Journal-related Activities and Other Special Activities at the 2012 American Society of Anesthesiologists Annual Meeting

21st Annual Journal Symposium: Respiratory Depression Tuesday, October 16, 2012, 8:00 AM to 11:00 AM, West Salon G, Walter E. Washington Convention Center, Washington, D.C. This year ANESTHESIOLOGY will sponsor three sessions at the Annual Meeting of the American Society of Anesthesiologists (ASA). The Journal Symposium will highlight postoperative respiratory depression, in lectures and presentations of original research. Various perioperative interventions associated with anesthesia and surgery significantly influence respiratory function. Patterns and severity of the perioperative respiratory depression may significantly depend on coexisting diseases, consciousness, and other structural and functional factors relating to breathing stability. This symposium will explore mechanisms and clinical management for preventing, detecting, and treating respiratory depression that should change our clinical practice and patient outcome. This symposium provides the scientist and clinician with state-of-the-art information to help guide clinical practice.Two invited speakers will lead the session. Kingman Strohl, M.D., Professor of Medicine and Physiology & Biophysics, Division of Pulmonary, Critical Care, and Sleep Medicine at University Hospitals Case Medical Center, Case Western Reserve University, will provide new evidence of the pathophysiology of respiratory depression that incorporates breathing patterning and genetic predisposition as factors operating in our clinical practice. Matthias Eikermann, M.D., Ph.D., Assistant Professor of Department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital, and Harvard Medical School, will discuss how anesthesia, surgery, and immobility influence perioperative respiratory muscle function.These lectures will be followed by the oral presentations of 10 abstracts, summarized below, that were selected for their relevance to the Symposium topic. The full text for each abstract can be found at the ASA abstract Web site.“Association of Preoperative Oximetry Parameters with Postoperative Adverse Events” by F. Chung, L. Zhou, and P. Liao, Department of Anesthesia, University Health Network, Toronto, Ontario, Canada. The authors explored the association of parameters extracted from preoperative nocturnal oximetry with postoperative adverse events in 573 surgical patients. Mean SpO2, oxygen desaturation index (hourly desaturation events with SpO2drop to 4% or more for 10 s or more), and cumulative time percentage with SpO2less than 90% were identified to be significant indicators for postoperative adverse events. Preoperative nocturnal oximetry may be useful in stratifying patients for the risk of postoperative adverse events.“Perioperative Auto-CPAP Treatment Improved Oxygen Saturation in Patients with Moderate or Severe Obstructive Sleep Apnea (OSA)” by P. Liao and F. Chung, Department of Anesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada. The authors examined whether perioperative auto-CPAP treatment improves oxygenation in 177 patients with moderate and severe obstructive sleep apnea, randomly assigned to either auto-CPAP group (n = 87) or control group (n = 90). Because of the dropout from postoperative pain, nausea, and vomiting, 100 (auto-CPAP = 39, control = 61) completed follow-up for 5 postoperative nights. The overall CPAP compliance rate was 45% (39/87). No significant postoperative pressure increase was observed. Compared with the control group, variables of sleep-disordered breathing severity were improved (oxygen desaturation index and cumulative time percentage with SpO2less than 90% in auto-CPAP group were significantly decreased) on preoperative and postoperative nights.“Differential Effects of Co- and Pre-Administration of Picrotoxin with Flumazenil on Diazepam-Induced Hypoglossal Nerve Inhibition” by S. Nakamura, M. Suzuki, M. Nishida, T. Mieda, K. Terayama, H. Nagasaka, T. Azma, A. Kitamura, N. Matsumoto, Division of Anesthesia, JA Kumagaya General Hospital, Kumagaya, Japan, Department of Pharmacology, Saitama Medical University, Hidaka, Japan, Hanyu General Hospital, Hanyu, Japan, SMU International Medical Center, Hidaka, Japan, Meikai University, Sakado, Japan, Saitama Medical University, Moroyama, Japan. In anesthetized adult rabbit preparation, the authors examined how patterns of administration of flumazenil (a specific benzodiazepines receptor antagonist) and/or picrotoxin (a noncompetitive GABAAreceptor antagonist) change diazepam-induced inhibition of the hypoglossal nerve activity. They found that flumazenil alone, picrotoxin alone, and administration of both drugs reversed the depressed hypoglossal nerve activity, as expected. In contrast, flumazenil with preadministered picrotoxin resulted in marked excitation of the hypoglossal nerve activity (150%-control).