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THE INDEPENDENT MONTHLY NEWSPAPER FOR ANESTHESIOLOGISTS AnesthesiologyNews.com • J u l y 2 0 1 2 • Volume 38 Number 7
40th Anniversary 1972-2012
Trial Questions Steroids In Cardiac Surgery Drugs do not save lives, researchers find Boston—Steroids do not appear to reduce the risk for mortality, heart attack, stroke and other key outcomes in patients undergoing cardiac surgery, according to a large randomized trial of the therapy. Although some clinicians said the results offer proof that steroids should not be used in this patient population, others said subset analyses in the study and improvements in secondary end points are evidence steroids can benefit at least some see steroids page 24
Residual Paralysis: The Problem That Won’t Go Away
S
ixty years ago, Henry Knowles Beecher, MD, and Donald Todd, MD, published a provocative study in the Annals of Surgger e r y. T ery Th he study showed that patients given neu e ro romu omu musc scul ular ar blocking agents were six times as likelyy to di die iin n reccovvery as those who did not receive the druugs gs.. Mo Mostt Most of that excess mortality resulted from m respira r ra tory events. Six decades later, shockingly little has nts changed. As many as 100,000 patien annually in the United States suffeer respiratory complications and otheer adverse events after surgery because theey experience residual paralysis from neuroomuscular blocking agents, experts warn.. see residual page 28
INSIDE
Tissue-Engineering Anesthesiologist Redefines Stem Cells
D
o stem cells exist? When Charles Vacanti, MD, asks the question, one had better listen to the answer. After all, Dr. Vacanti, chair of anesthesiology, perioperative and pain medicine at Brigham and Women’s Hospital, in Boston, is a pioneer in tissue engineering and a leading expert in the field of stem cell research. But his response might come as a surprise: “I think not. I don’t think they naturally reside in tissue.” That’s not to say that stem cells cannot be generated. Indeed, Dr. Vacanti has come to believe that stem cells, which are thought to have the ability to become virtually any line of cell in the body, often are the byproduct of the methods researchers have been using to isolate them. Quite literally, they can
08 | COMMENTARY A Keynesian’s take on U.S. health care.
be shaken, stirred or chemically coaxed out of a dish. Previously, scientists have believed that stem cells either reside in the tissues or can be induced by genetic manipulation, dedifferentiating them and allowing them in effect to become blank slates. But in new, unpublished work, Dr. Vacanti’s group exposed various cell types to different forms of chemical and physical stresses—nearly killing them but performing no genetic manipulations, he said. Using a spectrographic analysis and green fluorescent imaging techniques, they observed that the stress caused
11 | PAIN MEDICINE Rise in newborn withdrawal as more pregnant women use opioids.
18 | TECHNOLOGY Robots, checklists and the future of anesthesia.
32 | CLINICAL ANESTHESIOLOGY Cutting back on unnecessary transfusions.
38 | AD LIB Sweet kisses and hammer blows—a history of self-experimentation in anesthesia (Part 1).
see stem cells page 37
McMahonMedicalBooks.com Sota Omoigui’s Anesthesia Drugs Handbook, Fourth Edition Sota Omoigui
see page 35
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