm concentration and morphology in 13 men did not change significantly after one year of exposure to anesthetic gases. However, the group of men who had one or more confounding factors (excluding exposure to anesthetic gases) showed significantly higher percentages of sperm abnormalities than did the group of men without such factors. These results suggest that limited exposure to anesthetic gases does not significantly affect sperm production as judged by changes in sperm concentration and morphology. These data are reassuring, but since the hospitals surveyed used modern gas-scavenging devices, men who are occupationally exposed to anesthetic gases without this protection should be studied for fuller assessment of the possible human spermatotoxic effects. |
Advances in and limitations of up-and-down methodology: A précis of clinical use, study design, and dose estimation in anesthesia research | Sequential design methods for binary response variables exist for determination of the concentration or dose associated with the 50% point along the dose-response curve; the up-and-down method of Dixon and Mood is now commonly used in anesthesia research. There have been important developments in statistical methods that (1) allow the design of experiments for the measurement of the response at any point (quantile) along the dose-response curve, (2) demonstrate the risk of certain statistical methods commonly used in literature reports, (3) allow the estimation of the concentration or dose-the target dose-associated with the chosen quantile without the assumption of the symmetry of the tolerance distribution, and (4) set bounds on the probability of response at this target dose. This article details these developments, briefly surveys current use of the up-and-down method in anesthesia research, reanalyzes published reports using the up-and-down method for the study of the epidural relief of pain during labor, and discusses appropriate inferences from up-and-down method studies. © 2007 American Society of Anesthesiologists, Inc. |
Bromide concentrations of anesthetists | Serum bromide concentrations were measured in 12 operating room workers (primarily anesthetists) from two hospitals where halothane is administered daily. These halothane exposed workers were compared with ten healthy laboratory technicians. Serum bromide concentrations in the halothane exposed group ranged from 0.24 to 0.97 and averaged 0.53 mM/l. The corresponding values for laboratory workers ranged from 0.11 to 1.25 and averaged 0.38 mM/l. The two groups were not significantly different at the P < 0.05 level. Measurements of halothane concentration at the anesthetist's head level in an operating room from each hospital showed 30 and 104 ppm halothane. |
Halothane biotransformation in anesthetists | Serum bromide levels were measured in 115 anesthetists by use of x-ray fluorescence spectrometry. Bromide levels peaked at 184 ± 21 μM in anesthetists regularly exposed to halothane (n=20), at 58 ± 4 μM in anesthetists sporadically exposed to halothane (n=71) and at 46 ± 3 μM in nonexposed anesthetists (n=24). Kinetic studies were carried out in five other anesthetists after ten days of exposure to halothane. Average daily halothane concentration was 19.2 ± 3.2 ppm; duration of exposure was 3.8 ± 0.2 hours/day. Mean serum bromide level increased from 40 ± 4 μM before exposure to 220 ± 36 μM on the last day of exposure. Serum bromide half-life was 14 ± 1.7 days. The study demonstrates that anesthetists debrominate halothane in a dose-related fasion. Serum bromide levels achieved, however, were far below those reported to result in clincal bromism. |
Left ventricular diastolic function in the normal and diseased heart: Perspectives for the anesthesiologist (second of two parts) | Several important questions remain to be answered by future research. First, it is unclear whether any abnormal index of diastolic function can be used to estimate disease severity, or to prognostically identify patients who will subsequently develop systolic abnormalities or frank left ventricular dysfunction. A temporal relationship between the appearance of diastolic dysfunction and ultimate left ventricular decompensation may, theoretically, exist, but such a relationship has yet to be established. Second, a growing body of evidence indicates that pharmacologic therapy with Ca2+ channel antagonists, β-adrenergic agonists or antagonists, phosphodiesterase inhibitors, or angiotensin converting enzyme inhibitors may acutely or chronically benefit certain patients with diastolic dysfunction. Whether the impact of early recognition and therapeutic intervention in patients with diastolic dysfunction can be translated into an improvement of quality of life or enhanced survival remains unknown. Third, recent evidence indicates that fundamental changes in the biochemistry of the cardiac myocyte may represent a final common pathway for the development of congestive heart failure resulting from intrinsic cardiac disease. Altered expression of genes coding for the ATP-dependent Ca2+ pumps in the sarcolemma and the sarcoplasmic reticulum, regulatory proteins such as phospholamban, and the proteins composing the contractile apparatus have been identified that play critical roles in the pathophysiology of myocardial failure, and have important implications for potential pharmacologic therapy. Future research will more clearly elucidate these cellular and biochemical mechanisms of left ventricular failure. Lastly, although intravenous and inhalational anesthetics produce derangements in normal diastolic function to varying degrees, whether the effects of these agents on diastolic performance are exacerbated in disease processes manifested by abnormal diastolic mechanics requires further evaluation. |
