DOCSLIB.ORG

Epidural Neostigmine Versus Fentanyl to Decrease Bupivacaine Use in Patient-Controlled Epidural Analgesia During Labor a Randomized, Double-Blind, Controlled Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Epidural Neostigmine Versus Fentanyl to Decrease Bupivacaine Use in Patient-Controlled Epidural Analgesia During Labor a Randomized, Double-Blind, Controlled Study Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor A Randomized, Double-blind, Controlled Study Jessica L. Booth, M.D., Vernon H. Ross, M.D., Kenneth E. Nelson, M.D., Lynnette Harris, B.S.N., James C. Eisenach, M.D., Peter H. Pan, M.D. ABSTRACT Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/127/1/50/379751/20170700_0-00015.pdf by guest on 27 September 2021 Background: The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use com- pared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. Methods: A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epi- dural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Results: Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor char- acteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). Conclusions: The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl. (ANESTHESIOLOGY 2017; 127:50-57) RADITIONALLY epidural infusions for labor analge- What We Already Know about This Topic T sia have consisted of a combination of local anesthetic plus an adjuvant opioid. The addition of an opioid to epi- • Single- and intermittent-dose epidural neostigmine reduces dural local anesthetic reduces the dose of local anesthetic local anesthetic requirement for labor analgesia • Effects of adding neostigmine to epidural local anesthetic needed for analgesia, thereby minimizing side effects from infusion on local anesthetic consumption for labor analgesia local anesthetic blockade, especially maternal motor block are unknown and, potentially, hypotension. However, these epidurally What This Article Tells Us That Is New administered opioids can produce side effects themselves, including pruritus and decreased fetal heart rate variability.1 • Adding neostigmine (2, 4, or 8 μg/ml) to bupivacaine for patient-controlled epidural analgesia during labor did not For these reasons, there has been interest in nonopioid adju- reduce bupivacaine requirement compared with bupivacaine vants to reduce epidural local anesthetic dose. The cholines- plus fentanyl terase inhibitor, neostigmine, produces analgesia when given intrathecally or epidurally, via increased acetylcholine stimu- lation of spinal muscarinic and possibly nicotinic receptors.2 contrast, epidural administration of neostigmine has been Studies of intrathecal neostigmine in the mid to late shown in both adults and children to reduce local anes- 1990s demonstrated analgesic efficacy and lack of neurologic thetic requirements in the postoperative setting without injury but also dose-dependent, severe nausea and vomit- nausea and vomiting.5–9 Epidural neostigmine also has been ing, and further clinical development was abandoned.3,4 In shown in small, single-dose studies to reduce epidural local This article is featured in “This Month in Anesthesiology,” page 1A. Submitted for publication June 27, 2016. Accepted for publication April 4, 2017. From the Department of Anesthesiology, Section on Obstetric Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Copyright © 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Anesthesiology 2017; 127:50-57 Anesthesiology, V 127 • No 1 50 July 2017 Copyright © 2017, the American Society of Anesthesiologists,<zdoi;10.1097/ALN.0000000000001669> Inc. Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. PERIOPERATIVE MEDICINE anesthetic requirement for labor analgesia to a degree simi- Carolina; No. 5917), written informed consent for study par- lar to that of opioids, including a study in which epidural ticipation was obtained before a patient’s request for labor analgesia was titrated via patient-controlled epidural anal- epidural analgesia. Parturients were eligible to participate gesia (PCEA).10–12 In contrast to opioids, there are no large if they were American Society of Anesthesiologists physical randomized controlled studies evaluating the effects of epi- status II, spoke English, weighed less than 115 kg, were in dural neostigmine as an adjunct to local anesthetics in the active labor with a single fetus, had cervical dilation 5 cm or obstetric population for continuous PCEA during labor. The less, and had not received IV analgesics within 60 min before purpose of the current study was to compare the effects of epidural administration. Patients with allergies to local anes- epidural neostigmine, 2, 4, or 8 μg/ml, with that of a com- thetics, fentanyl, or neostigmine