Anaesthesiology Update

Hull and East Yorkshire Hospitals NHS Trust Anaesthesiology Update

February 2018

You may need an NHS OpenAthens username and password to access the full text links. (Register here - https://openathens.nice.org.uk/ )

Alternatively you can request an article from Knowledge Services using this link: https://www.surveymonkey.co.uk/r/ILLs

To allow us to continue to produce these bulletins, we really need your feedback. Please use this short evaluation form: https://www.surveymonkey.co.uk/r/X99JBWZ

[email protected]

Latest from the Cochrane Database of Systematic Reviews

Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults

Heinrich Rüschen, Kavitha Aravinth, Catey Bunce, Desta Bokre

Online Publication Date: March 2018

Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia

Patrick Welsch, Nurcan Üçeyler, Petra Klose, Brian Walitt, Winfried Häuser

Online Publication Date: February 2018

Paravertebral anaesthesia with or without sedation versus general anaesthesia for women undergoing breast cancer surgery

Anjolie Chhabra, Hemanshu Prabhakar, Rajeshwari Subramaniam, Mahesh Kumar Arora, Anurag Srivastava, Mani Kalaivani

Online Publication Date: February 2018

BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization

Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam

Online Publication Date: February 2018

Combination pharmacotherapy for the treatment of fibromyalgia in adults

Joelle Thorpe, Bonnie Shum, R Andrew Moore, Philip J Wiffen, Ian Gilron

Online Publication Date: February 2018

See full search strategy

1. The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: Protocol for a multi-centre prospective randomized, controlled trial

2. Burning Mouth Syndrome: Aetiopathogenesis and Principles of Management

3. How is symptom flare defined in musculoskeletal conditions: A systematic review

4. Pre-anesthetic assessment with three core questions for the detection of obstructive sleep apnea in childhood: An observational study

5. Accuracy of patient opioid use reporting at the time of medical cannabis license renewal

6. Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness

7. Pilot Testing of a Brief Couple-Based Mind-Body Intervention for Patients With Metastatic Non-Small Cell Lung Cancer and Their Partners

8. Factors Associated With Attrition in a Multicenter Longitudinal Observational Study of Patients With Advanced Cancer

9. The Diagnostic Sensitivity of the Memorial Delirium Assessment Scale-Spanish Version

10. Minimal Clinically Important Difference of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) for Fatigue Worsening in Asian Breast Cancer Patients

11. Impact of Opioid Therapy on Sleep and Respiratory Patterns in Adults With Advanced Cancer Receiving Palliative Care

12. Identifying Opportunities to Improve Pain Among Patients With Serious Illness

13. Measuring the Psychosocial Dimensions of Quality of Life in Patients With Advanced Cancer: Psychometrics of the German Quality of Life at the End of Life-Cancer-Psychosocial Questionnaire

14. Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial

15. Impact of pectoral nerve block on postoperative pain and quality of recovery in patients undergoing breast cancer surgery: A randomised controlled trial

16. Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis A systematic review

17. Transvenous Lead Extraction: A Clinical Commentary for Anesthesiologists

18. Volatile Anesthesia for Carotid Endarterectomy: Friend or Foe for the Brain? 19. Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross-sectional study

20. Diuretics Combined With Compression in Resistant Limb Edema of Advanced Disease-A Case Series Report

21. Development and Assessment of a Measure of Parent and Child Needs in Pediatric Palliative Care

22. The Structure of the FACT-Cog v3 in Cancer Patients, Students, and Older Adults

23. Effects of Exercise Training on Restless Legs Syndrome, Depression, Sleep Quality, and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis

24. Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

25. Journal of clinical monitoring and computing 2017 end of year summary: anesthesia

27. Unusual elevation in Entropy but not in PSI during general anesthesia: A case report

30. Quality Improvement Pearls for the Palliative Care and Hospice Professional

31. A Comparison of the Strain and Tissue Doppler-Based Indices as Echocardiographic Correlates of the Left Ventricular Filling Pressures

32. The effects of Desflurane and Sevoflurane on Nesfatin-1 levels in laparoscopic Cholecystectomy: A randomized controlled trial

33. Incidence and factors contributing to postdischarge nausea and vomiting in pediatric ambulatory surgical cases

34. Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data

35. Evaluation of the stability and stratification of propofol and ketamine mixtures for pediatric anesthesia 36. Volatile anesthesia for a pediatric patient with very long-chain acyl-coenzyme A dehydrogenase deficiency: A case report

37. The gut microbiota as a key regulator of visceral pain

38. Lateral Supratrochanteric Approach to Sciatic and Femoral Nerve Blocks in Children: A Feasibility Study

39. Drug Errors and Protocol for Prevention among Anaesthetists in Nigeria

40. Anti-inflammatory effects of propranolol in the temporomandibular joint of female rats and its contribution to antinociceptive action

41. Acupuncture versus titrated morphine in acute renal colic: A randomized controlled trial

42. The influence of type of anesthesia, perioperative pain, and preoperative health status on chronic pain six months after thoracotomy-A prospective cohort study

43. Efficacy of mirogabalin (DS-5565) on patient-reported pain and sleep interference in patients with diabetic neuropathic pain: Secondary outcomes of a phase II proof-of-concept study

44. Changes in the skin conductance monitor as an end point for sympathetic nerve blocks

45. Application of virtual navigation with multimodality image fusion in foramen ovale cannulation

46. A novel chronic opioid monitoring tool to assess prescription drug steady state levels in oral fluid

47. Addressing disparities in low back pain care by developing culturally appropriate information for Aboriginal Australians: "My back on track, my future"

48. Feasibility of continuous sedation monitoring in critically ill intensive care unit patients using the NeuroSENSE WAV_CNS index

49. Sensory distribution of the lateral femoral cutaneous nerve block - a randomised, blinded trial

50. Ultrasound-guided bilateral superficial cervical block and preemptive single-dose oral tizanidine for post-thyroidectomy pain: a randomized-controlled double-blind study

52. Ultrasound-guided lumbar plexus block in children and adolescents using a transverse lumbar paravertebral sonogram: Initial experience 53. Cost-effectiveness of intravenous acetaminophen and ketorolac in adolescents undergoing idiopathic scoliosis surgery

54. Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics-A prospective randomized double-blinded study

55. Prevalence of neuropathic pain in patients with traumatic brachial plexus injury: A multicenter prospective hospital-based study

56. Prospective, randomized blind effect-on-outcome study of conventional vs high- frequency spinal cord stimulation in patients with pain and disability due to failed back surgery syndrome

58. Group visits for overdose education and naloxone distribution in primary care: A pilot quality improvement initiative

60. A pilot study of hyperoxemia on neurological injury, inflammation and oxidative stress

61. Comparison of lumbar plexus block using the short axis in-plane method at the plane of the transverse process and at the articular process: A randomized controlled trial

62. AAPM 2016 Annual Meeting Late-Breaking Abstracts

63. Frequency of naloxone use for opioid overdose based on ward type in a tertiary care medical center

64. Ultrasound-guided greater occipital nerve block at a novel proximal location: A feasibility study

65. Ketamine infusion: A useful tool for chronic neuropathic pain

66. A before-and-after observational study of a protocol for use of the C-MAC videolaryngoscope with a Frova introducer in pre-hospital rapid sequence intubation

68. Gastric ultrasound in the third trimester of pregnancy: a randomised controlled trial to develop a predictive model of volume assessment

69. Chronic back pain cured by low-dose levodopa: Is it a variant of restless legs syndrome? 70. Reliability study in five languages of the translation of the pain observational scale Algoplus

71. Pediatric Intracranial Hypertension: a Current Literature Review

72. Respiratory quotient estimations as additional prognostic tools in early septic shock

73. Le monitorage du cerveau frappe une note discordante chez les anesthesiologistesMonitoring the brain strikes a discordant note for anesthesiologists

74. As if one pain problem was not enough: Prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes

75. Managing severe pain and abuse potential: The potential impact of a new abuse- deterrent formulation oxycodone/naltrexone extended-release product

76. Risk factors for opioid-induced respiratory depression and failure to rescue: A review

77. Obstructive sleep apnea and bariatric surgical guidelines: Summary and update

78. Anticipated and unanticipated difficult airway management

79. An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea

80. Improve postoperative sleep: What can we do?

81. Perioperative pulmonary thromboembolism: Current concepts and treatment options

82. Postoperative thrombocytopenia: Why you should consider antiplatelet therapy?

83. Vitamin C in sepsis

84. Intraoperative vasoplegia: Methylene blue to the rescue!

85. Perioperative neurocognition in elderly patients

86. An overview of perioperative considerations in elderly patients for thoracic surgery: Demographics, risk/benefit, and resource planning

87. An observational feasibility study of a new anaesthesia drug storage tray

88. Management of trauma pain in the emergency setting: Low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison

89. Clinimetric properties of the nepali version of the pain Catastrophizing scale in individuals with chronic pain

92. Pharmacogenetic guidance: Individualized medicine promotes enhanced pain outcomes

93. Utility of Radionuclide Bone Scintigraphy in Complex Regional Pain Syndrome

94. A data analytics approach to identify factors underlying patient satisfaction from the RELIEF global registry

96. Improved functional capacity but stagnant reallife physical activity after both injection and surgical decompression for lumbar spinal stenosis

97. Discriminating physical performance phenotypes of patients with chronic low back pain

98. The incidence of spinal cord stimulator complications from a single institution: A retrospective chart review

99. Does cervical interlaminar epidural steroid injection with low-dose lidocaine cause objective upper extremity weakness? a preliminary study

100. The effect of patient satisfaction surveys on physician practice patterns

101. Forward flexed posture as a cause of Meralgia paresthetica: A case report

102. Predictive factors associated with a successful clinical outcome from radiofrequency ablation of the genicular nerves for the treatment of chronic knee pain due to osteoarthritis

103. Cadaveric study of the articular branches of the shoulder joint

104. Use of esophageal balloon pressure-volume curve analysis to determine esophageal wall elastance and calibrate raw esophageal pressure: A bench experiment and clinical study

105. A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve Repair

106. Bioactive chromone constituents from Vitex negundo alleviate pain and inflammation

107. Tramadol use in a patient with Brugada syndrome and morphine allergy: A case report

108. Noteworthy Literature published in 2017 for Abdominal Organ Transplantation

109. Effectiveness of Bilateral Superficial Cervical Plexus Block as Part of Postoperative Analgesia for Patients Undergoing Thyroidectomy in Empress Zewditu Memorial Hospital, Addis Ababa, Ethiopia

110. Efficacy of Bilateral Transversus Abdominis Plane and Ilioinguinal-Iliohypogastric Nerve Blocks for Postcaesarean Delivery Pain Relief under Spinal Anesthesia 111. Psychosocial predictors of posttreatment pain after nonmetastatic breast cancer treatment: A systematic review and meta-analysis of prospective studies

112. Altered perfusion of the sensorimotor cortex in patients with cervical spondylotic myelopathy: An arterial spin labeling study

113. Transesophageal Echocardiography Use in Diagnosis and Management of Embolized Intravascular Foreign Bodies

114. Delayed Development of Malignant Hyperthermia Following Cardiopulmonary Bypass

115. BioGlue-Associated Loss of Aortic Valve Leaflet Motility Sonographically Masked by Both Newly Replaced Mechanical Aortic and Mitral Valves

116. Does transcutaneous electrical nerve stimulation reduce pain and improve quality of life in patients with idiopathic chronic orchialgia? A randomized controlled trial

117. Appropriateness of sham or placebo acupuncture for randomized controlled trials of acupuncture for nonspecific low back pain: A systematic review and meta-analysis

118. A mixed-methods evaluation of the Association of Anaesthetists of Great Britain and Ireland Uganda Fellowship Scheme

119. Experimental Low Back Pain Decreased Trunk Muscle Activity in Currently Asymptomatic Recurrent Low Back Pain Patients During Step Tasks

120. Opportunity Knocks? The Expansion of Volatile Agent Use in New Clinical Settings

121. Prevalence and Characteristics of Pruritus and Association With Quality of Life in People Living With HIV: A Cross-Sectional Study

122. Combining Novel Renal Injury Markers with Delta Serum Creatinine Early after Cardiac Surgery and Risk-Stratification for Serious Adverse Outcomes: An Exploratory Analysis

123. Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study

124. Haloperidol for delirium in critically ill patients - protocol for a systematic review

125. Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: Comparison of nasal tracheal intubation and laryngeal mask airway

126. Intraoperative Transesophageal Echocardiogram During Orthotopic Liver Transplantation: TEE to the Rescue!

127. L'indice de masse corporelle predit la sensibilite a l'insuline au cours de la chirurgie cardiaque : etude observationnelle prospectiveBody mass index predicts insulin sensitivity during cardiac surgery: a prospective observational study 128. Unravelling Fibromyalgia-Steps Toward Individualized Management

129. Design of a Novel Multifunction Decision Support Display for Anesthesia Care: AlertWatch OR

130. Chronic Calf Pain Caused by Fibroma-Induced Chronic Inflammation Around the Tibial and Peroneal Nerves that Was Misdiagnosed as Centralized Neuropathic Pain: A Case Report

131. Computer simulated modeling of healthy and diseased right ventricular and pulmonary circulation

132. Burst Spinal Cord Stimulation: Review of Preclinical Studies and Comments on Clinical Outcomes

133. Changes in tissue and cerebral oxygenation following spinal anesthesia in infants: a prospective study

134. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass

135. Minimally Invasive Determinations of Oxygen Delivery and Consumption in Cardiac Surgery: An Observational Study

137. Comparing adductor canal block with local infiltration analgesia in total knee arthroplasty: A prospective, blinded and randomized clinical trial

138. A mini-fluid challenge of 150 mL predicts fluid responsiveness using Modelflow^R pulse contour cardiac output directly after cardiac surgery

139. Ccr2 upregulation in drg neurons plays a crucial role in gastric hyperalgesia associated with diabetic gastropathy

140. Translation and validation of simplified Chinese version of the pain catastrophizing scale in chronic pain patients: Education may matter

141. Echocardiographic Guidance and Troubleshooting for Venovenous Extracorporeal Membrane Oxygenation Using the Dual-Lumen Bicaval Cannula

142. The Hemodynamic Effects of Different Pacing Modalities After Cardiopulmonary Bypass in Patients With Reduced Left Ventricular Function

143. Elective Intraoperative Use of an Avalon Elite Catheter During Lung Transplantation

144. Ultrasound-Guided Interscalene Brachial Plexus Nerve Block With an Ultralow Volume of Local Anesthetic for Post-Thoracotomy Shoulder Girdle Pain 145. Validation of a Mathematical Model of Bidirectional Glenn Circulation With Aortopulmonary Collaterals and the Implications for Q_P/Q_S Calculation

146. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2017

147. Intraoperative Anesthetic Management of Lung Transplantation: Center-Specific Practices and Geographic and Centers Size Differences

148. Aortic Valve Cusp Coaptation Surface Area Using 3-Dimensional Transesophageal Echocardiography Correlates with Severity of Aortic Valve Insufficiency

149. Ischemic Mitral Regurgitation: A Paradigm Shift in Surgical Management?

150. Two Cases of Postoperative Right Coronary Artery Intervention in Pediatric Patients Following Congenital Heart Surgery

152. Ventricular Assist Device Implantation in a Patient With Severe Systemic Right Ventricular Failure and Pulmonary Hypertension Secondary to Congenitally Corrected Transposition of Great Arteries

153. Ascending Aortic Aneurysm Causing Right Ventricular Outflow Tract Obstruction and Severe Tricuspid Regurgitation

154. Unexpected Intraoperative Transesophageal Echocardiographic Finding Before Aortic Valve Replacement Surgery

156. Novel ultrasound-guided inter-semispinal plane block: a comparative pilot study in healthy volunteers

157. A Tale of Three Surgeries: Management of a Massive Recurrent Mycotic Aortic Pseudoaneurysm

159. Morphologic Evaluation of the Mitral Annulus During Displacement of the Heart in Off- Pump Coronary Artery Bypass Surgery

160. Deployment of a Sapien 3 Transcatheter Valve for Severe Tricuspid Insufficiency in a Patient With Non-obstructive Cor Triatriatum Dexter 161. The Role of Hemoglobin A1c as a Biomarker and Risk Assessment Tool in Patients Undergoing Non-cardiac and Cardiac Surgical Procedures

162. Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without Dexmedetomidine in Video-Assisted Thoracoscopic Surgery

163. Copeptin Release in Cardiac Surgery-A New Biomarker to Identify Risk Patients?

164. Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design of a Randomized Controlled Trial

165. Outcomes Following Three-Factor Inactive Prothrombin Complex Concentrate Versus Recombinant Activated Factor VII Administration During Cardiac Surgery

166. A Story of Migration of a Surgically Implanted Aortic Sutureless Valve

167. Effectiveness and Safety of Aprotinin Use in Thoracic Aortic Surgery

168. Right Ventricular Rupture After Extubation of a Patient With an Open Chest

169. Peripheral Nerve Injury in Cardiac Surgery

170. Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity

171. A Comparison of Inflammatory Responses Between Robotically Enhanced Coronary Artery Bypass Grafting and Conventional Coronary Artery Bypass Grafting: Implications for Hybrid Revascularization

172. Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care

173. Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary Artery Bypass Grafting

174. Giant Thebesian Valve Appearing As a Right Atrial Mass

175. Intrapericardial Cisplatin Instillation in Recurrent Postinfarction Cardiac Tamponade

176. Noteworthy Literature published in 2017 for Perioperative Echocardiography

177. Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists

178. Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

179. Performance of a second generation pulmonary capnotracking system for continuous monitoring of cardiac output

180. Comparison of TIVA with different combinations of ketamine-propofol mixtures in pediatric patients 181. Choice of desflurane or propofol for the maintenance of general anesthesia does not affect the risk of periprocedural myocardial damage in patients undergoing transfemoral transcatheter aortic valve implantation

182. Postoperative mortality and morbidity following non-cardiac surgery in a healthy patient population

183. Population analysis of predictors of difficult intubation with direct laryngoscopy in pediatric patients with and without thyroid disease

184. The Effect of Ketamine Infusion in the Treatment of Complex Regional Pain Syndrome: a Systemic Review and Meta-analysis

185. Association between fentanyl test results and rescue morphine requirements in children after adenotonsillectomy

186. Cytotoxicity of propofol in human induced pluripotent stem cell-derived cardiomyocytes

187. Quality Improvement in Anesthesiology - Leveraging Data and Analytics to Optimize Outcomes

188. Human Factors Applied to Perioperative Process Improvement

189. Developing Multicenter Registries to Advance Quality Science

190. Effect of Remote Ischemic Preconditioning on Intestinal Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A Randomized Controlled Pilot Trial

191. Pre-emptive awake airway management under dexmedetomidine sedation in a parturient with spinal muscular atrophy type-2

192. Pulmonary and laryngeal tuberculosis in a 25-weeks' gestation parturient, diagnosed after failed tracheal intubation

193. Thrombosis after aortic balloon occlusion during cesarean delivery for abnormally invasive placenta

194. Prophylactic use of an intra-aortic balloon pump in a high-risk patient with peripartum cardiomyopathy requiring cesarean delivery

195. A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise

196. A survey of international antisepsis procedures for neuraxial catheterisation in labour

197. Hereditary haemorrhagic telangiectasia in pregnancy: regional and general anaesthesia

198. Heart Transplantation in Patients >60 Years: Importance of Relative Pulmonary Hypertension and Right Ventricular Failure on Midterm Survival 199. Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A Post Hoc Subgroup Analysis of a Prospective Trial

200. Dynamic Shunting Across a Patent Foramen Ovale in Adult Cardiac Surgery- Perioperative Challenges and Management

201. Preliminary Experience in Combined Somatic and Cerebral Oximetry Monitoring in Liver Transplantation

202. Factors Related to the Severity of Early Postoperative Infection After Heart Transplantation in Patients Surviving Prolonged Mechanical Support Periods: Experience at a Single University

203. Prevalence and Predictors of Patient Nonadherence to Pharmacological Acute Pain Therapy at Home After Day Surgery: A Prospective Cohort Study

204. Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators

205. Stimulation of the L2-L3 Dorsal Root Ganglia Induces Effective Pain Relief in the Low Back

208. Validation of the Japanese Version of the Fremantle Back Awareness Questionnaire in Patients with Low Back Pain

209. Erector Spinae Plane Block for Surgery of the Posterior Thoracic Wall in a Pediatric Patient

211. A New Step Toward Evidence of in Vivo Perineural Dexamethasone Safety: An Animal Study

212. Sensory Assessment and Regression Rate of Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Volunteers 213. Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial

214. Ultrasound Identification of Diaphragm by Novices Using ABCDE Technique

215. Relative Contributions of Adductor Canal Block and Intrathecal Morphine to Analgesia and Functional Recovery after Total Knee Arthroplasty: A Randomized Controlled Trial

216. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version

217. Local Anesthetic Systemic Toxicity in Total Joint Arthroplasty: Incidence and Risk Factors in the United States from the National Inpatient Sample 1998-2013

218. Local Anesthetic Systemic Toxicity: A Review of Recent Case Reports and Registries

219. Le bruit de l'air : echographie pulmonaire au point d'intervention en medecine perioperatoireThe sound of air: point-of-care lung ultrasound in perioperative medicine

220. Enthesitis: A hallmark of psoriatic arthritis

221. Protecting the Right Ventricle in ARDS: The Role of Prone Ventilation

222. Analysis of mortality in a cohort of 650 cases of bacteremic osteoarticular infections

223. Extracorporeal Membrane Oxygenation-Assisted Airway Management for Difficult Airways

224. Validation of the Swedish version of Quality of Recovery score -15: A multicentre, cohort study

225. Mallory-Weiss syndrome diagnosed after tracheal extubation

226. Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients

227. Hypertension, mitral valve disease, atrial fibrillation and low education level predict delirium and worst outcome after cardiac surgery in older adults

228. Effect of auricular point acupressure on axial neck pain after anterior cervical discectomy and fusion: A randomized controlled trial

229. TNF-alpha and sTNF-RII are associated with pain following hip fracture surgery in older adults

230. Innovative technology using virtual reality in the treatment of pain: Does it reduce pain via distraction, or is there more to it?

231. Rational urine drug monitoring in patients receiving opioids for chronic pain: Consensus recommendations 232. Pain management for primary care providers: A narrative review of high-impact studies, 2014-2016

233. No transfer of pressure to adjacent discs during human low-pressure controlled discography: A prospective clinical study

234. Unknown left atrial appendage mass! real-time three-dimensional transesophageal echocardiography helps in identification

235. Quadricuspid aortic valve: A rare intraoperative diagnosis by transesophageal echocardiography

236. Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

237. Bleeding in the lung complicates a routine intracardiac repair: What went wrong!!!

238. Successful resolution with apixaban of a massive left atrial appendage thrombus due to nonrheumatic atrial fibrillation: A case report and review

239. Large inferolateral left ventricular aneurysm

240. Right atrial fibroma in an adult patient

241. Transesophageal echocardiography evaluation of the aortic arch branches

242. Long-term quality of life postacute kidney injury in cardiac surgery patients

244. Atrioventricular septal defects

245. Retrospective study of complete atrioventricular canal defects: Anesthetic and perioperative challenges

246. The influence of fluid management on outcomes in preeclampsia: A systematic review and meta-analysis

247. Ultra-Short-Acting beta-Blockers (Esmolol and Landiolol) in the Perioperative Period and in Critically Ill Patients

248. The Influence of Self-Efficacy, Fear-Avoidance Belief, and Coping Styles on Quality of Life for Chinese Patients with Chronic Nonspecific Low Back Pain: A Multisite Cross-Sectional Study

249. A Randomized Controlled Trial Examining the Effect of the Addition of the Mandibular Block to Cervical Plexus Block for Carotid Endarterectomy 250. Delirium and effect of circadian light in the intensive care unit: a retrospective cohort study

251. Factors associated with non-response at health-related quality of life follow-up in a septic shock trial

252. Early experience of full-endoscopic interlaminar discectomy for adolescent lumbar disc herniation with sciatic scoliosis

253. The termination level of the dural sac relevant to caudal epidural block in lumbosacral transitional vertebrae: A comparison between sacralization and lumbarization groups

254. Outcome of transforaminal epidural steroid injection according to the severity of lumbar foraminal spinal stenosis

255. Sacroiliac joint intraarticular injection in true anteroposterior view: Description of a new C-arm guided method

256. Implication of two different doses of intradiscal ozone-oxygen injection upon the pain alleviation in patients with low back pain: A randomized, single-blind study

257. Reducing radiation exposure in lumbar transforaminal epidural steroid injections with pulsed fluoroscopy: A randomized, double-blind, controlled clinical trial

258. Ultrasound-guided genicular nerve block for knee osteoarthritis: A double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid

259. Efficacy of pain relief in different postherpetic neuralgia therapies: A network meta- analysis

260. Fusion or not for degenerative lumbar spinal stenosis: A meta-analysis and systematic review

263. Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study

264. Incidence of hyperoxia and related in-hospital mortality in critically ill patients: a retrospective data analysis 265. The adequate rocuronium dose required for complete block of the adductor muscles of the thigh

266. A comparison between McGrath MAC videolaryngoscopy and Macintosh laryngoscopy in children

267. Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU)

268. Frontoethmoidal encephalocele: a pediatric airway challenge

269. An unusual blood pressure reading

270. Norwegian standard for the safe practice of anaesthesia

271. Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting: Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

272. Health-related quality of life in gout in primary care: Baseline findings from a cohort study

273. Systolic Anterior Motion of the Mitral Valve During Pulmonary Endarterectomy in a Patient with Chronic Thromboembolic Pulmonary Hypertension: A Case Report

274. Hemodynamic Management in Aortic Root Replacement in a Patient With Coarctation of the Aorta

275. ACGME Accreditation Guide for Adult Cardiothoracic Anesthesiology Fellowship

276. Association Between Optic Nerve Head Blood Flow Measured Using Laser Speckle Flowgraphy and Radial Arterial Pressure During Aortic Arch Surgery

277. Anesthesia for Cardiac Ablation

278. Developing Capacity to Do Improvement Science Work

279. Diffusing Innovation and Best Practice in Health Care

280. Handovers in Perioperative Care

281. Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises

282. Use of Simulation in Performance Improvement

283. Right Atrial Myxoma with Pulmonary Artery Hypertension: Role of Transesophageal Echocardiography in Detection of Cause and Perioperative Management

284. Number and Type of Post-Traumatic Stress Disorder Symptom Domains Are Associated With Patient-Reported Outcomes in Patients With Chronic Pain 285. Train-of-four recovery precedes twitch recovery during reversal with sugammadex in pediatric patients: A retrospective analysis

286. Association of red blood cell transfusion and short- and longer-term mortality after coronary artery bypass graft surgery

287. Systolic Anterior Motion of the Mitral Valve Causing Dynamic Left Ventricular Outflow Tract Obstruction: An Underappreciated Complication During Lung Transplantation

288. Total Intravenous Versus Volatile Induction and Maintenance of Anesthesia in Elective Carotid Endarterectomy: Effects on Cerebral Oxygenation and Cognitive Functions

289. Mechanical discordance between left atrium and left atrial appendage

291. Validation of the Pain Coping Questionnaire in Finnish

292. Pain-relieving effectiveness, quality of life and tolerability of repeated capsaicin 8% patch treatment of peripheral neuropathic pain in Scandinavian clinical practice

293. Giant Cell Arteritis: Practical Pearls and Updates

295. Image Guidance Technologies for Interventional Pain Procedures: Ultrasound, Fluoroscopy, and CT

296. Pediatric Patients with High Pulmonary Arterial Pressure in Congenital Heart Disease Have Increased Tracheal Diameters Measured by Computed Tomography

297. Assessing health-related quality of life in primary Sjogren's syndrome-The PSS-QoL

298. 4-Valve Heart Disease and Right Heart Failure

299. Membrane attack complex (mac) deposition in lupus nephritis is associated with hypertension and poor clinical response to treatment

300. Anomalies in target-controlled infusion: An analysis after 20 years of clinical use

301. Flawed Study Design and Incorrect Presentation of Data Negatively Impact Potentially Useful Interventional Treatments for Patients with Low Back Pain: A Critical Review of JAMA's MinT Study

302. Alkaptonuric Ochronosis and the Failure of Regional Cerebral Tissue Oxygen Saturation Monitoring by Two Different Near-infrared Spectroscopy Devices 303. Respiratory changes in subclavian vein diameters predicts fluid responsiveness in intensive care patients: a pilot study

305. A Comparative Study of Point-of-Care Prothrombin Time in Cardiopulmonary Bypass Surgery

306. Topical benzydamine hydrochloride for prevention of postoperative sore throat in adults undergoing tracheal intubation for elective surgery: A systematic review and meta- analysis

307. A triple-blind, placebo-controlled randomised trial of the ilioinguinal-transversus abdominis plane (I-TAP) nerve block for elective caesarean section

309. Aortic dissection masquerading as a bicuspid aortic valve

310. A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body

311. Evaluation of effect of entropy monitoring on isoflurane consumption and recovery from anesthesia

312. A prospective randomized study comparing recovery following anesthesia with a combination of intravenous dexmedetomidine and desflurane or sevoflurane in spinal surgeries

313. Comparison of maintenance, emergence and recovery characteristics of sevoflurane and desflurane in pediatric ambulatory surgery

314. Sevoflurane sparing effect of dexmedetomidine in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial

315. Tracheal intubation through laryngeal mask airway CTrachTM with polyvinyl chloride tube: Comparison between two orientations of the tracheal tube

316. I-Gel versus laryngeal mask airway (LMA) classic as a conduit for tracheal intubation using ventilating bougie

317. Front of neck access: A survey among anesthetists and surgeons

318. Dexmedetomidine as an adjunctive analgesic to ropivacaine in pectoral nerve block in oncological breast surgery: A randomized double-blind prospective study 319. The effect of intravenous infusion of N-acetyl cysteine in cirrhotic patients undergoing liver resection: A randomized controlled trial

320. Case scenario: Power of positive end-expiratory pressure

321. Case 2-2011: Acute Myocardial Infarction in a Pregnant Patient Requiring Coronary Artery Bypass Graft Surgery

322. Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy: A feasibility study

Full strategy

1. The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: Protocol for a multi-centre prospective randomized, controlled trial Author(s): Wong J.; Lam D.; Singh M.; Chung F.; Choi S.; Siddiqui N.; Sockalingam S. Source: BMC Anesthesiology; 2018; vol. 18 (no. 1) Publication Date: 2018 Publication Type(s): Article Available at BMC Anesthesiology - from BioMed Central Available at BMC Anesthesiology - from Europe PubMed Central - Open Access Abstract:Background: Delirium is a common problem that occurs in 5-50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway - are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium. However, few studies have investigated the effect of perioperative treatment of OSA to prevent postoperative delirium. Methods: This multi-centre randomized controlled trial will enrol 634 elderly patients undergoing elective hip/knee replacement surgery. The study has been approved by the Research Ethics Boards of the three participating institutions. Patients will be screened with the STOP-Bang questionnaire. Those with a score of 3 or greater will have a portable home sleep study using the ApneaLinkTM Air device. Patients identified to have OSA will be randomized to 1) Auto-titrating continuous positive airway pressure (APAP) applied during sleep for 72 h after surgery or until discharge if they are discharged before 72 h or 2) Control group - routine care, no APAP. All patients will be evaluated for delirium for 72 h after surgery or until discharge if they are discharged before 72 h. The primary outcome is the occurrence of delirium - assessed twice daily using the Confusion Assessment Method for 72 h or until discharge if the hospital stay is < 72 h. Discussion: Delirium is associated with increased morbidity and mortality, and higher healthcare costs. With the aging population, the incidence of postoperative delirium will likely increase as the number of elderly individuals undergoing surgery rises. The results of our study will be published in a peer- reviewed journal and presented at local and international medical conferences. Our study findings may lead to improved surgical outcomes, enhanced patient safety and reduced healthcare costs. Copyright © The Author(s). 2018. Database: EMBASE

2. Burning Mouth Syndrome: Aetiopathogenesis and Principles of Management Author(s): Feller L.; Fourie J.; Khammissa R.A.G.; Ballyram R.; Lemmer J.; Bouckaert M. Source: Pain Research and Management; 2017; vol. 2017 Publication Date: 2017 Publication Type(s): Review Available at Pain research & management - from Europe PubMed Central - Open Access Available at Pain research & management - from EBSCO (MEDLINE Complete) Available at Pain research & management - from Hindawi Open Access Journals Available at Pain research & management - from PubMed Central Abstract:Burning mouth syndrome (BMS) is a chronic debilitating oral condition characterised by a burning sensation of the oral mucosa in an otherwise apparently normal person. Its aetiology and pathogenesis are obscure, but both psychogenic factors and peripheral and central neuropathies appear to be implicated. There is no cure for BMS, and treatment with either local or systemic medications focuses on the relief of symptoms and on improving quality of life. In recalcitrant cases, psychological/psychiatric intervention may be helpful. In order to improve treatment outcomes, a better understanding of the pathogenesis of this syndrome might provide a basis for the development of more effective management strategies. In this short review, we discuss current knowledge of the diagnosis, aetiopathogenesis, and management of BMS. Copyright © 2017 L. Feller et al. Database: EMBASE

3. How is symptom flare defined in musculoskeletal conditions: A systematic review Author(s): Costa N.; Hodges P.W.; Ferreira M.L.; Cross M.; Makovey J. Source: Seminars in Arthritis and Rheumatism; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: To systematically review the definitions for "flare" in musculoskeletal conditions, the derivation processes, and validation of definitions for the 12 most burdensome musculoskeletal conditions. Methods: A literature search was conducted in MEDLINE, EMBASE, CINAHL, AMED, PsycInfo and Lilacs to identify studies that investigated derivation or validation of a flare definition, which we considered as a phrase or group of domains. Results: Reports of derivation of flare definitions were identified for 9/12 musculoskeletal conditions. Validation of flare definitions was initiated for 4/12. For each condition, different derivation and validation methods have been used, with variable levels of consumer involvement, and in some cases different groups have worked on the process in parallel. Although some flare definitions began simply as "symptom worsening" or "change in treatment" most evolved into multidimensional definitions that include: pain, impact on function, joint symptoms, and emotional elements. Frequently initial attempts to create phrase to define the term flare evolved into consensus on the breadth of domains involved. Validation has compared flare definitions/domains against measures of disease activity, clinicians' diagnosis, response to drug therapy, or a combination. Conclusion: This review suggests that greater characterisation and definition of flares in musculoskeletal conditions are linked to the inclusion of multiple perspectives, multifaceted domains and compound comparators for their validation. Further work is required to optimise and test the derived definitions for most musculoskeletal conditions. As some elements are disease- specific, flare definitions cannot be extrapolated to other conditions. Research regarding flare in back pain (most burdensome disease) is limited. Copyright © 2018 Elsevier Inc. Database: EMBASE

4. Pre-anesthetic assessment with three core questions for the detection of obstructive sleep apnea in childhood: An observational study Author(s): Schnoor J.; Busch T.; Turemuratov N.; Merkenschlager A. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC anesthesiology - from BioMed Central Available at BMC anesthesiology - from Europe PubMed Central - Open Access Available at BMC anesthesiology - from PubMed Central Abstract:Background: Children with obstructive sleep apnea are at high risk for perioperative airway obstruction. Many "at risk" children may remain unrecognized. The aim of this study is to find a clinically practicable test to identify obstructive sleep apnea in childhood. Methods: In this pilot study, we prospectively compared four parental questionnaires with the respective findings of subsequent sleep laboratory testing in children. Right before sleep laboratory testing, children's parents answered both the Pediatric Sleep Questionnaire, a subscale of the Sleep Related Breathing Disorder questionnaire (PSQ-SRBD-Subscale), and an eight-item questionnaire derived from it. Finally, we condensed the eight-item questionnaire to three core issues: Does your child regularly snore at night? Does your child demonstrate labored breathing during sleep? Does your child have breathing pauses during sleep? With it, two similar questionnaires were generated that differed in the formation of the resulting score. One questionnaire was built by a quotient comparable to the abovementioned questionnaires and a second as quick test that functioned as a simple sum score. Both sensitivity and specificity were determined by using a Receiver Operating Characteristic analysis. Results: In total, 53 children were included in the study. Both the PSQ-SRBD-questionnaire and self-derived eight-item questionnaire failed to reach statistically significant results in detecting obstructive sleep apnea. The set of three core questions with a score built by a quotient was statistically significant and provided sensitivity and a moderate specificity of 0.944 and 0.543, respectively. This could be slightly optimized by creating a simple sum-score (specificity of 0.571). Conclusions: The use of three core-questions may facilitate the detection of pediatric obstructive sleep apnea within the scope of the anesthesia survey. While the study has some limitations, future studies with both unselective collectives and older children might prove this ultra-short questionnaire to be advantageous in detecting pediatric OSA in clinical practices. Copyright © 2018 The Author(s). Database: EMBASE

5. Accuracy of patient opioid use reporting at the time of medical cannabis license renewal Author(s): Vigil J.M.; Stith S.S.; Reeve A.P. Source: Pain Research and Management; 2018; vol. 2018 Publication Date: 2018 Publication Type(s): Article Available at Pain Research and Management - from Europe PubMed Central - Open Access Available at Pain Research and Management - from EBSCO (MEDLINE Complete) Available at Pain Research and Management - from Hindawi Open Access Journals Available at Pain Research and Management - from International DOI Foundation Abstract:The decision to authorize a patient for continued enrollment in a state-sanctioned medical cannabis program is difficult in part due to the uncertainty in the accuracy of patient symptom reporting and health functioning including any possible effects on other medication use. We conducted a pragmatic convenience study comparing patient reporting of previous and current prescription opioid usage to the opioid prescription records in the Prescription Monitoring Program (PMP) among 131 chronic pain patients (mean age = 54; 54% male) seeking the first annual renewal of their New Mexico Medical Cannabis Program (NMMCP) license. Seventy-six percent of the patients reported using prescription opioids prior to enrollment in the NMMCP, however, the PMP records showed that only 49% of the patients were actually prescribed opioids in the six months prior to enrollment. Of the 64 patients with verifiable opioid prescriptions prior to NMMCP enrollment, 35 (55%) patients reported having eliminated the use of prescription opioids by the time of license renewal. PMP records showed that 26 patients (63% of patients claiming to have eliminated the use of opioid prescriptions and 41% of all patients with verifiable preenrollment opioid use) showed no prescription opioid activity at their first annual NMMCP renewal visit. Copyright © 2018 Jacob M. Vigil et al. Database: EMBASE

6. Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness Author(s): Frush B.W.; Curlin F.A.; Brauer S.G.; Yoon J.D. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 906-912 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Context: Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness. Objectives: This study sought to determine how patient age, patient disposition, and physician religiousness affect physician recommendations in the context of advanced illness. Methods: A survey was mailed to a stratified random sample of U.S. physicians, which included three vignettes depicting advanced illness scenarios: 1) cancer, 2) heart failure, and 3) dementia with acute infection. One vignette included experimental variables to test how patient age and patient disposition affected physician recommendations. After each vignette, physicians indicated their likelihood to recommend disease-directed medical care vs. hospice care. Results: Among eligible physicians (n = 1878), 62% (n = 1156) responded. Patient age and stated patient disposition toward treatment did not significantly affect physician recommendations. Compared with religious physicians, physicians who reported that religious importance was "not applicable" were less likely to recommend chemotherapy (adjusted odds ratio [OR] 0.39, 95% CI 0.23-0.66) and more likely to recommend hospice (OR 1.90, 95% CI 1.15-3.16) for a patient with cancer. Compared with physicians who ever attended religious services, physicians who never attended were less likely to recommend left ventricular assist device placement for a patient with congestive heart failure (OR 0.57, 95% CI 0.35-0.92). In addition, Asian ethnicity was independently associated with recommending chemotherapy (OR 1.72, 95% CI 1.13-2.61) and being less likely to recommend hospice (OR 0.59, 95% CI 0.40-0.91) for the patient with cancer; and it was associated with recommending antibiotics for the patient with dementia and pneumonia (OR 1.64, 95% CI 1.08-2.50). Conclusion: This study provides preliminary evidence that patient disposition toward more and less aggressive treatment in advanced illness does not substantially factor into physician recommendations. Non-religious physicians appear less likely to recommend disease-directed medical treatment in the setting of advanced illness, although this finding was not uniform and deserves further research. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

7. Pilot Testing of a Brief Couple-Based Mind-Body Intervention for Patients With Metastatic Non-Small Cell Lung Cancer and Their Partners Author(s): Milbury K.; Engle R.; Owens A.; Chaoul A.; Bruera E.; Cohen L.; Tsao A.; Liao Z. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 953-961 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Context: Given the generally incurable nature of metastatic lung cancer, patients and their spouses/partners are at risk for psychological and spiritual distress. To address this concern, we developed a couple-based mind-body (CBMB) intervention. Objectives: This formative research aimed at examining the intervention's acceptability and initial efficacy in patients with metastatic lung cancer undergoing treatment and their spouses. Methods: Intervention content evaluation sessions and an ensuing single-arm trial were conducted. To evaluate intervention content, participants performed intervention exercises and then participated in semistructured interviews and completed written evaluations. In the single- arm trial, four intervention sessions were delivered over two weeks, focusing on cultivating mindfulness, interpersonal connection, gratitude, and purpose. Newly recruited couples completed measures of depressive symptoms, cancer distress, spiritual well-being, and sleep disturbances before and after the intervention. Results: Content evaluations by seven dyads of patients and their partners revealed high acceptability ratings for the CBMB intervention (e.g., all participants would recommend the intervention). Consent and adherence rates (54% and 67%, respectively) were acceptable in the single-arm trial. All patients (n = 7 dyads; 67% male; mean age, 55 years) and partners (33% male; mean age, 59 years) rated the intervention as useful. Paired t-test analyses revealed large effect sizes for reduced sleep disturbances (d = 1.83) and medium effect sizes for cancer-specific distress (d = 0.61) for patients and large effect sizes for depressive symptoms (d = 0.90) for partners. Conclusion: Based on these results, the CBMB intervention appears to be acceptable and subjectively useful. In addition, we observed preliminary evidence of quality of life gains in both patients and their partners. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

8. Factors Associated With Attrition in a Multicenter Longitudinal Observational Study of Patients With Advanced Cancer Author(s): Perez-Cruz P.E.; Shamieh O.; Paiva C.E.; Kwon J.H.; Muckaden M.A.; Bruera E.; Hui D. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 938-945 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Context: Attrition is common in longitudinal observational studies in palliative care. Few studies have examined predictors of attrition. Objectives: To identify patient characteristics at enrollment associated with attrition in palliative oncology outpatient setting. Methods: In this longitudinal observational study, advanced cancer patients enrolled in an outpatient multicenter study were assessed at baseline and two to five weeks later. We compared baseline characteristics between patients who returned for follow-up and those who dropped out. Results: Seven hundred forty-four patients were enrolled from Jordan, Brazil, Chile, Korea, and India. Attrition rate was 33%, with variation among countries (22%-39%; P = 0.023). In univariate analysis, baseline predictors for attrition were cognitive failure (odds ratio [OR] 1.23 per point in Memorial Delirium Assessment Scale; P < 0.01), functional status (OR 1.55 per 10-point decrease in Karnofsky Performance Status; P < 0.01), Edmonton Symptom Assessment Scale [ESAS] physical score (OR 1.03 per point; P < 0.01), ESAS emotional score (OR 1.05 per point; P < 0.01), and shorter duration between cancer diagnosis and palliative care referral in months (OR 0.89 per log; P = 0.028). In multivariate analysis, cognitive failure (OR 1.12 per point; P = 0.007), ESAS physical score (OR 1.18 per point; P = 0.027), functional status (OR 1.35 per 10-point decrease; P < 0.001), and shorter duration from cancer diagnosis (OR 0.86 per log; P = 0.01) remained independent predictors of attrition. Conclusion: Advanced cancer patients with cognitive failure, increased physical symptoms, poorer performance status, and shorter duration from cancer diagnosis were more likely to dropout. These results have implications for research design, patient selection, and data interpretation in longitudinal observational studies. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

9. The Diagnostic Sensitivity of the Memorial Delirium Assessment Scale-Spanish Version Author(s): Barahona E.; Pinhao R.; Galindo V.; Noguera A. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 968-972 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Background: Although Memorial Delirium Assessment Scale (MDAS) is a successful tool for delirium evaluation and monitoring, it is nevertheless important to determine whether cutoff scores vary according to the studied population. The main objective of this study was to evaluate the diagnostic sensitivity of the recently validated Spanish version of the MDAS. The secondary objective was to analyze possible diagnostic differences when used in a hospice or general hospital setting. Methodology: A prospective study was conducted with advanced cancer patients in two settings (hospice and general hospital). A diagnosis of delirium was established according to clinical criteria and the Confusion Assessment Method. Sensitivity (S), specificity (Sp), positive predictive value, and negative predictive value were determined according to the receiver operating characteristics curve. The MDAS values for different centers were studied using nonparametric tests (Mann- Whitney). Results: A total of 67 patients were included, 28 of whom had been diagnosed with delirium (15/40 hospice and 13/27 general hospital). The mean MDAS scores were 13.6 and 5.5 for the delirium and nondelirium groups, respectively. A cutoff score of 7 gave the optimal screening diagnosis balance (S 92.6%, Sp 71.8%, positive predictive value 70.1%, and negative predictive value 93.3%). Diagnoses of anxiety and depression were not related with delirium (P <= 0.44). A diagnosis of dementia was related to delirium (P <= 0.052) but did not influence the diagnostic sensitivity of MDAS (P <= 0.26). No differences were found between hospice and general hospital settings as regards the diagnostic sensitivity of MDAS. Conclusion: A screening cutoff of 7 appears to be optimal for MDAS Spanish version. No differences were found between advanced cancer patients cared for in a hospice or general hospital. However, more research is required to define the MDAS cutoff for patients with advanced cancer and dementia. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

10. Minimal Clinically Important Difference of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) for Fatigue Worsening in Asian Breast Cancer Patients Author(s): Chan A.; Yo T.E.; Wang X.J.; Ng T.; Chae J.-W.; Yeo H.L.; Shwe M.; Gan Y.X. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 992 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Context: The minimal clinically important difference (MCID) of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), a questionnaire that measures cancer-related fatigue, has not been established in patients with cancer. Objectives: This study aims to determine the MCID of the MFSI-SF. Methods: Breast cancer patients completed the MFSI-SF and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) before chemotherapy and at least three weeks later. The EORTC-QLQ-C30 fatigue scale (EORTC-FA) was used as an anchor, and a receiver operating characteristic (ROC) curve was also used to identify the optimal MCID cut-off for fatigue deterioration. A distribution-based approach used one- third of the SD, half of the SD, and one SEM of the total MFSI-SF score to determine the MCID. Results: A total of 201 patients were analyzed. Change scores of the MFSI-SF and EORTC-FA were moderately correlated (r = 0.47, P < 0.001). The EORTC-FA-anchored MCID was 8.69 points (95% CI: 4.03-13.34). The MCID attained from the ROC curve method was 4.50 points (sensitivity: 68.8%; specificity: 64.1%). For the distribution-based approach, the MCIDs corresponding to one-third of the SD, half of the SD, and one SEM were 5.39, 8.99, and 10.79 points, respectively. Conclusion: The MCID of the MFSI-SF identified by all approaches ranged from 4.50 to 10.79 points. The MCID can be used to interpret the clinical significance of fatigue deterioration in patients with breast cancer and to determine sample sizes for future clinical trials. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

11. Impact of Opioid Therapy on Sleep and Respiratory Patterns in Adults With Advanced Cancer Receiving Palliative Care Author(s): Good P.; Pinkerton R.; Bowler S.; Craig J.; Hardy J. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 962-967 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Context: In advanced cancer, abnormal sleep patterns may contribute to poor quality of life, but the impact of opioid-related sleep disorders has not been explored in detail in these patients. Objective: To document sleep and respiratory patterns in patients with cancer, receiving a range of opioids, determine factors that contribute to severity of central or obstructive apnea, and to what extent these contribute to sleep disturbance. Methods: Adults with advanced cancer admitted to a palliative care service underwent a sleep analysis by an unattended polysomnography. Total sleep time, apnea hypopnea index, central apnea index, obstructive apnea hypopnea index, arousal index, and oxygen desaturation were measured. Baseline assessment included body habitus, Mallampati score, comorbidity indices, concomitant medications, and the Berlin questionnaire. Epworth Sleepiness Scale, Stanford Sleepiness Scale, and Wu cancer fatigue scales were documented. Results: Twenty-eight patients were studied, including 25 receiving opioids. In the latter group, the apnea hypopnea index was mildly abnormal in six patients and severely abnormal in 10 patients. Central apnea index and obstructive apnea hypopnea index were abnormal in nine and 17 patients, respectively. There was no significant correlation between opioid dose and polysomnographic results. Conclusion: In patients with advanced cancer receiving opioid analgesia, there was a high prevalence of respiratory disturbance, both central and obstructive, and deranged sleep patterns. Addressing sleep-disordered breathing in cancer patients has the potential to improve daytime drowsiness and quality of life. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

12. Identifying Opportunities to Improve Pain Among Patients With Serious Illness Author(s): Bischoff K.E.; O'Riordan D.L.; Kinderman A.; Pantilat S.Z.; Fazzalaro K. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 881-889 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Context: Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams. Objective: Identify characteristics associated with pain and pain improvement among inpatients referred to PC. Methods: Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement. Results: Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty- eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of- stay by two days (P = 0.003). Conclusion: Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

13. Measuring the Psychosocial Dimensions of Quality of Life in Patients With Advanced Cancer: Psychometrics of the German Quality of Life at the End of Life-Cancer-Psychosocial Questionnaire Author(s): Grunke B.; Philipp R.; Vehling S.; Scheffold K.; Harter M.; Schulz-Kindermann F.; Oechsle K.; Mehnert A.; Lo C. Source: Journal of Pain and Symptom Management; Mar 2018; vol. 55 (no. 3); p. 985 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Context: Quality of life (QoL) is a central focus of care in advanced cancer. Specialized instruments, such as the Quality of Life at the End of Life-Cancer (QUAL-EC), may be useful to assess psychosocial issues associated with QoL unique to this population. Objectives: To evaluate the measurement of the psychosocial dimensions of QoL using the German translation of the QUAL-EC-Psychosocial (QUAL-EC-P) questionnaire, including factor structure and psychometrics. Methods: About 183 patients with advanced cancer from the University Medical Center Hamburg-Eppendorf and University Medical Center Leipzig completed the QUAL-EC-P questionnaire. We conducted exploratory factor analysis as well as item and reliability analysis. We examined convergent validity with correlations between the scale and relevant psychological constructs. Results: The sample was 60% female with mean age of 57.7 (SD = 11.7). We extracted three factors accounting for 44% of the variance aligning with the structure of the instrument. The QUAL-EC-P questionnaire showed good to acceptable internal consistency for the QoL-psychosocial total score (alpha = 0.77), the Life completion subscale (alpha = 0.77), and the Relationship with health care provider subscale (alpha = 0.81). The Preparation for end of life subscale had adequate albeit low internal consistency (alpha = 0.64) because concerns about family were less associated with financial worry and fear of death than expected. The psychosocial dimensions of QoL correlated negatively with depression (r = -0.27, P <= 0.001), anxiety (r = - 0.32, P <= 0.001), demoralization (r = -0.63, P <= 0.001), and attachment insecurity (r = - 0.51, P <= 0.001) and positively with spiritual well-being (r = 0.63, P <= 0.001). Conclusion: The QUAL-EC-P questionnaire may be used to assess the psychosocial aspects of QoL and promote their clinical discussion in patients with advanced cancer. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

14. Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial Author(s): Arnuntasupakul V.; Chalachewa T.; Leurcharusmee P.; Tiyaprasertkul W.; Finlayson R.J.; Tran D.Q. Source: European Journal of Anaesthesiology; Mar 2018; vol. 35 (no. 3); p. 224-230 Publication Date: Mar 2018 Publication Type(s): Article Abstract:BACKGROUND Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN A randomised, observer-blinded, equivalence trial. SETTING Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from12May 2016 to 10 January 2017. PATIENTS A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5mugml-1 and 5mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). The equivalence margin was 7.4 min. RESULTS Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (+/-SD) total anaesthesia time [15.3 (+/-6.5) vs. 20.1 (+/-9.0) min; mean difference, +/-4.8; 95% confidence interval,-8.1 to-1.9;P=0.005] andmean (+/-SD) onset time [10.2 (+/-5.6) vs. 15.5 (+/-9.0) min; P=0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block- related pain, opioid consumption or adverse events. CONCLUSION Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (+/-7.4 min). Copyright © 2018 European Society of Anaesthesiology. All Rights Reserved. Database: EMBASE

15. Impact of pectoral nerve block on postoperative pain and quality of recovery in patients undergoing breast cancer surgery: A randomised controlled trial Author(s): Kamiya Y.; Yoshida T.; Takamatsu M.; Hasegawa M.; Koyama Y. Source: European Journal of Anaesthesiology; Mar 2018; vol. 35 (no. 3); p. 215-223 Publication Date: Mar 2018 Publication Type(s): Article Abstract:BACKGROUND In recent years, thoracic wall nerve blocks, such as the pectoral nerve (PECS) block and the serratus plane block have become popular for peri-operative pain control in patients undergoing breast cancer surgery. The effect of PECS block on quality of recovery (QoR) after breast cancer surgery has not been evaluated. OBJECTIVES To evaluate the ability of PECS block to decrease postoperative pain and anaesthesia and analgesia requirements and to improve postoperative QoR in patients undergoing breast cancer surgery. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Sixty women undergoing breast cancer surgery between April 2014 and February 2015. INTERVENTIONS The patients were randomised to receive a PECS block consisting of 30 ml of levobupivacaine 0.25% after induction of anaesthesia (PECS group) or a saline mock block (control group). The patients answered a 40-item QoR questionnaire (QoR-40) before and 1 day after breast cancer surgery. MAIN OUTCOME MEASURES Numeric Rating Scale score for postoperative pain, requirement for intra-operative propofol and remifentanil, and QoR-40 score on postoperative day 1. RESULTS PECS block combined with propofol-remifentanil anaesthesia significantly improved the median [interquartile range] pain score at 6 h postoperatively (PECS group 1 [0 to 2] vs. Control group 1 [0.25 to 2.75]; P=0.018]. PECSblock also reduced propofol mean (+/- SD) estimated target blood concentration to maintain bispectral index (BIS) between 40 and 50 (PECS group 2.65 (+/- 0.52) vs. Control group 3.08 (+/- 0.41)mugml-1; P<0.001) but not remifentanil consumption (PECS group 10.5 (+/- 4.28) vs. Control group 10.4 (+/-4.68)mugkg-1 h-1; P=0.95). PECS block did not improve the QoR-40 score on postoperative day 1 (PECS group 182 [176 to 189] vs. Control group 174.5 [157.75 to 175]). CONCLUSION In patients undergoing breast cancer surgery, PECS block combined with general anaesthesia reduced the requirement for propofol but not that for remifentanil, due to the inability of the PECS block to reach the internal mammary area. Further, PECS block improved postoperative pain but not the postoperative QoR-40 score due to the factors that cannot be measured by analgesia immediately after surgery, such as rebound pain. Copyright © 2018 European Society of Anaesthesiology. All Rights Reserved. Database: EMBASE

16. Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis A systematic review Author(s): Tajaate N.; Schreiber J.-U.; Fuchs-Buder T.; Jelting Y.; Kranke P. Source: European Journal of Anaesthesiology; Mar 2018; vol. 35 (no. 3); p. 184-192 Publication Date: Mar 2018 Publication Type(s): Conference Paper Abstract:BACKGROUND Neostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine. OBJECTIVE(S) The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9. DESIGN We performed a systematic search of the literature from January 1992 to December 2015. DATA SOURCES OR SETTING PubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: 'neostigmine', 'sugammadex', 'edrophonium' or 'pyridostigmine' AND 'neuromuscular block', 'reversal' or 'reverse'. ELIGIBILITY CRITERIA Studies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio >=0.9 was attained). RESULTS 19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) <10%] 70mg kg-1 neostigmine was used (five trials, 118 patients), and the mean reversal time was 17.1 min (95% confidence interval (CI) [12.4 to 21.8]). In patients with moderate residual block (T1 10% to <25%) the mean neostigmine dose was 56mg kg-1 (seven trials, 342 patients), and the mean reversal time was 11.3 min (95% CI [9.2 to 13.4]). In patients with a shallow residual block (T1 >= 25%) the mean neostigmine dose was 40mg kg-1 (13 trials, 535 patients), and the mean reversal time was 8.0 min (95% CI [6.8 to 9.2]). CONCLUSION Based on the findings of this systematic review, we recommend that the administration of neostigmine be delayed until an advanced degree of prereversal recovery has occurred (i.e. a T1 >25% of baseline), or that a recovery time longer than 15 min be accepted. Copyright © 2018 European Society of Anaesthesiology. All Rights Reserved. Database: EMBASE

17. Transvenous Lead Extraction: A Clinical Commentary for Anesthesiologists Author(s): Sonny A.; Wakefield B.J.; Sale S.; Mehta A.R.; Mick S.; Wilkoff B.L. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:With increasing use of cardiovascular implantable electronic devices, the need for lead extractions has increased to an annual volume of more than 10,000 extractions worldwide. This article provides a focused clinical commentary on the perioperative management, identification, and treatment of life-threatening complications associated with lead extractions. In addition, a summary of indications, techniques, and lead extraction complications is provided. Although uncommon, lead extractions are associated with a consistent rate of major procedure-related complications and mortality. Major life- threatening complications include vascular laceration, cardiac avulsion, hemothorax, pericardial effusion, and cardiac arrest. Comprehensive preoperative risk assessment and adequate planning and preparedness are crucial to decreasing all procedure-related adverse events. The location of the procedure (electrophysiology suite v hybrid operating room) and the nature of cardiac surgical backup are determined after meticulous risk stratification. In addition to decisions on vascular access, invasive monitoring, and modality of rhythm support, transesophageal echocardiography plays a crucial role in early diagnosis, timely management, and potential prevention of these complications. Copyright © 2018 Elsevier Inc. Database: EMBASE

18. Volatile Anesthesia for Carotid Endarterectomy: Friend or Foe for the Brain? Author(s): Lomivorotov V.V.; Shmyrev V.A.; Moroz G.B. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

19. Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross-sectional study Author(s): Plinsinga M.L.; Mellor R.; Grimaldi A.; Vicenzino B.; Coombes B.K.; Nicolson P.; Bennell K.; Hodges P. Source: European Journal of Pain (United Kingdom); 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at European Journal of Pain - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Gluteal tendinopathy is the most common lower limb tendinopathy presenting to general practice. It has a high prevalence amongst middle-aged women and impacts on daily activities, work participation and quality of life. The aim was to compare physical and psychological characteristics between subgroups of severity of pain and disability. Methods: A multicentre cross-sectional cohort of 204 participants (mean age 55 years, 82% female) who had a clinical diagnosis of gluteal tendinopathy with magnetic resonance imaging confirmation were assessed. A range of physical and psychosocial characteristics were recorded. Pain and disability were measured with the VISA-G questionnaire. A cluster analysis was used to identify mild, moderate and severe subgroups based on total VISA-G scores. Between-group differences were then evaluated with a MANCOVA, including sex and study site as covariates, followed by a Bonferroni post hoc test. Significance was set at 0.05. Results: There were significantly higher pain catastrophizing and depression scores in the more severe subgroups. Lower pain self- efficacy scores were found in the severe group compared to the moderate and mild groups. Greater waist girth and body mass index (BMI), lower activity levels and poorer quality of life were reported in the severe group compared to the mild group. Hip abductor muscle strength and hip circumference did not differ between subgroups of severity. Conclusions: Individuals with severe gluteal tendinopathy present with psychological distress, poorer quality of life, greater BMI and waist girth. Given these features, the consideration of psychological factors in more severe patients may be important to optimize patient outcomes and reduce healthcare utilization. Significance: Patients with severe gluteal tendinopathy exhibit greater psychological distress, poorer quality of life and greater waist girth and BMI when compared to less severe cases. This implies that clinicians ought to consider psychological factors in the management of more severe gluteal tendinopathy. Copyright © 2018 European Pain Federation - EFIC. Database: EMBASE

20. Diuretics Combined With Compression in Resistant Limb Edema of Advanced Disease- A Case Series Report Author(s): Gradalski T. Source: Journal of Pain and Symptom Management; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Introduction: The extremity edema of advanced disease is a common, multifactorial feature, which impairs patients' activities and quality of life. The most frequently chosen management is based on combined decongestive physiotherapy or pharmacotherapy (with diuretics or steroids). Subcutaneous lymphatic drainage in refractory edema may decrease the swelling, prevent spontaneous lymphorrhea, but also increase the risk of infection. Safe and effective conservative management in diuretics- resistant edemas is lacking. The objective of this prospective, observational study was to assess the effectiveness and tolerability of combined physiotherapeutic and diuretic therapy in edemas refractory to parenteral diuretics. Methods: A group of 19 patients with advanced disease and severe bilateral leg edema resistant to parenteral diuretic therapy were treated for three days with a combination of multilayer short-stretch compression bandaging and furosemide in hypersaline intravenous infusion. Results: A clinically meaningful decrease in mean limb volume (of 1.52 L; 20.6%; P < 0.0001)-strongly correlating with patients' weight loss (rho = 0.71; P = 0.0001), with a lowering of the intensity of complaints-was achieved. The treatment was well tolerated, without decreasing the performance status in any patient. Stable levels of blood pressure, laboratory kidney profile (potassium, sodium, creatinine clearance), and serum albumin were observed. Maintenance of the achieved results with a good compliance was seen during an informal follow-up at the hospice. Conclusion: The combination of compression therapy with hypersaline diuretics could be considered as a valuable option for refractory cases of limb edema in advanced disease. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

21. Development and Assessment of a Measure of Parent and Child Needs in Pediatric Palliative Care Author(s): Donnelly J.P.; Downing K.; Misasi J.; Cloen J.; Gupton A.W.; Fragen P.; Michelson K. Source: Journal of Pain and Symptom Management; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Context: Pediatric palliative care has no evidence-based needs assessment measure. The Parent and Child Needs Survey (PCNeeds) is a new instrument designed to assess the needs of children in palliative care, including children receiving end-of-life care, and their families. Objectives: This study examines the psychometrics of and respondents' perceptions about the PCNeeds. Methods: Parents of children in four outpatient pediatric palliative care programs completed the PCNeeds and the World Health Organization Quality of Life-Brief tool (WHOQOL-BREF). Parents answered questions about demographics and the experience of completing the PCNeeds. Internal scale reliability was measured with Cronbach's alpha. Validity was assessed by correlating the PCNeeds total and subscale scores with the WHOQOL-BREF subscales. Additional respondent perceptions were obtained via written comments and analyzed using content analysis. Results: The 93 respondents were predominantly female (n = 69, 74%); white (n = 79, 85%); college graduates (n = 71, 76%); and married or partnered (n = 75, 81%). Internal reliability was acceptable (Cronbach's alpha = 0.83), and validity correlations with the WHOQOL-BREF subscales were consistent with theoretical expectations (moderate negative correlations ranging from -0.36 to -0.51). The most frequently cited need not addressed by our survey was sibling impact (n = 17, 18%). Twelve parents (13%) indicated that no content was missing. The least met needs were financial impact, family impact, and the child's physical problems besides pain. Sixty- eight percent of parents (n = 63) rated completion of the survey as "easy" or "very easy." Conclusion: Initial psychometric analysis of the PCNeeds is encouraging, but further study of reliability and validity with more diverse respondents is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

