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    107 results match your criteria Perioperative Management of the Female Patient

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    Use of Methohexital and Dexmedetomidine for Maintenance of Anesthesia in a Patient With Mitochondrial Myopathy: A Case Report.
    A A Case Rep 2017 Jan;8(2):33-35
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and †Harvard Medical School, Boston, Massachusetts.
    Provision of anesthesia for patients with mitochondrial disorders is associated with a unique set of challenges. These disorders are rare, which complicates efforts to develop high quality, evidence-based guidelines to inform the perioperative management of those who suffer from them. Accordingly, case reports remain an important source of information regarding their care. Read More

    Left Ventricular Assist Device Insertion in a Patient With Biventricular Noncompaction Cardiomyopathy, Ebstein Anomaly, and a Left Atrial Mass: A Case Report.
    A A Case Rep 2016 Dec;7(12):251-255
    From the Department of Anesthesiology, Allegheny Health Network, Pittsburgh, Pennsylvania.
    In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation. Read More

    A Case Report of the Anesthetic Management for Liver Retransplantation in a Patient With a Bronchobiliary Fistula.
    A A Case Rep 2016 Nov;7(10):219-221
    From the Departments of *Anesthesia and Perioperative Medicine, †Surgery, and ‡Oncology, Western University, London, Ontario, Canada.
    A 64-year-old woman with a previous liver transplant developed graft failure with biliary complications including a bronchobiliary fistula, which did not respond to preoperative conservative therapy. Liver retransplantation provided definitive therapy for the liver failure and bronchobiliary fistula. We present anesthestic considerations for the intraoperative management of a liver retransplant with one-lung ventilation. Read More

    How Rescue Echocardiography Changed the Intraoperative Management of an Obese Patient with Refractory Hypotension?
    A A Case Rep 2016 Jun;6(12):391-3
    From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
    The value of perioperative echocardiography as a rescue tool to complement the clinical assessment of patients who develop hemodynamic instability during noncardiac surgery is becoming increasingly recognized. Several studies have demonstrated the utility of echocardiography in establishing a diagnosis during clinical emergencies. We present the case of an obese patient with refractory hypotension during laparoscopic gynecologic surgery in which rescue transesophageal echocardiography was pivotal in elucidating a diagnosis and changing the course of management. Read More

    Management of a Patient With Tetralogy of Fallot, Congenital Diaphragmatic Hernia, and Complete Left Lung Agenesis.
    A A Case Rep 2016 Jul;7(1):16-20
    From the *Pediatric Anesthesiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and †Pediatric Anesthesiology and Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
    We describe the rare case of an infant with congenital diaphragmatic hernia, unilateral lung agenesis, and unpalliated single-ventricle physiology. Infants with congenital diaphragmatic hernia and parallel circulation are at risk for maldistribution of systemic and pulmonary blood flow. Optimal perioperative management should include an assessment of the ratio of pulmonary to systemic blood flow (Qp:Qs). Read More

    The Anesthetic Implications of Aqueous Drainage Devices and Glaucoma: A Report of a Patient Undergoing Urgent Prone Cervical Decompression and Fusion.
    A A Case Rep 2016 Aug;7(3):63-6
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California; †The Eye Institute of Utah and the University of Utah John A. Moran Eye Center, Salt Lake City, Utah; and ‡Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
    The pathophysiology of glaucoma and perioperative visual loss is similar. A patient with glaucoma may be at increased risk of perioperative visual loss. For both, goals of management include optimizing ocular perfusion pressure and oxygen delivery. Read More

    Intraoperative Autotriggered Pressure Support Ventilation Resistant to Increased Flow Trigger Threshold.
    A A Case Rep 2016 Jul;7(1):9-12
    From the Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami, Miami, Florida.
    Oscillations from cardiac pulsations are normally transmitted to mediastinal structures without any consequence. Autotriggering (AT) of mechanical ventilation occurs when an inspiratory trigger, typically negative inspiratory flow in anesthesia ventilators, is met in the absence of patient effort. AT can lead to respiratory alkalosis, opioid overdose, prolonged mechanical ventilation, and lung hyperinflation. Read More

    Effects of Postoperative Pain Management on Immune Function After Laparoscopic Resection of Colorectal Cancer: A Randomized Study.
    Medicine (Baltimore) 2016 May;95(19):e3602
    From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine (SYK, H-YN, B-NK); Department of Surgery, Division of Colon and Rectal Surgery, Yonsei University College of Medicine (NKK, SHB, BSM, HH); Biostatistics Collaboration Unit, Yonsei University College of Medicine (JL); and Research Center for Silver Science, Institute of Symbiotic Life-TECH, National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University (JHL), Seoul, Republic of Korea.
    There has been a rising interest in the possible association between perioperative opioid use and postoperative outcomes in cancer patients. Continuous surgical wound infiltration with local anesthetics is a nonopioid analgesic technique that can be used as a postoperative pain management alternative to opioid-based intravenous patient-controlled analgesia (IV PCA). The aim of this study was to compare the effects of an opioid-based analgesic regimen versus a local anesthetic wound infiltration-based analgesic regimen on immune modulation and short-term cancer recurrence or metastasis in patients undergoing laparoscopic resection of colorectal cancer. Read More

