Performance and impact of an airway management team launched during the COVID-19 pandemic.

Purpose: To determine the performance and impact of an airway management team (AMT) assembled during the COVID-19 pandemic.

Methods: We conducted a retrospective cohort review of all adult patients who had received airway management services from the AMT (n = 269) and administered a survey questionnaire targeting physicians who had the option to activate the AMT (n = 77). The retrospective review determined the performance of the AMT, and the physicians' survey evaluated the impact of the AMT.

The effects of adding local infiltration analgesia of the knee to a multimodal pain protocol for total arthroplasty: A matched pair retrospective study.

: We hypothesize that the addition of local infiltration analgesia (LIA) to a multimodal pain protocol will reduce the total amount of opioids consumed for acute pain control post total knee arthrolplasty (TKA). : This study was a retrospective, matched pair study including patients who had primary TKA. All patients included in the analysis had preoperative oral celecoxib and acetaminophen, had single-dose spinal anesthetic with intrathecal morphine, and had intravenous patient-controlled analgesia with an opioid agent in addition to gabapentin and celecoxib in the first 48 h.

Pre-operative biomarkers and imaging tests as predictors of post-operative delirium in non-cardiac surgical patients: a systematic review.

Background: Post-operative delirium (POD) is a common post-operative complication in elderly individuals and imposes a significant health and financial burden. Identifying predictive biomarkers may help understand the pathophysiology of POD. Our objective is to summarize the evidence of pre-operative biomarkers and imaging tests to predict POD in patients undergoing non-cardiac surgery.

40-Hz ASSR for Measuring Depth of Anaesthesia During Induction Phase.

This paper proposes an anaesthesia monitoring system that accurately measures the depth of anaesthesia through 40-Hz auditory steady-state response. With accurate and fast depth of anaesthesia measuring, the monitor can reduce the incidence of awareness during surgical operation. The proposed denoising method for extracting 40-Hz auditory steady-state cycles, adaptive multilevel wavelet denoising, enabled the system to extract auditory steady-state response cycles from fewer epochs and over short periods of time which is of crucial importance in monitoring anaesthesia.

Tranexamic acid administration to older patients undergoing primary total hip arthroplasty conserves hemoglobin and reduces blood loss.

Background: Tranexamic acid effects in older people are difficult to predict. This study investigated the following research questions: 1) Is tranexamic acid effective in older patients undergoing primary total hip arthroplasty (THA)? and 2) Is there a difference in the effect of tranexamic acid between younger and older patients?

Methods: This was a 2-phase retrospective matched-pair study of patients who underwent THA in 2007-2013. All procedures were performed by surgeons with at least 10 years' experience as senior consultant.

Ultrasound guided transversus abdominis plane vs surgeon administered intraoperative regional field infiltration with bupivacaine for early postoperative pain control in children undergoing open pyeloplasty.

Purpose: Regional analgesic techniques are commonly used in pediatric urology. Ultrasound guided transversus abdominis plane block has recently gained popularity. However, there is a paucity of information supporting a benefit over regional field infiltration.

Continuous infraclavicular brachial plexus blockade: effect on survival of replanted digits.

In replantation surgery, the use of continuous brachial plexus blockade (CBPB) is popular as it improves postoperative analgesia and vascular flow. The aim of our study was to determine whether CBPB may affect the odds of survivability of replanted digit(s). A four-year retrospective chart review was performed and various parameters affecting replant survival were examined.

Effects of aging and propofol on the cardiovascular component of the autonomic nervous system.

Study Objectives: To determine the combined effects of aging and propofol on autonomic nervous system activity using heart rate variability (HRV) analysis.

Design: Prospective, two-parallel group, repeated-measures study.

Setting: Operating room of an academic hospital.

Can ultrasound of the tibial nerve detect diabetic peripheral neuropathy? A cross-sectional study.

Objective: Peripheral nerve imaging by portable ultrasound (US) may serve as a noninvasive and lower-cost alternative to nerve conduction studies (NCS) for diagnosis and staging of diabetic sensorimotor polyneuropathy (DSP). We aimed to examine the association between the size of the posterior tibial nerve (PTN) and the presence and severity of DSP.