“Predictors of the Ability to Protect the Airway in Long-term Ventilated Patients” by H. Mirzakhani, J. Williams, J. Mello, F. Xue, E. M. Kelly, S. J. Emma, M. Eikermann. Speech, Language, Swallowing and Reading Disabilities, Anesthesia, Critical Care and Pain Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts. The authors tested a hypothesis that manual muscle testing predicts the ability to protect the airway during swallowing in long-term ventilated, tracheostomized patients. They assessed the ability to protect the airway during fiberoptic endoscopic evaluation of swallowing by using the penetration-aspiration scale (PAS, 0–8), and valleculae and pyriform sinus residue scale (VPSR, 0–4) in 30 long-term ventilated patients. Medical research council (MRC) score independently predicted inability to clear secretions from the perilaryngeal area during swallowing (VPSR more than 1, odds ratio: 0.84 [CI: 0.77 to 0.98], P value = 0.024). Area under the curve of the receiver-operating curve for medical research council score to predict VPSR score more than 1 was 0.753 (P value = 0.019). PAS score was significantly correlated with residue (r = 0.7, P < 0.001). The authors conclude that muscle strength measurement might be a viable tool to predict a patient's predisposition to aspiration.“Development and Validation of the MGH Postoperative Respiratory Complications Prediction Score (PORCS)” by B. Brueckmann, J. Wanderer, B. T. Bateman, M. G. Sundrup, C. L. Schlett, M. Eikermann, Department of Anesthesia, Critical Care and Pain Medicine, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. To predict preoperatively adverse respiratory outcome, defined as reintubation after primary extubation in the operating room, a total of 55,488 patients undergoing surgery under general anesthesia were randomly split by half into development and validation dataset (each n = 27,744). The overall reintubation rate was 0.7% (n = 384), and a large portion (36%) died subsequently. The Massachusetts General Hospital postoperative respiratory complications prediction score, including independent predictors for reintubation determined by development dataset, was validated to predict severe postoperative respiratory complications.“Risk Factors for Opioid-induced Respiratory Depression Deduced from Thirty Years of Case Reports” by A. Dahan, M. Niesters, L. Aarts, F. Overdyk, Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands. Opioid-induced respiratory depression (OIRD) is a potentially life-threatening complication of opioid therapy. The authors identified available case reports on risk factors for OIRD; 185 relevant papers describing 246 individual patients were identified. Most reports involved opioid-use for acute pain relief, but reports related to chronic pain treatment appeared to be increasing during the last few years. Frequently reported associations accompanying OIRD were age more than 60 yr, sleep disordered breathing, renal impairment, and drug interactions with sedative (benzodiazepines), opioid cocktails, droperidol, magnesium, and propofol.“Nocturnal Oxyhemoglobin Desaturation Predicts Spontaneous Pain in Subjects with Sleep-disordered Breathing, Independently of Sleep Fragmentation and Systemic Inflammation: A Reanalysis of the Cleveland Family Study” by A. Doufas, L. Tian, F. Davies, Department of Anesthesia, Health Research and Policy, Stanford University School of Medicine, Stanford, California. The authors evaluated if nocturnal desaturation (expressed as respiratory disturbance status), sleep disruption (electroencephalogram), and inflammation (cytokine expression), all of which are signs and symptoms of sleep-disordered breathing, have differential effects on pain behavior (chest pain, morning headache, headache during sleep). They found that nadir SaO2was negatively associated with pain, an association that remained significant after adjusting for sleep fragmentation and inflammation. In contrast, the obstructive apnea-hypopnea index was positively associated with pain adjusted for sleep fragmentation and inflammation. These findings support that nocturnal desaturation may promote pain behavior in subjects suffering for sleep-disordered breathing independently of disturbances in their sleep continuity and the presence of systemic inflammation.