    In the Aftermath: Attitudes of Anesthesiologists to Supportive Strategies After an Unexpected Intraoperative Patient Death.
    Anesth Analg 2016 May;122(5):1614-24
    From the *Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia; †Western Health, Melbourne, Victoria, Australia; ‡Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne; and §Schools of Psychology, Information Technology and Electrical Engineering, and Medicine, The University of Queensland, St Lucia, Queensland, Australia.
    Background: Although most anesthesiologists will have 1 catastrophic perioperative event or more during their careers, there has been little research on their attitudes to assistive strategies after the event. There are wide-ranging emotional consequences for anesthesiologists involved in an unexpected intraoperative patient death, particularly if the anesthesiologist made an error. We used a between-groups survey study design to ask whether there are different attitudes to assistive strategies when a hypothetical patient death is caused by a drug error versus not caused by an error. Read More

    Perioperative Respiratory Adverse Events in Pediatric Ambulatory Anesthesia: Development and Validation of a Risk Prediction Tool.
    Anesth Analg 2016 May;122(5):1578-85
    From the *Department of Anesthesia, Cincinnati Children's Hospital, University of Cincinnati Medical Center, Cincinnati, Ohio; †Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, Ohio; and ‡Process Improvement, James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, Cincinnati, Ohio.
    Background: Perioperative respiratory adverse events (PRAEs) are the most common cause of serious adverse events in children receiving anesthesia. Our primary aim of this study was to develop and validate a risk prediction tool for the occurrence of PRAE from the onset of anesthesia induction until discharge from the postanesthesia care unit in children younger than 18 years undergoing elective ambulatory anesthesia for surgery and radiology. The incidence of PRAE was studied. Read More

    Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair.
    Medicine (Baltimore) 2016 Apr;95(15):e3335
    From the Division of Vascular Surgery, Department of Surgery, Jikei University school of Medicine, Tokyo, Japan.
    The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Read More

    The Risk of Falls After Total Knee Arthroplasty with the Use of a Femoral Nerve Block Versus an Adductor Canal Block: A Double-Blinded Randomized Controlled Study.
    Anesth Analg 2016 May;122(5):1696-703
    From the Departments of *Anesthesiology and Critical Care, †Orthopedic Surgery, and ‡Physical Therapy and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania; §Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California; and ∥Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California.
    Background: Adductor canal block (ACB) has emerged as an appealing alternative to femoral nerve block (FNB) that produces a predominantly sensory nerve block by anesthetizing the saphenous nerve. Studies have shown greater quadriceps strength preservation with ACB compared with FNB, but no advantage has yet been shown in terms of fall risk. The Tinetti scale is used by physical therapists to assess gait and balance, and total score can estimate a patient's fall risk. Read More

    Severe Nausea and Vomiting in the Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia II Trial.
    Anesthesiology 2016 May;124(5):1032-40
    From the Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia (P.S.M.); Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China (M.T.V.C.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.K., A.F.); Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia (M.J.P.); School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia (M.J.P.); Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia (P.J.P.); Institute for Breathing and Sleep, Victoria, Australia (P.J.P.); Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.); Department of Anaesthesia, Intensive Care and Pharmacology, Geneva University Hospitals, University of Geneva, Switzerland (G.H.); Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada (W.S.B.); Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (W.S.B.); Department of Anesthesia, Perioperative and Acute Pain Management, Barwon Health, Geelong, Victoria, Australia (C.O.); and Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom (J.R.S.).
    Background: The Evaluation of Nitrous oxide in the Gas Mixture for Anesthesia II trial randomly assigned 7,112 noncardiac surgery patients to a nitrous oxide or nitrous oxide-free anesthetic; severe postoperative nausea and vomiting (PONV) was a prespecified secondary end point. Thus, the authors evaluated the association between nitrous oxide, severe PONV, and effectiveness of PONV prophylaxis in this setting.