Research Design And Methods: We performed a cross-sectional study of 98 consecutive diabetic patients classified by NCS as subjects with DSP or control subjects.

Protecting the brain during neurosurgical procedures: strategies that can work.

Purpose Of Review: The quest for neuroprotection strategies during periods of neuronal vulnerability persists despite decades of basic and clinical research. This review will focus on the latest developments in the area of clinical brain protection with the major emphasis on strategies that can be beneficial during neurosurgical procedures.

Recent Findings: Brain protection in neurosurgical patients may be achieved by nonpharmacological and pharmacological strategies.

Spectral features of electroencephalogram in characterizing various brain states under anesthesia.

The administration of the anesthetic agents is known to alter the electroencephalogram (EEG) signal significantly with the brain being their primary target. In this study, we analyzed the EEG recorded from six ASA I/II patients undergoing a 1-2 hour surgery. The EEG was collected before and during induction, maintenance and recovery of anesthesia using the 10/20 lead-system.

Topical Tranexamic Acid to Reduce Postoperative Blood Loss in Total Knee Arthroplasty.

Introduction: Total knee arthroplasty alleviates pain and restores function in patients with osteoarthritis of the knee, but it is associated with postoperative blood loss resulting in anemia and allogeneic blood transfusion in 10% to 38% of patients.

Step 1 Prepare Solution: Prepare tranexamic acid solution using aseptic technique.

Step 2 Apply Solution: Apply tranexamic acid solution to the open joint and soft-tissue surfaces.

Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial.

Background: Topical application of tranexamic acid to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications. The objective of the present trial was to assess the efficacy and safety of the topical application of tranexamic acid on postoperative blood loss in patients undergoing primary unilateral total knee arthroplasty with cement.

Methods: In a prospective, double-blind, placebo-controlled trial, 124 patients were randomized to receive 1.

Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs.

Background And Objectives: Intraneural injection can be seen as nerve expansion during ultrasound-guided regional anesthesia. The purpose of this animal study was to determine if nerve expansion seen on ultrasound during intraneural injection results in nerve injury.

Methods: Ten pigs underwent general anesthesia for this randomized control study.

Improved esophageal patency when inserting the ProSeal laryngeal mask airway with an Eschmann tracheal tube introducer.

Purpose: We hypothesized that a more accurate alignment of the tip of the drain tube with the upper esophageal opening would be achieved in adult patients, as confirmed by fibreoptic bronchoscopy, by placing the ProSeal laryngeal mask airway (PLMA) by means of guiding it over an Eschmann tracheal tube introducer, commonly know as a gum elastic bougie (GEB), that was previously inserted into the esophagus, rather than by placing the PLMA with a curved metal introducer (IT).

Methods: Seventy-five adult elective surgery patients, whose airway management involved a PLMA, were randomly allocated to either the GEB- or IT-guided techniques. After inserting the PLMA, alignment of the tip of the drain tube relative to the esophageal opening was verified by a fibrescope introduced through the drain tube.

Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block.

Background And Objectives: The aim of this study was to determine the minimum effective anesthetic volume required to produce an effective supraclavicular block for surgical anesthesia using an ultrasound (US)-guided technique.

Methods: Twenty-one adults undergoing elective upper limb surgery received a US-guided supraclavicular block. The initial volume of local anesthetic (LA; 50:50 mixture of lidocaine 2% and bupivacaine 0.

Tranexamic Acid reduces perioperative blood loss in adult patients having spinal fusion surgery.

Background: Spinal reconstructive surgery in adults can be associated with significant blood loss, often requiring allogeneic blood transfusion. The objective of this randomized, prospective, double-blind, multicenter study was to evaluate the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss and transfusion in adult patients having elective posterior thoracic/lumbar instrumented spinal fusion surgery.

Methods: One hundred fifty-one adult patients were randomized to receive either a bolus of 10 mg/kg IV of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr of TXA, or an equivalent volume of placebo (normal saline).

