Advances in Anesthesia RSS feed: Current Issue. Each year, Advances in Anesthesia brings you the best current thinking from the preeminent practitioners in your field. A distinguished editorial board identifies current areas of major progress and controversy and invites specialists to contribute original articles on these topics. These insightful overviews bring concepts to a clinical level and explore their everyday impact on patient care. Volume 28 Highlights (coming Fall 2010) Suggamadex in Other Countries An Update on PCOD Anesthesia for the Transplant Patient for Non-transplant Surgery Unusual Infectious Agents and Anesthesia Herbal Medications and Nutraceuticals: Perioperative Considerations Modern Understanding of Mechanical Ventilation in Normal and Diseased Lung Biomarkers: Understanding, Progress, and Implications in the Perioperative Period Physician Performance Measures and Professional Practice Evaluation Ultrasound-Guided Central Venous Cannulation Perioperative Implication of Obstructive Sleep Apnea Thoracolumbar-Paravertebral Post-Dural Puncture Headache Lipid Emulsion Editor-in-Chief: Thomas M. McLoughlin, Jr., MD Associate Editors: Joel O. Johnson, MD, PhD and Francis V. Salinas, MD http://www.advancesinanesthesia.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Advances in Anesthesia0737-61462912011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.advancesinanesthesia.com/article/PIIS0737614611000165/abstract?rss=yesContributors10.1016/S0737-6146(11)00016-5Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-3ixxhttp://www.advancesinanesthesia.com/article/PIIS0737614611000177/abstract?rss=yesContents10.1016/S0737-6146(11)00017-7Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-3xixivhttp://www.advancesinanesthesia.com/article/PIIS0737614611000025/abstract?rss=yesThe benefits of regional anesthesia have been repeatedly shown in numerous clinical studies for a wide spectrum of surgical procedures. In all cases, the benefits of a regional technique must be balanced against the potential risk for complications. One of the most debilitating complications is the development of a new or worsened neurologic deficit . Numerous risk factors may influence the development of perioperative nerve injury . Therefore, it is important that anesthesia providers are aware of these risk factors when selecting suitable candidates for a regional technique.Regional Anesthesia in the Patient with Preexisting Neurologic DisordersAdam K. Jacob, Sandra L. Kopp10.1016/j.aan.2011.07.001Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-3118http://www.advancesinanesthesia.com/article/PIIS0737614611000086/abstract?rss=yesEver since the introduction of neuromuscular blocking drugs into anesthesia practice, the mechanism by which the paralytic effect is reversed has been imperfect. Traditional muscle relaxant reversal using inhibitors of anticholinesterase is a flawed process for several reasons. The mechanism of reversal is indirect, the efficacy is limited, rapid reversal of deep block is not possible, and undesirable cardiovascular and autonomic responses occur .Sugammadex: Past, Present, and FutureJames E. Caldwell10.1016/j.aan.2011.07.007Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-31937http://www.advancesinanesthesia.com/article/PIIS0737614611000074/abstract?rss=yesIn today’s operating rooms, almost 30% of anesthesiologists, 36% of anesthesiology residents, and 51% of certified registered nurse anesthetists (CRNAs) are women . Many of these women are of childbearing age, and experience at least 1 pregnancy during their career. It is important for them, their colleagues, and their employers to be aware of the possible occupational hazards that exist for pregnant anesthesia providers. This review covers the occupational hazards of waste anesthetic gases, radiation, magnetic resonance imaging (MRI), medications and chemicals in the operating room, and infectious patients. Theoretic risks, animal evidence, and human evidence for risk are presented, and measures to minimize risk are discussed.Occupational Hazards for the Pregnant Anesthesia ProviderCari L. Meyer10.1016/j.aan.2011.07.006Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-33958http://www.advancesinanesthesia.com/article/PIIS0737614611000037/abstract?rss=yesWhereas the practice of veterinary medicine is centuries old, veterinary anesthesia is relatively young, originating in the mid-nineteenth century . At that time, chloroform was the dominant agent used to induce an anesthetic state in veterinary patients, although agents such as ethyl chloride, chloral hydrate, and cyclopropane were also used . The widespread practice of veterinary anesthesia began in the 1920s with the discovery of the barbiturates, and pentobarbitone was the first to be widely used . Prior to the acceptance of this pharmacologic means of restraint, anesthesia and analgesia of animals involved far more physical than chemical restraint. Over the years and decades that followed, veterinary anesthesia continued to evolve, accepting the use of halogenated anesthetics, opioids, nitrous oxide, and tranquilizers. As the art and science of general anesthesia evolved in veterinary medicine, it became clear that specialization of veterinarians in anesthesia was