    Methods: Univariate and multivariate analyses of patient, surgical, and other perioperative characteristics were used to identify the risk factors for severe PONV and to measure the impact of severe PONV on patient outcomes. Read More

    Active Warming Utilizing Combined IV Fluid and Forced-Air Warming Decreases Hypothermia and Improves Maternal Comfort During Cesarean Delivery: A Randomized Control Trial.
    Anesth Analg 2016 May;122(5):1490-7
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California; †Pacific Alliance Medical Center, Los Angeles, California; and ‡Department of Anesthesia, Santa Clara Valley Medical Center, San Jose, California.
    Background: The aim of this study was to apply both IV fluid and forced-air warming to decrease perioperative hypothermia in women undergoing cesarean delivery with spinal anesthesia. The authors hypothesize that combined-modality active warming (AW) would increase maternal temperature on arrival at the postanesthesia care unit (PACU) and decrease the incidence of maternal perioperative hypothermia (<36°C) compared with no AW.

    Methods: Forty-six healthy women (n = 23 per group) undergoing scheduled cesarean delivery with spinal anesthesia (10-12 mg bupivacaine + 10 μg fentanyl) were enrolled in this double-blinded, randomized controlled trial. Read More

    Current Selection Criteria and Perioperative Therapy Used for Fetal Myelomeningocele Surgery.
    Obstet Gynecol 2016 Mar;127(3):593-7
    Departments of Obstetrics, Gynecology and Reproductive Sciences and Pediatric Surgery, University of Texas Health School of Medicine at Houston, and the Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas; the Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, and the Fetal Center, Vanderbilt University Medical Center, Nashville, Tennessee; the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; the Department of Surgery, Division of Pediatric Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; the Department of Pediatrics, Division of Cardiology, and the Fetal Treatment Center, University of California San Francisco, San Francisco, California; the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ochsner Baptist Medical Center, New Orleans, Louisiana; the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Michigan Health Systems, Ann Arbor, Michigan; the Department of Obstetrics, Gynecology and Women's Health, Division of Maternal-Fetal Medicine, St. Louis University School of Medicine, St. Louis, Missouri; and the Department of Surgery, Division of Pediatric Neurosurgery, Mayo Clinic, Rochester, Minnesota.
    Objective: To determine the current maternal and fetal selection criteria and operative approaches used at centers performing fetal myelomeningocele surgery.

    Methods: The 17 principal investigators participating in the Fetal Myelomeningocele Consortium were asked to participate in an anonymous online survey regarding the current practice of maternal-fetal surgery for neural tube defect repair and results were tabulated. The 35-question survey related to diagnostic testing, inclusion and exclusion criteria, and clinical management. Read More

    Simulation Study Assessing Healthcare Provider's Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center.
    Simul Healthc 2016 Feb;11(1):25-31
    From the Department of Anesthesiology, Perioperative and Pain Medicine (G.H., B.C.) and Department of Obstetrics and Gynecology (K.D.), Stanford University School of Medicine, Stanford, CA.
    Introduction: The aim of the study was to assess knowledge of labor and delivery healthcare providers at a tertiary referral center in the management of pre-eclampsia and eclampsia.

    Methods: Thirteen multidisciplinary teams participated in this institutional review board-exempt study. Each group encountered the same scenario that involved a pre-eclamptic parturient who progressed to eclampsia. Read More

    Variations in the Use of Perioperative Multimodal Analgesic Therapy.
    Anesthesiology 2016 Apr;124(4):837-45
    From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (K.S.L., E.P., K.F.H., J.L., B.T.B.); Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (K.S.L., B.T.B.); Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada (K.S.L.); and Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.P.R).
    Background: Practice guidelines for perioperative pain management recommend that multimodal analgesic therapy should be used for all postsurgical patients. However, the proportion of patients who actually receive this evidence-based approach is unknown. The objective of this study was to describe hospital-level patterns in the utilization of perioperative multimodal analgesia. Read More

    Early experience with endoscopic revision of lumbar spinal fusions.
    Neurosurg Focus 2016 Feb;40(2):E10
    Department of Neurological Surgery, University of Washington, Seattle, Washington; and.
    Approximately half a million spinal fusion procedures are performed annually in the US. It is estimated that up to one-third of arthrodesis constructs require revision surgeries. In this study the authors present endoscopic treatment strategies targeting 3 types of complications following arthrodesis surgery: 1) adjacent-level foraminal stenosis; 2) foraminal stenosis at an arthrodesis segment; and 3) stenosis caused by a displaced interbody cage. Read More

    To Pack or Not to Pack? A Randomized Trial of Vaginal Packing After Vaginal Reconstructive Surgery.
    Female Pelvic Med Reconstr Surg 2016 Mar-Apr;22(2):111-7
    From the *Division of Urogynecology, Department of Obstetrics and Gynecology, and †Hatton Research Institute, TriHealth Good Samaritan Hospital, Cincinnati, OH.
    Objective: Placement of vaginal packing after pelvic reconstructive surgery is common; however, little evidence exists to support the practice. Furthermore, patients have reported discomfort from the packs. We describe pain and satisfaction in women treated with and without vaginal packing. Read More

