• Despite being the subject of more than 4,000 publications (according to PubMed), two decades of study using the best tools in molecular biology, and previous collections in Anesthesia & Analgesia, malignant hyperthermia (MH) remains a mysterious disease. As described in an editorial by Dr. Jerome Parness (Hot on the Trail of “I Know it When I See It!), we have only identified two of the five genes associated with MH: the type 1 ryanodine receptor, and the skeletal muscle isoform of the dihydropyridine receptor. Many aspects of the clinical presentation, diagnostic testing, and even the basic genetics remain unknown. Five papers on MH in this issue of the Journal address some of these unknowns.
• Subramaniam and colleagues (Increased Glycemic Variability in Patients with Elevated Preoperative Hba1C Predicts Adverse Outcomes Following Cardiac Surgery) found that postoperative glycemic variability increased the risks of major adverse events following cardiac surgery. Elevated preoperative HbA1C identified patients at risk for elevated postoperative glycemic variability, and may prove useful for identifying patients who would benefit from increased glycemic control.
• In a meta-analysis on the use of hydrocortisone therapy in septic shock, Wang and colleagues (Low-dose Hydrocortisone Therapy Attenuates Septic Shock in Adult Patients but Does Not Reduce 28-day Mortality: a Meta-analysis of Randomized Controlled Trial) demonstrated that even though steroids ameliorated the symptoms of shock at 7 and 28 days, there was no effect on 28-day mortality.
• Memtsoudis and colleagues (The Impact of Sleep Apnea on Postoperative Utilization of Resources and Adverse Outcomes) looked at the relationship between sleep apnea and adverse postoperative outcomes in more than 500,000 orthopedic patients from approximately 400 United States institutions. Sleep apnea increased the risk of pulmonary complications (RR=1.86), cardiac complications (RR=1.59), and considerably increased resource utilization. In their accompanying editorial, Chung and Mokhlesi (Postoperative Complications Associated with Obstructive Sleep Apnea: Time to Wake Up!) observe that this rate of complications provides strong evidence that we need better guidelines for improving the care of patients with sleep apnea.
On the Cover
Without warning the sleeping menace awakens. Malignant hyperthermia is amongst the most formidable clinical crises to be contended with in the operating room. On this month’s cover we peer down from the cytosol into the sarcoplasmic reticulum through the recoiling subunit gates of an incensed ryanodine receptor. what ensues is well known to us: a powerful and unbridled release of calcium that will send skeletal muscle into a state of metabolic overdrive. This month’s issue aims to further illuminate what we know about this dreadful foe.