Research Publications Spotlight

Cobey FC, Ferreira R, Ursprung WW, Karhausen J, Swaminathan M, Mackensen GB. A Novel Approach to Assess the Three-Dimensional Anatomy of a Mitral Valve Regurgitant Jet Orifice. J Cardiothorac Vasc Anesth. 2016 Sep 13. pii: S1053-0770(16)30386-X. [Epub ahead of print]


Vora MU, Nicholas TA, Kassel CA, Grant SA. Adductor Canal Block for Knee Surgical Procedures: Review Article. J Clin Anesth. 2016 Dec;35:295-303. Epub 2016 Oct 11.

Abstract

Adductor canal block (ACB) has recently emerged as an alternative to femoral nerve block for pain control after various knee procedures especially knee arthroplasty. In this review article, we will review the anatomy of adductor canal, sonoanatomy, and ultrasound-guided approach for ACB as well as review current evidence regarding the indications of the ACB.


Ji RR, Chamessian A, Zhang YQ. Pain Regulation by Non-Neuronal Cells and Inflammation. Science. 2016 Nov 4;354(6312):572-577.

Abstract

Acute pain is protective and a cardinal feature of inflammation. Chronic pain after arthritis, nerve injury, cancer, and chemotherapy is associated with chronic neuroinflammation, a local inflammation in the peripheral or central nervous system. Accumulating evidence suggests that non-neuronal cells such as immune cells, glial cells, keratinocytes, cancer cells, and stem cells play active roles in the pathogenesis and resolution of pain. We review how non-neuronal cells interact with nociceptive neurons by secreting neuroactive signaling molecules that modulate pain. Recent studies also suggest that bacterial infections regulate pain through direct actions on sensory neurons, and specific receptors are present in nociceptors to detect danger signals from infections. We also discuss new therapeutic strategies to control neuroinflammation for the prevention and treatment of chronic pain.


Brown KS, Zahir H, Grosso MA, Lanz HJ, Mercuri MF, Levy JH. Nonvitamin K Antagonist Oral Anticoagulant Activity: Challenges in Measurement and Reversal. Crit Care. 2016 Sep 23;20(1):273.

Abstract

BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) are approved for the prevention of stroke in patients with nonvalvular atrial fibrillation and for the treatment of venous thromboembolism. These include the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. Bleeding is a complication for all anticoagulants and concerns regarding bleeding risk and the suitability of effective reversal strategies may be a barrier to their prescription. Despite the reduced risk of bleeding compared with vitamin K antagonists, questions persist regarding the management of bleeding related to NOAC use.

MAIN TEXT: To date, although a number of assays are responsive to NOACs, no single routine laboratory test has been identified to accurately measure the clinical anticoagulation state of patients on NOACs or established as a reliable predictor of bleeding risk. In addition, the establishment of a reliable human bleeding model to test novel inhibitors of the coagulation cascade has proved challenging. Although routine monitoring of anticoagulant levels is not necessary in patients taking NOACs, anticoagulant reversal and a means of measuring reversal may be required for patients who present with bleeding or require urgent surgery. Prothrombin complex concentrates are pooled plasma products containing varying amounts of inactive vitamin K-dependent clotting factors in addition to vitamin K-dependent proteins and can replenish factors in the intrinsic and extrinsic coagulation cascade, reversing an anticoagulant effect. Only one agent, idarucizumab, has been approved for rapid reversal of dabigatran-induced anticoagulation and one more agent, andexanet alfa, has been submitted for approval to reverse the anticoagulatory effects of direct and indirect factor Xa inhibitors.

CONCLUSIONS: This review discusses the laboratory tests available for assessing anticoagulation, human models of bleeding, and the use of current strategies-including prothrombin complex concentrates for reversal of anticoagulation by NOACs-to manage bleeding in patients.