also were excluded. The monly used concentration of fentanyl (2 μg/ml) when added institutional review board initially approved the enrollment to 0.125% bupivacaine via PCEA during labor. We hypoth- of 200 patients for a goal of 160 evaluable patients, but an Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/127/1/50/379751/20170700_0-00015.pdf by guest on 27 September 2021 esized that epidural bupivacaine with neostigmine would amendment to increase the number of enrolled patients to reduce total hourly bupivacaine use compared with epidural 220 was approved in April 2013 due to the need to replace bupivacaine with fentanyl for labor analgesia. A secondary excluded or ineligible patients. Based on updated data used analysis was intended to evaluate the clinical dose response in our power analysis, our goal of 40 evaluable patients per of 2 to 8 μg/ml of epidural neostigmine on local anesthetic group also was revised at that time to a minimum of 35 consumption for labor analgesia compared with 2 μg/ml of patients per group for the final analysis (fig. 1). fentanyl if significant clinical differences were detected for all Patients were randomized in a balanced manner to one of doses of neostigmine studied. four study groups via a computer-generated number allot- ment that was concealed in a sealed envelope. At the time Materials and Methods of epidural labor analgesia request, an anesthesiologist not The study was registered before recruitment of the first sub- involved in the patient’s care or data collection prepared the ject (http://www.clinicaltrials.gov; NCT00779467), was epidural study solution. All members of the patient’s care performed under Investigational New Drug (No. 42281) team were blinded to the assignment and study drug. A lum- oversight by the U.S. Food and Drug Administration, and bar epidural catheter was inserted after the administration was reviewed on an ongoing basis by a data safety monitor- of a combined subarachnoid and intravenous test dose with ing board. After approval from the institutional review board 45 mg lidocaine and 15 μg epinephrine. Patients were ran- (Wake Forest School of Medicine, Winston-Salem, South domized to receive 15 ml bupivacaine, 1.25 mg/ml, mixed Fig. 1. Enrollment diagram. VAS = visual analog scale. Anesthesiology 2017; 127:50-57 51 Booth et al. Copyright © 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Epidural Neostigmine versus Fentanyl for Analgesia with one of four adjuvant medications: 2 μg/ml fentanyl We obtained permission from the institutional review board or 2, 4, or 8 μg/ml phenol-free neostigmine methylsulfate to increase the number of enrolled patients because we did (1 mg/ml, American Regent, USA; 10-ml multidose vial but not have enough evaluable patients after 200 patients con- discarded after single use). If the patient reported a verbal sented initially. Study enrollment occurred over a 5-yr period pain score greater than 3 on a 0 to 10 scale at 20 min after (October 2008 to November 2013), with intermittent pauses epidural injection, she was excluded from the study and the in enrollment due to neostigmine shortages, researcher avail- epidural catheter was replaced or managed by the anesthesi- ability for enrollment, and technical issues. Final analysis of ologist at his or her discretion. the previous neostigmine study by Ross et al.12 revealed a After the initial dosing of the epidural catheter with the mean bupivacaine use of 11.9 ± 3.0 ml/h. With these new study solution to establish labor analgesia, a PCEA infusion data, a sample size of 35 evaluable
Load more

Recommended publications
  • A Comprehensive Guide Ram Roth Elizabeth A.M. Frost Clifford Gevirtz
    The Role of Anesthesiology in Global Health A Comprehensive Guide Ram Roth Elizabeth A.M. Frost Cli ord Gevirtz Editors Carrie L.H. Atcheson Associate Editor 123 The Role of Anesthesiology in Global Health Ram Roth • Elizabeth A.M. Frost Clifford Gevirtz Editors Carrie L.H. Atcheson Associate Editor The Role of Anesthesiology in Global Health A Comprehensive Guide Editors Ram Roth Elizabeth A.M. Frost Department of Anesthesiology Department of Anesthesiology Icahn School of Medicine at Mount Sinai Icahn School of Medicine at Mount Sinai New York , NY , USA New York , NY , USA Clifford Gevirtz Department of Anesthesiology LSU Health Sciences Center New Orleans , LA , USA Associate Editor Carrie L.H. Atcheson Oregon Anesthesiology Group Department of Anesthesiology Adventist Medical Center Portland , OR , USA ISBN 978-3-319-09422-9 ISBN 978-3-319-09423-6 (eBook) DOI 10.1007/978-3-319-09423-6 Springer Cham Heidelberg New York Dordrecht London Library of Congress Control Number: 2014956567 © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work.