“Ketamine to Avoid Hypoventilation in Patient Undergoing Deep Sedation: A Randomized Controlled Double-blinded Study” by G. De Oliveira, Jr., P. Fitzgerald, R. McCarthy, Department of Anesthesiology, Northwestern University, Chicago, Illinois. Ketamine has been shown to activate breathing and abolish the coupling between loss of consciousness and upper airway dilator muscle dysfunction in rodents, but it is unknown if ketamine can prevent hypoventilation in humans undergoing deep sedation utilizing a common and standard anesthetic regimen. The authors evaluated in a randomized trial the effect of ketamine to prevent hypoventilation in patients undergoing deep sedation. In female patients undergoing breast segmental mastectomy under monitored anesthesia care during propofol sedation, ketamine (0.5 mg/kg bolus IV followed by 1.5 mcg−1· kg−1· min−1infusion) compared with saline was associated with a more than 50% decrease in the duration of hypoventilation (transcutaneous carbon dioxide value more than 50 mmHG), and a significantly higher median respiratory rate, without a difference in propofol consumption between groups. These data suggest that preclinical data reporting on a ketamine-induced respiratory stimulating effect translate to humans under propofol anesthesia.“Evaluation of the Accuracy of a Continuous, Noninvasive System for Monitoring Tidal Volume, Respiratory Rate, and Minute Ventilation in Nonintubated Patients” by J. E. Freeman, N. Yocum, A. Panasyuk, M. Lalli, S. Panasyuk, D. Fahy, E. Messana, C. J. Voscopoulos, Respiratory Motion, Inc, Waltham, Massachusetts, Brigham and Women's Hospital, Boston, Massachusetts. This authors compared in 47 subjects the accuracy and precision of a “bio-impedance” respiratory monitor (ExSpiron; Respiratory Motion, Inc., Waltham, MA) for continuous, real-time respiration monitoring of tidal volume and respiratory rate with a handheld spirometer (Wright Respirometer, nSpire Health, Inc., Longmont, CO) during series of 1-min breathing tests taken at two subsequent days. Preliminary data analysis did not reveal major differences in values derived from the two data acquisition techniques of tidal volume and respiratory rate monitoring.“Accuracy of Acoustic Respiration Rate Monitoring in Pediatric Patients” by M. Patino, M. Mahmoud, D. Kurth, D. T. Redford, T. Quigley, P. Szmuk, Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. The authors compared automated measurements of respiratory rate taken by acoustic respiratory monitoring (Rainbow Acoustic Monitoring, RAM, Masimo Corporation, Irvine, CA) and capnography in 26 pediatric, postanesthesia care unit patients (ages: 14 months–14 yr [average 7.6]) with the assessment of a respiratory therapist who reviewed the capnography and acoustic monitor derived waveforms manually. Preliminary statistical analysis revealed that respiratory rate measurements via acoustic monitoring and capnography produce similar readings of respiratory rate.ANESTHESIOLOGY will sponsor two Best Abstract sessions this year, one in basic science and one in clinical science. These abstracts were chosen by a panel of editors who examined the highest-scoring abstracts from the ASA subcommittees, choosing those with important scientific and clinical application and novelty. Subsequently, a combination of these editors and appointees from the ASA will choose one abstract in each category to receive the Best Abstract award for basic and for clinical science at the meeting in Washington, D.C.Following are summaries of the superlative abstracts that will be presented.Monday, October 15, 2012, 8:00 AM to 11:00 AM, Room 144C, Walter E. Washington Convention Center, Washington, D.C. “Effects of Forebrain HCN1 Channels Contribute to Hypnotic Actions of Ketamine” by Xiangdong Chen, M.D., Ph.D., Douglas A. Bayliss, Ph.D., Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China, Department of Pharmacology, University of Virginia, Charlottesville, Virginia. Not all of the effects of ketamine can be explained by of the A by HCN1 was by ketamine in but not in from specific HCN1 The median ketamine to produce was by and duration of was in HCN1 This the of ketamine is at by inhibition of HCN1 of and the the by M.D., R. Ph.D., Department of Anesthesia, Stanford University and Hospital, Stanford University, Stanford, California. to as and and their activity. of the of