22. The Structure of the FACT-Cog v3 in Cancer Patients, Students, and Older Adults Author(s): Costa D.S.J.; Vardy J.L.; Loh V.; Birney D.P.; Gessler D.; Dhillon H.M.; Fardell J.E. Source: Journal of Pain and Symptom Management; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Context: The Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) version 3 questionnaire is designed to assess perceived cognitive function and impact on quality of life in cancer patients. Objectives: We examined the factor structure of the FACT- Cog version 3 in samples of cancer patients, older adults, and students. Methods: Data from three populations were sourced. Cancer patient data (N = 158) came from two studies, one evaluating a web-based cognitive training program, and the other evaluating symptoms in patients receiving chemotherapy. The older adult sample (N = 477) was commercial brain training users in the general population. The student sample (N = 154) came from a study examining the relation between cognitive test performance and perceived cognitive function. Results: The patient sample conformed to the traditional four-factor structure (impairments, abilities, noticeability, and quality of life), with some support for separating the broad impairment/ability factors into specific cognitive domains. The older adult sample was best described using both impairments/abilities and specific cognitive domains. The student sample suggested two impairment/ability factors but separation of concentration/acuity and memory/verbal impairment items. Conclusion: The FACT-Cog can be used in populations other than cancer patients, with modifications to the scoring system. Even when used with cancer patients, it is worth considering scoring specific cognitive domains separately. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

23. Effects of Exercise Training on Restless Legs Syndrome, Depression, Sleep Quality, and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis Author(s): Song Y.-Y.; Hu R.-J.; Jiang X.-L.; Diao Y.-S.; Chen L. Source: Journal of Pain and Symptom Management; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Context: Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain. Objectives: This meta-analysis was conducted to identify whether exercise training is beneficial in the treatment of the symptoms of RLS, depression, poor sleep quality, and fatigue in patients receiving HD. Methods: A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing exercise training with routine care on RLS, depression, sleep quality, and fatigue among HD patients. Quality assessment was conducted using the Cochrane risk of bias tool, and RevMan 5.3 was used to analyze the data. Results: Fifteen RCTs that met our inclusion criteria were included. The pooled effect size showed that exercise training was effective on RLS (P < 0.001), depression (P < 0.001), and fatigue (P < 0.001). However, effect size combinations for sleep quality were not performed owing to the sensitivity analysis results. Conclusion: Exercise training may help HD patients to reduce the severity of RLS, depression, and fatigue. More high-quality RCTs with larger samples and comparative RCTs focused on different exercise regimens are needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

24. Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure Author(s): Moller M.H.; Granholm A.; Perner A.; Junttila E.; Haney M.; Oscarsson-Tibblin A.; Haavind A.; Laake J.H.; Wilkman E.; Sverrisson K.O. Source: Acta Anaesthesiologica Scandinavica; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Acta Anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Adult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient-important treatment recommendations on this topic. Methods: This guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient-important outcome measures, including mortality and serious adverse reactions. Results: For all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions. Conclusions: We suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents. Copyright © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Database: EMBASE

25. Journal of clinical monitoring and computing 2017 end of year summary: anesthesia Author(s): Hendrickx J.F.A.; de Wolf A.M.; Skinner S. Source: Journal of Clinical Monitoring and Computing; Feb 2018 ; p. 1-5 Publication Date: Feb 2018 Publication Type(s): Article In Press Database: EMBASE

26. Bloc du plan des muscles erecteurs du rachis pour la prise en charge de la douleur chronique a l'epaule : une presentation de casErector spinae plane block for the management of chronic shoulder pain: a case report Author(s): Forero M.; Rajarathinam M.; Adhikary S.D.; Chin K.J. Source: Canadian Journal of Anesthesia; Mar 2018; vol. 65 (no. 3); p. 288-293 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Purpose: The erector spinae plane (ESP) block has been described in the successful management of both thoracic and abdominal pain. Since the erector spinae muscle extends to the cervical spine, the ESP block may be potentially useful in painful conditions of the shoulder girdle. Clinical features: We performed a series of ESP blocks at the T2/T3 level in an elderly male patient with chronic shoulder pain. Immediate and profound analgesia with improved range of motion was consistently observed following the block. There was detectable sensory block in the congruent cervico-thoracic dermatomes with no motor block. Computed tomography imaging showed the spread of radiocontrast up to the C3 level in the vicinity of the neural foramina. Clinical analgesia generally outlasted the expected duration of conduction blockade and significantly contributed to overall improvement in the patient's symptoms. Conclusions: The ESP block may be a promising alternative to other interventional procedures in the management of chronic shoulder pain and deserves further study. Copyright © 2017, Canadian Anesthesiologists' Society. Database: EMBASE

27. Unusual elevation in Entropy but not in PSI during general anesthesia: A case report Author(s): Kim Y.S.; Chung D.; Oh S.K.; Won Y.J.; Lee I.O. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC Anesthesiology - from BioMed Central Available at BMC Anesthesiology - from Europe PubMed Central - Open Access Abstract:Background: EEG monitoring is useful for determining an adequate level of anesthesia. However it is sometimes interfered by various reasons. We describe a case in which we successfully confirmed the adequate depth of anesthesia by monitoring the patient state index (PSI), which was computed from the SedLine monitor data in Root (Masimo) during general anesthesia. Our case showed unusual elevations in entropy, but not in PSI. Case presentation: A 34-year-old woman was scheduled for emergency surgery for a left tibial open fracture and a right femoral closed fracture, which were sustained during a traffic accident. Forty-five minutes after intubation, the response entropy abruptly increased up to 100 and state entropy to 91. Despite the absence of other abnormal events, the entropy data led to two types of incorrect decisions. The first was owing to the effect of the EMG and the second was misleading during the surgeon's hammering. However, PSI from the SedLine monitor seemed to be less influenced by the same events. Conclusions: In this report, we suggest that the PSI, derived from new-generation SedLine (Root, Masimo) may be a useful parameter for clinically determining the level of sedation. The use of two monitoring devices with different EEG algorithms might be helpful for determining the anesthetic depth and making decisions. Copyright © 2018 The Author(s). Database: EMBASE

28. Utilite et innocuite de la bronchoscopie flexible chez les patients atteints d'une leucemie aigue en phase critique : une etude de cohorte retrospectiveThe utility and safety of flexible bronchoscopy in critically ill acute leukemia patients: a retrospective cohort study Author(s): Deotare U.; Ibrahimova N.; Minden M.D.; Merman E.; Kraguljac A.P.; Croucher D.; Kumar V.; Lee C.; Mehta S.; Pincus D. Source: Canadian Journal of Anesthesia; Mar 2018; vol. 65 (no. 3); p. 272-279 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Purpose: Flexible bronchoscopy with bronchoalveolar lavage (BAL) is commonly performed in immunocompromised patients. Nevertheless, it remains unclear whether bronchoscopy with BAL leads to changes in medical management or is associated with procedural complications among critically ill acute leukemia (AL) patients. Methods: We evaluated 71 AL patients who underwent diagnostic bronchoscopy with BAL in the intensive care unit (ICU) between 1 January 2007 and 31 December 2012. We recorded baseline characteristics, vital signs (before, during, and after the procedure), changes in medical management following the procedure, and procedural complications. Using a multivariable logistic regression model, we explored the relationship between patient characteristics and whether bronchoscopy changed management or caused complications. Patient characteristics included as predictors in the regression model were age, sex, immunosuppression status (those undergoing active chemotherapy), and the Acute Physiology And Chronic Health Evaluation II score. Results: The most common indication for ICU admission was respiratory failure (51 patients, 72%), followed by sepsis (14 patients, 20%). Overall, the results obtained from bronchoscopy with BAL were associated with a change in management in 32 patients (45%), most commonly a change in antimicrobial therapy as a result of an infectious pathogen being identified (17 patients, 24%). Complications were documented in nine patients (13%) and included post-procedural hypoxia (six patients, 8%), the need for intubation (one patient, 9% of non-intubated patients), and tracheal perforation (one patient, 1%). No clinically significant changes in patient vital signs were observed during or immediately following the procedure. Patient characteristics did not predict whether bronchoscopy was associated with changes in medical management or procedural complications in multivariable analyses. Conclusions: Flexible bronchoscopy with BAL is relatively safe and helps to guide medical management among patients with AL admitted to the ICU. Copyright © 2017, Canadian Anesthesiologists' Society. Database: EMBASE

29. Comparaison randomisee entre le bloc interscalenique et le bloc combine infraclaviculaire et suprascapulaire pour une chirurgie arthroscopique de l'epauleA randomized comparison between interscalene and combined infraclavicular- suprascapular blocks for arthroscopic shoulder surgery Author(s): Aliste J.; Bravo D.; Finlayson R.J.; Tran D.Q. Source: Canadian Journal of Anesthesia; Mar 2018; vol. 65 (no. 3); p. 280-287 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Background: This randomized trial aimed to evaluate combined infraclavicular- suprascapular blocks (ICB-SSBs) as a diaphragm-sparing alternative to interscalene blocks (ISBs) for arthroscopic shoulder surgery. We hypothesized that ICB-SSB would provide equivalent postoperative analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis. Methods: Following research ethics board approval and written informed consent, participants in the ISB group received an ultrasound-guided ISB with 20 mL of levobupivacaine 0.25% and epinephrine 5 micro g.mL-1. In the ICB-SSB group, ultrasound-guided ICB (20 mL) and SSB (10 mL) were carried out using the same local anesthetic. Thirty minutes after the block was performed, a blinded investigator assessed the presence of hemidiaphragmatic paralysis. Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12 and 24 hr. Consumption of intra- and postoperative narcotics was also tabulated. Results: Compared to its ICB-SSB counterpart, the ISB group displayed non-equivalent (i.e., lower) postoperative pain scores at 30 min (difference of the medians, -4; 99% confidence interval [CI], -6 to -3), required less cumulative morphine iv at 24 hr (difference of the means, -6.1 mg; 95% CI, -10.5 to -1.6), and resulted in a higher incidence of hemidiaphragmatic paralysis (18/20 vs 0/20 patients, respectively; P < 0.001). Although postoperative pain scores at one, two, and three hours appeared lower in the ISB group, the upper bounds of the 99% CIs did not exceed the equivalence margin. Conclusion: Compared with ICB-SSB, ISB provided non-equivalent (i.e., lower) postoperative pain scores 30 min after arthroscopic shoulder surgery. Thereafter, postoperative analgesia was comparable between the two groups. Further trials are required to compare ISB with ICB-SSB using a proximal (i.e., costoclavicular) technique for ICB. Trial registration: www.clinicaltrials.gov, NCT02993939. Registered 12 December 2016. Copyright © 2017, Canadian Anesthesiologists' Society. Database: EMBASE

30. Quality Improvement Pearls for the Palliative Care and Hospice Professional Author(s): Kamal A.H.; Nicolla J.M.; Power S. Source: Journal of Pain and Symptom Management; Nov 2017; vol. 54 (no. 5); p. 758-765 Publication Date: Nov 2017 Publication Type(s): Article Abstract:Rapid changes in how palliative care clinicians are evaluated and paid present an imperative for clinicians to adeptly and routinely perform quality improvement in usual practice. Like empathic communication and facilitating goals of care discussions, quality improvement skills must be learned, honed, and practiced, so identifying problems and brainstorming solutions becomes a natural component of delivering serious illness care. Using our experience in both failures and successes in performing quality improvement, here we provide a prioritized list of 10 pearls specifically aimed to palliative care and hospice professionals. We aim to demystify quality improvement, highlight areas where rigor and a systematic approach are needed for success, and offer our own lessons learned and mistakes made to promote success for our colleagues and our field. Copyright © 2017 American Academy of Hospice and Palliative Medicine Database: EMBASE

31. A Comparison of the Strain and Tissue Doppler-Based Indices as Echocardiographic Correlates of the Left Ventricular Filling Pressures Author(s): Magoon R.; Malik V.; Choudhury A.; Chauhan S.; Hote M.P.; Ramakrishnan S.; Singh V. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objectives: Diastolic strain and strain rate, combined with E (peak transmitral velocity), have been proposed as novel noninvasive predictors of left ventricle (LV) filling pressures, avoiding angulation errors inherent to tissue Doppler indices (TDI). The primary objective was to study the correlation of strain-based indices (SBI) and TDI with pulmonary artery catheter-derived LV end-diastolic pressures (LVEDP). The secondary aim was to determine appropriate cut-off of indices to predict LVEDP >=15 mmHg. Design: A prospective observational clinical study. Setting: Single university hospital. Participants: One hundred twenty adults with preserved ejection fraction (EF) undergoing coronary artery bypass grafting. Interventions: None. Measurements and Main Results: Two-dimensional speckle-tracking echocardiography estimated global longitudinal diastolic strain (Ds) and strain rate (DSr) at peak mitral filling to compute E/Ds and E/10DSr. TDI was measured as the ratio of E and e' (mitral annular diastolic velocity). E/e', E/Ds, and E/10DSr were significantly higher (p < 0.001) in patients with LVEDP >=15 mm Hg (31/120). Correlation of E/Ds, E/10DSr with LVEDP was R = 0.86 and 0.88 (p < 0.001), respectively, compared with a correlation of R = 0.63 (p < 0.001) for E/e'. SBI correlated well with LVEDP >=15 mm Hg compared with TDI. E/Ds >=11 and E/10DSr >=12 had higher sensitivity and specificity (96.77%, 93.26%; 100%, 96.63%, respectively; area under the curve [AUC] = 0.99) than E/e'>=13 (74%,75%; AUC = 0.84) for prediction of LVEDP >=15 mmHg. SBI accurately predicted elevated LVEDP in the indeterminate zone of 8

32. The effects of Desflurane and Sevoflurane on Nesfatin-1 levels in laparoscopic Cholecystectomy: A randomized controlled trial Author(s): Ozcan A.T.D.; Ciftci A.; Altin C.B.; Aksoy S.M.; But A.; Erdogan S.; Ergin M.; Kara H. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC anesthesiology - from BioMed Central Available at BMC anesthesiology - from Europe PubMed Central - Open Access Available at BMC anesthesiology - from PubMed Central Abstract:Background: Nesfatin-1 is involved in cardiovascular regulation, stress-related responses. The objective of this study is to investigate the impact of volatile anesthetics on Nesfatin-1 levels. Method: Fourty-two patients aged 30-65 years with the American Society Anesthesiology (ASA) Class I-II who were scheduled for laparoscopic cholecystectomy were included in the study Patients were randomized into two group; desflurane administered group (Group I, n = 21) and sevoflurane administered group (Group II, n = 21). For anesthesia maintenance, the patients received 6% desflurane or 2% sevoflurane in 40% O2 and 60% air. The patient's heart rate (HR), mean, systolic and diastolic arterial pressures (MAP, SAP, DAP), peripheral O2 saturation (SpO2) were monitored and recorded before induction, after induction, after intubation, and during extubation. Blood samples were collected before induction (T1), and after extubation when aldrete score was 10 (T2). Results: Demographic data were similar between the groups. The preoperative levels of nesfatin were similar in the two groups (p = 0.715). In desflurane group, post-operative nesfatin levels were similar compared to preoperative levels (p = 0.073). In sevoflurane group, post-operative nesfatin levels were similar (p = 0.131). The nesfatin levels (postoperative vs preoperative) were similar between the groups (p = 0.900). Conclusion: In conclusion, this study results suggest that nesfatin-1 levels are not affected by the use of sevoflurane or desflurane in patients undergoing laparoscopic cholecystectomy. Copyright © 2018 The Author(s). Database: EMBASE

33. Incidence and factors contributing to postdischarge nausea and vomiting in pediatric ambulatory surgical cases Author(s): Efune P.N.; Minhajuddin A.; Szmuk P. Source: Paediatric Anaesthesia; Mar 2018; vol. 28 (no. 3); p. 257-263 Publication Date: Mar 2018 Publication Type(s): Article Available at Paediatric anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Little is known regarding the incidence and contributing factors of postdischarge nausea and vomiting in children. Aims: The aim of this study was to determine the incidence of postdischarge nausea and vomiting in day surgery patients and to identify demographic, intraoperative, and postoperative variables that influence the risk. Methods: In this prospective observational study, a postdischarge questionnaire was administered to parents of ambulatory patients who received anesthesia and the electronic records were reviewed. Results: Of 1041 ambulatory patients who received general anesthesia, 143 (14%) experienced postdischarge nausea and vomiting. Patients who did not receive intraoperative opioids had a lower incidence (8%) than those who received short- acting opioids (14%) (difference of 6%, 95% CI 1.9%-10.2%, P <.001) or long-acting opioids (24%) (difference of 16%, 95% CI 8.1%-24.3%, P <.001). Patients who received short-acting opioids also had a lower incidence than those who received long-acting opioids (difference of 10%, 95% CI 2.2%-18.1%, P <.001). The incidence also differed between those patients who received postdischarge opioids at home (29%) and those who did not (13%) (difference of 16%, 95% CI 7.5%-27.6%, P <.001). There was no association with age, gender, airway management, nitrous oxide use, amount of intravenous fluids, duration of anesthesia, intraoperative antiemetic administration or dosage, length of time from recovery room discharge to first oral intake, or length of ride home from the hospital. Multivariate generalized linear regression analysis confirmed intraoperative (short-acting opioids odds ratio 1.686, 95% CI 1.020-2.787; long-acting opioids odds ratio 3.093, 95% CI 1.634-5.874) and postdischarge (odds ratio 2.037 95% CI 1.142-3.632) opioids to be independent risk factors for postdischarge nausea and vomiting. Conclusion: We found an incidence of postdischarge nausea and vomiting of 14%. Intraoperative and postdischarge opioids increase the risk, with long-acting intraoperative opioids further accentuating the risk. Copyright © 2018 John Wiley & Sons Ltd Database: EMBASE

34. Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data Author(s): Eisler L.; Huang G.; Lee K.-E.M.; Busse J.A.; Lin A.Y.; Ing C.; Sun M.; Sun L.S. Source: Paediatric Anaesthesia; Mar 2018; vol. 28 (no. 3); p. 218-225 Publication Date: Mar 2018 Publication Type(s): Article Available at Pediatric Anesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Perioperative aspiration is a rare but potentially devastating complication, occurring in 1-10 per 10 000 anesthetics based on studies of quality assurance databases. Quality assurance reporting is known to underestimate the incidence of adverse outcomes, but few large studies use supplementary data sources. This study aims to identify the incidence of and risk factors for perioperative aspiration in children using quality assurance data supplemented by administrative billing records, and to examine the utility of billing data as a supplementary data source. Methods: Aspiration events for children receiving anesthesia at a tertiary care pediatric hospital between 2008 and 2014 were identified using (i) a perioperative quality assurance database and (ii) hospital administrative billing records with International Classification of Diseases, Ninth Revision Clinical Modification coded diagnoses of aspiration. Records were subject to review by pediatric anesthesiologists. Following identification of all aspiration events, the incidence of perioperative aspiration was calculated and risk factors were assessed. Results: 47 272 anesthetic cases were evaluated over 7 years. The quality assurance database identified 20 cases of perioperative aspiration occurring in surgical inpatients, same-day admissions, and outpatients. Using hospital administrative data (which excludes outpatients with shorter than a 24-hour stay), 9 cases of perioperative aspiration were identified of which 6 had not been found through quality assurance data. Overall, International Classification of Diseases, Ninth Revision coding demonstrated a positive predictive value of 94.5% for any aspiration event; however, positive predictive value was <4% for perioperative aspiration. A total incidence of 5.5 perioperative aspirations per 10 000 (95% CI: 3.7-8.0 per 10 000) anesthetics was found. Conclusion: Quality assurance data offer an efficient way to measure the incidence of rare events, but may underestimate perioperative complications. International Classification of Diseases, Ninth Revision codes for aspiration used as a secondary data source were nonspecific for perioperative aspiration, but when combined with record review yielded a 30% increase in identified cases of aspiration over quality assurance data alone. The use of administrative data therefore holds potential for supplementing quality assurance studies of rare complications. Copyright © 2018 John Wiley & Sons Ltd Database: EMBASE

35. Evaluation of the stability and stratification of propofol and ketamine mixtures for pediatric anesthesia Author(s): Izgi M.; Ankay Yilbas A.; Celebioglu B.; Basaran B.; Uluer M.S.; Muderrisoglu A. Source: Paediatric Anaesthesia; Mar 2018; vol. 28 (no. 3); p. 275-280 Publication Date: Mar 2018 Publication Type(s): Article Available at Pediatric Anesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: The combination of propofol and ketamine is commonly used for total intravenous anesthesia. These drugs can be delivered in different syringes or in the same syringe. We hypothesized that the drugs might separate and different concentrations of each drug could be found in different parts of the syringe during the procedure period when they were mixed in 1 syringe. Methods: Twelve 60-mL polypropylene syringes were prepared by mixing propofol and ketamine as 4 groups on the basis of propofol/ketamine mixture ratios (5:1 and 6.7:1) and propofol solution concentrations. Syringes were placed upright in the vertical position into a rack and kept at room temperature (21.5- 22.5degreeC), in daylight conditions and were not moved for 360 minutes. Samples of the mixture were taken from both the top and the bottom of the syringe. The first 1 mL of the samples was discarded, the following second 1 mL of the samples was filtered using 0.2- mum polytetrafluoroethylene filters and measured twice (n = 6). Samples were taken at the following time intervals: T0, T10, T30, T60, T90, T120, T180, T240, T300, and T360 min. Syringes were checked visually for any color change and separation lines between the drugs. Results: There were no significant differences between the propofol and ketamine concentrations of the top and bottom samples in all 4 groups. In addition, there were no statistically significant changes of propofol and ketamine concentrations of samples over 360 minutes in any of the 4 groups. No visual changes were observed during 6 hours' observation. Conclusion: The results of our measurements demonstrated that mixtures of propofol (1% and 2%) and ketamine at 5:1 and 6.7:1 ratios could be used in terms of mixture homogeneity and stability in a polypropylene syringe during a 6-hour period at room temperature. Copyright © 2018 John Wiley & Sons Ltd Database: EMBASE

36. Volatile anesthesia for a pediatric patient with very long-chain acyl-coenzyme A dehydrogenase deficiency: A case report Author(s): Hess A.S.; Jochman J.D.; Muldowney B.L.; Rice G.M. Source: Paediatric Anaesthesia; Mar 2018; vol. 28 (no. 3); p. 296-297 Publication Date: Mar 2018 Publication Type(s): Article Available at Pediatric Anesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:We report the case of a 3-year-old boy with very long-chain acyl-coenzyme A dehydrogenase deficiency presenting for adenotonsillectomy who was successfully and safely managed with a balanced anesthetic including sevoflurane. The anesthetic management is described, and the controversy surrounding volatile anesthetics in these patients is discussed. Copyright © 2018 John Wiley & Sons Ltd Database: EMBASE

37. The gut microbiota as a key regulator of visceral pain Author(s): O'Mahony S.M.; Cryan J.F.; Dinan T.G. Source: Pain; 2017; vol. 158 (no. 4) Publication Date: 2017 Publication Type(s): Review Database: EMBASE

38. Lateral Supratrochanteric Approach to Sciatic and Femoral Nerve Blocks in Children: A Feasibility Study Author(s): Albokrinov A.A.; Huz T.B.; Perova-Sharonova V.M.; Fesenko U.A. Source: Anesthesiology Research and Practice; 2017; vol. 2017 Publication Date: 2017 Publication Type(s): Article Available at Anesthesiology research and practice - from Europe PubMed Central - Open Access Available at Anesthesiology research and practice - from Hindawi Open Access Journals Available at Anesthesiology research and practice - from PubMed Central Abstract:Background. Sciatic and femoral nerve blocks (SNB and FNB) result in effective lower limb analgesia. Classical SNB and FNB require patient repositioning which can cause pain and discomfort. Alternative approaches to sciatic and femoral nerve blocks in supine patients can be useful. Materials and Methods. Neurostimulator-guided SNB and FNB from the lateral supratrochanteric approach were performed. Local anesthetic spread in SNB and FNB after radiographic opacification was analyzed. Time and number of attempts to perform blocks, needle depth, and clinical efficacy were assessed. Results. Mean needle passes number and procedure time for SNB were 2.5 +/- 0.3 and 2.4 +/- 0.2 min, respectively. Mean needle passes number and procedure time for FNB were 2.7 +/- 0.27 and 2.59 +/- 0.23 min, respectively. Mean skin to nerve distance was 9.1 +/- 0.45 cm for SNB and 8.8 +/- 0.5 cm for FNB. Radiographic opacification of SNB showed local anesthetic spread close to the sacrum and involvement of sacral plexus nerve roots. Spread of local anesthetic in FNB was typical. Intraoperative fentanyl administration was required in 2 patients (9.5%) with mean dose 1.8 +/- 0.2 mcg/kg. Mean postoperative pain score was 0.34 +/- 0.08 of 10. Conclusion. The lateral supratrochanteric approach to SNB and FNB in children can be an effective lower limb analgesic technique in supine patients. The trial is registered with ISRCTN70969666. Copyright © 2017 Andrew A. Albokrinov et al. Database: EMBASE

39. Drug Errors and Protocol for Prevention among Anaesthetists in Nigeria Author(s): Johnson U.U.; Ebirim L.N. Source: Anesthesiology Research and Practice; 2017; vol. 2017 Publication Date: 2017 Publication Type(s): Article Available at Anesthesiology research and practice - from Europe PubMed Central - Open Access Available at Anesthesiology research and practice - from Hindawi Open Access Journals Available at Anesthesiology research and practice - from PubMed Central Abstract:Background. Drugs are often prescribed, dispensed, and administered by the same person during anaesthesia, and this may increase the risk of drug error. Objectives. To assess the frequency of drug administration errors by anaesthetists, the drugs commonly involved, and the effects of such errors. Method. A questionnaire-based study was carried out among participants at an annual conference of Nigerian anaesthetists. Sixty-six of the 80 participants returned the completed questionnaire. The respondents comprised 1 nurse anaesthetist, 34 resident doctors, 3 doctors with diploma in anaesthesia, and 28 consultant anaesthetists. The collated data on drug errors, the effect of such errors on patients, and formulated protocols to prevent future occurrence were subjected to descriptive analysis using Microsoft Excel. Result. Drug error was reported by 71.21% and witnessed by 22.72% of the respondents. Most of the drug errors occurred during general anaesthesia (90.3%) for emergency procedures (51.61%), and muscle relaxants were most commonly involved (58.06%). Conclusion. Drug errors are common among anaesthetists in Nigeria and their incidence is greater during general anaesthesia for emergency procedures, largely as a result of ampoule swaps due to similarities in ampoule design and packaging. Guidelines on their prevention should be developed by all health institutions. Copyright © 2017 U. U. Johnson and L. N. Ebirim. Database: EMBASE

40. Anti-inflammatory effects of propranolol in the temporomandibular joint of female rats and its contribution to antinociceptive action Author(s): Zanelatto F.B.; Dias E.V.; Teixeira J.M.; Sartori C.R.; Parada C.A.; Tambeli C.H. Source: European Journal of Pain (United Kingdom); Mar 2018; vol. 22 (no. 3); p. 572-582 Publication Date: Mar 2018 Publication Type(s): Article Available at European Journal of Pain - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: beta-Blockers reduce temporomandibular joint (TMJ) pain. We asked whether they also reduce TMJ inflammation and, if so, whether this anti-inflammatory effect contributes to its analgesic action. Methods: We measured many parameters of the inflammatory response after co-administration of the beta-blocker propranolol with the inflammatory agent carrageenan in the TMJ of female rats. We also hypothesized that the activation of beta-adrenoceptors in the TMJ induces nociception mediated, at least in part, by the inflammatory response. To test this hypothesis, we examined the nociceptive response induced by the activation of the beta-adrenoceptors in the TMJ in female rats pretreated with thalidomide and fucoidan. Results: We found that the co-administration of propranolol with carrageenan in the TMJ of female rats significantly reduced several parameters of the inflammatory response induced by carrageenan such as plasma extravasation, neutrophil migration and the release of the pro-inflammatory cytokines TNF- alpha, IL-1beta and CINC-1. Furthermore, the injection of the beta-adrenergic receptor agonist isoproterenol in the TMJ induced nociception that was significantly reduced by thalidomide, fucoidan and by the co-administration of propranolol but not of the alpha- adrenergic receptor antagonist phentolamine. Conclusions: Propranolol has anti- inflammatory effects that contribute to its antinociceptive action in the TMJ of females. Significance: beta-Blockers have an anti-inflammatory effect on temporomandibular joint (TMJ) that contributes to its analgesic effect. The results of this work suggest that beta- blockers can be used to treat the painful conditions of TMJ, especially when they are associated with an inflammatory process. Copyright © 2017 European Pain Federation - EFIC Database: EMBASE

41. Acupuncture versus titrated morphine in acute renal colic: A randomized controlled trial Author(s): Beltaief K.; Grissa M.H.; Msolli M.A.; Bzeouich N.; Fredj N.; Sakma A.; Boubaker H.; Bouida W.; Boukef R.; Nouira S. Source: Journal of Pain Research; Feb 2018; vol. 11 ; p. 335-341 Publication Date: Feb 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Objective: The objective of this study was to compare the analgesic effect and tolerance profile of acupuncture versus intravenous (IV) titrated morphine in patients presenting to the emergency department (ED) with renal colic. Materials and methods: A total of 115 patients were randomized into two groups. Patients in the IV titrated-morphine group (n=61) received 0.1 mg/kg morphine every 5 minutes until pain score dropped by at least 50% of its baseline value. Patients in the acupuncture group (n=54) received an acupuncture session of 30 minutes following a prespecified protocol. The visual analog scale (VAS) was used to assess pain intensity at baseline and at 10, 20, 30, 45, and 60 minutes following the start of the treatment protocol. Possible treatment side effects were also recorded. Results: No significant differences were found between the two groups concerning age, sex, or baseline VAS score. From the 10th minute until the end of the intervention, acupuncture was associated with a deeper analgesic effect than titrated morphine (P<0.05 from the 10th minute and over). Analgesia was also faster in the acupuncture group, with time to obtain 50% reduction of baseline VAS of 14 minutes in the acupuncture group versus 28 minutes in the IV titrated-morphine group (P<0.001). Only three patients in the acupuncture group experienced minor side effects versus 42 in the morphine group (P<0.001). No major side effects were observed in this study. Conclusion: In ED patients with renal colic, acupuncture was associated with a much faster and deeper analgesic effect and a better tolerance profile in comparison with titrated IV morphine. Copyright © 2018 Beltaief et al. Database: EMBASE

42. The influence of type of anesthesia, perioperative pain, and preoperative health status on chronic pain six months after thoracotomy-A prospective cohort study Author(s): Kampe S.; Geismann B.; Weinreich G.; Stamatis G.; Ebmeyer U.; Gerbershagen H.J. Source: Pain Medicine (United States); Nov 2017; vol. 18 (no. 11); p. 2208-2213 Publication Date: Nov 2017 Publication Type(s): Article Abstract:Background. Chronic post-thoracotomy pain (CPP) has a high incidence. However, less is known about risk factors and the influence of different analgesia therapies. Methods. In this prospective cohort study, patients either received standardized epidural analgesia or began an oral analgesic protocol with controlled-release oxycodone immediately postoperatively. Patients answered a baseline questionnaire on the day before surgery and a follow-up questionnaire six months postoperatively. The questionnaire included Short- Form 12, the Neuropathic Pain Scale, and descriptive questions for CPP. Pain protocols of all patients were examined. Logistic regression was used to analyze the risk factors related to CPP. Results. One hundred seventy-four patients were enrolled; data of 131 patients were available after the six-month follow-up period. Fifty-one patients (39%) had CPP six months postoperatively. Of these, more than 80% had impaired daily activity or ability to work, or reported sleeping disturbance due to CPP. The strongest predictive factors for the development of CPP were: thoracic pain for three months preoperatively (odds ratio [OR] 5 3.54, 95% confidence interval [CI] 5 1.69-7.40, P50.001), thoracic pain for 12 months preoperatively (OR52.73, 95% CI51.28-5.83, P50.009), and higher pain scores at rest in the first five postoperative days compared with patients without CPP (OR51.79, 95% CI51.24- 2.57, P50.002). Neuropathic pain was present in 4.8% of patients. Patients with CPP had a reduced physical (P50.005) and mental health status (P50.03) six months after surgery compared with patients without CPP. Conclusions. Preoperative thoracic pain and higher pain scores in the first five postoperative days seem to be the strongest risk factors for the development of CPP. CPP patients reported poorer mental and physical health before and six months after surgery. Copyright © 2017 American Academy of Pain Medicine. All rights reserved Database: EMBASE

43. Efficacy of mirogabalin (DS-5565) on patient-reported pain and sleep interference in patients with diabetic neuropathic pain: Secondary outcomes of a phase II proof-of- concept study Author(s): Merante D.; Rosenstock J.; Sharma U.; Feins K.; Hsu C.; Vinik A. Source: Pain Medicine (United States); Nov 2017; vol. 18 (no. 11); p. 2198-2207 Publication Date: Nov 2017 Publication Type(s): Article Abstract:Objective. To evaluate the effects of mirogabalin on patient-reported pain and sleep interference in diabetic peripheral neuropathic pain (DPNP). Subjects. Adults (>=18 years) with type 1 or 2 diabetes, glycosylated hemoglobin of 10% or less at screening, and DPNP for six months or more were eligible for participation. Methods. Subjects (N5452) were randomly assigned (2:1:1:1:1:1:1) to receive placebo, doseranging mirogabalin (5, 10, 15, 20, 30 mg/day), or pregabalin (300 mg/day) for five weeks. Secondary efficacy end points studied here included patient global impression of change (PGIC), modified brief pain inventory (BPI), and average daily sleep interference score (ADSIS). Correlation plots were generated to examine the relationship between ADSIS and average daily pain score (ADPS). Results. At week 5, significant reductions in ADSIS were observed in the mirogabalin 15, 20, and 30 mg/ day groups, compared with placebo (P < 0.05). Baseline ADSIS and ADPS were strongly correlated (R250.4407), as were mean changes from baseline in ADSIS and ADPS at week 5 (R250.6694). The mirogabalin 30 mg/day group showed significant improvement compared with placebo in four of six BPI subscales at end point; the mirogabalin 15 mg/day group showed significant improvement in three of six BPI subscales (P < 0.05). At end of treatment, the percentage of subject with PGIC status of "much improved or better" was greater in all mirogabalin dose groups than in the placebo group (P < 0.05). A low incidence of treatment-related adverse events was reported for mirogabalin. Conclusions. Results support the effectiveness of mirogabalin in improving patient-reported pain and sleep interference in DPNP. Copyright © 2017 American Academy of Pain Medicine. All rights reserved Database: EMBASE

44. Changes in the skin conductance monitor as an end point for sympathetic nerve blocks Author(s): Gungor S.; Rana B.; Bae J.J.; Mount L.; Buschiazzo V.; Fields K.; Storm H. Source: Pain Medicine (United States); Nov 2017; vol. 18 (no. 11); p. 2187-2197 Publication Date: Nov 2017 Publication Type(s): Article Abstract:Objective. There is a lack of objective methods for determining the achievement of sympathetic block. This study validates the skin conductance monitor (SCM) as an end point indicator of successful sympathetic blockade as compared with traditional monitors. Methods. This interventional study included 13 patients undergoing 25 lumbar sympathetic blocks to compare time to indication of successful blockade between the SCM indices and traditional measures, clinically visible hyperemia, clinically visible engorgement of veins, subjective skin temperature difference, unilateral thermometry monitoring, bilateral comparative thermometry monitoring, and change in waveform amplitude in pulse oximetry plethysmography, within a 30-minute observation period. Differences in the SCM indices were studied pre- and postblock to validate the SCM. Results. SCM showed substantially greater odds of indicating achievement of sympathetic block in the next moment (i.e., hazard rate) compared with all traditional measures (clinically visible hyperemia, clinically visible engorgement of veins, subjective temperature difference, unilateral thermometry monitoring, bilateral comparative thermometry monitoring, and change in waveform amplitude in pulse oximetry plethysmography; P <= 0.011). SCM indicated successful block for all (100%) procedures, while the traditional measures failed to indicate successful blocks in 16-84% of procedures. The SCM indices were significantly higher in preblock compared with postblock measurements (P < 0.005). Conclusions. This preliminary study suggests that SCM is a more reliable and rapid response indicator of a successful sympathetic blockade when compared with traditional monitors. Copyright © 2017 American Academy of Pain Medicine. All rights reserved Database: EMBASE

45. Application of virtual navigation with multimodality image fusion in foramen ovale cannulation Author(s): Qiu X.; Zhang M.; Lei Y.; Xia J.; Liu W.; Lin H.; Zhou S. Source: Pain Medicine (United States); Nov 2017; vol. 18 (no. 11); p. 2181-2186 Publication Date: Nov 2017 Publication Type(s): Article Abstract:Objective. Idiopathic trigeminal neuralgia (ITN) can be effectively treated with radiofrequency thermocoagulation. However, this procedure requires cannulation of the foramen ovale, and conventional cannulation methods are associated with high failure rates. Multimodality imaging can improve the accuracy of cannulation because each imaging method can compensate for the drawbacks of the other. We aim to determine the feasibility and accuracy of percutaneous foramen ovale cannulation under the guidance of virtual navigation with multimodality image fusion in a self-designed anatomical model of human cadaveric heads. Design. Five cadaveric head specimens were investigated in this study. Spiral computed tomography (CT) scanning clearly displayed the foramen ovale in all five specimens (10 foramina), which could not be visualized using two-dimensional ultrasound alone. The ultrasound and spiral CT images were fused, and percutaneous cannulation of the foramen ovale was performed under virtual navigation. After this, spiral CT scanning was immediately repeated to confirm the accuracy of the cannulation. Results. Postprocedural spiral CT confirmed that the ultrasound and CT images had been successfully fused for all 10 foramina, which were accurately and successfully cannulated. The success rates of both image fusion and cannulation were 100%. Conclusions. Virtual navigation with multimodality image fusion can substantially facilitate foramen ovale cannulation and isworthy of clinical application. Copyright © 2017 American Academy of Pain Medicine. All rights reserved Database: EMBASE

46. A novel chronic opioid monitoring tool to assess prescription drug steady state levels in oral fluid Author(s): Shaparin N.; Mehta N.; Kunkel F.; Stripp R.; Borg D.; Kolb E. Source: Pain Medicine (United States); Nov 2017; vol. 18 (no. 11); p. 2162-2169 Publication Date: Nov 2017 Publication Type(s): Article Abstract:Objective. Interpretation limitations of urine drug testing and the invasiveness of blood toxicology have motivated the desire for the development of simpler methods to assess biologically active drug levels on an individualized patient basis. Oral fluid is a matrix well-suited for the challenge because collections are based on simple noninvasive procedures and drug concentrations better correlate to blood drug levels as oral fluid is a filtrate of the blood. Well-established pharmacokinetic models were utilized to generate oral fluid steady state concentration ranges to assess the interpretive value of the alternative matrix to monitor steady state plasma oxycodone levels. Methods. Paired oral fluid and plasma samples were collected from patients chronically prescribed oxycodone and quantitatively analyzed by liquid chromatography tandem mass spectrometry. Steady state plasma concentration ranges were calculated for each donor and converted to an equivalent range in oral fluid. Measured plasma and oral fluid oxycodone concentrations were compared with respective matrix-matched steady state ranges, using each plasma steady state classification as the control. Results. A high degree of correlation was observed between matrices when classifying donors according to expected steady state oxycodone concentration. Agreement between plasma and oral fluid steady state classifications was observed in 75.6% of paired samples. This study supports novel application of basic pharmacokinetic knowledge to the pain management industry, simplifying and improving individualized drug monitoring and risk assessment through the use of oral fluid drug testing. Many benefits of established therapeutic drug monitoring in plasma can be realized in oral fluid for patients chronically prescribed oxycodone at steady state. Copyright © 2017 American Academy of Pain Medicine. All rights reserved Database: EMBASE

47. Addressing disparities in low back pain care by developing culturally appropriate information for Aboriginal Australians: "My back on track, my future" Author(s): Lin I.B.; Ryder K.; Green C.; Coffin J.; Dalgety E.; Scott B.; Straker L.M.; Smith A.J.; O'Sullivan P.B. Source: Pain Medicine (United States); Nov 2017; vol. 18 (no. 11); p. 2070-2080 Publication Date: Nov 2017 Publication Type(s): Article Abstract:Objectives. Addressing disparities in low back pain care (LBP) is an important yet largely unaddressed issue. One avenue to addressing disparities, recommended by clinical guidelines, is to ensure that LBP information is culturally appropriate. Our objectives were, first, to develop LBP information that was culturally appropriate for Aboriginal Australians living in a rural area and, second, to compare this to traditional information. Methods. The overall information development process was guided by a "cultural security" framework and included partnerships between Aboriginal/non- Aboriginal investigators, a synthesis of research evidence, and participation of a project steering group consisting of local Aboriginal people. LBP information (entitled My Back on Track, My Future [MBOT]) was developed as five short audio-visual scenarios, filmed using Aboriginal community actors. A qualitative randomized crossover design compared MBOT with an evidence-based standard (the Back Book [BB]). Twenty Aboriginal adults participated. Qualitatively we ascertained which information participants' preferred and why, perceptions about each resource, and LBP management. Results. Thirteen participants preferred MBOT, four the BB, two both, and one neither. Participants valued seeing "Aboriginal faces," language that was understandable, the visual format, and seeing Aboriginal people undertaking positive changes in MBOT. In contrast, many participants found the language and format of the BB a barrier. Participants who preferred the BB were more comfortable with written information and appreciated the detailed content. Conclusions. The MBOT information was more preferred and addressed important barriers to care, providing support for use in practice. Similar processes are needed to develop pain information for other cultural groups, particularly those underserved by existing approaches to care. Copyright © 2017 American Academy of Pain Medicine. All rights reserved Database: EMBASE

48. Feasibility of continuous sedation monitoring in critically ill intensive care unit patients using the NeuroSENSE WAV_CNS index Author(s): West N.; Brodie S.M.; Sunderland S.; Griesdale D.E.G.; Ansermino J.M.; Gorges M.; McBeth P.B.; van Heusden K.; Dumont G.A. Source: Journal of Clinical Monitoring and Computing; Feb 2018 ; p. 1-11 Publication Date: Feb 2018 Publication Type(s): Article In Press Abstract:Sedation in the intensive care unit (ICU) is challenging, as both over- and under- sedation are detrimental. Current methods of assessment, such as the Richmond Agitation Sedation Scale (RASS), are measured intermittently and rely on patients' behavioral response to stimulation, which may interrupt sleep/rest. A non-stimulating method for continuous sedation monitoring may be beneficial and allow more frequent assessment. Processed electroencephalography (EEG) monitors have not been routinely adopted in the ICU. The aim of this observational study was to assess the feasibility of using the NeuroSENSETM monitor for EEG-based continuous sedation assessment. With ethical approval, ICU patients on continuous propofol sedation were recruited. Depth-of-hypnosis index (WAVCNS) values were obtained from the NeuroSENSE. Bedside nurses, blinded to the NeuroSENSE, performed regular RASS assessments and maintained the sedation regimen as per standard of care. Participants were monitored throughout the duration of their propofol infusion, up to 24 h. Fifteen patients, with median [interquartile range] age of 57 [52-62.5] years were each monitored for a duration of 9.0 [5.7-20.1] h. Valid WAVCNS values were obtained for 89% [66-99] of monitoring time and were widely distributed within and between individuals, with 6% [1-31] spent < 40 (very deep), and 3% [1-15] spent > 90 (awake). Significant EEG suppression was detected in 3/15 (20%) participants. Observed RASS matched RASS goals in 36/89 (40%) assessments. The WAVCNS variability, and incidence of EEG suppression, highlight the limitations of using RASS as a standalone sedation measure, and suggests potential benefit of adjunct continuous brain monitoring. Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature Database: EMBASE

49. Sensory distribution of the lateral femoral cutaneous nerve block - a randomised, blinded trial Author(s): Nersesjan M.; Andersen J.H.; Mathiesen O.; Hagi-Pedersen D.; Thybo K.H.; Dahl J.B.; Broeng L. Source: Acta Anaesthesiologica Scandinavica; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Acta Anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: The lateral femoral cutaneous nerve (LFCN) block may be used for post-operative pain management in patients undergoing total hip arthroplasty. The aim of this trial was to investigate the sensory coverage of the posterior and the lateral incision lines and the involvement of the femoral nerve after an LFCN block. Methods: The study was a randomised, blinded trial in 20 healthy volunteers. All subjects received a bilateral LFCN block randomised to 8 ml ropivacaine on the right side and 8 ml isotonic saline on the left side, or vice versa. An orthopaedic surgeon depicted the incision lines (invisible to the investigators) prior to block performance. The distribution of the blocked area and the coverage of the incision lines were assessed with temperature discrimination and pinprick test before unblinding the incision lines. Pain during tonic heat stimulation and involvement of the femoral nerve by measuring quadriceps strength were assessed. Results: The mean difference in block coverage of the posterior (primary outcome) and the lateral incision lines tested with temperature discrimination were 5.8% (95% CI: -2.2 to 14.0%, P = 0.146) and 18.9% (95% CI: 6.5-31.4%, P = 0.005), respectively, comparing the active with the placebo side. A varying anatomic distribution area was observed. No clinically significant differences for experimental pain and quadriceps muscle strength were found. The block failure rate was 15%. Conclusion: An LFCN block consisting of 8 ml 0.75% ropivacaine had limited coverage of the posterior and lateral incision lines. Copyright © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Database: EMBASE

50. Ultrasound-guided bilateral superficial cervical block and preemptive single-dose oral tizanidine for post-thyroidectomy pain: a randomized-controlled double-blind study Author(s): Ahiskalioglu A.; Yayik A.M.; Dostbil A.; Doymus O.; Ari M.A.; Alici H.A.; Oral Ahiskalioglu E.; Celik E.C.; Karadeniz E.; Sengoz F. Source: Journal of Anesthesia; Feb 2018 ; p. 1-8 Publication Date: Feb 2018 Publication Type(s): Article In Press Abstract:Purposes: The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery. Methods: Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C, n = 20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC, n = 20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC + T, n = 20) received BSCPB with 0.25% bupivacaine plus tizanidine 6 mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24 h. Results: Compared with Group C, rest and swallowing pain scores in Group SC and Group SC + T were statistically lower at all postoperative time points (p < 0.05). Fentanyl consumption was lower in Group SC and Group SC + T than in Group C at time periods 0-4 and 4-8 h (p < 0.05). Fentanyl consumption was lower in Group SC + T than in Group SC at 0-4 h (p = 0.006). Total fentanyl consumption was higher in Group C than in the other groups (p < 0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC + T than in the other groups (p < 0.05). Conclusions: Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache. Clinical trials registry: The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359). Copyright © 2018 Japanese Society of Anesthesiologists Database: EMBASE

51. Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels in patients with open midline incisions undergoing transabdominal gynecological surgery: A randomized-controlled trial Author(s): Jin F.; Li Z.; Tan W.-F.; Ma H.; Li X.-Q.; Lu H.-W. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC anesthesiology - from BioMed Central Available at BMC anesthesiology - from Europe PubMed Central - Open Access Available at BMC anesthesiology - from PubMed Central Abstract:Background: Nerve block is usually performed before surgery because it inhibits reflection of the skin incision and reduces the amount of intraoperative anesthetic used. We hypothesized that performing rectus sheath block (RSB) after surgery would result in a longer duration of the analgesic effects and have a subtle influence on sleep time after surgery but that it would not decrease the perioperative cytokine levels of patients undergoing gynecological surgery. Methods: A randomized, double-blinded, controlled trial was conducted from October 2015 to June 2016. Seventy-seven patients undergoing elective transabdominal gynecological surgery were randomly assigned to the following two groups: a general anesthesia group who received 0.5% ropivacaine hydrochloride RSB preoperatively and saline RSB postoperatively, and another group who received the opposite sequence. The objective of the trial was to evaluate the postoperative pain, sleep and changes in cytokine levels of patients during the postoperative 48 h. Results: A total of 61 female patients (mean age: 50 years; range: 24-65 years) were included in the final study sample. There was no significant difference in the pain, consumption of oxycodone, or time to first administration of patient-controlled intravenous analgesia between the two groups. The postoperative sleep stages N2 and N3 were increased by 52.9 and 29.1 min per patient, respectively, in the preoperative RSB group compared with those in the postoperative group. The preoperative IL-6 concentration in the preoperative RSB group was lower than that in the same group at the end of surgery and 24 h postoperatively. Conclusions: We concluded that preoperative RSB might preserve postoperative sleep by inhibiting the increase of IL-6 without shortening the analgesia time compared with postoperative RSB in female patients undergoing elective midline incision transabdominal gynecological surgery. Copyright © 2018 The Author(s). Database: EMBASE

52. Ultrasound-guided lumbar plexus block in children and adolescents using a transverse lumbar paravertebral sonogram: Initial experience Author(s): Boretsky K.; Eastburn E.; Sullivan C.; Hernandez M.A. Source: Paediatric Anaesthesia; Mar 2018; vol. 28 (no. 3); p. 291-295 Publication Date: Mar 2018 Publication Type(s): Article Available at Paediatric anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: The clinical reliability and reproducibility of ultrasound-guided lumbar plexus blocks is not established in pediatric populations. We present the results of a combined nerve stimulation ultrasound-guided lumbar plexus block using the vertebral body, transverse process, and psoas muscle as landmarks on a transverse lumbar paravertebral sonogram with mid-axillary transducer placement, "shamrock method," in children and adolescents. Aims: Our primary objective was to determine the rate of achieving sensory changes in the lumbar plexus distribution. Secondary outcomes were performance time, reliability of echo-landmarks, measures of patient comfort, and complications. Methods: We reviewed prospectively collected quality assurance data and electronic medical records of 21 patients having major orthopedic surgery with lumbar plexus block catheter for postoperative analgesia. Results: Twenty-one patients were studied with mean age and weight (SD, range) of 13.6 years (3.8, 6-18) and 49.3 kg (18.6, 19.2-87.6). Surgical procedures included periacetabular osteotomy, pelvic osteotomy, and proximal femoral osteotomy. Mean volume of 0.5 mL/kg (0.05) 0.2% ropivacaine produced thermal sensory changes to femoral and lateral femoral cutaneous nerves in 20/21 (95% CI 0.76 to >0.99) and 19/21 (95% CI 0.70-0.99) patients. Identification of transverse process (TP), vertebral body (VB), and psoas muscle (PM): 21/21 (95% CI 0.86-1.0). Average block performance time was 9:08 minutes (2:09, 2-13). Average opioid consumption (SD) in operating room, postanesthesia care unit, 0-12 and 12-24-hour periods were 0.17 mg/kg (0.08), 0.08 mg/kg (0.06), 0.06 mg/kg (0.06), and 0.06 mg/kg (0.05). Median pain score by severity category in postanesthesia care unit: (0-3) 66.7%, (4-6) 28.5%, (>7) 4.8%; 0-12 hours: (0-3) 76.2%, (4-6) 19.0%, (>7) 4.8%; 12-24 hours: (0-3) 57.2%, (4-6) 42.8%, (>7) 0%. No complications were recorded. Conclusion: Ultrasound guidance using lateral imaging of transverse process, vertebral body, and psoas muscle allows practitioners to reach the nerves of the lumbar plexus and achieve sensory block in pediatric patients with a high success rate. Copyright © 2018 John Wiley & Sons Ltd Database: EMBASE

53. Cost-effectiveness of intravenous acetaminophen and ketorolac in adolescents undergoing idiopathic scoliosis surgery Author(s): Chidambaran V.; Subramanyam R.; Sadhasivam S.; Geisler K.; Stubbeman B.; Ding L.; Sturm P.; Jain V.; Eckman M.H. Source: Paediatric Anaesthesia; Mar 2018; vol. 28 (no. 3); p. 237-248 Publication Date: Mar 2018 Publication Type(s): Article Available at Pediatric Anesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Enhanced recovery after surgery protocols increasingly use multimodal analgesia after major surgeries with intravenous acetaminophen and ketorolac, despite no documented cost-effectiveness of these strategies. Aims: The goal of this prospective cohort study was to model cost-effectiveness of adding acetaminophen or acetaminophen + ketorolac to opioids for postoperative outcomes in children having scoliosis surgery. Methods: Of 106 postsurgical children, 36 received only opioids, 26 received intravenous acetaminophen, and 44 received acetaminophen + ketorolac as analgesia adjuncts. Costs were calculated in 2015 US $. Decision analytic model was constructed with Decision Maker software. Base-case and sensitivity analyses were performed with effectiveness defined as avoidance of opioid adverse effects. Results: The groups were comparable demographically. Compared with opioids-only strategy, subjects in the intravenous acetaminophen + ketorolac strategy consumed less opioids (P =.002; difference in mean morphine consumption on postoperative days 1 and 2 was -0.44 mg/kg (95% CI -0.72 to -0.16); tolerated meals earlier (P <.001; RR 0.250 (0.112-0.556)) and had less constipation (P <.001; RR 0.226 (0.094-0.546)). Base-case analysis showed that of the 3 strategies, use of opioids alone is both most costly and least effective, opioids + intravenous acetaminophen is intermediate in both cost and effectiveness; and opioids + intravenous acetaminophen and ketorolac is the least expensive and most effective strategy. The addition of intravenous acetaminophen with or without ketorolac to an opioid-only strategy saves $510-$947 per patient undergoing spine surgery and decreases opioid side effects. Conclusion: Intravenous acetaminophen with or without ketorolac reduced opioid consumption, opioid-related adverse effects, length of stay, and thereby cost of care following idiopathic scoliosis in adolescents compared with opioids-alone postoperative analgesia strategy. Copyright © 2018 John Wiley & Sons Ltd Database: EMBASE

54. Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics-A prospective randomized double-blinded study Author(s): Schmitz A.; Weiss M.; Sabandal C.; Buehler P.K.; Kellenberger C.; Ogorman Tuura R.; Scheer I.; Makki M.; Klaghofer R. Source: Paediatric Anaesthesia; Mar 2018; vol. 28 (no. 3); p. 264-274 Publication Date: Mar 2018 Publication Type(s): Article Available at Pediatric Anesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Introduction: Deep sedation using propofol has become a standard technique in children. This double-blinded randomized clinical trial aims to compare the clinical effects of propofol-mono-sedation vs a combination of propofol and ketamine at induction and a reduced propofol infusion rate for maintenance in children undergoing diagnostic magnetic resonance imaging. Methods: Children aged from 3 months to 10 years scheduled as outpatients for elective magnetic resonance imaging with deep sedation were included. They were randomized into 2 groups, receiving either 1 mg/kg ketamine at induction, then a propofol infusion rate of 5 mg/kg/h or a propofol infusion rate of 10 mg/kg/h without prior ketamine. Time to full recovery (modified Aldrete score = 10) was the primary outcome. Further outcomes were quality of induction, immobilization during image acquisition, recovery, postoperative nausea and vomiting, emergence delirium using the Pediatric Anesthesia Emergence Delirium scale, vital signs and adverse cardiorespiratory events. All patients and parents as well as anesthetists, imaging technicians, and postsedation personnel were blinded. Data are given as median (range). Results: In total, 347 children aged 4.0 (0.25-10.9) years, weighing 15.6 (5.3-54) kg, ASA classification I, II, or III (141/188/18) were included. The ketamine-propofol group showed significantly shorter recovery times (38 (22-65) vs 54 (37-77) minutes; median difference 14 (95% CI: 8, 20) minutes; P <.001), better quality of induction, and higher blood pressure, but higher incidence of movement requiring additional sedative drugs. There were no significant differences in respiratory side effects, cardiovascular compromise, emergence delirium, or postoperative nausea and vomiting. Conclusion: Both sedation concepts proved to be reliable with a low incidence of side effects. Ketamine at induction with a reduced propofol infusion rate leads to faster postanesthetic recovery. Copyright © 2018 John Wiley & Sons Ltd Database: EMBASE

55. Prevalence of neuropathic pain in patients with traumatic brachial plexus injury: A multicenter prospective hospital-based study Author(s): Ciaramitaro P.; Padua L.; Devigili G.; Eleopra R.; Rota E.; Tamburin S.; Cruccu G.; Truini A. Source: Pain Medicine (United States); Dec 2017; vol. 18 (no. 12); p. 2428-2432 Publication Date: Dec 2017 Publication Type(s): Article Abstract:Objective. Prevalence and clinical characteristics of neuropathic pain due to traumatic brachial plexus injury. Design. Observational epidemiological study. Setting. Hospital-based multicenter study. Subjects. One hundred seven prospectively enrolled patients with brachial plexus injury. Methods. All the patients underwent clinical examination and neurophysiological testing for a definitive diagnosis of the brachial plexus lesion. The DN4 questionnaire was used to identify neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to evaluate the different symptoms of neuropathic pain. The SF36 questionnaire and the Beck Depression Inventory (BDI) were used to assess quality of life and mood disturbances in patients with neuropathic pain. Results. Of the 107 enrolled patients, 74 had pain (69%); neuropathic pain, as assessed by means of the DN4, was identified in 60 (56%) of these patients. According to the NPSI, the most frequent and severe pain type was the spontaneous burning pain. Clinical and neurophysiological findings showed that pain is unrelated to age but is associated with the severity of peripheral nerve damage. The SF36 questionnaire and BDI showed that neuropathic pain impairs quality of life and causes depression. Conclusions. Our study provides information on the prevalence, characteristics, and variables associated with neuropathic pain due to traumatic brachial plexus injuries that might provide a basis for improving the clinical management of this condition. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

56. Prospective, randomized blind effect-on-outcome study of conventional vs high- frequency spinal cord stimulation in patients with pain and disability due to failed back surgery syndrome Author(s): De Andres J.; Monsalve-Dolz V.; Fabregat-Cid G.; Villanueva-Perez V.; Harutyunyan A.; Asensio-Samper J.M.; Sanchis-Lopez N. Source: Pain Medicine (United States); Dec 2017; vol. 18 (no. 12); p. 2401-2421 Publication Date: Dec 2017 Publication Type(s): Article Abstract:Objectives. Spinal cord stimulation (SCS) for patients with failed back surgery syndrome (FBSS) show variable results and limited to moderate evidence. In the last years the stimulation of high frequency (HF) has been considered as a better alternative in this pathology for its supposed benefits compared to the stimulation with conventional frequency (CF). To compare in one year follow-up, the efficacy of high-frequency SCS (HF) versus conventional frequency SCS (CF) on the patients with FBSS. Design. Prospective, Randomized blind trial. Setting. Academic University Pain Medicine Center. Subject. Seventy eight patients with FBSS diagnosis based on internationally recognized criteria, and refractory to conservative therapy for at least 6 months, have been initially recruited, and Methods. Sixty subjects met the eligibility criteria and were randomized and scheduled for the trial phase.The patients were randomly assigned in either, one of the two groups: CF SCS or HF SCS. Within the study methods, special attention was paid to standardizing patient programming, so that these parameters would not impact the results.The trial period was considered successful if there was ? 50% reduction in the NRS from baseline. Results. A total of 55 subjects successfully completed all assessments during one year follow-up. Change patterns in scores do not differ based on high versus conventional frequency, with significant global average reduction at 1year similarly for both groups. Among all the items included in the Short Form-12 questionnaire (SF-12), only the variations in the social function score between the instants t1 and t2 are somewhat higher in the high frequency group. Conclusion. The evolutionary pattern of the different parameters studied in our patients with FBSS does not differ according to their treatment by spinal stimulation, with conventional or high frequency, in one year follow-up. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

57. The MOBILE Study-A Phase IIa enriched enrollment randomized withdrawal trial to assess the analgesic efficacy and safety of ASP8477, a fatty acid amide hydrolase inhibitor, in patients with peripheral neuropathic pain Author(s): Bradford D.; Stirling A.; Ernault E.; Liosatos M.; Tracy K.; Moseley J.; Blahunka P.; Smith M.D. Source: Pain Medicine (United States); Dec 2017; vol. 18 (no. 12); p. 2388-2400 Publication Date: Dec 2017 Publication Type(s): Article Abstract:Objective. To evaluate the analgesic efficacy and safety of ASP8477 in patients with peripheral neuropathic pain (PNP). Design. Enriched enrollment randomized withdrawal. Setting. Centers in Poland (four), Czech Republic (six), and the United Kingdom (two). Subjects. Patients aged 18 years or older with PNP resulting from painful diabetic peripheral neuropathy or postherpetic neuralgia. Methods. A four-week screening period followed by a single-blind period (six-day dose titration and three-week maintenance period with ASP8477 [20/30mg BID]). Treatment responders (defined as a >= 30% decrease in the mean average daily pain intensity during the last three days of the single-blind period) were stratified by disease and randomized to receive placebo or continue ASP8477 during a three-week, double-blind, randomized withdrawal period. The primary end point was change in mean 24-hour average numeric pain rating scale (NPRS) from baseline to end of double-blind period. Results. Among 132 patients who enrolled, 116 entered the single-blind period and 63 (ASP8477, N531; placebo, N532) completed the double-blind period. There was no difference in mean 24-hour average NPRS score (P50.644) or in time-totreatment failure (P50.485) between ASP8477 and placebo. During the single-blind period, 57.8% of patients were treatment responders. ASP8477 was well tolerated. During the single-blind period, 22% of patients experienced at least one treatmentrelated adverse event (TEAE); during the doubleblind period, 8% in the ASP8477 arm and 18% in the placebo arm experienced at least one TEAE. Conclusions. ASP8477 was well tolerated in patients with PNP; however, ASP8477 did not demonstrate a significant treatment difference compared with placebo. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

58. Group visits for overdose education and naloxone distribution in primary care: A pilot quality improvement initiative Author(s): Spelman J.F.; Peglow S.; Schwartz A.R.; Burgo-Black L.; McNamara K.; Becker W.C. Source: Pain Medicine (United States); Dec 2017; vol. 18 (no. 12); p. 2325-2330 Publication Date: Dec 2017 Publication Type(s): Article Abstract:Objective. Opioid prescribing for chronic pain significantly contributes to opioid overdose deaths in the United States. Naloxone as a takehome antidote to opioid overdose is underutilized and has not been evaluated in the high-risk chronic pain population. The objective was to increase overdose education and naloxone distribution (OEND) to high-risk patients on long-term opioid therapy for pain by utilizing group visits in primary care. Design. Quality improvement intervention among two primary care clinics. Setting. A large, academic facility within the Veterans Health Administration. Subjects. Patients prescribed >= 100mg morphineequivalent daily dose or coprescribed opioids and benzodiazepines. Methods. One clinic provided usual care with respect to OEND; another clinic encouraged attendance at an OEND group visit to all of its high-risk patients. Results. We used attendance at group visits, prescriptions of naloxone issued, and patient satisfaction scores to evaluate this format of OEND. Key Results. Group OEND visits resulted in significantly more naloxone prescriptions than usual care. At these group visits, patients were engaged, valued the experience, and all requested a prescription for the naloxone kit. Conclusion. This quality improvement pilot study suggests that OEND group visits are a promising model of care. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

59. Accurate Prognostic Awareness Facilitates, Whereas Better Quality of Life and More Anxiety Symptoms Hinder End-of-Life Care Discussions: A Longitudinal Survey Study in Terminally Ill Cancer Patients' Last Six Months of Life Author(s): Tang S.T.; Chen J.-S.; Chang W.-C.; Hsieh C.-H.; Chou W.-C.; Hou M.-M.; Chen C.H.; Wen F.-H. Source: Journal of Pain and Symptom Management; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Context: Terminally ill cancer patients do not engage in end-of-life (EOL) care discussions or do so only when death is imminent, despite guidelines for EOL care discussions early in their disease trajectory. Most studies on patient-reported EOL care discussions are cross sectional without exploring the evolution of EOL care discussions as death approaches. Cross-sectional studies cannot determine the direction of association between EOL care discussions and patients' prognostic awareness, psychological well-being, and quality of life (QOL). Objectives/Methods: We examined the evolution and associations of accurate prognostic awareness, functional dependence, physical and psychological symptom distress, and QOL with patient-physician EOL care discussions among 256 terminally ill cancer patients in their last six months by hierarchical generalized linear modeling with logistic regression and by arranging time-varying modifiable variables and EOL care discussions in a distinct time sequence. Results: The prevalence of physician- patient EOL care discussions increased as death approached (9.2%, 11.8%, and 18.3% for 91- 180, 31-90, and 1-30 days before death, respectively) but only reached significance in the last month. Accurate prognostic awareness facilitated subsequent physician-patient EOL care discussions, whereas better patient-reported QOL and more anxiety symptoms hindered such discussions. The likelihood of EOL care discussions was not associated with levels of physical symptom distress, functional dependence, or depressive symptoms. Conclusion: Physician-patient EOL care discussions for terminally ill Taiwanese cancer patients remain uncommon even when death approaches. Physicians should facilitate EOL care discussions by cultivating patients' accurate prognostic awareness early in their cancer trajectory when they are physically and psychologically competent, with better QOL, thus promoting informed and value-based EOL care decision making. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Database: EMBASE