    [Show full text]
  • Orientation for New Clinicians
    PROFESSIONAL AFFAIRS ORIENTATION FOR NEW CLINICIANS TABLE OF CONTENTS SCORE: CLINICAL ORIENTATION ........................................................................................... 4 I. SCHEDULE ........................................................................................................................ 5 A. QGenda ......................................................................................................................... 5 B. Weekly Schedule .......................................................................................................... 5 C. OR Daily Schedule ....................................................................................................... 5 D. Anesthesia Daily Call Team ......................................................................................... 6 II. ELECTRONIC MEDICAL RECORD ............................................................................... 6 A. BIDMC Portal: ............................................................................................................. 6 B. Anesthesia Intranet ....................................................................................................... 6 C. Perioperative Information Management System (PIMS) ............................................. 7 D. Talis: ............................................................................................................................. 7 E. Online Medical Record (OMR): ..................................................................................
    [Show full text]
  • Curriculum Vitae Michael A. Frölich, MD Anesthesiology And
    Curriculum Vitae Michael A. Frölich, MD Anesthesiology and Perioperative Medicine University of Alabama at Birmingham School of Medicine Office Address: 619 19th Street South. Birmingham, AL 35249-6810 Office Telephone: 001 (205) 975 – 0145 E-mail: [email protected] | [email protected] Citizenship: German | American Languages: German | English | Italian | Portuguese 1 Academic Appointments (reverse chronological order) University of Alabama at Birmingham Professor of Anesthesiology with Tenure 2012 - current Associate Professor of Anesthesiology with Tenure 2004 -2012 University of Florida Associate Professor of Anesthesiology with Tenure 2004 Assistant Professor of Anesthesiology 1998 -2004 Ludwig Maximilians Universität, München Facharzt für Anästhesie und Intensivmedizin 1996 -1998 Medical Training (reverse chronological order) Harvard University, Boston Fellowship in Obstetric Anesthesia 1995 -1996 Emory University, Atlanta Residency in Anesthesiology 1992 -1995 Internship in Medicine and Pediatrics (Transitional Year) 1991 -1992 Ludwig Maximilians Universität, Zentralklinikum Augsburg Arzt im Praktikum, Septische Intensivstation 1988 -1991 Universität Wien, Vienna, Austria Studium der Medizin 1982 -1988 Advanced Degrees University of Alabama at Birmingham M.S., Masters in Science of Biostatistics 2008 – 2012 University of Florida M.S., Masters in Science of Clinical Investigation (NIH K-30) 2001 – 2004 2 University Appointments University of Alabama System Faculty Representative to the Board of Trustees 2013 - 2014 University of
    [Show full text]
  • Obstetric Anesthesiology: Practice Guidelines and You How to Avoid Surprises and Improve Outcomes by Mark Zakowski, M.D
    Obstetric Anesthesiology: Practice Guidelines and You How to Avoid Surprises and Improve Outcomes By Mark Zakowski, M.D. s the speed of change seems to be increas- ing exponentially, we are often faced Awith information overload. One area that we cannot become lax about is the ever- increasing Practice Guidelines and Committee Opinions that affect the multidisciplinary area of obstetric anesthesiology. This article will review what national societies have urged upon their members, discussing new topics, as a continuation of a prior CME article in the Bulletin.1 The American College of Obstetricians and Gynecologists (ACOG) has released other documents that are very informative and pertinent to obstetric anesthesiol- ogy practice. This article will also review documents by the American Society of Anesthesiologists (ASA). Both societies have important guidelines that affect your daily practice. This review is intended to help you understand changes in clinical practice and to improve patient outcomes. Anesthesia When the Parturient Is on Antidepressants In February 2010, ACOG released a committee opinion stating that depression is very common before, during and after pregnancy. Indeed, one in seven pre- and postpartum women is treated for depression. Practitioners should be alert to signs of depression.2 Some women may be reluctant to mention a histo- ry of depression/mood disorder, especially in the presence of friends or family. Be sure to check the prenatal records or ask about this on the preanesthesia assessment. Moreover, antidepressant
    [Show full text]
  • Hemodynamic Stability During Labor and Delivery with Continuous Epidural Infusion