    Transient Intraoperative Central Diabetes Insipidus in Moyamoya Patients Undergoing Revascularization Surgery: A Mere Coincidence?
    A A Case Rep 2016 Apr;6(8):224-7
    From the *Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California; and †Medical Student, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California.
    We present 2 patients with Moyamoya disease undergoing revascularization surgery who developed transient intraoperative central diabetes insipidus with spontaneous resolution in the immediate postoperative period. We speculate that patients with Moyamoya disease may be predisposed to a transient acute-on-chronic insult to the arginine vasopressin-producing portion of their hypothalamus mediated by anesthetic agents. We describe our management, discuss pertinent literature, and offer possible mechanisms of this transient insult. Read More

    A New Surgical Procedure "Dumbbell-Form Resection" for Selected Hilar Cholangiocarcinomas With Severe Jaundice: Comparison With Hemihepatectomy.
    Medicine (Baltimore) 2016 Jan;95(2):e2456
    From the Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
    The aim of the study is to evaluate the therapeutic effect of a new surgical procedure, dumbbell-form resection (DFR), for hilar cholangiocarcinoma (HCCA) with severe jaundice. In DFR, liver segments I, IVb, and partial V above the right hepatic pedicle are resected.Hemihepatectomy is recognized as the preferred procedure; however, its application is limited in HCCAs with severe jaundice. Read More

    The Use of Somatosensory Evoked Potentials to Determine the Relationship Between Intraoperative Arterial Blood Pressure and Intraoperative Upper Extremity Position-Related Neurapraxia in the Prone Surrender Position During Spine Surgery: A Retrospective Analysis.
    Anesth Analg 2016 May;122(5):1423-33
    From the Department of Anesthesiology, Temple University School of Medicine, Philadelphia, Pennsylvania.
    Background: Peripheral nerve injury is a significant perioperative problem. Intraoperative position-related neurapraxia may indicate impending peripheral nerve injury and can be detected by changes in somatosensory evoked potentials (SSEP). The purpose of this retrospective analysis of spine surgeries performed under general anesthesia with SSEP monitoring was to determine the relationship between intraoperative mean arterial blood pressure (MAP) and intraoperative upper extremity position-related neurapraxia in the prone surrender (superman) position. Read More

    Avoidance of serious medical errors in refractive surgery using a custom preoperative checklist.
    J Cataract Refract Surg 2015 Oct;41(10):2171-8
    From the Massachusetts Eye and Ear Infirmary (Robert, Choi, Melki), Brigham and Women's Hospital (Urman, Melki), Beth Israel Deaconess Medical Center (Shapiro, Melki), Harvard Medical School, the Institute For Safety in Office-Based Surgery (Shapiro, Urman), and Boston Eye Group (Melki), Boston, Massachusetts, USA. Electronic address:
    Purpose: To implement and measure the effect of a surgical safety checklist on the prevention of serious medical errors (never-events).

    Setting: Boston Eye Group, Boston, Massachusetts, USA.

    Design: Retrospective cohort study. Read More

    A Model for Better Leveraging the Point of Preoperative Assessment: Patients and Providers Look Beyond Operative Indications When Making Decisions.
    A A Case Rep 2016 Apr;6(8):241-8
    From the *Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; †Department of Anesthesiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; ‡Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York §Department of Anesthesiology, Roswell Park Cancer Institute, Buffalo, New York; ‖Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania; ¶Center for Surgery and Public Health and #Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; **Ariadne Labs, Boston, Massachusetts; ††Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; and ‡‡Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
    Previous literature on preoperative evaluation focuses on the impact on the day of surgery cancellations and delays; however, the framework of cancellations and delays at the time of the elective outpatient preoperative anesthesia visit has not been categorized. We describe the current model in the preoperative clinic at Brigham and Women's Hospital, examining the pattern of cancellations at the time of this preoperative visit and the framework used for categorizing the issues involved. Looking at this broader framework is important in an era of patient-centered care; we seek to identify targets to modify the preoperative assessment and adequately assess and capture the spectrum of issues involved. Read More

    Patient-specific Immune States before Surgery Are Strong Correlates of Surgical Recovery.
    Anesthesiology 2015 Dec;123(6):1241-55
    From the Baxter Laboratory in Stem Cell Biology, Stanford University, Stanford, California (G.K.F., B.G., N.A., G.P.N.); Department of Microbiology and Immunology, Stanford University, Stanford, California (G.K.F., G.P.N.); and Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California (B.G., E.A.G., M.T., M.S.A.).
    Background: Recovery after surgery is highly variable. Risk-stratifying patients based on their predicted recovery profile will afford individualized perioperative management strategies. Recently, application of mass cytometry in patients undergoing hip arthroplasty revealed strong immune correlates of surgical recovery in blood samples collected shortly after surgery. Read More

