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May 2008, Volume 106, Issue 5
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Many studies demonstrate the utility of lipid emulsions in treating the cardiovascular effects of local anesthetic overdose, including a collection of papers in this month’s issue of Anesthesia & Analgesia. On the basis of these findings, anesthesiology departments should stock lipid emulsions in all clinical settings where large doses of local anesthetics are injected. Lipids to the rescue! |
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April 2008, Volume 106, Issue 4
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How do you assess intravascular volume? New algorithms improve the utility of respiratory variation in arterial blood pressure as a measure of intravascular volume status.
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March 2008, Volume 106, Issue 3
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Medical advances take many forms: better drugs, better devices, and better delivery
of health care to patients. In Zambia some hospitals are so poor that they wash
their "disposable" latex gloves. Our enthusiasm for scientific progress must not
blind us to the need for progress in providing basic anesthesia services to the
world's poor. Photograph by Eva-Susanne Ehrenreich.
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February 2008, Volume 106, Issue 2
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Dr. Paul Janssen discovered of more than 80 pharmaceuticals, including fentanyl,
sufentanil, alfentanil, etomidate, droperidol, and haloperidol. As patients we may
have benefited from diphenoxylate (Lomotil), loperamide (Imodium),
miconazole, ketoconazole, levamisole, lorcainide, astemizole, cisapride,
and risperidone. Dr. Janssen passed away in 2003, but still contributes to the
lives of our patients.
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January 2008, Volume 106, Issue 1
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It has long been recognized that alcohol in moderate doses is
good for the heart. It is also known that volatile anesthetics
protect the heart from ischemic injury. Not only do the mechanisms
of cardioprotection for alcohol and volatile anesthetics overlap,
but volatile anesthetic further enhances the protection against
ischemic injury provided by regular alcohol consumption.
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December 2007, Volume 105, Issue 6
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Spinal surgery is frequently performed to alleviate low back pain,
but with variable success. Diagnostic spinal injections have been
used to predict the outcome of surgical intervention and decrease the
incidence of failed back surgery. Available data suggest that the
ability of diagnostic spinal injections to predict surgical outcome
is more "Wheel of Fortune" than accurate scientific forecasting.
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November 2007, Volume 105, Issue 5
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Pain is hell. The cover depicts the banishment of Pain, represented by a
well recognized figure from the triptych "The Garden of Earthly Delights"
by the Dutch painter Hieronymus Bosch. This issue of Anesthesia & Analgesia
features 7 articles describing scientific efforts to banish pain from the
lives of our patients.
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October 2007, Volume 105, Issue 4
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The cover is an adaptation of "Despair" by Edvard Munch (1893) to convey
the hopelessness of the addicted physician. Articles in this issue of Anesthesia
& Analgesia describe how physician diversion of drugs is detected through
electronic medical information systems. The electronic milieu that detected
diversion is suggested by the "Matrix" background, and contains readable messages.
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September 2007, Volume 105, Issue 3
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The melting brains in the airless environment suggest hypoxic brain injury.
This allusion to Salvador Dal's "The Persistence of Memory" suggests that
memory, a critical component of cognition, will survive, and is used to highlight
a remarkable study demonstrating protection and partial reversal of hypoxic
brain injury in this issue of Anesthesia & Analgesia.
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August 2007, Volume 105, Issue 2
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Children instinctually rely on adults to protect them, as suggested by
the tiny hand clutching the gloved fingers. This issue of Anesthesia &
Analgesia examines cardiac arrest in children, and reminds us that we
have inadequate outcome data to precisely guide our efforts
to reduce anesthesia morbidity and mortality. (The child is clutching
his father's hand).
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July 2007, Volume 105, Issue 1
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Millions have a drug problem: they can't get any. In Uganda, non-governmental
organizations and the government cooperated to make morphine available in
palliative care. Photo: WHO, Marko Kokic. A landmark treatise in this issue
of Anesthesia & Analgesia explores pain management as a universal human right.
