April cover infection small

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

Recent news reports have highlighted the risks of nosocomial infection. Fourteen articles in this issue of Anesthesia & Analgesia document how anesthesiologists make a difference in perioperative infection. Research papers identify the reservoirs of bacterial contamination in the operating room, our role in hospital-acquired infections, and changes in anesthesia practice to reduce hospital-acquired infections.

Hamaekers and colleagues (Rescue Ventilation Through a Small-Bore Transtracheal Cannula in Severe Hypoxic Pigs Using Expiratory Ventilation Assistance) describe the ability of a novel device incorporating active support of expiration to facilitate transtracheal ventilation and restore oxygenation in pig model of airway obstruction with severe hypoxia.

Borkett and colleagues (A Phase IIa, Randomized, Double-Blind Study of Remimazolam (CNS 7056) Versus Midazolam for Sedation in Upper Gastrointestinal Endoscopy) from Paion UK Ltd report that a new benzodiazepine ester, remimazolam, produced rapid onset and offset of sedation for patients undergoing a diagnostic upper GI endoscopy.

Banergee and colleagues (EN3427: A Novel Cationic Aminoindane with Long-Acting Local Anesthetic Properties) at Endo Pharmaceuticals report on a novel TRP channel-mediated local anesthetic, EN3427, that combined with lidocaine produced ~ 24 hours of analgesia in rats. As noted by Berde in his editorial (Developing Better Local Anesthetics), better local anesthetics “could have an enormously positive impact on patient comfort, perioperative outcomes, including rehabilitation, and on the progression from acute to chronic pain.”

Naveen Nathan, MD, Cover Editor and Illustrator:

The most expansive gradient in the operating room is not that of end-organ perfusion pressure, core-to-ambient temperature or even the ascent to steady-state plasma drug concentration. It is that which graduates from the sanctity of the sterile environment to the hidden civilization of unicellular life that thrives amidst every groove, crevasse and ridge of the anesthetic workplace. Truly this is an inert workstation to us but a teeming metropolis to the masses hidden in plain sight. In our honorable roles as shepherds of our patients’ well-being, we unwittingly act as vessels that provide passage to every would-be symbiote, commensal and parasite to our defenseless host. A reminder of the exponent that defines their propagative potential should suffice to astound even the most dismissive mind.