What is the appropriate “zero reference” for the CVP? The study by Giordano and colleagues suggests that to minimize venous air embolus during liver resection it should be the most anterior site of the resection, determined by preoperative imaging or by passing sterile tubing to the surgeons to establish the zero reference point during the resection. The accompanying editorial places these recommendations into clinical context of CVP-based treatment algorithms.

The two-edged ability of protamine to reverse heparin-induced coagulopathy, or to cause coagulopathy on its own, is dissected in a carefully performed study by Bolliger and colleagues. In their accompanying editorial “Crouching clot, hidden hemorrhage”: Nielsen and Malayaman place the findings in clinical perspective: how should you respond to the request for “just a little more protamine” if you suspect protamine-induced coagulopathy?

Rapid response teams respond within a few minutes to a rapidly deteriorating patient who hasn’t reached the “code blue” stage. The study by Lighthall and colleagues shows that cardiac arrest rates and overall mortality decreased at a US veterans’ hospital when a rapid response system was instituted.

There is considerable institutional variability in deciding which patients would benefit from decompressive craniotomy for intracranial hypertension. The review by Li and colleagues provides an overview of the management of intracranial hypertension, including the evidence supporting decompressive craniectomy as a therapeutic option in patients with raised intracranial pressure.

Evidence continues to accumulate showing that systemic lidocaine is a potent antiinflammatory drug that may have a role in multi-model perioperative analgesia. Su and colleagues show that lidocaine reduces the intercellular concentration of calcium in microglia, directing inhibiting p38 MAPK and attenuating the production of TNF-alpha, IL-1beta, and IL-6.