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June 2007, Volume 104, Issue 6
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"In one ear and out the other" is the title of an editorial in this issue of
Anesthesia & Analgesia. The associated case report describes how physicians
failed to pass along information that a patient's glucose could not be monitored
at the bedside. Their insulin titration, based on falsely elevated readings,
killed the patient. Failure to listen can be deadly.
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May 2007, Volume 104, Issue 5
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Is ultrasound imaging the "holy grail" (see screen) for providing fast and
reliable nerve blocks? Or is it just another fad, like 3D glasses 50 years ago?
This question is explored in this issue of Anesthesia & Analgesia.
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April 2007, Volume 104, Issue 4
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According to church elders, scripture is unclear about whether Jehovah's Witnesses
can receive "fractions of fractions" derived from blood. Patient must decide
for themselves. Three editorials, from individuals with divergent views
on transfusion in Jehovah's Witnesses, all reach the same conclusion: the decision
of the patient must be respected.
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March 2007, Volume 104, Issue 3
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Sugammadex permanently binds rocuronium and vecuronium, like a black hole that
irreversibly draws in light and matter. The cover shows a black hole, ringed by
a molecule of sugammadex. The molecules on the cover are rocuronium (purple) and
a single molecule of vecuronium (blue). The molecular coordinates of sugammadex,
rocuronium, and vecuronium are based on x-ray crystallography, and were
supplied by Organon Pharmaceuticals.
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February 2007, Volume 104, Issue 2
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This issue of Anesthesia & Analgesia explores two forms of alternative
medicine: acustimulation and magnetic therapy. There are data suggesting
efficacy of acustimulation (acupuncture and acupressure) in several
clinical settings. There is no setting in which static
magnets have reproducibly demonstrated efficacy.
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January 2007, Volume 104, Issue 1
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The stress of anesthesia and surgery has been compared to a marathon. Do beta blockers
help patients cross the finish line? Maybe, but some patients on placebo do well,
while others (check out the background) fall short. This issue of Anesthesia & Analgesia explores
the data around perioperative beta-blockade. Northern California residents will
recognize the allusion to the "Bay to Breakers" race held yearly in San Francisco.
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December 2006, Volume 103, Issue 6
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The operating schedule is like a large elephant that must be moved through
the constraints imposed by the available resources. This issue of Anesthesia
& Analgesia explores the importance of matching operating room resources to
clinical needs, which can often be done through rational rearrangement of
existing resources.
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November 2006, Volume 103, Issue 5
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Recent data, and an FDA advisory meeting, have left clinicians with a difficult
choice regarding aprotinin. If they give aprotinin, they may damage organs. If
they don't, patients may require extensive transfusion. This issue of Anesthesia
& Analgesia explores the controversy surrounding aprotinin.
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October 2006, Volume 103, Issue 4
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Our colleagues occasionally complain about the
amount of time required for resident teaching. How much time is typically added to a
case when it involves teaching? As explained in a series of papers
in this issue of Anesthesia & Analgesia, just 4.5 minutes. The cover is not
posed, but shows our Correspondence Editor, Dr. Lawrence Saidman, teaching
a Stanford resident.
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September 2006, Volume 103, Issue 3
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Dolphins require regular sleep, just like all mammals. They also need to
continually swim, be on the lookout for predators, and surface for air. As discussed
in this issue of Anesthesia & Analgesia, half of the dolphin brain sleeps at a time,
as shown by the two BIS monitors, one monitoring the awake side in the water, and one
monitoring the sleeping side in the stars.
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August 2006, Volume 103, Issue 2
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As suggested by the "isoflurane purple" umbrella, inhaled anesthetics provide protection
to both the heart and the brain from adverse conditions. This issue of Anesthesia & Analgesia offers
recent research results on the mechanism of cardioprotection and neuroprotection.
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July 2006, Volume 103, Issue 1
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The children playing on the dexmedetomidine molecule appear to be enjoying
themselves, but they are precariously placed. The "not approved in children"
appears like a warning sign in a park: all too readily ignored.
This issue of Anesthesia & Analgesia
explores the safety of dexmedetomidine in children, and the complex issues
involved in studying drugs in vulnerable patients.
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Covers and Artwork copyright 2006 International Anesthesia Research Society
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