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Cracking Open the Door on Perioperative Visual Loss Random ON THE COVER: The cover highlights perioperative visual loss – a rare but dreaded complication of spinal fusion surgery. Featured in this issue is a study assessing factors that might predict ischemic optic neu- ropathy (ION) in this setting using detailed data from the ASA Postoperative Visual Loss Registry. Retinal fundus image: David T. Miller, C.R.A., Wake Forest University Eye Center, Winston-Salem, North Carolina. ● Warner: Cracking Open the Door on Perioperative Visual Loss, p. 1 Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/116/1/A13/255543/0000542-201201000-00001.pdf by guest on 02 October 2021 ● The Postoperative Visual Loss Study Group: Risk Factors Associated with Ischemic Optic Neu- ropathy after Spinal Fusion Surgery, p. 15 ᭛ THIS MONTH IN ANESTHESIOLOGY 9A ᭜ EDITORIAL VIEWS Cracking Open the Door on Perioperative Visual Loss 1 Mark A. Warner Random Clinical Decisions: Identifying Variation in Perioperative Care 3 Sachin Kheterpal Ketamine: A Familiar Drug We Trust 6 Jaume Canet and Jorge Castillo Novel Oral Anticoagulants: New Challenges for Anesthesiologists in Bleeding Patients 9 Donat R. Spahn and Wolfgang Korte Sympathetic Nerve Blocks, Pragmatic Trials, and Responder Analysis 12 Navil F. Sethna and Charles B. Berde ■ PERIOPERATIVE MEDICINE ᭛᭜ Risk Factors Associated with Ischemic Optic Neuropathy after Spinal Fusion Surgery 15 The Postoperative Visual Loss Study Group Obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration were significantly and independently associated with the development of ischemic optic neuropathy after spinal fusion surgery in a multivariate model. ᭛ Refers to This Month in Anesthesiology See Supplemental Digital Content ᭜ Refers to Editorial Views CME Article CONTENTS ᭛᭜ Variation in the Practice of Preoperative Medical Consultation for Major Elective Noncardiac Surgery: A Population-based Study 25 Duminda N. Wijeysundera, Peter C. Austin, W. Scott Beattie, Janet E. Hux, and Andreas Laupacis Patients scheduled for major elective noncardiac surgery frequently undergo preoperative medical consultations. A population-based administrative database was used to conduct a cohort study of patients who underwent major elective noncardiac surgery between April 2004 and February 2009. Multilevel logistic regression models were used to identify patient-level and hospital-level predictors of consultation. Differences in rates across hospitals were large (range, 10 to 897 per 1,000 procedures), were not explained by surgical procedure volume or hospital teaching status, and persisted after adjustment for patient-level and surgery-level factors. Further research is needed to better understand the basis for this substantial interhospital variation, and to determine which patients benefit most from preoperative consultation. Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/116/1/A13/255543/0000542-201201000-00001.pdf by guest on 02 October 2021 ᭜ Ketamine Activates Breathing and Abolishes the Coupling between Loss of Consciousness and Upper Airway Dilator Muscle Dysfunction 35 Matthias Eikermann, Martina Grosse-Sundrup, Sebastian Zaremba, Mark E. Henry, Edward A. Bittner, Ulrike Hoffmann, and Nancy L. Chamberlin Ketamine is a respiratory-stimulating hypnotic and analgesic that abolishes the coupling between loss-of-consciousness and upper airway dilator muscle dysfunction. In rats it is associated with increased genioglossus electromyogram compared with propofol and sleep. An Allosteric Coagonist Model for Propofol Effects on ␣1␤2␥2L ␥-Aminobutyric Acid Type A Receptors 47 Dirk Ruesch, Elena Neumann, Hinnerk Wulf, and Stuart A. Forman Propofol at low concentrations enhances agonist activation of ␣1␤2␥2L ␥-aminobutyric acid type A receptors, and at high concentrations directly activates these receptors. Both effects are mediated by the same propofol binding sites via allosteric coagonism. Selective 5-HT1A-R-agonist Repinotan Prevents Remifentanil-induced Ventilatory Depression and Prolongs Antinociception 56 Ulf Guenther, Nils U. Theuerkauf, Daniel Huse, Michael F. Boettcher, Georg Wensing, Christian Putensen, and Andreas Hoeft Repinotan prevents depression of spontaneous ventilation if given before bolus injection of remifentanil or during continuous infusion of remifentanil. Remifentanil-induced antinociception is prolonged by repinotan. Evaluation of Pulse Cooximetry in Patients Undergoing Abdominal or Pelvic Surgery 65 Richard L. Applegate II, Steven J. Barr, Carl E. Collier, James L. Rook, Dustin B. Mangus, and Martin W. Allard Pulse cooximetry provides continuous hemoglobin measurement. Results suggest that in patients undergoing surgery in which large blood loss