Anesthesia & Analgesia's supplement for education and dialog

Paradoxical Air Embolism to Left Anterior Descending Artery in a Patient with ASD

The patient experiences profound hypotension after induction: quick, what’s your differential diagnosis?  Let’s also say the patient has a secundum atrial septal defect (ASD) that’s to be closed in the cardiac catheterization lab.  Is your differential diagnosis any different now? Dr. Dinesh Kumar, Department of Cardiac Thoracic & Vascular Anesthesia, Sri Chitra Tirunal Institute of(…)

Noninvasive measurement of hemoglobin and the effect of perfusion

Noninvasive monitoring has come a long way.  First there was blood pressure, followed by oximetry and end-tidal carbon dioxide.  Now there are many more noninvasive blood tests, including noninvasive hemoglobin measurement, monitored continuously via spectrophotometric finger sensors (Masimo Corporation, Irvine, California, SpHb).  What factors affect the accuracy of this device? Dr. Ronald D. Miller, Anesthesia(…)

Does anesthesia exposure for surgery for malignant disease affect the risk of malignancy after surgery?

Anesthetics are known to affect the immune response, yet recently in this journal it was shown that the risk of malignant disease within 5 years postoperatively could not be associated with the duration of general anesthesia and time with Bispectral Index (BIS) under 45 in patients without a history of malignancy.  What about patients with(…)

Dead space, alveolar CO2, and minute ventilation: a critical relationship for small children

Many of us may work in an area that is not designed specifically for the care of children undergoing anesthesia. In this setting it might prove tempting to use an adult breathing circuit.  Is this appropriate? How might it affect patient outcome? Drs. Matthew F. Pearsall and Jeffrey M. Feldman, General Anesthesia Division, Children’s Hospital(…)

Micromolar concentrations of dexamethasone diminish the efficiency of sugammadex

Sugammadex binds and inactivates the aminosteroid nondepolarizing muscle relaxants rocuronium and vecuronium. Sugammadex is available in 50 countries, but the United States is not one of them.  The US Food and Drug Administration turned down approval for the drug in 2008 because it sought more information concerning allergic reactions and bleeding events.  Approval was also(…)