60. A pilot study of hyperoxemia on neurological injury, inflammation and oxidative stress Author(s): Lang M.; Bendel S.; Skrifvars M.B.; Tanskanen P.; Siironen J.; Ala-Peijari M.; Koivisto T.; Djafarzadeh S. Source: Acta Anaesthesiologica Scandinavica; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Acta Anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Normobaric hyperoxia is used to alleviate secondary brain ischaemia in patients with traumatic brain injury (TBI), but clinical evidence is limited and hyperoxia may cause adverse events. Methods: An open label, randomised controlled pilot study comparing blood concentrations of reactive oxygen species (ROS), interleukin 6 (IL-6) and neuron-specific enolase (NSE) between two different fractions of inspired oxygen in severe TBI patients on mechanical ventilation. Results: We enrolled 27 patients in the Fi O2 0.40 group and 38 in the Fi O2 0.70 group; 19 and 23 patients, respectively, completed biochemical analyses. In baseline, there were no differences between Fi O2 0.40 and Fi O2 0.70 groups, respectively, in ROS (64.8 nM [22.6-102.1] vs. 64.9 nM [26.8-96.3], P = 0.80), IL- 6 (group 92.4 pg/ml [52.9-171.6] vs. 94.3 pg/ml [54.8-133.1], P = 0.52) or NSE (21.04 ug/l [14.0-30.7] vs. 17.8 ug/l [14.1-23.9], P = 0.35). ROS levels did not differ at Day 1 (24.2 nM [20.6-33.5] vs. 29.2 nM [22.7-69.2], P = 0.10) or at Day 2 (25.4 nM [21.7-37.4] vs. 47.3 nM [34.4-126.1], P = 0.95). IL-6 concentrations did not differ at Day 1 (112.7 pg/ml [65.9-168.9) vs. 83.9 pg/ml [51.8-144.3], P = 0.41) or at Day 3 (55.0 pg/ml [34.2-115.6] vs. 49.3 pg/ml [34.4-126.1], P = 0.95). NSE levels did not differ at Day 1 (15.9 ug/l [9.0-24.3] vs. 15.3 ug/l [12.2-26.3], P = 0.62). There were no differences between groups in the incidence of pulmonary complications. Conclusion: Higher fraction of inspired oxygen did not increase blood concentrations of markers of oxidative stress, inflammation or neurological injury or the incidence of pulmonary complications in severe TBI patients on mechanical ventilation. Copyright © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Database: EMBASE

61. Comparison of lumbar plexus block using the short axis in-plane method at the plane of the transverse process and at the articular process: A randomized controlled trial Author(s): Lu R.; Shen C.; Yang C.; Chen Y.; Li J.; Lu K. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC anesthesiology - from BioMed Central Available at BMC anesthesiology - from Europe PubMed Central - Open Access Available at BMC anesthesiology - from PubMed Central Abstract:Background: Although the safety and effectiveness of the short-axis in-plane method has been confirmed for lumbar plexus block, the operation is difficult and has a high rate of epidural spread at the plane of the articular process. Therefore, we developed a new in-plane technique, called the beach chair method, which displays images from the transverse process. We compared the operative difficulty and incidence of epidural spread of the beach chair method with those of the control method (at the plane of the articular process) in this randomized controlled clinical trial. Methods: Sixty patients, aged 18 to 75 years, scheduled for unilateral arthroscopic knee surgery were randomized to receive double-guided lumbar plexus block by the beach chair method (n = 30) or the control method (n = 30) with 30 ml 0.5% ropivacaine hydrochloride; all patients received a sciatic nerve block with 10 ml 1% lidocaine hydrochloride and 10 ml 0.5% ropivacaine hydrochloride. Results: The incidence of epidural spread after lumbar plexus block was significantly lower in the beach chair group than that in the control group [1 case (3.3%) vs. 9 (30.0%), P = 0.006]. Moreover, the imaging time (34.2 +/- 16.7 s vs. 48.9 +/- 16.8 s, P = 0.001), needling time (85.0 +/- 45.3 s vs. 131.4 +/- 88.2 s, P = 0.013) and number of needle punctures (2.7 +/- 1.3 vs. 4.5 +/- 2.1, P = 0.000) were significantly lower in the beach chair group than those in the control group; the ultrasound visibility score of the beach chair group was better than that of the control group. There were no significant differences in the remaining indicators. Conclusions: The beach chair method was easier and was associated with a lower incidence of epidural spread than the control method. Therefore, the beach chair method (at the plane of the transverse process) provides another promising option for lumbar plexus block for the non-obese population. Copyright © 2018 The Author(s). Database: EMBASE

62. AAPM 2016 Annual Meeting Late-Breaking Abstracts Author(s): anonymous Source: Pain Medicine (United States); Feb 2016; vol. 17 (no. 2) Publication Date: Feb 2016 Publication Type(s): Conference Review Abstract:The proceedings contain 8 papers. The topics discussed include: peptide-derived orally active kappa-opioid receptor agonists for peripheral pain in rats; atherosclerotic disease and its relationship to lumbar degenerative disc disease, facet arthritis, and stenosis using computed tomography angiography; development of chronic pain and dynamic changes of CCR21 monocyte and Cx3CR11 microglia after sciatic nerve injury in mice; phenotyping of NCS-1 knockout mice as a tool for understanding neuropathic pain; genetics and fibromyalgia: mesocorticolimbic genetic variants are associated with risk of fibromyalgia; prevalence of genetic variants in nociceptive versus neuropathic pain patients; utilization of genetic testing in clinical care for medication risk and response; ZX007: novel extended-release formulation of hydrocodone bitartrate resistant to physical manipulation and extraction of hydrocodone; heart rhythm analysis by sparse representation for acute deep pain detection; Ehlers Danlos, POTS, and a headache cured; slowly titrated intrathecal ziconotide completely ameliorated chronic post herpetic neuralgia in a patient whose pain was refractory: an optimized medication regimen, radiofrequency ablations, spinal cord stimulation, and intrathecal opioid therapy; and caudal lysis of adhesions as neuromodulation-sparing treatment for failed back surgery syndrome (FBSS). Database: EMBASE

63. Frequency of naloxone use for opioid overdose based on ward type in a tertiary care medical center Author(s): Rudd-Barnard G.; Glassman P.; Moaleji-Wafa N.; Pangarkar S. Source: Pain Medicine (United States); Feb 2016; vol. 17 (no. 2) Publication Date: Feb 2016 Publication Type(s): Conference Abstract Abstract:Opioid overdose has become an increasingly common occurrence in the health care setting. Recently published data from the National Poison Data System suggests that opioids occupy four of the top six causes of overdose deaths in the United States. Although outpatient use of prescribed opioid medications is a top concern, hospitalbased administration of opioid overdoses has not been given the same scrutiny. One way to track opioid overdoses in the inpatient setting is through evaluating naloxone use in the hospital. Naloxone is a potent opioid antagonist indicated for the reversal of known or suspected opioid overdose. In an attempt to understand where opioid overdoses commonly occur and guide future quality improvement measures, we investigated ward location within the hospital where naloxone was administered in 2013. Omnicell transaction data for Naloxone was reviewed in a tertiary care VA Medical Center in Los Angeles. Data was available for 63 Naloxone events demonstrating; 28 occurrances in the Emergency Room, 10 in the ICU, CPC 7, Surgical unit 6, PACU 6, SPS, and 2 from aenesthesia department. The available data suggests an area in which education on opioid prescribing, appropriate administration, and monitoring may improve in patient outcomes. It may further reduce harm and avoid untoward outcomes for patients at high risk for complication. Further research should focus on implementing specific opioid monitoring programs in ICU settings to reduce overdose risk. References: 1) Dart RC, Bronstein AC, Spyker DA, et al. Poisoning in the United States: 2012 emergency medicine report of the national poison data system. Annals of emergency medicine. 2015;65(4):416-422. 2) Khelemsky Y, Kothari R, Campbell N, Farnad S. Incidence and Demographics of Post-Operative Naloxone Administration: A 13-Year Experience at a Major Tertiary Teaching Institution. Pain physician. 2015;18(5):E827-829. 3) Beaudoin FL, Merchant RC, Janicki A, McKaig DM, Babu KM. Preventing iatrogenic overdose: A review of in-emergency department opioid-related adverse drug events and medication errors. Annals of emergency medicine. Database: EMBASE

64. Ultrasound-guided greater occipital nerve block at a novel proximal location: A feasibility study Author(s): O'Brien T.; Pingree M.; Eldrige J.; Moeschler S.; Sole J. Source: Pain Medicine (United States); Feb 2016; vol. 17 (no. 2) Publication Date: Feb 2016 Publication Type(s): Conference Abstract Abstract:Introduction: Greater occipital nerve (GON) blocks at the superior nuchal line are frequently utilized to treat occipital neuralgia and cervicogenic headache. The advent of high resolution ultrasound has led to the development of guided injection techniques at novel locations. This feasibility study is the first to clinically evaluate an ultrasound guided GON block at the level of C2 as the nerve courses superficial to the obliquus capitis inferior (OCI) muscle. Methods: Patients with a diagnosis of occipital neuralgia or cervicogenic headache were recruited for the study. Ultrasound-guided GON blocks utilizing the novel proximal approach were performed by experienced clinicians. Success of nerve blockade was evaluated 30 minutes following injection by a physician not involved with the study. Visual analog scale (VAS) pain scores were recorded pre-injection and at 30 minutes, 2 weeks, and 4 weeks post-injection. Results: A total of 14 injections were performed with a mean procedure time of 3.75 minutes. Anesthesia in the GON distribution was achieved for 86% of patients following injection. Mean VAS scores decreased by a mean of 3.78 at 30 minutes (p<0.001), 2.64 at 2 weeks (p0.006), and 2.21 at 4 weeks (p0.01). There were no significant adverse events reported during the study period. Conclusions: This feasibility study demonstrates safety, successful nerve blockade, and significant reductions in pain scores over four weeks for a novel proximal technique to ultrasound guided GON blocks. Our results should prompt further research comparing this approach to other injection techniques for patients with occipital neuralgia and cervicogenic headache. References: 1) Tubbs RS, Watanabe K, Loukas M, Cohen-Gadol AA. The intramuscular course of the greater occipital nerve: novel findings with potential implications for operative interventions and occipital neuralgia. Surg Neurol Int. 2014;5:155. 2) Cesmebasi A, Muhleman MA, Hulsberg P, Gielecki J, Matusz P, Tubbs RS, et al. Occipital neuralgia: Anatomic considerations. Clin Anat. 2015;28:101-8. 3) Greher M, Moriggl B, Curatolo M, Kirchmair L, Eichenberger U. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: A comparison of two selective techniques confirmed by anatomical dissection. Database: EMBASE

65. Ketamine infusion: A useful tool for chronic neuropathic pain Author(s): Fujinaka M.; Bunch J.; Qian X. Source: Pain Medicine (United States); Feb 2016; vol. 17 (no. 2) Publication Date: Feb 2016 Publication Type(s): Conference Abstract Abstract:Though ketamine infusion is beneficial for CRPS pain, its therapeutic role for other neuropathic pain conditions remains unclear. The purpose of this retrospective study was to highlight other neuropathic pain conditions for which ketamine infusion may be useful. This case series examined 5 patients with chronic, neuropathic pain conditions including failed back surgery syndrome, periscapular pain, spinal schwannoma, and erythromelalgia. Prior to receiving ketamine infusion, these patients had poorly managed pain despite appropriate multi-modal therapy. AAA had periscapular neuropathic pain for over 15 years with a VAS score of 8/10 on average. She received a ketamine infusion that lowered her VAS score to a 2/10, which was sustained for over 3 months. BBB had low back pain for over 30 years and then had worse pain after an L4-L5 discectomy and fusion. She received a ketamine infusion that improved her pain, function, and sleep for over 4 months. CCC had a T12 schwannoma causing a VAS score of 7/10 for over 5 years. He received a ketamine infusion and had nearly complete resolution of pain for over 5 months. DDD had over 10 years of low back pain and was found to be responsive to ketamine infusion. Repeat ketamine infusions provided him relief and increased functionality for 2-5 months. EEE had pain related to erythromelalgia for 10 years. She had repeat ketamine infusions, which provided pain relief and increased function for 1-3 months. Ketamine infusion may be a useful tool for refractory, chronic, neuropathic pain conditions other than CRPS. Database: EMBASE

66. A before-and-after observational study of a protocol for use of the C-MAC videolaryngoscope with a Frova introducer in pre-hospital rapid sequence intubation Author(s): Angerman S.; Nurmi J.; Kirves H. Source: Anaesthesia; Mar 2018; vol. 73 (no. 3); p. 348-355 Publication Date: Mar 2018 Publication Type(s): Article Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Results using videolaryngoscopy in pre-hospital rapid sequence intubation are mixed. A bougie is not commonly used with videolaryngoscopy. We hypothesised that using videolaryngoscopy and a bougie as core elements of a standardised protocol that includes a drugs and a laryngoscopy algorithm would result in a high first-pass tracheal intubation success rate. We employed videolaryngoscopy (C-MAC) combined with a bougie (Frova intubating introducer) in an anaesthetist-staffed helicopter emergency medical service. Data for adult tracheal intubation were collected prospectively as part of the airway registry of our unit for 22 months after implementation of the protocol (n = 543) and compared with controls (n = 238) treated in the previous year before the implementation. The mean first- pass success rate (95%CI) was 98.2% (96.6-99.0%) in the study group and 85.7% (80.7- 89.6%) in the control group, p < 0.0001. Combining C-MAC videolaryngoscopy and bougie with a standardised rapid sequence induction protocol leads to a high first attempt intubation success rate when performed by an anaesthetist-led helicopter emergency medical service team. Copyright © 2018 The Association of Anaesthetists of Great Britain and Ireland Database: EMBASE

67. Peri-operative management of patients with type-2 diabetes mellitus undergoing non- cardiac surgery using liraglutide, glucose-insulin-potassium infusion or intravenous insulin bolus regimens: a randomised controlled trial Author(s): Polderman J.A.W.; Hollmann M.W.; Preckel B.; Hermanides J.; van Steen S.C.J.; DeVries J.H.; Thiel B.; Godfried M.B.; Houweling P.L. Source: Anaesthesia; Mar 2018; vol. 73 (no. 3); p. 332-339 Publication Date: Mar 2018 Publication Type(s): Article Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:In this open-label multicentre randomised controlled trial, we investigated three peri-operative treatment strategies to lower glucose and reduce the need for rescue insulin in patients aged 18-75 years with type-2 diabetes mellitus undergoing non-cardiac surgery. Patients were randomly allocated using a web-based randomisation program to premedication with liraglutide (liraglutide group), glucose-insulin-potassium infusion (insulin infusion group) or insulin bolus regimen (insulin bolus group), targeting a glucose < 8.0 mmol.l-1. The primary outcome was the between group difference in median glucose levels 1 h after surgery. We analysed 150 patients (liraglutide group n = 44, insulin infusion group n = 53, insulin bolus group n = 53) according to the intention-to-treat principle. Median (IQR [range]) plasma glucose 1 h postoperatively was lower in the liraglutide group compared with the insulin infusion and insulin bolus groups (6.6 (5.6-7.7 [4.2-13.5]) mmol.l-1 vs. 7.5 (6.4-8.3 [3.9-16.6]) mmol.l-1 (p = 0.026) and 7.6 (6.4-8.9 [4.7-13.2]) mmol.l-1) p = 0.006, respectively). The incidence of hypoglycaemia and postoperative complications did not differ between the groups. Six patients had pre-operative nausea in the liraglutide group, of which two had severe nausea, compared with no patients in the insulin infusion and insulin bolus groups (p = 0.007). The pre-operative administration of liraglutide stabilised perioperative plasma glucose levels and reduced peri-operative insulin requirements, at the expense of increased pre-operative nausea rates. Copyright © 2017 The Association of Anaesthetists of Great Britain and Ireland Database: EMBASE

68. Gastric ultrasound in the third trimester of pregnancy: a randomised controlled trial to develop a predictive model of volume assessment Author(s): Arzola C.; Siddiqui N.T.; Perlas A.; Downey K.; Ye X.Y.; Carvalho J.C.A. Source: Anaesthesia; Mar 2018; vol. 73 (no. 3); p. 295-303 Publication Date: Mar 2018 Publication Type(s): Article Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Bedside gastric ultrasonography can be performed reliably by anaesthetists to assess gastric content in the peri-operative period. We aimed to study the relationship between gastric cross-sectional area, assessed by ultrasound, and volumes of clear fluids ingested by pregnant women. We recruited 60 non-labouring third-trimester pregnant women in a randomised controlled and assessor-blinded study. A standardised scanning protocol of the gastric antrum was performed in the 45degree semirecumbent and 45degree semirecumbent-right lateral positions. Subjects were randomly allocated to drink one out of six predetermined volumes of apple juice (0 ml, 50 ml, 100 ml, 200 ml, 300 ml, 400 ml). Qualitative and quantitative assessments at a baseline period after an 8-h fast, and immediately after the drink, were used to establish the correlation between antral cross- sectional area and volume ingested. A predictive model to estimate gastric volume was developed. Antral cross-sectional area in the semirecumbent right lateral position significantly correlated with the ingested volume (Spearman rank correlation = 0.7; p < 0.0001). A cut-off value of 9.6 cm2 discriminated ingested volumes >= 1.5 ml.kg-1 with a sensitivity of 80%, a specificity of 66.7%, and an area under the curve of 0.82. A linear predictive model was developed for gastric volume based only on antral cross-sectional area (Volume (ml) = -327.1 + 215.2 x log (cross-sectional area) (cm2)). We conclude that in pregnant women in the third trimester of gestation, the antral cross-sectional area correlates well with volumes ingested, and this cut-off value in the semirecumbent right lateral position discriminates high gastric volumes. Copyright © 2017 The Association of Anaesthetists of Great Britain and Ireland Database: EMBASE

69. Chronic back pain cured by low-dose levodopa: Is it a variant of restless legs syndrome? Author(s): Zeng Z.-F.; Liang Y.-R.; Chen Y.; Jing X.-N.; Peng S.-D.; Tao E.-X. Source: Journal of Pain Research; Feb 2018; vol. 11 ; p. 277-279 Publication Date: Feb 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Chronic back pain is one of the most common reasons for missed work and visits to the doctor. This report presents 2 interesting cases of chronic back pain that were effectively relieved by low-dose levodopa. These 2 patients showed no sign of anatomical problem of the spine or relative structures, but the discomforts on the back manifested some characteristics resembling those in restless legs syndrome (RLS), and one of them actually developed RLS after many years of back problem. We believe that this type of chronic back pain might be a variant of RLS, which we would like to call "restless back", and it can be effectively treated by dopaminergic drugs. Copyright © 2018 Zeng et al. Database: EMBASE

70. Reliability study in five languages of the translation of the pain observational scale Algoplus Author(s): Pickering G.; Monacelli F.; Garrote J.M.P.-C.; Guarda H.; Batalha L.; Gibson; Savas S.; Odetti P.; Gandolfo F.; Pastorino E.; Mugeiro M.J.C.; Dias I.P.; Kilavuz A.; Macian N.; The Doloplus Team; Pereira B. Source: Pain Medicine (United States); Feb 2018; vol. 19 (no. 2); p. 252-261 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective. Acute pain is frequent and underestimated in older persons, especially when they suffer from cognitive impairment. Algoplus is an observational scale for acute pain evaluation, validated in French in older persons with communication disorders. We present the validation by an international expert team of the Algoplus scale in five languages: English, Spanish, Italian, Portuguese, and Turkish. Methods. A total of 181 older consecutive patients were included in five countries (Spain, Australia, Italy, Portugal, and Turkey). Test-retest and interrater reliabilities were determined by weighted kappa coefficient for each item and internal consistency by Kuder-Richardson-20 (KD). Results. Regarding test-retest reliability, the kappa coefficient for the five items ranged from 0.68 to 0.84. Inter-rater reliability kappa values ranged from 0.64 to 0.82. Internal consistency was indicated at a KDgreater than 0.6. Satisfaction was good to excellent for all teams. Results show that reliability tests are good to excellent for all items of Algoplus. Conclusions. This study shows evidence that Algoplus is an acceptable, reproducible, reliable, and easy-to-use tool. It provides a unique opportunity to include the translated Algoplus scale in daily assessment of older persons with communication disorders in many countries. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

71. Pediatric Intracranial Hypertension: a Current Literature Review Author(s): Aylward S.C.; Way A.L. Source: Current Pain and Headache Reports; Feb 2018; vol. 22 (no. 2) Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of Review: The purpose of this review is to provide an update on pediatric intracranial hypertension. Recent Findings: The annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population. Summary: Pediatric intracranial hypertension is a disorder that if left untreated can lead to poor quality of life and morbidity. There are no current treatment studies in pediatrics, but adult data suggests acetazolamide remains an acceptable first-line medication. Copyright © 2018, Springer Science+Business Media, LLC, part of Springer Nature. Database: EMBASE

72. Respiratory quotient estimations as additional prognostic tools in early septic shock Author(s): Mesquida J.; Saludes P.; Perez-Madrigal A.; Proenca L.; Cortes E.; Ensenat L.; Espinal C.; Gruartmoner G. Source: Journal of Clinical Monitoring and Computing; Feb 2018 ; p. 1-8 Publication Date: Feb 2018 Publication Type(s): Article In Press Abstract:Central venous-to-arterial carbon dioxide difference (PcvaCO2), and its correction by the arterial-to-venous oxygen content difference (PcvaCO2/CavO2) have been proposed as additional tools to evaluate tissue hypoxia. Since the relationship between pressure and content of CO2 (CCO2) might be affected by several factors, some authors advocate for the use of CcvaCO2/CavO2. The aim of the present study was to explore the factors that might intervene in the difference between PcvaCO2/CavO2 and CcvaCO2/CavO2, and to analyze their association with mortality. Observational study in a 30-bed mixed ICU. Fifty-two septic shock patients within the first 24 h of ICU admission were studied. After restoration of mean arterial pressure, hemodynamic and metabolic parameters were evaluated. A total of 110 sets of measurements were performed. Simultaneous PcvaCO2/CavO2 and CcvaCO2/CavO2 values were correlated, but agreement analysis showed a significant proportional bias. The difference between PcvaCO2/CavO2 and CcvaCO2/CavO2 was independently associated with pH, ScvO2, baseline CcvaCO2/CavO2 and hemoglobin. A stepwise regression analysis showed that pH was the single best predictor for the magnitude of such difference, with very limited effect of other variables. At inclusion, variables associated with ICU-mortality were lactate, pH, PcvaCO2/CavO2, and the difference between PcvaCO2/CavO2 and CcvaCO2/CavO2. Initial ScvO2, PcvaCO2, CcvaCO2/CavO2, and cardiac index were not different in survivors and non-survivors. In a population of early septic shock patients, simultaneous values of PcvaCO2/CavO2 and CcvaCO2/CavO2 were not equivalent, and the main determinant of the magnitude of the difference between these two parameters was pH. The PcvaCO2/CavO2 ratio was associated with ICU mortality, whereas CcvaCO2/CavO2 was not. Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature Database: EMBASE

73. Le monitorage du cerveau frappe une note discordante chez les anesthesiologistesMonitoring the brain strikes a discordant note for anesthesiologists Author(s): Avidan M.S.; Graetz T.J. Source: Canadian Journal of Anesthesia; Feb 2018 ; p. 1-6 Publication Date: Feb 2018 Publication Type(s): Article In Press Database: EMBASE

74. As if one pain problem was not enough: Prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes Author(s): Page M.G.; Fortier M.; Choiniere M.; Ware M.A. Source: Journal of Pain Research; 2018; vol. 11 ; p. 237-254 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Introduction: The presence of multiple coexisting chronic pain (CP) conditions (eg, low-back pain and migraines) within patients has received little attention in literature. The goals of this observational longitudinal study were to determine the prevalence of coexisting CP conditions, identify the most frequent ones and patterns of coexistence, investigate the relationships among patients' biopsychosocial characteristics and number of CP conditions, and determine the impact of coexisting CP conditions on treatment response. Patients and methods: A total of 3,966 patients attending multidisciplinary pain-treatment centers who were enrolled in the Quebec Pain Registry were included. Patients completed self-report and nurse-administered questionnaires before their first visit and 6 months later. Results were analyzed using descriptive statistics, factor and cluster analyses, negative binomials with log-link generalized linear models, and linear mixed-effect models. Results: A third of patients reported coexisting CP conditions. No specific patterns of comorbidities emerged. The presence of coexisting CP conditions was associated with longer pain duration, older age, being female, and poorer quality of life. The presence of more than one CP condition did not have a clinically significant impact on treatment responses. Discussion: The novelty of the study results relate to the heterogeneity that was found in the patterns of coexistence of CP conditions and the fact that having multiple CP conditions did not clinically impact treatment response. These results highlight the need for future research that examines causes of coexistence among CP conditions across the spectrum of CP, as opposed to focusing on specific conditions, and to examine whether multiple CP conditions impact on additional domains, such as treatment satisfaction. These results highlight the importance of studying the pathophysiological mechanisms underlying the development of coexisting CP conditions, in order eventually to prevent/minimize their occurrence and/or develop optimal treatment and management approaches. Copyright © 2018 Page et al. Database: EMBASE

75. Managing severe pain and abuse potential: The potential impact of a new abuse- deterrent formulation oxycodone/naltrexone extended-release product Author(s): Pergolizzi J.V.; Taylor R.; LeQuang J.A.; Raffa R.B. Source: Journal of Pain Research; Feb 2018; vol. 11 ; p. 301-311 Publication Date: Feb 2018 Publication Type(s): Review Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Proper management of severe pain represents one of the most challenging clinical dilemmas. Two equally important goals must be attained: the humanitarian/medical goal to relieve suffering and the societal/legal goal to not contribute to the drug abuse problem. This is an age-old problem, and the prevailing emphasis placed on one or the other goal has resulted in pendulum swings that have resulted in either undertreatment of pain or the current epidemic of misuse and abuse. In an effort to provide efficacious strong pain relievers (opioids) that are more difficult to abuse by the most dangerous routes of administration, pharmaceutical companies are developing products in which the opioid is manufactured in a formulation that is designed to be tamper resistant. Such a product is known as an abuse-deterrent formulation (ADF). ADF opioid products are designed to deter or resist abuse by making it difficult to tamper with the product and extracting the opioid for inhalation or injection. To date, less than a dozen opioid formulations have been approved by the US Food and Drug Administration to carry specific ADF labeling, but this number will likely increase in the coming years. Most of these products are extended- release formulations. Copyright © 2018 Pergolizzi, Jr et al. Database: EMBASE

76. Risk factors for opioid-induced respiratory depression and failure to rescue: A review Author(s): Gupta K.; Prasad A.; Wong J.; Chung F.F.; Nagappa M.; Abrahamyan L. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 110-119 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period. Recent findings In the postoperative period, OIRD has often been reported resulting in morbidity and mortality. The risk factors which predispose surgical patients to increased risk of OIRD are not clearly defined. A literature search was performed for adult surgical patients who were prescribed opioids during their hospital stay and any available reports on postoperative respiratory depression/respiratory events. Summary Elderly, female sex, presence of obstructive sleep apnea, chronic obstructive pulmonary disease, cardiac disease, diabetes mellitus, hypertension, neurologic disease, renal disease, obesity, two or more comorbidities, opioid dependence, use of patient controlled analgesia, different routes of administration of opioids and concomitant administration of sedatives are significant risk factors for postoperative OIRD. The majority of patients with OIRD are deeply sedated and inadequately monitored. In patients with underlying risk factors, the dose of opioids should be carefully titrated. Enhanced monitoring of sedation level, respiratory rate, pulse oximetry and capnography is needed in the first 24 h after surgery. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

77. Obstructive sleep apnea and bariatric surgical guidelines: Summary and update Author(s): De Raaff C.A.L.; Van Wagensveld B.A.; De Vries N. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 104-109 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review Increasing numbers of bariatric surgical procedures and the high prevalence of obstructive sleep apnea (OSA) in this population have resulted in a growing interest in the perioperative management of OSA in bariatric surgery. This review provides a summary of the first consensus guideline on this topic as well as an update of the newest literature available. Recent findings All bariatric patients should be screened for OSA and obesity hypoventilation syndrome (OHS) to reduce the risk of perioperative complications. Intraoperative precautions are preoxygenation, induction and intubation in ramped position, continuous positive airway pressure (CPAP) and positive end-expiratory pressure during induction, maintenance of low tidal volumes during surgery, multimodal anesthesia and analgesia with avoidance of opioids and extubation when patients are free of neuromuscular blockage. CPAP therapy and continuous monitoring with a minimum of pulse oximetry is recommended in the early postoperative period. Summary Multiple precautions exist to minimize the risk of cardiopulmonary complications and to enhance recovery after surgery. A combination of these procedures seems to provide optimal perioperative care of OSA patients undergoing bariatric surgery. Nearly 75% of recommendations are based on low quality of evidence, indicating the high value of experts' opinion and potential for future research. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

78. Anticipated and unanticipated difficult airway management Author(s): Xu Z.; Ma W.; Hester D.L.; Jiang Y. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 96-103 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review Management of difficult airway is far from optimal despite of continuous progress in science and technology. The purpose of this review is to summarize the current research in the field and bring readers up to date. Recent findings New technologies for intubation make providers more confident to handle difficult airways, but there is lack of evidence indicating the reduction in incidence of 'cannot intubate cannot ventilate (CICV)'. Optimization of mask ventilation should reduce the incidence of difficult mask ventilation but it is greatly underappreciated. Even optimization of preoxygenation is not directly associated with any decreased incidence of difficult airway, but it prolongs time of safe apnea oxygenation; therefore, is likely to improve the outcome of the patients if CICV occurs. Summary Improvement of managing difficult airway relies on optimized mask ventilation, utilization of the appropriate tools for intubation, maximization of the safe apnea oxygenation time, prompt surgical airway in response to severe hypoxia in case effective noninvasive interventions are not achievable. It seems that a simplified and concise algorithm of difficult airway management needs to be established in order to enable providers to easily remember and execute. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

79. An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea Author(s): Madhusudan P.; Wong J.; Prasad A.; Sadeghian E.; Chung F.F. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 89-95 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review There is a high prevalence of obstructive sleep apnea (OSA) in the surgical population, however, a significant proportion of patients are undiagnosed. The Society of Anesthesia and Sleep Medicine (SASM) has issued recent guidelines for preoperative assessment and preparation of patients with known or suspected OSA. The purpose of this review is to highlight key points in the new guidelines and explore the possibilities of different strategies in optimizing patients with OSA preoperatively. Recent findings Recent knowledge on phenotypes and endotypes has provided a better understanding of the disease and its underlying pathogenesis. Phenotypes refer to the predominant morphological characteristics of an individual whereas endotypes refer to the predominant underlying mechanism of the disease. Phenotypes and endotypes in OSA are heterogenous. Heterogeneity in the pathogenic mechanisms implies that opportunities other than the use of continuous positive airway pressure (CPAP) may exist to optimize or manage OSA patients preoperatively. Summary The prevalence of OSA in surgical patients is high. SASM has made recommendations in their published guidelines for the optimum preoperative preparation of patients with OSA. In the future, research may shift towards finding the underlying mechanism of OSA for targeted therapy. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

80. Improve postoperative sleep: What can we do? Author(s): Su X.; Wang D.-X. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 83-88 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review We reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. Recent findings Normal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients after surgery. Factors associated with the development of postoperative sleep disturbances include old age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative pain, environment stress, as well as other factors leading to discomfort of patients. Development of sleep disturbances produces harmful effects on postoperative patients, that is, leading to higher risk of delirium, increased sensitivity to pain, more cardiovascular events, and poorer recovery. Both nonpharmacological and pharmacological measures (such as zolpidem, melatonin, and dexmedetomidine) can be used to improve postoperative sleep. Recent evidences show that sleep promotion may improve patients' outcome, but requires further evidences. Summary Sleep disturbances are common in patients after surgery and produce harmful effects on postoperative recovery. Sleep-promotion therapy may be helpful to improve postoperative recovery, but long-term effects deserve further study. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

81. Perioperative pulmonary thromboembolism: Current concepts and treatment options Author(s): Ruohoniemi D.M.; Sista A.K.; Doany C.F.; Heerdt P.M. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 75-82 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review Anesthesiologists are familiar with pulmonary emboli prophylaxis paradigms and many have witnessed acute intraoperative embolization. Clinicians must balance conservative anticoagulation and aggressive intervention in perioperative submassive pulmonary emboli, yet the bulk of the literature excludes surgery as a relative contraindication. This review will summarize the current treatment options for acute pulmonary emboli, drawing attention to special considerations in perioperative submassive pulmonary emboli, and discuss right ventricular monitoring to improve assessment of intervention efficacy. Recent findings Recent reviews have identified the elevated risk and inadequacy of treatment of pulmonary embolism in intra and postoperative patients, in part because of the risks of systemic anticoagulation. Early studies of catheter-directed therapies have shown promising efficacy with a reduction in bleeding risk, which is especially important for perioperative patients. Success relies on defining endpoints, yet the practice of measuring mean pulmonary artery pressure alone to assess intervention efficacy is flawed. Summary Identifying submassive pulmonary emboli that requires treatment and optimizing therapy remains difficult. Researchers must consider avoiding systemic anticoagulation and focus on designing trials that evaluate intervention efficacy in surgical patients. The success of catheter-directed therapy in early trials warrants further investigation into using these therapies in the treatment of perioperative submassive pulmonary emboli. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

82. Postoperative thrombocytopenia: Why you should consider antiplatelet therapy? Author(s): Vasquez A.O.R.; Fontes M.L.; Kertai M.D. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 61-66 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long- term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. Recent findings Our recent findings suggest that in some patients, the hemostatic balance during and after surgery may shift toward a hypercoagulable state and contribute to acute organ failure. Summary For over 6 decades, major postoperative complications after cardiac surgery have remained unchanged. The potential influence of microthrombosis involving platelets has been underappreciated and use of perioperative antiplatelet therapy remains very limited - primarily because of a culture of fear of bleeding. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

83. Vitamin C in sepsis Author(s): Kuhn S.-O.; Meissner K.; Mayes L.M.; Bartels K. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 55-60 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review This narrative review summarizes recent insights into the role of vitamin C in sepsis. Recent findings Septic shock remains a major source of morbidity and mortality in critically ill patients. Although many nutritional supplements have previously been tested unsuccessfully, vitamins are still being explored as a therapeutic option in septic patients. In particular, vitamin C-containing regimens as adjunctive therapy in sepsis have received much attention. Summary In-vitro evidence supports a critical role for vitamin C in cellular mechanisms relevant to the pathophysiology of sepsis. However, whether this justifies therapeutic use of vitamin C in septic patients remains uncertain. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

84. Intraoperative vasoplegia: Methylene blue to the rescue! Author(s): McCartney S.L.; Ghadimi K.; Duce L. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 43-49 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). Recent findings Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation. MTB has been used in postgraft reperfusion during liver transplantation and anaphylaxis in a limited number of cases. Additionally, this medication has been used in septic shock with promising results, but similar to the cardiac surgical population, the effects of MTB administration on clinical outcomes has yet to be elucidated. Summary MTB should be considered during vasoplegic syndrome in cardiac surgery with cardiopulmonary bypass and usage may be more effective in an early critical window, prior to end-organ hypoperfusion. Other perioperative scenarios of MTB use show promise, but additional studies are required to develop formative conclusions. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

85. Perioperative neurocognition in elderly patients Author(s): Fu H.; Fan L.; Wang T. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 24-29 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review The extrinsic risk factors for postoperative cognitive disturbance have been a source of concern during the perioperative period, and these risk factors remain the subject of controversy. This review of recent studies focuses on the effect of these factors on postoperative cognitive disturbance during the perioperative period. Recent findings Impairment of cerebral autoregulation may predispose patients to intraoperative cerebral malperfusion, which may subsequently induce postoperative cognitive disturbance. The neurotoxicity of several volatile anesthetics may contribute to cognitive functional decline, and the impact of intravenous anesthesia on cognitive function requires further exploration. Multimodal analgesia may not outperform traditional postoperative analgesia in preventing postoperative delirium. Furthermore, acute pain and chronic pain may exacerbate the cognitive functional decline of patients with preexisting cognitive impairment. The nuclear factor-kappa beta pathway is an important node in the neuroinflammatory network. Summary Several intraoperative factors are associated with postoperative cognitive disturbance. However, if these factors are optimized in perioperative management, postoperative cognitive disturbance will improve. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

86. An overview of perioperative considerations in elderly patients for thoracic surgery: Demographics, risk/benefit, and resource planning Author(s): Castillo M. Source: Current Opinion in Anaesthesiology; Feb 2018; vol. 31 (no. 1); p. 1-5 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of review Increasing numbers of geriatric patients will present for thoracic surgery as the population ages. The changes in physiologic reserve as well as the increase in comorbid conditions among this population must be considered in order to optimize patient care in the perioperative period. Recent findings For elderly patients with cancer, the risk- benefit relationship for thoracic surgery remains favorable. Consideration of comorbidities, especially chronic obstructive pulmonary disease and congestive heart failure, is important in the setting of surgical treatment, as they have implications for perioperative care as well as postoperative morbidity and mortality. Overall survival, quality of life, and health status must be considered in decisions regarding cancer treatment. Summary Elderly patients with early-stage lung cancer derive benefit from surgical treatment, despite their increased prevalence of comorbidities, because survival associated with untreated lung cancer is so dismal. Some studies suggest that even late-stage lung cancer patients may benefit from surgery as part of a multimodal approach. Further studies could help target implementation of resources to optimize overall patient health and physiologic condition in order to decrease morbidity and mortality and to optimize quality of life. © Copyright 2018 Wolters Kluwer Health, Inc. Database: EMBASE

87. An observational feasibility study of a new anaesthesia drug storage tray Author(s): Almghairbi D.S.; Evley R.; Moppett I.K.; Sharp L.; Griffiths R.; Gupta S. Source: Anaesthesia; Mar 2018; vol. 73 (no. 3); p. 356-364 Publication Date: Mar 2018 Publication Type(s): Article Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Drug errors in the anaesthetic domain remain a serious cause of iatrogenic harm. To help reduce this issue, we explored the potential safety impact of using a simple colour- coded tray for anaesthetic drug preparation and storage. Over a six-month period, three different trained researchers observed 30 cases at three NHS Trusts. Ten observations involved standard drug trays in 'normal' practice, and 20 observations, involved 'Rainbow trays' before and after their introduction. We conducted 20 semi-structured interviews immediately after completing the Rainbow tray observation with the anaesthetists involved. All discussions and detailed notes taken were transcribed, qualitatively analysed using line- by-line coding and then synthesised into narrative themes. We found that using standard, single compartment trays enabled quick, cheap, and portable drug preparation and storage, but was linked to potential or actual harmful errors, such as syringe swaps. Rainbow trays were perceived to be easy to use and effective at all three sites, aiding drug identification and separation, and hence likely to reduce drug error and increase patient safety. We have demonstrated that it is feasible to introduce a new colour-coded compartmentalised Rainbow drugs tray into clinical practice at three NHS hospitals in England. Further research is needed into their effect on the prevalence of drug error. Copyright © 2018 The Association of Anaesthetists of Great Britain and Ireland Database: EMBASE

88. Management of trauma pain in the emergency setting: Low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison Author(s): Porter K.M.; Siddiqui M.K.; Sharma I.; Dickerson S.; Eberhardt A. Source: Journal of Pain Research; 2018; vol. 11 ; p. 11-21 Publication Date: 2018 Publication Type(s): Review Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Background: Low-dose methoxyflurane and nitrous oxide (N2O; 50:50 with oxygen) are both self-administered, self-titrated, rapid-acting, nonnarcotic, and noninvasive inhalational agents with similar onset times of pain relief. The aim of this review was to compare the clinical efficacy, safety, and tolerability of these analgesics in emergency care. Materials and methods: A systematic literature search and review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were performed using Embase, Medline, the Cochrane Library, several clinical trial registers, and emergency- medicine conference material. Results: Although both compounds have been used for many years in emergency care, the search found only a few controlled studies and no head-to- head trials performed in this setting. Two double-blind, randomized studies comparing their respective study medication (low-dose methoxyflurane or N2O) to placebo were identified that could be compared in an indirect approach by using placebo as a bridging comparator. Both agents provided rapid pain relief to trauma patients, with no significant differences between them; both treatments were generally well tolerated. Conclusion: Both low-dose methoxyflurane and N2O are suitable options for the pain treatment of trauma patients in the emergency setting. Due to the ease of administration and portability, inhaled low-dose methoxyflurane, however, may not only offer advantages in emergency situations in remote or difficult-to-reach locations and mass-casualty situations but also be of significant value in urban and rural environments. Copyright © 2018 Porter et al. Database: EMBASE

89. Clinimetric properties of the nepali version of the pain Catastrophizing scale in individuals with chronic pain Author(s): Sharma S.; Abbott J.H.; Thibault P.; Jensen M.P. Source: Journal of Pain Research; 2018; vol. 11 ; p. 265-276 Publication Date: 2018 Publication Type(s): Article Available at Journal of Pain Research - from Europe PubMed Central - Open Access Abstract:Background: Pain catastrophizing is an exaggerated negative cognitive response related to pain. It is commonly assessed using the Pain Catastrophizing Scale (PCS). Translation and validation of the scale in a new language would facilitate cross-cultural comparisons of the role that pain catastrophizing plays in patient function. Purpose: The aim of this study was to translate and culturally adapt the PCS into Nepali (Nepali version of PCS [PCS-NP]) and evaluate its clinimetric properties. Methods: We translated, cross-culturally adapted, and performed an exploratory factor analysis (EFA) of the PCS-NP in a sample of adults with chronic pain (N=143). We then confirmed the resulting factor model in a separate sample (N=272) and compared this model with 1-, 2-, and 3-factor models previously identified using confirmatory factor analyses (CFAs). We also computed internal consistencies, test-retest reliabilities, standard error of measurement (SEM), minimal detectable change (MDC), and limits of agreement with 95% confidence interval (LOA95%) of the PCS-NP scales. Concurrent validity with measures of depression, anxiety, and pain intensity was assessed by computing Pearson's correlation coefficients. Results: The PCS-NP was comprehensible and culturally acceptable. We extracted a two-factor solution using EFA and confirmed this model using CFAs in the second sample. Adequate fit was also found for a one-factor model and different two- and three-factor models based on prior studies. The PCS-NP scores evidenced excellent reliability and temporal stability, and demonstrated validity via moderate-to-strong associations with measures of depression, anxiety, and pain intensity. The SEM and MDC for the PCS-NP total score were 2.52 and 7.86, respectively (range of PCS scores 0-52). LOA95%was between -15.17 and +16.02 for the total PCS-NP scores. Conclusion: The PCS-NP is a valid and reliable instrument to assess pain catastrophizing in Nepalese individuals with chronic pain. Copyright © 2018 Sharma et al. Database: EMBASE

90. Development and implementation of an inpatient multidisciplinary pain management program for patients with intractable chronic musculoskeletal pain in Japan: Preliminary report Author(s): Takahashi N.; Kasahara S.; Yabuki S. Source: Journal of Pain Research; 2018; vol. 11 ; p. 201-211 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Introduction: Multidisciplinary pain management is a useful method to treat chronic musculoskeletal pain. Few facilities in Japan administer a multidisciplinary pain management program, especially an inpatient program. Therefore, we implemented a multidisciplinary pain management program in our hospital based on biopsychosocial factors guided by the recommendations of the International Association for the Study of Pain. The purpose of this study is to describe our inpatient pain management program for Japanese patients, which uses the biopsychosocial method of pain self-management. Materials and methods: Fourteen patients with intractable chronic musculoskeletal pain, who were implemented a multidisciplinary pain management program in our hospital, were studied using the evaluation of the pain and associated factors and physical function. Results: Significant improvement in outcomes were seen in the brief pain inventory, the pain catastrophizing scale (rumination, magnification, and helplessness), the pain disability assessment scale, the hospital anxiety and depression scale (anxiety and depression), the pain self-efficacy questionnaire, the EuroQol five dimensions questionnaire, and muscle endurance and physical fitness. We found no statistically significant differences in static flexibility or walking ability. Conclusion: We developed an inpatient chronic pain management program for Japanese patients. Our results suggest that our program improves chronic musculoskeletal pain coping mechanisms, and that the program can improve patients' quality of life and some physical function. This inpatient pain management program is being expanded to better help intractable chronic musculoskeletal pain patients. Copyright © 2018 Takahashi et al. Database: EMBASE

91. Altered low-frequency oscillation amplitude of resting state-fMRI in patients with discogenic low-back and leg pain Author(s): Zhou F.; Hong S.; Liu J.; Jiang J.; Huang M.; Gong H.; Gu L.; Zhang Y. Source: Journal of Pain Research; 2018; vol. 11 ; p. 165-176 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Objective: The aim of this study was to explore the amplitude of intrinsic low- frequency oscillations (LFOs) in patients with discogenic low-back and leg pain (LBLP). Participants and methods: We obtained and compared the LFO amplitude from 25 right- handed discogenic LBLP patients (13 males; mean age 55.16+/-1.83 years) and 27 well- matched healthy controls (15 males; mean age 52.96+/-1.63 years). The LFO amplitude was examined using the voxel-wise amplitude of low-frequency fluctuations (ALFFs), and partial correlation analysis was performed to determine the relationship between the regions with altered ALFF values and clinical parameters in discogenic LBLP patients. Results: Compared with healthy controls, the patients with discogenic LBLP showed a significant increase in ALFF in the affective system of the pain matrix (left anterior cingulate cortex, right anterior insula/frontal operculum, and bilateral orbitofrontal cortex) and information-processing regions (middle occipital/temporal gyrus). In addition, a significant decrease in ALFF was observed in the default mode network (DMN; inferior parietal lobule (IPL) and medial prefrontal cortex [mPFC]) and the processing system of the pain matrix (basal ganglia/ thalamus/midbrain, postcentral gyrus [PoCG], and fusiform gyrus). Several regions with altered ALFF were associated with disease duration, visual analog scale scores, Barthel index, and fine sensory modality measurements (two-point tactile discrimination of the left and/or right leg). Further operating characteristic curves analysis suggested that the mean ALFF values in the right IPL, left IPL/PoCG, left anterior cingulate cortex, and left mPFC could serve as markers to separate individuals with discogenic LBLP from healthy subjects. Conclusion: Our results revealed widespread abnormalities in ALFF in the pain matrix and information-processing regions as well as a decrease in ALFF in the DMN. These results open up an important new avenue to better understand the nature of the link between intrinsic activity and peripheral pain and sensory impairment in discogenic LBLP patients. Copyright © 2018 Zhou et al. Database: EMBASE

92. Pharmacogenetic guidance: Individualized medicine promotes enhanced pain outcomes Author(s): Dragic L.L.; Wegrzyn E.L.; Fudin J.; Schatman M.E. Source: Journal of Pain Research; 2018; vol. 11 ; p. 37-40 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:The use of pharmacogenomics has become more prevalent over the past several years in treating many disease states. Several cytochrome P450 enzymes play a role in the metabolism of many pain medications including opioids and antidepressants. Noncytochrome P450 enzymes such as methylenetetrahydrofolate reductase (MTHFR) and catechol-O-methyl transferase (COMT) also play a role in the explanation of opioid dosage requirements as well as in response to certain antidepressants. We present the case of a patient with reduced COMT and MTHFR expression treated with leucovorin 10 mg daily for the management of chronic pain. The use of leucovorin in this patient decreased pain scores, which were clinically significant and increased functionality. This case demonstrates the importance of pharmacogenetics testing in patients, as this can help direct providers to better therapeutic options for their patients. Copyright © 2018 Dragic et al. Database: EMBASE

93. Utility of Radionuclide Bone Scintigraphy in Complex Regional Pain Syndrome Author(s): Howard B.A.; Roy L.; Pyati S.; Kaye A.D. Source: Current Pain and Headache Reports; Jan 2018; vol. 22 (no. 1) Publication Date: Jan 2018 Publication Type(s): Review Abstract:Purpose of Review: To describe the current understanding of the role of three- phase bone scintigraphy (TPBS) in the diagnosis and management of complex regional pain syndrome (CRPS), discuss its advantages and limitations, and present three examples of TPBS patterns typically seen in CRPS patients. Recent Findings: CRPS is a debilitating disorder frequently presenting with pain to ordinarily non-painful stimuli, redness, swelling, following fractures, stroke, myocardial infarction, surgery, or even minor trauma, and its diagnosis, based on clinical criteria and supportive imaging findings, is difficult. Of the available adjunctive diagnostic imaging modalities, radionuclide bone scintigraphy using a TPBS protocol is the most sensitive and specific for detecting abnormalities commonly seen with this condition-classically, increased periarticular uptake on delayed phase of TPBS, with variable increased uptake on perfusion phases, depending on chronicity. Recent studies have (1) demonstrated a more heterogeneous correlation of TPBS findings with CRPS diagnosis using the current Budapest criteria than in studies using older criteria, (2) pointed to the utility of novel quantitative scintigraphic techniques, and (3) highlighted the value of the early perfusion phases of TPBS in predicting treatment response. Summary: TPBS remains a valuable imaging adjunct to clinical diagnosis of CRPS. In combination with a multi-modal analgesic approach, TPBS can be used to follow disease course and potentially treatment response, although prospective trials are needed to further delineate its role. Copyright © 2018, Springer Science+Business Media, LLC, part of Springer Nature. Database: EMBASE

94. A data analytics approach to identify factors underlying patient satisfaction from the RELIEF global registry Author(s): Huynh D.; Woon R.; Lin S.; Jain R. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1622 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Background: Many spinal cord stimulation (SCS) studies report only weak to moderate correlation between pain ratings and patient satisfaction, such that some patients with minimal pain reduction still report treatment satisfaction, suggesting that pain ratings may not account for all facets of the patient experience. Objective: We examined the relationships between pain ratings and quality of life responses following spinal cord stimulation (SCS) in order to identify key factors underlying patient satisfaction by analyzing the following: 1) Clinical data combined across a series of questionnaires 2) Machine learning feature selection algorithms. Methods: The data analyzed was obtained as part of a prospective, multi-center, global registry (RELIEF, Boston Scientific). Data was combined across a series of questionnaires (e.g. Baseline Medical History, NRS Pain Intensity, Oswestry Disability Index, EQ-5D-5L Quality of Life, Beck Depression Inventory, Resource Utilization Index, etc). Subjects with less than 20% data missing were retained for analysis (N = 319). Machine learning feature selection algorithms were used to compute the assessment (CART, Relieff, Information Gain) and develop the final model. Results: This analysis found that roughly half of assessed subjects with <= 1 NRS point pain reduction are still satisfied with SCS therapy. The analyzed data further indicates that satisfaction with paresthesia coverage as well as with comfort of stimulation, and improvement of simple tasks such as usual activities and mobility were the most influential features underlying patient satisfaction when pain reduction is <= 1 NRS point. Discussion/Conclusions: For subjects with <= 1 point NRS pain reduction, satisfaction with paresthesia coverage and comfort of stimulation as well as improvement in the ability to perform simple tasks are the most highly related to patient satisfaction. More in depth investigation is now warranted of the identified features found to interact with subjects' overall satisfaction. Database: EMBASE

95. Multi-institutional randomized, double-blind, placebo-controlled, prospective study of intraarticular lumbar zygapophysial joint corticosteroid injection(s) as treatment of chronic low back pain in a selected population Author(s): Zheng P.; Huynh L.; Smuck M.; Ith A.; Kennedy D.J.; Schneider B.; Levin J. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1619 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Background data: Studies on the intra-articular (IA) injection of corticosteroids into the lumbar zygapophyseal (Z-joint) joints have mixed outcomes due to heterogeneous selection criteria. No studies to date have used the only validated selection criteria for zjoints, dual comparative medial branch blocks (MBB), as the selection criteria. Objectives: To determine if IA injection of corticosteroid is effective in reducing the need for radiofrequency ablation (RF) in those with dual comparative MBB confirmed z-joint pain. Methods: This was a randomized, double blind, placebo-controlled study. 56 subjects that had >=80% pain relief during an initial screening MBB were recruited at 2 academic medical centers to receive a second confirmatory MBB and concurrent IA injection of either corticosteroid or saline per randomization. 29 received intra-articular corticosteroid (triamcinolone 20mg) of which 24 also had a positive confirmatory MBB per SIS guidelines with >=80% pain relief from both MBBs. 27 received IA saline into the z-joint during the confirmatory MBB, of which 22 also had a positive confirmatory MBB. The primary outcome measure was the categorical need for RF and the secondary outcome was time to RF. Results: There was no statistical significant difference in the need for a RF between the groups (16/24 steroid (67% [95% CI 47-82%]) vs 15/22 saline (68% [95% CI 47-84%]), p = 1.00). The average time to RF was also not different at 6.5 weeks steroids versus 6.0 weeks saline (p = 0.82). Conclusions: Intra-articular corticosteroids were not effective in reducing the need for and time to a radiofrequency ablation of the medial branches in those with dual medial branch block confirmed z-joint pain. Database: EMBASE

96. Improved functional capacity but stagnant reallife physical activity after both injection and surgical decompression for lumbar spinal stenosis Author(s): Zheng P.; Muaremi A.; Tomkins-Lane C.; Smuck M. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1619 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Background data: Lumbar spinal stenosis (LSS) is a costly and debilitating condition. Alleviation of pain and improvement of function are the primary goals of interventions such as injections and surgeries. While prior studies have measured subjective improvements in function after such interventions, few have examined objective markers of functional improvement. Objectives: We compared reported and measured function as well as free- living physical activity in patients who underwent either injection or surgical decompression for LSS. Methods: Participants were asked to complete 3 reported functional outcome questionnaires: ODI (Oswestry Disability Index), SSSQ (Spinal Stenosis Symptom Questionnaire), and SF-36. Objective function was measured through SPWT (Self Paced Walking Test). 7 days of real-life physical activity (performance) was measured using Actigraph accelerometers. All outcome testing were performed before intervention and 1 week after epidural injections and 6 months after surgeries. Results: Participants included 17 who underwent injections (average 70.1+/-6.7 years old, 47% women) and 28 who underwent surgeries (average 70.1+/-8.9 years old, 60.7% women). All subjective measures (ODI, SSSQ, and SF-36) improved significantly after injections and surgeries; as did objective functional measures including maximum ambulated distance (SPWT). However, objectively measured real-life physical activity did not change after either injections or surgeries. Patients were just as sedentary after surgeries as they were after injections (82.7+/-5.4% vs 88.6+/-5.8%, p = 0.09). Conclusions: Our studies were the first to track real-life physical activity in people with LSS post-intervention. We found that after both injections and surgeries, participants demonstrated significant improvements in self-reported function and objectively measured physical capacity, but not physical activity as measured by continuous activity monitoring. This lack of improvement in performance, despite improvements in self- reported function and objective capacity, suggests a role for post-intervention rehabilitation focused specifically on increasing activity after interventions in the LSS population. Database: EMBASE

97. Discriminating physical performance phenotypes of patients with chronic low back pain Author(s): Zheng P.; Muaremi A.; Leutheuser H.; Tomkins-Lane C.; Smuck M. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1618-1619 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Background data: Musculoskeletal disorders are associated with significant mobility limitations. It is important to determine how physical performance differs between patients with and without chronic low back pain (cLBP) to eventually develop disease- specific physical activity guidelines to re-mobilize these patients. Objectives: We aimed to develop a model capable of differentiating the physical performance phenotypes of patients with and without cLBP. Methods: This was a retrospective matched comparison study. We tracked physical activity using the Actigraph accelerometer in 23 patients with cLBP. Their data was compared to age and sex matched individuals from the National Health and Nutrition Examination Survey (NHANES) 2003-4 dataset. Individuals were excluded if they reported mobilitylimiting disorders (history of painful musculoskeletal conditions, congestive heart failure, emphysema, or prior stroke). We examined the data and used machine learning techniques to build a predictive model using 1) standard intervals from Freedson's group and 2) the Physical Performance analysis designed by our group to specifically interrogate data from patients with mobility-limiting disorders. Primary outcomes were classification accuracy and true positive rate of model at differentiating cLBP versus no cLBP. Results: Given age and gender, we were able to create a model using 4 features of sedentary activity and 1 variable of light intensity that achieved 91% classification accuracy with 62% true positive rate. When we included age and gender as predictive variables, we then get a true positive rate of 81%. Conclusions: We showed that it is possible to build models from free-living physical activity data capable of discriminating the physical performance phenotypes of those with and without cLBP. Similar to our prior results, sedentary and light activity are most distinct between the two populations. With this understanding of baseline physical activity differences, we hope to eventually develop disease-specific physical activity guidelines to rehabilitate these patients. Database: EMBASE

98. The incidence of spinal cord stimulator complications from a single institution: A retrospective chart review Author(s): Rejaei D.; Ahmed S. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1616 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Background: Complications associated with spinal cord stimulation (SCS) can be broadly categorized to hardware-related complications and biologic complications. Lead migration is the most commonly reported hardware-related complication and wound infection is the most commonly reported biologic complication (1). Objectives: To delineate the most common complications associated with SCS from a single academic institution. Methods: A retrospective chart review evaluating all SCS permanent implants that required revisions from a single academic institution between January/2001 and December/2012. Data including patient age, gender, reason for SCS implantation, reason for revision, presence of diabetes, smoking, opioid use, and BMI were recorded. Results: During this time frame 338 patients underwent trials for SCS implantation and of them 167 patients underwent permanent implantation. Of the patients undergoing permanent implantation, 23 required revisions with a total number of 46 revisions performed. 10 patients were female and 13 were male. The incidence of revisions was 7% due to device no longer providing relief from lead migration and hardware malfunction, 7% due to IPG battery depletion requiring replacement, 5% due to infectious complications, 2% due to pain at the IPG site, 2% due to requiring addition of a percutaneous lead to redirect stimulation current, 2% due to loss of pain coverage despite paresthesia presence, 1 revision due to possible allergic reaction to nickel within the device, 1 revision due to exposed IPG secondary to skin breakdown without infection. Our patients requiring revisions had an average BMI of 28.7. 26% of patients requiring revisions were smokers. 21% of patients requiring revisions had diabetes. Discussion/Conclusion: Our complication rates validate reports from prior studies and fall within similar ranges (1). Future studies on our data will compare patients who required revisions to those who did not to delineate possible risk factors that could predict the risk of complication formation. Database: EMBASE

99. Does cervical interlaminar epidural steroid injection with low-dose lidocaine cause objective upper extremity weakness? a preliminary study Author(s): McCormick Z.L.; Nelson A.; Kendall M.; McCarthy R.J.; Nagpal G.; Walega D.R. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1615 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Summary of Background Data: Low-dose local anesthetic is used in cervical interlaminar epidural steroid injections (CIESI) by some providers, yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for post-procedure safety, as even mild weakness may pose a hazard during performance manual activities that require the upper extremity/extremities such as using a handrail or cane handle for support. Objective: Determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Methods: This prospective case series was conducted in an academic pain center. Adults with cervical radicular pain underwent CIESI with 1mL of 1% lidocaine (3mL total injectate). Elbow flexion (EF), wrist extension (WE), elbow extension (EE), and handgrip strength were measured by dynamometry at baseline, 15 minutes and 30 minutes post-injection. Changes in strength from baseline and the proportion of participants with a minimum perceptible change in EF, WE, EE, and handgrip strength (>=20%) and 95% confidence intervals (CI) were calculated. Results: Twentyseven participants were included. At 15 and 30minutes post-injection, there was no within-participant difference in EF, WE, EE, and handgrip strength from baseline overall. Nonetheless, 5 (19%, 95% CI 4-33) of the participants demonstrated a>= 20% strength decrease in at least 1 myotomal distribution. A>= 20% decrease in strength was present in left EF 4% (95% CI 0-11%), right EF 7% (95% CI 0-17%), left WE 4% (95% CI 0-11%), and right WE 7% (95% CI 0-17%). Conclusions: These preliminary data suggest that CIESI with an injectate volume of 3mL that includes 1mL of 1% lidocaine may result in objective upper extremity weakness that is above the minimum threshold of perception in subset of patients. Further study should include a control group and internal validation to confirm the present results. Database: EMBASE

100. The effect of patient satisfaction surveys on physician practice patterns Author(s): Levin J.; Mattie R.; Kennedy D.; Lungren M. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1613 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Background Data: Patient satisfaction surveys have been associated with higher costs and increased mortality (1). They have not been shown to be valid in determining quality or effectiveness of surgical spine care (2), and spine surgeons who recommend against surgical treatment receive lower scores (3). Objectives: To evaluate if patient satisfaction surveys affect the way that physicians practice. Methods: A survey was distributed to members of the Spine Intervention Society. Results: 74% of physicians use patient satisfaction surveys, and 14% have an income affected by them. 32% of physicians agreed that the surveys improve patient care, while 41% disagreed. 10% of physicians agreed that the surveys should be used as a factor in determining a physician's compensation, while 75% disagreed. If a poor score would negatively affect physicians' incomes: 54% would refuse to accept a new patient into his/her practice if he/she suspected the patient might give a poor score, while 43% would discontinue the care of a current patient; 41% would order more imaging tests; 32% would perform more invasive procedures; 31% would order more laboratory tests; 29% would prescribe more pain medications; 27% would approve unjustified disability paperwork; 19% would not tell an unsafe driver to stop driving, while 15% would not report this driver to the DMV; 11% would prescribe more antibiotics. 38% of respondents are aware of practitioners who purposefully manipulate the system. Discussion/Conclusions: The findings of this multi-specialty physician practice survey suggest that routine implementation of patient satisfaction surveys may affect the way that physicians practice medicine, and in some circumstances lead to inappropriate care or denial of health care services. This unintended practitioner behavior may be amplified further when satisfaction scores are tied to physician compensation. More thorough study is undoubtedly needed before patient satisfactions scores can be used as a reliable metric in health care systems. Acknowledgement: The authors would like to acknowledge Sandra Ray and the Spine Intervention Society Research Division for their contribution and work on refining the development of our survey. Database: EMBASE

101. Forward flexed posture as a cause of Meralgia paresthetica: A case report Author(s): Khan J.; Saltzman L.S. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1610 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:A 55 year old male with PMH of HIV presented with back pain and was diagnosed with osteomyelitis affecting the L1 and L2 vertebral bodies. He was treated with intravenous antibiotics. He subsequently developed bilateral anterior thigh pain, right greater than left. At re-evaluation, it was determined that nerve root compression at L1 and L2 due to osteomyelitis were the cause of the symptoms. He received epidural steroid injections twice over the course of the next few months without relief. At 1 year follow up from original presentation, the patient presented with marked flexed posture and expressed that the forward flexion occurred during the year due to persistent pain. At this time, he was given a lumbar corset to assist with standing posture because his symptoms were postulated to be due to compression of the lateral femoral cutaneous nerve (LFCN). Results: At 1 week follow up, the patient expressed that his right anterolateral thigh pain had significantly decreased. At 3 weeks, the patient stated that his right thigh pain decreased to nil and that his left thigh pain was rare. He was able to decrease reliance on Tramadol. Discussion: Meralgia Paresthetica is a mononeuropathy affecting the LFCN. Most commonly, the nerve is compressed as it passes through the inguinal ligament. Obesity, pregnancy, abnormal positioning, intraabdominal masses, as well as external causes such as seatbelts, girdles, tight trousers have all been implicated as causes of LFCN compression. However, meralgia paresthetica resulting from a prolonged flexed posture has not been described in the literature. This case is unique as meralgia paresthetica often has an elusive etiology. Thus, when a prominent flexed posture and these symptoms are identified as causative, a lumbar corset to assist with standing posture and program focused on balancing and strengthening postural muscles is the treatment of choice. Database: EMBASE

