The connection between Dr. Harold Griffith and Richard Gill: new insights into the history of curare use in anesthesia from previously unknown correspondence.

Dr. Harold R. Griffith and Richard C.

Migration of an Inferior Vena Cava Tumor Thrombus during Renal Cell Carcinoma Resection.

Approximately 4%-10% of patients with renal cell carcinoma (RCC) have tumoral vascular invasion with resultant thrombi in the renal vein and in the inferior vena cava (IVC). The authors describe an interesting case of IVC tumor thrombus that migrated to the right cardiac chambers during RCC resection. The diagnosis was made by intraoperative transesophageal echocardiography (TEE), which revealed the presence of a free-floating thrombus between the right atrium (RA) and right ventricle (RV).

Postoperative hypotonia in a patient with stiff person syndrome: a case report and literature review.

Purpose: Stiff person syndrome (SPS), an autoimmune disease that manifests with episodic muscle rigidity and spasms, has anesthetic considerations because postoperative hypotonia may occur. This hypotonia has been linked to muscle relaxants and volatile anesthetics and may persist in spite of neostigmine administration and train-of-four (TOF) monitoring suggesting full reversal. We present a patient with SPS who experienced hypotonia following total intravenous anesthesia (TIVA), which was promptly reversed with sugammadex.

Opioid-receptor antagonism increases pain and decreases pleasure in obese and non-obese individuals.

Rationale: Endogenous opioids inhibit nociceptive processing and promote the experience of pleasure. It has been proposed that pain and pleasure lie at opposite ends of an affective spectrum, but the relationship between pain and pleasure and the role of opioids in mediating this relationship has not been tested.

Objectives: Here, we used obese individuals as a model of a dysfunctional opioid system to assess the role of the endogenous opioid peptide, beta-endorphin, on pain and pleasure sensitivity.

Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis.

Purpose: Takotsubo cardiomyopathy (TC) is described as transient ventricular dysfunction following emotional or physical trauma. A few reports have described patients with TC in association with various circumstances of thyrotoxicosis. We report an unusual case of TC in a patient with a large retrosternal goiter and normal thyroid function.

Epidural blood patch in a patient with multiple sclerosis: is it safe?

Purpose: Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system resulting in demyelination and axonal injury. Epidural blood patch (EBP) to treat postdural puncture headache (PDPH) in an MS patient may be of concern because of the potential for this to interfere with axonal conduction. Even with normal axons, pressure can interfere with impulse conduction, and it is unknown whether affected axons of the MS patient are particularly vulnerable to the increase in epidural pressure that occurs as a consequence of the EBP.

Montreal's contribution to the Quebec anesthesia workforce: a comparison between anesthesia residents trained at McGill University and those trained at Université de Montréal.

Purpose: Alumni from McGill University (MAA) and alumni from Université de Montréal (UMA) anesthesia residency programs were compared with regard to demographic characteristics and practice location.

Methods: McGill University alumni and UMA (1990-2010) were studied according to age, sex, pre-anesthesia education, fellowship training, advanced research training, and practice location. Logistic regression analysis of demographics in relation to practice location was performed.

Combined heart and liver transplantation on cardiopulmonary bypass: report of four cases.

Purpose: Combined heart and liver transplant is a rare procedure to treat end-stage cardiac and liver disease. First performed during cardiopulmonary bypass and anticoagulation, subsequent concerns about increased bleeding changed the strategy to performing liver implantation following separation from cardiopulmonary bypass. Considering the overall decrease in transfusion requirements during liver transplant and the potential benefits to the transplanted heart to remain on cardiopulmonary bypass during liver implantation, we revised the strategy for combined heart and liver transplant.

Case report: nasotracheal intubation--look before leaping to assess the laryngeal view.

Purpose: To describe an airway management plan, including oral to nasal endotracheal tube exchange, when nasal intubation is required in the unanticipated difficult airway.

Clinical Features: A nasal intubation was required for a patient undergoing oropharyngeal surgery. Following loss of consciousness and paralysis, a Cormack-Lehane class 3 view was obtained, and pressure over the thyroid cartilage failed to reveal the vocal cords.

Nail-Patella syndrome: a case report and anesthetic implications.

Purpose: To report a case of asystole during combined epidural and general anesthesia occurring in a patient with Nail-Patella syndrome (NPS), and to review the management and anesthetic implications of this rare genetic syndrome.

Clinical Features: A 64-yr-old male with NPS, renal impairment and coronary artery disease presented for right hemicolectomy for colon cancer. Following initiation of surgery and during insertion of a nasogastric tube there was sudden loss of the patient's pulse oxymetry, and arterial pressure waveforms with an asystolic electrocardiogram signal.

Effect of laparoscopic versus open gastric bypass surgery on postoperative pain and bowel function.

Background: This study was designed to assess postoperative pain and bowel function in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGBP) performed either by open or laparoscopic technique.

Methods: We prospectively studied patients scheduled for RYGBP between July 2002 and June 2003. Patients were assigned to the laparoscopic or open procedure by one surgeon.

Cortical processing of complex auditory stimuli during alterations of consciousness with the general anesthetic propofol.

Background: The extent to which complex auditory stimuli are processed and differentiated during general anesthesia is unknown. The authors used blood oxygenation level-dependent functional magnetic resonance imaging to examine the processing words (10 per period; compared with scrambled words) and nonspeech human vocal sounds (10 per period; compared with environmental sounds) during propofol anesthesia.

Methods: Seven healthy subjects were tested.

Upper airway compromise secondary to edema in Graves' disease.

Purpose: We report an unusual case of upper airway compromise in a patient with Graves' disease. We speculate that this complication may be due, in part, to poorly controlled hyperthyroidism.

Clinical Features: A 26-yr-old female suffering from Graves' disease underwent a total thyroidectomy.

Brain imaging in research on anesthetic mechanisms: studies with propofol.

Brain imaging helps to refine our understanding of the anesthetic effect and is providing novel information that result in the formulation of hypotheses. They have shown that anesthetics act on specific structures that have been known to be important for consciousness at large. They have also helped to show that anesthetics act on specific structures regionally, rather than being non-specific, general depressant of the central nervous system (CNS).

Decreased heart rate and blood pressure in a recent cardiac transplant patient after spinal anesthesia.

Purpose: To describe the cardiovascular effects of neuraxial blockade in a heart transplant patient.

Clinical Features: A 69-yr-old 70-kg male underwent orthotopic heart transplant (bicaval anastomosis technique) for ischemic cardiomyopathy. Five months after transplantation, the patient underwent a transurethral bladder tumour resection under spinal anesthesia.

Autonomic nervous system response to epidural analgesia in laboring patients by wavelet transform of heart rate and blood pressure variability.

Background: Epidurals are effective in relieving labor pain but result in a sympathectomy that may compromise maternal hemodynamic stability and fetal perfusion. Decreases in blood pressure and heart rate can be corrected, but markers of autonomic activity would be useful to predict and prevent such changes. The goal of this study was to find markers describing the changes in autonomic nervous system activity with epidural anesthesia in laboring patients.