Simulation-based assessment in anesthesiology: Requirements for practical implementation | Simulations have taken a central role in the education and assessment of medical students, residents, and practicing physicians. The introduction of simulation-based assessments in anesthesiology, especially those used to establish various competencies, has demanded fairly rigorous studies concerning the psychometric properties of the scores. Most important, major efforts have been directed at identifying, and addressing, potential threats to the validity of simulation-based assessment scores. As a result, organizations that wish to incorporate simulation-based assessments into their evaluation practices can access information regarding effective test development practices, the selection of appropriate metrics, the minimization of measurement errors, and test score validation processes. The purpose of this article is to provide a broad overview of the use of simulation for measuring physician skills and competencies. For simulations used in anesthesiology, studies that describe advances in scenario development, the development of scoring rubrics, and the validation of assessment results are synthesized. Based on the summary of relevant research, psychometric requirements for practical implementation of simulation-based assessments in anesthesiology are forwarded. As technology expands, and simulation-based education and evaluation takes on a larger role in patient safety initiatives, the groundbreaking work conducted to date can serve as a model for those individuals and organizations that are responsible for developing, scoring, or validating simulation-based education and assessment programs in anesthesiology. |
Designing and implementing the objective structured clinical examination in anesthesiology | Since its description in 1974, the Objective Structured Clinical Examination (OSCE) has gained popularity as an objective assessment tool of medical students, residents, and trainees. With the development of the anesthesiology residents' milestones and the preparation for the Next Accreditation System, there is an increased interest in OSCE as an evaluation tool of the six core competencies and the corresponding milestones proposed by the Accreditation Council for Graduate Medical Education. In this article the authors review the history of OSCE and its current application in medical education and in different medical and surgical specialties. They also review the use of OSCE by anesthesiology programs and certification boards in the United States and internationally. In addition, they discuss the psychometrics of test design and implementation with emphasis on reliability and validity measures as they relate to OSCE. Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. |
Sleep, anesthesiology, and the neurobiology of arousal state control | Sleep, like breathing, is a biologic rhythm that is actively generated by the brain. Neuronal networks that have evolved to regulate naturally occurring sleep preferentially modulate traits that define states of sedation and anesthesia. Sleep is temporally organized into distinct stages that are characterized by a unique constellation of physiologic and behavioral traits. Sleep and anesthetic susceptibility are genetically modulated, heritable phenotypes. This review considers 40 yr of research regarding the cellular and molecular mechanisms contributing to arousal state control. Clinical and preclinical data have debunked and supplanted the primitive view that sleep need is a weakness. Sleep deprivation and restriction diminish vigilance, alter neuroendocrine control, and negatively impact immune function. There is overwhelming support for the view that decrements in vigilance can negatively impact performance. Advances in neuroscience provide a foundation for the sea change in public and legal perspectives that now regard a sleep-deprived individual as impaired. © 2005 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. |
Understanding Research Methods: Up-and-down Designs for Dose-finding | Summary For the task of estimating a target benchmark dose such as the ED50 (the dose that would be effective for half the population), an adaptive dose-finding design is more effective than the standard approach of treating equal numbers of patients at a set of equally spaced doses. Up-and-down is the most popular family of dose-finding designs and is in common use in anesthesiology. Despite its widespread use, many aspects of up-and-down are not well known, implementation is often misguided, and standard, up-to-date reference material about the design is very limited. This article provides an overview of up-and-down properties, recent methodologic developments, and practical recommendations, illustrated with the help of simulated examples. Additional reference material is offered in the Supplemental Digital Content. © 2022 Lippincott Williams and Wilkins. All rights reserved. |