Practice patterns related to block selection, nerve localization and risk disclosure: a survey of the American Society of Regional Anesthesia and Pain Medicine.

Background And Objectives: We aimed to identify current clinical practice patterns among members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) members that relate to complications of regional anesthesia (RA).

Methods: Invitations were posted to the 3,732 ASRA members, to participate in our survey. Members were asked to report the types and numbers of blocks performed annually, preferred nerve localization techniques, and routine risk disclosure practices prior to common neuraxial (NAB) and peripheral nerve (PNB) block techniques.

Evolution of ultrasound guided axillary brachial plexus blockade: retrospective analysis of 662 blocks.

Purpose: Ultrasound (US) is being used increasingly to guide needle placement during axillary brachial plexus blockade (AXB). This retrospective study investigated whether US guidance can increase the success rate, decrease block onset time, and reduce local anesthetic (LA) volume for AXB compared to a traditional (TRAD) approach, namely, peripheral nerve stimulation (PNS) and transarterial (TA) techniques.

Methods: The anesthetic records, operative reports, discharge summaries, and surgical consultation notes of all patients who had undergone AXB for surgical anesthesia at the Toronto Western Hospital, between October 2003 and November 2006 were, retrospectively reviewed for evidence of block success and associated complications.

Mechanisms of morphine enhancement of spontaneous seizure activity.

Background: High-dose opioid therapy can precipitate seizures; however, the mechanism of such a dangerous adverse effect remains poorly understood. The aim of our study was to determine whether the neuroexcitatory activity of high-dose morphine is mediated by selective stimulation of opioid receptors.

Methods: Mice hippocampi were resected intact and bathed in low magnesium artificial cerebrospinal fluid to induce spontaneous seizure-like events recorded from CA1 neurons.

Management of the airway in patients undergoing cervical spine surgery.

The perioperative management of the airway in patients with cervical spine disease requires careful consideration. In an observational prospective cohort study, we assessed the preoperative factors that may have influenced the anesthesiologists' choice for the technique of intubation and the incidence of postoperative airway complications. We recorded information from 327 patients: mean (+/-SD) age 51+/-15 year, 138 females and 189 males, for anterior surgical approach (n=195) and posterior (n=132).

Myelination of congenitally dysmyelinated spinal cord axons by adult neural precursor cells results in formation of nodes of Ranvier and improved axonal conduction.

Emerging evidence suggests that cell-based remyelination strategies may be a feasible therapeutic approach for CNS diseases characterized by myelin deficiency as a result of trauma, congenital anomalies, or diseases. Although experimental demyelination models targeted at the transient elimination of oligodendrocytes have suggested that transplantation-based remyelination can partially restore axonal molecular structure and function, it is not clear whether such therapeutic approaches can be used to achieve functional remyelination in models associated with long-term, irreversible myelin deficiency. In this study, we transplanted adult neural precursor cells (aNPCs) from the brain of adult transgenic mice into the spinal cords of adult Shiverer (shi/shi) mice, which lack compact CNS myelin.

Neurological complications after regional anesthesia: contemporary estimates of risk.

Background: Regional anesthesia (RA) provides excellent anesthesia and analgesia for many surgical procedures. Anesthesiologists and patients must understand the risks in addition to the benefits of RA to make an informed choice of anesthetic technique. Many studies that have investigated neurological complications after RA are dated, and do not reflect the increasing indications and applications of RA nor the advances in training and techniques.

Disclosure of risks associated with regional anesthesia: a survey of academic regional anesthesiologists.

Background And Objectives: In view of the relatively few large studies available to estimate the rates of complications following regional anesthesia, we aimed to identify and quantify the risks that academic regional anesthesiologists and regional anesthesia fellows disclose to their patients before performing central and peripheral nerve blockade.

Methods: We asked 23 North American regional anesthesia fellowship program directors to distribute a questionnaire to the regional anesthesiologists and regional anesthesia fellows at their institutions. The questionnaire was designed to capture the risks and corresponding incidences that are routinely disclosed to patients before performing the most common central and peripheral nerve block techniques.