102. Predictive factors associated with a successful clinical outcome from radiofrequency ablation of the genicular nerves for the treatment of chronic knee pain due to osteoarthritis Author(s): McLean House L.; Walega D.R.; Korn M.; Khan D.M.; Nagpal G.; Garg A.; Omar I.M.; Reddy R.D.; McCormick Z.L. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1608-1609 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Background: Radiofrequency ablation of the genicular nerves has been introduced as a treatment for chronic knee pain, yet predictive factors of successful outcomes are poorly described. Objective: Identify factors that predict clinical success following cooled radiofrequency ablation (cRFA) of the genicular nerves for the treatment of chronic knee pain due to osteoarthritis (OA). Setting: Academic pain medicine center. Methods: Cross- sectional cohort study of patients with knee OA, anterior-posterior and lateral weight- bearing radiographs, pain numerical rating scale (NRS) score >=4, diagnostic response (>=50% pain relief) to genicular nerve blocks, who underwent subsequent cRFA of the genicular nerves with minimum 6-month follow-up. Outcome data were collected by standardized phone survey. The primary outcome was a composite "treatment success" variable defined as: >=30% reduction NRS score, patient global impression of change (PGIC) of "improved" or better, and lack of total knee arthroplasty (TKA). Multivariate logistic regression was used to identify covariates associated with treatment success including age, gender, body mass index, duration of symptoms, baseline NRS score, marital status, comorbid mood disorder, history of arthroscopy, knee compartment-specific Kelgren- Lawrence OA scores, and unilateral vs. bilateral procedures. Results: Fifty-four patients (79 discrete knees), median age of 66 years [IQR: 62-75], 22% male, were included. Median time to follow-up was 6 [IQR 6-7] months. Forty-three treatments (54%; 95% CI: 43-65%) met success criteria. In the multivariate model, younger age (p=0.01), shorter symptom duration (p=0.04), higher baseline NRS score (p=0.02), and lack of prior arthroscopy (p=0.04) were associated with successful treatment (AU-ROC curve: 0.84). Conclusions: Genicular nerve cRFA resulted in a 54% success rate at minimum 6-month follow-up using a composite definition. Younger age, shorter symptom duration, higher baseline NRS score, and lack of prior arthroscopy predicted success. These factors should be considered when selecting patients for genicular cRFA to treat painful knee OA. References: 1) Pedersen et al. The risk of venous thromboembolism, myocardial infarction, stroke, major bleeding and death in patients undergoing total hip and knee replacement: a 15-year retrospective cohort study of routine clinical practice. Database: EMBASE

103. Cadaveric study of the articular branches of the shoulder joint Author(s): Bickelhaupt B.; Fehl J.; Eckmann M.; Benfield J.; Nagpal A.; Curley J.; Rahimi O. Source: Pain Medicine (United States); Aug 2017; vol. 18 (no. 8); p. 1606 Publication Date: Aug 2017 Publication Type(s): Conference Abstract Abstract:Chronic shoulder pain affects 20% of individuals in their lifetime (1). There are periarticular and intraarticular causes, leading to a multifactorial etiologies pain, often difficult to treat (2,3). Innervation of the glenohumeral joint can be divided into anterior and posterior segments from articular branches of the axillary (AN), suprascapular (SN), and lateral pectoral nerves (LPN). This cadaveric study investigated the anatomic relationships of the articular branches of the SN, AN, LPN, providing implications for fluoroscopic and ultrasound guided peripheral nerve blockade or ablation. 18 cadavers, 37 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade. 17 cadavers and 33 shoulders were successfully evaluated. Articular branches of the LPN traveled with acromial branches of the thoracoacromial artery, superior to the coracoid process, and continued distally to innervate the anterior shoulder joint. SN sensory branches were identified posteriorly traveling laterally from the spinoglenoid notch toward the posterior glenohumeral joint capsule. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus traveling deep to the deltoid muscle and then superiorly toward the inferior portion of the posterior capsule. Safe zones for blocking terminal articular branches of the SN, AN, and LPN appear accessible with potential avoidance of motor blockade. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint. Articular branches of the SN and AN are accessible in the capsule overlying the glenohumeral joint posteriorly. Blockade of articular sensory nerves to the shoulder would allow for alleviation of chronic pain with minimal risk of motor impairment. References: 1) Andrews, JR. Diagnosis and treatment of chronic painful shoulder: Review of nonsurgical interventions. Arthroscopy. 2005;21:333-347. 2) Van Der Windt D, Koes, BT, de Jong BA, Bouter LM. Shoulder disorders in general practice: Incidence, patient characteristics, and management. Database: EMBASE

104. Use of esophageal balloon pressure-volume curve analysis to determine esophageal wall elastance and calibrate raw esophageal pressure: A bench experiment and clinical study Author(s): Sun X.-M.; Chen G.-Q.; Huang H.-W.; He X.; Yang Y.-L.; Shi Z.-H.; Xu M.; Zhou J.-X. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC Anesthesiology - from BioMed Central Available at BMC Anesthesiology - from Europe PubMed Central - Open Access Abstract:Background: Accurate measurement of esophageal pressure (Pes) depends on proper filling of the balloon. Esophageal wall elastance (Ees) may also influence the measurement. We examined the estimation of balloon-surrounding elastance in a bench model and investigated a simplified calibrating procedure of Pes in a balloon with relatively small volume. Methods: The Cooper balloon catheter (geometric volume of 2.8 ml) was used in the present study. The balloon was progressively inflated in different gas-tight glass chambers with different inner volumes. Chamber elastance was measured by the fitting of chamber pressure and balloon volume. Balloon pressure-volume (P-V) curves were obtained, and the slope of the intermediate linear section was defined as the estimated chamber elastance. Balloon volume tests were also performed in 40 patients under controlled ventilation. The slope of the intermediate linear section on the end-expiratory esophageal P-V curve was calculated as the Ees. The balloon volume with the largest Pes tidal swing was defined as the best volume. Pressure generated by the esophageal wall during balloon inflation (Pew) was estimated as the product of Ees and best volume. Because the clinical intermediate linear section enclosed filling volume of 0.6 to 1.4 ml in each of the patient, we simplified the estimation of Ees by only using parameters at these two filling volumes. Results: In the bench experiment, bias (lower and upper limits of agreement) was 0.5 (0.2 to 0.8) cmH2O/ml between the estimated and measured chamber elastance. The intermediate linear section on the clinical and bench P-V curves resembled each other. Median (interquartile range) Ees was 3.3 (2.5-4.1) cmH2O/ml. Clinical best volume was 1.0 (0.8-1.2) ml and ranged from 0.6 to 1.4 ml. Estimated Pew at the best volume was 2.8 (2.5-3.5) cmH2O with a maximum value of 5.2 cmH2O. Compared with the conventional method, bias (lower and upper limits of agreement) of Ees estimated by the simple method was - 0.1 (- 0.7 to 0.6) cmH2O/ml. Conclusions: The slope of the intermediate linear section on the balloon P-V curve correlated with the balloon- surrounding elastance. The estimation of Ees and calibration of Pes were feasible for a small-volume-balloon. Copyright © 2018 The Author(s). Database: EMBASE

105. A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve Repair Author(s): Moscarelli M.; Terrasini N.; Nunziata A.; Sarto P.D.; Haxhiademi D.; Punjabi P.; Angelini G.; Solinas M.; Buselli A. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: Minimally invasive mitral valve repair may be associated with prolonged cardioplegic arrest times and ischemic reperfusion injury. Intravenous (propofol) and volatile (sevoflurane) anesthesia are used routinely during cardiac surgery and are thought to provide cardioprotection; however, the individual contribution of each regimen to cardioprotection is unknown. Therefore, the authors sought to compare the cardioprotective effects of propofol and sevoflurane anesthesia in patients undergoing minimally invasive mitral valve repair. Design: A single-center single-blind randomized controlled trial. Setting: A specialized regional cardiac surgery center in Italy. Participants: The study enrolled 62 adults undergoing elective isolated minimally invasive mitral valve repair for degenerative disease. Exclusion criteria included secondary mitral regurgitation, previously treated coronary artery disease, diabetes mellitus, chronic renal failure requiring dialysis, atrial fibrillation, and documented allergy to either propofol or sevoflurane. Interventions: All patients received video-assisted minimally invasive right minithoracotomy. Patients were randomized to receive propofol or sevoflurane anesthesia in a 1:1 ratio. Measurements and Main Results: Cardiac troponin I release was measured over the first 72 hours postoperatively. Operative, cross-clamp, and total bypass times were similar between groups. Cardiac troponin I release was reduced nonsignificantly in the propofol group (p = 0.62), and peak troponin I release was correlated with cross-clamp time in both groups. There were no differences in terms of intraoperative lactate release and blood pH between groups. Conclusion: Propofol and sevoflurane anesthesia were associated with similar degrees of myocardial injury, indicating comparable cardioprotection. Myocardial injury was related directly to the duration of cardioplegic arrest. Copyright © 2018 Elsevier Inc. Database: EMBASE

106. Bioactive chromone constituents from Vitex negundo alleviate pain and inflammation Author(s): Khan A.; Naz S.; Farooq U.; Shahid M.; Ullah I.; Ali I.; Rauf A.; Mabkhot Y.N. Source: Journal of Pain Research; 2018; vol. 11 ; p. 95-102 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Background: Vitex negundo L. has been widely studied for its beneficial effect in inflammatory and pain conditions. The present study describes the isolation of two new bioactive chromone constituents from V. negundo and their in vivo evaluation for anti- inflammatory and antinociceptive activities. Methods: Two new chromone derivatives, namely, methyl 3-(2-(5-hydroxy-6-methoxy-4-oxo-4H-chromen-2-yl)ethyl)benzoate (1) and 3-(1-hydroxy-2-(5-hydroxy-6-methoxy-4-oxo-4H-chromen-2-yl)ethyl)benzoic acid (2) were isolated from V. negundo and their structures were determined through various spectroscopic techniques including mass spectrometry, UV, IR,1H NMR,13C NMR, and two- dimensional-NMR like correlation spectroscopy and heteronuclear multiple bond correlation techniques. The isolated compounds (1-2) were tested for their prospective antinociceptive activity in acetic acid-induced abdominal constriction assay and anti-inflammatory activity in the carrageenan-induced paw edema assay in mice. Results: Significant attenuation (P<0.001) of tonic visceral nociception was demonstrated by compound 1 and 2 at doses of 50 and 100 mg/kg. At similar doses, these compounds (1-2) also showed potent amelioration (P<0.001) of carrageenan-induced paw swelling. Conclusion: The isolated chromone derivatives (1-2) from V. negundo are able to alleviate nociception and inflammation and the findings corroborated that V. negundo may be used as a potential source of antinociceptive and anti-inflammatory candidates. Copyright © 2018 Khan et al. Database: EMBASE

107. Tramadol use in a patient with Brugada syndrome and morphine allergy: A case report Author(s): Sahutoglu C.; Kocabas S.; Askar F.Z. Source: Journal of Pain Research; 2018; vol. 11 ; p. 191-194 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Brugada syndrome is a rare syndrome characterized by arrhythmias and sudden death, particularly in younger individuals. A mutation in a gene encoding the human cardiac sodium channels is responsible for this syndrome. In the literature, there are several case reports of Brugada syndrome in association with the use of several anesthetic agents. Herein, we present our anesthetic practice and the use of tramadol in a 75-year-old female patient who underwent pulmonary lobectomy under general anesthesia and was diagnosed with Brugada syndrome. Copyright © 2018 Sahutoglu et al. Database: EMBASE

108. Noteworthy Literature published in 2017 for Abdominal Organ Transplantation Author(s): Zerillo J.; Smith N.K.; Sakai T. Source: Seminars in Cardiothoracic and Vascular Anesthesia; Mar 2018; vol. 22 (no. 1); p. 67-80 Publication Date: Mar 2018 Publication Type(s): Article Abstract:In 2017, we identified more than 400 peer reviewed publications on the topic of pancreas transplantation, more than 500 on intestinal transplantation, more than 4000 on renal transplantation, and more than 4700 on liver transplantation. This annual review highlights the most pertinent literature for anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We explore a wide range of topics, including risk for and prediction of perioperative complications, recommendations on perioperative management, economic analyses, and education of the trainees in abdominal transplantation anesthesia and critical care. Copyright © 2018, © The Author(s) 2018. Database: EMBASE

109. Effectiveness of Bilateral Superficial Cervical Plexus Block as Part of Postoperative Analgesia for Patients Undergoing Thyroidectomy in Empress Zewditu Memorial Hospital, Addis Ababa, Ethiopia Author(s): Aweke Z.; Abiy S.; Ayalew N.; Sahile W.A.; Kassa A.A. Source: Anesthesiology Research and Practice; 2018; vol. 2018 Publication Date: 2018 Publication Type(s): Article Available at Anesthesiology Research and Practice - from Europe PubMed Central - Open Access Available at Anesthesiology Research and Practice - from Hindawi Open Access Journals Available at Anesthesiology Research and Practice - from International DOI Foundation Abstract:Introduction. The pain after thyroid surgery is considered of moderate intensity and short duration. Most trials showed significant reduction in pain intensity and severity of pain in patients for whom bilateral superficial cervical plexus block (BSCPB) was done. Objective. To assess the postoperative analgesic effect of BSCPB for thyroid surgery. Methods. Sixty six euthyroid patients were recruited and assigned to two groups (33 patients each). Group 1 BSCPB and Group 2 standard analgesia. The unpaired Student's t- test and Mann-Whitney test were used for comparison. Statistical significance was stated at p value < 0.05. Results. The median postoperative pain score (NRS) was 3 in the BSCPB group and 5 in the control group (p=0.002). There was also statistically significant difference at 6th, 12th, and 24th hour showing a lower median pain score in the BSCPB group compared to the control group. The median time was (360 minutes) in the treatment group and (180 minutes) in the control group (p=0.0006). The median tramadol consumption within 24 hours is 0 mg in the BSCPB group compared to 100 mg in the control group (p=0.001). Conclusion and Recommendation. BSCPB done for thyroidectomy under general anesthesia decreases the postoperative pain score, total analgesia consumption, and time to first analgesia request. Copyright © 2018 Zemedu Aweke et al. Database: EMBASE

110. Efficacy of Bilateral Transversus Abdominis Plane and Ilioinguinal-Iliohypogastric Nerve Blocks for Postcaesarean Delivery Pain Relief under Spinal Anesthesia Author(s): Ahemed S.A.; Denu Z.A.; Getinet Kassahun H.; Yilikal Fentie D. Source: Anesthesiology Research and Practice; 2018; vol. 2018 Publication Date: 2018 Publication Type(s): Article Available at Anesthesiology Research and Practice - from Europe PubMed Central - Open Access Available at Anesthesiology Research and Practice - from Hindawi Open Access Journals Available at Anesthesiology Research and Practice - from International DOI Foundation Abstract:Background. Caesarean delivery can be associated with considerable postoperative pain. While the benefits of transversus abdominis plane (TAP) and ilioinguinal- iliohypogastric (II-IH) nerve blocks on pain after caesarean delivery via Pfannenstiel incision have been demonstrated, no enough investigations on the comparison of these blocks on pain after caesarean delivery have been conducted in our setup. Method. An institutional- based prospective observational cohort study was conducted to compare the analgesic efficacy of those blocks. We observed 102 postoperative parturients. The outcome measure was the severity of pain measured using a numeric rating scale. Result. Twenty-four hours after surgery, the NRS score at rest was (0.90 +/- 0.80) versus (0.67 +/- 0.58) and at movement (1.2 +/- 1.07) versus (0.88 +/- 0.76) for the TAP and II-IH groups, respectively. Twenty-four hours after surgery, the mean tramadol consumption was (55.45 +/- 30.51) versus (37.27 +/- 27.09) mg in TAP and II-IH groups, respectively (p = 0.009). The mean first analgesic requirement time was also prolonged in the II-IH group. Conclusion and Recommendations. There was no statically significant difference between TAP and II-IH blocks regarding postoperative pain score, but the II-IH block significantly reduced the total tramadol consumption and prolonged the time to first analgesic request than TAP. Thus, we recommend the II-IH nerve block. Copyright © 2018 Seid Adem Ahemed et al. Database: EMBASE

111. Psychosocial predictors of posttreatment pain after nonmetastatic breast cancer treatment: A systematic review and meta-analysis of prospective studies Author(s): Johannsen M.; Frederiksen Y.; Zachariae R.; Jensen A.B. Source: Journal of Pain Research; 2018; vol. 11 ; p. 23-36 Publication Date: 2018 Publication Type(s): Review Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Background: The search for risk factors of pain after breast cancer, which affects a considerable proportion of the women, has primarily focused on clinical factors. The aim of this meta-analysis was to explore the less well-studied psychosocial predictors of pain after breast cancer treatment. Methods: Two independent searches were conducted in PubMed, PsycINFO, Web of Science, and CINAHL. Eligible studies were prospective, observational studies of women aged >=18 years, diagnosed and treated for nonmetastatic breast cancer >=3 months previously. Additional inclusion criteria were that studies had assessed at least one pain outcome and at least one psychosocial predictor. The psychosocial predictors investigated included: 1) psychological-behavioral states, 2) psychological traits, and 3) social support. Effect size correlations (ESr) were chosen as the effect size and pooled using a random effects model. We also explored a number of study characteristics as possible moderators of the effect with meta-regression. Results: Of the total of 13 eligible studies identified, most studies measured psychosocial predictors at presurgery. Neither psychological-behavioral states (ESr: 0.05; p=0.13; K=11) nor psychological traits (ESr: 0.02; p=0.48; K=6) emerged as statistically significant predictors of pain. In contrast, higher levels of social support were statistically significantly associated with less pain (ESr: -0.24; p<0.001; K=4). In studies of psychological-behavioral states, longer follow-up was associated with smaller effect sizes (p=0.023). Furthermore, older mean sample age was associated with larger effect sizes for both psychological-behavioral states (p=0.0004) and psychological traits (p=0.035). Conclusion: The results of this meta-analysis suggest that psychosocial factors measured at presurgery may only be of modest predictive value in identifying women at risk of developing pain after breast cancer treatment. While speculative, psychosocial factors may play a larger role in the postsurgery trajectory, which could be valuable to investigate in future studies. Copyright © 2018 Johannsen et al. Database: EMBASE

112. Altered perfusion of the sensorimotor cortex in patients with cervical spondylotic myelopathy: An arterial spin labeling study Author(s): Zhou F.; Huang M.; Wu L.; Tan Y.; Guo J.; He L.; Gong H.; Zhang Y. Source: Journal of Pain Research; 2018; vol. 11 ; p. 181-190 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Objective: Advanced magnetic resonance imaging studies have shown functional plasticity or reorganization and metabolite alterations of N-acetyl aspartate in the sensorimotor cortex (SMC), a hallmark region and key brain network, in patients with cervical spondylotic myelopathy (CSM). However, the nature of perfusion in the SMC and the relationship between regional cerebral blood flow (CBF), motor function scores, and structural damage of the cervical cord in patients with CSM are not fully understood. Materials and methods: All right-handed participants underwent pseudo-continuous arterial spin labeling pulse sequence scanning, and CBF was then calculated and compared between CSM and healthy groups. Clinical and structural associations were assessed in the SMC. Receiver operating characteristic (ROC) and leave-one-out cross-validation analyses were used to estimate the sensitivity and specificity of the significantly altered CBF in the SMC to distinguish myelopathy-related impairment. Results: A total of 18 pairs of CSM patients and well-matched healthy subjects were included in the analyses. Compared with healthy subjects, CSM patients exhibited significantly decreased CBF in the left premotor ventral/precentral operculum (PMv/PrCO) and the bilateral dorsal anterior cingulate cortex (dACC); and increased CBF in the left paracentral lobule (PCL), the right PCL/supplementary motor area (PCL/SMA), and the right postcentral gyrus (PoCG; Gaussian random field correction at P<0.01). In the CSM group, the CBF values in the right PoCG were negatively correlated with Japanese Orthopaedic Association scores, and the CBF values in several regions were negatively correlated with Neck Disability Index scores. Finally, the ROC analysis revealed that significantly increased CBF in the left PCL, the right PCL/SMA, and the right PoCG discriminated patients with myelopathy-related impairment from healthy subjects. Conclusion: Regional CBF was reduced in operculum-integrated (PMv/PrCO) and motor control (dACC) regions but increased in sensory (PoCG) and motor-sensory processing (PCL/ SMA) regions in patients with CSM. Copyright © 2018 Zhou et al. Database: EMBASE

113. Transesophageal Echocardiography Use in Diagnosis and Management of Embolized Intravascular Foreign Bodies Author(s): Herbert J.T.; Kertai M.D. Source: Seminars in Cardiothoracic and Vascular Anesthesia; Mar 2018; vol. 22 (no. 1); p. 100-103 Publication Date: Mar 2018 Publication Type(s): Article Abstract:The increasing use of endovascular interventions coupled with the large number of published case series detailing complications attest to the likelihood that anesthesiologists will encounter a case of intravascular foreign body embolization during their careers. Transesophageal echocardiography is essential to the diagnosis and management of traumatic and intravascular foreign bodies embolized to the heart because it can identify not only the foreign body but also hemodynamically significant lesions to radiolucent anatomic structures prior to and during surgical exploration. In this case presentation, we review how intraoperative transesophageal echocardiography facilitated the intraoperative assessment and management of a post-liver transplant patient who underwent open surgical removal of migrated inferior vena cava stent from the right ventricle with concomitant tricuspid valve annuloplasty. Copyright © 2017, © The Author(s) 2017. Database: EMBASE

114. Delayed Development of Malignant Hyperthermia Following Cardiopulmonary Bypass Author(s): Sams S.H.; Revilla S.; Stahl D.L. Source: Seminars in Cardiothoracic and Vascular Anesthesia; Mar 2018; vol. 22 (no. 1); p. 95-99 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Malignant hyperthermia (MH) is a rare but potentially life-threatening disorder encountered during general anesthesia. The use of cardiopulmonary bypass during cardiac surgery can obscure many of the cardinal signs and symptoms of MH. The development of postoperative MH following cardiac surgery is rare, but anesthesiologists and intensivists must maintain a high index of suspicion in order to make a prompt diagnosis. Initiation and tailored maintenance of MH therapy must also consider the complex physiologic changes of patients in the immediate post-cardiac surgery period. In this article, we present a case of the development of postoperative MH in the cardiac intensive care unit after elective open heart surgery with cardiopulmonary bypass. Copyright © 2017, © The Author(s) 2017. Database: EMBASE

115. BioGlue-Associated Loss of Aortic Valve Leaflet Motility Sonographically Masked by Both Newly Replaced Mechanical Aortic and Mitral Valves Author(s): Smeltz A.M.; Caranasos T.G.; Teeter E.G. Source: Seminars in Cardiothoracic and Vascular Anesthesia; Mar 2018; vol. 22 (no. 1); p. 91-94 Publication Date: Mar 2018 Publication Type(s): Article Abstract:BioGlue is a surgical adhesive widely used to help reinforce complex cardiac and vascular repairs. Since its introduction, several case reports have emerged revealing complications that all providers should be mindful of whenever the product is used. This report considers a unique situation where BioGlue was used after double cardiac valve repair that resulted in adhesion of the new mechanical aortic valve leaflets and was difficult to visualize with transesophageal echocardiography. Copyright © 2017, © The Author(s) 2017. Database: EMBASE

116. Does transcutaneous electrical nerve stimulation reduce pain and improve quality of life in patients with idiopathic chronic orchialgia? A randomized controlled trial Author(s): Tantawy S.A.; Kamel D.M.; Abdelbasset W.K. Source: Journal of Pain Research; 2018; vol. 11 ; p. 77-82 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Background: Chronic orchialgia is defined as testicular pain, which may be either unilateral or bilateral, lasting for more than 3 months. It disturbs a patient's daily activities and quality of life (QoL), inciting the patient to search for treatments to alleviate the pain. It is estimated that 25% of chronic orchialgia cases are idiopathic. Purpose: The purpose of this study was to investigate how effective transcutaneous electrical nerve stimulation (TENS) is in pain reduction and how it consequently affects the QoL in patients with idiopathic chronic orchialgia (ICO). Patients and methods: Seventy-one patients were randomly assigned to group A (study group), which included 36 patients who received TENS and analgesia, and group B (control group), which included 35 patients who received analgesia only. The outcome measures were the participants' demographic data and results of the visual analog scale (VAS) and QoL questionnaire. These outcomes were measured before and after 4 weeks of treatment and at 2-month follow-up. Results: The results showed that compared to pretreatment, there was a significant reduction in pain postintervention and at 2-month follow-up in group A (P<0.0001 and <0.001, respectively; F=7.1) as well as a significant improvement in QoL at these time points (P<0.0001 and <0.0001, respectively). There were no significant differences in the VAS score and QoL in group B at different time points of evaluation. Conclusion: The findings indicate that TENS is effective in reducing pain and improving patients' QoL in cases of ICO. TENS is an easy-to-use, effective, noninvasive, and simple method for ICO-associated pain control and QoL improvement. Copyright © 2018 Tantawy et al. Database: EMBASE

117. Appropriateness of sham or placebo acupuncture for randomized controlled trials of acupuncture for nonspecific low back pain: A systematic review and meta-analysis Author(s): Xiang Y.; Li R.; He J. Source: Journal of Pain Research; 2018; vol. 11 ; p. 83-94 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Objectives: To establish whether sham acupuncture (SA) or placebo acupuncture (PA) is more efficacious for reducing low back pain (LBP) than other routine treatments and to discuss whether SA or PA is appropriate for randomized controlled trials of acupuncture for LBP. Methods: Six databases were searched on 31 May 2017. We included only randomized controlled trials of adults with LBP and lower back myofascial pain syndrome. The studies had at least two control arms: a sham-controlled acupuncture arm and a routine care or waiting list arm (people who did not receive acupuncture until the end of treatment). Trials were combined using meta-analysis methods when the data allowed statistical pooling. Pooled effect sizes were calculated by random effects models. Results: This review identified 7 trials (1768 participants); all were included in the meta-analysis. We found statistically significant differences in pain reduction post-intervention between SA or PA and routine care or a waiting list, with a standardized mean difference of -0.36 (95% CI - 0.54 to -0.18; I2statistic=16%; participants=624; studies=6) for the Visual Analog Scale and - 0.35 (95% CI -0.49 to -0.20; I2statistic=0%; participants=736; studies=1) for the Chronic Pain Grade Scale; however, no significant difference was observed between SA or PA and routine care or no treatment for post-intervention function. Conclusion: Compared with routine care or a waiting list, SA or PA was more efficacious for pain relief post-intervention. Concluding that SA or PA is appropriate for acupuncture research would be premature. Guidelines evaluating SA or PA control methods are needed to determine the specific effect of acupuncture over placebo. Copyright © 2018 Xiang et al. Database: EMBASE

118. A mixed-methods evaluation of the Association of Anaesthetists of Great Britain and Ireland Uganda Fellowship Scheme Author(s): Hewitt-Smith A.; Bulamba F.; Pappenheim K.; Ttendo S.; Walker I.A.; Smith A.F. Source: Anaesthesia; Mar 2018; vol. 73 (no. 3); p. 284-294 Publication Date: Mar 2018 Publication Type(s): Article Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:The Association of Anaesthetists of Great Britain and Ireland and the then Uganda Society of Anaesthesia established the Uganda Fellowship Scheme in 2006, to provide scholarships to encourage doctors to train in anaesthesia in Uganda. We conducted an evaluation of this programme using online questionnaires and face-to-face semi-structured interviews with trainees who received scholarships, as well as with senior surgeons and anaesthetists. Focus group discussions were held to assess changes in attitudes towards anaesthesia over the last 10 years. Interviews were recorded, transcribed and analysed using the constant comparative method. A total of 54 Ugandan doctors have received anaesthesia scholarships since 2006 (median funding per trainee (IQR [range]) 5520 (5520- 6750 [765-9000]). There has been a four-fold increase in the number of physician anaesthetists in Uganda during this time. All those who received funding remain in the region. The speciality of anaesthesia is undergoing a dramatic transformation led by this group of motivated young anaesthetists. There is increased access to intensive care, and this has allowed surgical specialities to develop. There is greater understanding and visibility of anaesthesia, and the quality of education in anaesthesia throughout the country has improved. The Uganda Fellowship Scheme provided a relatively small financial incentive to encourage doctors to train as anaesthetists. Evaluation of the project shows a wide-ranging impact that extends beyond the initial goal of simply improving human resource capacity. Financial incentives combined with strong 'north-south' links between professional organisations can play an important role in tackling the shortage of anaesthesia providers in a low-income country and in improving access to safe surgery and anaesthesia. Copyright © 2018 The Association of Anaesthetists of Great Britain and Ireland Database: EMBASE

119. Experimental Low Back Pain Decreased Trunk Muscle Activity in Currently Asymptomatic Recurrent Low Back Pain Patients During Step Tasks Author(s): Larsen L.H.; Hirata R.P.; Graven-Nielsen T. Source: Journal of Pain; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Low back pain (LBP) patients show reorganized trunk muscle activity but if similar changes are manifest in recurrent LBP (R-LBP) patients during asymptomatic periods remains unknown. In 26 healthy and 27 currently asymptomatic R-LBP participants electromyographic activity (EMG) was recorded from trunk and gluteal muscles during series of stepping up and down on a step bench before and during experimentally intramuscular induced unilateral and bilateral LBP. Pain intensity was assessed using numeric rating scale (NRS) scores. Root mean square EMG (RMS-EMG) normalized to maximal voluntary contraction EMG and pain-evoked differences from baseline (DELTARMS- EMG) were analyzed. Step task duration was calculated from foot sensors. R-LBP compared with controls showed higher baseline RMS-EMG and NRS scores of experimental pain (P < .05). In both groups, bilateral compared with unilateral experimental NRS scores were higher (P < .001) and patients compared with controls reported higher NRS scores during both pain conditions (P < .04). In patients, unilateral pain decreased DELTARMS-EMG in the Iliocostalis muscle and bilateral pain decreased DELTARMS-EMG in all back and gluteal muscles during step tasks (P < .05) compared with controls. In controls, bilateral versus unilateral experimental pain induced increased step task duration and trunk RMS-EMG whereas both pain conditions decreased step task duration and trunk RMS-EMG in R-LBP patients compared with controls (P < .05). Perspective: Task duration and trunk muscle activity increased in controls and decreased in R-LBP patients during experimental muscle LBP. These results indicate protective strategies in controls during acute pain whereas R-LBP patients showed higher pain intensity and altered strategies that may be caused by the higher pain intensity, but the long-term consequence remains unknown. Copyright © 2018 The American Pain Society. Database: EMBASE

120. Opportunity Knocks? The Expansion of Volatile Agent Use in New Clinical Settings Author(s): Jerath A.; Parotto M.; Wasowicz M.; Ferguson N.D. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

121. Prevalence and Characteristics of Pruritus and Association With Quality of Life in People Living With HIV: A Cross-Sectional Study Author(s): Xu T.; Shetty A.K.; Badiger S.; Chan Y.H.; Yosipovitch G. Source: Journal of Pain and Symptom Management; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

122. Combining Novel Renal Injury Markers with Delta Serum Creatinine Early after Cardiac Surgery and Risk-Stratification for Serious Adverse Outcomes: An Exploratory Analysis Author(s): McIlroy D.R.; Farkas D.; Pan K.; Lee H.T.; Pickering J.W. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: To evaluate the prognostic utility of multiple novel urinary biomarkers of renal injury when used alone, in pair-wise combination with an early delta serum creatinine (DELTASCr) term, and combined as a broad biomarker panel for the prediction of serious adverse outcomes that may reflect AKI in patients undergoing cardiac surgery. Design: Post-hoc analysis of prospective observational study. Setting: Academic medical center. Participants: 603 adults undergoing cardiac surgery. Interventions: None. Measurements and Main Results: Urinary cystatin-c, kidney injury molecule-1, chemokine (C-C motif) ligand 2 and interleukin-18 were measured at baseline and <1 hour, 3 hours and 18-24 hours after separation from cardiopulmonary bypass (CPB). DELTASCr-initial was defined as the difference in SCr from baseline to first postoperative measure. The primary outcome of hospital mortality or renal replacement therapy occurred in 25 patients. Concordant elevation of any urinary biomarker measured 3 hours after CPB together with DELTASCr-initial>=0 mg.dL-1 provided excellent early risk stratification for the primary outcome (OR >=15.1, 95% CI 4.1-55.4). Combining four urinary biomarkers together with DELTASCr-initial and neutrophil gelatinase-associated lipocalin, previously reported from the same cohort, to provide a 6-point AKI risk score enabled early identification of patients reaching the primary outcome (ROCAUC 0.86, 95% CI 0.79-0.92) with potentially useful sensitivity and specificity at varied cut-points. Conclusions: Combining novel urinary biomarkers of renal injury with a creatinine-based metric soon after cardiac surgery provided excellent prognostic utility for serious adverse outcomes. Future studies are required to confirm these findings and determine optimal biomarker combinations for cost- effective risk stratification. Copyright © 2018 Elsevier Inc. Database: EMBASE

123. Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study Author(s): Litton E.; Hillis G.; Bass F.; Delaney A.; Marasco S.; Myles P.S.; McGuinness S.; Reid C.M.; Smith J.A. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). Design: Inception cohort study. Setting: A total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom. Participants: Adult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina). Interventions: Outcomes of interest were a composite outcome of in-hospital mortality, postoperative acute myocardial infarction (AMI), acute kidney injury (AKI), or stroke as well as 6-month vital status and quality of life using the EuroQol 5-dimensional questionnaire (EQ5D). Measurements and Main Results: The study included 136 participants over a 29-month period. Overall, in-hospital and 6-month mortality occurred in 7 (5%) and 11 (8%) participants, respectively. The composite outcome occurred in 60 (44%). The mean increase in EQ5D summary index at 6 months was 0.10 (standard deviation 0.24, p = 0.01). Perioperative AMI, AKI, or stroke significantly decreased the odds of a clinically meaningful improvement in quality of life (odds ratio 0.32; 95% confidence interval 0.13-0.79; p = 0.014). Preoperative IABC was used in 39 participants and did not predict postoperative outcomes. Conclusions: The study identified a group of patients at risk of LCOS in whom CABG surgery was associated with a substantial burden of perioperative morbidity. Preoperative IABC use was variable, supporting the need for further research. Copyright © 2018 Elsevier Ltd. Database: EMBASE

124. Haloperidol for delirium in critically ill patients - protocol for a systematic review Author(s): Barbateskovic M.; Kraus S.R.; Jakobsen J.C.; Wetterslev J.; Collet M.O.; Mathiesen O.; Perner A. Source: Acta Anaesthesiologica Scandinavica; 2017 Publication Date: 2017 Publication Type(s): Article In Press Available at Acta Anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: In the intensive care unit, the prevalence of delirium is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer intensive care unit stay, increased long-term mortality, and cognitive impairment. Thus, the burden of delirium for patients, relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients. Methods: We will search for randomised clinical trials in the following databases: Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, and Allied and Complementary Medicine Database. Two authors will independently screen and select references for inclusion using Covidence, extract data and assess the methodological quality of the included randomised clinical trials using the Cochrane risk of bias tool. Any disagreement will be resolved by consensus. We will analyse the extracted data using Review Manager, STATA 15, and Trial Sequential. Analysis: The aim of this study was to assess the quality of the evidence, we will create a 'Summary of Findings' table containing our primary and secondary outcomes using the GRADE assessment. Discussion: Our ambition with this systematic review is to provide reliable and powered evidence to better inform decision makers on the use of or future trials with haloperidol for the management of delirium in critically ill patients. Copyright © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Database: EMBASE

125. Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: Comparison of nasal tracheal intubation and laryngeal mask airway Author(s): Keles S.; Kocaturk O. Source: Journal of Pain Research; 2018; vol. 11 ; p. 103-110 Publication Date: 2018 Publication Type(s): Article Available at Journal of pain research - from Europe PubMed Central - Open Access Available at Journal of pain research - from PubMed Central Abstract:Background: Several studies have identified side effects of general anesthesia with endotracheal intubation, such as laryngeal pain, dysphonia, and postoperative nausea and vomiting (PONV). The laryngeal mask airway (LMAw) is believed to decrease these side effects. The aim of this trial was to compare postoperative discomfort, emergence delirium, and recovery time of patients who received either an LMAw or nasotracheal intubation (NTI). Patients and methods: A total of 70 children were randomly assigned to the LMAw group (n=35) or the NTI group (n=35). Both groups underwent mask induction with 8% sevoflurane. The NTI group received muscle relaxant, whereas the LMAw group did not. Postoperative laryngeal pain, dental pain, dysphonia, and PONV were assessed immediately and at 1 hour and 6 hours postoperatively. The Wong-Baker Faces Scale was used to evaluate the patients' self-reported pain. In addition, decayed, missing, and filled teeth (dft/DMFT) values, dental procedure type, number of dental procedures, duration of the dental operation, duration of anesthesia, recovery time, emergence delirium, pediatric dentist's access to the mouth, and parents' satisfaction levels were recorded. Data were analyzed using descriptive statistics, chi-square tests, and two-sample t-tests. Results: The incidence of postoperative laryngeal pain was significantly higher in the NTI group immediately (97.2% vs. 8.5%, P=0.00), 1 hour (94.2% vs. 0%, P=0.00), and 6 hours postoperatively (25.7% vs. 0%, P=0.00). There were no statistically significant differences between the two groups in dental pain scores, dft/DMFT values, duration of anesthesia, duration of the dental operation, number of dental procedures, the incidence of PONV, or pediatric dentist's access to the mouth (P>0.05). Emergence delirium and recovery time were significantly higher in the NTI group (P<0.05). Conclusion: The LMAw provided a more comfortable postoperative period than NTI for children who underwent full-mouth dental rehabilitation under general anesthesia. Copyright © 2018 Salehi et al. Database: EMBASE

126. Intraoperative Transesophageal Echocardiogram During Orthotopic Liver Transplantation: TEE to the Rescue! Author(s): De Marchi L.; Lee J.; Rawtani N.; Nguyen V. Source: Seminars in Cardiothoracic and Vascular Anesthesia; Feb 2018 Publication Date: Feb 2018 Publication Type(s): Article In Press Abstract:Supported by a growing number of studies and case reports in the literature, perioperative use of TEE in non-cardiac cases has significantly increased the past two decades. The utility of TEE in monitoring hemodynamic, and diagnosing causes of hypotension refractory to conventional therapy, have made it an almost indispensible tool during major surgeries, such liver transplantation. Despite this fact, compared to the adult population, there is a lack of an equivalent amount of literature on the perioperative use of TEE in pediatric cases. In our case we report the utilization of TEE during a pediatric liver transplant, to diagnose a post reperfusion suprahepatic anastomosis stricture. In this case, the cooperation of the anesthesia, the surgical, and the cardiology teams, helped in resolving the case, allowing a positive outcome for the patient. To our knowledge, this is the first case describing the use of TEE during a pediatric liver transplant. Copyright © 2018, The Author(s) 2018. Database: EMBASE

127. L'indice de masse corporelle predit la sensibilite a l'insuline au cours de la chirurgie cardiaque : etude observationnelle prospectiveBody mass index predicts insulin sensitivity during cardiac surgery: a prospective observational study Author(s): Nakadate Y.; Sato H.; Sato T.; Codere-Maruyama T.; Schricker T.; Matsukawa T. Source: Canadian Journal of Anesthesia; Feb 2018 ; p. 1-9 Publication Date: Feb 2018 Publication Type(s): Article In Press Abstract:Purpose: Taking into account the previously described link between body weight and diabetes mellitus (DM) in non-surgical patients, and the understanding that the degree of intraoperative insulin resistance is a predictor of adverse clinical outcomes, we investigated the relationship between body mass index (BMI) and insulin sensitivity during cardiac surgery. Methods: We prospectively enrolled 400 patients scheduled for elective cardiac surgery and divided them into groups based on the presence or absence of type-2 DM. They were further categorized into four subgroups based on their BMI: group 1- normal weight, BMI 18.5-24.9 kg.m-2; group 2 - overweight, BMI 25-29.9 kg.m-2; group 3 - obese, BMI 30-34.9 kg.m-2; group 4 - morbidly obese, BMI >= 35 kg.m-2. Insulin sensitivity was assessed using the hyperinsulinemic-normoglycemic clamp technique during surgery. We also analyzed the association of BMI, quality of postoperative glycemic control, and postoperative outcomes. Results: A linear negative relationship between BMI and insulin sensitivity (r = 0.42, P < 0.001) was observed, independent of the patients' diabetic state. There was also a positive correlation between BMI and postoperative glycemia (r = 0.30, P < 0.001) though the relationship between BMI and major and infectious complication was not significant (P = 0.56, P = 0.10, respectively). Conclusions: Patient BMI may be used as a simple predictor of insulin sensitivity during cardiac surgery and as a predictor of the quality of postoperative glycemic control. A larger cohort will be necessary to evaluate the association of BMI, perioperative insulin resistance, and clinical outcomes. Copyright © 2018 Canadian Anesthesiologists' Society Database: EMBASE

128. Unravelling Fibromyalgia-Steps Toward Individualized Management Author(s): Hauser W.; Perrot S.; Clauw D.J.; Fitzcharles M.-A. Source: Journal of Pain; Feb 2018; vol. 19 (no. 2); p. 125-134 Publication Date: Feb 2018 Publication Type(s): Article Abstract:The heterogeneity of the clinical presentation and the pathophysiologic mechanisms associated with fibromyalgia (FM), and the modest results on average for any therapy, call for a more individualized management strategy. Individualized treatment can be on the basis of subgrouping of patients according to associated conditions (mental health problems, chronic overlapping pain conditions, other somatic diseases) or on disease severity. Categorizing FM as mild, moderate, or severe can be on the basis of clinical assessment (eg, degree of daily functioning) or on questionnaires. Shared decision-making regarding treatment options can be directed according to patient preferences, comorbidities, and availability in various health care settings. The European League Against Rheumatism guidelines recommend a tailored approach directed by FM key symptoms (pain, sleep disorders, fatigue, depression, disability), whereas the German guidelines recommend management tailored to disease severity, with mild disease not requiring any specific treatment, and more severe disease requiring multicomponent therapy (combination of drug treatment with aerobic exercise and psychological treatments). When indicated, treatments should follow a stepwise approach beginning with easily available therapies such as aerobic exercise and amitriptyline. Successful application of a tailored treatment approach that is informed by individual patient characteristics should improve outcome of FM. Perspective: This article presents suggestions for an individualized treatment strategy for FM patients on the basis of subgroups and disease severity. Categorizing FM as mild, moderate, or severe can be on the basis of clinical assessment (eg, degree of daily functioning) or questionnaires. Subgroups can be defined according to mental health and somatic comorbidities. Copyright © 2017 The American Pain Society Database: EMBASE

129. Design of a Novel Multifunction Decision Support Display for Anesthesia Care: AlertWatch OR Author(s): Tremper K.K.; Mace J.J.; Gombert J.M.; Tremper T.T.; Bagian J.P.; Adams J.F. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC anesthesiology - from BioMed Central Available at BMC anesthesiology - from Europe PubMed Central - Open Access Available at BMC anesthesiology - from PubMed Central Abstract:Background: This paper describes the design of a multifunction alerting display for intraoperative anesthetic care. The design was inspired by the multifunction primary flight display used in modern aviation. Results: The display retrieves live data from multiple sources; the physiologic monitors, the anesthesia information management system, the laboratory values and comorbidities from patient's problem summary list, medical history or history & physical. This information is integrated into a display composed of readily identifiable icons of organ systems, which are color coded to signify normal range, marginal range, abnormal range (by green, yellow, red respectively) and orange outlines for comorbidities/risk factors. There are dozens of text alerts, which can be presented as black text (informational), red text (important information) and red scrolling text (highest importance information). The alerts are derived from current standards in the literature and some involve complex calculations being conducted in the background. Conclusions: The goal of such a system is to improve the quality and safety of anesthetic care by providing enhanced situational awareness in a fashion analogous to the "glass cockpit" and its primary flight display which has improved aviation safety. Copyright © 2018 The Author(s). Database: EMBASE

130. Chronic Calf Pain Caused by Fibroma-Induced Chronic Inflammation Around the Tibial and Peroneal Nerves that Was Misdiagnosed as Centralized Neuropathic Pain: A Case Report Author(s): Park J.; Ok S.-H.; Han J.Y.; Park M.; Seo E.H.; Kim Y.A. Source: Pain Practice; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Introduction: The etiology of calf pain varies widely; therefore, it is difficult to diagnose and requires careful history taking and physical examination by primary care unit physicians. Because ultrasonography is easy to perform, cheap, and readily available to physicians during a routine consultation, it is the first choice of modality for the evaluation of calf pain. However, simple inflammation around the nerve should also be considered as a possible etiology. Here we describe a 35-year-old man with chronic pain in the right calf that was actually caused by fibroma-induced chronic inflammation around the tibial and peroneal nerves but misdiagnosed as centralized neuropathic pain. Case Report: The patient presented with chronic pain and a tingling sensation in the right calf. He had a slowly growing tibial nerve neurilemmoma that was excised at 28 years of age; however, the pain and tingling sensation persisted. He visited several hospitals for 7 years and was misdiagnosed with peripheral nerve injury-induced neuropathic pain. At 35 years of age, he visited our hospital for further evaluation. Ultrasonography revealed a mass in the popliteal region, which was excised and confirmed to be a fibroma via histopathological analysis. Severe inflammation was observed in the operative field. His symptoms finally ameliorated after this surgery. Conclusion: The findings from this case suggest that ultrasonography should be used as the primary modality for the evaluation of calf pain. Although the features of unresolved calf pain are similar to those of neuropathic pain, more curable etiologies should be considered. Copyright © 2018 World Institute of Pain. Database: EMBASE

131. Computer simulated modeling of healthy and diseased right ventricular and pulmonary circulation Author(s): Chou J.; Rinehart J.B. Source: Journal of Clinical Monitoring and Computing; Jan 2018 ; p. 1-10 Publication Date: Jan 2018 Publication Type(s): Article In Press Abstract:We have previously developed a simulated cardiovascular physiology model for in- silico testing and validation of novel closed-loop controllers. To date, a detailed model of the right heart and pulmonary circulation was not needed, as previous controllers were not intended for use in patients with cardiac or pulmonary pathology. With new development of controllers for vasopressors, and looking forward, for combined vasopressor-fluid controllers, modeling of right-sided and pulmonary pathology is now relevant to further in- silico validation, so we aimed to expand our existing simulation platform to include these elements. Our hypothesis was that the completed platform could be tuned and stabilized such that the distributions of a randomized sample of simulated patients' baseline characteristics would be similar to reported population values. Our secondary outcomes were to further test the system in representing acute right heart failure and pulmonary artery hypertension. After development and tuning of the right-sided circulation, the model was validated against clinical data from multiple previously published articles. The model was considered 'tuned' when 100% of generated randomized patients converged to stability (steady, physiologically-plausible compartmental volumes, flows, and pressures) and 'valid' when the means for the model data in each health condition were contained within the standard deviations for the published data for the condition. A fully described right heart and pulmonary circulation model including non-linear pressure/volume relationships and pressure dependent flows was created over a 6-month span. The model was successfully tuned such that 100% of simulated patients converged into a steady state within 30 s. Simulation results in the healthy state for central venous volume (3350 +/- 132 ml) pulmonary blood volume (405 +/- 39 ml), pulmonary artery pressures (systolic 20.8 +/- 4.1 mmHg and diastolic 9.4 +/- 1.8 mmHg), left atrial pressure (4.6 +/- 0.8 mmHg), PVR (1.0 +/- 0.2 wood units), and CI (3.8 +/- 0.5 l/min/m2) all met criteria for acceptance of the model, though the standard deviations of LAP and CI were somewhat narrower than published comparators. The simulation results for right ventricular infarction also fell within the published ranges: pulmonary blood volume (727 +/- 102 ml), pulmonary arterial pressures (30 +/- 4 mmHg systolic, 12 +/- 2 mmHg diastolic), left atrial pressure (13 +/- 2 mmHg), PVR (1.6 +/- 0.3 wood units), and CI (2.0 +/- 0.4 l/min/m2) all fell within one standard deviation of the reported population values and vice-versa. In the pulmonary hypertension model, pulmonary blood volume of 615 +/- 90 ml, pulmonary arterial pressures of 80 +/- 14 mmHg systolic, 36 +/- 7 mmHg diastolic, and the left atrial pressure of 11 +/- 2 mmHg all met criteria for acceptance. For CI, the simulated value of 2.8 +/- 0.4 l/min/m2 once again had a narrower spread than most of the published data, but fell inside of the SD of all published data, and the PVR value of 7.5 +/- 1.6 wood units fell in the middle of the four published studies. The right-ventricular and pulmonary circulation simulation appears to be a reasonable approximation of the right-sided circulation for healthy physiology as well as the pathologic conditions tested. Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature Database: EMBASE

132. Burst Spinal Cord Stimulation: Review of Preclinical Studies and Comments on Clinical Outcomes Author(s): Chakravarthy K.; Kent A.R.; Raza A.; Xing F.; Kinfe T.M. Source: Neuromodulation; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Neuromodulation: Technology at the Neural Interface - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Burst spinal cord stimulation (SCS) technology uses a novel waveform that consists of closely packed high-frequency electrical impulses followed by a quiescent period. Within the growing field of neuromodulation, burst stimulation is unique in that it mimics the natural burst firing of the nervous system, in particular the thalamo-cingulate rhythmicity, resulting in modulation of the affective and attentional components of pain processing (e.g., medial thalamic pathways). Study Design: A review of preclinical and clinical studies regarding burst SCS for various chronic pain states. Methods: Available literature was reviewed on burst stimulation technology. Data sources included relevant literature identified through searches of PubMed, MEDLINE/OVID, SCOPUS, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was to understand the mechanisms of action with regards to burst stimulation and to review clinical data on the indications of burst SCS for various chronic pain states. Results: We present both mechanisms of action and review uses of burst stimulation for various pain states. Conclusions: Burst stimulation offers a novel pain reduction tool with the absence of uncomfortable paresthesia for failed back surgery syndrome, diabetic neuropathic pain, and anesthesia dolorosa. Preclinical models have emphasized that the potential mechanisms for burst therapy could be related to neural coding algorithms that mimic the natural nervous system firing patterns, resulting in effects on both the medial and lateral pain pathways. Other mechanisms include frequency dependent opioid release, modulation of the pain gate, and activation of electrical and chemical synapses. Copyright © 2018 International Neuromodulation Society. Database: EMBASE

133. Changes in tissue and cerebral oxygenation following spinal anesthesia in infants: a prospective study Author(s): Froyshteter A.B.; Tumin D.; Whitaker E.E.; Martin D.P.; Hakim M.; Walia H.; Bhalla T.; Tobias J.D. Source: Journal of Anesthesia; Jan 2018 ; p. 1-5 Publication Date: Jan 2018 Publication Type(s): Article In Press Abstract:Use of spinal anesthesia (SA) in children may address concerns about potential neurocognitive effects of general anesthesia. We used near-infrared spectroscopy (NIRS) to assess the effects of SA on cerebral and tissue oxygenation in 19 patients aged 7 +/- 3 months. Prior to SA placement, NIRS monitors were placed on the forehead (cerebral) and the thigh (tissue). Intraoperative cerebral and tissue saturation were 73 +/- 7 and 80 +/- 11%, respectively, before SA placement. NIRS measurements were monitored every minute for 30 min after SA placement and modeled using mixed-effects linear regression. Regression estimates showed that cerebral saturation remained stable from 67% [95% confidence interval (CI) 63, 71%] after SA placement to 68% (95% CI 65, 72%) at the conclusion of monitoring. After SA placement, tissue saturation was elevated compared to baseline values; but further change [from 91% (95% CI 89, 93%) to 93% (95% CI 91, 95%) at the end of monitoring] was clinically non-significant. All patients breathed spontaneously on room air without changes in oxygen saturation. Blood pressure and heart rate decreased after SA placement, but no changes in hemodynamic parameters required treatment. These data provide further evidence of the neutral effect of SA on cerebral oxygenation 30 min after block placement. Copyright © 2018 Japanese Society of Anesthesiologists Database: EMBASE

134. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass Author(s): Yamazaki Y.; Morimoto Y.; Oba K.; Matsui Y. Source: Journal of Anesthesia; Jan 2018 ; p. 1-7 Publication Date: Jan 2018 Publication Type(s): Article In Press Abstract:Purpose: The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery. Methods: A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed "poor outcome", which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation. Results: After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51-18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10-2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28-2.74, p = 0.001). Conclusions: The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults. Copyright © 2018 Japanese Society of Anesthesiologists Database: EMBASE

135. Minimally Invasive Determinations of Oxygen Delivery and Consumption in Cardiac Surgery: An Observational Study Author(s): Burtman D.T.M.; Stolze A.; genaamd Dengler S.E.K.; Boer C.; Vonk A.B.A. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: Evaluate minimally invasive assessment of oxygen delivery (DO2) and oxygen consumption (VO2) and determine its level of agreement with the gold standard approach of those measurements in patients undergoing cardiac surgery. Design: Observational study. Setting: Single center, VU University Medical Center (Amsterdam, The Netherlands). Participants: The study comprised 29 adult patients. Intervention: Parallel measurements of invasive and minimally invasive parameters required for the calculation of DO2 and VO2. Measurements and Main Results: Measurements were performed after anesthesia induction (T1) and before sternal closure (T2) in adult cardiac surgery. The invasive approach included arterial and pulmonary artery catheter-derived blood sampling and cardiac output measurements. The minimally invasive approach included pulse oximetry, point-of-care hemoglobin, Nexfin-based cardiac output, and central venous catheter-derived blood sampling. Level of agreement was determined using Bland-Altman analysis and percentage error. DO2 and VO2 levels were determined in patients 71 +/- 8 years old. DO2 measurements showed a level of agreement of -17 +/- 57 L/min/m2 and -18 +/- 72 L/min/m2 with percentage errors of 35% and 38% at T1 and T2, respectively. VO2 assessment showed a level of agreement of -5 +/- 18 L/min/m2 and -12 +/- 22 L/min/m2, with percentage errors of 47% at T1 and T2. The highest percentage errors were for cardiac output measurements, 33% and 28% at T1 and T2, respectively. Conclusion: Agreement between minimally invasive and invasive DO2 and VO2 determinations is, moderate and poor, respectively. These findings may be explained by the poor agreement between minimally invasive and invasive cardiac output measurements. Copyright © 2017 The Authors. Database: EMBASE

136. Gestion peroperatoire basee sur l'oxymetrie cerebrale pour ameliorer les resultats perioperatoires : meta-analyse d'essais randomises controlesIntraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials Author(s): Zorrilla-Vaca A.; Healy R.; Grant M.C.; Joshi B.; Brown C.; Mirski M.A.; Rivera-Lara L. Source: Canadian Journal of Anesthesia; Jan 2018 ; p. 1-14 Publication Date: Jan 2018 Publication Type(s): Article In Press Abstract:Purpose: Although evidence from observational studies in a variety of clinical settings supports the utility of cerebral oximetry as a predictor of outcomes, prospective clinical trials thus far have reported conflicting results. This systematic review and meta- analysis was designed to evaluate the influence of management associated with intraoperative cerebral oximetry on postoperative outcomes. The primary outcome was postoperative cognitive dysfunction (POCD), with secondary outcomes that included postoperative delirium, length of intensive care unit (ICU) stay, and hospital length of stay (LOS). Source: After searching the PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar databases, all randomized controlled trials (RCTs) assessing the impact of intraoperative cerebral oximetry-guided management on clinical outcomes following surgery were identified. Principal findings: Fifteen RCTs comprising 2,057 patients (1,018 in the intervention group and 1,039 in control group) were included. Intraoperative management guided by the use of cerebral oximetry was associated with a reduction in the incidence of POCD (risk ratio [RR] 0.54; 95% confidence interval [CI], 0.33 to 0.90; P = 0.02; I2 = 85%) and a significantly shorter length of ICU stay (standardized mean difference [SMD], -0.21 hr; 95% CI, -0.37 to -0.05; P = 0.009; I2 = 48%). In addition, overall hospital LOS (SMD, - 0.06 days; 95% CI, -0.18 to 0.06; P = 0.29; I2 = 0%) and incidence of postoperative delirium (RR, 0.69; 95% CI, 0.36 to 1.32; P = 0.27; I2 = 0%) were not impacted by the use of intraoperative cerebral oximetry. Conclusions: Intraoperative cerebral oximetry appears to be associated with a reduction in POCD, although this result should be interpreted with caution given the significant heterogeneity in the studies examined. Further large (ideally multicentre) RCTs are needed to clarify whether POCD can be favourably impacted by the use of cerebral oximetry-guided management. Copyright © 2018 Canadian Anesthesiologists' Society Database: EMBASE

137. Comparing adductor canal block with local infiltration analgesia in total knee arthroplasty: A prospective, blinded and randomized clinical trial Author(s): Tong Q.J.; Lim Y.C.; Tham H.M. Source: Journal of Clinical Anesthesia; May 2018; vol. 46 ; p. 39-43 Publication Date: May 2018 Publication Type(s): Article Abstract:Study objective: Total knee arthroplasty (TKA) is associated with significant pain post-operatively. Our hypothesis is that adductor canal block (ACB) would be superior to local infiltration analgesia (LIA) in terms of providing analgesia, while still preserving quadriceps strength and enabling early postoperative rehabilitation. Design: A prospective, blinded and randomized clinical trial between LIA and ACB was conducted. Setting: Tertiary care urban hospital. Patients: 40 patients (ASA I to III) undergoing primary TKA under single- dose spinal anesthesia were prospectively randomized from January 2014 to October 2015. Interventions: The LIA group received local infiltration of Ropivacaine 150 mg, Ketorolac 30 mg, Morphine 10 mg, and Adrenaline 200 mcg in a total volume of 75 mls, administered intraoperatively by the surgeon. The ACB group was given an ACB postoperatively by one of the study investigators at the end of surgery with 30 mls of 0.5% Ropivacaine. Measurements: The primary outcome was total Morphine consumption in the first 24 h. Secondary outcomes included total Morphine consumption in the first 48 h, pain scores, quadriceps strength, the Timed Up and Go test (TUG), the 30 s Chair Stand Test (30s-CST) and length of hospital stay. Main results: The median (interquartile range) 24 h Morphine consumption was 6 mg (2.3-18.3) in the ACB group and 17.5 mg (12-24.3) in the LIA group, p = 0.004. The 48 h Morphine consumption was 14.5 mg (7.5-28.5) in the ACB group as compared to 24 mg (14-33.8) in the LIA group, p = 0.03. There were no statistically significant differences in the other secondary outcomes. Conclusion: ACB group had statistically significant reduced total Morphine consumption in the first 24 and 48 hours as compared to LIA group, with no statistically significant differences in functional outcomes of TKA patients. Copyright © 2018 Elsevier Inc. Database: EMBASE

138. A mini-fluid challenge of 150 mL predicts fluid responsiveness using Modelflow^R pulse contour cardiac output directly after cardiac surgery Author(s): Smorenberg A.; Geerts B.F.; Cherpanath T.G.V.; de Wilde R.B.P.; Jansen J.R.C.; Maas J.J.; Groeneveld A.B.J. Source: Journal of Clinical Anesthesia; May 2018; vol. 46 ; p. 17-22 Publication Date: May 2018 Publication Type(s): Article Abstract:Study objective: The mini-fluid challenge may predict fluid responsiveness with minimum risk of fluid overloading. However, the amount of fluid as well as the best manner to evaluate the effect is unclear. In this prospective observational pilot study, the value of changes in pulse contour cardiac output (CO) measurements during mini-fluid challenges is investigated. Design: Prospective observational study. Setting: Intensive Care Unit of a university hospital. Patients: Twenty-one patients directly after elective cardiac surgery on mechanical ventilation. Interventions: The patients were subsequently given 10 intravenous boluses of 50 mL of hydroxyethyl starch with a total of 500 mL per patient while measuring pulse contour CO. Measurements: We measured CO by minimal invasive ModelflowR (COm) and PulseCOR (COli), before and one minute after each fluid bolus. We analyzed the smallest volume that was predictive of fluid responsiveness. A positive fluid response was defined as an increase in CO of > 10% after 500 mL fluid infusion. Main results: Fifteen patients (71%) were COm responders and 13 patients (62%) COli responders. An increase in COm after 150 mL of fluid > 5.0% yielded a positive and negative predictive value (+ PV and - PV) of 100% with an area under the curve (AUC) of 1.00 (P < 0.001). An increase in COli > 6.3% after 200 mL was able to predict a fluid response in COli after 500 mL with a + PV of 100% and - PV of 73%, with an AUC of 0.88 (P < 0.001). Conclusion: The use of minimal invasive ModelflowR pulse contour CO measurements following a mini-fluid challenge of 150 mL can predict fluid responsiveness and may help to improve fluid management. Copyright © 2018 Elsevier Inc. Database: EMBASE

139. Ccr2 upregulation in drg neurons plays a crucial role in gastric hyperalgesia associated with diabetic gastropathy Author(s): Aye-Mon A.; Hori K.; Kozakai Y.; Nakagawa T.; Nakamura T.; Shiraishi Y.; Okuda H.; Ozaki N.; Hiraga S. Source: Molecular Pain; Jan 2018; vol. 14 Publication Date: Jan 2018 Publication Type(s): Article Available at Molecular pain - from Europe PubMed Central - Open Access Available at Molecular pain - from EBSCO (MEDLINE Complete) Available at Molecular pain - from PubMed Central Abstract:Background: Diabetic gastropathy is a complex neuromuscular dysfunction of the stomach that commonly occurs in diabetes mellitus. Diabetic patients often present with upper gastrointestinal symptoms, such as epigastric discomfort or pain. The aim of this study was to assess gastric sensation in streptozocin-induced diabetes mellitus (DM) rats and to determine the contribution of C-C motif chemokine receptor 2 (CCR2) signaling to gastric hyperalgesia. Results: DM rats showed signs of neuropathy (cutaneous mechanical hyperalgesia) from two weeks after streptozocin administration until the end of the experiment. Accelerated solid gastric emptying was observed at two weeks after streptozocin administration compared to the controls. Intense gastric hyperalgesia also developed in DM rats at two weeks after streptozocin administration, which was significantly reduced after intrathecal administration of the CCR2 antagonist INCB3344. Immunochemical analysis indicated that CCR2 expression was substantially upregulated in small and medium-sized dorsal root ganglia neurons of DM rats, although the protein level of monocyte chemoattractant protein-1, the preferred ligand for CCR2, was not significantly different between the control and DM groups. Conclusions: These data suggest that CCR2 activation in nociceptive dorsal root ganglia neurons plays a role in the pathogenesis of gastric hyperalgesia associated with diabetic gastropathy and that CCR2 antagonist may be a promising treatment for therapeutic intervention. Copyright © The Author(s) 2018. Database: EMBASE