    Emergent Airway Management of an Uncooperative Child with a Large Retropharyngeal and Posterior Mediastinal Abscess.
    A A Case Rep 2016 Feb;6(3):61-4
    From the *Department of Anesthesiology and Perioperative Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; †New Jersey Medical School, Newark, New Jersey; ‡Division of Pediatric Surgery, Hackensack University Medical Center, Hackensack, New Jersey; and §Division of Pediatric Anesthesiology, Hackensack University Medical Center, Hackensack, New Jersey.
    Retropharyngeal abscesses are deep neck space infections that can lead to life-threatening airway emergencies and other catastrophic complications. Retropharyngeal abscesses demand prompt diagnosis and early establishment of a definitive airway when there is airway compromise. This can be difficult in an uncooperative patient. Read More

    Spasm in Arterial Grafts in Coronary Artery Bypass Grafting Surgery.
    Ann Thorac Surg 2016 Mar 14;101(3):1222-9. Epub 2015 Nov 14.
    Department of Cardiothoracic Surgery, Oxford University, Oxford, United Kingdom.
    Spasm of arterial grafts in coronary artery bypass grafting surgery is still a clinical problem, and refractory spasm can occasionally be lethal. Perioperative spasm in bypass grafts and coronary arteries has been reported in 0.43% of all coronary artery bypass grafting surgery, but this may be an underestimate. Read More

    Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.
    A A Case Rep 2015 Dec;5(11):189-91
    From the Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida.
    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. Read More

    First-Attempt Intubation Success of Video Laryngoscopy in Patients with Anticipated Difficult Direct Laryngoscopy: A Multicenter Randomized Controlled Trial Comparing the C-MAC D-Blade Versus the GlideScope in a Mixed Provider and Diverse Patient Population.
    Anesth Analg 2016 Mar;122(3):740-50
    From the *Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon; †Department of Anesthesia, University of Iowa, Iowa City, Iowa; and ‡Department of Anesthesiology, University of Texas at Houston, Houston, Texas.
    Background: Intubation success in patients with predicted difficult airways is improved by video laryngoscopy. In particular, acute-angle video laryngoscopes are now frequently chosen for endotracheal intubation in these patients. However, there is no evidence concerning whether different acute-angle video laryngoscopes can be used interchangeably in this scenario and would allow endotracheal intubation with the same success rate. Read More

    Surgical Therapy of Cervical Spine Fracture in Patients With Ankylosing Spondylitis.
    Medicine (Baltimore) 2015 Nov;94(44):e1663
    From the Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
    The present study aimed to explore surgical treatments and assess the effects based on the features of cervical spine fracture in patients with ankylosing spondylitis (AS) and to summarize the experiences in perioperative management. Retrospective analysis was performed in 25 AS patients with cervical spine fracture treated in our hospital from January 2011 to December 2013. The patients were divided according to fracture segments, including 4 cases at C4 to C5, 8 cases at C5 to C6, and 13 cases at C6 to C7. Read More

    Anesthesia Management for Palliative Surgery of Massive Hepatic Metastatic Melanoma.
    A A Case Rep 2016 Apr;6(7):189-92
    From the *Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and †Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
    We report the perioperative management of a patient with melanoma. Surgical intervention was withheld at multiple institutions because of the presence of metastases; the patient was undergoing experimental immunotherapy and had responded everywhere except in the liver. She underwent hepatic right trisegmentectomy to improve her quality of life and to allow resumption of immunotherapy. Read More

    A Smartphone-based Decision Support Tool Improves Test Performance Concerning Application of the Guidelines for Managing Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy.
    Anesthesiology 2016 Jan;124(1):186-98
    From the Departments of Anesthesiology (M.D.M., J.M.E., R.K.G., J.M.C.), Surgery (J.M.E.), Biomedical Informatics (J.M.E.), and Biostatistics (Y.S., M.S.S.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina (W.R.H.); Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (M.P.S.); Department of Anesthesiology, University of Kentucky, Lexington, Kentucky (A.N.D., R.M.S.); Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio (K.R.M.); Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (R.L.); Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois (M.E.N.); and Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (E.L.M.).
    Background: The American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus statement on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy is the standard for evaluation and management of these patients. The authors hypothesized that an electronic decision support tool (eDST) would improve test performance compared with native physician behavior concerning the application of this guideline.

