Short-duration hyperoxia causes genotoxicity in mouse lungs: protection by volatile anesthetic isoflurane.

High concentrations of oxygen (hyperoxia) are routinely used during anesthesia, and supplemental oxygen is also administered in connection with several other clinical conditions. Although prolonged hyperoxia is known to cause acute lung injury (ALI), whether short-duration hyperoxia causes lung toxicity remains unknown. We exposed mice to room air (RA or 21% O) or 60% oxygen alone or in combination with 2% isoflurane for 2 h and determined the expression of oxidative stress marker genes, DNA damage and DNA repair genes, and expression of cell cycle regulatory proteins using quantitative PCR and Western analyses.

Rate-Dependent Left Bundle Branch Block in an Ambulatory Surgery Patient: A Case Report.

A 52-year-old woman, ASA II (American Society of Anesthesia classification II) scheduled for cholecystectomy in an ambulatory center, exhibited a wide-complex tachycardia with ectopy on the monitor after induction with propofol and succinylcholine. Blood pressure remained stable; amiodarone was administered for presumed ventricular tachycardia. A 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) at 98 beats per minute (bpm), which resolved when the heart rate slowed.

Use of Prothrombin Complex Concentrate for Warfarin Reversal Before the Performance of an Epidural Blood Patch in a Patient With Cortical Vein Thrombosis and Subdural Hematoma: A Case Report.

Compared to conventional therapy, several studies with prothrombin complex concentrate (PCC) have recently demonstrated its superior efficacy in rapidly replacing vitamin K-dependent factors for patients with life-threatening hemorrhage. We present a novel use of PCC in a patient with intracranial hypotension, who had received warfarin for treatment of cortical vein thrombosis. However, after anticoagulation, she proceeded to develop bilateral subdural hematomas with descent of cerebellar tonsils.

Biphasic response of checkpoint control proteins in hyperoxia: exposure to lower levels of oxygen induces genome maintenance genes in experimental baboon BPD.

Breathing high concentrations of oxygen (hyperoxia) causes lung injury and is associated with lung diseases such as bronchopulmonary dysplasia (BPD), respiratory distress syndrome and persistent pulmonary hypertension of the newborns. Hyperoxia (95-100 %O2) causes DNA damage and growth arrest of lung cells and consequently cells die by apoptosis or necrosis. Although supplemental oxygen therapy is clinically important, the level and duration of hyperoxic exposure that would allow lung cells to reenter the cell cycle remains unclear.

Do residency applicants know what the ACGME core competencies are? One program's experience.

Purpose: To determine the degree of knowledge that medical students applying to the St. Luke's-Roosevelt Hospital Center anesthesiology residency program had regarding the core physician competencies mandated by the Accreditation Council for Graduate Medical Education.

Method: As a part of the department's annual resident-selection process, in the fall of 2008, 193 interviewed fourth-year U.

Pulmonary artery flow patterns after the Fontan procedure are predictive of postoperative complications.

Objective: Pulmonary artery (PA) flow reversal has been associated with poor outcome in patients with atriopulmonary (APC) and total cavopulmonary connection (TCPC) lateral tunnel (LT) Fontan modification. The authors studied PA flow after TCPC in relation to the incidence of early Fontan outcome and complications.

Design: A prospective observational study.

Thoracic paravertebral block for implantable cardioverter-defibrillator and laser lead extraction.

Implantable cardioverter defibrillators (ICDs) are routinely placed in the cardiac electrophysiology laboratory. Previously, these procedures were performed in the operating room during general anesthesia. In recent years, electrophysiologists have been performing these procedures using local anesthetics in conjunction with intravenous sedation.

Assessment of cerebral oxygen balance during deep hypothermic circulatory arrest by continuous jugular bulb venous saturation and near-infrared spectroscopy.

Objective: The purpose of this study was to compare jugular venous bulb saturation (SjvO(2)) and regional cerebral oximetry (rSO(2)) by near-infrared spectroscopy (NIRS) during procedures with deep hypothermic circulatory arrest (DHCA).

Design: Prospective observational study.

Setting: Academic hospital.

Anesthetic management of staged separation of craniopagus conjoined twins.

We present a case of successful separation of craniopagus conjoined twins. The procedure was staged to permit each child to develop adequate independent cerebral venous drainage and to prevent deleterious, perioperative cerebral edema. Surgical hemorrhage, blood product delivery, and hemodilution were minimized.

The postoperative cardiovascular arrest of a 5-year-old male: an initial presentation of Duchenne's muscular dystrophy.

Anesthesia may be administered to patients with Duchenne's muscular dystrophy, but cases are reported in which apparently healthy children suffer hyperkalemic cardiac arrest. We present the case of a 5-year-old boy whose muscular dystrophy was discovered following a fatal, perioperative cardiac arrest in the postanesthesia care unit.

Caudal anesthesia in pediatric cardiac surgery: does it affect outcome?

Objective: The purpose of this study was to examine the influence of caudal anesthesia on outcomes (pediatric intensive care unit [PICU] length of stay, hospital length of stay, ventilatory time, early extubation rate) in pediatric patients undergoing congenital heart disease repair requiring cardiopulmonary bypass (CPB).

Design: Retrospective.

Setting: University teaching hospital.

Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: a clinical series.

Background: Central venous cannulation can be particularly difficult in pediatric patients. Central line placement is associated with many well-known complications. While ultrasound-guided techniques are well established, the majority of central venous catheters are placed using landmark guidance.

A report of a case: anesthetic management of a parturient with severe thrombotic stenosis of a mechanical aortic valve--an exercise in coordination of subspecialties.

The pregnant woman with valvular heart disease presents significant challenges to the obstetric, anesthesiology, and cardiology teams. Although successful outcomes for both mother and fetus are possible with coordinated medical care, the patient with a prosthetic valve who requires systemic anticoagulation provides a dilemma of insufficient anticoagulation leading to valve thrombosis versus the risks of maternal perinatal hemorrhage or fetal effects from oral or parenteral anticoagulants. This case report describes the peripartum management of a patient at 27 weeks' gestation with thrombus on a prosthetic aortic valve.

Selective use of off-pump coronary bypass surgery reduces mortality and neurologic morbidity associated with high-risk coronary bypass surgery: a 400-case comparative experience.

The frequency of use of off-pump coronary artery bypass (CAB) surgery to surgically treat coronary artery disease has varied greatly from center to center and from surgeon to surgeon because of preference, training, and experience. We report an experience with 400 consecutive isolated CAB procedures selectively managed with on-pump or off-pump surgery, according to the perceived potential for aortic embolization or stroke as determined by clinical and imaging determinations. The off-pump CAB group (46 patients) was 7.

Arterial versus venous sampling for activated coagulation time measurements during cardiac surgery: a comparative study.

Objective: Activated coagulation times (ACTs) are widely used for monitoring anticoagulation during cardiac surgery. Significant variability of this test is well known. Variability in test results was studied, which may arise from the sample drawing site.