140. Translation and validation of simplified Chinese version of the pain catastrophizing scale in chronic pain patients: Education may matter Author(s): Shen B.; Zhan G.; Wu B.; Lian Q.; Apkarian A.V.; Huang L.; Abdullah T.B. Source: Molecular Pain; Jan 2018; vol. 14 Publication Date: Jan 2018 Publication Type(s): Article Available at Molecular Pain - from Europe PubMed Central - Open Access Available at Molecular Pain - from EBSCO (MEDLINE Complete) Abstract:Objective: Pain catastrophizing is linked to many aspects of pain perception and defines a unique dimension in predicting pain intensity and physical disability. Pain Catastrophizing Scale (PCS) is an effective, validated,self-report measure, commonly used in clinical trials. Here, we present a Simplified Chinese PCS (SC-PCS) version developed in Chinese patients suffering from chronic pain. Methods: The SC-PCS was generated in five steps and tested on an initial patient cohort (N 1/4 30). A convenience sample (N 1/4 200) of in-hospital patients with non-malignant pain lasting for more than 12 weeks were recruited for the study, of which 81 completed 5 additional pain questionnaires. A subset (N 1/4 24) of the patients completed an additional SC-PCS, 10 days after the initial query to assess test- retest validation. Results: Intra-class correlations coefficient indicated high reproducibility and temporal consistency, (0.97), for the total score. Cronbach's alpha determined high internal consistency across the SC-PCS total score and its three subscales (0.87, 0.85, 0.62, and 0.65). The SC-PCS total score moderately or weakly (R 1/4 0.2 to 0.49), but significantly, correlated with other measurements, such as pain Visual Analog Scale, Beck Depression Inventory, Pain Anxiety Symptoms Scales, Positive and Negative Affect Schedule, and education. We used exploratory factor analysis to examine the dimensionality of the SC-PCS, which indicated instability of the current three-factor model. However, a confirmatory factor analysis indicated that the three-factor model had the best goodness-fitting. Conclusions: We demonstrate the successful translational adaptation from English to Simplified Chinese as well as the reliability and validity of SC-PCS. An important discovery was education level significantly correlated with SC-PCS, identifying a future consideration for other cross-cultural development of self-reported measures. Copyright © The Author(s) 2018. Database: EMBASE

141. Echocardiographic Guidance and Troubleshooting for Venovenous Extracorporeal Membrane Oxygenation Using the Dual-Lumen Bicaval Cannula Author(s): Griffee M.J.; Tonna J.E.; McKellar S.H.; Zimmerman J.M. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 370- 378 Publication Date: Feb 2018 Publication Type(s): Review Database: EMBASE

142. The Hemodynamic Effects of Different Pacing Modalities After Cardiopulmonary Bypass in Patients With Reduced Left Ventricular Function Author(s): Gielgens R.C.W.; Herold I.H.F.; Korsten H.H.M.; Bouwman R.A.; van Straten A.H.M.; Soliman Hamad M.A.; van Gelder B.M.; Bracke F.A. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: Patients with decreased left ventricular function undergoing cardiac surgery have a greater chance of difficult weaning from cardiopulmonary bypass and a poorer clinical outcome. Directly after weaning, interventricular dyssynchrony, paradoxical septal motion, and even temporary bundle-branch block might be observed. In this study, the authors measured arterial dP/dtmax, mean arterial pressure (MAP), and cardiac index using transpulmonary thermodilution, pulse contour analysis, and femoral artery catheter and compared the effects between right ventricular (A-RV) and biventricular (A-BiV) pacing on these parameters. Design: Prospective study. Setting: Single-center study. Participants: The study comprised 17 patients with a normal or prolonged QRS duration and a left ventricular ejection fraction <=35% who underwent coronary artery bypass grafting with or without valve replacement. Interventions: Temporary pacing wires were placed on the right atrium and both ventricles. Different pacing modalities were used in a standardized order. Measurements and Main Results: A-BiV pacing compared with A-RV pacing demonstrated higher arterial dP/dtmax values (846 +/- 646 mmHg/s v 800 +/- 587 mmHg/s, p = 0.023) and higher MAP values (77 +/- 19 mmHg v 71 +/- 18 mmHg, p = 0.036). Conclusion: In patients with preoperative decreased left ventricular function undergoing coronary artery bypass grafting, A-BiV pacing improve the arterial dP/dtmax and MAP in patients with both normal and prolonged QRS duration compared with standard A-RV pacing. In addition, arterial dP/dtmax and MAP can be used to evaluate the effect of intraoperative pacing. In contrast to previous studies using more invasive techniques, transpulmonary thermodilution is easy to apply in the perioperative clinical setting. Copyright © 2018 The Authors Database: EMBASE

143. Elective Intraoperative Use of an Avalon Elite Catheter During Lung Transplantation Author(s): Goyal S.; Banayan J.; Chaney M.A.; Nunnally M.; Patel K.D. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

144. Ultrasound-Guided Interscalene Brachial Plexus Nerve Block With an Ultralow Volume of Local Anesthetic for Post-Thoracotomy Shoulder Girdle Pain Author(s): Saranteas T.; Alevizou A.; Sidiropoulou T.; Florou P.; Kostopanagiotou G.; Mavrogenis A.; Tomos P.; Papadimos T. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: To evaluate the efficacy of ultrasound-guided interscalene nerve block using an ultralow volume of local anesthetic (5 mL of ropivacaine, 0.75%) for the management of post-thoracotomy shoulder girdle pain. Design: Open-cohort, prospective, single-center study. Setting: University hospital. Interventions: Patients with post- thoracotomy shoulder girdle pain (visual analog scale [VAS] >=5) received an ultrasound- guided interscalene nerve block. Measurements and Main Results: Thirty minutes after block implementation, the VAS was used to quantify pain across the shoulder girdle. The index (I) was calculated to indicate improvement of pain as follows: I=VASbeforeinterscalenenerveblock- VASafterinterscalenenerveblock/VASbeforeinterscalenenerveblockx100 Nerve bocks resulting in I >=75% were considered excellent. Total tramadol consumption 36 hours after nerve blocks, patients' satisfaction, and complications related to the procedure also were assessed. Patients were segregated in the following 2 groups: group A, which comprised patients with pain in the shoulder area (glenohumeral and acromioclavicular joints) (n = 30), and group B, which comprised patients with pain in the scapula (n = 17). I was significantly greater in group A (88.3% +/- 14%) than in group B (43.2% +/- 22%). In groups A and B, 90% and 11% of patients, respectively, demonstrated excellent pain control. Total tramadol consumption in group A, 25 (0-100) mg, was significantly less that of group B, 250 (150-500) mg. Patients' satisfaction also was significantly higher in group A compared with group B. No complications were recorded. Conclusions: Ultrasound-guided interscalene nerve block can substantially alleviate post-thoracotomy pain in the shoulder but not in the scapular area. Copyright © 2018 Elsevier Inc. Database: EMBASE

145. Validation of a Mathematical Model of Bidirectional Glenn Circulation With Aortopulmonary Collaterals and the Implications for Q_P/Q_S Calculation Author(s): Fang Z.A.; Ghelani S.J.; Koutsogiannaki S.; DiNardo J.A.; Yuki K. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: A mathematical model of the oxygen delivery kinetics of the bidirectional Glenn (BDG) shunt circulation incorporating aortopulmonary collateral (APC) flow was created. The model was used to characterize oxygen delivery and compare modeled data to actual patient data obtained using cardiac magnetic resonance imaging (MRI) and catheterization. In addition, cardiac MRI and catheterization assessment of pulmonary blood flow in the presence of APC flow were compared. Design: Mathematical model and retrospective data analysis of patients who underwent cardiac MRI and catheterization. The mathematical model is based on the concept that APC flow to the lungs is recirculated pulmonary venous blood flow, which does not contribute to systemic oxygen delivery. Setting: Single-center, university teaching hospital. Participants: The study included 98 patients with BDG shunt undergoing cardiac MRI and cardiac catheterization. Measurements and Main Results: In the absence of APC flow, the pulmonary blood flow to systemic blood flow ratio (Qp/Qs) calculated using cardiac catheterization data closely matched that obtained with cardiac MRI. In the presence of APC flow, Qp/Qs calculated using cardiac catheterization data systematically underestimated values obtained with cardiac MRI. A mathematical model of BDG shunt oxygen delivery incorporating variable APC flow was created. The model provided reasonable prediction of actual patient data for arterial blood oxygen, superior vena cava oxygen saturation, and oxygen delivery obtained at the time of cardiac catheterization in patients. Conclusion: The oxygen delivery kinetics of a BDG shunt incorporating variable APC flow can be modeled mathematically. Model output can be used to predict blood oxygen saturation after coil embolization of APC flow in the cardiac catheterization laboratory. Copyright © 2018 Elsevier Inc. Database: EMBASE

146. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2017 Author(s): Evans A.S.; Weiner M.; Baron E.L.; Silvay G.; Patel P.A.; Gutsche J.T.; Gordon E.K.; Patel S.; Guelaff E.; Feinman J.W.; Dashell J.; Munroe R.; Lauter D.; Weiss S.J.; Augoustides J.G.; Jayaraman A.; Ramakrishna H.; Renew J.R.; Martin A.K.; Fritz A.V.; Riha H.; Ghadimi K. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

147. Intraoperative Anesthetic Management of Lung Transplantation: Center-Specific Practices and Geographic and Centers Size Differences Author(s): Tomasi R.; Betz D.; Schlager S.; Kammerer T.; Hoechter D.J.; Weig T.; Zwisler B.; von Dossow V.; Slinger P.; Klotz L.V.; Marczin N. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 62- 69 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: Although increasing evidence in lung transplantation (LTx) suggests that intraoperative management could influence outcomes, there are no guidelines available regarding intraoperative management of LTx. The overall goal of the study was to assess geographic and center volume-specific clinical practices in perioperative management. Design: Prospective data analysis. Setting: Online survey from a single-center university hospital. Participants: European and non-European LTx centers. Interventions: An online survey was sent to 176 centers currently performing LTx procedures. It covered organizational data, general anesthesia considerations, fluid therapy and coagulation, antioxidant and anti-inflammatory therapies, and ventilation strategies. Measurements and Main Results: The response rates were 57.5% (n = 42) from European and 32% (n = 33) from non-European countries. Significant differences between European and non-European countries were use of volatile hypnotics (p = 0.016), use of sufentanil (p < 0.001), inotropic agents (p = 0.001) and colloid infusion (p < 0.001), use of calibrated pulse contour analysis (p = 0.004), use of intraoperative traditional laboratory-based coagulation tests (p = 0.001) and platelet function analysis (p = 0.005), and use of higher peak inspiratory pressure (p = 0.009). Center volume-specific differences were use of fentanyl (p = 0.03) and the use of higher peak inspiratory pressure (p = 0.005) for ventilation. Induction of anesthesia and use of advanced hemodynamic monitoring, therapy for pulmonary hypertension, antioxidant and anti-inflammatory therapies, and ventilation strategies were not different among the centers. Conclusions: This survey demonstrated for the first time statistically significant differences among European and non-European centers and among low- versus high- volume centers regarding intraoperative management during LTx. These observations will be of some guidance for the LTx community and may trigger more extensive studies. Copyright © 2018 Elsevier Inc. Database: EMBASE

148. Aortic Valve Cusp Coaptation Surface Area Using 3-Dimensional Transesophageal Echocardiography Correlates with Severity of Aortic Valve Insufficiency Author(s): Sohmer B.; Chamberland M.-E.; Jafar R.; Boodhwani M.; Labrosse M.R.; Patel P. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: The aim of this study was to test both in humans and using finite element (FE) aortic valve (AV) models whether the coaptation surface area (CoapSA) correlates with aortic insufficiency (AI) severity due to dilated aortic roots to determine the validity and utility of 3-dimensional transesophageal echocardiographic-measured CoapSA. Design: Two-pronged, clinical and computational approach. Setting: Single university hospital. Participants: The study comprised 10 patients with known AI and 98 FE simulations of increasingly dilated human aortic roots. Interventions: The CoapSA was calculated using intraoperative 3-dimensional transesophageal echocardiography data of patients with isolated AI and compared with established quantifiers of AI. In addition, the CoapSA and effective regurgitant orifice area (EROA) were determined using FE simulations. Measurements and Main Results: In the 10 AI patients, regurgitant fraction (RF) increased with EROA (R2 = 0.77, p = 0.0008); CoapSA decreased with RF (R2 = 0.72, p = 0.0020); CoapSA decreased with EROA (R2 = 0.71, p = 0.0021); and normalized CoapSA (CoapSA / [Ventriculo-Aortic Junction x Sinotubular Junction]) decreased with EROA (R2 = 0.60, p = 0.0088). In the 98 FE simulations, normalized CoapSA decreased with EROA (R2 = 0.50, p = 0.0001). Conclusions: In both human and FE AV models, CoapSA was observed to be inversely correlated with AI severity, EROA, and RF, thereby supporting the validity and utility of 3D TEE-measured CoapSA. A clinical implication is the expectation that high values of CoapSA, measured intraoperatively after AV repairs, would correlate with better long- term outcomes of those repairs. Copyright © 2018 Elsevier Inc. Database: EMBASE

149. Ischemic Mitral Regurgitation: A Paradigm Shift in Surgical Management? Author(s): Malhotra A.K.; Evans A.S.; Weiner M.M.; Ramakrishna H. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 580- 585 Publication Date: Feb 2018 Publication Type(s): Review Database: EMBASE

150. Two Cases of Postoperative Right Coronary Artery Intervention in Pediatric Patients Following Congenital Heart Surgery Author(s): Vecchione T.; Hall S.R.; Brady K.M.; Easley R.B.; Qureshi A.M.; Parekh D.R.; McKenzie E.D. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

151. Detection of Pulmonary Venous Channel Stenosis in a Newly Created Left Atrium After the Senning Procedure in a Child Undergoing a Double Switch Operation for L- Transposition of the Great Arteries Author(s): Kurokawa S.; Sato K.; Sasaki N.; Moriwaki S.; Nomura M.; Ozaki M. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

152. Ventricular Assist Device Implantation in a Patient With Severe Systemic Right Ventricular Failure and Pulmonary Hypertension Secondary to Congenitally Corrected Transposition of Great Arteries Author(s): Toyama H.; Saito K.; Mori S.; Ui A.; Yamauchi M.; Takei Y.; Kobayashi N.; Tatebe S.; Adachi O.; Ejima Y. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 436- 440 Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

153. Ascending Aortic Aneurysm Causing Right Ventricular Outflow Tract Obstruction and Severe Tricuspid Regurgitation Author(s): Hankins S.J.; Tolpin D.A. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 441- 444 Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

154. Unexpected Intraoperative Transesophageal Echocardiographic Finding Before Aortic Valve Replacement Surgery Author(s): Deriy L.; Gerstein N.S.; Hassan M.F.; Schevchuck A. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 603- 605 Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

155. B-Type Natriuretic Peptide and Hemoglobin are Two Major Factors Significantly Associated With Baseline Cerebral Oxygen Saturation Measured Using the INVOS Oximeter in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery Author(s): Yamamoto M.; Hayashida M.; Kakemizu-Watanabe M.; Ando N.; Kawagoe I.; Yusuke S.; Inada E.; Mukaida H. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 187- 196 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: To investigate an association between the preoperative plasma B-type natriuretic peptide (BNP) concentration and cerebral regional saturation (rSO2) measured using the INVOS oximeter (Medtronic, Minneapolis, MN). Design: A retrospective data analysis. Setting: Single university hospital. Participants: Patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Interventions: None. Measurements and Main Results: Associations of variables obtained from preoperative blood laboratory tests and transthoracic echocardiography with baseline rSO2 before induction of general anesthesia were investigated using bivariate and multivariate regression analyses in 330 OPCAB patients. With bivariate analyses, age; body size-related variables such as weight and body surface area; hematologic function-related variables such as blood hemoglobin (Hb) concentration and arterial oxygen saturation; renal function-related variables including estimated glomerular filtration rate, creatinine, and blood urea nitrogen; hepatic function- related variables including cholinesterase, albumin, total bilirubin, and alanine aminotransferase; serum electrolytes including sodium, chloride, and phosphorus; BNP or log-transformed BNP; and 13 transthoracic echocardiography variables such as left ventricular ejection fraction highly significantly correlated with baseline rSO2 (p < 0.0001). However, the multiple regression analysis revealed that only BNP and Hb remained major factors significantly associated with baseline rSO2 (p < 0.0001), while estimated glomerular filtration rate, arterial oxygen saturation, and body surface area remained minor factors (p < 0.05). Baseline rSO2 correlated better with log-transformed BNP than with BNP, indicating that rSO2 correlated with BNP in an exponential fashion. Conclusions: Preoperative BNP and Hb concentrations were 2 major factors associated with INVOS rSO2 in patients undergoing OPCAB. Copyright © 2018 Database: EMBASE

156. Novel ultrasound-guided inter-semispinal plane block: a comparative pilot study in healthy volunteers Author(s): Ohgoshi Y.; Nishizakura R.; Takahashi Y.; Takeda K.; Nakayama H.; Kawamata M.; Kurahashi K. Source: Journal of Anesthesia; Feb 2018; vol. 32 (no. 1); p. 143-146 Publication Date: Feb 2018 Publication Type(s): Article Abstract:We previously reported that a novel multifidus cervicis plane (MCP) block could anesthetize the dorsal rami of the cervical spinal nerves. While MCP sonoanatomy is easily detectable in most patients, it is sometimes difficult to recognize the MCP injection plane, especially in elderly patients. Thus, we proposed the inter-semispinal plane (ISP) block as an alternative for the MCP block. The aim of this study was to evaluate the utility of the ISP block by evaluating the area and duration of anesthesia, compared with that of the MCP block in eight healthy volunteers. Each participant underwent unilateral ultrasound-guided MCP block and ISP block. For each block, 20 ml of ropivacaine 0.2% was injected, and the area of anesthesia was determined using the pinprick test. The anesthetic area ranged from C4 to T2 (3/8; 37.5%), T3 (2/8; 25%), or T4 (3/8; 37.5%) in the MCP block, and from C4 to T1 (1/8; 12.5%), T2 (3/8; 37.5%), T3 (2/8; 25%), or T4 (1/8; 12.5%) in the ISP block. The mean (standard deviation) duration of sensory loss following MCP and ISP blocks was 329 (77) min and 349 (70) min, respectively. Thus, the ISP block may be a reliable alternative to the MCP block. Copyright © 2017, Japanese Society of Anesthesiologists. Database: EMBASE

157. A Tale of Three Surgeries: Management of a Massive Recurrent Mycotic Aortic Pseudoaneurysm Author(s): Henley M.D.; Kolarczyk L.M.; Teeter E.G.; Barrick B.P.; Martinelli S.M.; Farber M.A.; Ikonomidis J.S.; Caranasos T.G. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 550- 557 Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

158. The Feasibility and Impact of Routine Combined Limited Transthoracic Echocardiography and Lung Ultrasound on Diagnosis and Management of Patients Admitted to ICU: A Prospective Observational Study Author(s): Haji K.; Tharmaraj D.; Azraee M.; Haji D.; Hopkins L.; Canty D.J.; Royse A.G.; Royse C.F. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. Design: Prospective observational study. Settings: Tertiary ICU. Participants: Ninety-three critically ill participants within 24 hours of admission to ICU. Methods: A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound. Ultrasound was performed by an independent intensivist and checked for accuracy offline by a second reviewer. Results: Ultrasound images were interpretable in 99%, with good interobserver agreement. The hemodynamic diagnosis was altered in 66% of participants, including new (14%) or altered (25%) abnormal states or exclusion of clinically diagnosed abnormal state (27%). Valve pathology of at least moderate severity was diagnosed for mitral regurgitation (7%), aortic stenosis (1%), aortic stenosis and mitral regurgitation (1%), tricuspid regurgitation (3%), and 1 case of mitral regurgitation was excluded. Lung pathology diagnosis was changed in 58% of participants including consolidation (13%), interstitial syndrome (4%), and pleural effusion (23%), and exclusion of clinically diagnosed consolidation (6%), interstitial syndrome (3%), and pleural effusion (9%). Management changed in 65% of participants including increased (12%) or decreased (23%) fluid therapy, initiation (10%), changing (6%) or cessation (9%) of inotropic, vasoactive or diuretic drugs, non-invasive ventilation (3%), and pleural drainage (2%). Conclusion: Routine screening of patients with combined limited TTE and lung ultrasound on admission to ICU is feasible and frequently alters diagnosis and management. Copyright © 2018 Elsevier Inc. Database: EMBASE

159. Morphologic Evaluation of the Mitral Annulus During Displacement of the Heart in Off-Pump Coronary Artery Bypass Surgery Author(s): Toyama Y.; Kanda H.; Iwasaki H.; Kanao-Kanda M.; Iida T.; Kunisawa T.; Igarashi K. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 334- 340 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: To evaluate the morphologic changes of the mitral annulus using 3- dimensional transesophageal echocardiography during heart displacement to expose the anastomosis site in off-pump coronary artery bypass surgery (OPCAB). Design: Prospective case series. Setting: Single center, university hospital. Participants: The study comprised 34 consecutive patients who underwent OPCAB of the left circumflex artery (LCX) and the right coronary artery (RCA). Interventions: None. Measurements and Main Results: Mitral annulus parameters were measured using the Mitral Valve Quantification program after sternotomy (physiologic position) and during displacement of the heart to expose the LCX (LCX position) and the RCA (RCA position). The height of the mitral annulus was significantly lower in the LCX (5.76 +/- 0.90 mm) and RCA (5.92 +/- 0.97 mm) positions than in the physiologic position (6.96 +/- 0.99 mm; both p < 0.0001). The percent change in the height of the mitral annulus was significantly greater in the mitral regurgitation group than in the mitral regurgitation nondeterioration group when in the LCX (-16.3% +/- 6.0% v -11.9% +/- 3.3%, p = 0.0203) and RCA (-16.9% +/- 6.3% v -12.1% +/- 3.8%, p = 0.0207) positions. The anteroposterior and intercommissural diameters, annulus perimeter, and surface area of the mitral annulus did not differ significantly among all heart positions. Conclusions: The mitral annulus flattened and lost its saddle shape without expanding while in the LCX and RCA positions. The greater percent change in the height of the mitral annulus may aggravate mitral regurgitation. Copyright © 2018 Elsevier Inc. Database: EMBASE

160. Deployment of a Sapien 3 Transcatheter Valve for Severe Tricuspid Insufficiency in a Patient With Non-obstructive Cor Triatriatum Dexter Author(s): Bennett J.M.; Hernandez A.; Nikolla I. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

161. The Role of Hemoglobin A1c as a Biomarker and Risk Assessment Tool in Patients Undergoing Non-cardiac and Cardiac Surgical Procedures Author(s): Haines D.; Miranda H.G.; Flynn B.C. Publication Date: Feb 2018 Publication Type(s): Review Database: EMBASE

162. Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without Dexmedetomidine in Video-Assisted Thoracoscopic Surgery Author(s): Xu J.; Yang X.; Hu X.; Zhang J.; Wang Y.; Chen X. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: Thoracic paravertebral block (TPVB) is reported to have advantages in postoperative pain management in unilateral thoracic surgeries. Previous studies have demonstrated that dexmedetomidine could be used as an adjuvant to local anesthetics, with the aim of prolonging the duration of neural blockade. However, little is known about whether such a combination could improve the quality of postoperative analgesia compared with local anesthetic only when TPVB is used for patients undergoing video-assisted thoracoscopic surgery (VATS). Design: A prospective, randomized, controlled study. Setting: Single-center university hospital. Participants: The study included 60 patients undergoing VATS under general anesthesia. Interventions: The patients were allocated randomly into the following 2 groups: 0.375% ropivacaine, 20 mL only (group R, n = 30), and 0.375% ropivacaine, 20 mL plus 1 mug/kg of dexmedetomidine (group RD, n = 30). At the end of surgery, TPVB guided using ultrasound was performed at 4 points-T4-5, T5-6, T6-7, and T7-8- of the surgical side; 5 mL of solution were injected at each point. Postoperatively, the intravenous nonsteroidal anti-inflammatory drug flurbiprofen was used as part of multimodal analgesia. Measurements and Main Results: Pain scores at rest and during coughing were evaluated by a blinded observer in the postanesthesia care unit postoperatively at 1, 2, 4, 8, 12, 24, 36, and 48 hours, and the dermatomal levels of sensory blockade, postoperative requirements for rescue analgesia, adverse events, and patient satisfaction also were recorded. There was a significant reduction in postoperative pain scores at rest starting from the postoperative 8th hour until the 48th hour and during coughing starting at the postoperative 4th hour until the 48th hour in the group RD compared with those in group R (p = 0.043). The dermatomal levels of sensory blockade were comparable in the 2 groups. Patient satisfaction after surgery was significantly higher in the group RD than in group R (p < 0.001). Total consumption of the intravenous rescue analgesic morphine and adverse events were not significantly different between the 2 groups. Conclusions: Compared with ropivacaine only, the addition of dexmedetomidine, 1 mug/kg, to local anesthetic for multilevel TPVB in patients undergoing VATS prolonged the duration of postoperative analgesia and improved patient satisfaction without serious side effects when combined with postoperative intravenous nonsteroidal anti-inflammatory drug administration. Copyright © 2018 Elsevier Inc. Database: EMBASE

163. Copeptin Release in Cardiac Surgery-A New Biomarker to Identify Risk Patients? Author(s): Holm J.; Szabo Z.; Cederholm I.; Alehagen U.; Lindahl T.L. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: To describe the dynamics of copeptin in open cardiac surgery during the perioperative course. Design: Prospective cohort study. Setting: Single tertiary hospital. Participants: Twenty patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB). Interventions: No intervention. Measurements and Main Results: Copeptin concentrations were measured pre-, peri-, and postoperatively until day 6 after surgery. Patients were analyzed as a whole cohort (n = 20) and in a restricted "normal cohort" consisting of patients with normal preoperative copeptin concentration (<10 pmol/L) and perioperative uneventful course (n = 11). In the whole cohort, preoperative copeptin concentration was 7.0 pmol/L (interquartile range: 3.1-11 pmol/L). All patients had an early rise of copeptin, with 80% having peak copeptin concentration at weaning from CPB or upon arrival in the intensive care unit. Patients in the "normal cohort" had copeptin concentration at weaning from CPB of 194 pmol/L (98-275), postoperative day 1, 27 pmol/L (18-31); and day 3, 8.9 pmol/L (6.3-12). Conclusions: Regardless of cardiac surgical procedure and perioperative course, all patients had an early significant rise of copeptin concentrations, generally peaking at weaning from CBP or upon arrival in the intensive care unit. Among patients with normal copeptin concentration preoperatively and uneventful course, the postoperative copeptin concentrations decreased to normal values within 3-to-4 days after cardiac surgery. Furthermore, the restricted "normal cohort" generally tended to display lower levels of copeptin concentration postoperatively. Further studies may evaluate whether copeptin can be a tool in identifying risk patients in cardiac surgery. Copyright © 2018 Elsevier Inc. Database: EMBASE

164. Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design of a Randomized Controlled Trial Author(s): Shehata N.; Whitlock R.; Fergusson D.A.; Thorpe K.E.; Hall J.; MacAdams C.; Grocott H.P.; Rubens F.; Fremes S.; Lellouche F.; Bagshaw S.; Royse A.; Royse C.F.; Rosseel P.M.; Hare G.; Mazer C.D.; Medicis E.D.; Hudson C.; Belley-Cote E.; Bainbridge D.; Kent B.; Shaw A.; Byrne K.; Syed S.; McGuiness S. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 121- 129 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: To determine if a restrictive transfusion threshold is noninferior to a higher threshold as measured by a composite outcome of mortality and serious morbidity. Design: Transfusion Requirements in Cardiac Surgery (TRICS) III was a multicenter, international, open-label randomized controlled trial of two commonly used transfusion strategies in patients having cardiac surgery using a noninferiority trial design (ClinicalTrials.gov number, NCT02042898). Setting: Eligible patients were randomized prior to surgery in a 1:1 ratio. Participants: Potential participants were 18 years or older undergoing planned cardiac surgery using cardiopulmonary bypass (CPB) with a preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more. Interventions: Five thousand patients; those allocated to a restrictive transfusion group received a red blood cell (RBC) transfusion if the hemoglobin concentration (Hb) was less than 7.5 g/dL intraoperatively and/or postoperatively. Patients allocated to a liberal transfusion strategy received RBC transfusion if the Hb was less than 9.5 g/dL intraoperatively or postoperatively in the intensive care unit or less than 8.5 g/dL on the ward. Measurements and Main Results: The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or new onset renal dysfunction requiring dialysis at hospital discharge or day 28, whichever comes first. The primary outcome was analyzed as a per-protocol analysis. The trial monitored adherence closely as adherence to the transfusion triggers is important in ensuring that measured outcomes reflect the transfusion strategy. Conclusion: By randomizing prior to surgery, the TRICS III trial captured the most acute reduction in hemoglobin during cardiopulmonary bypass. Copyright © 2018 Database: EMBASE

165. Outcomes Following Three-Factor Inactive Prothrombin Complex Concentrate Versus Recombinant Activated Factor VII Administration During Cardiac Surgery Author(s): Harper P.C.; Smith M.M.; Nuttall G.A.; Oliver W.C.; Barbara D.W.; Brinkman N.J.; Passe M.A.; Schroeder D.R.; Said S.M. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: To compare outcomes following inactive prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa) administration during cardiac surgery. Design: Retrospective propensity-matched analysis. Setting: Academic tertiary-care center. Participants: Patients undergoing cardiac surgery requiring cardiopulmonary bypass who received either rFVIIa or the inactive 3-factor PCC. Interventions: Outcomes following intraoperative administration of rFVIIa (263) or factor IX complex (72) as rescue therapy to treat bleeding. Measurements and Main Results: In the 24 hours after surgery, propensity- matched patients receiving PCC versus rFVIIa had significantly less chest tube outputs (median difference -464 mL, 95% confidence interval [CI] -819 mL to -110 mL), fresh frozen plasma transfusion rates (17% v 38%, p = 0.028), and platelet transfusion rates (26% v 49%, p = 0.027). There were no significant differences between propensity-matched groups in postoperative stroke, deep venous thrombosis, pulmonary embolism, myocardial infarction, or intracardiac thrombus. Postoperative dialysis was significantly less likely in patients administered PCC versus rFVIIa following propensity matching (odds ratio = 0.3, 95% CI 0.1- 0.7). No significant difference in 30-day mortality in patients receiving PCC versus rFVIIa was present following propensity matching. Conclusions: Use of rFVIIa versus inactive PCCs was significantly associated with renal failure requiring dialysis and increased postoperative bleeding and transfusions. Copyright © 2018 Elsevier Inc. Database: EMBASE

166. A Story of Migration of a Surgically Implanted Aortic Sutureless Valve Author(s): Amir A.; Moore A.; Carvalho G.; Codere-Marayuma T.; Schricker T.; Villeneuve V.; Hatzakorzian R. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

167. Effectiveness and Safety of Aprotinin Use in Thoracic Aortic Surgery Author(s): Chivasso P.; Bruno V.D.; Marsico R.; Annaiah A.S.; Curtis A.; Zebele C.; Angelini G.D.; Bryan A.J.; Rajakaruna C. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: To determine the effectiveness and safety of aprotinin use in adult patients undergoing thoracic aortic surgery. Design: Single-center, retrospective study. Setting: All cases performed at a single university hospital. Participants: Between January 2004 and December 2014, 846 adult patients underwent thoracic aortic surgery. Due to missing or duplicated data on primary outcomes, 314 patients were excluded. The final sample of 532 patients underwent surgery on the thoracic aorta. Interventions: The patients were divided in the following 2 groups: 107 patients (20.1%) received aprotinin during the surgery, which represented the study group, whereas the remaining 425 patients (79.9%) underwent surgery without the use of aprotinin. Measurements and Main Results: To adjust for patient selection and preoperative characteristics, a propensity score-matched analysis was conducted. Mean total blood loss at 12 hours after surgery was similar between the 2 groups. The blood product transfusion rates did not differ in the 2 groups, except for the rate of fresh frozen plasma transfusion being significantly higher in the aprotinin group. Re- exploration for bleeding and the incidence of a major postoperative bleeding event were similar between the groups. Rates of in-hospital mortality, renal failure, and cerebrovascular accidents did not show any statistically significant difference. Aprotinin did not represent a risk factor for mortality over the long term (hazard ratio 1.14, 95% confidence interval 0.62- 2.08, p = 0.66). Conclusions: The use of aprotinin demonstrated a limited effect in reducing postoperative bleeding and prevention of major bleeding events. Aprotinin did not adversely affect early outcomes and long-term survival. Copyright © 2018 Elsevier Inc. Database: EMBASE

168. Right Ventricular Rupture After Extubation of a Patient With an Open Chest Author(s): Doody R.; O'Brien E.O.; Cronin B. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

169. Peripheral Nerve Injury in Cardiac Surgery Author(s): Jellish W.S.; Oftadeh M. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 495- 511 Publication Date: Feb 2018 Publication Type(s): Review Database: EMBASE

170. Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity Author(s): Hernandez-Palazon J.; Fuentes-Garcia D.; Falcon-Arana L.; Burguillos-Lopez S.; Domenech-Asensi P.; Roca-Calvo M.J.; Jara-Rubio R. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: The aim of this study was to measure the level of preoperative anxiety in patients scheduled for cardiac surgery, identify any influencing clinical factors, and assess the relationship between anxiety and postoperative morbidity. Design: A prospective and consecutive study. Setting: A single university hospital. Participants: The study comprised 200 patients scheduled for cardiac surgery. Interventions: Each patient was asked to grade his or her preoperative anxiety level using the Visual Analogue Scale for Anxiety, Amsterdam Preoperative Anxiety and Information Scale, and set of specific anxiety-related questions. Demographic data (age, sex, body mass index) and anesthetic and surgical data (American Society of Anesthesiologists physical status, EuroSCORE surgical risk, preoperative length of stay, and previous anesthetic experience) were registered. Also, postoperative morbidity was assessed. Measurements and Main Results: Twenty-eight percent of the patients developed high preoperative anxiety. The mean Amsterdam Preoperative Anxiety and Information Scale score was 11.4 +/- 4.3, and the mean Visual Analogue Scale for Anxiety score was 48 +/- 21. Patients scheduled for coronary artery bypass surgery, who had no previous anesthetic experience, and who were hospitalized before surgery, had higher anxiety scores. Coronary bypass surgery (odds ratio 3.026; 1.509-6.067; p = 0.002) was associated independently with preoperative high-level anxiety. Anxiety most commonly was caused by waiting for surgery, not knowing what is happening, fearing not being able to awaken from anesthesia, and being at the mercy of staff. Anxiety did not modify the postoperative course. Conclusions: In patients waiting to undergo cardiac surgery, both fear of the unknown and lack of information, especially related to the surgery, are crucial factors in high levels of preoperative anxiety in cardiac surgery. Coronary bypass surgery is a determining factor for preoperative anxiety. The anxiety level did not modify the postoperative course in these patients. Copyright © 2018 Elsevier Inc. Database: EMBASE

171. A Comparison of Inflammatory Responses Between Robotically Enhanced Coronary Artery Bypass Grafting and Conventional Coronary Artery Bypass Grafting: Implications for Hybrid Revascularization Author(s): Leyvi G.; Vivek K.; Sehgal S.; Warrick A.; Moncada K.A.; Shilian N.; Leff J.D.; Michler R.E.; DeRose J.J. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: The inflammatory response elicited by robotically enhanced coronary artery bypass grafting (r-CABG) has not been well described. When r-CABG is performed as part of hybrid coronary revascularization, the inflammatory milieu and the timing of percutaneous coronary intervention may affect the stent patency negatively in the short and long term. The goal of this study was to describe the extent and time course of cytokine release after r-CABG compared with conventional CABG (c-CABG) and to elucidate the optimal timing for r-CABG in the setting of hybrid coronary revascularization for a future study. Design: Prospective, observational study. Setting: Tertiary-care center in a university hospital. Participants: The study comprised patients scheduled to undergo r-CABG or c- CABG from October 2012 to November 2014. Interventions: Cytokine levels of interleukin (IL)-6, IL-8, IL-10; tumor necrosis factor-alpha; and C-reactive protein (CRP) were measured at the following time points: preprocedure; at the end of the procedure; and at 4, 8, 12, 24, and 48 hours after the procedure. Measurements and Main Results: Twenty-eight patients undergoing r-CABG and 10 patients undergoing c-CABG were enrolled. The levels of cytokines after r-CABG and c-CABG were compared using the mixed-effect linear regression model for longitudinal data. Cytokine release in the r-CABG group was comparatively less for IL-6, IL-10, tumor necrosis factor, and CRP levels. They all trended toward the baseline by the 48th hour in both groups, except CRP levels, which reached their peak at 48 hours in both groups. Conclusions: The inflammatory response to r-CABG was blunted compared with that of c-CABG. The high CRP levels on the second postoperative day after r-CABG were a cause for concern in regard to percutaneous coronary intervention performed at that time period, but additional studies are necessary. Copyright © 2018 Elsevier Inc. Database: EMBASE

172. Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care Author(s): Kolarczyk L.M.; Arora H.; Zvara D.A.; Isaak R.S.; Manning M.W. Publication Date: Feb 2018 Publication Type(s): Review Abstract:Health care reimbursement models are transitioning from volume-based to value- based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. Database: EMBASE

173. Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary Artery Bypass Grafting Author(s): Wilczynski M.; Wybraniec M.T.; Mizia-Stec K.; Sanak M.; Goral J. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: The purpose of the study was to evaluate the impact of intravenous metamizole on platelet inhibition by aspirin in patients with coronary artery disease early after on-pump coronary artery bypass grafting (CABG). Design: Prospective, single-blind, randomized trial. Setting: Tertiary referal hospital. Participants: The study comprised 43 patients with multivessel coronary artery disease undergoing CABG. Interventions: Patients were randomized to postoperative intravenous metamizole +/- opioids (study group; n = 23) or opioids alone (control group; n = 20). Aspirin was withheld at least 7 days before the surgery and reinitiated (300 mg) immediately after the procedure prior to metamizole use, and continued daily thereafter (150 mg). Platelet function was evaluated using multielectrode impedance aggregometry (acid-induced platelet activation [ASPI] and collagen-induced platelet activation [COL] test), P-selectin expression and urinary 11- dehydro-thromboxane B2 (11-DTXB2) level at baseline, postoperative day (POD) 0, POD 1, POD 2, and POD 6. Residual platelet reactivity (RPR) was defined as ASPI test >400 AU*min. Measurements and Main Results: In all study participants, postoperative ASPI test value moderately decreased (1058.2 v 966.6 AU*min, p = 0.047), urinary 11-DTXB2 level increased (923.4 v 4367.3 pg/mg, p < 0.001), and P-selectin expression and COL test value remained stable postprocedure. The decreases of ASPI (p = 0.146) and COL test (p = 0.642), and P- selectin expression (p = 0.318) did not differ between both groups. Patients in the control group had higher postoperative increase of urinary 11-DTXB2 level (p = 0.001). The prevalence of RPR was high and comparable between study and control groups (day 1, 95.6% v 100%, p = 0.535; day 6, 100% v 90%, p = 0.21). Multivariate analysis revealed that metamizole use did not predict the fluctuations of ASPI and COL test values and P-selectin expression, yet it independently predicted postoperative change of 11-DTXB2 level (b = - 0.518, p = 0.001). Conclusions: Intravenous metamizole preceded by a loading dose of aspirin did not modify platelet response to aspirin in the postoperative period after CABG. Copyright © 2018 Elsevier Inc. Database: EMBASE

174. Giant Thebesian Valve Appearing As a Right Atrial Mass Author(s): Rajagopalan S.; Khan F.; Lee S.; Palvadi R.R. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 445- 447 Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

175. Intrapericardial Cisplatin Instillation in Recurrent Postinfarction Cardiac Tamponade Author(s): Papanikolaou J.; Platogiannis N.; Platogiannis D. Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

176. Noteworthy Literature published in 2017 for Perioperative Echocardiography Author(s): Goeddel L.A.; Kostibas M.; Metkus T.; Brady M.B. Source: Seminars in Cardiothoracic and Vascular Anesthesia; Mar 2018; vol. 22 (no. 1); p. 31-34 Publication Date: Mar 2018 Publication Type(s): Article Abstract:In this inaugural review, we present noteworthy advances in perioperative echocardiography relevant to the cardiac anesthesiologist. These studies come from different clinical realms including advances in mitral valve imaging, perioperative echocardiographic evaluation, and critical care echocardiography. The importance of perioperative echocardiography continues to grow with cardiac anesthesiologists positioned in a critical role throughout the perioperative care continuum. Copyright © 2018, © The Author(s) 2018. Database: EMBASE

177. Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists Author(s): Del Rio J.M.; Maerz D.; Subramaniam K. Source: Seminars in Cardiothoracic and Vascular Anesthesia; Mar 2018; vol. 22 (no. 1); p. 49-66 Publication Date: Mar 2018 Publication Type(s): Article Abstract:Thoracic organ transplantation constitutes a significant proportion of all transplant procedures. Thoracic solid organ transplantation continues to be a burgeoning field of research. This article presents a review of remarkable literature published in 2017 regarding perioperative issues pertinent to the thoracic transplant anesthesiologists. Copyright © 2018, © The Author(s) 2018. Database: EMBASE

178. Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients Author(s): Wang C.; Zhang H.; Fu Q. Source: Acta Anaesthesiologica Scandinavica; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Acta Anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: The median effective dose (ED50) of sedative dexmedetomidine adjuvant to peripheral nerve block (PNB) has not yet been verified in elderly patients. This study assessed the ED50 of intravenous dexmedetomidine for sedation in elderly patients who were undergoing total knee arthroplasty (TKA) with PNB. Methods: Forty-two patients aged 65-85 years were included and stratified into two groups according to age: young-old group (aged 65-74 years) and middle-old group (aged 75-85 years). After the PNB was performed, a pre-calculated dose of dexmedetomidine was administered for 10 min. The Observer's Assessment of Alertness/Sedation scale, bispectral index score, blood pressure and heart rate were recorded. ED50 values of dexmedetomidine for adequate sedation were estimated by the up-and-down method of Dixon and probit regression. Results: The ED50 of single-dose dexmedetomidine adjuvant to PNB was 0.57 mug/kg (95% confidence interval [CI], 0.47-0.65) in the young-old group and 0.38 mug/kg (95% CI, 0.28-0.46) in the middle-old group. The ED50 of dexmedetomidine differed significantly between the two groups (P < 0.001). In addition, no significant adverse hemodynamic or hypoxemic effects were noted. Conclusion: We determined the ED50 for sedation using intravenous dexmedetomidine adjuvant to PNB in elderly patients. The ED50 of dexmedetomidine in the middle-old group decreased by 33% compared with that in the young-old group with a mean age difference of 11 years between the two groups. Copyright © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Database: EMBASE

179. Performance of a second generation pulmonary capnotracking system for continuous monitoring of cardiac output Author(s): Peyton P.J.; Kozub M. Source: Journal of Clinical Monitoring and Computing; Feb 2018 ; p. 1-8 Publication Date: Feb 2018 Publication Type(s): Article In Press Abstract:Technologies for minimally-invasive cardiac output measurement in patients during surgery remain little used in routine practice. We tested a redeveloped system based on CO2 elimination (VCO2) by the lungs for use in ventilated patients, which can be seamlessly integrated into a modern anesthesia/monitoring platform, and provides automated, continuous breath-by-breath cardiac output monitoring. A prototype measurement system was constructed to measure VCO2 and end-tidal CO2 concentration with each breath. A baseline measurement of non-shunt cardiac output was made during a brief oscillating change in ventilator rate, according to the differential CO2 Fick approach and repeated at 5-10 min intervals. Continuous breath-by-breath monitoring of cardiac output was performed between these intervals from measurement of VCO2, using a derivation of the Fick equation applied to pulmonary CO2 elimination and cardiac output displayed in real time. Measurements were compared with simultaneous measurements by thermodilution in 50 patients undergoing cardiac surgery or liver transplantation. Overall mean bias [sd] for agreement in cardiac output measurement was - 0.3 [1.1] L/min, percentage error +/- 38.7%, intraclass correlation coefficient = 0.91. Concordance in measurement of changes of at least 15% in cardiac output was 81.4%, with a mean angular bias of - 1.7degree, and radial limits of agreement of +/- 76.2degree on polar plot analysis. The accuracy and precision compared favourably to other clinical techniques. The method is relatively seamless and automated and has potential for continuous, cardiac output monitoring in ventilated patients during anesthesia and critical care. Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature Database: EMBASE

180. Comparison of TIVA with different combinations of ketamine-propofol mixtures in pediatric patients Author(s): Biricik E.; Karacaer F.; Gulec E.; Ilginel M.; Ozcengiz D.; Surmelioglu O. Source: Journal of Anesthesia; Feb 2018; vol. 32 (no. 1); p. 104-111 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Purpose: Adding ketamine to propofol has been suggested to be useful for sedation and general anesthesia. This study aimed to determine the effect of TIVA with different ratios of ketofol on recovery in children. Methods: Seventy-five children aged 3-12 years and undergoing adenoidectomy and/or tonsillectomy surgery were randomized into three groups. Ratios of 1:5, 1:6.7 and 1:10 ketamine-propofol mixture (ketofol) were prepared in the same syringe for groups I, II and III, respectively. Induction and maintenance of anesthesia were performed with 1:5, 1:6.7 and 1:10 ratios of ketofol in groups I, II and III, respectively. A McFarlan infusion dose regimen was used (15 mg/kg/h for 15 min, 13 mg/kg/h for 15 min, 11 mg/kg/h for 30 min) and infusion rates were decreased for the different ratios. Infusion rates were reduced to 67, 80 and 90% of the McFarlan dose regimen for groups I, II and III, respectively. Extubating time, length of stay in PACU, postoperative PAED and FLACC scores were recorded. Results: Extubating time was significantly lower [mean 254.3 +/- 92.7 s (95% CI 216.6-292.6, p = 0.001)] in group III than in groups I and II [371.3 +/- 153 s (308.1-434.48) and 343.2 +/- 123.7 s (292.2-394.3), respectively]. Length of stay in the PACU was lower in group III [median 15 min (interquartile range 15-20, p = 0.001)] than in groups I and II: 20 (15-27.5) and 20 min (20- 27.5), respectively. Conclusion: TIVA with a 1:10 ratio of ketofol admixture with a 90% reduction of McFarlan regimen can provide improved recovery conditions. Trial registration: ClinicalTrials.gov identifier: NCT02848963. Copyright © 2017, Japanese Society of Anesthesiologists. Database: EMBASE

181. Choice of desflurane or propofol for the maintenance of general anesthesia does not affect the risk of periprocedural myocardial damage in patients undergoing transfemoral transcatheter aortic valve implantation Author(s): Okitsu K.; Iritakenishi T.; Imada T.; Kuri M.; Shibata S.C.; Fujino Y. Source: Journal of Anesthesia; Feb 2018; vol. 32 (no. 1); p. 82-89 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Purpose: This study aimed to reveal whether the occurrence of periprocedural myocardial damage (PMD) decreases in patients who received volatile anesthetics to maintain general anesthesia compared with those who received propofol during transcatheter aortic valve implantation (TAVI). Methods: We included one hundred and forty adult patients who underwent transfemoral TAVI under general anesthesia from January 2015 to March 2017 in this single-center retrospective review. We compared the rate of patients who developed PMD between those who received desflurane (Group D, n = 72) and propofol (Group P, n = 68) for anesthetic maintenance. PMD was represented by the peak levels of creatine kinase myocardial band (CK-MB) and troponin I within 72 h following the procedure and defined as an increase >5 times in CK-MB or >15 times in troponin I compared with the institutional upper reference limits. Further analysis was performed to identify the independent predictors of PMD. Results: There was no significant difference in the rate of PMD between groups (Group D 72.2% to Group P 70.6%, P = 0.85) or levels of CK- MB (Group D 7.85 [1.3-72.7] ng/mL to Group P 8.45 [1.8-49.7] ng/mL; P = 0.59) and troponin I (Group D 1.061 [0.050-10.8] ng/mL to Group P 1.214 [0.036-29.0] ng/mL; P = 0.97). The risk of PMD was higher in patients with more intraprocedural blood loss (odds ratio 1.49 per 100 mL, P = 0.048) and lower in those with an implanted permanent pacemaker (odds ratio 0.17; P = 0.02). Conclusions: Desflurane does not appear to be more cardioprotective than propofol when used for anesthetic maintenance in patients undergoing transfemoral TAVI. Copyright © 2017, Japanese Society of Anesthesiologists. Database: EMBASE

182. Postoperative mortality and morbidity following non-cardiac surgery in a healthy patient population Author(s): Gabriel R.A.; Sztain J.F.; A'Court A.M.; Hylton D.J.; Waterman R.S.; Schmidt U. Source: Journal of Anesthesia; Feb 2018; vol. 32 (no. 1); p. 112-119 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Purpose: Perioperative mortality ranges from 0.4% to as high as nearly 12%. Currently, there are no large-scale studies looking specifically at the healthy surgical population alone. The primary objective of this study was to report 30-day mortality and morbidity in healthy patients and define any risk factors. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset, all patients assigned an American Society of Anesthesiologists physical status (ASA PS) classification score of 1 or 2 were included. Further patients were excluded if they had a comorbidity or underwent a procedure not likely to classify them as ASA PS 1 or 2. Multivariable logistic regression was performed to identify predictors of the outcomes, in which odds ratios (OR) and 95% confidence intervals (95% CI) were reported. Results: There were 687,552 healthy patients included in the final analysis. Following surgery, 0.7, 7.0, and 0.7 per 1000 persons experienced 30-day mortality, sepsis, and stroke or myocardial infarction, respectively. Healthy patients greater than 80 years of age had the highest odds for mortality (OR 17.7, 95% CI 12.4-25.1, p < 0.001). Case duration was associated with increased mortality, especially in cases greater than or equal to 6 h (OR 3.0, 95% CI 2.0-4.5, p < 0.001). Conclusions: Thirty-day mortality and morbidity is, as expected, lower in the healthy surgical population. Age may be an indication to further risk stratify patients that are ASA PS 1 or 2 to better reflect perioperative risk. Copyright © 2017, Japanese Society of Anesthesiologists. Database: EMBASE

183. Population analysis of predictors of difficult intubation with direct laryngoscopy in pediatric patients with and without thyroid disease Author(s): Shah A.C.; Sinnott S.; Cravero J.P.; Ng W.C.K. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Purpose: There are no data on the prevalence and predictors of difficult intubation (DI) in pediatric patients with thyroid disease. This study (1) assesses the prevalence of DI in patients with thyroid disease undergoing elective operations, (2) identifies other predictors of DI in children, and (3) evaluates the effect of DI on postoperative care and length-of-stay. Methods: A single-center retrospective cohort analysis of procedures in patients assigned with an ICD-9 code for thyroid disease between June 2012 and February 2016. A comparative group was created which comprised of patients without thyroid disease receiving orthopedic or urologic surgeries to determine differences in DI prevalence. Univariate analyses compared demographics and intubation details between groups, and logistic regression identified independent variables associated with DI. Patients with and without DI were compared based on procedure duration, PACU-LOS, and escalation-of-care. Results: DI prevalence was greater in the thyroid group (4.9%, 51/1046) compared to the non-thyroid group (2.6%, 33/1289) (OR 1.95, 95% CI 1.25-3.05; p = 0.003). DI was associated with younger age, higher American Society of Anesthesiologists (ASA) class, and smaller body habitus (p < 0.001 for all comparisons). Congenital hypothyroidism (OR 2.49, 95% CI 1.44-4.32; p = 0.002)) and acquired hypothyroidism (OR 2.20, 95% CI 1.42-3.41; p < 0.001) were seen in a greater proportion of DI patients. After adjustment for demographic confounders, age and ASA class were independently associated with DI (p < 0.05), while hypothyroidism did not reach statistical significance (p = 0.077). Direct laryngoscopy (DL) was most frequently used as the successful subsequent maneuver in securing the airway in DI patients. A longer PACU length-of-stay was seen after procedures with DI (p < 0.001). Conclusion: Elective pediatric surgical patients with thyroid-related diagnoses at our institution had a higher prevalence of DI than those without thyroid disease, but this finding could not be isolated to thyroid pathology. Repeat DL achieves successful intubation in the majority of DI patients. DI patients often require longer recovery times due to prolonged cardiopulmonary monitoring. Copyright © 2017, Japanese Society of Anesthesiologists. Database: EMBASE

184. The Effect of Ketamine Infusion in the Treatment of Complex Regional Pain Syndrome: a Systemic Review and Meta-analysis Author(s): Zhao J.; Wang Y.; Wang D. Source: Current Pain and Headache Reports; Feb 2018; vol. 22 (no. 2) Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose of Review: Complex regional pain syndrome (CRPS) is a painful debilitating neurological condition that accounts for approximately 1.2% of adult chronic pain population. Ketamine, an NMDA receptor antagonist, is an anesthetic agent that has been used by some pain specialists for CRPS. There is a growing body of clinical evidence to support the use of ketamine in the treatment of neuropathic pain, especially CRPS. This meta-analysis study was aimed to examine the efficacy of ketamine in the treatment of CRPS. Recent Findings: A search of Embase, Pubmed, Web of Knowledge, Cochrane, Clinical Trial.gov, and FDA.gov between Jan 1, 1950, and August 1, 2017, was conducted to evaluate ketamine infusion therapy in the treatment of CRPS. We selected randomized clinical trials or cohort studies for meta-analyses. I2 index estimates were calculated to test for variability and heterogeneity across the included studies. The primary outcome is pain relief. The effect of ketamine treatment for complex regional pain syndrome was assessed by 0-10 scale numerical rating pain score. The secondary outcome is the pain relief event rate, which is defined as the percentage of participants who achieved 30% or higher pain relief in each of the qualified studies. Our meta-analysis results showed that the Ketamine treatment led to a decreased mean of pain score in comparison to the self-controlled baseline (p < 0.000001). However, there is a statistical significance of between-study heterogeneity. The immediate pain relief event rate was 69% (95% confidence interval (CI) 53%, 84%). The pain relief event rate at the 1-3 months follow-ups was 58% (95% CI 41%, 75%). Summary: The current available studies regarding ketamine infusion for CRPS were reviewed, and meta-analyses were conducted to evaluate the efficacy of ketamine infusion in the treatment of CRPS. Our findings suggested that ketamine infusion can provide clinically effective pain relief in short term for less than 3 months. However, because of the high heterogeneity of the included studies and publication bias, additional random controlled trials and standardized multicenter studies are needed to confirm this conclusion. Furthermore, studies are needed to prove long-term efficacy of ketamine infusion in the treatment of CRPS. Copyright © 2018, Springer Science+Business Media, LLC, part of Springer Nature. Database: EMBASE

185. Association between fentanyl test results and rescue morphine requirements in children after adenotonsillectomy Author(s): Li Y.-H.; Wang X.; Zhou Z.-J.; Zhuang P.-J. Source: Journal of Anesthesia; Feb 2018; vol. 32 (no. 1); p. 77-81 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Purpose: Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy. Methods: Intravenous fentanyl (1 micro g/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3-7 years who underwent adenotonsillectomy. The result was considered positive if the patient's respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children's Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 micro g/kg) was given when the score was >=6. Results: The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) micro g/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 micro g/kg) (P = 0.001). Conclusions: We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result. ClinicalTrials.gov ID: NCT02484222. Copyright © 2017, Japanese Society of Anesthesiologists. Database: EMBASE

186. Cytotoxicity of propofol in human induced pluripotent stem cell-derived cardiomyocytes Author(s): Kido K.; Ito H.; Yamamoto Y.; Uchida T.; Makita K. Source: Journal of Anesthesia; Feb 2018; vol. 32 (no. 1); p. 120-131 Publication Date: Feb 2018 Publication Type(s): Article Available at Journal of anesthesia - from International DOI Foundation Abstract:Purpose: Propofol infusion syndrome (PRIS) is a lethal condition caused by propofol overdose. Previous studies suggest that pathophysiological mechanisms underlying PRIS involve mitochondrial dysfunction; however, these mechanisms have not been fully elucidated. This study aimed to establish an experimental model of propofol-induced cytotoxicity using cultured human induced pluripotent stem cell (iPSC)-derived cardiomyocytes to determine the mechanisms behind propofol-induced mitochondrial dysfunction, and to evaluate the protective effects of coenzyme Q10 (CoQ10). Methods: Human iPSC-derived cardiomyocytes were exposed to propofol (0, 2, 10, or 50 micro g/ml) with or without 5 micro M CoQ10. Mitochondrial function was assessed by measuring intracellular ATP, lactate concentrations in culture media, NAD+/NADH ratio, and the mitochondrial membrane potential. Propofol-induced cytotoxicity was evaluated by analysis of cell viability. Expression levels of genes associated with mitochondrial energy metabolism were determined by PCR. Intracellular morphological changes were analyzed by confocal microscopy. Results: Treatment with 50 micro g/ml propofol for 48 h reduced cell viability. High concentrations of propofol (>= 10 micro g/ml) induced mitochondrial dysfunction accompanied by downregulation of gene expression of PGC-1alpha and its downstream targets (NDUFS8 and SDHB, which are involved in the respiratory chain reaction; and CPT1B, which regulates beta-oxidation). Cardiomyocytes co-treated with 5 micro M CoQ10 exhibited resistance to propofol-induced toxicity through recovery of gene expression. Conclusions: Propofol-induced cytotoxicity in human iPSC-derived cardiomyocytes may be associated with mitochondrial dysfunction via downregulation of PGC-1alpha-regulated genes associated with mitochondrial energy metabolism. Co-treatment with CoQ10 protected cardiomyocytes from propofol-induced cytotoxicity. Copyright © 2017, The Author(s). Database: EMBASE

187. Quality Improvement in Anesthesiology - Leveraging Data and Analytics to Optimize Outcomes Author(s): Valentine E.A.; Falk S.A. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions. Audit and feedback strategies are effective in facilitating positive change. Copyright © 2017 Elsevier Inc. Database: EMBASE

188. Human Factors Applied to Perioperative Process Improvement Author(s): Keebler J.R.; Lazzara E.H.; Blickensderfer E.; Looke T.D. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:This article discusses some of the major theories of the science of human factors/ergonomics (HF/E) in relation to perioperative medicine, with a focus on safety and errors within these systems. The discussion begins with human limitations based in cognition, decision making, stress, and fatigue. Given these limitations, the importance of measuring human performance is discussed. Finally, using the HF/E perspective on safety, high-level recommendations are provided for increasing safety within the perioperative environment. Copyright © 2017 Elsevier Inc. Database: EMBASE

189. Developing Multicenter Registries to Advance Quality Science Author(s): Schleelein L.E.; Harris K.A.; Elliott E.M. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:There are several benefits to clinical registries as an information repository tool, ultimately lending itself to the acquisition of new knowledge. Registries have the unique advantage of garnering much data quickly and are, therefore, especially helpful for niche populations or low-prevalence diseases. They can be used to inform on the ideal structure, process, or outcome involving an identified population. The data can be used in many ways, for example, as an observational tool to reveal associations or as a basis for framing future research studies or quality improvement projects. Copyright © 2017 Elsevier Inc. Database: EMBASE

190. Effect of Remote Ischemic Preconditioning on Intestinal Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A Randomized Controlled Pilot Trial Author(s): Struck R.; Wittmann M.; Muller S.; Meybohm P.; Muller A.; Bagci S. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: Cardiopulmonary bypass (CPB) surgery commonly threatens the heart and remote organs with ischemia-reperfusion injury. Transient episodes of ischemia to nonvital tissue, known as remote ischemic preconditioning (RIPC), is thought to help local and remote vital organs to withstand subsequent ischemic insults. Design: Prospective, randomized, double-blinded control trial. Setting: Tertiary referral academic teaching hospital. Participants: Thirty patients undergoing elective CPB surgery. Intervention: RIPC was achieved via three 5-minute cycles of upper limb ischemia using a blood pressure cuff or control (sham cuff). Measurements and Main Results: Primary outcome was the occurrence of intestinal injury, as measured by an increase in intestinal fatty acid binding protein (I-FABP). Secondary outcomes included incidence of gastrointestinal complications and duration of intensive care unit (ICU) stay. RIPC did not affect serum IFABP levels at the end of surgery and on the first postoperative day (p = 0.697 and p = 0.461, respectively). For all patients, mean I-FABP levels significantly increased at the end of surgery and decreased to under baseline levels on the first postoperative day (from a mean [+/- standard deviation] baseline value of 764 +/- 492 pg/mL to 2,002 +/- 974 pg/mL and decreased to 568 +/- 319 pg/mL, p < 0.001). All patients remained clinically absent of gastrointestinal complications until hospital discharge. Duration of ICU stay was not correlated with I-FABP levels at the end of surgery. Neither duration of CPB nor duration of aortic clamping significantly correlated with postoperative I-FABP levels. Conclusions: These findings suggest that RIPC does not affect intestinal injury in patients undergoing CPB surgery. In patients undergoing cardiac surgery, intestinal injury appears to be moderate and transient without any clinical relevant complication. Copyright © 2017 Elsevier Inc. Database: EMBASE

191. Pre-emptive awake airway management under dexmedetomidine sedation in a parturient with spinal muscular atrophy type-2 Author(s): Godlewski C.A.; Castellanos P.F. Source: International Journal of Obstetric Anesthesia; Feb 2018; vol. 33 ; p. 81-84 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Historically, pregnancy in females with spinal muscular atrophy was contraindicated due to the great risk to the parturient, but with improved management and increased survival more patients are becoming pregnant. We describe the management of a pregnant patient with spinal muscular atrophy type-2, who had severe restrictive lung disease, extensive spinal fusion that precluded neuraxial anesthesia, and chronic respiratory failure on nocturnal Bilevel Positive Airway Pressure. Airway management was further complicated by limited mouth opening and cervical spine ankylosis. Copyright © 2017 Elsevier Ltd Database: EMBASE

192. Pulmonary and laryngeal tuberculosis in a 25-weeks' gestation parturient, diagnosed after failed tracheal intubation Author(s): Geier J.; Orlando B. Publication Date: Feb 2018 Publication Type(s): Article Abstract:A pregnant woman at 25 weeks of gestation was diagnosed with laryngeal tuberculosis following a failed intubation for upper gastrointestinal endoscopy. Laryngeal tuberculosis represents approximately 1% of all cases of tuberculosis in the United States and presents a unique diagnostic challenge, because accompanying laryngeal changes are both varied and nonspecific. This report highlights both the challenges of the pregnant airway and the diagnosis and treatment of laryngeal tuberculosis. Copyright © 2017 Elsevier Ltd Database: EMBASE

193. Thrombosis after aortic balloon occlusion during cesarean delivery for abnormally invasive placenta Author(s): Luo F.; Wu Z.; Mei J.; Yue J.; Xie L.; Yu X. Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background: Abnormally invasive placenta is a major cause of postpartum hemorrhage and cesarean hysterectomy. An increasing number of obstetricians worldwide employ prophylactic aortic balloon occlusion to manage bleeding during cesarean delivery in these patients. However, the safety of this procedure in pregnant women has not been confirmed. Methods: The clinical records of patients who were suspected of having abnormally invasive placenta and who received prophylactic aortic balloon catheterization before cesarean delivery were retrospectively studied for thrombotic complications. Results: There were 121 patients with suspected abnormally invasive placenta who received prophylactic aortic balloon catheterization before surgery and 115 had the balloon inflated during surgery. Twelve of these 121 patients (10%) developed thrombotic complications. Except for one case of venous thrombosis, all other patients exhibited arterial thrombosis in the limbs on the catheterization side and 11 cases (92%) of thrombosis were discovered within 24 hours of delivery. Eventually, eight patients received arterial thromboembolectomy, and four patients received conservative anticoagulation treatment. Conclusion: Aortic balloon occlusion for the management of bleeding in women with an abnormally invasive placenta may not uncommonly result in thrombosis. Therefore, the risks and benefits of the procedure must be carefully weighed before it is utilized in these patients. Copyright © 2017 Database: EMBASE