    Methods: Anesthesiology trainees and faculty at 8 institutions participated in a prospective, randomized trial in which they completed a 20-question test involving clinical scenarios related to the ASRA guidelines. Read More

    Forced-Air Warming During Pediatric Surgery: A Randomized Comparison of a Compressible with a Noncompressible Warming System.
    Anesth Analg 2016 Jan;122(1):219-25
    From the Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria.
    Background: Perioperative hypothermia is a common problem, challenging the anesthesiologist and influencing patient outcome. Efficient and safe perioperative active warming is therefore paramount; yet, it can be particularly challenging in pediatric patients. Forced-air warming technology is the most widespread patient-warming option, with most forced-air warming systems consisting of a forced-air blower connected to a compressible, double layer plastic and/or a paper blanket with air holes on the patient side. Read More

    Perioperative Mortality, 2010 to 2014: A Retrospective Cohort Study Using the National Anesthesia Clinical Outcomes Registry.
    Anesthesiology 2015 Dec;123(6):1312-21
    From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California.
    Background: The National Anesthesia Clinical Outcomes Registry collects demographic and outcome data from anesthesia cases, with the goal of improving safety and quality across the specialty. The authors present a preliminary analysis of the National Anesthesia Clinical Outcomes Registry database focusing on the rates of and associations with perioperative mortality (within 48 h of anesthesia induction).

    Methods: The authors retrospectively analyzed 2,948,842 cases performed between January 1, 2010, and May 31, 2014. Read More

    Anesthetic Management of Patients with Congenital Insensitivity to Pain with Anhidrosis: A Retrospective Analysis of 358 Procedures Performed Under General Anesthesia.
    Anesth Analg 2015 Nov;121(5):1316-20
    From the *Department of Anesthesiology and Critical Care, Soroka Medical Center, Ben-Gurion University of the Negev, Faculty of Health Science, Beer-Sheva, Israel; †Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; and ‡Department of Oral and Maxillofacial Surgery, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel.
    Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disorder characterized by recurrent episodic fevers, anhidrosis, absent reaction to noxious stimuli, self-mutilating behavior, and mental retardation. The anesthetic management of patients with CIPA is challenging. Autonomic nervous system abnormalities are common, and patients are at increased risk for perioperative complications. Read More

    Surgical Considerations and Challenges for Bilateral Continuous-Flow Durable Device Implantation.
    ASAIO J 2016 Mar-Apr;62(2):e18-21
    From the *Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota; †Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Department of Cardiology, Mayo Clinic, Rochester, Minnesota; and §Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
    The concept of biventricular support with durable centrifugal pumps is evolving, and the surgical strategy and best practice guidelines for implantation of right-sided devices are still unknown. We present optimal strategy for bilateral HeartWare continuous-flow ventricular assist device (HVAD) implantation in a series of four patients. Patients were implanted with the HVAD pumps simultaneously or sequentially. Read More

    The Radiogenomic Risk Score: Construction of a Prognostic Quantitative, Noninvasive Image-based Molecular Assay for Renal Cell Carcinoma.
    Radiology 2015 Oct 19;277(1):114-23. Epub 2015 Aug 19.
    From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Box 951721, CHS 17-135, 10833 LeConte Ave, Los Angeles, CA 90095-1721 (N.J., M.Z., S.B., M.D.K.); Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex (E.J.); Department of Radiology, Hospital of Veterans Affairs, University of California-San Diego, San Diego, Calif (M.Z., L.A.); Scottsdale Medical Imaging, Scottsdale, Ariz (R.K.); Department of Urology, Stanford University School of Medicine, Stanford, Calif (H.Z., J.D.B.); Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea Hospital, Umea, Sweden (R.T.S., B.L.); and Department of Statistics, Stanford University, Stanford, Calif (R.J.T.).
    Purpose: To evaluate the feasibility of constructing radiogenomic-based surrogates of molecular assays (SOMAs) in patients with clear-cell renal cell carcinoma (CCRCC) by using data extracted from a single computed tomographic (CT) image.

    Materials And Methods: In this institutional review board approved study, gene expression profile data and contrast material-enhanced CT images from 70 patients with CCRCC in a training set were independently assessed by two radiologists for a set of predefined imaging features. A SOMA for a previously validated CCRCC-specific supervised principal component (SPC) risk score prognostic gene signature was constructed and termed the radiogenomic risk score (RRS). Read More

    Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators.
    Anesthesiology 2015 Nov;123(5):1024-32
    From the Department of Anesthesiology and Pain Medicine (G.A.R., S.A.L., G.A.V.N., J.D., K.M.N.) and Division of Cardiology, Department of Medicine (L.W.L., J.E.P.), University of Washington, Seattle, Washington.
    Background: Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary.

