this month in anesthesiology

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Low Reticulocyte Hemoglobin Content Is Associated with a Higher Blood Transfusion Rate in Critically Ill Patients: A Cohort Study  

Approximately 3,500 blood transfusions are given to intensive care unit (ICU) patients daily in the United States.Although there are no reliable predictors of transfusion requirements, ICU patients with functional iron deficiency may be at higher risk for developing anemia requiring blood transfusion. A prospective cohort study of 62 patients was conducted to assess the effects of low reticulocyte hemoglobin content (CHr
29 pg) on transfusion rates. The overall transfusion rate was 22.6%; the rate was 39.1%versus 12.8%, in low-CHr and normal-CHr patients, respectively. Patients with low CHr (37%) had a longer medianICU stay (8 vs. 5 days), were more likely to have sepsis, and weremore prone to acute renal failure (39% vs. 13%) and ICU-acquired infection (30% vs. 10%) compared with patients with normal CHr. Low CHr was significantly associated with transfusion regardless of age, severity of illness, trauma, or hemoglobin level. Low CHr is common at ICU admission and was associated with higher transfusion requirements.

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低含量网织红细胞血红蛋白与危重病人（Ⅲ）较高的输血率相关：队列研究
在美国每天大约3500名输血患者需送重症监护室（ICU）。虽然有没有输血要求可靠的预测，重症监护病房患者功能性铁缺乏，可有更高的风险发展贫血需要输血。62例患者的前瞻性队列研究进行评估的效果低蛋白血含量(CHr
29 pg)相关的输血率。整体输血率22.6％；低Chr和正常人输血率39.1％vs12.8％。低Chr（37％）住ICU天数增加（8vs5天），更可能有败血症和容易发生急性肾功能衰竭（39％比13％）和患者与正常人ICU获得性感染（30％比10％）。低Chr与输血率不分年龄，严重的疾病，外伤，或血红蛋白水平。低Chr是在重症监护病房常见入院输血需求相对较高。

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Implicit Memory Formation during Routine Anesthesia in Children: A Double masked Randomized Controlled Trial
儿童常规麻醉期间隐记忆的形成：随机双盲对比实验随机对照试验

Despite evidence for implicit memory, which may result in changes in behavior during anesthesia in adults,evidence in children is less clear. This randomized, double-blind controlled trial in children aged 5 to 12 yr(N=312) used perceptual priming (via a degraded auditory stimulus recognition task) to detect potential development of implicit memory after anesthesia. Either a sheep sound or white noise was played continuously through headphones during general anesthesia. On recovery, children were played a sheep sound degraded by a white noisemask that progressively decreased over 60 s, with the outcome being the time taken to correctly recognize the sheep sound. There was little evidence that exposure to a sheep sound during anesthesia was associated with postoperative time to recognition of a degraded sheep sound. This study presents additional support that implicitmemory formation during routine anesthesia is not a clinical concern for pediatric anesthesiologists.

尽管有隐记忆的证据，这可能导致在麻醉期间成年人行为的变化，儿童证据不太清楚。这项随机双盲对照试验在5岁至12岁（N=312）通过使用退化的听觉刺激识别任务知觉启动来检测麻醉后的儿童隐记忆潜在发展。全身麻醉期间通过耳机播放绵羊声音或噪声。关于恢复，孩子们发挥了白色noisemask，逐渐下降超过60 S与目前采取的正确识别声音的时间结果羊，绵羊声音退化。很少有证据表明，麻醉暴露羊的声音与术后时间的退化羊声音识别有关。本研究提出更多的支持，在日常麻醉隐记忆的形成不是一个儿科临床麻醉医师常关注。

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Association of Perioperative Risk Factors andCumulative Duration of Low Bispectral Index with
Intermediate-term Mortality after Cardiac Surgery inhe B-Unaware Trial

Mortality after cardiac surgery may be associated with patient-related and surgery-related variables such as persistent hypotension and the cumulative duration of low processed electroencephalogram-based bispectral index (BIS).This prospective, randomized study assessed the relationships among cumulative duration of lowBIS (
45), intermediate-term mortality, and anesthetic dose in patients (N460) who underwent cardiac surgery during a 1-yr period. During a median follow-up of 3 yr, 17.8% of patients died. There was no statistically significant difference in end-tidal anesthetic gas concentrations between patients who died and those who survived. However, cumulative duration of low BIS was independently associated with intermediate-term mortality with a 29%increased risk of death for every cumulative hour spent with a BIS less than 45. These data suggest that intermediate-term mortality after cardiac surgery was not causally related to excessive anesthetic dose.

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