Anesthesiology
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Randomized Controlled Trial Multicenter Study
Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during Noncardiac Surgery.
Colloids are thought to sustain blood pressure and cardiac index better than crystalloids. However, the relative effects of intraoperative hydroxyethyl starch and crystalloid administration on the cardiac index and blood pressure remain unclear. This study therefore tested in this subanalysis of a previously published large randomized trial the hypothesis that intraoperative goal-directed colloid administration increases the cardiac index more than goal-directed crystalloid administration. Further, the effects of crystalloid and colloid boluses on blood pressure were evaluated. ⋯ There were not clinically meaningful differences in the cardiac index or mean pressure variability in patients given goal-directed colloid and crystalloids. As might be expected from longer intravascular dwell time, the interval between boluses was longer with colloids. However, on a case basis, the number of boluses differed only slightly. Colloids do not appear to provide substantial hemodynamic benefit.
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Multicenter Study
Intraoperative Hypotension and Acute Kidney Injury after Noncardiac Surgery in Infants and Children: A Retrospective Cohort Analysis.
Age- and sex-specific reference nomograms for intraoperative blood pressure have been published, but they do not identify harm thresholds. The authors therefore assessed the relationship between various absolute and relative characterizations of hypotension and acute kidney injury in children having noncardiac surgery. ⋯ In distinct contrast to adults, the authors did not find any association between intraoperative hypotension and postoperative renal injury. Avoiding short periods of hypotension should not be the clinician's primary concern when trying to prevent intraoperative renal injury in pediatric patients.
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Observational Study
Mediastinal Masses, Anesthetic Interventions, and Airway Compression in Adults: A Prospective Observational Study.
Central airway occlusion is a feared complication of general anesthesia in patients with mediastinal masses. Maintenance of spontaneous ventilation and avoiding neuromuscular blockade are recommended to reduce this risk. Physiologic arguments supporting these recommendations are controversial and direct evidence is lacking. The authors hypothesized that, in adult patients with moderate to severe mediastinal mass-mediated tracheobronchial compression, anesthetic interventions including positive pressure ventilation and neuromuscular blockade could be instituted without compromising central airway patency. ⋯ These observations suggest a need to reassess prevailing assumptions regarding positive pressure ventilation and/or paralysis and mediastinal mass-mediated airway collapse, but do not prove that conventional (nonstaged) inductions are safe for such patients.
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Review Historical Article
A Beautiful Friendship-and a Lesson about Friends and Colleagues: A Classic Partnership Revisited.
David Warner, M. D., and Michael Todd, M. D., first met in 1985. ⋯ That collaboration has now lasted for 35 yr, resulting in more than 70 joint publications. More importantly, they have had the privilege of working together with close to 1,000 colleagues from around the world, in a dozen medical specialties. Their careers are an example of what can be accomplished by friendship, mutual commitment, persistence, and a willingness to join with others.