Can sagittal approach for cadaveric study of TTP block spread more than transverse approach?

An ultrasound-guided transversus thoracic plane (TTP) block can release the pain at internal mammary area [1,2]. An injection point of the TTP block was between the transversus thoracic muscle and the intercostal muscle between the fourth and fifth ribs next to the sternum [3]. The spread of local anesthetic for peripheral nerve block is important for good perioperative pain management. In particular, the spread of local anesthetic for the TTP block is more important because of trunk block. There was no study, which investigated the difference of local anesthetic's spread in approach of the TTP block.

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Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials

To compare the use of inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting.

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Neuraxial hypothermia incidence misinterpreted

We read with interest the recent systematic review by Shaw et al. [1] and applaud the authors for discussing the prevalence of perioperative hypothermia in patients receiving neuraxial anesthetics. However, we have concerns that they have inaccurately interpreted the data of a 2017 publication by Frisch et al. [2] examining hypothermia in patients undergoing total hip and knee arthroplasty, a population that often receives neuraxial anesthesia. When describing the Frisk et al. study, the Shaw et al.

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Overnight call and cognitive functioning: Will tablet-based assessment be the solution for safety check in residents?

In this issue of the Journal of Clinical Anesthesia, Williams and colleagues investigated whether measurable sensorimotor and executive function differences exist in anesthesiology residents after a single overnight call shift versus a routine daytime shift using two tablet-based pointing tasks (i.e., ProPoint and AntiPoint) [1]. They found increased reaction times on both tasks amongst overnight call residents compared to those residents working daytime hours, which was suggestive of sensorimotor and cognitive slowing in the overnight call residents.

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Dexmedetomidine and Renal Protection after Cardiac Surgery

Dexmedetomidine is a well-known alpha 2 adrenergic agonist and widely used drug. First approved by Food and Drug Administration (FDA) in 1999 as a sedative, now dexmedetomidine has been a focus of extensive research because of its anti-inflammatory, sympatholytic actions. In a recent study Brandao et al. has described significantly lower reoperation rate, neurological injury, decrease hospital stay and improved thirty day mortality in their retrospective analysis of cardiac surgical patients who received dexmedetomidine during procedure [1].

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Sensorimotor and executive function slowing in anesthesiology residents after overnight shifts

Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist following a single overnight call versus routine shift, and whether factors like stress, rest and caffeine affect these measures.

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The LMA Supreme: Is it a suitable alternative to the i-gel and LMA ProSeal for airway maintenance in children?

In this issue of the Journal of Clinical Anesthesia, Bhattacharjee and colleagues [1] present their results from a meta-analysis of randomized controlled trials comparing the LMA Supreme™ (Teleflex; Triangle park, NC USA) with the i-gel™ (Intersurgical, Wokingham UK) and LMA ProSeal™ (Teleflex; Triangle park, NC USA) in children. This comparison of supraglottic airway (SGA) devices is timely, as emerging data continues to suggest that SGA use for airway management in children result in fewer peri-operative airway complications when compared to tracheal intubation [2,3].

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Erratum to “Anesthesiologists' perceptions of minimum acceptable work habits of nurse anesthetists” [J Clin Anesth 38 (2017) 107–110]

The authors regret that the affiliation A was incorrectly displayed. This affiliation should read "Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA".

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Fishing for answers in an ocean of data: The potential for big data analytics to enhance our knowledge of the complex regional pain syndromes

In an era of expanding costs and declining reimbursement, the healthcare industry has dramatically expanded the collection of demographic and clinical data to facilitate billing efficiency and maintain financial solvency. Electronic health data collection has primarily emphasized the capture of diagnostic coding, medication delivery, laboratory utilization, and procedural interventions to support third party reimbursement claims, improve efficiency, and provide transparency. Although much of the electronic stored data was never directly intended to answer clinical questions, or guide clinical care, the use of data analytics has created opportunities to winnow through the vast data collections and pull out useful insights into previously unrecognized patterns of common and uncommon medical disorders [1–3].

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Bioimpedence: A noninvasive measure of stroke volume and cardiac output

If a non-invasive measure of cardiac output is not accurate is it still non-invasive?

http://ift.tt/2sIyde5

Revolutionizing medication administration safety: Automated carts are here - Are anesthesiologists ready?

