2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting.

These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade.

These practice guidelines provide evidence-based recommendations on the management of neuromuscular monitoring and antagonism of neuromuscular blocking agents during and after general anesthesia. The guidance focuses primarily on the type and site of monitoring and the process of antagonizing neuromuscular blockade to reduce residual neuromuscular blockade.

Treatment of primary and secondary osteoarthritis of the knee.

OBJECTIVES: Systematic review of outcomes of three treatments for osteoarthritis (OA) of the knee: intra-articular viscosupplementation; oral glucosamine, chondroitin or the combination; and arthroscopic lavage or debridement. DATA SOURCES: We abstracted data from: 42 randomized, controlled trials (RCTs) of viscosupplementation, all but one synthesized among six meta-analyses; 21 RCTs of glucosamine/chondroitin, 16 synthesized among 6 meta-analyses; and 23 articles on arthroscopy. The search included foreign-language studies and relevant conference proceedings. REVIEW METHODS: The review methods were defined prospectively in a written protocol. We sought systematic reviews, meta-analyses, and RCTs published in full or in abstract. Where randomized trials were few, we sought other study designs. We independently assessed the quality of all primary studies. RESULTS: Viscosupplementation trials generally report positive effects on pain and function scores compared to placebo, but the evidence on clinical benefit is uncertain, due to variable trial quality, potential publication bias, and unclear clinical significance of the changes reported. The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), a large (n=1,583), high-quality, National Institutes of Health-funded, multicenter RCT showed no significant difference compared to placebo. Glucosamine sulfate has been reported to be more effective than glucosamine hydrochloride, which was used in GAIT, but the evidence is not sufficient to draw conclusions. Clinical studies of glucosamine effect on glucose metabolism are short term, or if longer (e.g., 3 years), excluded patients with metabolic disorders. The best available evidence for arthroscopy, a single sham-controlled RCT (n=180), showed that arthroscopic lavage with or without debridement was equivalent to placebo. The main limitations of this trial are the use of a single surgeon and enrollment of patients at a single Veterans Affairs Medical Center. No studies reported separately on patients with secondary OA of the knee. The only comparative study was an underpowered, poor-quality trial comparing viscosupplementation to arthroscopy with debridement. CONCLUSIONS: Osteoarthritis of the knee is a common condition. The three interventions reviewed in this report are widely used in the treatment of OA of the knee, yet the best available evidence does not clearly demonstrate clinical benefit. Uncertainty regarding clinical benefit can be resolved only by rigorous, multicenter RCTs. In addition, given the public health impact of OA of the knee, research on new approaches to prevention and treatment should be given high priority.

Ethnic and geographic variation in gastrostomy placement among hospitalized older patients.

While whites may receive more healthcare services than African Americans, gastrostomies are more commonly placed in older African Americans. The purpose of this study was to explore geographic and ethnic variations in gastrostomy placement among older individuals. Data from National Hospital Discharge Surveys conducted between 1996 and 1999 were analyzed. The overall gastrostomy placement rate (per 1,000 discharges) in individuals aged 65 years or older during the four years was 10.9 (95% Confidence Interval [CI]: 10.3-11.5)--among African Americans 20.0 (95% CI: 17.8-22.2) and among whites 10.2 (95% CI: 9.5-10.9). According to region, placement rates per 1000 discharges were 8.9 (95% CI: 7.6-10.2) in the west and 8.5 (95% CI: 7.8-9.2) in the midwest; but 11.8 (95% CI: 10.8-12.8) in the northeast and 12.9 (95% CI: 12.0-13.9) in the south. In multivariate analyses, including sex, age, any stroke diagnosis, ethnicity (African-American and white), and region, the ethnic and regional differences persisted. The substantially higher gastrostomy placement rate among older hospitalized African Americans in the United States appears to be independent of geographical variation.

Musical experience and dementia. Hypothesis.

BACKGROUND AND AIMS: Cognitively stimulating activities appear to protect against the development of dementing illness--playing a musical instrument may be one of these activities. Consistent with this notion, the aim of this study was to explore the hypothesis that dementia might be less common among orchestral musicians. METHODS: A cross-sectional survey of 23 older orchestral musicians who were former members of a single orchestra was carried out. Prior musical background, family history, and health history were obtained. A cognitive screen was administered in person or by telephone. Musicians were also queried regarding their awareness of living former orchestral colleagues with dementia. RESULTS: The mean age of participants was 76.9 +/- 6.8 (SD). No participant was aware of a living former or current orchestral member with either reported or suspected dementia. CONCLUSIONS: The results are consistent with the hypothesis that dementing illness may be less among orchestral musicians--possibly from a lifetime engaged in a cognitively stimulating endeavor.