is likely, an invasive hemoglobin measurement should be used to guide intraoperative transfusion management. Effect of Glutamate and Blood Glutamate Scavengers Oxaloacetate and Pyruvate on Neurological Outcome and Pathohistology of the Hippocampus after Traumatic Brain Injury in Rats 73 Alexander Zlotnik, Igor Sinelnikov, Benjamin F. Gruenbaum, Shaun E. Gruenbaum, Michael Dubilet, Elena Dubilet, Akiva Leibowitz, Sharon Ohayon, Adi Regev, Matthew Boyko, Yoram Shapira, and Vivian I. Teichberg The authors demonstrate that the blood glutamate scavengers oxaloacetate and pyruvate provide neuroprotection after traumatic brain injury, as evidenced by neurological outcome improvement and reduced neuronal loss in extensive regions of the hippocampus. CONTENTS Association between the Apolipoprotein E4 and Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Intravenous Anesthesia and Inhalation Anesthesia 84 Yingmin Cai, Haitao Hu, Pengbin Liu, Gaifeng Feng, Weijiang Dong, Bing Yu, Yulin Zhu, Jinxin Song, and Minggang Zhao Gene polymorphism of apolipoprotein E has been associated with development of dementia. Information on a possible role of apolipoprotein E in postoperative cognitive dysfunction in elderly patients after inhalational anesthesia is scarce. ■ CRITICAL CARE MEDICINE ᭜ Evaluation of Prothrombin Complex Concentrate and Recombinant Activated Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/116/1/A13/255543/0000542-201201000-00001.pdf by guest on 02 October 2021 Factor VII to Reverse Rivaroxaban in a Rabbit Model 94 Anne Godier, Anastasia Miclot, Bernard Le Bonniec, Marion Durand, Anne-Marie Fischer, Joseph Emmerich, Catherine Marchand-Leroux, Thomas Lecompte, and Charles-Marc Samama In rivaroxaban-treated rabbits, recombinant-activated factor VII and prothrombin complex concentrate partially improved laboratory coagulation parameters, including thromboelastography and thrombin generation assay. However, none of them was clinically effective to reduce rivaroxaban-induced bleeding. Determination of the Optimal Mean Arterial Pressure for Postbleeding Resuscitation after Hemorrhagic Shock in Rats 103 Tao Li, Yu Zhu, Yuqiang Fang, and Liangming Liu Hemorrhagic shock after bleeding has been controlled also requires permissive hypotensive resuscitation; 70 mmHg target resuscitation pressure is the optimal hypotensive resuscitation pressure. ■ PAIN MEDICINE ᭜ Predictors of Pain Relieving Response to Sympathetic Blockade in Complex Regional Pain Syndrome Type 1 113 Frank van Eijs, Jose´ Geurts, Maarten van Kleef, Catharina G. Faber, Roberto S. Perez, Alfons G.H. Kessels, and Jan Van Zundert In patients with complex regional pain syndrome type 1, allodynia and hypoesthesia seem to be negative predictors for pain relief after sympathetic blockade. Pain increase occurs as often as pain decrease after sympathetic blockade. Intrathecal Injection of Metabotropic Glutamate Receptor Subtype 3 and 5 Agonist/ Antagonist Attenuates Bone Cancer Pain by Inhibition of Spinal Astrocyte Activation in a Mouse Model 122 Bing-xu Ren, Xiao-ping Gu, Ya-guo Zheng, Cheng-long Liu, Dan Wang, Yu-e Sun, and Zheng-liang Ma Activation of spinal astrocyte may contribute to the development of bone cancer pain. Spinal mGluR3 activation or mGluR5 inhibition reduced bone cancer pain. Inhibition of spinal astrocyte activation may contribute to the analgesic effects. Heart Rate Variability in Complex Regional Pain Syndrome during Rest and Mental and Orthostatic Stress 133 Astrid J. Terkelsen, Henning Mølgaard, John Hansen, Nanna B. Finnerup, Karsten Krøner, and Troels S. Jensen Patients with complex regional pain syndrome have increased heart rate and decreased heart rate variability and are less able to protect their cardiac output during orthostatic stress compared with healthy control subjects. CONTENTS Lidocaine Metabolites Inhibit Glycine Transporter 1: A Novel Mechanism for the Analgesic Action of Systemic Lidocaine? 147 Robert Werdehausen, David Kremer, Timo Brandenburger, Lukas Schlo¨ sser, Janusz Jadasz, Patrick Ku¨ ry, Inge Bauer, Carmen Arago´ n, Volker Eulenburg, and Henning Hermanns Metabolites of lidocaine are revealed to act as inhibitors of glycine transporter 1, providing a molecular mechanism for the observed antinociceptive effect of systemic lidocaine. Usefulness of Olanzapine as an Adjunct to Opioid Treatment and for the Treatment of Neuropathic Pain 159 Kazuhiro Torigoe, Kae Nakahara, Mahardian Rahmadi, Kazumi Yoshizawa, Hiroshi Horiuchi, Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/116/1/A13/255543/0000542-201201000-00001.pdf by guest on 02 October 2021 Shigeto Hirayama, Satoshi Imai, Naoko Kuzumaki, Toshimasa Itoh, Akira Yamashita, Kiyoshi Shakunaga, Mitsuaki Yamasaki, Hiroshi
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