BACKGROUND Heparin is the standard anticoagulant used during Cardiopulmonary Bypass (CPB). However, there are problems with heparin, including immunogenicity and variability of effect, that make a search for an alternative desirable. We have reported that dabigatran anticoagulation provides adequate conditions for CPB in a rabbit model. We used a sheep model of CPB in this current study to assess the

BACKGROUND Vulnerability to perioperative neurocognitive disorder (PND) and the mechanisms initiating PND, which may serve as targets for prevention, are incompletely understood. We hypothesized that sevoflurane can induce persistent upregulation of the hypothalamic-pituitary-adrenal (HPA) axis, inflammation, and behavioral deficits in young adult male rats by stimulating hypothalamic arginine vasopressin

BACKGROUND Perioperative hyperglycemia is associated with adverse patient outcomes including surgical site infections. This study examined whether an automated insulin dosing reminder is associated with a lower risk for postoperative hyperglycemia and other secondary and safety outcomes in patients at high risk for intraoperative hyperglycemia. METHODS We conducted a pragmatic trial using a sequential

BACKGROUND Postoperative delirium is a common and serious complication following non-cardiac surgery. A possible precipitating factor may be perioperative hemodynamic changes, with subsequent changes in brain perfusion. This study aims to investigate whether intraoperative hypotension, perioperative average blood pressure, or blood pressure variability are associated with postoperative delirium. METHODS

Surgical site infections are common, result in increased patient morbidity and mortality, and increase the economic burden to society. Anesthesiologists play a key role in perioperative infection prevention, with data suggesting that evidence-based measures can significantly reduce the incidence of these infections. This systematic review aimed to identify and compare current recommendations for the

Healthcare cybersecurity incidents are increasing in frequency and severity. Ransomware, a type of malicious software that results in the encryption of data and systems for financial extortion, often renders computers and networks inaccessible for prolonged periods of time. Clinical workflows, which depend on connected technology such as electronic health records, laboratory systems, and imaging platforms

BACKGROUND/INTRODUCTION Remimazolam is not approved for use in pediatric patients. The pharmacokinetics of remimazolam have been reported to be similar to those of adult patients after scaling for body size. This manuscript reports on the pharmacokinetics and pharmacodynamics of pediatric patients aged ≥6 to ≤18 years and a subsequent model-based optimization of the used dosing regimen. METHODS 31

BACKGROUND General anesthesia (GA), such as isoflurane, induces analgesia (loss of pain) and loss of consciousness through mechanisms that are not fully understood. A distinct population of GABAergic neurons has been recently identified in the central amygdala (CeA) that can be activated by general anesthesia (CeAGA) and exert antinociceptive functions. In this study, we aim to explore the underlying

BACKGROUND Sugammadex is well-tolerated and effective for reversing neuromuscular blockade (NMB) in adults and children ≥2 years old. There is little information on its use in younger children. The aim of this study was to evaluate the efficacy and tolerability of sugammadex in children under 2 years of age. METHODS Phase IV, randomized, parallel-group, multicenter, clinical trial of sugammadex in

BACKGROUND A functional anesthetic target has long been suspected to reside within mitochondria and disruption of bioenergetic capacity is believed to play a role in the anesthetic response. Unfortunately, the exact mechanism by which changes in mitochondrial target activity result in clinically relevant anesthetic endpoints remains unknown. Here we leveraged knowledge of propofol toxicity to guide

BACKGROUND Propofol is a widely used anesthetic for total intravenous anesthesia (TIVA). Though generally safe, rare but serious complications can occur in vulnerable groups, such as critically ill patients and children. Clinicians often rely on surrogate measures (e.g., predicted effect-site concentrations or bispectral index), yet more direct indicators of anesthetic exposure and metabolic stress

BACKGROUND The applicability of four major traditional in-hospital mortality models in the Chinese setting is unclear due to disease spectrum and population heterogeneity. This study aimed to test the performance of these models in the Chinese setting and to construct and externally validate a novel model. METHODS 21,855 consecutive pediatric patients who underwent congenital heart surgery from January

BACKGROUND Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are leading causes of transfusion-related morbidity and mortality. Soluble factors in red blood cell (RBC) supernatant may increase risk for these complications. We hypothesized that point-of-care allogeneic RBC washing may be an effective intervention to mitigate elevations in soluble factors

BACKGROUND The objective of this study was to describe thrombin generation in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Change in the endogenous thrombin potential (ETP) across three measurements before and after CPB (after protamine and at chest closure) was the primary outcome. Secondary analyses explored an association between thrombin generation and transfusion requirements

BACKGROUND Anesthesiologists manage life-threatening, critical events in a fast-paced, high-distraction atmosphere, with little time to deliberate about treatment options. The Society for Pediatric Anesthesia developed the Pedi Crisis 2.0 Mobile Application to assist in managing critical pediatric perioperative events. We hypothesized that the application could be used as a formal educational assessment

BACKGROUND Measuring the quality of a patient's recovery is vital, and reliable patient-centered outcome metrics are needed for clinical investigations and quality improvement. Currently, assessment tools to measure quality of recovery in pediatric patients are lacking. This study aimed to develop a scale to assess the quality of recovery (QoR) construct in pediatric patients. METHODS Using a mixed-methods

BACKGROUND Children undergoing moderate to deep sedation for diagnostic and therapeutic procedures are susceptible to hypoxemia because of their anatomical and physiological features. However, optimal oxygen administration methods are unclear. This study aimed to evaluate the efficacy of oxygen supplementation during sedation using either low-flow or high-flow nasal cannula (HFNC). METHODS This prospective

BACKGROUND Postpartum hemorrhage (PPH) is the leading preventable cause of maternal mortality. Most PPH cases are caused by uterine atony, which is inconsistently defined in clinical care. We used the electronic health record (EHR) to prompt communication between the anesthesia and obstetric care teams about uterine tone using a validated 11-point numeric rating scale (NRS) at 0, 5, and 10-minutes

BACKGROUND Anesthetic agents are well known for their effects on memory and pain, however, prior studies quantifying anesthetic-modulation of memory have not included experimental noxious stimulation. This study used functional magnetic resonance imaging (fMRI) to determine how low doses of propofol, dexmedetomidine, and fentanyl affect the brain systems for memory encoding and pain perception. METHODS

BACKGROUND Postoperative Acute kidney injury (AKI) is a significant concern for cardiac surgery patients with chronic kidney disease (CKD). Effective pharmacological interventions to mitigate these risks are urgently needed. This study aimed to evaluate the efficacy and safety of perioperative nitric oxide (NO) administration in preventing AKI and limiting CKD progression in patients undergoing cardiac

Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and

Health services research frequently focuses on variation in the structure, process, and outcomes of clinical care. Robust approaches for detection and attribution of variation are foundational to both quality improvement and outcomes research. Describing care in structured healthcare systems across hospitals in which clinicians work to provide care for patients as a multileveled structure allows the