    ORIGINAL CONTRIBUTION Hemodynamic Stability During Labor and Delivery With Continuous Epidural Infusion Mark A. Gerhardt, MD, PhD Vit B. Gunka, MD Robert J. Miller, DO Context: Epidural anesthesia for labor pain is frequently com- Conclusions: Continuous epidural infusion of 0.2% ropiva- plicated by maternal hypotension. caine hydrochloride without bolus administration reduces the incidence of hypotension by 67% and is safer than tradi- Objective: To test whether continuous epidural infusion (CEI) tional bolus dosing for routine labor. This method requires fur- of local anesthetic, without bolus administration, lowers the ther study in high-risk patients, including those with incidence of hypotension in parturient patients. preeclampsia and cardiovascular disease. Methods: In a single-blind clinical study, subjects were ran- J Am Osteopath Assoc. 2006;106:692-698 domly assigned to CEI-only (10 mL/h of 0.2% ropivacaine hydrochloride without bolus) or control (10 mL of 0.2% ropi- ost parturient patients elect to receive epidural anes- vacaine hydrochloride per hour with 10-mL bolus) epidural Mthesia to ease the physical demands and discomfort of dosing groups. The incidence of hypotension (20% decrease childbirth.1 However, epidural anesthesia is frequently asso- in systolic blood pressure or mean arterial pressure (MAP), sys- ciated with hypotension,2,3 requiring intervention with fluid tolic blood pressure lower than 100 mm Hg, or MAP lower and/or vasopressors. Furthermore, the fetus may be com- than 65 mm Hg) was recorded for 2 hours after dosing. Sta- promised because uterine blood flow depends on maternal tistical analysis included a 2ϫ2 ␹2 analysis, the Fisher exact test, perfusion.4 Fetal distress can develop rapidly.
    [Show full text]
  • A Virtual Event May 13-16 Program Guide
    SOAP 2021 Annual Meeting Building Moving Bridges Forward A Virtual Event May 13-16 Program Guide Jointly provided by the American Society of Anesthesiologists and the Society for Obstetric Anesthesia and Perinatology. #SOAPAM2021 // SOAP 2021 Annual Meeting- Building Bridges and Moving Forward Jump to Table of Contents The Society for Obstetric Anesthesia and Perinatology would like to thank the following Supporters of the SOAP 53rd Annual Meeting. PLATINUM SPONSOR BRONZE SPONSORS MEDIA PARTNER Page - 2 // // SOAP 2021 Annual Meeting- Building Bridges and Moving Forward Jump to Table of Contents SOAP 53rd Virtual Annual Meeting Building Bridges & Moving Forward Welcome Letter ...............................................................................................................4 Planning Committees ......................................................................................................6 Program Faculty ................................................................................................................7 Program Information & Policies .......................................................................................16 Session Descriptions ........................................................................................................19 Program Schedule Thursday ............................................................................................22 Program Schedule Friday .................................................................................................24 Program Schedule
    [Show full text]
  • From 'OOPS to EXIT': a Review of the Origins and Progression of Ex Utero
    a & hesi C st lin e ic n a A l f R o e l s Journal of Anesthesia & Clinical e a a n r r c u h o Nnamani, J Anesth Clin Res 2015, 6:7 J ISSN: 2155-6148 Research DOI: 10.4172/2155-6148.1000540 Review Article Open Access From ‘OOPS to EXIT’: A Review of the Origins and Progression of Ex Utero Intrapartum Treatment Nwamaka Nnamani* UTSW Anesthesiology, 5323 Harry Hines Blvd, Dallas, Texas 75390-9068, USA *Corresponding author: Nwamaka Nnamani, Assistant Instructor, UTSW Anesthesiology, 5323 Harry Hines Blvd, Dallas, Texas 75390-9068, USA, Tel: 773-749-2220; E-mail: [email protected] Received date: Feb 27, 2015, Accepted date: July 08, 2015, Published date: July 13, 2015 Copyright: © 2015 Nnamani N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Advancement in the safety of obstetric anesthesiology has largely been due to better pharmacotherapy, monitoring devices and airway adjuncts. Similarly, the rate of fetal mortality has declined in the last two decades particularly due to improved neonatal intensive care and the wide-spread use of surfactant for premature births. The field of perinatology has long recognized that certain high-risk fetal anomalies, which previously carried significant mortality rates may now be amenable to the Ex Utero Intrapartum Treatment (EXIT). This review discusses the history of EXIT and focuses on the role of the anesthesiologist during this procedure; with emphasis that the successful outcome of many EXIT procedures is a testament to the advancements in obstetric anesthesiology, our understanding of maternal and fetal physiology, safer anesthetic agents, and improved overall safety of general anesthesia in parturients.