194. Prophylactic use of an intra-aortic balloon pump in a high-risk patient with peripartum cardiomyopathy requiring cesarean delivery Author(s): Samalavicius R.S.; Urbonas K.; Misiuriene I.; Puodziukaite L.; Radaviciute I.; Norkiene I.; Janusauskas V.; Zorinas A.; Rucinskas K.; Serpytis P. Source: International Journal of Obstetric Anesthesia; Feb 2018; vol. 33 ; p. 67-71 Publication Date: Feb 2018 Publication Type(s): Article Abstract:The use of intra-aortic balloon counter-pulsation for circulatory support in pregnant women with cardiac failure is limited to several case reports. Few publications have addressed the use of intra-aortic balloon counter-pulsation during delivery. We report a case using prophylactic intra-aortic balloon counter-pulsation during the management of a cesarean delivery in a patient with peripartum cardiomyopathy. A 28-year-old primigravid female at 37 weeks of gestation was admitted with signs of worsening heart failure, and transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 25%. A plan to proceed with cesarean delivery, using hemodynamic support with intra- aortic balloon counter-pulsation, was made during a multidisciplinary meeting. Shortly after initiation of intra-aortic balloon counter-pulsation, the patient's hemodynamics improved, with a decrease in heart rate and an increase in mean arterial blood pressure. After uneventful cesarean delivery of a healthy 3.2 kg infant, the patient was transferred to intensive care and was extubated three hours later. Due to hemodynamic instability, intra- aortic balloon counter-pulsation support and vasopressor infusion were maintained for four postoperative days. The patient was discharged from the hospital on diuretics and beta- blocker treatment after 20 days. Heart failure persisted, requiring heart transplantation 25 months later. This report highlights the role of a multidisciplinary team approach in the management of delivery in an obstetric patient with peripartum cardiomyopathy. Copyright © 2017 Elsevier Ltd Database: EMBASE

195. A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise Author(s): Dyer R.A.; Emmanuel A.; Adams S.C.; Arcache M.J.; Vorster A.; Reed A.R.; James M.F.; Schulein S.; van Dyk D.; Lombard C.J.; Wong C.A.; Higgins N.; Joolay Y. Source: International Journal of Obstetric Anesthesia; Feb 2018; vol. 33 ; p. 23-31 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background: Studies in healthy patients undergoing elective caesarean delivery show that, compared with phenylephrine, ephedrine used to treat spinal hypotension is associated with increased fetal acidosis. This has not been investigated prospectively in women with severe preeclampsia. Methods: Patients with preeclampsia requiring caesarean delivery for a non-reassuring fetal heart tracing were randomised to receive either bolus ephedrine (7.5-15 mg) or phenylephrine (50-100 micro g), to treat spinal hypotension. The primary outcome was umbilical arterial base excess. Secondary outcomes were umbilical arterial and venous pH and lactate concentration, venous base excess, and Apgar scores. Results: Among 133 women, 64 who required vasopressor treatment were randomised into groups of 32 with similar patient characteristics. Pre-delivery blood pressure changes were similar. There was no difference in mean [standard deviation] umbilical artery base excess (- 4.9 [3.7] vs -6.0 [4.6] mmol/L for ephedrine and phenylephrine respectively; P=0.29). Mean umbilical arterial and venous pH and lactate concentrations did not significantly differ between groups (7.25 [0.08] vs 7.22 [0.10], 7.28 [0.07] vs 7.27 [0.10], and 3.41 [2.18] vs 3.28 [2.44] mmol/L respectively). Umbilical venous oxygen tension was higher in the ephedrine group (2.8 [0.7] vs 2.4 [0.62]) kPa, P=0.02). There was no difference in 1- or 5-min Apgar scores, numbers of neonates with 1-min Apgar scores <7 or with a pH <7.2. Conclusions: In patients with severe preeclampsia and fetal compromise, fetal acid-base status is independent of the use of bolus ephedrine versus phenylephrine to treat spinal hypotension. Copyright © 2017 Elsevier Ltd Database: EMBASE

196. A survey of international antisepsis procedures for neuraxial catheterisation in labour Author(s): Fayman K.; Allan A.; Hudson C.; Logarta M. Source: International Journal of Obstetric Anesthesia; Feb 2018; vol. 33 ; p. 8-16 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background: Neuraxial analgesia during labour is a mainstay of anaesthetic practice globally. Despite the potential for significant neurological and infectious complications, international antisepsis practices for neuraxial anaesthesia vary widely. Aims: The primary aim of this study was to clarify international antisepsis practices prior to neuraxial analgesia in labour. The secondary aim was to determine an approximate international incidence of neuraxial infections and neurological complications secondary to neuraxial analgesia techniques in labour. Materials and methods: Heads of Departments of Anaesthesiology were invited to complete an online questionnaire exploring antisepsis practices and complications of neuraxial catheterisation. Data from 151 institutions in 13 countries were collected over 11 months. Results: Data were collected for an estimated 6 008 540 deliveries and 3 770 800 neuraxial catheterisations. The average annual birth rate per institution was 3979 births, with an average of 2497 neuraxial catheterizations (representing 62.8% of deliveries). Forty-nine percent of responders reported always wearing sterile gowns for the procedure, whereas 47.7% never wear gowns. Chlorhexidine was used by 88.1% of those surveyed, and 96.7% always wore facemasks. Thirty-four percent of institutions reported infectious complications over a 10-year period. Ninety neuraxial infections were estimated, giving an approximate incidence of 1:41 898 catheterisations (2.39 infections per 100 000 catheterisations). A total of 202 neurological complications were reported, with an approximate incidence of 1:18 667 catheterisations (5.36 neurological complications per 100 000 catheterisations). Conclusion: The survey demonstrated marked variation in aseptic practice between both responding centres and countries. The incidence of infectious and neurological complications secondary to neuraxial catherisation in labour has been approximated. Copyright © 2017 Elsevier Ltd Database: EMBASE

197. Hereditary haemorrhagic telangiectasia in pregnancy: regional and general anaesthesia Author(s): Crawford M.; Burns R.; Cooper S.; Mackay T. Source: International Journal of Obstetric Anesthesia; Feb 2018; vol. 33 ; p. 84-86 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Hereditary haemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is a rare autosomal dominant multisystem disorder, characterised by mucocutaneous telangiectases and arteriovenous malformations affecting any organ. The physiological changes in pregnancy pose significant obstetric and anaesthetic challenges for women affected by the disease. The optimal timing and mode of delivery requires careful consideration; and the benefits and risks of both regional and general anaesthetic techniques must be carefully considered, depending on the organs affected. This case report describes the successful management of a patient with this disease and severe pulmonary involvement, who received both regional and general anaesthesia as a result of a complication in the initial anaesthetic plan. The report demonstrates the benefits of a multidisciplinary approach to a complex case, achieved through providing care in a tertiary centre with appropriate expertise and resources. Copyright © 2017 Database: EMBASE

198. Heart Transplantation in Patients >60 Years: Importance of Relative Pulmonary Hypertension and Right Ventricular Failure on Midterm Survival Author(s): Bianco J.C.; Mc Loughlin S.; Bonofiglio F.C.; Denault A.Y.; Marenchino R.G.; Rojas J.I. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 32- 40 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objectives: To determine the impact of recipient age and perioperative risk factors on midterm survival after orthotopic heart transplantation (OHT). The authors hypothesized that perioperative variables are more important as predictors of mortality than is a recipient's age. Design: Retrospective study. Setting: Tertiary care university hospital. Participants: The study comprised 126 consecutive adults who underwent OHT. Interventions: After Institutional Review Board approval, the authors analyzed 126 consecutive adult patients who underwent OHT between January 2009 and December 2015 and followed-up with them up until June 2016. Patients were divided into the following 2 groups according to the recipient's age at the time of transplantation: older group (>=60 y old) and younger group (18 to 59 y). Measurements and Main Results: Actuarial survival rates for all patients were 88.1%, 78.6%, and 72.2% at 30 days, 1 year, and after a median follow-up of 18.9 months (midterm survival) (1st quartile: 8.1; 3rd quartile: 37.4), respectively. In the unadjusted analysis, the older group demonstrated a significant increase in 1-year mortality (p = 0.005) and a trend toward worse midterm mortality (p = 0.087). Multivariable analysis was performed using Cox proportional hazards regression analysis. Independent risk factors related to midterm mortality after OHT were as follows: preoperative relative pulmonary hypertension using the mean arterial-to-mean pulmonary artery pressure ratio <=3 (hazard ratio [HR] 5.39, 95% confidence interval [CI] 1.64-17.74, p = 0.006); cardiopulmonary bypass duration (per each 10-min increment) (HR 1.14, 95% CI 1.08-1.22, p < 0.001); and postoperative right ventricular dysfunction (HR 3.50, 95% CI 1.52- 8.05, p = 0.003). Neither recipients >=60 years old (HR 2.15, 95% CI 0.98-4.67, p = 0.054) nor donor/recipient body surface area ratio (HR 1.01, 95% CI 0.98-1.04, p = 0.463) was an independent risk factor for midterm mortality. Conclusions: In patients undergoing heart transplantation, survival was related more to preoperative relative pulmonary hypertension, cardiopulmonary bypass duration, and postoperative right ventricular failure than to recipient age. Older patients should be selected for OHT carefully, taking into consideration preoperative factors other than age. Copyright © 2018 Elsevier Inc. Database: EMBASE

199. Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A Post Hoc Subgroup Analysis of a Prospective Trial Author(s): Datzmann T.; Reinelt H.; Hoenicka M.; Liebold A.; Gorki H. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 205- 211 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: The restriction of hydroxyethyl starch (HES) has mandated changes in volume management based on data of critically ill patients. Reliable data of structural renal damage after HES treatment in cardiac surgical patients are lacking. The influence of 6% HES 130/0.4 was investigated in this study. Design: An exploratory post hoc subgroup analysis of a prospective trial was performed. Setting: The study was carried out at a university hospital. Participants: Forty-four low-risk cardiac surgical patients were examined. Interventions: Twenty-two patients received only crystalloid solutions, and 22 were treated with balanced 6% HES 130/0.4. Measurements and Main Results: Functional renal parameters and the structural biomarkers alpha-glutathione S-transferase, kidney injury molecule-1, liver fatty acid-binding protein, and neutrophil gelatinase-associated lipocalin were investigated. Volume balances, vasopressor dosages, blood losses, and coagulation parameters were compared. Most functional and structural renal parameters did not differ between the groups (serum creatinine p = 0.8380). Liver fatty acid-binding protein was transiently higher in the HES group only at 24 hours postoperatively (p = 0.0002). No differences in mortality, acute kidney injury, and need for renal replacement therapy were observed. Blood coagulation was significantly more compromised in the HES group at intensive care unit arrival (factor II, p = 0.0012; factor X, p = 0.0031; thrombocytes, p = 0.0010). Blood losses, and vasopressor dosages tended to be higher in HES-treated patients without significance. Conclusion: Overall, the values and time courses of the biomarkers used did not indicate evidence of a mechanism for tubular injury caused by HES. Copyright © 2018 Elsevier Inc. Database: EMBASE

200. Dynamic Shunting Across a Patent Foramen Ovale in Adult Cardiac Surgery- Perioperative Challenges and Management Author(s): Patel P.A.; Augoustides J.G.T.; Patel S.; Feinman J.W.; Gutsche J.T.; Hall A.; Weber B.; Fabbro M.; Maldonado Y. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 542- 549 Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

201. Preliminary Experience in Combined Somatic and Cerebral Oximetry Monitoring in Liver Transplantation Author(s): Hu T.; Denault A.Y.; Collin Y.; Lapointe R.; Carrier F.M.; Massicotte L.; Fortier A.; Lambert J.; Vandenbroucke-Menu F. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 73- 84 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: The use of cerebral near-infrared spectroscopy (NIRS) has become widespread in cardiac surgery after research demonstrated an association between perioperative cerebral desaturations and postoperative complications. Somatic NIRS desaturation also is associated with an increased risk of postoperative complications and mortality. The objective of this study was to explore the trends of both somatic and cerebral NIRS during liver transplantation. Design: A prospective, single-site, observational case series. Setting: Tertiary care center. Participants: The study comprised 10 patients undergoing liver transplantation. Interventions: NIRS sensors were placed on the forehead (cerebral regional oxygen saturation [rSO2]) and on the right arm and right leg (somatic rSO2) to measure tissue perfusion. Desaturation was defined as a 20% decrease of baseline values for 15 seconds. Measurements and Main Results: In all patients, parallel changes in both cerebral and somatic rSO2 values were observed during phlebotomy, bleeding, transfusion, portal vein clamping, and the use of vasoactive agents. Induction of anesthesia increased cerebral rSO2 more than it did somatic values. However, ascites removal, abdominal manipulation, and clamping of the inferior vena cava (IVC) were associated with nonparallel changes in cerebral and somatic rSO2. Ascites removal was associated with increased somatic leg rSO2, and IVC clamping and abdominal hypertension were associated with a significant reduction in somatic leg rSO2. Somatic leg desaturation instead of arm or cerebral desaturation was associated with more postoperative complications. Conclusions: The use of combined NIRS monitoring allows for the identification of the source of somatic or cerebral desaturation. Compromised venous flow from the IVC from clamping or abdominal compartment syndrome typically is associated with the appearance of more pronounced leg than arm desaturation. Copyright © 2018 Elsevier Inc. Database: EMBASE

202. Factors Related to the Severity of Early Postoperative Infection After Heart Transplantation in Patients Surviving Prolonged Mechanical Support Periods: Experience at a Single University Author(s): Abe R.; Shibata S.C.; Uchiyama A.; Fujino Y.; Saito S.; Toda K.; Sawa Y.; Tsukamoto Y.; Sakata Y.; Tomono K. Source: Journal of Cardiothoracic and Vascular Anesthesia; Feb 2018; vol. 32 (no. 1); p. 53- 59 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective: The authors examined the effect of prolonged support with continuous- flow ventricular assist devices (CF-VADs) and other related factors on the severity of infections within 30 days of heart transplantation (HTx). Design: A retrospective analysis of consecutive HTx procedures. Setting: University hospital, between 2010 and 2016. Participants: A cohort of 53 heart transplantation recipients (median age, 38.5 yr; interquartile range [IQR], 30.3-49.2 yr; women, 34%). Interventions: Forty-nine patients required CF-VAD support (median duration, 946 d; IQR, 600-1,132 d). Measurements and Main Results: Severity of postoperative infections was categorized as follows: no infection, minor infection (resolved within 14 days), major infection (resolved after >14 days), and severe infection (septic shock). Results were expressed as number (frequency) and median with IQR. Potential risk factors for increased infection severity were expressed as odds ratio (OR) with 95% confidence interval (CI). Postoperatively, no infection, minor infection, major infection, and severe infection occurred in 32 (60.4%), 8 (15.1%), 8 (15.1%), and 5 patients (9.4%), respectively. Active ventricular assist device (VAD)-specific infections at the time of HTx occurred in 37.7% of patients. Moderate-to-severe primary graft dysfunction occurred in 26.4% of the patients. Multivariable analysis indicated that risk factors for increased infection severity included active VAD-specific infection (OR 4.8; 95% CI 2.3-11.2) and moderate-to-severe primary graft dysfunction (OR 8.8; 95% CI 2.1-42.5) but not duration of CF-VAD support (OR 1.0; 95% CI 1.0-1.0). Conclusion: Active VAD-specific infection and poor graft function likely contribute to the severity of early postoperative infections after HTx. Copyright © 2018 Elsevier Inc. Database: EMBASE

203. Prevalence and Predictors of Patient Nonadherence to Pharmacological Acute Pain Therapy at Home After Day Surgery: A Prospective Cohort Study Author(s): Stessel B.; Theunissen M.; Marcus M.A.; Joosten E.A.; Fiddelers A.A.A.; Hoofwijk D.M.N.; Buhre W.F.F.A.; Gramke H.-F.; van Kuijk S.M.J.; Peters M.L. Publication Date: 2018 Publication Type(s): Article Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Good adherence to prescribed analgesics can be crucial to suppress or even prevent acute postoperative pain after day surgery. The aim of this study was to analyze prevalence and predictors of analgesic nonadherence after day surgery. Methods: Elective patients scheduled for day surgery were prospectively enrolled from November 2008 to April 2010. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. The primary outcome parameter was analgesic nonadherence. Adherence was defined according to the patient's response to the questionnaire item "analgesia use as prescribed": full adherence, "yes"; partial adherence, "yes, sometimes"; nonadherence, "no." Bivariate and multivariate logistic regression analyses were performed to identify predictors of analgesic nonadherence. Results: A total of 1,248 patients were included. The prevalence rates of analgesic nonadherence and partial adherence were 21.6% and 20.0%, respectively, in the total study population but dropped to 9.4% and 19.8%, respectively, in patients with moderate to severe pain. Low postoperative pain intensity and short duration of surgery were the most important predictors of analgesic nonadherence. The most important preoperative predictors for analgesic nonadherence were low preoperative pain intensity, low preoperative expectations of pain, and low fear of short-term effects of surgery. Conclusion: Analgesic nonadherence and partial adherence are common after day surgery but decrease as average pain intensity increases. Patients at risk for analgesic nonadherence can be identified during the preoperative period based on preoperative pain intensity, preoperative expectations of pain, and fear of surgery. Copyright © 2017 World Institute of Pain Database: EMBASE

204. Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators Author(s): Marlow N.M.; Vaughn I.A.; Jo A.; Simpson K.N.; Zoller J.S.; Short E.B. Publication Date: 2018 Publication Type(s): Article Available at Pain practice : the official journal of World Institute of Pain - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Objective: To examine medication adherence and healthcare costs for combination prescription initiators (duloxetine/milnacipran/venlafaxine with pregabalin) vs. monotherapy initiators (duloxetine, milnacipran, venlafaxine, and pregabalin) among patients with fibromyalgia syndrome (FMS). Methods: Our retrospective cohort study used claims data for the South Carolina Blue Cross Blue Shield State Health Plan (SHP). Patients with FMS >= 18 years of age, with prescription initiation from July 1, 2007, through June 30, 2010, and SHP enrollment for 12 months pre- and post-index periods were included (combination: n = 100; pregabalin: n = 665; duloxetine: n = 713; milnacipran: n = 131; venlafaxine: n = 272). Medication adherence measures included high adherence (medication possession ratio >= 80%) and total supply days. Healthcare costs comprised direct medical expenditures. Propensity score methods of inverse probability of treatment weights were used to control for selection bias due to differing pre-index characteristics. Results: Odds ratios for high adherence were significantly increased (P < 0.05) among the combination cohort vs. the venlafaxine (2.15), duloxetine (1.39), and pregabalin (2.20) cohorts. Rate ratios for total supply days were significantly higher (P < 0.05) for combination vs. venlafaxine (1.23), duloxetine (1.08), and pregabalin (1.32) cohorts. Expenditures for total health care were significantly higher (P < 0.05) for combination vs. duloxetine ($26,291 vs. $17,190), milnacipran ($33,638 vs. $22,886), and venlafaxine ($26,586 vs. $16,857) cohorts. Conclusions: Medication adherence was considerably better for combination prescription initiators; however, expenditures for total health care were higher. Still, our findings suggest important clinical benefits with the use of combination prescription therapy, and prospective studies of medication adherence are warranted to examine causal relationships with outcomes not captured by healthcare claims databases. Copyright © 2017 World Institute of Pain Database: EMBASE

205. Stimulation of the L2-L3 Dorsal Root Ganglia Induces Effective Pain Relief in the Low Back Author(s): Huygen F.; Liem L.; Cusack W.; Kramer J. Source: Pain Practice; 2018; vol. 18 (no. 2); p. 205-213 Publication Date: 2018 Publication Type(s): Article Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Introduction: Chronic low back pain affects millions of people worldwide and can arise through a variety of clinical origins. In the case of failed back surgery syndrome (FBSS), previous surgical procedures can contribute to low back pain that is often unresponsive to intervention. Although spinal cord stimulation (SCS) can be an effective treatment modality, it does not provide sufficient pain relief for some intractable cases. Recently, alternative neuromodulation options have been developed, including dorsal root ganglion (DRG) stimulation. The objective of this report is to further investigate these clinical observations. Methods: Twelve patients with significant chronic discogenic low back pain due to FBSS were included. All subjects underwent implantation of DRG stimulation systems that had at least 1 lead placed at L2 or L3. Subjects' pain ratings, mood, and quality of life were tracked prospectively for up to 12 months. Results: More than half of subjects reported 50% or better pain relief in the low back, and the average low back pain relief was 45.5% at 12 months. Concomitant reductions in overall pain, leg pain, pain interference, mood, and quality of life were also found. Discussion: For the studied population, DRG stimulation at the L2-L3 levels was effective at relieving low back pain. These reductions in pain were associated with improvements in quality of life. Thus, DRG stimulation at these levels may be effective for low back pain by recruiting both segmental and nonsegmental neural pathways that are not otherwise accessible via traditional SCS. Copyright © 2017 World Institute of Pain Database: EMBASE

206. L'ajout de protoxyde d'azote a la fin d'une anesthesie a l'isoflurane accelere la recuperation precoce sans augmenter le risque de nausees et vomissements postoperatoires : une etude clinique randomiseeNitrous oxide added at the end of isoflurane anesthesia hastens early recovery without increasing the risk for postoperative nausea and vomiting: a randomized clinical trial Author(s): Mraovic B.; Simurina T.; Gan T.J. Source: Canadian Journal of Anesthesia; Feb 2018; vol. 65 (no. 2); p. 162-169 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background: Nitrous oxide (N2O) has been reported to increase the risk of postoperative nausea and vomiting (PONV) in a dose-dependent manner. We investigated the effect of adding N2O at the end of isoflurane inhalational anesthesia on the recovery and incidence of PONV. Our hypothesis was that N2O would reduce the time to early recovery without increasing the incidence of PONV. Methods: After obtaining ethics committee approval and written informed consent, 100 women at American Society of Anesthesiologists physical status I-III and scheduled for laparoscopic-assisted vaginal hysterectomy were randomized into two groups (G) according to the carrier gas: GO2 (air in 30% oxygen) and GN2O (the same mixture until the last 30 min of surgery, when 70% N2O in 30% oxygen was used). No PONV prophylaxis was given. Anesthesia was induced with thiopental 5 mg.kg-1, vecuronium 0.1 mg.kg-1, and fentanyl 1-2 mug.kg-1iv and maintained with isoflurane. Indicators of early recovery (time to extubation, eye opening, following commands, orientation) were assessed by an anesthesiologist unaware of the group assignment. The incidence and severity of PONV was measured at two and 24 hr postoperatively. Results: Altogether, 82 participants completed the study (42 in GO2, 40 in GN2O) and were analyzed. The mean (SD) time of N2O administration in GN2O patients was 27.1 (10.1) min. The mean (SD) time to extubation was faster in GN2O patients [5.4 (2.9) min] than in GO2 patients [7.5 (3.7) min] (mean difference, 2.0 min; 95% confidence interval [CI], 0.6 to 3.4, P = 0.009). The ability to open eyes, follow commands, and being oriented were all faster in GN2O patients than in GO2 patients (differences of 3.9 min, 95% CI, 1.6 to 6.1, P = 0.001; 3.4 min, 95% CI, 1.0 to 5.7, P = 0.006; 3.8 min, 95% CI, 0.9 to 6.7, P = 0.010, respectively). The incidence of PONV was not different between the groups, but the rescue antiemetic was required less often in the GN2O patients (mean difference in metoclopramide dose between the GN2O and GO2 groups, 5.1 mg; 95% CI, 0.8 to 9.4, P = 0.019). Conclusions: Adding N2O during the last 30 min of an isoflurane-based inhalational anesthetic reduced the time to extubation, eye opening, and orientation. Copyright © 2017, Canadian Anesthesiologists' Society. Database: EMBASE

207. Ultrasound-Guided Intra-articular Injection of the Radio-ulnar and Radio-humeral Joints and Ultrasound-Guided Dry Needling of the Affected Limb Muscles to Relieve Fixed Pronation Deformity and Myofascial Issues around the Shoulder, in a Case of Complex Regional Pain Syndrome Type 1 Author(s): Pai R.S.; Vas L. Publication Date: 2018 Publication Type(s): Article Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Complex regional pain syndrome (CRPS) occurs due to different pathophysiological mechanisms. Presently there is no description of definitive treatment that can resolve the especially recalcitrant motor issues of disability in CRPS type 1 (CRPS-1). Case Report: We have herein described the successful management of motor disability with a multimodal approach in a patient with CRPS-1 that occurred as a result of a fracture sustained in the lower end of the radius. Sensory/sudomotor/vasomotor symptoms were relieved completely by medications and stellate ganglion block in 2 weeks. Ultrasound- guided dry needling secured near-complete improvement of shoulder and hand movements in 45 days. Ultrasound guided intra-articular (radio-ulnar and radio-humeral joint) injections with steroid reduced residual pain and improved forearm movements by 50% initially. The patient continued to receive regular sessions of dry needling, physiotherapy, and cognitive behavioral therapy. By the end of 1 year, the functions of the limb improved remarkably, as did the functional outcome scores. Conclusion: In this patient with CRPS-1, intra-articular injections with steroid reduced nociception in the affected local structures and sensitization in the nervous system; dry needling resolved the myofascial issues; sustained physiotherapy maintained the motor recovery; and behavioral therapy techniques addressed the cognitive and life stress issues. It was concluded that the presenting symptoms in this case were a consequence of interactions between humoral, nervous, and myofascial systems. Copyright © 2017 World Institute of Pain Database: EMBASE

208. Validation of the Japanese Version of the Fremantle Back Awareness Questionnaire in Patients with Low Back Pain Author(s): Nishigami T.; Mibu A.; Tanaka K.; Yamashita Y.; Shimizu M.E.; Wand B.M.; Catley M.J.; Moseley G.L.; Stanton T.R. Source: Pain Practice; 2018; vol. 18 (no. 2); p. 170-179 Publication Date: 2018 Publication Type(s): Article Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: There is a growing interest in the role of disturbed body perception in people with persistent pain problems such as chronic low back pain (CLBP). A questionnaire, the Fremantle Back Awareness Questionnaire (FreBAQ), was recently developed as a simple and quick way of assessing disturbed perceptual awareness of the back in people with CLBP and appears to have acceptable psychometric properties. The aim of the present study was to develop a Japanese version of the FreBAQ (FreBAQ-J) and evaluate its psychometric properties in a sample of Japanese people with low back pain (LBP). Methods: Translation of the FreBAQ into Japanese was conducted using a forward-backward method. One hundred participants with LBP completed the resultant FreBAQ-J. A subset of the participants completed the FreBAQ-J again 2 weeks later. Validity was investigated by examining the relationship between the FreBAQ-J and clinical valuables. Rasch analysis was used to assess targeting, category ordering, unidimensionality, person fit, internal consistency, and differential item functioning. Results: The FreBAQ-J was significantly correlated with pain in motion, disability, pain-related catastrophizing, fear of movement, and anxiety symptomatology. The FreBAQ-J had acceptable internal consistency, a minor departure from unidimensionality, and good test-retest reliability, and was functional on the category rating scale. Conclusions: The FreBAQ-J has acceptable psychometric properties and is suitable for use in people with LBP. Participants with high levels of disturbed body perception are well targeted by the scale. The functioning of one item (item 8) was poor. Further study is warranted to confirm if this item should be excluded. Copyright © 2017 World Institute of Pain Database: EMBASE

209. Erector Spinae Plane Block for Surgery of the Posterior Thoracic Wall in a Pediatric Patient Author(s): Hernandez M.A.; Palazzi L.; Lapalma J.; Forero M.; Chin K.J. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 217-219 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Objective Historically, regional anesthesia for surgery on the posterior thoracic wall has been limited to neuraxial and paravertebral nerve blocks. The erector spinae plane (ESP) block is a novel technique that anesthetizes the dorsal rami of the spinal nerves innervating the posterior thoracic wall. We report the use of the ESP block for this clinical application in a pediatric patient. Case Report A healthy 3-year-old girl was scheduled for resection of a giant paraspinal lipoma extending over the T4-T7 dermatomes. She received a preoperative single-shot ESP block at the level of the T1 transverse process; this level was chosen to avoid the lipoma and cover the planned surgical incision over the T2-T8 dermatomes. Hemodynamic stability and excellent pain control perioperatively were obtained with minimal anesthetic requirements and no systemic analgesics apart from fentanyl administered for induction of anesthesia. Return to normal function (ambulation, feeding, and communication) was achieved within 2 hours after surgery. A pain score of 0 on the FLACC (Face, Legs, Activity, Cry, Consolability) scale was maintained until discharge from the hospital 4 hours after the surgery. First analgesic use was 18 hours after hospital discharge. No complications were reported. Conclusions The ESP block is an effective option for surgery on the posterior thoracic wall. The opioid- and anesthetic-sparing effects exhibited in this case facilitated rapid postoperative recovery and early discharge. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

210. The European society of regional anaesthesia and pain therapy/American society of regional anesthesia and pain medicine recommendations on local anesthetics and adjuvants dosage in pediatric regional anesthesia Author(s): Suresh S.; Ecoffey C.; Bosenberg A.; Lonnqvist P.-A.; De Oliveira G.S.; De Leon Casasola O.; De Andres J.; Ivani G. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 211-216 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background and Objectives Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Methods Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Results Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. Conclusions High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

211. A New Step Toward Evidence of in Vivo Perineural Dexamethasone Safety: An Animal Study Author(s): Marty P.; Bennis M.; Legaillard B.; Ferre F.; Minville V.; Cavaignac E.; Lebon J.; Brouchet A. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 180-185 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background and Objectives The aim of this study was to analyze histological nerve toxicity of perineural dexamethasone administration in combination with ropivacaine on mice. Efficacy of perineural dexamethasone in combination with regional anesthesia is clearly demonstrated. However, the safety of this procedure is still a matter of debate. Methods A sciatic nerve block was performed on 90 mice. Five groups, each containing 18 mice assigned randomly, were used in these experiments: the sham group (isotonic saline solution), R group (perineural ropivacaine), D group (perineural dexamethasone), RDPN group (perineural ropivacaine and perineural dexamethasone), and the RDS group (perineural ropivacaine and systemic dexamethasone). Sensory and motor blocks were evaluated every 30 minutes for 14 hours. Fourteen and 28 days after this procedure, 9 mice in each group were killed for sciatic nerve histological assessment. Results No statistical difference was observed between different groups for Wallerian degeneration (P = 0.28 at day 14 and P = 0.22 at day 28) and perineural inflammation (P = 0.9 at day 14). Motor and sensory block durations were tested for each group. A statistical difference was observed for motor block duration between the RDPN group (150 minutes [127-172 minutes]), the RDS group (120 minutes [90-120 minutes]), and the R group (60 minutes [60-90 minutes]). Sensory block duration was also statistically different: 660 minutes (660-720 minutes) in the RDPN group, 480 minutes (427-660 minutes) in RDS group, 330 minutes (240-410) in the R group. Conclusions A combination of ropivacaine and perineural dexamethasone allows longer sensory block duration compared with ropivacaine alone or ropivacaine and systemic dexamethasone, without increased neural toxicity. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

212. Sensory Assessment and Regression Rate of Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Volunteers Author(s): Chen Y.; Shi K.; Zhang X.; Xu X.; Wang Q.; Xia Y.; Papadimos T.J. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 174-179 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background and Objectives The analgesic effect and duration of a transversus abdominis plane (TAP) block remain controversial. Transversus abdominis plane blocks are effective for somatic/incisional pain but do not provide analgesia for visceral pain from intra-abdominal procedures. The purpose of this study was to assess the area and extent of cutaneous sensory blockade and the regression of dermatomal anesthesia after bilateral oblique subcostal TAP block. Methods This observational, prospective clinical study consisted of 12 healthy volunteers. All volunteers received a bilateral oblique subcostal TAP block under real-time ultrasound guidance with 20 mL of 0.375% ropivacaine. The anterior abdominal cutaneous area was divided into 3 parts (midabdomen, left-lateral abdomen, right-lateral abdomen) using 2 lines drawn in a parasagittal fashion 5 cm lateral to the midline. The area of cutaneous sensory blockade involving the anterior abdomen was assessed 30 minutes after institution of the block using a cold stimulus. This was followed by repeated measurements using a cold stimulus applied along parasagittal lines drawn 3 cm lateral to the midline at 0.5, 6, 10, 14, 18, 22, and 26 hours after blockade. Results The area of cutaneous sensory blockade of the abdomen was 332 (SD, 73) cm2; that of the midabdomen was 253 (SD, 29) cm2, which represented an average of 90% of the area of the midabdomen; and that of the lateral abdominal wall (combination of left-lateral abdomen and right-lateral abdomen) was 79 (SD, 62) cm2, which represented an average of 26% of total lateral abdominal area. Dermatomes T7-T12 of the midabdomen were successfully blocked in all volunteers after using the bilateral oblique subcostal technique. However, T6 and L1 were only variably blocked. The area of cutaneous sensory block of the anterior abdomen regressed over the ensuing 22 hours in the following manner: 90%, 87%, 73%, 50%, 22%, 3%, and 0% at 0.5, 6, 10, 14, 18, 22, and 26 hours, respectively. Conclusions Bilateral oblique subcostal TAP block produces a widespread cutaneous sensory blockade with a consistent dermatomal distribution in the midabdomen for a considerable effective duration. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

213. Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial Author(s): Koning M.V.; Stolker R.J.; Teunissen A.J.W.; Van Der Harst E.; Ruijgrok E.J. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 166-173 Publication Date: Feb 2018 Publication Type(s): Article Available at Regional Anesthesia and Pain Medicine - from PubMed Central Abstract:Background and Objectives: Management of postoperative pain after laparoscopic segmental colonic resections remains controversial. We compared 2 methods of analgesia within an Enhanced Recovery After Surgery (ERAS) program. The goal of the study was to investigate whether administration of intrathecal bupivacaine/morphine would lead to an enhanced recovery. Methods A single-center, randomized, double-blind controlled trial was performed (NL43488.101.13). Patients scheduled for laparoscopic segmental intestinal resections were considered. Exclusion criteria were patients in whom contraindications to spinal anesthesia were present, conversion to open surgery, and gastric and rectal surgery. The intervention group received single-shot intrathecal bupivacaine/morphine (12.5 mg/300 mug), with an altered dose for older patients. The control group received a sham procedure and a bolus of piritramide (0.1 mg/kg). Both groups received standardized general anesthesia and a patient-controlled intravenous analgesia pump as postoperative analgesia. All patients were treated according to an ERAS protocol. A decrease in days to "fit for discharge" was the primary outcome. Results Fifty-six patients were enrolled. Intervention group patients were fit for discharge earlier (median of 3 vs 4 days, P = 0.044). Furthermore, there was a significant decrease in opioid use and lower pain scores on the first postoperative day in the intervention group. There were no differences in adverse events (except for more pruritus), time to mobilization, fluid administration, or patient satisfaction. Conclusions: This randomized controlled trial shows that intrathecal morphine is a more effective method of postoperative analgesia in laparoscopic surgery than intravenous opioids within an ERAS program. Recovery is faster and less painful with intrathecal morphine. Other studies have confirmed these results, although data on faster recovery are new and require confirmation in future trials. © Copyright 2017 The Author(s). Database: EMBASE

214. Ultrasound Identification of Diaphragm by Novices Using ABCDE Technique Author(s): Khurana J.; Gartner S.C.; Naik L.; Tsui B.C.H. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 161-165 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background and Objectives In this study, we examined the consistency, rapidity, and reproducibility of the ABCDE technique for diaphragm identification. Operators using this method place the probe at the Anterior axillary line, watch for Breathing (lung sliding), and then move the probe Caudally to identify the Diaphragm for Examination. Methods A convenience sample of 100 patients was recruited from the preadmission clinic. Two novice operators each scanned the diaphragm using a linear ultrasound transducer in B-mode. Both operators completed the examination on all participants using the ABCDE technique, their times were averaged, and clinical success was defined as identification of the diaphragm in less than 2 minutes. Results An average of 33.7 seconds was taken to scan and identify the right hemidiaphragm (RD) (median, 25 seconds; 95% confidence interval, 28.8-38.5 seconds) with a 98% clinical success ratio, and an average of 46.9 seconds was taken to identify the left hemidiaphragm (LD) (median, 39.5 seconds; 95% confidence interval, 40.2-53.6 seconds) with a 97% clinical success ratio. In patients with a body mass index (BMI) of less than 30 kg/m2, a 100% success ratio was seen when scanning the RD and 97% when scanning the LD. For those with a BMI of 30 kg/m2 or greater, a 94% success rate was seen when scanning the RD and 97% when scanning the LD. No clinically significant differences were found between the times required for scanning either side of the diaphragm, regardless of the BMI. Conclusions The ABCDE technique demonstrates a fast, reliable, and simple method in which ultrasound can be used to visualize the diaphragm. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

215. Relative Contributions of Adductor Canal Block and Intrathecal Morphine to Analgesia and Functional Recovery after Total Knee Arthroplasty: A Randomized Controlled Trial Author(s): Biswas A.; Perlas A.; Ghosh M.; Chin K.; Niazi A.; Pandher B.; Chan V. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 154-160 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background and Objectives Effective postoperative analgesia may enhance early rehabilitation after orthopedic surgery. This randomized double-blind trial investigates the relative contributions of adductor canal block and low-dose intrathecal morphine (ITM) to postoperative analgesia and functional recovery after total knee arthroplasty. Methods Two-hundred one patients undergoing elective unilateral total knee arthroplasty under spinal anesthesia were randomized to 3 groups. All patients received standardized intraoperative local infiltration analgesia and postoperative oral analgesics. Patients in group 1 received a "sham" adductor canal block with 30 mL of normal saline. Patients in group 2 received an adductor canal block with 30 mL of ropivacaine 0.5% with 1:400,000 epinephrine, whereas patients in group 3 received the adductor canal block with the active drug and 100 mug of ITM. The primary outcome measure was the Timed Up and Go (TUG) test on the second postoperative day. Secondary outcomes included postoperative pain scores and opioid requirements, distance walked, time to hospital discharge, and self- reported functional outcomes at 3 months. Results All 3 groups had similar values of TUG test on postoperative day (POD) 2 (46 [36-62], 45 [33-61], and 52 [41-69]; P = 0.166) as well as other short-term and 3-month functional outcomes. Patients in group 3 showed a favorable analgesic profile as evidenced by 3 positive secondary outcomes. These positive outcomes were lower pain scores 12 hours postoperatively both at rest (4 [2-6.3], 4 [2.3-6], and 3 [1-4]; P = 0.007) and on movement (6 [4-8], 6 [3-8], and 4 [2-6]; P = 0.002), a lower incidence of "rescue" intravenous patient-controlled analgesia (42%, 34%, and 20%; P = 0.031), and the lowest cumulative opioid requirements for the first 48 hours postoperatively (86 +/- 71, 68 +/- 46, and 59 +/- 39; P < 0.005, group 3 compared with group 1). Conclusions Our data suggest that there is no difference in either the primary outcome of TUG test on POD 2, other immediate functional secondary outcomes, or in global functional outcome at 3 months postoperatively across all 3 groups. Our data also suggest an improved analgesic profile in the first 48 hours postoperatively when both adductor canal block and low-dose ITM (100 mug) are added to local infiltration analgesia as evidenced by several positive secondary outcomes of lower pain scores and opioid requirements. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

216. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version Author(s): Neal J.M.; Woodward C.M.; Harrison T.K. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 150-153 Publication Date: Feb 2018 Publication Type(s): Article Abstract:The American Society of Regional Anesthesia and Pain Medicine (ASRA) periodically revises and updates its checklist for the management of local anesthetic systemic toxicity. The 2017 update replaces the 2012 version and reflects new information contained in the third ASRA Practice Advisory on Local Anesthetic Systemic Toxicity. Electronic copies of the ASRA checklist can be downloaded from the ASRA Web site (www.asra.com) for inclusion in local anesthetic toxicity rescue kits or perioperative checklist repositories. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

217. Local Anesthetic Systemic Toxicity in Total Joint Arthroplasty: Incidence and Risk Factors in the United States from the National Inpatient Sample 1998-2013 Author(s): Rubin D.S.; Matsumoto M.M.; Weinberg G.; Roth S. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 131-137 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Background Local anesthetic systemic toxicity (LAST) is a rare and potentially devastating complication of regional anesthesia. Single-institution registries have reported a decreasing incidence, but these results have limited broad applicability. A recent study using a US database found a relatively high incidence of LAST. We used the National Inpatient Sample, a US database of inpatient admissions, to identify the national incidence and associated risk factors for LAST in total joint arthroplasties. Methods In this retrospective study, we studied patients undergoing hip, knee, or shoulder arthroplasty, from 1998 to 2013, with an adjunct peripheral nerve blockade. We used a multivariable logistic regression to identify patient conditions, hospital level variables, and procedure sites associated with LAST. Results A total of 710,327 discharges met inclusion criteria. The average adjusted incidence was 1.04 per 1000 peripheral nerve blocks, with decreasing trend over the 15-year study period (odds ratio [OR], 0.90; P = 0.002). Shoulder arthroplasty (OR, 4.35; P = 0.0001) compared with knee or hip arthroplasty and medium-size (OR, 3.34; P = 0.003) and large- size (OR, 2.40; P = 0.025) hospitals as compared with small hospitals were associated with increased odds of LAST. Conclusions The incidence of LAST nationally in total joint arthroplasty with adjunct nerve blocks is similar to recent estimates from academic centers, with a small decreasing trend through the study period. Despite an overall low incidence rate, practitioners should continue to maintain vigilance for manifestations of LAST, especially as the use of regional anesthesia continues to increase. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

218. Local Anesthetic Systemic Toxicity: A Review of Recent Case Reports and Registries Author(s): Gitman M.; Barrington M.J. Source: Regional Anesthesia and Pain Medicine; Feb 2018; vol. 43 (no. 2); p. 124-130 Publication Date: Feb 2018 Publication Type(s): Article Abstract:This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single- center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21-0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature. © Copyright 2018 American Society of Regional Anesthesia and Pain Medicine. Database: EMBASE

219. Le bruit de l'air : echographie pulmonaire au point d'intervention en medecine perioperatoireThe sound of air: point-of-care lung ultrasound in perioperative medicine Author(s): Goffi A.; Kruisselbrink R.; Volpicelli G. Source: Canadian Journal of Anesthesia; Feb 2018 ; p. 1-18 Publication Date: Feb 2018 Publication Type(s): Article In Press Abstract:Purpose: Lung ultrasound (LUS) has emerged as an effective and accurate goal- directed diagnostic tool that can be applied in real time for the bedside assessment of patients with respiratory symptoms and signs. Lung ultrasound has definite and easily recognized findings and has been shown to outperform physical examination and chest radiography for the diagnosis and monitoring of many pulmonary and pleural conditions. In this article, we review the principles of LUS image acquisition and interpretation, summarizing key terms and sonographic findings. Principal findings: Although LUS is easy to learn, adequate training and performance in an organized fashion are crucial to its clinical effectiveness and to prevent harm. Therefore, we review normal LUS findings and propose step-wise approaches to the most common LUS diagnoses, such as pneumothorax, pleural effusion, interstitial syndrome, and lung consolidation. We highlight potential pitfalls to avoid and review a recently published practical algorithm for LUS use in clinical practice. Conclusions: Because of the unique physical properties of the lungs, only a careful and systematic analysis of both artifacts and anatomical images allows accurate interpretation of sonographic findings. Future studies exploring the use of software for automatic interpretation, quantitative methods for the assessment of interstitial syndrome, and continuous monitoring devices may further simplify and expand the use of this technique at the bedside in acute medicine and the perioperative setting. Copyright © 2018 Canadian Anesthesiologists' Society Database: EMBASE

220. Enthesitis: A hallmark of psoriatic arthritis Author(s): Kaeley G.S.; Eder L.; Aydin S.Z.; Gutierrez M.; Bakewell C. Source: Seminars in Arthritis and Rheumatism; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: To describe the growing importance of enthesitis in patients with psoriatic arthritis (PsA) and discuss the advantages and disadvantages of clinical and imaging methods currently used to assess enthesitis. Methods: PubMed literature searches were conducted using the terms psoriatic arthritis, entheses, enthesitis, pathology, imaging, ultrasound, magnetic resonance imaging, clinical, and indices. Articles were deemed relevant if they provided insight into the pathology, monitoring, and/or diagnosis of enthesitis in PsA, or if they discussed clinical or imaging indices used to assess enthesitis. Results: Enthesitis is an early manifestation of PsA that is associated with increased disease activity and reduced quality of life. A variety of clinical indices exist to assess enthesitis in PsA; however, the Leeds Enthesitis Index and Maastricht Ankylosing Spondylitis Enthesitis Score index have been the most frequently used indices in recent clinical trials. Limitations of these indices include an inability to discern structural involvement, risk of missing subclinical enthesitis, and lack of sensitivity in detecting enthesitis, especially in patients with central sensitization and/or pain amplification. Such limitations have led to the emergent importance of imaging techniques in the assessment of enthesitis. Although there have been recent advances in magnetic resonance imaging, ultrasound (US) appears to be the preferred method for detecting enthesitis because it allows for accurate assessment of the soft-tissue components of entheses and also for new bone formation. Hypoechogenicity, increased thickness of tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity have been identified as important US characteristics of enthesitis. Conclusion: Enthesitis is thought to be integrally involved in the pathogenesis of PsA and is associated with worse prognostic outcomes in patients with PsA. A validated US index with entheses that are less confounded by mechanical factors and obesity would be the most effective measure of enthesitis in PsA. As imaging techniques continue to advance, our understanding of enthesitis and its involvement in PsA will also improve. Copyright © 2018 The Authors. Database: EMBASE

221. Protecting the Right Ventricle in ARDS: The Role of Prone Ventilation Author(s): Zochios V.; Parhar K.; Vieillard-Baron A. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

222. Analysis of mortality in a cohort of 650 cases of bacteremic osteoarticular infections Author(s): Gomez-Junyent J.; Murillo O.; Grau I.; Benavent E.; Ribera A.; Ariza J.; Pallares R.; Cabo X.; Tubau F. Source: Seminars in Arthritis and Rheumatism; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objectives: The mortality of patients with bacteremic osteoarticular infections (B- OAIs) is poorly understood. Whether certain types of OAIs carry higher mortality or interventions like surgical debridement can improve prognosis, are unclarified questions. Methods: Retrospective analysis of a prospective cohort of patients with B-OAIs treated at a teaching hospital in Barcelona (1985-2014), analyzing mortality (30-day case-fatality rate). B-OAIs were categorized as peripheral septic arthritis or other OAIs. Factors influencing mortality were analyzed using logistic regression models. The association of surgical debridement with mortality in patients with peripheral septic arthritis was evaluated with a multivariate logistic regression model and a propensity score matching analysis. Results: Among 650 cases of B-OAIs, mortality was 12.2% (41.8% of deaths within 7 days). Compared with other B-OAI, cases of peripheral septic arthritis were associated with higher mortality (18.6% vs 8.3%, p < 0.001). In a multiple logistic regression model, peripheral septic arthritis was an independent predictor of mortality (adjusted odds ratio [OR] 2.12; 95% CI: 1.22-3.69; p = 0.008). Cases with peripheral septic arthritis managed with surgical debridement had lower mortality than those managed without surgery (14.7% vs 33.3%; p = 0.003). Surgical debridement was associated with reduced mortality after adjusting for covariates (adjusted OR 0.23; 95% CI: 0.09-0.57; p = 0.002) and in the propensity score matching analysis (OR 0.81; 95% CI: 0.68-0.96; p = 0.014). Conclusions: Among patients with B-OAIs, mortality was greater in those with peripheral septic arthritis. Surgical debridement was associated with decreased mortality in cases of peripheral septic arthritis. Copyright © 2018 Elsevier Inc. Database: EMBASE

223. Extracorporeal Membrane Oxygenation-Assisted Airway Management for Difficult Airways Author(s): Yunoki K.; Miyawaki I.; Yamazaki K.; Mima H. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

224. Validation of the Swedish version of Quality of Recovery score -15: A multicentre, cohort study Author(s): Lyckner S.; Boregard I.-L.; Zetterlund E.-L.; Chew M.S. Source: Acta Anaesthesiologica Scandinavica; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Acta Anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Quality of recovery (QoR) after surgery is often focused on morbidity, mortality and physiological changes, while well-being and emotional state are other important aspects that are often ignored. QoR is poorly investigated in clinical settings and a psychometrically tested questionnaire, QoR-15, has recently been developed. QoR-15 has not been validated for Swedish conditions. The aim of this study was to translate, adapt and validate QoR-15 to Swedish conditions (QoR-15swe). Methods: A translation and cultural adaption was performed resulting in a Swedish version of the instrument, QoR-15swe. Patients answered the QoR-15swe before surgery, 24 and 48 h after surgery. Feasibility, validity, reliability and responsiveness of the QoR-15swe were evaluated. Results: The QoR- 15swe was feasible in 85.5% of the eligible patients. Construct validity was good, with significant correlations between QoR-15swe score and, ASA-PS class, grade of surgery, length of surgery and time in the post-anaesthesia care unit. The instrument demonstrated good internal consistency with an inter-item Cronbach's alpha of 0.83-0.87, and inter- dimension Cronbach's alpha was acceptable 0.71-0.76. Test-retest repeatability was also good with Cronbach's alpha > 0.99 and an interclass correlation coefficient of 0.992 (CI: 0.981-0.997). There were no floor and ceiling effects. Responsiveness assessed by Cliff's effect size was -0.23 indicating a moderate ability to detect change at 24 h postoperatively. Conclusion: We have translated and culturally adapted the QoR-15 into Swedish. The score demonstrated acceptable validity, reliability and responsiveness. The QoR-15swe is a clinically acceptable and feasible outcome measure after surgery in a Swedish population. Copyright © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Database: EMBASE

225. Mallory-Weiss syndrome diagnosed after tracheal extubation Author(s): Ebana H.; Obara S.; Murakawa M. Source: Journal of Anesthesia; Jan 2018 ; p. 1 Publication Date: Jan 2018 Publication Type(s): Article In Press Database: EMBASE

226. Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients Author(s): Davis F.; Roberts B.A.; Risko R.; Gostine M.; Cappelleri J.C.; Sadosky A. Source: Pain Practice; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Objective: To evaluate the effectiveness of opioids and/or pregabalin on patient- reported outcomes among fibromyalgia (FM) patients based on levels of improvement. Methods: A total of 1,421 FM patients were identified, with 3,082 observational periods of opioids with or without pregabalin use between April 2008 and February 2015. Patients were categorized by opioids, and pregabalin with and without opioids; opioids were designated by morphine equivalent dose (MED) of <= 20 (low MED), > 20 to < 100 (moderate MED), >= 100 (high MED), and pregabalin doses of <= 150 mg, 151 to 300 mg, and 301 to 450 mg. Proportions of patients meeting clinically relevant thresholds of >= 30% and >= 50% improvement for pain interference (ability to enjoy life; activity; mood; relationships; sleep), pain severity, and fatigue were compared among treatments, and area under the curve (AUC) for improvement and worsening of effects was determined, enabling ranking of treatments. Further analysis compared pregabalin doses. Results: Pregabalin without opioids resulted in the highest proportions of patients with >= 30% improvement on all pain items and pain interference with "ability to enjoy life,""activity""mood," and "sleep." For the >= 50% threshold, pregabalin alone was highest for all pain interference items and for "average pain" and "worst pain." Pregabalin was consistently lowest across thresholds for fatigue, but showed better results combined with moderate MED opioids. Pregabalin doses recommended for treatment of FM (151 to 450 mg) generally resulted in the highest proportion of patients achieving thresholds relative to opioids. The AUC results were consistent with thresholds; pregabalin without opioids resulted in the greatest benefits with regard to improvement, with the highest ranking for overall improvement and overall effects. Conclusion: Pregabalin without opioids provided the most favorable outcomes overall based on >= 30% and >= 50% improvement thresholds and AUC, with support for moderate MED opioids + pregabalin in patients suffering from fatigue. While most patients took less than recommended pregabalin doses, higher doses may lead to improved outcomes. Copyright © 2018 World Institute of Pain. Database: EMBASE

227. Hypertension, mitral valve disease, atrial fibrillation and low education level predict delirium and worst outcome after cardiac surgery in older adults Author(s): Oliveira F.R.; Calderaro D.; Gualandro D.M.; Caramelli B.; Lima J.W.; Oliveira V.H.; Oliveira M. Source: BMC Anesthesiology; Feb 2018; vol. 18 (no. 1) Publication Date: Feb 2018 Publication Type(s): Article Available at BMC anesthesiology - from BioMed Central Available at BMC anesthesiology - from Europe PubMed Central - Open Access Available at BMC anesthesiology - from PubMed Central Abstract:Background: Delirium is a common complication after cardiac surgery in older adult patients. However, risk factors and the influence of delirium on patient outcomes are not well established. We aimed to determine the incidence, predisposing and triggering factors of delirium following cardiac surgery. Methods: One hundred seventy-three consecutive patients aged >=60 years were studied. Patients' characteristics and two cognitive function assessment tests were recorded preoperatively. Perioperative variables were blood transfusion, orotracheal intubation time (OIT), renal dysfunction, and hypoxemia. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. The composite outcome consisted of death, infection, and perioperative myocardial infarction until hospital discharge or 30 days after surgery, and for up to 18 months. Results: One hundred six patients (61.27%) were men and the age was 69.5+/-5.8 years. EuroSCORE II index was 4.06+/-3.86. Hypertension was present in 75.14%, diabetes in 39.88%, and 30.06% were illiterate. Delirium occurred in 59 patients (34.1%). Education level (OR 0.81, 0.71-0.92), hypertension (OR 2.73, 1.16-6.40), and mitral valve disease (OR 2.93, 1.32-6.50) were independent predisposing factors for delirium, and atrial fibrillation after surgery (OR 2.49, 1.20-5.20) represented the potential triggering factor. Delirium (OR 2.35, 1.20-4.58) and OIT>=900 min (OR 2.50; 1.30-4.80) were independently associated with the composite outcome. Conclusions: In older adult patients submitted to cardiac surgery, delirium is a frequent complication that is associated with worst outcome. Independent risk factors for delirium included education level, hypertension, mitral valve disease, and atrial fibrillation after cardiac surgery. Copyright © 2018 The Author(s). Database: EMBASE

228. Effect of auricular point acupressure on axial neck pain after anterior cervical discectomy and fusion: A randomized controlled trial Author(s): Xia B.; Hu S.; Xu T.; Tong P.; Xie Y. Source: Pain Medicine (United States); Jan 2018; vol. 19 (no. 1); p. 193-201 Publication Date: Jan 2018 Publication Type(s): Article Abstract:Objectives. To evaluate the effect of auricular point acupressure (APA) on axial neck pain after anterior cervical discectomy and fusion (ACDF) surgery. Design. A prospective randomized controlled trial was performed. Subjects and setting. Twenty-nine participants were randomly divided into two groups, real or sham APA. Participants were enrolled from Shaoxing Hospital of Traditional Chinese Medicine, affiliated with Zhejiang Chinese Medical University. Methods. Eligible participants received a four-week real or sham APA treatment according to their assigned groups. The clinical outcomes were assessed by the criteria of Hosono et al., the Brief Pain Inventory Short Form (BPI), and the 36-item Short Form Health Survey (SF-36). In addition, plasma interleukin (IL)-1b, IL-6, and tumor necrosis factor (TNF)-a were analyzed. Results. Patients with severe or moderate axial neck pain accounted for 28.6% and 35.7% in the real APA group at the end of treatment and one-month follow-up. BPI scores were decreased in the real APA group at the end of treatment and one-month follow-up. The total mean score of SF-36 was improved in the real APA group and significantly higher than in the sham APA group. Additional, the levels of IL-1beta, IL-6, and TNF-alpha were decreased in the real APA group. Conclusions. The findings supported the therapeutic effect of APA treatment on axial neck pain after ACDF surgery, and they exert the possible therapeutic effect on downregulating the levels of plasma IL-1beta, IL-6, and TNF-alpha. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

229. TNF-alpha and sTNF-RII are associated with pain following hip fracture surgery in older adults Author(s): Ko F.C.; Rubenstein W.J.; Lee E.J.; Siu A.L.; Morrison R.S. Source: Pain Medicine (United States); Jan 2018; vol. 19 (no. 1); p. 169-177 Publication Date: Jan 2018 Publication Type(s): Article Abstract:Objective. To explore whether plasma inflammatory mediators on postoperative day 3 (POD3) are associated with pain scores in older adults after hip fracture surgery. Design. Cross-sectional study. Setting. Mount Sinai Hospital, New York, New York. Subjects. Forty patients age 60 years or older who presented with acute hip fracture at Mount Sinai Hospital between November 2011 and April 2013. Methods. Plasma levels of six inflammatory mediators of the nuclear factor kappa B pathway were measured using blood collected on POD3. Selfreported pain scores (i.e., pain with resting, walking, and transferring) were assessed at baseline (prefracture) and on POD3. Linear regression models using log-transformed data were performed to determine associations between inflammatory mediators and postoperative pain. Results. Interleukin 18 (IL-18) was positively associated with POD3 resting pain score in the unadjusted model (b50.66, P50.03). Tumor necrosis factor a (TNF-a) and soluble TNF receptor II (sTNF-RII) were positively associated with POD3 resting pain score in the adjusted model (b50.99, P50.03, and b50.86, P50.04, respectively). Moreover, TNF-a was positively associated with POD3 walking pain score in the adjusted model (b51.59, P50.05). Pain with transferring was not associated with these inflammatory mediators. Conclusions. These findings suggest that TNF-a and its receptors may influence pain following hip fracture. Further study of the TNF-a pathway may inform future clinical applications that monitor and treat pain in the vulnerable elderly who are unable to accurately report pain. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

230. Innovative technology using virtual reality in the treatment of pain: Does it reduce pain via distraction, or is there more to it? Author(s): Gupta A.; Scott K.; Dukewich M. Source: Pain Medicine (United States); Jan 2018; vol. 19 (no. 1); p. 151-159 Publication Date: Jan 2018 Publication Type(s): Article Abstract:Objective. Virtual reality (VR) is an exciting new technology with almost endless possible uses in medicine. One area it has shown promise is pain management. This selective review focused on studies that gave evidence to the distraction or nondistraction mechanisms by which VR leads to the treatment of pain. Methods. The review looked at articles from 2000 to July 29, 2016, focusing on studies concerning mechanisms by which virtual reality can augment pain relief. The data was collected through a search of MEDLINE and Web of Science using the key words of "virtual reality" and "pain" or "distraction." Results. Six studies were identified: four small randomized controlled studies and two prospective/ pilot studies. The search results provided evidence that distraction is a technique by which VR can have benefits in the treatment of pain. Both adult and pediatric populations were included in these studies. In addition to acute pain, several studies looked at chronic pain states such as headaches or fibromyalgia. These studies also combined VR with other treatment modalities such as biofeedback mechanisms and cognitive behavioral therapy. Conclusions. These results demonstrate that in addition to distraction, there are novel mechanisms for VR treatment in pain, such as producing neurophysiologic changes related to conditioning and exposure therapies. If these new mechanisms can lead to new treatment options for patients with chronic pain, VR may have the ability to help reduce opioid use and misuse among chronic pain patients. More studies are needed to reproduce results from prospective/pilot studies in large randomized control studies. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

231. Rational urine drug monitoring in patients receiving opioids for chronic pain: Consensus recommendations Author(s): Argoff C.E.; Alford D.P.; Fudin J.; Adler J.A.; Bair M.J.; Dart R.C.; Gandolfi R.; McCarberg B.H.; Stanos S.P.; Gudin J.A.; Polomano R.C.; Webster L.R. Source: Pain Medicine (United States); Jan 2018; vol. 19 (no. 1); p. 97-117 Publication Date: Jan 2018 Publication Type(s): Review Abstract:Objective. To develop consensus recommendations on urine drug monitoring (UDM) in patients with chronic pain who are prescribed opioids. Methods. An interdisciplinary group of clinicians with expertise in pain, substance use disorders, and primary care conducted virtual meetings to review relevant literature and existing guidelines and share their clinical experience in UDM before reaching consensus recommendations. Results. Definitive (e.g., chromatography-based) testing is recommended as most clinically appropriate for UDM because of its accuracy; however, institutional or payer policies may require initial use of presumptive testing (i.e., immunoassay). The rational choice of substances to analyze for UDM involves considerations that are specific to each patient and related to illicit drug availability. Appropriate opioid risk stratification is based on patient history (especially psychiatric conditions or history of opioid or substance use disorder), prescription drug monitoring program data, results from validated risk assessment tools, and previous UDM. Urine drug monitoring is suggested to be performed at baseline for most patients prescribed opioids for chronic pain and at least annually for those at low risk, two or more times per year for those at moderate risk, and three or more times per year for those at high risk. Additional UDM should be performed as needed on the basis of clinical judgment. Conclusions. Although evidence on the efficacy of UDM in preventing opioid use disorder, overdose, and diversion is limited, UDM is recommended by the panel as part of ongoing comprehensive risk monitoring in patients prescribed opioids for chronic pain. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

232. Pain management for primary care providers: A narrative review of high-impact studies, 2014-2016 Author(s): Becker W.C.; Bair M.J.; Picchioni M.; Starrels J.L.; Frank J.W. Source: Pain Medicine (United States); Jan 2018; vol. 19 (no. 1); p. 40-49 Publication Date: Jan 2018 Publication Type(s): Review Abstract:Objective. This manuscript reviews high-impact, peer-reviewed studies published from January 2014 to March 2016 that are relevant to pain management in primary care. Given the recent release of the US Centers for Disease Control and Prevention's "Guideline for Prescribing Opioids for Chronic Pain" emphasizing the primacy of nonopioid treatment, we focused our review on nonopioid pain management. Design. Narrative review of peer- reviewed literature. Methods. We searched three article summary services and queried expert contacts for high-impact, English-language studies related to the management of pain in adults in primary care. All authors reviewed 142 study titles to arrive at group consensus on article content domains. Within article domains, individual authors selected studies approved by the larger group according to their impact on primary care clinical practice, policy, and research, as well as quality of the study methods. Through iterative discussion, 12 articles were selected for detailed review, discussion, and presentation in this narrative review. Results. We present key articles addressing each of six domains of pain management: pharmacotherapy for acute pain; interventional treatments; medical cannabis; complementary and integrative medicine care management in chronic pain; and prevention. Within each section, we conclude with implications for pain management in primary care. Conclusions. There is growing evidence for multiple nonopioid treatment modalities available to clinicians for the management of pain in primary care. The dissemination and implementation of these studies, including innovative care management interventions, warrant additional study and support from clinicians, educators, and policy- makers. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

233. No transfer of pressure to adjacent discs during human low-pressure controlled discography: A prospective clinical study Author(s): Kallewaard J.W.; Geurts J.W.; Terheggen M.; Terwiel C.; van Kleef M.; Kessels A.; Willems P.C. Source: Pain Medicine (United States); Jan 2018; vol. 19 (no. 1); p. 29-39 Publication Date: Jan 2018 Publication Type(s): Article Abstract:Background. A substantial part of low back pain (LBP) originates from degeneration of the intervertebral disc. To confirm the diagnosis of discogenic pain, provocation discography seems the best available tool. However, provocation discography is also considered to be a controversial and subjective test because the patient's personal pain response is the most crucial for the result of the test. Recently, an in vivo porcine study and a study in nine human subjects showed passing of pressure to the adjacent discs during discography. This could mean that the concordant pain the patient describes originates from an adjacent disc. The object of this study is to assess if during human lumbar pressurecontrolled provocation discography there is pressure transmission to adjacent discs. Methods. Consecutive patients between age 18 and 65 years with intractable low back pain and at least 50% preserved height of the suspected painful disc were included. Exclusion criteria were prior lumbar surgery of the suspected level, use of anticoagulants, pregnancy, local infection, and iodine allergy. An arterial blood pressure monitoring system simultaneously assessed the pressure in the adjacent discs while low-speed flow, pressurecontrolled discography was performed. Results. In 50 patients with a positive discography, the average intradiscal peak pressure was 15.1 psi (SD511.1). In 48 procedures, no pressure rise in the adjacent discs was found. A small pressure rise (1.1 psi) in the adjacent disc during discography was recorded in two patients. Conclusions. Pressure rise in adjacent discs does not seem to occur during low-speed flow pressurecontrolled lumbar provocation discography. Falsepositive pain reactions caused by potentially painful adjacent discs are therefore unlikely during pressure-controlled discography. Copyright © 2017 American Academy of Pain Medicine. Database: EMBASE

