dragon smallThe September issue of Anesthesia & Analgesia has just posted.

Dr. Steven Shafer, editor-in-chief, Anesthesia & Analgesia:

Turan and colleagues (The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery) report that increased vitamin D concentrations were associated with a reduction in severe adverse perioperative outcomes in adult noncardiac surgical patients. Zaloga and Butterworth observe in their accompanying special article (Hypovitaminosis D in Hospitalized Patients: A Marker of Frailty or a Disease Requiring Treatment?) that low vitamin D concentrations are a marker for chronic disease, possibly explaining the association with poorer outcomes. Lest we be wimpy, Roizen and Roizen (Vitamin D and Your Patients: Don’t Accept Wimpy) call for a double-blind, randomized, controlled trial to directly determine if vitamin D supplementation reduces adverse outcomes. The recent umbrella review by Theodoratou and colleagues precludes optimism, because “highly convincing evidence of a clear role of vitamin D does not exist for any outcome.”.

Hydroxyethyl starch solutions remain controversial. Raghunathan and colleagues (Intravenous Starches: Is Suspension the Best Solution?) suggest that balanced salt solutions are the best default, reserving colloids for acute hypovolemia. Irwin and Gan (Volume Therapy with Hydroxyethyl Starches: Are We Throwing the Anesthesia Baby Out with the Intensive Care Unit Bathwater?) suggest that “the continued usage of HES 130/0.4 in the perioperative setting seems fully justified.” Bringing order to these disparate views, Weiskopf (Hydroxyethyl Starches: A Tale of Two Contexts: The Problem of Knowledge) points out that “hydroxyethyl starch” is a generic term encompassing distinct molecular entities, and that the risks and benefits demonstrated in one clinical context (e.g., critical care) may not inform other contexts (e.g., perioperative volume replacement).

Naveen Nathan, MD, Cover Editor and Illustrator:

The invaluable articles contained in this month’s journal observe the complex, multilateral interpretations of the literature related to outcomes between regional versus general anesthetic techniques. The Certainty of Doubt (51 cm X 76 cm acrylic and wax color on board) offers a tongue-in cheek impression of this perpetual contest. A reptilian conglomerate of strategically arranged general anesthetic equipment emerges from the shadows. Its adversary, armed with the mother of all epidural needles, lowers his weapon and sheds his shield in a state of reflection. He wonders if there can ever be a true winner in this duel.