Week in review July 17-21, 2023
Myron Yaster MD
Unraveling The Mysteries of The Lymphatic (“Forgotten”) Circulation in Patients With Single Ventricle Congenital Heart Disease: More Opportunities For Sedation/Anesthesia
Susan Nicolson MD, James DiNardo MD, Lindsey Loveland BaptistMD , Viviane Nasr MD
Original article
Kristensen R, Kelly B, Kim E, Dori Y, Hjortdal VE. Lymphatic Abnormalities on Magnetic Resonance Imaging In Single-Ventricle Congenital Heart Defects Before Glenn Operation. J Amer Heart Association 2023; 12: e029376 PMID: 37318013
Staged reconstructive surgery has improved survival for children born with single-ventricle cardiac defects. However, these children are at risk for serious long-term complications, some related to the lymphatic system. There was an increasing prevalence of death at any time with advancing grade of lymphatic abnormality pre-Glenn. Some patients had lymphatic abnormalities pre-Glenn suggesting early identification may lead to better treatment.
Remembering the classics: T wave changes to detect intravascular injections of local anesthetics with epinephrine
Quentin A. Fisher MD
Original article
Fisher QA, Shaffner DH, Yaster M. Detection of intravascular injection of regional anaesthetics in children. Can J Anaesth. 1997 Jun;44(6):592-8. PMID: 9187777
In patients anesthetized with general vapor anesthetics, epinephrine in local anesthetics can help identify intravascular injections by ECG changes in the T wave. Dr. Fisher recounts his early discovery, why and how he performed his clinical study.
Perioperative Methadone
Myron Yaster MD and Rita Agarwal MD
Editorial
Pan S, Anderson TA. Perioperative Methadone: Perilous or Pain Panacea? Anesth Analg. 2023 Jul 1;137(1):72-75. doi: 10.1213/there.0000000000006332. Epub 2023 Jun 16. PMID: 37326865.
Original article
D'Souza RS, Esfahani K, Dunn LK. Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols-Superior Analgesic or Harmful Drug? Anesth Analg. 2023 Jul 1;137(1):76-82. doi: 10.1213/ANE.0000000000006331. Epub 2023 Jun 16. PMID: 37326866.
Methadone is a terrific analgesic that remains underutilized in the perioperative period. Why?
Waste Not, Want Not
Wanda Chin, MD; Shiu-Yi Emily Chen, MD
Editorial
Sundararaman, L. MBBS, MD. Health Care Wastage: An Affliction On Our Nation’s Health and Our Planet! ASA Monitor 2023, Jun Vol. 87, 18–191
Original Article
Vukelich, D. It’s Time for Hospital Workers to Identify and Eliminate Roadblocks to Reprocessing! ASA Monitor 2023, Jun Vol. 87, 205
How can we as perioperative physicians reduce health care expenditures and waste? And how does reducing waste, help to shore up resources, secure our supply chain, and protect our planet?
Reader response
Anonymous responds to the PAAD when private equity buys anesthesia practices. Dr. Mark Schreiner (retired) on Methadone pricing…it’s on par or cheaper than other opioids. Dr. David Polaner points out that epinephrine may or may not affect T wave changes on the ECG with intravascular injections if the patient is receiving TIVA and not vapor anesthesia.