    [Show full text]
  • Obstetric Anesthesia and Heart Disease
    REVIEW ARTICLE Deborah J. Culley, M.D., Editor ABSTRACT Maternal morbidity and mortality as a result of cardiac disease is increasing in the United States. Safe management of pregnancy in women with heart disease requires appropriate anesthetic, cardiac, and obstetric care. The Obstetric Anesthesia and anesthesiologist should risk stratify pregnant patients based upon cardiac Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/doi/10.1097/ALN.0000000000003833/506787/aln.0000000000003833.pdf by Marie-Louise Meng on 07 June 2021 disease etiology and severity in order to determine the appropriate type of Heart Disease: Practical hospital and location within the hospital for delivery and anesthetic manage- ment. Increased intrapartum hemodynamic monitoring may be necessary and Clinical Considerations neuraxial analgesia and anesthesia is typically appropriate. The anesthesiolo- gist should anticipate obstetric and cardiac emergencies such as emergency Marie-Louise Meng, M.D., Katherine W. Arendt, M.D. cesarean delivery, postpartum hemorrhage, and peripartum arrhythmias. This ANESTHESIOLOGY 2021; 135:164–83 clinical review answers practical questions for the obstetric anesthesiologist and the nonsubspecialist anesthesiologist who regularly practices obstetric anesthesiology. aternal mortality is increasing in the United States, (ANESTHESIOLOGY 2021; 135:164–83) Mand cardiovascular disease is now the leading cause.1,2 According to the Centers for Disease Control and Prevention, cardiovascular disease is currently responsible management of cardiovascular disease preconception, in preg- for one-quarter of maternal deaths in the United States and nancy, and in the peripartum and postpartum periods.12–14 similar trends are occurring in other high-income coun- These guidelines recommend that a “pregnancy heart team” tries.2–4 These trends may be a result of an increasing average care for pregnant patients with complex cardiovascular disease.
    [Show full text]
  • CA-1 Curriculum for Obstetric Anesthesia Department of Anesthesiology
    CA-1 Curriculum for Obstetric Anesthesia Department of Anesthesiology Description of Rotation or Educational Experience During clinical experience in obstetric anesthesia, residents will be assigned to the Maternal-Infant Care Center. The goals during this rotation are for residents to develop the skills to make appropriate clinical decisions regarding the conduct of anesthesia for cesarean section and peripartum surgeries, the management of analgesia during labor, and the intraoperative and perioperative management of patients with pregnancy specific pathology. Patient Care Goals Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: • Become facile in the delivery of regional analgesia during labor & delivery • Be conversant in alternative analgesic techniques for labor • Recognize obstetric pathology and its potential threat to mother or baby • Manage the patient during cesarean delivery with regional or general anesthesia Competencies • Appropriately directed History and Physical Examinations • Develop appropriate patient-specific analgesia plans for labor • Develop appropriate patient-specific anesthetic plans for Obstetric Surgical Procedures • Placement and Management of Lumbar Epidural Analgesia - Continuous Infusion • Placement and Management of Lumbar Epidural Analgesia – Patient Controlled • Placement and Management of Lumbar Epidural Anesthesia for Obstetric Surgical Procedures • Placement
    [Show full text]
  • The 2015 Gerard W. Ostheimer Lecture: What's New in Labor
    E REVIEW ARTICLE The 2015 Gerard W. Ostheimer Lecture: What’s New in Labor Analgesia and Cesarean Delivery Katherine W. Arendt, MD Every year the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review the literature pertinent to obstetric anesthesiology published the previ- ous calendar year. This individual selects the most notable contributions, creates a syllabus of the articles, and then presents his/her overview in an annual lecture named in honor of the late Gerard W. Ostheimer, a pioneering obstetric anesthesiologist from the Brigham and Women’s Hospital. This article reviews the literature published in 2014 focusing on the themes of labor analgesia and cesarean delivery. Its contents were presented as the Gerard W. Ostheimer Lecture at the 47th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, May 16, 2015, in Colorado Springs, Colorado. The syllabus is available as Supplemental Digital Content (http://links.lww.com/AA/B397). (Anesth Analg 2016;122:1524–31) bstetric anesthesiology is a dynamic field, the of delivery will be discussed. Further topics include the practice of which involves not only knowledge of impact of emergency cesarean delivery decision-to-delivery Oanesthesiology and obstetrics, but also perinatol- interval on obstetric outcomes, the incidence of intraopera- ogy, neonatology, cardiology, and hematology among other tive awareness during cesarean delivery, the appropriate medical fields. Recent rapid evolution of our practice is role for supplemental oxygen in nonhypoxemic pregnant evident in a number of areas, such as the prevention and women, the prevention of spinal anesthesia–associated treatment of postpartum hemorrhage and hypotension hypotension, the use of postcesarean oxytocin protocols, associated with spinal anesthesia.
