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Published ahead of print March 29, 2016

Standardization and accreditation of fellowship training have been considered in the field of neuroanesthesiology. A prior survey of members of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) suggested strong support for accreditation and standardization. In response, SNACC created a Task Force that developed curricular guidelines for neuroanesthesiology fellowship training programs. These guidelines represent a first step toward standards for neuroanesthesiology training and will be useful if accreditation is pursued in the future.

OBJECTIVE To assess the effects of sevoflurane, the most commonly used inhalation anesthetic, on apoptosis and β-amyloid protein (Aβ) levels in vitro and in vivo. SUBJECTS Naive mice, H4 human neuroglioma cells, and H4 human neuroglioma cells stably transfected to express full-length amyloid precursor protein. INTERVENTIONS Human H4 neuroglioma cells stably transfected to express full-length amyloid precursor protein were exposed to 4.1% sevoflurane for 6 hours. Mice received 2.5% sevoflurane for 2 hours. Caspase-3 activation, apoptosis, and Aβ levels were assessed. RESULTS Sevoflurane induced apoptosis and elevated levels of β-site amyloid precursor protein–cleaving enzyme and Aβ in vitro and in vivo. The caspase inhibitor Z-VAD decreased the effects of sevoflurane on apoptosis and Aβ. Sevoflurane-induced caspase-3 activation was attenuated by the γ-secretase inhibitor L-685,458 and was potentiated by Aβ. These results suggest that sevoflurane induces caspase activation which, in turn, enhances β-site amyloid precursor protein–cleaving enzyme and Aβ levels. Increased Aβ levels then induce further rounds of apoptosis. CONCLUSIONS These results suggest that inhalational anesthetic sevoflurane may promote Alzheimer disease neuropathogenesis. If confirmed in human subjects, it may be prudent to caution against the use of sevoflurane as an anesthetic, especially in those suspected of possessing excessive levels of cerebral Aβ.Arch Neurol. 2009;66(5):620-631--

A growing body of evidence from cells, rodents, and sub-human primates suggests that general anesthetics can be neurotoxic to the developing and senescent brain. We review this evidence and put the studies into perspective for the practicing clinician.

Objectives/HypothesisThe objective was to compare the laryngeal mask airway and endotracheal tube for airway protection from blood during sinonasal surgery.

Because of the physiologic and metabolic changes that occur during acclimatization, we hypothesized that LCGU may be normal during prolonged hypoxia. We exposed five Sprague–Dawley rats to hypoxia (air at 380 mm Hg) for 2 weeks (hypoxic group) and six rats to 2 weeks of hypoxia followed by 2 weeks of recovery in room air (recovered group). Six control rats breathed room air (control group). Regional brain glucose utilization was measured in awake animals by using 2-[14C]deoxyglucose autoradiography. Glucose utilization was comparable in the control and recovered groups and in most brain regions of hypoxic animals. Glucose utilization was decreased slightly in 10 of 12 gray matter regions examined and was 20 to 25 lower (p<0.05) in the olfactory and auditory cortices, the caudate nucleus, and the superior olive of the hypoxic group. White matter glucose utilization was unchanged. Hypoxic rats, compared to controls, had a lower PaO2(53 ± 3 vs. 76 ± 3 mm Hg, mean SEM, respectively), a lower PaCO2(22 ± 1 vs. 36 ± 2 mm Hg), and a higher mean pulmonary artery pressure (46 ± 3 vs. 14 ± 3 mm Hg) and hematocrit (61 ± 2 vs. 48 ± 1; p<0.005 for all comparisons). Pulmonary hypertension and polycythemia persisted in recovered rats. Arterial pressure, pH, and plasma glucose were unaffected. Therefore, while acute hypoxia may increase glucose utilization in most brain structures, prolonged exposure does not.

The article highlights the judging of submissions for the City College of New York's (CCNY) annual citywide poetry contest held at the apartment of poet Barry Wallenstein on New York's Upper West Side. The contest is part of the Poetry Outreach Center's year-long program and stemmed from the annual poetry festival started by Wallenstein in 1072 with the goal of encouraging the creation and appreciation of poetry at all levels of public education.

The article presents a letter to the editor in response to the article "Alzheimer's alert over anaesthetics," in the 28 October 2006 issue.

No abstract available.

Recent trials have confirmed the effectiveness of endovascular mechanical thrombectomy for selected acute ischemic stroke patients with large artery occlusion, whose outcomes remained poor despite optimal medical management. Among many challenges for thrombectomy implementation is determining whether general anesthesia (GA) reduces the benefits of thrombectomy, as several recent studies suggest.1,2Berkhemer et al.3approach this question with a post hoc analysis of Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), the first prospective, randomized study to compare endovascular treatment (predominantly mechanical thrombectomy using stent retrievers) with best medical care (including IV thrombolysis) to medical care alone for CT angiography–proven large artery stroke.4The analysis reveals a 51% decrease in the primary treatment effect—outcome on the modified Rankin Scale (mRS) at 90 days—in those treated under GA, and negative effects on secondary outcomes, including recanalization rate, infarct volume, and stroke progression.3In fact, endovascular therapy was only beneficial when GA was not used. These results agree with several prior studies1,2and, if correct, carry implications for clinical care.

The poem "The Surge" by Gregory Crosby is presented. First Line: starts not in your stomach, Last Line: through your mouth.

Presents the poem "Everything & Nothing," by Gregory Crosby. First Line: The spines, unbroken, on the shelves; Last Line: Of Everything & Nothing.

The poem "A Map of Texas" by Gregory Crosby is presented. First Line: To unfold it, and hear; Last Line: in the heart of.

Presents the poem "The Truth About Athena," by Gregory Crosby. First Line: She has to pry them open, Last Line: they'll ever find).

Presents the poem "Little Girl Blue," by Gregory Crosby.