necessary. In 1964, a group of scientists and veterinarians with a shared interest in anesthesia founded the Association of Veterinary Anaesthetists in Europe, but no certification in this specialty was offered. In the late 1960s and early 1970s, the charter members of the American College of Veterinary Anesthesiologists (ACVA) worked closely with physician anesthesiologists to establish formal training programs in veterinary anesthesia. After a great deal of work by these charter members, the ACVA was founded in 1975. The European counterpart of the ACVA is the European College of Veterinary Anaesthesia and Analgesia (ECVAA), founded in 1995. Both of these organizations serve to certify veterinarians specializing in veterinary anesthesia through residency programs and subsequent certification examinations.Veterinary AnesthesiaCarrie A. Schroeder, Lesley J. Smith10.1016/j.aan.2011.07.002Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-35984http://www.advancesinanesthesia.com/article/PIIS0737614611000049/abstract?rss=yesThere are few medical advances that have altered the landscape of their field as much as percutaneous coronary intervention (PCI). The earliest heart catheterizations were performed on animals in the eighteenth century by Hales, using metal and glass pipes . Understanding of the anatomy and physiology of the heart and vascular system, as well as the nature of circulation, advanced slowly over the next century. In the late nineteenth century, Fick developed his formula for calculating cardiac output, and he and others performed animal right-heart and left-heart catheterizations. These discoveries, along with the discovery of radiographs and fluoroscopy in the late 1890s, helped pave the way for a generation of innovators who pushed the limits of medically accepted therapy.Perioperative Considerations and Management in Patients with Intravascular StentsIsaac Lynch, Daniel A. Emmert, Michael H. Wall10.1016/j.aan.2011.07.003Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-385112http://www.advancesinanesthesia.com/article/PIIS0737614611000050/abstract?rss=yesThe “tools of the trade” for those who give anesthesia are potent drugs. Mastery of their use is an essential element of the specialty. By the nature of clinical practice in the operating room (OR), the anesthesia provider is continuously obtaining, using, and accounting for controlled substances in considerable quantities. The process makes the provider an expert in parenteral administration of substances. In addition to facilitating the administration of anesthesia, this repetitive process creates ideal conditions for diversion of controlled substances and self-medication. The unfortunate reality is that self-medication rapidly and reliably leads to chemical dependency with an unusually high potential for morbidity and mortality. Despite a heightened level of awareness, education about risk, and other efforts to prevent diversion, the incidence remains uncomfortably high. The result is that addiction to anesthesia drugs with its consequences is the leading cause of death in young anesthesia providers.Drug Diversion, Chemical Dependence, and AnesthesiologyJohn E. Tetzlaff10.1016/j.aan.2011.07.004Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-3113127http://www.advancesinanesthesia.com/article/PIIS0737614611000062/abstract?rss=yesThe concept of treating the fetus as a patient began as early as the 1960s when A.W. Liley, an obstetrician from New Zealand, discovered that he could withdraw ascitic fluid from fetuses suffering heart failure due to red cell alloimmunization. Intraperitoneal transfusion of red blood cells had been previously described in neonates . With this knowledge, Liley was able to medically treat a fetus suffering from hydrops fetalis due to red cell alloimmunization with an intraperitoneal red blood cell transfusion .Anesthesia for Intrauterine Fetal Therapy and Ex Utero Intrapartum TherapyKha M. Tran10.1016/j.aan.2011.07.005Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-3129148http://www.advancesinanesthesia.com/article/PIIS0737614611000098/abstract?rss=yesThe term, clinical pathway, refers to a multidisciplinary process of mutual decision making that results in the organized care of a well-defined group of patients during a well-defined period of time . Clinical pathways were first introduced in the 1980s when escalating medical costs pressured physicians to decrease resource use without jeopardizing patient safety or clinical outcomes. At that time, pathways were typically procedure specific (eg, coronary artery bypass grafting, total knee arthroplasty) and tailored to a specific institution . As a result, tremendous variability often existed from one institutional clinical pathway to another, making clinical comparisons between pathways and formal scientific study difficult.Clinical Pathways for Total Joint Arthroplasty: Essential Components for SuccessRebecca L. Johnson, Christopher M. Duncan, James R. Hebl10.1016/j.aan.2011.08.001Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-3149171http://www.advancesinanesthesia.com/article/PIIS0737614611000189/abstract?rss=yesIndex10.1016/S0737-6146(11)00018-9Advances in Anesthesia 29, 1 (2011)Advances in Anesthesia291S0737-6146(11)X0002-3173179