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AnesthesiologyNews.com • N o v e m b e r 2 0 1 3 • Volume 39 Number 11
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Misconduct May Take Bloom Off β-Blocker Rx
T
he debate over usin ng β-blockers perioperaatively for non-cardiacc surgery patients continues with a new meta-analysis from British researchers indicating that starting thee drugs specifically for surgery can increase a patient’s risk for death h bby 27%. % Reporting in Heartt (doi:10.1136/heart-jnl-2013304262 [Epub ahead of print]), investigators from Imperial College, in London, reviewed nine studies of perioperative β-blocker use in 10,529 patients, and found that β-blockers caused a “statistically and clinically significant increase in mortality.” Analyzing six of the studies, the team found that β-blockers reduced the risk for non-fatal myocardial infarction (MI) (relative see β-blocker page 26
Propofol Dosing By Weight May Shortchange Obese Patients
C
linicians should use bispectral index values to guide propofol indduction in patients with morbid obesity, according to Canadian researchers who found that BIS values are better than boddy weight in this population. The randomized study, which com mpared the efficacy of propofol target induction doses calculated using lean boddy weight (LBW), found the doses based on LBW were consistently lower than those based on the BIS monitoring (Covidien) and resulted in insufficient depth of anesthesia in 60% of cases. Many anesthesiologists use LBW to determine propofol dosing in bariatric surgerr y. But see propofol pa age 30
Anesthesiologist-Designed Portable ICU Has Military and Civilian Uses Toronto—At a chance meeting in 2002, retired Master Chief Thomas Eagles, a highly decorated medic in the U.S. Marine Corps, approached Joseph Fisher, MD, a highly bookish anesthesiologist-turnedinnovator.r Mr. Eagles had heard of Dr. Fisher’s research on improving the efficiency of oxygen delivery, and wanted him to lower the number of oxygen tanks that medics had to carry into the field. “When he asked me, I said, ‘Oh, for sure I can reduce the number of oxygen tanks—possibly even eliminate them altogether,’” Dr. Fisherr recalled recently. “I have no idea why he would believe me, but he did.” There are some good reasons to eliminate oxygen tanks in the field, according to Dr. Fisher, founder
6 16 of and chief scientist at Thornhill Research, Inc., in Toronto, Canada, a technology transfer company affiliated with the University of Toronto, where he is professor of medicine. “Helicopter pilots don’t want to fly with them because they may explode if they are struck by a see portable page 11
NEW PRODUCTS see pages 8 and 15
see page 17
Anesthesia Circuit Kits, from Dräger Medical, Inc.
Origin Anesthesia RCM, from Origin Healthcare Solutions
COMMENTARY
Surfing the Bore Tide—of health care change.
see insert between pages 16 and 17
Infiltration of the Transversus Abdominis Plane With EXPAREL for Postsurgical Pain Management
PAIN MEDICINE
Washington State pain clinic fosters ‘never give up’ attitude.
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PAIN MEDICINE
Ondansetron may inhibit the analgesic effect of acetaminophen
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CLINICAL ANESTHESIOLOGY
Adductor canal block bests femoral for early ambulation after TKA.