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THE INDEPENDENT MONTHLY NEWSPAPER FOR ANESTHESIOLOGISTS AnesthesiologyNews.com • F e b r u a r y 2 0 1 3 • Volume 39 Number 2
Registry Sheds Light On Poor Outcomes Of Nerve Blocks San Diego—Although the techniques of regional anesthesia have advanced dramatically in recent decades, the practice is still not without its complications—complications all anesthesiologists should be aware of if they are to fine-tune their practice and improve patient safety. Thanks to a database from Australia, the variety and scope of these events are becoming clearer. In a symposium at the 2012 spring meeting of the American Society of Regional Anesthesia and Pain Medicine, Michael
To Do Less Harm, Know What You Don’t Know Hint: It’s more than you might think New York—Most anesthesiologists understand th he significance of medical errors and their effect on n clinical practice. But are they willing to admit that their own long-held assumptions—even those acquired through years of apparently successful patient care—may be as much a part of the problem as negligence or ignorance? In a far-rangingg discussion at the recent PostGraduate Assembly in Anesthesiology (PGA), four speakers argued that factors such as poor communication, teamwork and leadership, as welll as flawed or biased decision making, might cauuse more medical errors than “technical” mistakes or lack of clinical knowledge.
see complications page 23
see retthink page 16
Two ‘Lows’ Better Than Three For Anesthesia Outcomes Results from cardiac surgery study differ from earlier analysis in other patients Washington—Patients who experience a “double mortality in non-cardiac patients (see Anesthesiology low” of blood pressure and brain function during car- News, November 2009, page 1). diac surgery do not appear to be at higher “Anesthesiologists are increasingly risk for perioperative death, a recent study involved in controlling intraoperative varisuggests. ables that impact postoperative outcomes, including hypothermia, transfusion and The findings diverge from previous research showing that a “triple low” of glucose control,” said Ankit Maheshwari, mean arterial pressure (MAP) and low MD, an anesthesia resident at Cleveland bispectral index (BIS; Covidien) values Clinic, in Ohio, who helped conduct the during low minimum alveolar concenlatest study. “In addition, very low blood tration (MAC) is a strong predictor of see double page 26
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see page 25.
INSIDE 08 | COMMENTARY Botched drugs, broken trust: lessons from the New England compounding scandal.
10 | PAIN MEDICINE The economic tab of chronic post-op pain.
11 | PAIN MEDICINE Cochrane review: Nerve blocks prevent chronic pain after major surgery.
15 | CLINICAL ANESTHESIOLOGY Desaturation and cardiac output go separate ways in one-lung ventilation study.
CME: PREANESTHETIC ASSESSMENT Lesson 302: PreAnesthetic Considerations For a Patient With Hereditary Hemorrhagic Telangiectasia, see page 19.