oct2 smallThe October issue of Anesthesia & Analgesia has just posted.

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

You transfuse platelets into your thrombocytopenic patient prior to an invasive procedure. According to Dr. Thomas Kander and colleagues at Skåne University Hospital in Sweden (The Effect and Duration of Prophylactic Platelet Transfusions Before Insertion of a Central Venous Catheter in Patients with Bone Marrow Failure Evaluated with Point-of-Care Methods and Flow Cytometry), the transfusion improves measures of coagulation for 1 to 4 hours. As Aryeh Shander and Terry Gernsheimer observe in the accompanying editorial (Are We Begging a Question or Begging an Answer?), there is no doubt that platelet transfusions improve measurements of coagulation profile. It is less clear how these measurements translate into reductions in clinically significant bleeding.

Anesthesiologists are increasingly responsible for procedural sedation throughout modern hospitals. Dr. Paul Niklewski and colleagues from Ethicon Endo Surgery (A Novel Index of Hypoxemia for Assessment of Risk During Procedural Sedation) offer evidence validating the use of AUCdesat, the total area under 90% arterial oxygen saturation, as a measure of the hypoxic risks of sedation.

Is long QT syndrome still a problem with modern anesthetics? Dr. Simon Whyte and colleagues from British Columbia Children’s Hospital (The Safety of Modern Anesthesia for Children with Long QT Syndrome) conducted a multicenter review of 103 children with long QT syndrome. Torsades de pointes was only seen in 5 neonates or infants, all undergoing pacemaker or defibrillator placement for long QT syndrome. There was no association with anesthesia.

Naveen Nathan, MD, Cover Editor and Illustrator:

The cover photograph is meant to symbolize the stark contrast between the highly technical models that describe front-end kinetics of intravenous anesthetic infusions, and their immersion in highly dynamic, real-world scenarios. Despite the extraordinarily elegant descriptions that characterize the rise to steady-state plasma and effect-site propofol concentrations, the sands of time do indeed funnel towards a critical sinkhole at the bottom of which lies the syndrome of airway obstruction. This month the journal offers yet another vantage point to reflect on our understanding of this unwelcome relationship.