Dr. Steven Shafer, editor-in-chief, Anesthesia & Analgesia:
Laukkala and colleagues (Long-Term Psychosocial Outcomes after Intraoperative Awareness with Recall) compared the long-term psychological outcome of 9 patients with intraoperative awareness with matched cohort controls. The median follow-up was 17.2 years after the event. The authors found no indication of long-term adverse psychological sequelae. In their accompanying editorial, Mashour and Avidan (Psychological Trajectories after Intraoperative Awareness with Explicit Recall) note that we cannot tell whether these patients recovered from near-term consequences (e.g., PTSD), or were intrinsically resistant to psychological injury.
Yang and colleagues (A Prospective Evaluation of the Incidence of Adverse Events in Nurse-Administered Moderate Sedation Guided by Sedation Scores or Bispectral Index) studied the utility of BIS monitoring in nurse-administered midazolam sedation. The incidence of complications in both groups was so low that no benefit was seen. van Loon and colleagues (Capnography During Deep Sedation with Propofol by Nonanesthesiologists: A Randomized Controlled Trial) asked a similar question: whether capnometry decreases the incidence of adverse events with nurse-administered propofol sedation. They observed hypoxia in 25% of patients regardless of whether capnometry was used. As noted in the accompanying editorial by Rosow (Safety in Sedation by Nonanesthesiologists), it is the anesthetic technique (bolus propofol versus bolus midazolam) that accounts for these differences. Monitoring cannot compensate for improper use of IV sedatives.
Englberger and colleagues (A Novel Blood-Sparing Agent in Cardiac Surgery? First In-Patient Experience with the Synthetic Serine Protease Inhibitor MDCO-2010: A Phase II, Randomized, Double-Blind, Placebo-Controlled Study in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass) describe the first-in-patient study of MDCO-2010, a synthetic serine protease inhibitor with a mode of action similar to aprotinin. Blood loss and transfusion requirements were reduced in patients receiving MDCO- 2010. In their accompanying editorial, Faraoni and Levy (Development of a Novel Blood-Sparing Agent in Cardiac Surgery: Do We Need Another Agent?) note that a subsequent multicenter trial found increased adverse events in patients receiving MDCO-2010, and the sponsor has suspended further development.
Kurth and colleagues (National Pediatric Anesthesia Safety Quality Improvement Program in the United States) describe the “Wake-Up Safe” multi-institutional initiative of the Society for Pediatric Anesthesiology, in collaboration with the Anesthesia Patient Safety Foundation, to determine the rate of serious adverse events in pediatric anesthesia. The quality improvement database has grown to nearly 750,000 pediatric anesthetics. As described by Tjia and colleagues (Wake Up Safe and Root Cause Analysis: Quality Improvement in Pediatric Anesthesia), root cause analysis identifies serious adverse events in the Wake-Up Safe initiative. The rate of serious adverse events in the database is 1.4 per 1000 anesthetics.
Naveen Nathan, MD, Cover Editor and Illustrator:
There is arguably no work of art more recognizable and misunderstood than Grant Wood’s American Gothic. So amenable to parody is this work, many versions of which have graced the covers of everything from TIME magazine to cult horror films, that its true artistic value lies in its ability to reach such expansive latitudes of alternative representation. Herein is presented another reincarnation and one devoid of any frivolity and mirth. In fact the image conveys two alternate realities that evolve in the aftermath of intraoperative awareness and recall. Both figures have endured awareness under anesthesia. The woman, despite her look of consternation, represents a sense of resilience sufficient to overcome the psychological devastation of posttraumatic stress. The male figure, on the other hand, is held captive by it. An editorial by Drs. Mashour and Avidan offers an illuminating contextual framework for the cover article and all are encouraged to receive its lessons.