234. Unknown left atrial appendage mass! real-time three-dimensional transesophageal echocardiography helps in identification Author(s): Tewari P.; Dixit A.; Soori R. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 97-98 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Left Atrial Appendage (LAA) is the most contractile part of Left atrium. It is also the most frequent place for thrombus formation that may lead to disastrous consequences. Complete trasoesophageal echocardiography examination always includes assessing LAA but sometimes unusually placed pectinate muscle, which is a normal structure may give baffling shadow that can only be interpreted correctly by Real time 3D echocardiography. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

235. Quadricuspid aortic valve: A rare intraoperative diagnosis by transesophageal echocardiography Author(s): Das A.; Rajashekar P.; Singh U. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 95-96 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Quadricuspid aortic valve (QAV) is a rare congenital anomaly frequently associated with other anomalies particularly coronary anomalies. It may be detected on transthoracic or transesophageal echocardiography. We present here a case report of a 27-year-old male patient with a QAV, the valve being regurgitant and requiring aortic valve replacement. It has been reported as isolated case reports in the literature and various theories exist to the development of QAV. The diagnosis requires a high degree of suspicion and a detailed assessment, and if asymptomatic, then patients need to be carefully followed up for the development of aortic regurgitation. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

236. Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study Author(s): Champion S.; Zieger L.; Hemery C. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 8-14 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Context: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate. Aims: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention. Setting and Design: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016. Methods: Five hundred and two patients with planned nonemergent cardiac surgery were included. Interventions: In the intervention arm, PONV prophylaxis (4 mg betamethasone with/without 0.625 mg droperidol) was administered in high-risk patients (two or more risk factors). Patients in the control arm were treated as per routine hospital practices. Results: Female sex, past history of PONV, and migraines were associated with a significantly increased risk of PONV, while motion sickness, smoking status, and volatile anesthetics were not. Pain and treatment with nefopam or ketoprofen were associated with an increased risk of PONV. PONV was less frequent in the active arm compared to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs. 15.3 mm, P = 0.043). Among the 180 patients (35.6%) with >=2 risk factors, prophylaxis was associated with reduced PONV (intention-to-treat: 46.8% vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In multivariate analysis, prophylaxis was independently associated with PONV (odds ratio [OR]: 0.324, 95% confidence interval: 0.167-0.629, P = 0.0009), as were female sex, past history of PONV, and migraines (OR: 3.027, 3.031, and 2.160 respectively). No drug-related side effects were reported. Conclusion: Betamethasone with/without droperidol was effective in decreasing PONV in high risk cardiac surgical patients without any side effect. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

237. Bleeding in the lung complicates a routine intracardiac repair: What went wrong!!! Author(s): Makhija N.; Magoon R.; Choudhury M.; Ramakrishnan S. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 78-81 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals. Nevertheless, the coiling of the collaterals in certain specific case scenarios is not feasible, rendering the management of a lung bleed, all the more challenging. We, hereby discuss a case of a 7-year-old girl with a massive endotracheal bleed at the time of weaning from cardiopulmonary bypass after corrective surgery for TOF. The subsequent approach and management are discussed. The optimal management of tetralogy with collaterals mandates an effective communication among the cardiologist, radiologist, anesthesiologist, and the surgeon. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

238. Successful resolution with apixaban of a massive left atrial appendage thrombus due to nonrheumatic atrial fibrillation: A case report and review Author(s): Ghalyoun B.; Lempel M.; Shamoon F.; Shaaban H. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 76-77 Publication Date: 2018 Publication Type(s): Review Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:A 32-year-old woman with a past medical history of paroxysmal atrial fibrillation, long QT syndrome, and implantation of an automatic iimplantable cardioverter-defibrillator (AICD) following cardiac arrest presented with disabling symptoms of paroxysmal atrial fibrillation due to recurrent AICD shocks. Before curative ablation, transesophageal echocardiography was performed to assess for existing thrombi. This is a rare case of successful resolution with apixaban of a massive left atrial appendage thrombus due to nonrheumatic atrial fibrillation that was successfully treated with apixaban. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

239. Large inferolateral left ventricular aneurysm Author(s): Flam B.; Albage A. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 68-70 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:The majority of cardiac left ventricular aneurysms involve the anterior and/or apical wall. We present a case of a 50-year-old man with heart failure caused by a large inferolateral left ventricular aneurysm and associated mitral regurgitation, managed by aneurysmectomy, mitral valvuloplasty, and surgical revascularization. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

240. Right atrial fibroma in an adult patient Author(s): Heidari A.; Sabzi F.; Faraji R. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 65-67 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Left atrial fibroma as a benign tumor is an exceedingly rare left atrial mass. It has various clinical signs and symptoms and sometimes leads to serious complications such as lethal arrhythmia and death. We report a case of right atrial fibroma in a 40-year-old male who presented with dyspnea and atrial fibrillation. Transthoracic echocardiography revealed a large sessile mass attached to interatrial septum near the coronary sinus valve in the right atrium. The patient underwent surgical resection of tumor through the right atrium. The postoperative course was unremarkable. Histopathological examination showed that it was a fibroma. The 6-month follow-up revealed that the patient was in well condition with no evidence of tumor recurrence. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

241. Transesophageal echocardiography evaluation of the aortic arch branches Author(s): Patil T.A.; Ambli S. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 53-56 Publication Date: 2018 Publication Type(s): Review Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Visualization of aortic arch branches by transesophageal echocardiography has been technically challenging. Visualizing these vessels helps in identifying the extent of dissection of the aorta, assessing the severity of carotid artery stenosis, presence of atheromatous plaques, patency of the left internal mammary artery graft, confirmation of subclavian artery cannulation, confirming holodiastolic flow reversal in the left subclavian artery by spectral Doppler imaging in case of severe aortic regurgitation, and confirming the optimal position of the intraaortic balloon perioperatively. The information obtained is helpful for diagnosis, monitoring, and decision-making during aortic surgery. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

242. Long-term quality of life postacute kidney injury in cardiac surgery patients Author(s): Mishra P.K.; Luckraz H.; Nandi J.; Panayiotou A.; Nevill A.; Giri R.; Nicholas J. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 41-45 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Background: Acute renal failure after cardiac surgery is known to be associated with significant short-term morbidity and mortality. There have as yet been no major reports on long-term quality of life (QOL). This study assessed the impact of acute kidney injury (AKI) and renal replacement therapy (RRT) on long-term survival and QOL after cardiac surgery. The need for long-term RRT is also assessed. Materials and Methods: Patients who underwent cardiac surgery between 2005 and 2011 (n = 6087) and developed AKI (RIFLE criteria, n = 570) were included. They were propensity-matched 1:1 to patients without renal impairment (control). Data were prospectively collected, and health-related QOL questionnaire was sent to patients who were alive at least 1-year postoperatively at the time of the study. Results: There was no significant difference in the preoperative characteristics between the two groups (age, gender, left ventricular ejection fraction, procedure, urgency, logistic Euroscore), respectively. Median follow-up was 52 months. Survival data were available in all patients. Questionnaires were returned in 64% of eligible patients. Long-term survival was significantly lower, and QOL, in particular the physical aspect, was significantly worse for the AKI group as compared to non-AKI group (38.8 vs. 44.2, P = 0.002), especially so in patients who required RRT. In alive respondents, despite an 18% (66/359) incidence of ongoing renal follow-up, the need for late RRT was only in 1.1% (4/359). Conclusion: AKI and especially the need for RRT following cardiac surgery are associated with increased long-term mortality as well as worse quality of life in a propensity- matched control group. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

243. A randomized controlled trial comparing the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass, assessed by changes in N-terminal brain natriuretic peptide Author(s): Kuppuswamy B.; Davis K.; Sahajanandan R.; Ponniah M. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 34-40 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Objective: The objective of the study is to compare the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass (CPB), the cardio protection been assessed by changes in N-terminal brain natriuretic peptide (NT proBNP). Methodology and Design: This study is designed as a participant blinded, prospective randomized clinical trial. Setting: Christian Medical College Hospital, Vellore, India. Participants: Patients undergoing elective coronary artery bypass surgery on CPB. Intervention: Anesthesia was maintained with 0.8-1.2 end tidal concentrations of isoflurane in the isoflurane group and in the propofol group, anesthesia was maintained with propofol infusion as described by Roberts et al. Measurements: Hemodynamic data were recorded at frequent intervals during the surgery and up to 24 h in the Intensive Care Unit (ICU). The other variables that were measured include duration of mechanical ventilation, dose and duration of inotropes in ICU, (inotrope score), duration of ICU stay, NT proBNP levels before induction and 24 h postoperatively, creatine kinase-MB levels in the immediate postoperative, first and second day. Results: Mean heart rate was significantly higher in propofol group during sternotomy, (P = 0.021). Propofol group had a significantly more number of patients requiring nitroglycerine in the prebypass period (P = 0.01). The increase in NT proBNP from preoperative to postoperative value was lesser in the isoflurane group compared to propofol even though the difference was not statistically significant. The requirement of phenylephrine to maintain mean arterial pressure within 20% of baseline, mechanical ventilation duration, inotrope use, duration of ICU stay and hospital stay were found to be similar in both groups. Conclusion: Propofol exhibit comparable myocardial protective effect like that of isoflurane in patients undergoing coronary artery bypass graft surgery. Considering the unproven mortality benefit of isoflurane and the improved awareness of green OT concept, propofol may be the ideal alternative to volatile anesthetics, at least in patients with good left ventricular function. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

244. Atrioventricular septal defects Author(s): Chauhan S. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 1-3 Publication Date: 2018 Publication Type(s): Review Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Database: EMBASE

245. Retrospective study of complete atrioventricular canal defects: Anesthetic and perioperative challenges Author(s): Janai A.R.; Bellinghausen W.; Turton E.; Bevilacqua C.; Zakhary W.; Ender J.; Kostelka M.; Bakhtiary F.; Hambsch J.; Daehnert I.; Loeffelbein F. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 15-21 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:Objective: The objective of this study was to highlight anesthetic and perioperative management and the outcomes of infants with complete atrioventricular (AV) canal defects. Design: This retrospective descriptive study included children who underwent staged and primary biventricular repair for complete AV canal defects from 1999 to 2013. Setting: A single-center study at a university affiliated heart center. Participants: One hundred and fifty-seven patients with a mean age at surgery of 125 +/- 56.9 days were included in the study. About 63.6% of them were diagnosed as Down syndrome. Mean body weight at surgery was 5.6 +/- 6.3 kg. Methods: Primary and staged biventricular repair of complete AV canal defects. Measurements and main results: A predefined protocol including timing of surgery, management of induction and maintenance of anesthesia, cardiopulmonary bypass, and perioperative intensive care treatment was used throughout the study. Demographic data as well as intraoperative and perioperative Intensive Care Unit (ICU) data, such as length of stay in ICU, total duration of ventilation including reintubations, and total length of stay in hospital and in hospital mortality, were collected from the clinical information system. Pulmonary hypertension was noted in 60% of patients from which 30% needed nitric oxide therapy. Nearly 2.5% of patients needed permanent pacemaker implantation. Thorax was closed secondarily in 7% of patients. In 3.8% of patients, reoperations due to residual defects were undertaken. Duration of hospital stay was 14.5 +/- 4.7 days. The in-hospital mortality was 0%. Conclusion: Protocolized perioperative management leads to excellent outcome in AV canal defect repair surgery. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

246. The influence of fluid management on outcomes in preeclampsia: A systematic review and meta-analysis Author(s): Pretorius T.; van Rensburg G.; Dyer R.A.; Biccard B.M. Source: International Journal of Obstetric Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Background: The optimal fluid management strategy to ensure best outcomes in preeclamptic patients remains a controversial issue, with little evidence to support any one approach. Objective: The aim of this systematic review was to investigate the effect of various fluid management strategies on clinical outcomes, haemodynamic indices and biochemical markers in preeclamptic women and their babies. Primary outcome measures were the occurrence of pulmonary oedema and/or the development of renal impairment. Methods: A systematic review of randomised fluid management strategies was conducted. Five electronic databases were searched using the expanded search terms: 'intravenous fluid', 'plasma substitutes', 'intravenous fluid management', 'intravenous fluid therapy', plasma volume expansion', 'fluid restriction', 'oncotic therapy', 'crystalloids', 'colloids', 'preeclampsia', 'toxemia of pregnancy', 'pregnancy-induced hypertension', 'eclampsia' and 'gestational proteinuric hypertension'. Results: Six randomised controlled trials (RCTs), from nine publications, were included in the final analysis. There were no differences between groups with respect to the incidence of pulmonary oedema, perinatal mortality, preterm delivery and caesarean section. Colloid volume expansion was associated with a significantly lower systolic and diastolic blood pressure, but had no effect on heart rate or cardiac index. Data on systemic vascular resistance (SVR), serum atrial natriuretic peptide (ANP) and urine volume could not be aggregated. Conclusion: Data on the ideal fluid strategy in women with preeclampsia is limited, and insufficient to make any strong recommendations. Further randomised controlled studies are needed to provide more evidence for which fluid management strategies are best suited to this heterogeneous patient group. Copyright © 2017 Elsevier Ltd. Database: EMBASE

247. Ultra-Short-Acting beta-Blockers (Esmolol and Landiolol) in the Perioperative Period and in Critically Ill Patients Author(s): Poveda-Jaramillo R.; Monaco F.; Zangrillo A.; Landoni G. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:beta-Blockers are useful drugs in several clinical cardiologic scenarios. Their use in the perioperative period and in critically ill patients is increasing, but their effect on clinically relevant outcomes remains controversial. Long-acting beta-blockers can have detrimental effects that are difficult to be counteracted in these settings. The authors describe the possible clinical uses of ultra-short-acting beta-blockers (esmolol and landiolol) in the perioperative period and in critically ill patients because these drugs have the beneficial effects of beta-blockers, but do not have the detrimental effects of long-acting agents. This narrative review focuses on ultra-short-acting beta-blockers in the following clinical settings: prevention and treatment of arrhythmias and myocardial ischemia in noncardiac and cardiac surgery, usage as cardioplegia adjuvants or to test the reversibility of systolic anterior motion of the mitral valve in cardiac surgery, medical treatment of aortic dissection before surgery, improvement of microcirculation and oxygenation in critically ill patients experiencing sepsis or undergoing extracorporeal membrane oxygenation, anesthesia induction, and coronary computed tomography angiography. Copyright © 2017 Elsevier Inc. Database: EMBASE

248. The Influence of Self-Efficacy, Fear-Avoidance Belief, and Coping Styles on Quality of Life for Chinese Patients with Chronic Nonspecific Low Back Pain: A Multisite Cross- Sectional Study Author(s): Du S.; Bai Y.; Jin S.; Zhang H.; Hu L.; Dong J.; Zhu Y. Source: Pain Practice; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: As a bio-psycho-social issue, chronic low back pain (CLBP) has been a significant topic in health management, and patients' quality of life (QOL) is gaining extensive attention. Self-efficacy, pain fear-avoidance belief (FAB), and coping styles play important roles in the QOL of CLBP patients. However, it remains unclear how self-efficacy and FAB influence QOL through specific coping styles. This study aimed to explore the influencing paths of self-efficacy, FAB, and coping styles on the QOL of patients with CLBP. Methods: This study relies on a multisite, cross-sectional design involving 221 CLBP patients. Stepwise multiple regression and structural equation modeling were employed. Results: CLBP patients lived with a poor global QOL. Self-efficacy played a direct, positive role in predicting QOL for patients with CLBP (beta = 0.35), and it also played an indirect, positive role in predicting QOL (beta = 0.19) through active coping styles (beta = 0.31). FAB played a direct, negative role in predicting QOL (beta = -0.33), and it also played an indirect, negative role in predicting QOL (beta = -0.32) through passive coping styles (beta = 0.32). Conclusions: Self-efficacy and FAB are both directly and indirectly related to global QOL, and coping styles are important mediating variables. Self-efficacy and active coping are protective factors for the QOL of CLBP patients, while FAB and passive coping are risk factors. Health education strategies are recommended by medical personnel to enhance CLBP patients' pain self-efficacy, decrease pain FAB, and modify pain coping styles, so that their global QOL can be improved. Copyright © 2018 World Institute of Pain. Database: EMBASE

249. A Randomized Controlled Trial Examining the Effect of the Addition of the Mandibular Block to Cervical Plexus Block for Carotid Endarterectomy Author(s): Kavrut Ozturk N.; Kavakli A.S.; Inanoglu K.; Sagdic K.; Umot Ayoglu R. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objectives: Although the cervical plexus block generally provides adequate analgesia for carotid endarterectomy, pain caused by metal retractors on the inferior surface of the mandible is not prevented by the cervical block. Different pain relief methods can be performed for patients who experience discomfort in these areas. In this study, the authors evaluated the effect of mandibular block in addition to cervical plexus block on pain scores in carotid endarterectomy. Design: A prospective, randomized, controlled trial. Setting: Training and research hospital. Participants: Patients who underwent a carotid endarterectomy. Interventions: Patients scheduled for carotid endarterectomy under cervical plexus block were randomized into 2 groups: group 1 (those who did not receive a mandibular block) and group 2 (those who received a mandibular block). The main purpose of the study was to evaluate the mandibular block in addition to cervical plexus block in terms of intraoperative pain scores. Measurements And Main Results: Intraoperative visual analog scale scores were significantly higher in group 1 (p = 0.001). The amounts of supplemental 1% lidocaine and intraoperative intravenous analgesic used were significantly higher in group 1 (p = 0.001 and p = 0.035, respectively). Patient satisfaction scores were significantly lower in group 1 (p = 0.044). The amount of postoperative analgesic used, time to first analgesic requirement, postoperative visual analog scale scores, and surgeon satisfaction scores were similar in both groups. There was no significant difference between the groups with respect to complications. No major neurologic deficits or perioperative mortality were observed. Conclusions: Mandibular block in addition to cervical plexus block provides better intraoperative pain control and greater patient satisfaction than cervical plexus block alone. Copyright © 2017 Elsevier Inc. Database: EMBASE

250. Delirium and effect of circadian light in the intensive care unit: a retrospective cohort study Author(s): Estrup S.; Kjer C.K.W.; Poulsen L.M.; Mathiesen O.; Gogenur I. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 367-375 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Delirium is a serious condition often experienced by critically ill patients in intensive care units (ICUs). The role of circadian light for this condition is unclear. The aim of this study was to describe incidence of delirium, risk factors for delirium, and the association between delirium and circadian light for patients in the ICU. Methods: This is a retrospective cohort study of all patients at a Danish ICU from 1 August 2015 to 31 January 2016. Exclusion criteria were heavy sedation, no Confusion Assessment Method for the ICU (CAM-ICU) scores, or inability to communicate in Danish. Delirium was defined as at least one positive CAM-ICU score or treatment with haloperidol. Three of nine beds at the ICU had a circadian light installation. Allocation to ICU beds with or without circadian light depended on availability at admission. Risk factors for development of delirium were analyzed by simple and multiple logistic regression. Results: We included 183 patients in the study. The incidence of delirium was 28% (95% CI 22, 35). Allocation to beds with or without circadian lighting was not associated with delirium incidence (OR 1.14; 95% CI 0.55, 2.37; P = 0.73). We found that Simplified Acute Physiology Score II (SAPS II) (OR 1.03; 95% CI 1.01, 1.06; P = 0.002), and dexmedetomidine was associated with delirium (OR 4.14; 95% CI 1.72, 10.03; P = 0.002). Conclusion: In this population of patients admitted to an ICU during 6 months, the incidence of delirium was 28%. We did not find an association between circadian light and development of delirium. Copyright © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Database: EMBASE

251. Factors associated with non-response at health-related quality of life follow-up in a septic shock trial Author(s): Kjaer M.N.; Hjortrup P.B.; Rygard S.L.; Perner A.; Mortensen C.B.; Andersen I. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 357-366 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Follow-up of intensive care unit (ICU) patients often includes health- related quality of life (HRQoL) surveying, but non-responders hamper the interpretation. Our aim was to assess factors for non-response to HRQoL survey in ICU patients with septic shock at follow-up in a clinical trial. Methods: In a post hoc follow-up registry study, we assessed all the Danish survivors in the Transfusion-Requirements in Septic Shock trial patients, who were mailed the Short Form 36-item Survey (SF-36) 1-year after randomization. We used covariates from the trial database merged with covariates from nation-wide registries using the unique national identification number to explore possible factors for not responding. Five covariates were pre-specified to be included in the primary multivariate analysis: age, number of days in hospital from randomization to follow-up, level of education, cohabitation and employment status at follow-up. We compared the mortality from 1-year survival (2012-2014) till end of final follow-up (January 2016) between non- responders and responders. Results: We assessed 308 survivors of whom 108 (35%) were non-responders. In the primary analysis lower age (odds ratio 1.03, 95% CI [1.01-1.05]), more admission days in hospital (1.006 [1.001-1.011]) and living alone (4.33 [2.46-7.63]) were associated with non-responding, whereas the level of education and employment status were not. Non-responders had a hazard ratio of 1.63 [0.97-2.72] for mortality from 1- year follow-up to final follow-up as compared to the responders. Conclusion: Being younger, spending more days in hospital and living alone were all associated with non-response at 1- year HRQoL follow-up among ICU patients with septic shock. Copyright © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Database: EMBASE

252. Early experience of full-endoscopic interlaminar discectomy for adolescent lumbar disc herniation with sciatic scoliosis Author(s): Tu Z.; Wang B.; Li L.; Li Y.; Dai Y.; Lv G.; Li T. Source: Pain Physician; 2018; vol. 21 (no. 1) Publication Date: 2018 Publication Type(s): Article Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Full-endoscopic interlaminar discectomy (FEID) has achieved satisfactory outcome in adolescent lumbar disc herniation (ALDH). Sciatic scoliosis is found to be a common presentation in ALDH. However, few reports are focused on the influences of sciatic scoliosis on ALDH and the prognosis of sciatic scoliosis after FEID. Objective: This study aims to evaluate the clinical and radiological results of FEID in the treatment of ALDH with sciatic scoliosis and to identify the effects of sciatic scoliosis on complication and recurrence. Study Design: A retrospective study. Setting: An inpatient surgery center. Methods: A series of cases of patients under age 20 with single-level ALDH that underwent FEID between January 2010 and December 2014 were retrospectively analyzed. The patients were divided into 2 groups according to if they had scoliosis or not. Clinical outcomes were evaluated using a visual analog scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI) for the functional assessment, and modified Macnab criteria for the patient satisfaction. Radiological parameters of the scoliosis group such as Cobb angle, CVSL-max, and CVSL-C7 were statistically analyzed. Results: No significant differences were found between both groups in terms of the mean operative time, the mean length of hospital stay, complications, and recurrences (P > 0.05). VAS and ODI scores were significantly improved in both groups (P < 0.05). However, there were no statistically significant differences between the 2 groups in VAS, ODI, and modified MacNab criteria (P > 0.05). For the scoliosis group, significant improvements were observed in the postoperative sagittal and coronal alignment parameters (P < 0.05). Limitations: This was a retrospective study with a relatively small sample size. Additionally, the length of follow-up was short. Conclusions: The application of FEID in the treatment of ALDH could achieve satisfactory clinical and radiological outcomes. Sciatic scoliosis was corrected spontaneously without increasing the risk of complication and recurrence. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

253. The termination level of the dural sac relevant to caudal epidural block in lumbosacral transitional vertebrae: A comparison between sacralization and lumbarization groups Author(s): Jeon J.Y.; Jeong Y.M.; Lee S.-W.; Kim J.H.; Choi H.-Y.; Ahn Y. Source: Pain Physician; 2018; vol. 21 (no. 1); p. 73-81 Publication Date: 2018 Publication Type(s): Article Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Lumbosacral transitional vertebrae (LSTV) are a relatively common variant and have been considered as one of the reasons for back pain. It is not unusual for clinicians to encounter patients with LSTV who require caudal epidural block (CEB) for pain management. Objective: We investigated the termination level of the dural sac (DS) and anatomical features of the lumbosacral region relevant to CEB in patients with LSTV and compared these findings between sacralization and lumbarization groups. Study Design: A retrospective evaluation. Setting: A university hospital with inpatient and outpatient LSTV cases presenting low back pain. Methods: Four hundred ninety-four LSTV patients were included and categorized into sacralization (n = 201) or lumbarization groups (n = 293). Magnetic resonance imaging (MRI) of all of the LSTV patients were reviewed to determine the level of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal level of sacral perineural cysts. Each lumbosacral vertebra column was divided into 3 equal portions (upper, middle, and lower thirds). The MRI findings in both of the groups were compared and analyzed. Results: The distribution frequency of the levels of DS termination demonstrated a significant difference between the 2 groups. The mean caudal DS level in the lumbarization group was significantly lower than the sacralization group (lower third of the S2 [131 {44.7%} of 293 patients] vs. lower third of the S1 [78 {38.8%} of 201 patients]). The DS terminated at the S3 in more than 19% of the lumbarization group, whereas in only one case of the sacralization group. Although the incidence of perineural cysts was not significantly different between the 2 groups, the mean level of caudal margin of perineural cysts in the lumbarization group was significantly lower than the sacralization group (middle third of the S3 [10 {35.7%} of 28 cases] vs. middle third of the S2 [11 {44%} of 25 cases]). Limitations: This study reveals several limitations including the practical challenge of accurate enumeration of the transitional segment and the constraints on generalizability posed by the single-country study. Conclusion: When planning CEB for patients with LSTV, pre-procedural MRI to check the anatomical structures, including the level of DS termination and caudal margin of perineural cysts, would be of great use for lowering the risk of unexpected dural puncture during the procedure, especially in the lumbarization cases. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

254. Outcome of transforaminal epidural steroid injection according to the severity of lumbar foraminal spinal stenosis Author(s): Chang M.C.; Lee D.G. Source: Pain Physician; 2018; vol. 21 (no. 1); p. 67-72 Publication Date: 2018 Publication Type(s): Article Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Lumbar foraminal spinal stenosis (LFSS) is a common cause of radicular pain in the lower extremities. Transforaminal epidural steroid injection (TFESI) is being used widely for controlling radicular pain induced by LFSS. The efficacy of TFESI has been demonstrated in previous studies. However, no study has evaluated the outcome of TFESI according to the severity of LFSS. Objective: In this study, we evaluated the outcome of TFESI in patients with chronic lumbar radicular pain due to LFSS according to the severity of LFSS by using magnetic resonance imaging (MRI). Study Design: A prospective observational study. Setting: A university hospital. Methods: Sixty patients with chronic lumbar radicular pain due to LFSS were included in this prospective study and received TFESI at our university hospital. Three patients were lost to follow-up. On the basis of sagittal lumbar MRI findings, we assigned patients with mild to moderate LFSS to group A (n = 31) and those with severe LFSS to group B (n = 26). Pain intensity was evaluated using a numeric rating scale (NRS) before treatment and at 1, 2, and 3 months after treatment. Results: Compared to pretreatment NRS scores, a significant decrease in NRS scores was observed in patients in both groups at 1, 2, and 3 months after treatment (P = 0.000). However, reductions in the NRS scores over time were significantly larger in group A (P = 0.023). Three months after treatment, 27 patients (87.1%) in group A and 11 patients (42.3%) in group B reported successful pain relief (pain relief of >= 50%). Limitations: This study had a small number of patients. Conclusions: After TFESI, chronic lumbar radicular pain was significantly reduced regardless of the severity of LFSS, and the effects of TFESI were sustained for at least 3 months after treatment. However, the outcome of TFESI was superior in the group with a mild to moderate degree of LFSS, compared to the group with a severe degree of LFSS. We believe that our study provides useful information for establishing a treatment plan for radicular pain due to LFSS. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

255. Sacroiliac joint intraarticular injection in true anteroposterior view: Description of a new C-arm guided method Author(s): Taheri A.; Abad M.; Zebardast J.; Shaabani S.; Lajevardi M. Source: Pain Physician; 2018; vol. 21 (no. 1); p. 61-66 Publication Date: 2018 Publication Type(s): Article Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: The anatomic characteristics of the sacroiliac joint (SIJ) make it difficult to achieve intraarticular injection without radiologic guidance. The classic C-arm guided SIJ intervention technique is difficult. Here we describe a new and simple method for SIJ intraarticular intervention. Objective: This study aims to introduce a new, simple approach for SIJ intraarticular intervention. Study Design: An observational case series study. Setting: The study was conducted at an academic medical center in a major metropolitan city. Methods: This method of intervention was performed on 57 patients (a total of 73 joints) who were selected for diagnostic and therapeutic SIJ intervention. The procedure was done in anteroposterior (AP) view, without any C-arm angulation. The accuracy of the intraarticular injection was confirmed by using intraarticular contrast material. A numerical rating scale (NRS) score was recorded for each joint before and after the procedure; the number of x-ray exposures and number of attempts were recorded for each procedure as well. Results: Successful intraarticular contrast spread was obtained in all SIJs. The number of x-ray exposures was about 9 +/- 3, and there was not a remarkable difference between cases according to gender of the patient (P = 0.1) or side of the joint (P = 0.2). In 5 cases, the first needle placement was not correct; there were no differences between gender (P = 0.4) and side of the joint (P = 0.4) regarding the first successful attempt. The NRS pain scores decreased in all of the patients more than 50% after the procedure; the pain scores were similar to the results of classic methods of intraarticular interventions with successful contrast spread, and there were no remarkable differences considering gender (P = 0.5) or side of the joint (P = 0.8). Limitations: This is a very small, nonrandomized, and controlled study; further blinded clinical trials are needed to clarify the probable advantages of this method compared with conventional ones. Conclusion: This observational study introduces a new and simple approach for SIJ intraarticular intervention, with a high success rate. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

256. Implication of two different doses of intradiscal ozone-oxygen injection upon the pain alleviation in patients with low back pain: A randomized, single-blind study Author(s): Elawamy A.; Kamel E.Z.; Hassanien M.; Wahba O.M.; Amin S.E. Source: Pain Physician; 2018; vol. 21 (no. 1) Publication Date: 2018 Publication Type(s): Article Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Low back pain (LBP) is mostly induced by disc herniation (DH) or degeneration and has a burden upon social activity and economical aspects of life. An abundance of medical and surgical interventions have evolved to resolve this problem, but one of the newly introduced techniques, which is the minimally invasive, low cost ozone- oxygen mixture (O3-O2) intradiscal injection, offers a rapid onset amelioration of symptoms with a sustained duration of pain relief. Objective: We aim to evaluate the quality of pain alleviation using 2 different doses of intradiscal injections of O3-O2 mixture. Study Design: A prospectively randomized, single-blind study. Setting: Pain clinic, anesthesia, intensive care, and pain department in Assiut University Hospitals. Methods: Sixty patients with symptomatizing single lumbar DH were subjected to O3-O2 intradiscal injection and randomly allocated into one of 2 groups; group A: received 10 mL, 40 micro g/ mL of O3-O2 and group B: received 10 mL, 30 micro g/mL of O3-O2. Pain score and functional ability of the patients using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were evaluated after 1, 6, and 12 months and compared to the basal values. Patient satisfaction and reduction of DH were evaluated after the sixth month. Results: There were no significant differences between the 2 groups regarding the clinical outcome; however both the ODI and VAS evaluations showed highly significant improvement (decreased) (P < 0.01) after injection and during the entire follow-up period. There were highly significant negative correlations between the DH reduction percentage and both the VAS and ODI scores after 6 months in both of the groups. Limitations: This study was limited by a small sample size; it was also an active control trial, which may explain the insignificant difference in between the groups, in addition to being a single-blind trial. Conclusion: Intradiscal injection of O3-O2 mixture is a very valuable maneuver in the reduction of DH size and improvement of pain quality, with either ozone concentrations of 40 micro g/mL or 30 micro g/mL. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

257. Reducing radiation exposure in lumbar transforaminal epidural steroid injections with pulsed fluoroscopy: A randomized, double-blind, controlled clinical trial Author(s): Braun E.; Sack A.M.; Sayed D.; Manion S.; Hamm B.; Brimacombe M.; Tollette M.; Khan T.W.; Orr W.; Nicol A. Source: Pain Physician; 2018; vol. 21 (no. 1); p. 53-60 Publication Date: 2018 Publication Type(s): Article Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Fluoroscopy-guided lumbar transforaminal epidural steroid injections (L-TFESI) result in radiation exposure that carries risks to patients, physicians, and procedural staff. Objective: We aim to evaluate the feasibility of using pulsed fluoroscopy to safely reduce radiation exposure during L-TFESI. Study Design: This is a prospective, double- blind, randomized controlled trial. Setting: This study took place in a single-center, academic, outpatient interventional pain management clinic. Methods: Patients undergoing L-TFESI were randomly assigned to either continuous mode fluoroscopy (high-dose), pulsed fluoroscopy with 8 pulses per second (medium-dose), or pulsed fluoroscopy with one pulse per second (low-dose). Data on radiation doses and other clinical and demographic factors were also collected. Results: In total, 231 cases were analyzed in the high-dose group (n = 81), medium-dose group (n = 72), and low-dose group (n = 78). Mean radiation effective dose (micro Sv) was 121 in the high-dose group, 57.9 in the medium-dose group, and 34.8 in the low-dose group (P < 0.001). The incidence of inadequate image quality in the pulsed groups was 6% (9/150). The body mass index (BMI, mean +/- SD) was significantly higher in patients with inadequate image quality (37.3 +/- 7.2) than with adequate quality (30.5 +/- 7.2, P = 0.005). Limitations: Radiation doses were measured using the meter on C-arm fluoroscopes rather than by direct measurement. Conclusions: The use of pulsed fluoroscopy during L-TFESI resulted in radiation dose reduction of up to 72.1% without causing any significant adverse events. Pulsed fluoroscopy should be considered as an initial fluoroscopic setting for L-TFESI to reduce radiation exposure. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

258. Ultrasound-guided genicular nerve block for knee osteoarthritis: A double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid Author(s): Kim D.-H.; Choi S.-S.; Yoon S.-H.; Lee S.-H.; Seo D.-K.; Lee I.-G.; Choi W.-J.; Shin J.- W. Source: Pain Physician; 2018; vol. 21 (no. 1); p. 41-51 Publication Date: 2018 Publication Type(s): Article Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Recently, several studies suggested that radiofrequency (RF) ablation of the genicular nerves is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA). Diagnostic genicular nerve block (GNB) with local anesthetic has been generally conducted before making decisions regarding RF ablation. Although GNB has been recently performed together with corticosteroid, the analgesic effects of corticosteroids for treating chronic pain remain controversial. Objectives: The current study aims to assess the effects of combining corticosteroids and local anesthesia during ultrasound-guided GNB in patients with chronic knee OA. Study Design: A randomized, double-blinded institutional study. Setting: This study took place at Asan Medical Center in Seoul, Korea. Methods: Forty-eight patients with chronic knee OA were randomly assigned to either the lidocaine alone group (n = 24) or lidocaine plus triamcinolone (TA) group (n = 24) before ultrasound-guided GNB. Visual analog scale (VAS), Oxford Knee Score (OKS), and global perceived effects (7-point scale) were assessed at baseline and at 1, 2, 4, and 8 weeks after the procedure. Results: The VAS scores were significantly lower in the lidocaine plus TA group than in the lidocaine alone group at both 2 (P < 0.001) and 4 (P < 0.001) weeks after GNB. The alleviation of intense pain in the lidocaine plus TA group was sustained up to 2 weeks after the procedure, in accordance with the definition of a minimal clinically important improvement. Although a similar intergroup difference in OKSs was observed at 4 weeks (P < 0.001), the clinical improvement in functional capacity lasted for only one week after the reassessment of OKSs, in accordance with a minimal important change. No patient reported any postprocedural adverse events during the follow-up period. Limitations: The emotional state of the patients, which might affect the perception of knee pain, was not evaluated. The follow-up period was 2 months; this period might be insufficient to validate the short-term effects of GNB. Conclusions: Ultrasound-guided GNB, when combined with a local anesthetic and corticosteroid, can provide short-term pain relief. However, the clinical benefit of corticosteroid administration was not clear in comparison with local anesthesia alone. Given the potential adverse effects, corticosteroids might not be appropriate as adjuvants during a GNB for chronic knee OA. The study protocol was approved by our institutional review board (2012-0210), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0001139). Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

259. Efficacy of pain relief in different postherpetic neuralgia therapies: A network meta- analysis Author(s): Song D.; He A.; Xu R.; Xiu X.; Wei Y. Source: Pain Physician; 2018; vol. 21 (no. 1); p. 19-32 Publication Date: 2018 Publication Type(s): Review Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Postherpetic neuralgia (PHN) is a nerve pain disease usually controlled by different therapies, i.e., topical therapies, antiepileptics, analgesics, antipsychotics, antidepressants, anti-dementia drugs, antivirals, amitriptyline, fluphenazine, and magnesium sulfate. It is believed that different therapies may lead to different levels of pain relief. Objectives: We proposed this study to compare the efficacy of PHN treatments. Study Design: We conducted a systematic review of the current literature. All relevant studies were retrieved from online databases. The standardized mean difference (SMD) was used for pain relief measurement in different PHN therapies. Setting: A conventional meta- analysis and a network meta-analysis (NMA) were carried out together with the surface under the cumulative ranking curve (SUCRA) for each therapy calculated regarding their efficacy. Results: A pairwise meta-analysis suggested that 4 treatment classes, including topical therapies, antiepileptics, analgesics, and antidepressants, exhibited better pain relief results than placebo. Likewise, a NMA suggested that patients with 4 treatment classes exhibited significant improvements in pain scores compared to those with placebo. Limitations: There is a lack of direct head-to-head comparisons of some treatments, especially for antivirals, anti-dementia drugs, and magnesium sulfate. Secondly, the specific agents belonging to the same class of therapies might exhibit different effects (gabapentin and carisbamate) with different mechanisms (opioids and ketamine) on reducing pain, and some agents were hard to find in literatures and were not involved in our study, which may influence our results. Conclusions: Analgesics were preferable to other treatments with respect to pain relief for PHN, while antivirals appeared to be less effective than other therapies. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

260. Fusion or not for degenerative lumbar spinal stenosis: A meta-analysis and systematic review Author(s): Shen J.; Xu S.; Ye S.; Hao J. Source: Pain Physician; 2018; vol. 21 (no. 1); p. 1-7 Publication Date: 2018 Publication Type(s): Review Available at Pain physician - from EBSCO (MEDLINE Complete) Abstract:Background: Degenerative lumbar spinal stenosis (DLSS) is the main cause for chronic low back pain in the elderly. When refractory to conservative treatment, symptomatic patients commonly undergo surgery. However, whether or not fusion is a relatively better surgical option still remains unclear. Objective: The purpose of the present study was to systematically review the clinical outcomes of spinal decompression with or without spinal fusion for DLSS. Study Design: A systematic review of the therapeutic effect for DLSS with or without fusion. Methods: A literature search of 5 electronic databases was performed including PubMed, EMBASE, MEDLINE, Cochrane Library, and CENTRAL from inception to August 2016. Only randomized controlled trials (RCTs) assessing the comparison between decompression and fusion surgery for DLSS were included. Results: A total of 5 RCTs involving 438 patients met the inclusion criteria. Low-quality evidence of the meta-analysis was performed for the heterogeneity of the included studies. Pooled analysis showed no significant differences between decompression alone and fusion groups for the Oswestry Disability Index (ODI) scores at the baseline (P = 0.50) and 2 years follow-up (P = 0.71), and the satisfaction rate of operations was also similar for the groups (P = 0.53). However, operation time (P = 0.002), blood loss (P < 0.00001), and length of hospital stay (P = 0.007) were remarkably higher in the fusion group. Furthermore, there was no difference in the reoperation rate between these 2 groups at the latest follow-up (P = 0.49). Limitation: The methodological criteria and sample sizes were highly variable. The studies were heterogeneous. Conclusion: The present meta-analysis is the first to compare the efficacy of decompression alone and spinal fusion for the treatment of DLSS, including 5 RCTs. Our results demonstrate that additional fusion surgery seems unlikely to result in better outcomes for patients with DLSS, but it may increase additional risks and costs. High-quality homogeneous research is required to provide further evidence about surgical procedures for patients with DLSS. Copyright © 2018, American Society of Interventional Pain Physicians. All rights reserved. Database: EMBASE

261. Implications perioperatoires des inhibiteurs du cotransporteur sodium-glucose de type 2 : une serie de cas d'acidocetose diabetique euglycemique chez trois patients suite a une chirurgie cardiaquePerioperative implications of sodium-glucose cotransporter-2 inhibitors: a case series of euglycemic diabetic ketoacidosis in three patients after cardiac surgery Author(s): Lau A.; Bruce S.; Ree R.; Rondi K.; Chau A.; Wang E. Source: Canadian Journal of Anesthesia; Feb 2018; vol. 65 (no. 2); p. 188-193 Publication Date: Feb 2018 Publication Type(s): Article Abstract:Purpose: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) comprise the newest class of oral hypoglycemic agents approved for treating type II diabetes mellitus (DM-II). Their use, however, has been associated with the rare development of euglycemic diabetic ketoacidosis (euDKA). We present three cases of euDKA that occurred following elective coronary artery bypass grafting surgery. The role of the anesthesiologist in the prevention, diagnosis, and management of this complication is also discussed. Clinical features: Three patients receiving chronic SGLT2i therapy for DM-II (discontinued one to two days preoperatively) underwent cardiac surgery. On the first postoperative day, each exhibited nausea, vomiting, and tachypnea. Although these nonspecific postoperative findings are common, our patients also exhibited anion gap metabolic acidosis (pH < 7.3, anion gap > 12 mmol.L-1) with lower than anticipated serum glucose levels of < 14 mmol.L-1. Serum and urine ketone analyses confirmed a diagnosis of euDKA. After insulin and dextrose infusions were initiated, rapid resolution of the metabolic abnormalities occured. Conclusions: Anesthesiologists should recognize that patients receiving SGLT2i preoperatively are at risk of developing euDKA. Hence, based on the pharmacokinetics of SGLT2i, discontinuing the medication at least two days prior to surgery should minimize the risk. Diagnosing euDKA is challenging and often delayed because of its nonspecific signs and symptoms. When suspected, serum and urine ketones should be monitored to reduce the time to diagnosis and treatment. Copyright © 2017, Canadian Anesthesiologists' Society. Database: EMBASE

262. Equivalence de l'efficacite analgesique entre la dexamethasone administree par voie perinerveuse vs intraveineuse en tant qu'adjuvant a un bloc du nerf peripherique : revue systematique et meta-analyseEquivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis Author(s): Hussain N.; Sawyer T.R.; Van den Langenbergh T.; Sermer C.; Fontes M.L.; Atrey A.; Shaparin N.; Vydyanathan A. Source: Canadian Journal of Anesthesia; Feb 2018; vol. 65 (no. 2); p. 194-206 Publication Date: Feb 2018 Publication Type(s): Review Abstract:Purpose: Dexamethasone is commonly used as an adjuvant to local anesthetics for peripheral nerve blockade; however, uncertainty persists regarding its optimal route of administration and safety. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare the incremental benefits of intravenous (IV) vs perineural (PN) dexamethasone when used as adjuvants for peripheral nerve blockade to improve analgesia. Sources: A search strategy was developed to identify eligible articles from the Cochrane and National Library of Medicine databases from inception until June 2017. The National Center for Biotechnology Information Medical Subject Headings browser thesaurus was used to identify search terms and combinations of keywords. Any clinical trial that randomly allocated adult patients (>= 18 yr old) to receive either IV or PN dexamethasone for peripheral nerve blockade was considered for inclusion. Principal findings: After full-text screening of potentially eligible articles, 14 RCTs were included in this review. Overall, the use of PN dexamethasone did not provide a significant incremental benefit to the duration of analgesia [ratio of means (ROM), 1.23; Hartung-Knapp-Sidik- Jonkman (HKSJ) 95% confidence interval (CI), 0.85 to 1.85; P = 0.23] or to motor block duration (ROM, 1.14; HKSJ 95% CI, 0.98 to 1.31; P = 0.07). Also, at 24-hr follow-up, there was no significant difference between the two groups regarding pain scores (standardized mean difference, 0.36; HKSJ 95% CI, -0.08 to 0.80; I2 = 75%; P = 0.09) and cumulative opioid consumption (mean difference, 5.23 mg; HKSJ 95% CI, -4.60 to 15.06; P = 0.15). Lastly, no long-term nerve-related complications were observed with the use of PN dexamethasone. Conclusions: The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade. Copyright © 2017, Canadian Anesthesiologists' Society. Database: EMBASE

263. Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study Author(s): Kostic P.; LoMauro A.; Frykholm P.; Aliverti A.; Larsson A.; Hedenstierna G. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 282-292 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Studies aimed at maintaining intraoperative lung volume to reduce post-operative pulmonary complications have been inconclusive because they mixed up the effect of general anesthesia and the surgical procedure. Our aims were to study: (1) lung volume during the entire course of anesthesia without the confounding effects of surgical procedures; (2) the combination of three interventions to maintain lung volume; and (3) the emergence phase with focus on the restored activation of the respiratory muscles. Methods: Eighteen ASA I-II patients undergoing ENT surgery under general anesthesia without muscle relaxants were randomized to an intervention group, receiving lung recruitment maneuver (LRM) after induction, 7 cmH2O positive end-expiratory pressure (PEEP) during anesthesia and continuous positive airway pressure (CPAP) during emergence with 0.4 inspired oxygen fraction (FiO2) or a control group, ventilated without LRM, with 0 cmH2O PEEP, and 1.0 FiO2 during emergence without CPAP application. End-expiratory lung volume (EELV) was continuously estimated by opto-electronic plethysmography. Inspiratory and expiratory ribcage muscles electromyography was measured in a subset of seven patients. Results: End-expiratory lung volume decreased after induction in both groups. It remained low in the control group and further decreased at emergence, because of active expiratory muscle contraction. In the intervention group, EELV increased after LRM and remained high after extubation. Conclusion: A combined intervention consisting of LRM, PEEP and CPAP during emergence may effectively maintain EELV during anesthesia and even after extubation. An unexpected finding was that the activation of the expiratory muscles may contribute to EELV reduction during the emergence phase. Copyright © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Database: EMBASE

264. Incidence of hyperoxia and related in-hospital mortality in critically ill patients: a retrospective data analysis Author(s): Kraft F.; Andel H.; Markstaller K.; Ullrich R.; Klein K.U.; Gamper J. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 347-356 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Mechanical ventilation with oxygen is life-saving, however, may result in hyperoxia. The aim was to analyse the incidence and duration of hyperoxia burden and related in-hospital mortality in critically ill patients. Methods: Patients of all ages admitted to intensive care units (ICUs) and with mechanical ventilation for at least seven consecutive days were included in this single centre retrospective medical record audit. The main outcome measure was time-weighted arterial partial pressure of oxygen (PaO2) over 7 days. Logistic regression for association with in-hospital mortality and propensity score matching was performed. Results: In total, 20,889 arterial blood gases of 419 patients were analysed. Time-weighted mean PaO2 was 14.0 +/- 2.4 kPa. Time-weighted mean FiO2 was 49.2 +/- 12.1%. Seventy-six (18.1%) patients showed continuous hyperoxia exposure, defined as time-weighted mean PaO2> 16 kPa. Duration of hyperoxia, hypoxia (PaO2< 8 kPa) and normoxia (PaO2 8-16 kPa) were 37.9 +/- 31.0 h (23.7%), 4.9 +/- 9.5 h (3.1%), and 116.8 +/- 29.6 h (73.2%). Hyperoxia occurred especially at low to moderate FiO2 in patients of first and second age quartiles (1-57 years) with smaller SAPS2 score. In-hospital mortality of patients with hyperoxia (32.9%) or normoxia did not differ (35.9%; P = 0.691). Conditional logistic regression showed no association between hyperoxia and in-hospital mortality (OR 1.46; 95%CI 0.72-2.96; P = 0.29). Conclusion: Substantial hyperoxia burden was observed in ICU patients. Young patients with less comorbidities showed hyperoxic episodes more often, especially with lower FiO2. Hyperoxia during 7 days of mechanical ventilation did not correlate to increased in-hospital mortality. Copyright © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Database: EMBASE

265. The adequate rocuronium dose required for complete block of the adductor muscles of the thigh Author(s): Fujimoto M.; Kawano K.; Yamamoto T. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 304-311 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Rocuronium can prevent the obturator jerk during transurethral resection of bladder tumors. We investigated the adequate rocuronium dose required for complete block of the thigh adductor muscles, and its correlation with individual responses of the adductor pollicis muscle to rocuronium. Methods: Eleven patients scheduled for transurethral resection of bladder tumors under general anesthesia were investigated. After general anesthesia induction, neuromuscular monitoring of the adductor pollicis muscle and ultrasonography-guided stimulation of the obturator nerve was commenced. Rocuronium, 0.15 mg/kg, was repeatedly administered intravenously. The adequate rocuronium dose required for complete block of the thigh muscles, defined as the cumulative dose of rocuronium administered until that time, and its correlation with the first twitch response of the adductor pollicis muscle on train-of-four stimulation after initial rocuronium administration was analyzed. Results: The rocuronium dose found adequate for complete block of the thigh muscles was 0.30 mg/kg in seven patients and 0.45 mg/kg in the remaining four patients, which did not correlate with the first twitch response. At the time of complete block of the thigh muscles, the neuromuscular blockade level of the adductor pollicis muscle varied greatly, although the level was never more profound than a post- tetanic count of 1. Conclusion: Although the response of the adductor pollicis muscle to rocuronium cannot be used to determine the adequate rocuronium dose required for complete block of the thigh muscles, intense blockade, with maintenance of post-tetanic count at <= 1 in the adductor pollicis muscle is essential to prevent the obturator jerk. Copyright © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Database: EMBASE

266. A comparison between McGrath MAC videolaryngoscopy and Macintosh laryngoscopy in children Author(s): Kim J.E.; Chang M.Y.; Lee S.Y.; Kim J.Y.; Kwak H.J.; Jung W.S. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 312-318 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: This prospective, randomised, controlled study was performed to evaluate the usefulness of the McGrath VL compared with Macintosh laryngoscopy in children with expected normal airway during endotracheal intubation, by comparing the time to intubation and difficulty of intubation. Methods: Eighty-four patients aged 1-10 years who underwent endotracheal intubation for elective surgery were randomly assigned to the McGrath group (n = 42) or the Macintosh group (n = 42). Anaesthesia was induced with 2.5-3.0 mg/kg of propofol and sevoflurane 5-8 vol%. Orotracheal intubation was performed 2 min after injection of rocuronium 0.6 mg/kg with McGrath VL or Macintosh laryngoscope; the primary outcome was the time to intubation. The Cormack and Lehane glottic grade, intubation difficulty score (IDS), and success rate on intubation were assessed. Haemodynamic changes were also recorded. Results: As the primary outcome, median time to intubation [interquartile range] did not differ between the McGrath group and the Macintosh group (25.0 [22.8-28.3] s vs. 26.0 [24.0-29.0] s, P = 0.301). The incidence of grade I glottic view was significantly higher in the McGrath group than in the Macintosh group (95% vs. 74%, P = 0.013). Median IDS was lower in the McGrath group than in the Macintosh group (0 [0-0] vs. 0 [0-1], P = 0.018). There were no significant differences in success rate on intubation or haemodynamics between the two groups. Conclusions: McGrath VL provides better laryngeal views and lower IDS but similar intubation times and success rates compared with the Macintosh laryngoscope in children with normal airway. Copyright © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Database: EMBASE

267. Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) Author(s): Granholm A.; Perner A.; Krag M.; Hjortrup P.B.; Haase N.; Holst L.B.; Marker S.; Collet M.O.; Moller M.H.; Jensen A.K.G. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 336-346 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). Methods: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism- corrected performance estimates. Results: The SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71-0.74), overall performance (Nagelkerke's R2) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance. Conclusions: The SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values. Copyright © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Database: EMBASE

268. Frontoethmoidal encephalocele: a pediatric airway challenge Author(s): Geddam L.M.; Mahmoud M.A.; Pan B.S.; Stevenson C.B.; Kandil A.I. Source: Canadian Journal of Anesthesia; Feb 2018; vol. 65 (no. 2); p. 208-209 Publication Date: Feb 2018 Publication Type(s): Article Database: EMBASE

269. An unusual blood pressure reading Author(s): de Medicis E. Source: Canadian Journal of Anesthesia; Feb 2018; vol. 65 (no. 2); p. 210 Publication Date: Feb 2018 Publication Type(s): Article Available at Canadian journal of anaesthesia = Journal canadien d'anesthesie - from International DOI Foundation Database: EMBASE

270. Norwegian standard for the safe practice of anaesthesia Author(s): Bekkevold M.; Haugen A.S.; Ulvik A.; Bruun A.-M.G.; Borke W.B.; Finjarn T.J.; Isern E.; Skjeflo G.W.; Ringvold E.-M. Source: Acta Anaesthesiologica Scandinavica; Mar 2018; vol. 62 (no. 3); p. 411-417 Publication Date: Mar 2018 Publication Type(s): Article Available at Acta anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Database: EMBASE

271. Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting: Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial Author(s): Bouabdallaoui N.; Rouleau J.L.; Stevens S.R.; Doenst T.; Wrobel K.; Bouchard D.; Deja M.A.; Michler R.E.; Chua Y.L.; Kalil R.A.K.; Selzman C.H.; Sun B.; Djokovic L.T.; Sopko G.; Daly R.C.; Velazquez E.J.; Lee K.L.; Al-Khalidi H.R. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. Design, Setting, Participants, and Interventions: A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time. Measurements and Main Results: At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2%) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of intubation time >36 hours included mitral valve procedure, New York Heart Association class, left ventricular systolic volume index, creatinine, previous coronary artery bypass grafting (CABG), and age. Results were similar in patients surviving 24 hours post-operation, where intubation time was also the strongest predictor of 30-day (HR 4.18, c-index 0.87) and 1-year (HR 2.81, c-index 0.78) mortality. Conclusions: Intubation time is the strongest predictor of 30-day and 1-year mortality among patients with ischemic heart failure undergoing CABG. Combining intubation time with other mortality risk factors may allow the identification of patients at the highest risk for whom the development of specific strategies may improve outcomes. Copyright © 2017 Elsevier Inc. Database: EMBASE

272. Health-related quality of life in gout in primary care: Baseline findings from a cohort study Author(s): Chandratre P.; Mallen C.; Richardson J.; Muller S.; Hider S.; Blagojevic-Bucknall M.; Roddy E.; Rome K. Source: Seminars in Arthritis and Rheumatism; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objectives: To examine gout-related, comorbid, and sociodemographic characteristics associated with generic and disease-specific health-related quality of life (HRQOL) in gout. Methods: Adults with gout from 20 general practices were mailed a questionnaire containing the Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form-36 Physical Function subscale (PF-10), Gout Impact Scale (GIS), and questions about gout-specific, comorbid and sociodemographic characteristics. Variables associated with HRQOL were examined using multivariable linear regression models. Results: A total of 1184 completed questionnaires were received (response 65.9%). Worse generic and gout- specific HRQOL was associated with frequent gout attacks (>=5 attacks PF-10 beta = -4.90, HAQ-DI beta = 0.14, GIS subscales beta = 8.94, 33.26), current attack (HAQ-DI beta = 0.15, GIS beta = -1.94, 18.89), oligo/polyarticular attacks (HAQ-DI beta = 0.11, GIS beta = 0.78, 7.86), body pain (PF-10 beta = -10.68, HAQ-DI beta = 0.29, GIS beta = 2.61, 11.89), anxiety (PF-10 beta = -1.81, HAQ-DI beta = 0.06, GIS beta = 0.38, 1.70), depression (PF-10 beta = - 1.98, HAQ-DI beta = 0.06, GIS 0.42, 1.47) and alcohol non-consumption (PF-10 beta = -16.10, HAQ-DI beta = 0.45). Gout-specific HRQOL was better in Caucasians than non-Caucasians (GIS beta = -13.05, -13.48). Poorer generic HRQOL was associated with diabetes mellitus (PF- 10 beta = -4.33, HAQ-DI beta = 0.14), stroke (PF-10 beta = -12.21, HAQ-DI beta = 0.37), renal failure (PF-10 beta = -9.43, HAQ-DI beta = 0.21), myocardial infarction (HAQ-DI beta = 0.17), female gender (PF-10 beta = -17.26, HAQ-DI beta = 0.43), deprivation (PF-10 beta = -7.80, HAQ-DI beta = 0.19), and body mass index >=35kg/m2 (PF-10 beta = -6.10, HAQ-DI beta = 0.21). Conclusions: HRQOL in gout is impaired by gout-specific, comorbid, and sociodemographic characteristics, highlighting the importance of comorbidity screening and early urate-lowering therapy. Both gout-specific and generic questionnaires identify the impact of disease-specific features on HRQOL but studies focusing on comorbidity should include generic instruments. Copyright © 2018 The Auhors. Database: EMBASE

273. Systolic Anterior Motion of the Mitral Valve During Pulmonary Endarterectomy in a Patient with Chronic Thromboembolic Pulmonary Hypertension: A Case Report Author(s): Hoshino K.; Takita K.; Demura M.; Kubo T.; Morimoto Y. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

274. Hemodynamic Management in Aortic Root Replacement in a Patient With Coarctation of the Aorta Author(s): Miyazawa K.; Sajima T.; Ishiguro Y. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

275. ACGME Accreditation Guide for Adult Cardiothoracic Anesthesiology Fellowship Author(s): Goldhammer J.E.; Herman C.R.; Heitz J.W.; Banks D.A. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

276. Association Between Optic Nerve Head Blood Flow Measured Using Laser Speckle Flowgraphy and Radial Arterial Pressure During Aortic Arch Surgery Author(s): Hayashi H.; Kawaguchi M.; Okamoto M.; Matsuura T.; Kawanishi H.; Tabayashi N.; Taniguchi S. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: This study was designed to investigate the association between ocular blood flow measured using laser speckle flowgraphy (LSFG) and radial arterial pressure during aortic arch surgery. Design: A prospective study. Setting: A single university hospital. Participants: This study included 24 patients undergoing aortic arch surgery with cardiopulmonary bypass (CPB) using antegrade selective cerebral perfusion (SCP). Interventions: Measurement of optic nerve head blood flow using LSFG and radial arterial pressure via a catheter in the radial artery. Methods and Main Results: Antegrade SCP was managed with 24 and 40-to-60 mmHg at the right radial artery, which usually corresponds to a flow rate of 10 mL/kg/min. Optic nerve head blood flow using LSFG and radial arterial blood pressure were evaluated simultaneously at the right side and recorded at the following 4 points: after the induction of anesthesia (phase 1), after the beginning of CPB (phase 2), after the beginning of antegrade SCP (phase 3), and after cessation of CPB (phase 4).A moderate positive correlation between %change of mean blur rate in the optic nerve head measured using LSFG and %change of radial mean arterial pressure was identified (r = 0.604, p < 0.001). Bland-Altman analysis showed that the bias (mean difference) was -1.2% (95% limits of agreement -47.4% to 45.0%), indicating good agreement between %changes of the values recorded using the 2 measurements. Conclusions: Intraoperative monitoring of optic nerve head blood flow using LSFG can be used as an additional cerebral perfusion parameter during aortic arch surgery with CPB using antegrade SCP. Copyright © 2017 Elsevier Inc. Database: EMBASE

277. Anesthesia for Cardiac Ablation Author(s): Fujii S.; Zhou J.R.; Dhir A. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:As the complexity and duration of cardiac ablation procedures increase, there is a growing demand for anesthesiologist involvement in the electrophysiology suites for sedation and anesthesia provision, hemodynamic and neuromonitoring, and procedural guidance through transesophageal echocardiography. To deliver high-quality perioperative care, it is important that the anesthesiologist is intimately familiar with the evolving techniques and technologies, the anesthetic options and ventilation strategies, and the anticipated postprocedural complications. Copyright © 2017 Elsevier Inc. Database: EMBASE

278. Developing Capacity to Do Improvement Science Work Author(s): McGhee I.; Gleicher Y. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:Developing capacity to do improvement science starts with prioritizing quality improvement training in all health professions curricula so that a common knowledge base and understanding are created. Educational programs should include opportunities for colearning with patients, health professionals, and leaders. In this way, knowledge translation (also called implementation) is more effective and better coordinated when applied across organizations. Key factors that enable and drive behavior change are reviewed, as is the importance of influence and leadership. A comprehensive approach that accounts for these factors hardwires quality improvement into the health care systems and creates a culture that enables its ongoing development. Copyright © 2017 Elsevier Inc. Database: EMBASE

279. Diffusing Innovation and Best Practice in Health Care Author(s): Greilich P.E.; Phelps M.E.; Daniel W. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Completing a successful pilot project can be exciting, however, effective diffusion is essential to achieving meaningful and lasting impact on the service line and health system. Copyright © 2017 Elsevier Inc. Database: EMBASE

280. Handovers in Perioperative Care Author(s): Barbeito A.; Agarwala A.V.; Lorinc A. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication. Copyright © 2017 Database: EMBASE

281. Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises Author(s): Goldhaber-Fiebert S.N.; Macrae C. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care. Copyright © 2017 Sara N. Goldhaber- Fiebert, Carl Macrae Database: EMBASE

282. Use of Simulation in Performance Improvement Author(s): Burden A.; Pukenas E.W. Source: Anesthesiology Clinics; Mar 2018; vol. 36 (no. 1); p. 63-74 Publication Date: Mar 2018 Publication Type(s): Review Abstract:Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. This article explores the use of simulation for performance improvement. Educational theories that underlie effective simulation programs are described as driving forces behind the advancement of simulation in performance improvement. Copyright © 2017 Elsevier Inc. Database: EMBASE

283. Right Atrial Myxoma with Pulmonary Artery Hypertension: Role of Transesophageal Echocardiography in Detection of Cause and Perioperative Management Author(s): Munirathinam G.K.; Kumar B.; Singh H. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

284. Number and Type of Post-Traumatic Stress Disorder Symptom Domains Are Associated With Patient-Reported Outcomes in Patients With Chronic Pain Author(s): Langford D.J.; Theodore B.R.; Balsiger D.; Tran C.; Doorenbos A.Z.; Tauben D.J.; Sullivan M.D. Source: Journal of Pain; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Post-traumatic stress disorder (PTSD) commonly accompanies complex chronic pain, yet PTSD is often overlooked in chronic pain management. Using the 4-item Primary Care (PC)-PTSD screening tool, we evaluated the relationship between the number and type of PC-PTSD symptoms endorsed and a set of patient-reported outcomes, including: pain intensity and interference, function, mood, quality of life, and substance abuse risk in a consecutive sample of patients with chronic pain (n = 4,402). Patients completed PainTracker, a Web-based patient-reported outcome tool that provides a multidimensional evaluation of chronic pain, as part of their intake evaluation at a specialty pain clinic in a community setting. Twenty-seven percent of the sample met PC-PTSD screening criteria for PTSD by endorsing 3 of the 4 symptom domains. Significant ordinal trends were observed between increasing number of PTSD symptoms and all outcomes evaluated. The occurrence of even 1 PTSD symptom was associated with overall poorer outcomes, suggesting that subsyndromal PTSD is clinically significant in the context of chronic pain. Among the 4 PTSD domains assessed, "numbness/detachment" was most strongly associated with negative pain outcomes in relative weight analysis. Results from this cross-sectional study suggest that a range of pain-related outcomes may be significantly related to comorbid PTSD. Perspective: We present evidence that PTSD symptoms are significantly related to a broad set of pain-related patient-reported outcomes. These findings highlight the need to evaluate for PTSD symptoms in patients with chronic pain, especially feelings of numbness or detachment from others, to improve understanding and management of chronic pain. Copyright © 2018 The American Pain Society. Database: EMBASE