using as of were assessed by three on that anesthetic to and the anesthetic structural of identified an the of which of of a series of propofol with to in a a of by G. M.D., Ph.D., D. Ph.D., M. M.D., Department of and Pain Medicine, Children's Research University of Washington, Department of and Pain Medicine, University of Washington, that the of has been in of the C. and with in of the The median anesthetic of and ketamine were determined in and in with a in a of than half the of and and half the of but 50% more These suggest the of to anesthetic is not the of of De A and by Ph.D., S. Ph.D., C. M.D., E. M.D., of and Physiology and Pharmacology, Medical Center, Physiology and Pharmacology, Medical Center, Medical Center, is a of that is for the and of long-term and the of long-term which is a and is in the from a the of of the into the of during and but did not either or to by by Chen, M.D., M.D., Ph.D., M.D., Ph.D., H. Chen, Ph.D., M.D., Ph.D., M.D., M.D., Ph.D., Department of Anesthesia, Critical Care and Pain Medicine, for Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Department of Anesthesiology, the Hospital, University, and after and to and which by and a in and of after of and of and after of and of did not and after may to and dysfunction by and is to Protect by M.D., Ph.D., M. M.D., Ph.D., H. Ph.D., Ph.D., Department of Anesthesiology, California. administration in both in and in of specific after not be by of from that were to improved functional were with a that was not than the of from that were These suggest is not for of the by M.D., Ph.D., Ph.D., T. Ph.D., N. M.D., Ph.D., N. M.D., Department of Anesthesia, Critical Care & Pain Medicine, Department of Massachusetts General Hospital, Boston, Massachusetts. in into a To the effects of loss of on functional in the were in the primary the and a association of two adult and or coupling of the as a of was loss of was a disruption of between and of remained in all three with and in via a by D. M.D., Ph.D., M. S. C. M.D., L. Ph.D., L. Ph.D., Department of Anesthesiology, University, Department of The School of Medicine, to general may in on in which to that are GABAAreceptor including and with by the activity of at the but without activity at the including and did These suggest of the to may which be of anesthetic and Effects of with by T. M.D., Ph.D., M.D., Ph.D., and University of Irvine, Irvine, California. The of propofol has been to of in on functional this for effect was and of the effect of propofol was found to be by subsequent effects in both and and and In propofol was found to subsequent Effects of in on on of A Study” by B. M.D., A. Ph.D., Department of Anesthesiology, Hospital for School of Health, to control for of the effect on of two drugs were to how for of between two can lead to the of the in the two and of for will be to of patients that large differences in the of are using those as independent variables in the score of in a by M.D., M.D., Ph.D., M.D., Ph.D., Department of Anesthesiology, University of California. of prevent the effect of was by in and ventilated that were anesthetized with ketamine and with and full of 5 of those with 1 mg/kg of function. with 1 10 of those with 5 and 10 after of and in by M.D., Ph.D., E. Ph.D., M.D., Ph.D., Ph.D., M.D., Ph.D., A. Ph.D., University of Chicago, Chicago, Illinois. The of opioid receptor in and has to Treatment of with or or factors or and with opioid receptor with These effects were by opioid receptor with These data suggest the opioid receptor in an effect that is by and October 16, 2012, to Washington Convention Center, West Salon G. and by C. M.D., N. Ph.D., B. Ph.D., M.D., F. M.D., P. M.D., of and University, Postoperative is common to the and of and functional associated with surgery by patients undergoing surgery and The found significant differences in that were correlated with postoperative perioperative in the functional to be associated with in the at after in Prediction and of by M.D., Ph.D., M.D., J. Ph.D., Anesthesiology, Department of and Department of Medicine, Washington University, The for of in patients in the of an acute Patients undergoing surgery and at of surgery, and on postoperative as as were and the change between and was The of the that preoperative can be in adult patients surgery and may be useful in preoperative risk for postoperative the postoperative increase in may be useful as of perioperative the Accuracy of a with by M.D., M.D., Dahan, M.D., Ph.D., M.D., Ph.D., Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands. on