2020 Severinghaus Lecture on Translational Science: Comment

Abstract

I appreciate Dr. Kissin's interest 1 in the Anesthesiology editorial which described, in the context of authorship integrity, escalating author counts in academic journals. 2 He wonders whether escalating author count is also common among anesthesia publications. He cites his own article on "the most influential original clinical articles that fomented important developments in anesthesiology over the past 50 yr." 3 He concludes that there has been "some increase" in author numbers, that the rise in the average number of authors per article was much less than that in three major general medical journals, that significant multiauthorship was not observed, and the top count did not exceed 11 authors.The analysis of Dr. Kissin is only partial. First, the analysis in his letter stops at 2007, 1 yet his own article, used as the basis for his letter, analyzes to 2015. 3 Second, the analysis in his article was not systematic, and, what constitutes "influential" is purely one opinion.I conducted a systematic analysis of all the articles published in seven major anesthesiology journals (Anesthesiology,

Perioperative Pulmonary Aspiration: Comment

“…For that very reason, use of cricoid pressure should have been listed under "Clinical Care Issues in Aspiration Claims" (table 5 of the publication), just as lack of cricoid pressure was. 1 In 79% of the 115 analyzed claims, only one anesthesia professional had cared for the patient, a nasogastric tube was in place immediately before the procedure in only 51% of patients with documented gastrointestinal obstruction or other acute intraabdominal pathology, and more than three attempts at endotracheal intubation were noted in 10 claims. 1 Quantitative information regarding the incidences of those clinical care issues during and in the absence of administration of cricoid pressure would help to understand why pulmonary aspirations occurred with comparable frequency under both circumstances.…”

“…1 In 79% of the 115 analyzed claims, only one anesthesia professional had cared for the patient, a nasogastric tube was in place immediately before the procedure in only 51% of patients with documented gastrointestinal obstruction or other acute intraabdominal pathology, and more than three attempts at endotracheal intubation were noted in 10 claims. 1 Quantitative information regarding the incidences of those clinical care issues during and in the absence of administration of cricoid pressure would help to understand why pulmonary aspirations occurred with comparable frequency under both circumstances. Possibly, clinical care issues other than use or nonuse of cricoid pressure were the primary determinants of pulmonary aspiration.…”

“…14 Of note, for 159 (60%) of them, the potential medicolegal consequences of not using cricoid pressure in a patient who subsequently aspirates were one of the main reasons for doing so. Anesthesiologist reviewers' judgment that omission of cricoid pressure contributes to cases of pulmonary aspiration, 1 and continued recommendation by some current guidelines of national professional societies to administer cricoid pressure, 15,16 are likely to contribute to those medicolegal concerns. The continued recommendations of British professional societies to use cricoid pressure 15,16 may explain why the United Kingdom is one of only a few countries in which cricoid pressure is still frequently applied, especially when compared with other European countries.…”

2020 Severinghaus Lecture on Translational Science: Reply

“…I thank Dr. Ortega 1 for clarifying the location of the Ether Monument in the Boston Public Garden. In fact, no living person is better suited to point out my oversight.…”