August2014The August issue of Anesthesia & Analgesia has just posted.

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

Ding and colleagues (Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study) at Peking Union Medical Center found that epidural anesthesia decreased the risk of postpartum depression. In their accompanying editorial Wisner and colleagues (Double Duty: Does Epidural Labor Analgesia Reduce Both Pain and Postpartum Depression?) explain how epidural analgesia reduces biological and psychosocial mediators of chronic pain and depression. These results extend the growing literature showing long-term benefits for parturients who receive epidural analgesia for labor and delivery.

Todd and colleagues (The Implementation of Quantitative Electromyographic Neuromuscular Monitoring in an Academic Anesthesia Department) at the University of Iowa document a decreased incidence of inadequate reversal of neuromuscular blockade after instituting a program combining quantitative neuromuscular monitoring with education on the need for adequate reversal of neuromuscular blockade. The accompanying editorial by Dutton and Donati (A Twitch in Time) emphasizes the link between institutional culture and acceptance of best practices.

A meta-analysis by Mishriky and Habib from Duke University (Nicotine for Postoperative Analgesia: A Systematic Review and Meta-Analysis) examined nicotine for postoperative analgesia. The authors found that an initially highly positive study demonstrating nicotine analgesia was not supported by subsequent studies. In their accompany editorial, Flood and Damaj (Nicotine Is Out: Nicotinic Agonists May Have Utility as Analgesics), conclude that “nicotine is out” as a potential analgesic adjuvant. Dr. Flood, who hammers the final nail in the coffin of perioperative nicotine analgesia, is the investigator who initially found such promising results. If only science always worked this way!

Sahinovic and colleagues (Accuracy of the Composite Variability Index as a Measure of the Balance Between Nociception and Antinociception During Anesthesia) from University Medical Center Groningen compared the Composite Variability Index, an EEG-based metric of antinociception, with the Bispectral Index, developed to assess hypnosis. The Composite Variability Index predicted response to stimulation more accurately than BIS. The accompanying editorial by Sleigh and Sanders (Intraoperative Analgesic Titration: The Hunting of the Snark) offers a startling interpretation of the findings: propofol may amplify the analgesic effects of remifentanil. The editorial points out that this interpretation of the data merits prospective assessment in adequate and well controlled clinical trials.

Naveen Nathan, MD, Cover Editor and Illustrator:

The Birth of Melancholia (35cm by 28cm, acrylic and wax color on board) was created to illuminate the darkest adaptations of a post-partum reality.  For some,  the most romanticized version of childbirth mutates into dense saturations of despondency. The afterglow of childbirth is replaced by the wistful spirit of one who has lost the sanctuary of coherence. As all the order of linear thought disarticulates into inexplicable guilt and self-loathing, women are far too often left to languish as prisoners of their own minds. A host of metaphors and allusions is meant to capture this disharmony, the most subtle of which includes hidden pharmacophores known to influence mood disorders. Fragments of biogenic amines and steroidal hormones can be found woven into the web that binds the mask to the figure.  Readers of this journal likely have a comfort zone defined by the amelioration of physical pain. We are now encouraged to expand our intellectual orbit such that our patients’ emotional suffering may yet someday meet with its conquest.