the effect of The and the of the effect of are the influence of with on the and of propofol in a in patients for general The found that with an increasing the propofol those This that not the of propofol but may influence the of propofol as A in of propofol may be Preoperative for an by M.D., G. M.D., J. M.D., M. M.D., M. M.D., Department of Care Medicine, The Medical The to and data using an anesthesia information management to to preoperative were extracted and for a to and preoperative were identified that both and preoperative of patients were but more than of all patients either a and or and a of this to preoperative that or decrease of on by B. M.D., M.D., M.D., M.D., of General and Health Cleveland Treatment of improves in patients. the effects of control on perioperative in major surgery Patients for major surgery during general anesthesia were in the for the control patients was than that for standard care patients (P < 0.001). control effect on the primary of major with odds of P = severe control did not the risk of severe after major and in by M. M.D., J. M.D., M.D., M.D., M.D., S. M.D., L. M.D., M.D., Department of Anesthesiology, University Medical Center, California. The clinical of patients suffering from may be by and of these complications the of The to if was of to the and severity of in by adult patients. The of in is associated with of the rate of the of was associated with improved from with Improved by M.D., Ph.D., A. M.D., M.D., H. Ph.D., Department of Anesthesiology, University of University of American University of after surgery is associated with and long-term but whether from improves to the by patients without has not been The examined the association of renal from on using data from patients. from was not associated with a risk of perioperative and of Severe and for by E. Bateman, M.D., M.D., Department of Anesthesiology, University of Massachusetts General Hospital, Boston, Massachusetts. as the of in the from the The examined risk and for severe during for using the dataset of available in the the The rate of was higher than and the rate of and severe with between and renal chronic of and were the predictors of severe during for of in Subjects via of at the of by M.D., S. C. Ph.D., Department of Anesthesiology, Medical University of Medical School, of Medicine, of propofol are of a by a of in a of the as a significant in the of and in Subjects were randomly assigned to or propofol groups. drug propofol subjects were to more than subjects at all propofol and not the of findings support the in which the of propofol is an in the in the are with Pain by J. M.D., Ph.D., M.D., Ph.D., A. A. M.D., S. M.D., K. M.D., C. M.D., M. M.D., L. M.D., A. M.D., University of Hospital, Massachusetts General Hospital, Boston, Massachusetts, Health Medical Center, Massachusetts, University Hospital, Hospital, University of is in tested the hypothesis that genetic in the receptor are associated with the severity of reported pain after Patients who to the after and were were at the time of pain in was assessed using a was extracted from and of specific in the was to the after a with the pain as compared with the patients with the or This genetic in the is associated with pain severity after and may be a for Pain in with and without by M.D., M.D., Ph.D., M.D., M.D., Ph.D., Department of and Pain Medicine, University of Washington, Washington, Department of Health and Cleveland of chronic pain to has been reported to be associated with an acute and chronic of pain in patients with is that with are at risk for after Medical of adult patients who at a were consumption surgery, but not was a for postoperative of for Nerve is with a of Systemic by J. Department of Hospital, anesthetic systemic is a life-threatening complication of The and of is a clinical that and reports on the and of nerve were of an of nerve and upper and increasing anesthetic were associated with an risk of this large series provides the evidence to that significantly the of October 15, 2012, to Walter E. Washington Convention Center, Washington, D.C. will be This of Research will on during the Annual C. M.D., of will as speakers will be the of the ASA in Research Ph.D., Department of Anesthesiology, University of Medical School, and the of the M.D., Assistant Department of Anesthesiology, Washington University School of Medicine, The of the Research will be during the information and will be in the of Research at the Annual

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