    Methods: Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. Read More

    Preoperative Surgical Risk Predictions Are Not Meaningfully Improved by Including the Surgical Apgar Score: An Analysis of the Risk Quantification Index and Present-On-Admission Risk Models.
    Anesthesiology 2015 Nov;123(5):1059-66
    From the Departments of Anesthesiology (M.A.T., J.M.E., J.P.W.), Biomedical Informatics (J.M.E., J.P.W.), Surgery (J.M.E.), and Health Policy (J.M.E.), Vanderbilt University Medical Center, Nashville, Tennessee.
    Background: Estimating surgical risk is critical for perioperative decision making and risk stratification. Current risk-adjustment measures do not integrate dynamic clinical parameters along with baseline patient characteristics, which may allow a more accurate prediction of surgical risk. The goal of this study was to determine whether the preoperative Risk Quantification Index (RQI) and Present-On-Admission Risk (POARisk) models would be improved by including the intraoperative Surgical Apgar Score (SAS). Read More

    An Evaluation of Factors Related to Postoperative Pain Control in Burn Patients.
    J Burn Care Res 2015 Sep-Oct;36(5):580-6
    From the Departments of *Surgery, †Biostatistics, and ‡Anesthesia, The University of Iowa Carver College of Medicine, Iowa City.
    Satisfactory treatment of burn pain continues to be elusive. The perioperative period is particularly challenging. The contributions of acute tolerance and opioid-induced hyperalgesia have not been previously explored in burn patients. Read More

    Historical Comparison of Overall Survival after Hepatic Resection for Patients With Large and/or Multinodular Hepatocellular Carcinoma.
    Medicine (Baltimore) 2015 Sep;94(35):e1426
    From the Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China (J-HZ, X-MY, S-DL, Y-YW, B-DX, LM, F-XW, W-PY, L-QL); Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, PR China (J-HZ, X-MY, S-DL, Y-YW, B-DX, LM, F-XW, W-PY, L-QL); and Disease Classification Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China (YC).
    The present study compared the efficacy of hepatic resection (HR) in patients with large hepatocellular carcinoma (HCC) and those with multinodular tumor and examined how that efficacy has changed over time in a large medical center.The intermediate stage of HCC comprises a highly heterogeneous patient population. Moreover, official guidelines have different views on the suitability of HR to treat such patients. Read More

    Anesthetic Management of Peripartum Right Ventricular Outflow Tract Tachycardia.
    A A Case Rep 2015 Sep;5(5):72-4
    From the Department of *Anesthesiology, Perioperative and Pain Medicine; ‡Department of Obstetrics and Gynecology, and the †Cardiovascular Division, Brigham & Women's Hospital, Boston, Massachusetts.
    Arrhythmia and palpitation are common during pregnancy. Right ventricular outflow tract tachycardia, a rare cause of palpitations occurring even in the absence of structural heart disease, is uncommon during pregnancy. Nevertheless, the presence of right ventricular outflow tract tachycardia in pregnancy requires careful cardiac evaluation with a focus on managing arrhythmogenic activity while maintaining patient comfort and safety. Read More

    Transversus Abdominis Plane Block Versus Surgical Site Infiltration for Pain Management After Open Total Abdominal Hysterectomy.
    Anesth Analg 2015 Nov;121(5):1383-8
    From the Departments of *Anesthesiology and Pain Management, †Obstetrics and Gynecology, and ‡Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
    Background: Surgical site infiltration and transversus abdominis plane (TAP) blocks are commonly used to improve pain relief after lower abdominal surgery. This randomized, observer-blinded study was designed to compare the analgesic efficacy of TAP blocks with surgical site infiltration in patients undergoing open total abdominal hysterectomy via a Pfannenstiel incision.

    Methods: Patients were randomized to receive either bilateral ultrasound-guided TAP blocks using bupivacaine 0. Read More

    The effect of an anaesthetic patient information video on perioperative anxiety: A randomised study.
    Eur J Anaesthesiol 2016 Feb;33(2):134-9
    From the Section of Anesthesiology (S-YL, K-YW), Section of General Surgery (H-AH), Section of Orthopedic Surgery, Pingtung Christian Hospital, Pingtung (S-CL), Nursing Department, Kaohsiung Armed Forces General Hospital (Y-TH), and Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan (H-YS).
    Background: Despite growing evidence that an educational anaesthesia video can effectively reduce perioperative anxiety, the ideal medium for addressing perioperative anxiety is unclear.

    Objective: The purpose of this study was to investigate the effect of viewing an anaesthetic patient information video on anxiety levels in patients scheduled to undergo surgery.

