This Month in Anesthesiology

Abstract

The investigators studied the association between anesthetic exposure before age 4 and the development of learning disabilities (LD) in reading, written language, and mathematics. Educational and medical records of all children born to mothers residing in five townships were examined. A single exposure to anesthesia (n = 449) was not associated with an increased risk of LD (hazard ratio = 1.0; 95% confidence interval, 0.79–1.27). However, children receiving two anesthetics (n = 100) or three or more anesthetics (n = 44) were at increased risk for LD (hazard ratio = 1.59; 95% confidence interval, 1.06–2.37, and hazard ratio = 2.60; 95% confidence interval 1.60–4.24, respectively). The authors noted they cannot determine whether anesthesia itself may contribute to LD, or whether the need for multiple anesthetics is a marker for other unidentified factors that contribute to LD.The authors hypothesized that natriuretic peptide system gene variants independently predict risk of ventricular dysfunction (VnD) after primary coronary artery bypass grafting. A total of 139 haplotype-tagging single nucleotide polymorphisms (SNPs) within 7 natriuretic peptide system genes were genotyped. Seven natriuretic SNPs were associated with decreased risk of postoperative VnD (odds ratios = 0.44–0.55; P = 0.010–0.036) and four natriuretic SNPs were associated with increased risk of postoperative VnD (odds ratios = 3.89–4.28; P = 0.007–0.034). Knowledge of natriuretic peptide system gene variants may result in a better understanding of postoperative VnD after primary coronary artery bypass grafting. These variants may also predict those patients at high risk for VnD so that preventative interventions can be explored. See the accompanying Editorial View on page 693 Exposure to anesthetics administered to young animals causes neurohistopathologic changes including apoptosis, a form of programmed cell death. The investigators examined isoflurane-mediated apoptosis in isolated neuronal tissues in vitro. The authors focused their investigation on a precursor of mature brain-derived neurotrophic factor (BDNF), called proBDNF, and its receptor, the p75 neurotrophin receptor (p75NTR). Inhibition of the proBDNF–p75NTRsignaling pathway blocked isoflurane-mediated neuronal apoptosis in cultured neurons from the developing rodent brain. If exposure to anesthesia and surgery in early life impairs neural development, the proBDNF–p75NTRsignaling pathway may be a target for future therapeutic intervention. See the accompanying Editorial View on page 709 The authors examined the association between preoperative executive function, depression, and other established clinical predictors of postoperative delirium among 998 patients undergoing major noncardiac surgery. Patients were screened prospectively using the Confusion Assessment Method as well as by retrospective chart review. Thirty-five patients developed delirium postoperatively (3.5%). Preoperative executive dysfunction (P = 0.007) and greater levels of depression (P = 0.049) were associated with a greater incidence of postoperative delirium. Complex tests for executive function were more strongly associated with postoperative delirium than simpler tests. In the future, preoperative screening of patients at risk for delirium may facilitate testing of preventative interventions.The pursuit of excellence should always be the number one agenda item for all anesthesiologists. See the accompanying Editorial View on page 712 A preoperative screening tool for obstructive sleep apnea and postanesthesia care unit monitoring identified patients at risk for later adverse postoperative respiratory events.Independent predictors of impossible mask ventilation were determined.Keys for safe perioperative airway management of obese patients with obstructive sleep apnea are reviewed.