pulseox3This issue contains a collection of 10 manuscripts arising out of the 2012 Innovations and Applications of Monitoring, Perfusion, Oxygenation, and Ventilation (IAMPOV) symposium, jointly sponsored by the Society for Technology in Anesthesia (an affiliate of Anesthesia & Analgesia), the Center for Devices and Radiological Health at the Food and Drug Administration, and the Department of Anesthesiology at the Yale School of Medicine.   Topics include cerebral oximetry in hypoxia (Factors Affecting the Performance of 5 Cerebral Oximeters During Hypoxia in Healthy Volunteers), tissue oximetry (Direct Pulse Oximetry Within the Esophagus, on the Surface of Abdominal Viscera, and on Free Flaps), measuring oxygen tension in the mitochondrion (Special Article: Measuring Mitochondrial Oxygen Tension: From Basic Principles to Application in Humans), the accuracy of co-oximetry in detecting carboxyhemoglobin (Accuracy of Carboxyhemoglobin Detection by Pulse CO-Oximetry During Hypoxemia), measuring ventilation using photoplethysmography (Special Article: Respiration Signals from Photoplethysmography), the use of electrical impedance tomography to monitor the brain following head trauma (Intracranial Electrical Impedance Tomography: A Method of Continuous Monitoring in an Animal Model of Head Trauma), and the possibility of using mobile phone computing power to bring critical monitors of vital signs to the developing world (Special Article: Universal Access to Essential Vital Signs Monitoring).

•Using 1998 through 2008 data from the National Inpatient Sample, Bauer and colleagues (Maternal Sepsis Mortality and Morbidity During Hospitalization for Delivery: Temporal Trends and Independent Associations for Severe Sepsis) determined that maternal sepsis occurred in approximately 1 of 11,000 deliveries, and parturients died from sepsis in approximately 1 of 100,000 deliveries. The incidence of severe sepsis and sepsis-related death increased during the study period. Risk factors included congestive heart failure, chronic liver disease, chronic renal disease, systemic lupus erythematous, and rescue cerclage placement.

• Statins help everything, right? Argalious and colleagues (The Association of Preoperative Statin Use and Acute Kidney Injury After Noncardiac Surgery) examined the records of 28,508 patients in the Cleveland Clinic Main Campus database, and found that perioperative use of statins had no effect on the incidence of kidney injury, dialysis, or mortality.

•Friesen and colleagues (The Hemodynamic Response to Dexmedetomidine Loading Dose in Children With and Without Pulmonary Hypertension) at Children’s Hospital Colorado found that dexmedetomidine does not significantly alter pulmonary vascular resistance in children with pulmonary hypertension. Dexmedetomidine causes similar increases in vascular tone and blood pressure in children with and without pulmonary hypertension.

Naveen Nathan MD, Cover Editor and Illustrator: As technological advancement outpaces our capacity to wield it, we as anesthesiologists have witnessed the evolution of increasingly high-fidelity instruments in and out of the operating room. These monitors have been engineered to communicate the well-being of disinclined patients at the utter depths of their consciousness. Though we may celebrate our own ingenuity and marvel at the latest entries into our armamentarium of surveillance, this month’s cover portrays the simplest of ideas that has given rise to our most cardinal monitors: spectrophotometry. The exploitation of a molecule’s optical signature has allowed us to scrutinize the most fundamental physiologic and pharmacologic considerations. Deep within the erythrocyte and enveloped by spiraling alpha helices the heme molecule is no exception. As delocalized electrons between pyridine and iron relax towards equilibrium at a lower thermodynamic energy state, extinction coefficients conveniently located in the red and infrared range emerge. Nature’s design of the expansive conjugated porphyrin ring system has proven fortuitous indeed.