In this month's issue of the Journal of Clinical Anesthesia, Wang and colleagues [1] present a randomized controlled trial assessing the use of an automated operating room anesthesia cart and its effect on the recording of medication errors. A search of the US National Library of Medicine database (PubMed, at http://ift.tt/1cTZOuj) for the term, "medication error" performed at the time of the writing of this editorial retrieved a total of 17,808 citations. So, why is another such article needed? In this innovative and important study, 78 anesthesiologists were trained on the use of an automated medication-dispensing cart, and the anesthetic management then was randomized to intraoperative medication administration using either the automated cart or a conventional manual cart [1].

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Acute pain management in the pediatric ambulatory setting: How do we optimize the child's postoperative experience?

The accompanying article by Cai and colleagues in this edition of The Journal of Clinical Anesthesia characterizes factors that influence postoperative pain in 204 healthy preschool age children during the first two weeks following outpatient surgery. [1] Postoperative pain management is a complex and challenging issue in pediatrics, especially with regard to ambulatory surgery. The authors, in their prospective study, explored the impact of various demographic, intra-operative, and parental factors on both pain and behavior-related outcomes in young children undergoing outpatient surgical procedures.

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Did we open a treasure chest of chest blocks? The jury is out.

According to estimates from the American Cancer Society, there will be more than 250,000 new cases of breast cancer diagnosed in the United States with breast cancer remaining as the second leading cause of over 40,000 cancer deaths in women in the year 2017 [1]. Many patients who are diagnosed will choose to undergo multiple oncoplastic surgical interventions, including breast conserving and reconstructive procedures. For these patients, acute postoperative and chronic pain remains a prevalent and devastating outcome that impacts on physical and psychosocial well-being.

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Acetaminophen and ondansetron: The central serotonergic connection

Acetaminophen is one of the most widely used analgesic drugs, yet the exact mechanism of its analgesic effect remains largely unknown. Although originally thought to share similar mechanistic properties with cyclooxygenase (COX) inhibitors, acetaminophen is only weakly anti-inflammatory [1] and appears to inhibit prostaglandin synthesis centrally rather than peripherally, accounting for its antipyretic activity [2]. However, COX inhibition by acetaminophen may only occur under specific low peroxide conditions, likely explaining its known tissue selectivity [3].

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Perioperative use of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists

Clinical repercussions of perioperative treatment with ACEIs/ARBs.

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Workload, efficiency, and productivity following open access scheduling in a gastrointestinal endoscopy suite

In this issue of the Journal, Tsai and colleagues describe a managerial intervention in their gastrointestinal endoscopy suite to accommodate the scheduling of additional cases for a new pediatric gastroenterologist on one day of the week [1]. Their intervention was to share the 2 existing locations with first case starts among the 3 separate gastroenterology groups, rather to expand the number of anesthetizing locations staffed at the start of the workday from 2 to 3 locations. One anesthesia provider was allocated to one adult group, and the other provider was shared between a second adult gastroenterology group and a new pediatric gastroenterologist in the third group.

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Maurice S. Albin, pioneer neuroanesthesiologist dies at 93; pioneered spinal cord injury care

Maurice Simeon Albin, MD, MSc, a pioneering anesthesiologist who specialized in neuroanesthesia, died at age 93 in Birmingham, Alabama.

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Assessing effects of intubating stylet use on early postoperative pharyngeal pain

In a small size randomized clinical trial assessing the effects of stylet use during tracheal intubation on early postoperative pharyngeal pain in anesthetized patients, Komasawa et al. [1] show that stylet use results in an increased incidence of early postoperative pharyngeal pain. To differentiate the effects of one factor on primary study endpoint, however, all of other factors have to be standardized for avoidance of potential biases. In this study, postoperative pharyngeal pain was evaluated when patients leaved operation room after sufficient recovery.

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The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial

To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen.

http://ift.tt/2sIpMzb

Post-operative cognitive dysfunction after total knee arthroplasty: It ain't what you do, it's the way that you do it

In this edition, Tanaka et al. [1] describe a prospective study designed to ascertain whether propofol vs desflurane anesthesia affects the incidence of early postoperative cognitive dysfunction (POCD) in elderly obese patients undergoing elective total knee arthroplasty (TKA).