    Design: A randomised controlled trial. Read More

    Hemostatic Management of Severe Thrombocytopenia in a Patient Undergoing Pulmonic Valve Replacement.
    A A Case Rep 2015 Jul;5(1):3-5
    From the *Department of Anesthesiology, University of Maryland Medical Center, Baltimore, Maryland; and †Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
    Perioperative management of thrombocytopenia is often focused on platelet transfusion. However, there are thrombocytopenic cases that are refractory to platelet transfusion as a result of immune response or consumptive coagulopathy. Acuity of the disease may necessitate an invasive procedure despite a grossly abnormal platelet count. Read More

    Perioperative Complications in Obstructive Sleep Apnea Patients Undergoing Surgery: A Review of the Legal Literature.
    Anesth Analg 2016 Jan;122(1):145-51
    From the *Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals, Case Western Reserve University, Cleveland, Ohio; †Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio; and ‡Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
    Background: Obstructive sleep apnea (OSA) is common in patients undergoing surgery. OSA, known or suspected, has been associated with significant perioperative adverse events, including severe neurologic injury and death. This study was undertaken to assess the legal consequences associated with poor outcomes related to OSA in the perioperative setting. Read More

    Bedside Gastric Ultrasonography in Term Pregnant Women Before Elective Cesarean Delivery: A Prospective Cohort Study.
    Anesth Analg 2015 Sep;121(3):752-8
    From the *Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Canada; and the †Department of Anesthesia, Toronto Western Hospital - University Health Network and University of Toronto, Toronto, Canada.
    Background: Bedside gastric ultrasound can reliably assess gastric contents in the perioperative period. We aimed to describe the qualitative and quantitative ultrasound assessment of the gastric antrum in fasted pregnant women at term.

    Methods: Pregnant women were examined after a minimum period of overnight fasting (solid food, 6 hours; clear liquids, 2 hours) before their scheduled cesarean delivery. Read More

    Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery.
    Anesthesiology 2015 Aug;123(2):307-19
    From the Emeritus Faculty, Durham VA Medical Center, Durham, North Carolina (T.G.M.); Department of Anesthesiology and Perioperative Medicine, University of Missouri, Columbia, Missouri (T.G.M.); Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), Aurora, Colorado (M.R.B., W.G.H.); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado (W.G.H.); Department of Anesthesiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (M.P.M.); Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, VA North Texas Health Care System, Dallas, Texas (S.T.J.S.-P.); Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine, Washington DC VA Medical Center, Washington, D.C. (D.R.B.); Department of Anesthesiology, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas (J.D.N.); Department of Surgery, University of Alabama Birmingham, Birmingham VA Medical Center, Birmingham, Alabama (J.S.R.); Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado (R.A.M.); and Department of Medicine (Cardiology), University of Colorado School of Medicine, Aurora, Colorado (K.E.H.).
    Background: Although deviations in intraoperative blood pressure are assumed to be associated with postoperative mortality, critical blood pressure thresholds remain undefined. Therefore, the authors estimated the intraoperative thresholds of systolic blood pressure (SBP), mean blood pressure (MAP), and diastolic blood pressure (DBP) associated with increased risk-adjusted 30-day mortality.

    Methods: This retrospective cohort study combined intraoperative blood pressure data from six Veterans Affairs medical centers with 30-day outcomes to determine the risk-adjusted associations between intraoperative blood pressure and 30-day mortality. Read More

    Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes.
    Anesthesiology 2015 Jul;123(1):55-65
    From the Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (G.F., A.J.D.); Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Victoria, Australia (G.F., A.J.D.); Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia (G.F., A.J.D.); Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, United Kingdom (G.B., N.S.M.); Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy (N.D.); Department of Anaesthesia, Montreal Children's Hospital, Montreal, Quebec, Canada (D.E.W.); Department of Anesthesia, McGill University, Montreal, Quebec, Canada (D.E.W.); Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands (J.C.d.G.); Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, United Kingdom (N.S.M.); Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts (M.E.M.); Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (S.J.A.); Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, United Kingdom (O.B.); Department of Anesthesiology and Paediatric Intensive Care, Ospedale Pediatrico "Vittore Buzzi," Milan, Italy (A.W.); and Department of Neurology, Boston Children's Hospital, Boston, Massachusetts (D.B.).
    Background: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. Read More

    Rationale and Design of the Balanced Anesthesia Study: A Prospective Randomized Clinical Trial of Two Levels of Anesthetic Depth on Patient Outcome After Major Surgery.
    Anesth Analg 2015 Aug;121(2):357-65
    From the *Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand; †Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia; ‡Anaesthesia, Perioperative and Pain Medicine Unit, Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia; §Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; ∥Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China; ¶Department of Statistics, University of Otago, Christchurch, New Zealand; #Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia; and **Academic Board of Anaesthesia and Perioperative Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
    Background: An association between relatively deep anesthesia, as guided by the bispectral index (BIS), and increased postoperative mortality has been demonstrated in 6 of 8 published observational studies, but association does not necessarily mean causality. Small clinical trials of anesthetic depth have demonstrated increased delirium and postoperative cognitive dysfunction in patients who were relatively deeply anesthetized, but have been inadequately powered to study mortality. A large-scale randomized study is required to determine whether causality exists. Read More

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