    [Show full text]
  • Department of Anesthesiology Journal Articles July 1St, 2018 to June 30Th, 2019
    Department of Anesthesiology Journal Articles July 1st, 2018 to June 30th, 2019 1. Ando M, Hastie J, Takayama H. Living, and living well, after cardiac surgery. J Thorac Cardiovasc Surg. 2018;156(5):1905. 2. Antonioli L, Blandizzi C, Fornai M, Pacher P, Lee HT, Haskó G. P2X4 receptors, immunity, and sepsis. Curr Opin Pharmacol. 2019;47:65-74. 3. Antonioli L, Blandizzi C, Pacher P, Guilliams M, Haskó G. Quorum sensing in the immune system. Nat Rev Immunol. 2018;18(9):537-538. 4. Antonioli L, Blandizzi C, Pacher P, Guilliams M, Haskó G. Rethinking Communication in the Immune System: The Quorum Sensing Concept. Trends Immunol. 2019;40(2):88-97. 5. Antonioli L, Caputi V, Fornai M, Pellegrini C, Gentile D, Giron MC, Orso G, Bernardini N, Segnani C, Ippolito C, Csóka B, Haskó G, Németh ZH, Scarpignato C, Blandizzi C, Colucci R. Interplay between colonic inflammation and tachykininergic pathways in the onset of colonic dysmotility in a mouse model of diet-induced obesity. Int J Obes (Lond). 2019;43(2):331-343. 6. Antonioli L, Fornai M, Blandizzi C, Pacher P, Haskó G. Adenosine signaling and the immune system: When a lot could be too much. Immunol Lett. 2019;205:9-15. 7. Berger M, Schenning KJ, Brown CH 4th, Deiner SG, Whittington RA, Eckenhoff RG, Angst MS, Avramescu S, Bekker A, Brzezinski M, Crosby G, Culley DJ, Eckenhoff M, Eriksson LI, Evered L, Ibinson J, Kline RP, Kofke A, Ma D, Mathew JP, Maze M, Orser BA, Price CC, Scott DA, Silbert B, Su D, Terrando N, Wang DS, Wei H, Xie Z, Zuo Z; Perioperative Neurotoxicity Working Group.
    [Show full text]
  • A Series of Anesthesia-Related Maternal Deaths in Michigan, 1985–2003 Jill M
    Anesthesiology 2007; 106:1096–104 Copyright © 2007, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. A Series of Anesthesia-related Maternal Deaths in Michigan, 1985–2003 Jill M. Mhyre, M.D.,* Monica N. Riesner, M.D.,* Linda S. Polley, M.D.,† Norah N. Naughton, M.D., M.B.A.‡ Background: Maternal Mortality Surveillance has been con- ANESTHETIC complication is the seventh leading cause ducted by the State of Michigan since 1950, and anesthesia- of pregnancy-related mortality in the United States, ac- related maternal deaths were most recently reviewed for the counting for 1.6% of all pregnancy-related deaths.1 Al- years 1972–1984. Methods: Records for pregnancy-associated deaths between though rare, anesthesia-related maternal mortality is po- 1985 and 2003 were reviewed to identify 25 cases associated tentially preventable. with a perioperative arrest or major anesthetic complication. The causes of anesthetic induced mortality have Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/106/6/1096/364376/0000542-200706000-00008.pdf by guest on 01 October 2021 Four obstetric anesthesiologists independently classified these evolved over time. For example, obstetric deaths associ- cases, and disagreements were resolved by discussion. Precise ated with regional anesthesia declined in the mid-1980s.2 definitions of anesthesia-related and anesthesia-contributing The decline was attributed the withdrawal of 0.75% maternal death were constructed. Anesthesia-related deaths bupivacaine, increased awareness of local anesthetic were reviewed to identify the chain of medical errors or care management problems that contributed to each patient death. toxicity, and the use of test dosing for epidural catheters.
    [Show full text]