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THE IN NDEPENDENT MONTHLY NEWSPAPER FOR ANESTHESIOLOGISTS AnesthesiologyNews.com • M a y 2 0 1 3 • Volume 39 Number 5
Klebsiella a Now Reigning Superbug
Another Benefit of Daily Aspirin: Better Outcomes After Trauma
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ospital pharmacists face several challenges in helping manage antibiotic-resistant, gram-negative superbugs that produce carbapenemases. One of the most worrisome is carbapenemase-producing Klebsiella pneumoniae (KPC). A report in the March issue of Infection Control and Hospital Epidemiology (2013;34:259-268) found that the proportion pr of K. pneumoniae caases resistant to carbapenems increased from 0.1% in 2001 to 4.5% in 2010. “That is huge,” said Robert Rapp, PharmD, emeritus professor of pharmacy and surgery at the University of Kentucky U
rauma patients with severe injuriees appear to have a better prognoo sis if they have been taking aspirin n or other antiplatelet drugs before being injured, researchers have found. The study found that trauma patientss at high risk for death were much less likely to develop transfusion-associated lung dysfunction or organ failure if they had been taking antiplatelet agents before being injured compared with others not on antiplatelet therapy. The findings, reported in the Febru-ary 2013 issue of Critical Care Medicine (2013;41:399-404), support a growin ng body of evidence implicating plateletts in
see superbugs page 22
see aspirin pag ge 32
Breathing for Two: a Life in Anesthesiology y The following is the second in a threepartt installment of excerpts from Breathing for Two, o a new memoir on a career in anesthesiology, by Wolf Pascoe (a pen name). The book is available at http://www.amazon.com/ dp/1939803012 and wolfpascoe.com.
INSIDE
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actual amphitheaters in those days, with rounded tiers of seating for medical students, rising away from a central stage. Ether, “sweet vitriol,” is a liquid at room temperature. It boils at 94 degrees Fahrenheit, turning easily to gas. A potent bronchodilator, he modern era of surgery— it had been used for hundreds of years to treat respiratory ailments. indeed, of medicine—may be said to have arrived precisely at 10:15 in Many physicians and scientists had studied ether, the morning on Friday, October 16, 1846, with Mor- including Sir Isaac Newton, who set it aside as an ton’s public demonstration of ether anesthesia. The uninteresting compound. By the nineteenth cenoperation took place in the surgical theater of Massa- tury, it was used chiefly by students for ether frolics. chusetts General Hospital, recognized from that time A quantity of ether was passed among the guests at forward as the Ether Dome. Operating rooms were see breathing page 10
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Avance CS2, from GE Healthcare, see pages 12 and 19.
Truflex Flexible Tip Stylet, from Truphatek, see pages 20 and 37.
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08 | COMMENTARY Older anesthesiologists: out of gas or simply road-tested?
17 | PAIN MEDICINE Feds see REMS programs falling short. Steven Zeitels, MD, airway surgeon to the stars.
30 | CLINICAL ANESTHESIOLOGY A vitamin for the lungs.
EDUCATIONAL REVIEW Current Concepts in the Management of the Difficult Airway, see insert at page 26.