285. Train-of-four recovery precedes twitch recovery during reversal with sugammadex in pediatric patients: A retrospective analysis Author(s): Vieira Carlos R.; Luis Abramides Torres M.; de Boer H.D. Source: Paediatric Anaesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Pediatric Anesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: After reversal of a rocuronium-induced neuromuscular blockade with sugammadex, the recovery of train-of-four ratio to 0.9 is faster than recovery of first twitch of the train-of-four to 90% in adults. These findings after reversal of neuromuscular blockade with sugammadex have not yet been investigated in pediatric patients. Aims: The aim of this retrospective analysis was to investigate the relationship of the recovery of first twitch of the train-of-four height and train-of-four ratio after reversal of rocuronium- induced neuromuscular blockade with sugammadex in pediatric patients. Methods: Patients ASA I-III, aged 2-11 years, and who underwent abdominal and/or perineal surgery were included in the analysis. After extracting the necessary data from the hospital database, the patients were divided into 2 groups based on the dose of sugammadex received: group A: 2 mg.kg-1 for reversal of moderate neuromuscular blockade and group B: 4 mg.kg-1 for reversal of deep neuromuscular blockade. The relationship of the recovery of first twitch of the train-of-four height and train-of-four ratio in these 2 groups were analyzed. Results: Data from 43 pediatric patients aged 2-11 years could be analyzed. The first twitch of the train-of-four height at the recovery of train-of-four ratio to 0.9 in group B was statistically significantly lower compared with group A. This height 3 and 5 minutes after the train-of- four ratio reached 0.9 showed no statistically significant differences between groups. Conclusion: The results were in line with the results found in adults and showed that the train-of-four ratio recovered to 0.9 was faster than first twitch of the train-of-four height recovered to the same level. Copyright © 2018 John Wiley & Sons Ltd. Database: EMBASE

286. Association of red blood cell transfusion and short- and longer-term mortality after coronary artery bypass graft surgery Author(s): Tantawy H.; Elgammal M.; Sukumar N.; Li A.; Dai F.; Elefteriades J.; Akhtar S. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: Red blood cell (RBC) transfusion has been linked to increased morbidity and mortality. However, strict RBC transfusion recommendations recently have been questioned. The aim of this study was to investigate the short- and long-term mortality outcomes after RBC transfusion in patients undergoing coronary artery bypass graft surgery (CABG). Design: This was a retrospective medical record review. Setting: Tertiary care academic medical center. Participants: The study included patients who underwent CABG from June 2006 to May 2013. Intervention: Adult (>18 years) cardiac surgery patients who were admitted to the cardiothoracic intensive care unit in a tertiary care academic medical center from June 2006 to May 2013 were collected. In all, 2,180 patients who underwent CABG surgery were included into propensity-score matching analyses, which were matched 1:1. Patients who did not receive transfusion of packed red blood cells (PRBC) (n = 937) were compared with those who received 1 to 5 U (n = 1,113). The study outcomes included mortality rates at 1, 3, and 6 months (short-term) and 1, 2, 3, and 4 years (long-term). Results: No statistical significant differences were found for the 1-month (2% v 1.1%, p = 0.292), 3-month (2.9% v 2%, p = 0.396), or 6-month mortality rate (4.3% v 3.4%, p = 0.602) in 446 patients with 1 to 5 U versus 446 matched patients with no PRBC transfusion. Patients in the transfused group compared with those in the no-transfusion group had statistically significant higher 3-year mortality rate (11% v 6.7%; hazard ratio, 1.64; 95% confidence interval, 1.03-2.63; p = 0.038). Conclusion: In the present study, patients undergoing CABG surgery and receiving <6 U of PRBC did not have statistically increased risk for in-hospital mortality and up to 2 years postoperatively. A modestly statistically significant difference was noted at 3 years. However, cumulatively, there was no statistical difference between the transfused and nontransfused groups at 4 years. Further studies are needed to confirm the findings and define the population that will benefit the most from blood transfusion. Copyright © 2018 Elsevier Inc. Database: EMBASE

287. Systolic Anterior Motion of the Mitral Valve Causing Dynamic Left Ventricular Outflow Tract Obstruction: An Underappreciated Complication During Lung Transplantation Author(s): Iyer M.H.; Essandoh M. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

288. Total Intravenous Versus Volatile Induction and Maintenance of Anesthesia in Elective Carotid Endarterectomy: Effects on Cerebral Oxygenation and Cognitive Functions Author(s): Kuzkov V.V.; Ivashchenko O.Y.; Ivashchenko N.Y.; Kirov M.Y.; Obraztsov M.Y.; Gorenkov V.M. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: Carotid endarterectomy (CEA) is effective for the prevention of stroke, yet can be associated with a postoperative cognitive dysfunction (POCD) that may be affected by the type of anesthesia. The aim of the study was to compare the effects of total intravenous anesthesia (TIVA) with propofol to volatile induction and maintenance of anesthesia (VIMA) with sevoflurane on cerebral tissue oxygen saturation (SctO2) and POCD. Design: Single-center, pilot randomized prospective study. Settings: Single-center, 1,000-bed clinical hospital. Participants: The study included 40 adult male patients. Interventions: None. Measurements and Main Results: Patients were randomized to the TIVA (n = 20) or the VIMA (n = 20) groups. Cardiorespiratory parameters and SctO2 were monitored during CEA and through 20 hours postoperatively. Cognitive functions were assessed preoperatively and on days 1 and 5 after CEA using the Montreal Cognitive Assessment Score (MoCA). In both groups, the ipsilateral SctO2 decreased after clamping, whereas the contralateral SctO2 asymmetrically decreased in the TIVA group only compared both with baseline and with the VIMA group. The changes in MoCA by day 1 correlated with the relative change in the ipsilateral SctO2 after the clamping in the TIVA group (rho = 0.54, p = 0.015). The improvement of MoCA from days 1 to 5 was related to the relative decline in MAP after the clamping. Better cognitive function was observed by day 5 after sevoflurane VIMA compared with TIVA. Conclusion: In CEA, VIMA with sevoflurane might preserve oxygenation in the contralateral hemisphere, suppress an asymmetry of cerebral oxygenation, and improve the early postoperative cognition compared with propofol anesthesia. Copyright © 2017 Elsevier Inc. Database: EMBASE

289. Mechanical discordance between left atrium and left atrial appendage Author(s): Khamooshian A.; Jeganthan J.; Amador Y.; Mahmood F.; Matyal R.; Laham R. Source: Annals of Cardiac Anaesthesia; 2018; vol. 21 (no. 1); p. 82-84 Publication Date: 2018 Publication Type(s): Article Available at Annals of Cardiac Anaesthesia - from Europe PubMed Central - Open Access Available at Annals of Cardiac Anaesthesia - from EBSCO (MEDLINE Complete) Available at Annals of Cardiac Anaesthesia - from ProQuest (Hospital Premium Collection) - NHS Version Available at Annals of Cardiac Anaesthesia - from annals.in Abstract:During standard transesophageal echocardiographic examinations in sinus rhythm (SR) patients, the left atrial appendage (LAA) is not routinely assessed with Doppler. Despite having a SR, it is still possible to have irregular activity in the LAA. This situation is even more important for SR patients where assessment of the left atrium is often foregone. We describe a case where we encountered this situation and briefly review how to assess the left atrium and its appendage in such a case scenario. Copyright © 2018 Annals of Cardiac Anaesthesia, Published by Wolters Kluwer- Medknow. Database: EMBASE

290. Convergent Validity of the Dutch Central Sensitization Inventory: Associations with Psychophysical Pain Measures, Quality of Life, Disability, and Pain Cognitions in Patients with Chronic Spinal Pain Author(s): Kregel J.; Schumacher C.; Dolphens M.; Malfliet A.; Goubert D.; Lenoir D.; Cagnie B.; Meeus M.; Coppieters I. Source: Pain Practice; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Objective: Symptoms of central sensitization (CS) have been described in patients with chronic spinal pain (CSP). Although a gold standard to diagnose CS is lacking, psychophysical pain measures are often used. The Central Sensitization Inventory (CSI) is proposed as an alternative method and indirect tool for the evaluation of CS symptomatology. The aim of the current study was to evaluate the convergent validity of the CSI by investigating the association with psychophysical pain measures and self-reported measures of current pain intensity, quality of life, disability, and catastrophizing in CSP patients. Methods: One hundred sixteen patients with nonspecific CSP were included in the present study. Patients completed the CSI, were subjected to pressure pain thresholds (PPTs) and a conditioned pain modulation (CPM) paradigm, and completed questionnaires for current pain intensity, quality of life, pain disability, and pain catastrophizing. Results: Higher CSI scores were weakly correlated with lower PPTs (-0.276 <= r <= -0.237; all P <= 0.01) and not with CPM efficacy (r = 0.017; P = 0.858). Higher CSI scores were moderately correlated with higher current pain intensity (r = 0.320; P < 0.001), strongly correlated with lower physical (r = -0.617; P < 0.001) and emotional (r = -0.635; P < 0.001) quality of life, and moderately correlated with higher pain disability (r = 0.472; P < 0.001) and higher pain catastrophizing (r = 0.464; P < 0.001). Conclusion: The CSI was weakly associated with PPTs and not with CPM efficacy in CSP patients. Moderate to strong associations were found with current pain intensity, quality of life, disability, and catastrophizing. The current results illustrate that the CSI does not reflect a direct measure of CS, yet is a representation of general distress, possible originating from CS symptoms. Copyright © 2018 World Institute of Pain. Database: EMBASE

291. Validation of the Pain Coping Questionnaire in Finnish Author(s): Marttinen M.K.; Kauppi M.J.; Santavirta N.; Pohjankoski H.; Vuorimaa H. Source: European Journal of Pain (United Kingdom); 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at European Journal of Pain - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Objective: The Pain Coping Questionnaire (PCQ), the first validated pain coping measurement developed specifically for children, has lacked proper validation in Finnish. The original PCQ by Reid et al. (Pain 1998; 76; 83-96) comprises eight-first-order and three higher-order scales. The aim herein was to determine the factor structure and validity of the Finnish PCQ translation in Finnish children. Methods: Exploratory factor analysis was used for the first-order and higher-order classification of 91 recruited patients aged 8-15. Cronbach's alpha was used for reliability. Relationships between the Children's Depression Inventory, patient-reported pain frequency and pain coping strategies were examined. Results: Analyses were executed with 38 items; one was excluded. A structure of eight-first- order (Internalizing/Catastrophizing [IC], Positive Self-Statements [PSS], Information Seeking [IS], Seeking Social Support [SSS], Cognitive Distraction [CD], Externalizing [EXT], Behavioural Distraction [BD], Problem Solving [PS]) and three higher-order scales (Approach [APP], Emotion-Focused Avoidance [EFA], Distraction [DIS]) proved the most consistent. Four first- order scales (PSS, CD, EXT, BD) emerged as identical to the original solution. Internal consistency reliability coefficients for all individual first- and second-order scales were satisfactory. A higher CDI score was positively related to EFA and negatively to DIS, and pain frequency positively related to APP and EFA. Conclusion: The exploratory factor analysis of the PCQ provided a both culturally and statistically satisfactory structure in the Finnish translation. This supports the reliability and validity of the PCQ in future national use and the value of the questionnaire also outside English-speaking countries. Significance: This study showed both culturally and statistically satisfactory factor structure of PCQ in the Finnish translation. This result supports reliability and validity of the PCQ in the national use in the future. The result shows that the PCQ is a reliable method to be used in different linguistic and cultural surroundings and, thus, encourages using it in various countries. The data consist of two patient groups, adolescents with JIA and musculoskeletal pain. Pain and specifically coping with pain are important aspects of clinical work. A valid pain coping scale may enhance distinguishing vulnerable pain coping style in children and adolescent before pain becomes chronic. Copyright © 2018 European Pain Federation - EFIC. Database: EMBASE

292. Pain-relieving effectiveness, quality of life and tolerability of repeated capsaicin 8% patch treatment of peripheral neuropathic pain in Scandinavian clinical practice Author(s): Hansson P.; Kvarstein G.; Jensen T.S.; Stromberg M. Source: European Journal of Pain (United Kingdom); 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at European Journal of Pain - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Context: Clinical trials have demonstrated the efficacy and safety of the capsaicin 8% patch in patients with peripheral neuropathic pain (PNP); however, few studies have assessed this treatment in a clinical practice. Objective: To determine whether treatment and re-treatment with the capsaicin 8% patch reduce PNP intensity in clinical practice. Methods: Three non-interventional, observational studies were concurrently conducted in Denmark, Norway and Sweden. Patients with probable or definite PNP received one or two treatments with the capsaicin 8% patch according to usual clinical practice. All analyses were performed on combined data. Results: Overall, 382 and 181 patients received treatment and re-treatment, respectively, with the capsaicin 8% patch. At the group level, a significant reduction in mean level of 'usual pain' intensity (Numerical Pain Rating Scale) over the last 24 h' score was observed from baseline to Weeks 2 through 8 [-1.05 (95% confidence interval: -1.27, 0.82); p < 0.001] with 28% and 31% of patients reporting a >=30% reduction in pain after first treatment and re-treatment, respectively. Improvements in health-related quality of life (EQ-5D-3L index) and overall health status (Patient Global Impression of Change) were observed early (Week 1) and throughout the treatment periods. Most application site reactions subsided within a week after treatment. Following treatment and re-treatment, 57% and 71% of patients, respectively, were willing to undergo further treatment with the capsaicin 8% patch. Conclusion: In Scandinavian clinical practice, capsaicin 8% patch treatment was associated with significant reductions in pain intensity and was well tolerated with over half of patients willing to undergo re-treatment. Copyright © 2018 European Pain Federation - EFIC. Database: EMBASE

293. Giant Cell Arteritis: Practical Pearls and Updates Author(s): Pradeep S.; Smith J.H. Source: Current Pain and Headache Reports; Jan 2018; vol. 22 (no. 1) Publication Date: Jan 2018 Publication Type(s): Review Abstract:Purpose of Review: The purpose of this review is to summarize recent updates and distill practical points from the literature which can be applied to the care of patients with suspected and confirmed giant cell arteritis (GCA). Recent Findings: Contemporary thinking implicates a fundamental failure of T regulatory cell function in GCA pathophysiology, representing opportunity for novel therapeutic avenues. Tocilizumab has become the first Food and Drug Administration-approved treatment for GCA following demonstration of efficacy and safety in a phase 3 clinical trial. Summary: There have been significant parallel advances in both our understanding of GCA pathophysiology and treatment. Tocilizumab, and other agents currently under investigation in phase 2 and 3 clinical trials, presents a new horizon of hope for both disease remission and avoidance of glucocorticoid-related complications. Copyright © 2018, Springer Science+Business Media, LLC, part of Springer Nature. Database: EMBASE

294. Perioperative incidence of airway obstructive and hypoxemic events in patients with confirmed or suspected sleep apnea - a prospective, randomized pilot study comparing propofol/remifentanil and sevoflurane/remifentanil anesthesia Author(s): Fassbender P.; Burgener S.; Haddad A.; Silvanus M.-T.; Peters J. Source: BMC Anesthesiology; Jan 2018; vol. 18 (no. 1) Publication Date: Jan 2018 Publication Type(s): Article Available at BMC anesthesiology - from BioMed Central Available at BMC anesthesiology - from Europe PubMed Central - Open Access Available at BMC anesthesiology - from PubMed Central Abstract:Background: Obstructive sleep apnea (OSA) is a risk factor for perioperative complications but data on anesthesia regimen are scarce. Methods: In patients with established or strongly suspected OSA, we assessed in a prospective, randomized design the effects on nocturnal apnea-hypopnea-index (AHI) and oxygen saturation (SpO2) of propofol/remifentanil or sevoflurane/remifentanil based anesthesia. Patients were selected by a history for OSA and / or a positive STOP - questionnaire and received general anesthesia using remifentanil (12mug/kg/h) combined either with propofol (4-6mg/kg/h, n=27) or sevoflurane (approx. 2.2vol% endtidal, n=27). AHI and SpO2 were measured during the nights before and after anesthesia. Results: There were no differences in AHI between anesthetic regimens nor between the pre- and postoperative nights (propofol: 8.6h-1 (median, CI: 3.6-21.9) vs. 7.9h-1 (1.8-28.8); p=0.97; sevoflurane: 3.8h-1 (1.8-7.3) vs. 2.9h-1 (1.2-9.5); p=0.85). Postoperative minimum SpO2 (propofol: 80.7%+/-4.6, sevoflurane: 81.6+/-4.6) did not differ from their respective preoperative baselines (propofol: 79.6%+/- 6.5; p=0.26, sevoflurane: 80.8%+/-5.2; p=0.39). Even in patients with a preanesthetic AHI>15, nocturnal AHI remained unchanged postoperatively. Conclusion: Thus, in a cohort of patients with suspected or confirmed OSA undergoing surgery of moderate duration and severity neither the volatile agent sevoflurane nor the intravenous anesthetic propofol altered nocturnal AHI or oxygen saturation, when combined with the short acting opioid remifentanil. Trial registration: German Clinical Trials Register, DRKS00005824retrospectively registered on 03/12/2014. Copyright © 2018 The Author(s). Database: EMBASE

295. Image Guidance Technologies for Interventional Pain Procedures: Ultrasound, Fluoroscopy, and CT Author(s): Wang D. Source: Current Pain and Headache Reports; Jan 2018; vol. 22 (no. 1) Publication Date: Jan 2018 Publication Type(s): Review Abstract:Chronic pain is a common medical condition. Patients who suffer uncontrolled chronic pain may require interventions including spinal injections and various nerve blocks. Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilization of image guidance has dramatically improved the accuracy and safety of these interventions. The first image guidance technology adopted by pain specialists was fluoroscopy. This was followed by CT and ultrasound. Fluoroscopy can be used to visualize bony structures of the spine. It is still the most commonly used guidance technology in spinal injections. In the recent years, ultrasound guidance has been increasingly adopted by interventionists to perform various injections. Because its ability to visualize soft tissue, vessels, and nerves, this guidance technology appears to be a better option than fluoroscopy for interventions including SGB and celiac plexus blocks, when visualization of the vessels may prevent intravascular injection. The current evidence indicates the efficacies of these interventions are similar between ultrasound guidance and fluoroscopy guidance for SGB and celiac plexus blocks. For facet injections and interlaminar epidural steroid injections, it is important to visualize bony structures in order to perform these procedures accurately and safely. It is worth noting that facet joint injections can be done under ultrasound guidance with equivalent efficacy to fluoroscopic guidance. However, obese patients may present challenge for ultrasound guidance due to its poor visualization of deep anatomical structures. Regarding transforaminal epidural steroid injections, there are limited evidence to support that ultrasound guidance technology has equivalent efficacy and less complications comparing to fluoroscopy. However, further studies are required to prove the efficacy of ultrasound-guided transforaminal epidural injections. SI joint is unique due to its multiplanar orientation, irregular joint gap, partial ankylosis, and thick dorsal and interosseous ligament. Therefore, it can be difficult to access the joint space with fluoroscopic guidance and ultrasound guidance. CT scan, with its cross- sectional images, can identify posterior joint gap, is most likely the best guidance technology for this intervention. Intercostal nerves lie in the subcostal grove close to the plural space. Significant risk of pneumothorax is associated with intercostal blocks. Ultrasound can provide visualization of ribs and pleura. Therefore, it may improve the accuracy of the injection and reduce the risk of pneumothorax. At present time, most pain specialists are familiar with fluoroscopic guidance techniques, and fluoroscopic machines are readily available in the pain clinics. In the contrast, CT guidance can only be performed in specially equipped facilities. Ultrasound machine is generally portable and inexpensive in comparison to CT scanner and fluoroscopic machine. As pain specialists continue to improve their patient care, ultrasound and CT guidance will undoubtedly be incorporated more into the pain management practice. This review is based on a paucity of clinical evidence to compare these guidance technologies; clearly, more clinical studies is needed to further elucidate the pro and cons of each guidance method for various pain management interventions. Copyright © 2018, Springer Science+Business Media, LLC, part of Springer Nature. Database: EMBASE

296. Pediatric Patients with High Pulmonary Arterial Pressure in Congenital Heart Disease Have Increased Tracheal Diameters Measured by Computed Tomography Author(s): Ohashi N.; Imai H.; Seino Y.; Baba H. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objectives: Determination of the appropriate tracheal tube size using formulas based on age or height often is inaccurate in pediatric patients with congenital heart disease (CHD), particularly in those with high pulmonary arterial pressure (PAP). Here, the authors compared tracheal diameters between pediatric patients with CHD with high PAP and low PAP. Design: Retrospective clinical study. Setting: Hospital. Participants: Pediatric patients, from birth to 6 months of age, requiring general anesthesia and tracheal intubation who underwent computed tomography were included. Patients with mean pulmonary artery pressure >25 mmHg were allocated to the high PAP group, and the remaining patients were allocated to the low PAP group. The primary outcome was the tracheal diameter at the cricoid cartilage level, and the secondary goal was to observe whether the size of the tracheal tube was appropriate compared with that obtained using predictable formulas based on age or height. Measurements and Main Results: The mean tracheal diameter was significantly larger in the high PAP group than in the low PAP group (p < 0.01). Pediatric patients with high PAP required a larger tracheal tube size than predicted by formulas based on age or height (p = 0.04 for age and height). Conclusions: Pediatric patients with high PAP had larger tracheal diameters than those with low PAP and required larger tracheal tubes compared with the size predicted using formulas based on age or height. Copyright © 2017 Elsevier Inc. Database: EMBASE

297. Assessing health-related quality of life in primary Sjogren's syndrome-The PSS-QoL Author(s): Lackner A.; Stradner M.H.; Hermann J.; Unger J.; Graninger W.B.; Dejaco C.; Stamm T. Source: Seminars in Arthritis and Rheumatism; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objectives: To develop a questionnaire for the assessment of health-related quality of life (HRQL) in primary Sjogren's syndrome (PSS), and to test its psychometric properties. Methods: Based on the concepts of a previous qualitative study, a questionnaire for the assessment of HRQL in PSS (PSS-QoL) was developed. Psychometric testing of PSS-QoL was performed after revising the first draft with feedback of patients (n = 6) and clinicians (n = 4). Convergent construct validity was assessed by correlating the score with the EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI), EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) and Euro-QoL 5D (EQ-5D). Reliability was examined by asking patients to complete the questionnaire twice 1-2 weeks apart. An English Version of the PSS-QoL was developed by using standard methodology with forward and back translation. Results: Out of the 75 PSS patients, 91% were female, mean (+/-SD) age was 58.5 +/- 12.5 years. PSS-QoL consists of 25 questions and can be divided into two main categories: physical (discomfort and dryness) and psychosocial. The internal consistency of the PSS-QoL revealed a Crohnbach's alpha of 0.892. Strong and moderate correlations were found between the PSS-QoL and ESSPRI (corrcoeff = 0.755) and EQ. 5D-pain/discomfort (corrcoeff = 0.531). Reproducibility of the PSS-QoL was high, yielding an ICC of 0.958 (95% CI: 0.926- 0.981). Conclusions: The PSS-QoL is the first specific tool for the assessment of patients' HRQL in PSS and showed good psychometric properties. It may serve as a novel patient- reported outcome measure in future clinical studies. Copyright © 2017 Elsevier Inc. Database: EMBASE

298. 4-Valve Heart Disease and Right Heart Failure Author(s): Hollon M.; Glas K.; Sumler M. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Carcinoid heart disease is a rare form of heart disease due to secretion of vasoactive compounds, including serotonin, from gastrointestinal tumors. This E-challenge examines the case of a patient with advanced carcinoid heart disease who presented to the operating room (OR) for a tricuspid valve replacement. Once the patient was in the OR, intraoperative transesophageal echocardiography was used to discover a patent foramen ovale and involvement of all 4 valves with regurgitant lesions. The patient underwent tricuspid valve replacement, pulmonic valve replacement, right ventricular outflow tract reconstruction, and patent foramen closure in the OR and experienced subsequent fulminant right heart failure. Mechanical circulatory support was required to separate the patient from cardiopulmonary bypass, which was first attempted with an intra-aortic balloon pump and subsequently achieved with implantation of a right ventricular assist device. Multiple reports of acute right heart failure are available in the literature; however, this case helps illustrate several important considerations for the anesthesiologist. The effects of chronic circulating vasoactive compounds on the heart valves are well documented; however, it is likely that advanced carcinoid heart disease also will trigger preexisting myocardial dysfunction, which may be underappreciated. Identifying patients who are at high risk for intraoperative right heart failure and considering what constitutes an adequate preoperative assessment of right heart function aid in preparing for OR management. In addition, reviewing the potential options for managing these patients when the traditional therapies are inadequate, including mechanical support and extracorporeal circulation, is a useful exercise in preparation. This case also highlights the contributions of intraoperative transesophageal echocardiography in the diagnosis and management of carcinoid heart disease, the need for additional preoperative optimization of these patients, and the management and potential complications of mechanical support. Copyright © 2017 Elsevier Inc. Database: EMBASE

299. Membrane attack complex (mac) deposition in lupus nephritis is associated with hypertension and poor clinical response to treatment Author(s): Wang S.; Belmont H.M.; Wu M.; Chiriboga L.; Zeck B. Source: Seminars in Arthritis and Rheumatism; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: To study membrane attack complex in lupus nephritis as a potential biomarker for disease intensity and prognostic indicator for response to treatment. Methods: Immunohistochemistry was performed using unconjugated, murine anti-human complement C9 on kidney biopsies from 30 SLE patients who fulfilled 4 ACR or SLICC criteria. Clinical parameters were assessed at time of biopsy, 6 and 12 months. Results: 30 renal biopsies were obtained from patients with Class II (2), III (5), IV (8), V (5), III+V (8) and IV+V (2). 13/30 (43.3%) biopsies stained positive for glomerular C9. Patients with positive C9 had significantly higher blood pressure, trend towards lower C3, and male gender. There was no significant difference for ISN/RPN class, activity or chronicity indices between C9 positive and negative groups. 5/11 (45.5%) patients positive for C9 did not respond to therapy at 6 months compared with 2/15 (13.3%) patients negative for C9. C9 positive patients were more likely to be a non-responder at 6 months (OR = 5.4, 95% CI: 0.8, 36.4) compared to C9 negative patients. After adjusting for systolic blood pressure, compliance to treatment and proteinuria in a multivariate logistic model, C9 positive patients remained more likely to be non-responders (OR = 4.6, 95% CI: 0.3, 70.9). Conclusion: This study suggests that MAC deposition measured as C9 staining may be a biomarker for more intense disease and poor response to treatment in lupus nephritis. MAC staining may be useful in routine studies of lupus biopsies and identify patients at risk for aggressive disease who may be candidates for novel therapies targeting terminal complement pathway. Copyright © 2018 Elsevier Inc. Database: EMBASE

300. Anomalies in target-controlled infusion: An analysis after 20 years of clinical use Author(s): Engbers F.H.M.; Dahan A. Source: Anaesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Although target-controlled infusion has been in use for more than two decades, its benefits are being obscured by anomalies in clinical practice caused by a number of important problems. These include: a variety of pharmacokinetic models available in open target-controlled infusion systems, which often confuse the user; the extrapolation of anthropomorphic data which provokes anomalous adjustments of dosing by such systems; and the uncertainty of regulatory requirements for the application of target-controlled infusion which causes uncontrolled exploitation of drugs and pharmacokinetic models in target-controlled infusion devices. Comparison of performance of pharmacokinetic models is complex and mostly inconclusive. However, a specific behaviour of a model in a target- controlled infusion system that is neither intended nor supported by scientific data can be considered an artefact or anomaly. Several of these anomalies can be identified in the current commercially available target-controlled infusion systems and are discussed in this review. Copyright © 2018 The Association of Anaesthetists of Great Britain and Ireland Database: EMBASE

301. Flawed Study Design and Incorrect Presentation of Data Negatively Impact Potentially Useful Interventional Treatments for Patients with Low Back Pain: A Critical Review of JAMA's MinT Study Author(s): van Kuijk S.M.; Van Zundert J.; van Kleef M.; Van Boxem K.; Hans G.; Vissers K.; Rathmell J. Source: Pain Practice; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Pain Practice - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Database: EMBASE

302. Alkaptonuric Ochronosis and the Failure of Regional Cerebral Tissue Oxygen Saturation Monitoring by Two Different Near-infrared Spectroscopy Devices Author(s): Namekawa M.; Kimura M.; Fujii C.; Yamashita S.; Ishida K. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Database: EMBASE

303. Respiratory changes in subclavian vein diameters predicts fluid responsiveness in intensive care patients: a pilot study Author(s): Giraud R.; Abraham P.S.; Siegenthaler N.; Bendjelid K.; Brindel P. Source: Journal of Clinical Monitoring and Computing; Jan 2018 ; p. 1-7 Publication Date: Jan 2018 Publication Type(s): Article In Press Abstract:The present pilot study investigated whether respiratory variation in subclavian vein (SCV) diameters correlates with fluid responsiveness in mechanically ventilated patients. Monocentric, prospective clinical study on fluid responsiveness in adult sedated, mechanically ventilated ICU patient, monitored with the PiCCOTM system (Pulsion Medical System, Germany), and requiring a fluid challenge (FC). A 10-min fluid bolus of 500 mL of 0.9% saline was administered. Cardiac output (CO) and dynamic parameters [stroke volume variation (SVV) and pulse pressure variation (PPV)] measured by transpulmonary thermodilution and pulse contour analysis (PiCCOTM) as well as classical hemodynamic parameters were recorded at baseline and after FC. Fluid responsiveness was described as an increase in CO of >= 15%. Ultrasound measurements obtained in the subclavian long-axis view were used to calculate the SCVvariability index. A cut-off value for SCV variation for the prediction of fluid responsiveness was determined using receiver operating curve (ROC) analysis. Nine of 20 FCs (45%) induced an increase in CO of >= 15%. At baseline, the SCVvariability index was greater in responders than in non-responders (34.0 +/- 21.4 vs. 9.0 +/- 5.5; p = 0.0005). Diagnostic performance for the SCVvariability index revealed a cut-off value of 14 with a sensitivity of 100% [Confidence interval (CI) 95% (90; 100)] and a specificity of 82% [CI 95% (48; 98)] for the prediction of fluid responsiveness. Other parameters, such as SVV and PPV, could not predict fluid responsiveness. The correlation coefficient between CO variation and the SCVvariability index was 0.73 (p < 0.001). The SCVvariability index was a reliable, non-invasive parameter for the prediction of fluid responsiveness at the bedside of mechanically ventilated, critically ill patients in this pilot study. Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature Database: EMBASE

304. Comparison of cardiac output optimization with an automated closed-loop goal- directed fluid therapy versus non standardized manual fluid administration during elective abdominal surgery: first prospective randomized controlled trial Author(s): Lilot M.; Bellon A.; Bouvet L.; Vassal O.; Lehot J.-J.; Gueugnon M.; Laplace M.-C.; Baffeleuf B.; Hacquard P.; Barthomeuf F.; Parent C.; Tran T.; Soubirou J.-L.; Piriou V.; Robinson P. Source: Journal of Clinical Monitoring and Computing; Jan 2018 ; p. 1-11 Publication Date: Jan 2018 Publication Type(s): Article In Press Abstract:An intraoperative automated closed-loop system for goal-directed fluid therapy has been successfully tested in silico, in vivo and in a clinical case-control matching. This trial compared intraoperative cardiac output (CO) in patients managed with this closed-loop system versus usual practice in an academic medical center. The closed-loop system was connected to a CO monitoring system and delivered automated colloid fluid boluses. Moderate to high-risk abdominal surgical patients were randomized either to the closed- loop or the manual group. Intraoperative final CO was the primary endpoint. Secondary endpoints were intraoperative overall mean cardiac index (CI), increase from initial to final CI, intraoperative fluid volume and postoperative outcomes. From January 2014 to November 2015, 46 patients were randomized. There was a lower initial CI (2.06 vs. 2.51 l min-1 m-2, p = 0.042) in the closed-loop compared to the control group. No difference in final CO and in overall mean intraoperative CI was observed between groups. A significant relative increase from initial to final CI values was observed in the closed-loop but not the control group (+ 28.6%, p = 0.006 vs. + 1.2%, p = 0.843). No difference was found for intraoperative fluid management and postoperative outcomes between groups. There was no significant impact on the primary study endpoint, but this was found in a context of unexpected lower initial CI in the closed-loop group. Trial registry number ID-RCB/EudraCT: 2013-A00770-45. ClinicalTrials.gov Identifier NCT01950845, date of registration: 17 September 2013. Copyright © 2018 Springer Science+Business Media B.V., part of Springer Nature Database: EMBASE

305. A Comparative Study of Point-of-Care Prothrombin Time in Cardiopulmonary Bypass Surgery Author(s): Okabayashi S.; Ogawa S.; Takeshita S.; Nakayama Y.; Sawa T.; Mizobe T.; Tanaka K.A.; Nishiyama T.; Nakajima Y. Source: Journal of Cardiothoracic and Vascular Anesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Abstract:Objective: Point-of-care (POC) devices allow for prothrombin time/international normalized ratio (PT/INR) testing in whole blood (WB) and timely administration of plasma or prothrombin complex concentrate during cardiopulmonary bypass surgery. This study evaluated the sensitivities of a new POC PT test, a dry-hematology method with heparin neutralization technology (DRIHEMATO PT-S [DRI PT-S]; A&T Corporation, Kanagawa, Japan), and compared it with other POC tests currently available. Design: Prospective, observational study. Setting: University hospital, single center. Participants: Healthy volunteers and warfarin-treated and cardiac surgical patients. Measurement and Main Results: In WB samples obtained from 6 healthy volunteers, PT-INR results of DRI PT-S were not affected by an in vitro addition of heparin <6.0 U/mL. In warfarin-treated samples (n = 88, PT/INR 0.98-3.87), PT-INR with DRI PT-S showed acceptable correlation with the laboratory method (r 2 = 0.85, p < 0.001). In blood samples obtained from cardiac surgical patients (n = 72), heparin prolonged the PT/INR with the laboratory assay, dry-hematology method with non heparin neutralization technology (DRI PT), Coaguchek XS (Roche Diagnostics, Basel, Switzerland), and Hemochron Jr. (Accriva Diagnostics, Edison, NJ), but DRI PT-S was not affected by heparin anticoagulation. In nonheparinized samples, different methods between DRI PT-S and the laboratory method yielded acceptable correlations (r 2 = 0.76, p < 0.0001). There was a moderate correlation between factor levels and the PT-INR with DRI PT-S (factor [F]II: r 2 = 0.63, FVII: r 2 = 0.47, FX: r 2 = 0.67; p < 0.0001). Conclusions: This study demonstrated that PT/INR can be accurately assessed using the dry- hematology method in WB under therapeutic heparin levels. Currently available other POC PT/INR tests are affected by heparin, and thus they are not recommended for coagulation monitoring during cardiopulmonary bypass. Copyright © 2017 Elsevier Inc. Database: EMBASE

306. Topical benzydamine hydrochloride for prevention of postoperative sore throat in adults undergoing tracheal intubation for elective surgery: A systematic review and meta- analysis Author(s): Kuriyama A.; Aga M.; Maeda H. Source: Anaesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Postoperative sore throat has a negative impact on patient satisfaction and recovery. Benzydamine hydrochloride is a non-steroidal anti-inflammatory drug available for topical use. We performed a systematic review and meta-analysis to assess the efficacy and safety of topical application of benzydamine to prevent postoperative sore throat in adults undergoing elective surgery under general anaesthesia. We searched PubMed, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials to identify relevant randomised controlled trials and pooled the data using a random effects model. The primary outcomes were the incidence and severity of sore throat 24 h after surgery/extubation, and adverse events. The quality of evidence was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) criteria. Thirteen randomised controlled trials involving 1842 patients were included. Compared with control patients who did not receive analgesia, benzydamine was associated with a decreased incidence of postoperative sore throat, with a risk ratio (95%CI) of 0.31 (0.20- 0.47), but not with significantly reduced severity, the standardised mean difference (95%CI) being -0.27 (-0.63 to 0.08). There were no significant adverse events related to benzydamine. Benzydamine was also associated with a reduced incidence of postoperative sore throat when compared with lidocaine, with a risk ratio (95%CI) of 0.18 (0.07-0.43). We judged the evidence for the outcome 'incidence of postoperative sore throat' as high quality. Copyright © The Association of Anaesthetists of Great Britain and Ireland. Database: EMBASE

307. A triple-blind, placebo-controlled randomised trial of the ilioinguinal-transversus abdominis plane (I-TAP) nerve block for elective caesarean section Author(s): Staker J.J.; Liu D.; Church R.; Panahkhahi M.; Lecong T.; Carlson D.J.; Lim A. Source: Anaesthesia; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:This study investigated the efficacy of a new ilioinguinal-transversus abdominis plane block when used as a component of multimodal analgesia. We conducted a prospective, triple-blind, placebo-controlled randomised study of 100 women undergoing elective caesarean section. All women had spinal anaesthesia with hyperbaric bupivacaine, 15 mug fentanyl and 150 mug morphine, as well as 100 mg diclofenac and 1.5 g paracetamol rectally. Women were randomly allocated to receive the ilioinguinal-transversus abdominis plane block or a sham block at the end of surgery. The primary outcome was the difference in fentanyl patient-controlled analgesia dose at 24 h. Secondary outcomes included postoperative pain scores, adverse effects and maternal satisfaction. The cumulative mean (95%CI) fentanyl dose at 24 h was 71.9 (55.6-92.7) mug in the ilioinguinal-transversus abdominis group compared with 179.1 (138.5-231.4) mug in the control group (p < 0.001). Visual analogue scale pain scores averaged across time-points were 1.9 (1.5-2.3) mm vs. 5.0 (4.3-5.9) mm (p = 0.006) at rest, and 4.7 (4.1-5.5) mm vs. 11.3 (9.9-13.0) mm (p = 0.001) on movement, respectively. Post-hoc analysis showed that the ilioinguinal-transversus abdominis group was less likely to use >= 1000 mug fentanyl compared with the control group (2% vs. 16%; p = 0.016). There were no differences in opioid-related side-effects or maternal satisfaction with analgesia. The addition of the ilioinguinal-transversus abdominis plane block provides superior analgesia to our usual multimodal analgesic regimen. Copyright © The Association of Anaesthetists of Great Britain and Ireland. Database: EMBASE

308. Perioperative use of transthoracic echocardiography in a patient with congenitally corrected transposition of great arteries, atrial septal defect and severe pulmonary stenosis for lower segment cesarean section Author(s): Saini V.; Samra T.; Kaur G. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 544-546 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:A 25-year-old female with congenitally corrected transposition of great arteries (CCTGAs), atrial septal defect, and severe pulmonary stenosis underwent lower segment cesarean section at 34 weeks of gestation using combined spinal epidural anesthesia (CSEA). We used transthoracic echocardiography (TTE) for intraoperative monitoring of the cardiovascular system because these patients are reported to have a high prevalence of myocardial perfusion defects, regional wall motion abnormalities, and impaired ventricular contractility. Scanning was done at four different time intervals; preoperatively, after initiation of CSEA, after delivery of child and postoperatively (6 and 24 h postdelivery) to detect regional wall motion and valvular abnormalities, calculate ejection fractions and optimize fluid administration. In this case report, we thus discuss the anatomical defects of CCTGA, physiologic concerns and emphasize on the use of TTE for perioperative management of such cases. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

309. Aortic dissection masquerading as a bicuspid aortic valve Author(s): Arora H.; Kumar P. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 541-543 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:A 37-year-old male presented to the Emergency Department with acute worsening of back pain and new onset dyspnea. Transthoracic echocardiography revealed moderate left ventricular dysfunction and a bicuspid aortic valve (BAV). In addition, he was noted to have a dilated thoracic aorta concerning for a dissection, severe aortic insufficiency (AI), and both a pericardial and pleural effusion. Magnetic resonance imaging revealed a Type A ascending aortic dissection. He was taken emergently to the operating room for repair. An intraoperative transesophageal echocardiography examination was performed which revealed a normal trileaflet AV with a Type A aortic dissection flap masquerading as a BAV. The dissection flap interfered with both the valve's function, causing severe AI, as well as the valve's appearance, causing it to look bicuspid on echocardiography. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

310. A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body Author(s): Datta R.; Agrawal J.; Sharma A.; Rathore V.; Datta S. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 534-540 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: The effect of stellate ganglion blocks (SGBs) was examined in complex regional pain syndromes (CRPS) of the upper body. Material and Methods: A total of 287 SGB were given to patients with documented CRPS on medications. Spontaneous and provoked pain assessment was done with numeric pain rating scale (NPRS). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and range of motion (ROM) was recorded before and after each blockade. Difference between a 15-point 'global rating of change' scale determined the minimal clinically important difference of the DASH score. Results: The overall mean pain reduction was 73.2% (r = 0.83, P < 0.001) considering spontaneous and 55.8% (r = 0.77, P < 0.001) on provoked pain. Mean DASH score decreased from 53 (range 36-63; P = 0.14) to 10.4 (range 10-49.2; P = 0.005). The sensitivity to change was 6.9 for spontaneous and 4.9 for provoked pain. Increase in ipsilateral limb temperature has a good correlation with Horner's syndrome (HS) and sympathetic blockade. Minor, self-limiting complications, such as hoarseness, dysphagia, local hematoma, and ipsilateral brachial plexus block occurred in 11.5%. A rare complication of contralateral HS was documented. One patient developed a small pneumothorax, but it did not require intervention. Conclusions: SGB are relatively safe and effective management in patients with neuropathic conditions already on pharmacotherapy. Serial blocks attained an average reduction in pain by >3 NPRS points from the baseline for both spontaneous and provoked pain with a decrease in mean DASH score and improvement in ROM. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

311. Evaluation of effect of entropy monitoring on isoflurane consumption and recovery from anesthesia Author(s): Goyal K.; Nileshwar A.; Budania L.; Gaude Y.; Mathew S.; Vaidya S. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 529-533 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Entropy monitoring entails measurement of the effect of anesthetic on its target organ rather than merely the concentration of anesthetic in the brain (indicated by alveolar concentration based on which minimum alveolar concentration [MAC] is displayed). We proposed this prospective randomised study to evaluate the effect of entropy monitoring on isoflurane consumption and anesthesia recovery period. Material and Methods: Sixty patients undergoing total abdominal hysterectomy under general anesthesia using an endotracheal tube were enrolled in either clinical practice (CP) or entropy (E) group. In group CP, isoflurane was titrated as per clinical parameters and MAC values, while in Group E, it was titrated to entropy values between 40 and 60. Data including demographics, vital parameters, alveolar isoflurane concentration, MAC values, entropy values, and recovery profile were recorded in both groups. Results: Demographic data and duration of surgery were comparable. Time to eye opening on command and time to extubation (mean +/- standard deviation) were significantly shorter, in Group E (6.6 +/- 3.66 and 7.27 +/- 4.059 min) as compared to Group CP (9.77 +/- 5.88 and 11.63 +/- 6.90 min), respectively. Mean isoflurane consumption (ml/h) was 10.81 +/- 2.08 in Group E and 11.45 +/- 2.24 in Group CP and was not significantly different between the groups. Time to readiness to recovery room discharge and postanesthesia recovery scores were also same in both groups. Conclusion: Use of entropy monitoring does not change the amount of isoflurane consumed during maintenance of anesthesia or result in clinically significant faster recovery. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

312. A prospective randomized study comparing recovery following anesthesia with a combination of intravenous dexmedetomidine and desflurane or sevoflurane in spinal surgeries Author(s): Patil Y.; Bagade S.; Patil N.; Jadhav N. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 524-528 Publication Date: 2017 Publication Type(s): Review Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Desflurane and sevoflurane are inhalational anesthetics which provide stable intraoperative hemodynamics and rapid emergence from anesthesia. Dexmedetomidine is an alpha2-agonist with sedative and hypnotic effects. We compared recovery following anesthesia with a combination of a continuous intravenous infusion of dexmedetomidine and desflurane or sevoflurane in cases of spine surgeries because no such data are available from India. Material and Methods: It was a single-blind, prospective, randomized study. After institutional ethics committee approval, patients were randomly allocated to one of the two groups of fifty patients each. Group D received desflurane and Group S received sevoflurane, along with dexmedetomidine 0.5 mug/kg/h IV infusion for maintenance of anesthesia. Results and Conclusions: Extubation time (ET) in Group D was shorter by 4.2 min than in Group S (10.1 +/- 2.2 and 14.2 +/- 1.3; P = 0.004). Postoperative recovery, postoperative analgesic, and antiemetic requirement between the groups were comparable The mean dial setting required to maintain the minimum alveolar concentration of 1 intraoperatively was 3.1 for desflurane and 0.7 for sevoflurane. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

313. Comparison of maintenance, emergence and recovery characteristics of sevoflurane and desflurane in pediatric ambulatory surgery Author(s): Kotwani M.; Malde A. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 503-508 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Increasing number of pediatric ambulatory surgeries are being carried out in general anesthesia using supraglottic airways (SGAs). Literature comparing sevoflurane and desflurane for the maintenance of SGA-based anesthesia is limited. Hence, we planned this prospective randomized study to compare the maintenance, emergence and recovery characteristics of sevoflurane and desflurane for pediatric ambulatory surgery. Material and Methods: Sixty children aged 6 months to 6 years posted for short surgical procedures were enrolled into the study. Anesthesia was induced with intravenous propofol (maximum 4 mg/kg), SGA was inserted, and children were randomized to receive sevoflurane or desflurane for the maintenance of anesthesia. No muscle relaxants were administered, and all children received caudal block and rectal paracetamol suppository. Demographic data, perioperative hemodynamics and adverse events, emergence and recovery characteristics, postoperative pain, and emergence agitation (EA) were recorded. Data were analyzed using SPSS (version 16.0, IBM Corporation, Armonk, New York, USA). P < 0.05 was considered statistically significant. Results: Demography, perioperative hemodynamics, and duration of inhalational anesthesia were comparable between two groups. There were no respiratory adverse events in either group during maintenance. Time to awakening and time to removal of SGA were shorter with desflurane (5.3 +/- 1.4 and 5.8 +/- 1.3 min) than sevoflurane (9.1 +/- 2.4 and 10.0 +/- 1.6 min) (P < 0.0001). Recovery (steward recovery score = 6) was faster with desflurane (18 +/- 8.4 min) than sevoflurane (45.3 +/- 9.7 min) (P < 0.001). The incidence of EA was 16.7% with desflurane and 10% with sevoflurane (P = 0.226). Conclusion: Desflurane provides faster emergence and recovery in comparison to sevoflurane when used for the maintenance of anesthesia through SGA in children. Both sevoflurane and desflurane can be safely used in children for lower abdominal surgeries. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

314. Sevoflurane sparing effect of dexmedetomidine in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial Author(s): Sharma P.; Gombar S.; Ahuja V.; Jain A.; Dalal U. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 496-502 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Sevoflurane is an excellent but expensive anesthetic agent for laparoscopic cholecystectomy. To decrease sevoflurane consumption during surgery adjuvants like dexmedetomidine may be used. Dexmedetomidine is a recently introduced drug which alleviates the stress response of surgery, produces sedation and analgesia. We aimed to evaluate sevoflurane sparing effect of dexmedetomidine in patients undergoing laparoscopic cholecystectomy under entropy-guided general anesthesia (GA). Material and Methods: In this prospective randomized control study, 100 American Society of Anesthesiologists physical status I-II adult surgical patients scheduled to undergo laparoscopic cholecystectomy were enrolled. Patients were randomly divided into two groups (n = 50). In dexmedetomidine group, patients received intravenous (IV) dexmedetomidine 0.5 mug/kg over 10 min before induction followed by 0.5 mug/kg/h infusion while in control group, patients received the same volume of normal saline. Results: Sevoflurane consumption was 41% lower in dexmedetomidine group as compared to control group (7.1 [1.6] vs. 12.1 [1.9] ml, P<0.001). A 40% reduction was observed in induction dose of propofol (83.0 [19.1] vs. 127.6 [24.8] mg, P<0.001). Mean Riker sedation- agitation score, visual analog score for pain and Aldrete's score were significantly lower in dexmedetomidine group as compared to control group. None of the patients experienced any significant side effects. Conclusion: A 41% reduction in sevoflurane consumption was observed in patients receiving IV dexmedetomidine as an adjuvant in patients undergoing laparoscopic cholecystectomy under GA. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

315. Tracheal intubation through laryngeal mask airway CTrachTM with polyvinyl chloride tube: Comparison between two orientations of the tracheal tube Author(s): Pavani K.; Krishna H.; Nandhini J. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 473-479 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Higher success rate of intubation is observed with the reverse orientation of polyvinyl chloride (PVC) tracheal tube while intubating through laryngeal mask airway (LMA) FastrachTM. It is not clear whether the same is true during intubation through LMA CTrachTM visualizing the process of intubation. The primary aim of this study was to compare the influence of the PVC tracheal tube orientation on the success rate of intubation while intubating through LMA CTrachTM. Material and Methods: One- hundred and fifty patients belonging to American Society of Anesthesiologists status I-II, undergoing elective surgery under general anesthesia were randomized to either group normal orientation or group reverse orientation. A maximum of 3 intubation attempts within a span of 3 min was allowed in each group before the change over to the other group. If intubation failed with the other orientation of the tube also, then intubation through LMA CTrachTM was abandoned and intubation done by direct laryngoscopy. The success of intubation, time, maneuvers, postoperative sore throat, and hoarseness were recorded. Results: Tracheal intubation through LMA CTrachTM with PVC tube was successful in 94.5% of patients in group normal orientation and in 98.6% of patients in group reverse orientation. The first attempt success rate was 75.3% and 86.3% in group normal and group reverse orientation, respectively. The incidence of a sore throat was higher in the group normal orientation than in the reverse orientation (31.8% and 26.5%, respectively). Conclusions: Overall success rate of intubation was comparable between the two groups. Though statistically insignificant, the first attempt success rate was higher in group reverse orientation. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

316. I-Gel versus laryngeal mask airway (LMA) classic as a conduit for tracheal intubation using ventilating bougie Author(s): Dhimar A.A.; Sangada B.R.; Upadhyay M.R.; Patel S.H. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 467-472 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Supraglottic airways (SGAs) are generally used for airway management; but can also be used as a conduit for tracheal intubation. Our primary aim was to evaluate i-Gel and laryngeal mask airway (LMA) classic as conduits for tracheal intubation using ventilating bougie by assessing number of attempts and time for insertion of SGAs, ventilating bougie and endotracheal tube (ETT), and total intubation time. Material and Methods: A randomized clinical trial was carried out in 58 patients requiring general anesthesia and endotracheal intubation for planned surgery. They were randomly divided into Group I and Group C. After induction of anesthesia, i-Gel was inserted in Group I and LMA Classic in Group C; ventilating bougie was passed through SGA followed by the removal of SGA and railroading of ETT over ventilating bougie. Parameters observed were number of attempts and time taken for device insertion, total intubation time, and hemodynamic variables. Results: Twenty-nine patients were included in each group. First attempt success rate for SGA insertion (86.2% in Group I and 75.9% in Group C (P = 0.5)), ventilating bougie insertion (79.32% in Group I and 82.8% in Group C (P = 0.99)) and ETT insertion (100% in Group I and 96.5% in Group C) was not different in the two groups. Total intubation time was 93.3 +/- 9.0 s in Group I and 108. 96 +/- 16.5 s in Group C (P < 0.0001). Conclusions: i- Gel and LMA Classic both can be used as a conduit for tracheal intubation using ventilating bougie with stable hemodynamic parameters. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

317. Front of neck access: A survey among anesthetists and surgeons Author(s): Mendonca C.; Pallister E.; Ahmad I.; Sajayan A.; Shanmugam R.; Sharma M.; Tosh W.; Kimani P. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 462-466 Publication Date: 2017 Publication Type(s): Review Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Emergency front of neck access (FONA) is the final step in a Can't Intubate-Can't Oxygenate (CICO) scenario. In view of maintaining simplicity and promoting standardized training, the 2015 Difficult Airway Society guidelines recommend surgical cricothyroidotomy using scalpel, bougie, and tube (SBT) as the preferred technique. Material and Methods: We undertook a survey over a 2-week period to evaluate the knowledge and training, preferred rescue technique, and confidence in performing the SBT technique. Data were collected from both anesthetists and surgeons. Results: One hundred and eighty-nine responses were collected across four hospitals in the United Kingdom. The majority of participants were anesthetists (55%). One hundred and eleven (59%) respondents were aware of the national guidelines (96.2% among anesthetists and 12.9% among surgeons). Only 71 (37.6%) respondents indicated that they had formal FONA training within the last one year. Seventy-five anesthetists (72.8%) knew that SBT equipment was readily available in their department, while most surgeons (81.2%) did not know what equipment available. One hundred and five (55.5%) respondents were confident in performing surgical cricothyroidotomy in a situation where the membrane was palpable and only in 33 (17.5%) where the cricothyroid membrane was not palpable. Conclusion: This survey has demonstrated that despite evidence of good training for anesthetists in FONA, there are still shortfalls in the training and knowledge of our surgical colleagues. In an emergency, surgeons may be required to assist or secure an airway in a CICO situation. Regular multidisciplinary training of all clinicians working with anesthetized patients should be encouraged and supported. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

318. Dexmedetomidine as an adjunctive analgesic to ropivacaine in pectoral nerve block in oncological breast surgery: A randomized double-blind prospective study Author(s): Kaur H.; Singh G.; Aggarwal S.; Kumar M.; Singh A.; Arora P. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 457-461 Publication Date: 2017 Publication Type(s): Review Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Pectoral nerve block (Pecs) using local anesthetic (LA) agent is a newer analgesic technique for breast surgeries. This study further evaluates the effect of addition of dexmedetomidine to LA agent on total duration of analgesia and postoperative morphine consumption. Material and Methods: A total of 60 American Society of Anesthesiologist Grade I and II female patients with age >=18 years, scheduled for oncological breast surgery, were enrolled in the study. Patients were randomized into two equal groups of 30 each. Group R (n = 30) received ultrasound (US)-guided Pecs block with 30 ml of 0.25% ropivacaine. Group RD (n = 30 patients) received US-guided Pecs block with 30 ml of ropivacaine 0.25% and dexmedetomidine 1 mu/kg body weight. Duration of analgesia and total postoperative morphine consumption was noted in 24 h period. Unpaired t-test and Chi-square test were used for statistical analysis. Results: A statistically highly significant increase in total duration of analgesia (in minutes) was recorded in Group RD as compared to Group R (469.6 +/- 81.5 in Group RD and 298.2 +/- 42.3 in Group R) (P = 0.000). Total postoperative morphine consumption in mg was also statistically significantly lower in Group RD as compared to Group R (14.8 +/- 2.4 in Group RD and 21.6 +/- 3.1 in Group R) (P = 0.000). No patient under study reported any adverse effects. Conclusion: Addition of 1 mu/kg dexmedetomidine to 0.25% ropivacaine for Pecs block increases the duration of analgesia and decreases postoperative morphine consumption. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

319. The effect of intravenous infusion of N-acetyl cysteine in cirrhotic patients undergoing liver resection: A randomized controlled trial Author(s): Sayed E.; Younis E.; Yassen K.; Gaballah K.; El-Einen A. Source: Journal of Anaesthesiology Clinical Pharmacology; 2017; vol. 33 (no. 4); p. 450-456 Publication Date: 2017 Publication Type(s): Article Available at Journal of Anaesthesiology Clinical Pharmacology - from Europe PubMed Central - Open Access Available at Journal of Anaesthesiology Clinical Pharmacology - from joacp.org Abstract:Background and Aims: Liver resection can lead to hepatocellular dysfunction. The aim was to evaluate the effect of N-acetyl cysteine (NAC) on liver enzymes (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), international normalized ratio (INR), C-reactive protein (CRP), and intercellular adhesion molecule 1 (ICAM 1) in cirrhotic patients undergoing liver resection. Material and Methods: A randomized controlled trial (RCT), Pan African Clinical Trial registry (PACTR201508001251260). 60 Child A patients were studied. NAC group (n = 30) received intravenous infusion of NAC 10 g/24 h in 250 ml of 5% dextrose during surgery and for 2 days. Controls (C) (n = 30) received a similar volume of 5% dextrose. All above parameter were measured during and after surgery. Results: ALT and AST were significantly elevated after surgery, but to a less extent with NAC versus C (day 3; 118.3 +/- 18.6 vs. 145.4 +/- 14.0 U/L. P < 0.01) and (121.5 +/- 19.5 vs. 146.6 +/- 15.1 U/L, P = 0.00), respectively. Lower serum CRP and ICAM 1 with NAC versus C on day 3 (44.2 +/- 13.4 vs. 68.7 +/- 48.2 mg/l, P = 0.003), (308.8 +/- 38.2 vs. 352.8 +/- 59.4 ng/ml, P = 0.002), respectively. Hospital stay was shorter with NAC versus C (6.1 +/- 0.8 vs. 6.9 +/- 1.2 days, P = 0.006). Duration of surgery, INR, and hemodynamics were comparable. Conclusion: Prophylactic NAC in hepatic patients undergoing liver surgery attenuated postoperative increase in transaminases, ICAM 1, and CRP blood levels. The impact of these findings and the cost benefit of reduced hospital stay on enhanced recovery after surgery needs to be evaluated. Copyright © 2018 Journal of Anaesthesiology Clinical Pharmacology. Database: EMBASE

320. Case scenario: Power of positive end-expiratory pressure Author(s): Stahl D.L.; Hess D.R.; North C.M.; Lewis A.; Kimberly W.T. Source: Anesthesiology; Jul 2014; vol. 121 (no. 6); p. 1320-1326 Publication Date: Jul 2014 Publication Type(s): Article Database: EMBASE

321. Case 2-2011: Acute Myocardial Infarction in a Pregnant Patient Requiring Coronary Artery Bypass Graft Surgery Author(s): Dhawan R.; Kacha A.; Chaney M.A.; Fox A.A.; Wong C.A. Source: Journal of Cardiothoracic and Vascular Anesthesia; Apr 2011; vol. 25 (no. 2); p. 353- 361 Publication Date: Apr 2011 Publication Type(s): Article PubMedID: 21295495 Database: EMBASE

322. Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy: A feasibility study Author(s): Ferrando C.; Suarez-Sipmann F.; Leon I.; Pozo N.; Carbonell J.; Puig J.; Pastor E.; Gracia E.; Gutierrez A.; Aguilar G.; Belda F.J.; Soro M.; Tusman G. Source: Acta Anaesthesiologica Scandinavica; 2018 Publication Date: 2018 Publication Type(s): Article In Press Available at Acta Anaesthesiologica Scandinavica - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS Abstract:Background: We conducted this study to test whether pulse-oximetry hemoglobin saturation (SpO2) can personalize the implementation of an open-lung approach during laparoscopy. Thirty patients with SpO2>= 97% on room-air before anesthesia were studied. After anesthesia and capnoperitoneum the FIO2 was reduced to 0.21. Those patients whose SpO2 decreased below 97% - an indication of shunt related to atelectasis - completed the following phases: (1) First recruitment maneuver (RM), until reaching lung's opening pressure, defined as the inspiratory pressure level yielding a SpO2>= 97%; (2) decremental positive end-expiratory (PEEP) titration trial until reaching lung's closing pressure defined as the PEEP level yielding a SpO2< 97%; (3) second RM and, (4) ongoing ventilation with PEEP adjusted above the detected closing pressure. Results: When breathing air, in 24 of 30 patients SpO2 was < 97%, PaO2/FIO2< 53.3 kPa and negative end-expiratory transpulmonary pressure (PTP-EE). The mean (SD) opening pressures were found at 40 (5) and 33 (4) cmH2O during the first and second RM, respectively (P < 0.001; 95% CI: 3.2-7.7). The closing pressure was found at 11 (5) cmH2O. This SpO2-guided approach increased PTP- EE (from -6.4 to 1.2 cmH2O, P < 0.001) and PaO2/FIO2 (from 30.3 to 58.1 kPa, P < 0.001) while decreased driving pressure (from 18 to 10 cmH2O, P < 0.001). SpO2 discriminated the lung's opening and closing pressures with accuracy taking the reference parameter PTP-EE (area under the receiver-operating-curve of 0.89, 95% CI: 0.80-0.99). Conclusion: The noninvasive SpO2 monitoring can help to individualize an open-lung approach, including all involved steps, from the identification of those patients who can benefit from recruitment, the identification of opening and closing pressures to the subsequent monitoring of an open-lung condition. Copyright © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Database: EMBASE

Strategy 384090 # Database Search term Results

1 EMBASE (0304-3959 OR 0007-0912 OR 234832 1471-6771 OR 1528-1175 OR 0003-3022 OR 1526-5900 OR 1441-2772 OR 1744-8069 OR 0049-0172 OR 1098-7339 OR 1526-7598 OR 0003-2999 OR 0885-3924 OR 0003-2409 OR 1365-2044 OR 1533-3159 OR 1090-3801 OR 0749-8047 OR 1525-1403 OR 1094-7159 OR 0001-5172 OR 1399-6576 OR 0265-0215 OR 1365-2346 OR 1155-5645 OR 1460-9592 OR 1537-1921 OR 0898-4921 OR 0832-610X OR 1496-8975 OR 1526-2375 OR 1526-4637 OR 0375-9393 OR 1178-7090 OR 1203-6765 OR 0959-289X OR 1753-3740 OR 1521-6896 OR 1473-6500 OR 0952-7907 OR 2090-1542 OR 2090-1550 OR 1387-1307 OR 1573-2614 OR 1530-7085 OR 1533-2500 OR 1471-2253 OR 1532-8422 OR 1053-0770 OR 1064-6655 OR 1534-3081 OR 1531-3433 OR 0913-8668 OR 1438-8359 OR 1687-6970 OR 1687-6962 OR 0310-057X OR 1448-0271 OR 1089-2532 OR 1754-9493 OR 0360-1293 OR 0952-8180 OR 1932-2275 OR 0970-9185 OR 0974-5181 OR 0971-9784 OR 1551-7489).is 2 EMBASE (Sevoflurane AND agitation).ti,ab 399

4 EMBASE exp "RESPIRATION CONTROL"/ 14042

5 EMBASE exp "AIRWAY OBSTRUCTION"/ 31557

6 EMBASE exp "AIRWAY REMODELING"/ 3358 7 EMBASE exp "AIRWAY RESISTANCE"/ 12486

8 EMBASE exp EXTUBATION/ 15237

9 EMBASE exp "DIABETES MELLITUS"/ 820593

10 EMBASE exp GYNECOLOGY/ 39039

11 EMBASE exp "RESPIRATORY DISTRESS 30030 SYNDROME, ADULT"/ 12 EMBASE exp "LARYNGEAL MASK"/ 19733

13 EMBASE exp "NERVE BLOCK"/ 33946

14 EMBASE exp HEART/ 634041

15 EMBASE exp "VISCERAL PAIN"/ 40171

16 EMBASE exp SEPSIS/ 227614

17 EMBASE exp "VASCULAR SURGERY"/ 400788

19 EMBASE exp "EXERCISE TEST"/ 73849

20 EMBASE exp "HEART FUNCTION TEST"/ 86673

21 EMBASE exp DELIRIUM/ 25597

22 EMBASE exp "ANTIINFECTIVE AGENT"/ 2802720

23 EMBASE exp "LOW BACK PAIN"/ 49122

24 EMBASE ("enhanced recovery after 4819 surgery" OR ERAS).ti,ab 25 EMBASE exp FIBROMYALGIA/ 17391

26 EMBASE exp "QUALITY CONTROL 1838560 PROCEDURES"/ 27 EMBASE exp "QUALITY OF LIFE"/ 408459

28 EMBASE ("fluid management").ti,ab 2794

29 EMBASE (2 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 6815869 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 19 OR 20 OR 21 OR 22 OR 23 OR 24 OR 25 OR 26 OR 27 OR 28) 31 EMBASE ("Conference Proceeding" OR 2769804 Editorial OR Erratum OR Letter OR Note OR "Short Survey").pt 32 EMBASE 1 and 29 79991

33 EMBASE 32 not 31 62073

34 EMBASE 33 [Since 31-Jan-2018] 322