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The management of a cystic hepatic lesion ruptured in the bile ducts: a case report

Hepatic cystadenoma is a rare benign cystic tumor; it tends to recur after incomplete surgical resection and has malignant potential. We report the case of a patient with a ruptured biliary cystadenoma in the ...

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Hematochezia caused by eosinophilic proctocolitis in a newborn before oral feeding: a case report

Hematochezia is a frequent symptom in early infancy. However, it occurs very rarely within the immediate neonatal period, and its occurrence before any oral intake is particularly rare. Because of the "congeni...

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Primary tuberculosis of cystic duct lymph node

Tuberculosis (TC) is very common and significant cause of morbidity and mortality worldwide. Isolated cystic duct lymph node TC cases without involvement of gallbladder are exceedingly rare. It is difficult to diagnose preoperatively because of lack of characteristic signs and symptoms of TC. We report a man aged 45 years who presented with right upper abdominal pain since 1week. It was associated with nausea and postprandial fullness. There was no evidence of jaundice and lymphadenopathy. Abdominal examination showed moderate right upper quadrant tenderness with positive Murphy's sign and splenomegaly but no signs of peritonism. Abdomen ultrasound revealed sludge in gallbladder, dilated pancreatic duct, coarse exotexture of liver, splenomegaly and no lymphadenopathy. He underwent laparoscopic cholecystectomy; histological report showed chronic caseating granulomatous lymphadenitis with Langhans type of giant cells in lymph node near cystic duct with chronic cholecystitis of gallbladder. Standard antituberculosis therapy was given for 12 months.

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Renal capillary haemangioma associated with renal cell carcinoma and polycythaemia in acquired cystic disease

Capillary haemangiomas are relatively common tumours, typically occurring in the subcutaneous tissue during childhood. However, visceral occurrence is very rare. These tumours make up a subset of vascular lesions that have previously, although rarely, been described in case reports in association with the kidney. Here we review the literature and describe a capillary haemangioma occurring in the renal hilum found to be coexistent with end-stage renal disease, renal cell carcinoma and polycythaemia. To our knowledge, this is the first case report to describe the occurrence of this tumour in the renal hilum in association with this constitution of renal pathologies.

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Ultrasound B scan: a simple tool to simplify the diagnosis

Description

Case 1: Posterior segment ultrasonography for a patient with total cataract shows a well defined mushroom-shaped mass arising from the choroid with underlying excavation. Surrounding choroid was normal; the dimensions were 6.9 mm in basal diameter and 9.3 mm in vertical height. As the ultrasonic waves pass through the mass there is progressive decrease in amplitude of the wave due to the homogeneous mass inside known as 'Positive angle kappa' (figure 1A). These findings are typically suggestive of a medium-sized choroidal melanoma.

Figure 1

(A) A well defined mass arising from the choroid having a high amplitude initial spike followed by progressive decline in the size of the amplitude (known as positive kappa angle) (red arrow) along with underlying choroidal excavation (yellow arrow) suggests choroidal melanoma. (B)Dome shaped, broad mounts extending from the periphery till the equator touching each other at the centre suggests a kissing choroidal detachment (red arrow)....

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Cutaneous Neurofibroma of the Lacrimal Caruncule: A Case Report

We describe the case of a neurofibroma on the lacrimal caruncle of a female patient with neurofibromatosis type 1 (NF1). NF1 is an autosomal dominant genetic disease with a wide variety of clinical manifestations, one of the most common of which is neurofibroma. The lesion was removed surgically under general anesthesia and sent to histopathological analysis, which confirmed the clinical diagnosis of a neurofibroma.
Case Rep Ophthalmol 2017;8:358–361

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Peripheral Retinal Neovascularization with Vitreous Hemorrhage in HIV Retinopathy

We report a case of peripheral retinal neovascularization and vitreous hemorrhage in the setting of HIV retinopathy that can serve to extend the clinical spectrum of this condition. A 53-year-old African-American woman with AIDS was referred for decreased vision in the left eye and was found to have peripheral retinal neovascularization and vitreous hemorrhage. She had a workup that was negative for etiologies of retinal ischemia. Peripheral laser photocoagulation was used to treat areas of nonperfusion. To our knowledge, this is the first reported case of peripheral retinal neovascularization and vitreous hemorrhage in the setting of HIV retinopathy, and it can serve to extend the clinical spectrum of this condition.
Case Rep Ophthalmol 2017;8:353–357

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