P values have become the scapegoat for a wide variety of problems in science. P values are generally over-emphasized, often incorrectly applied, and in some cases even abused. However, alternative methods of hypothesis testing will likely fall victim to the same criticisms currently leveled at P values if more fundamental changes are not made in the research process. Increasing the general level of statistical literacy and enhancing training in statistical methods provide a potential avenue for identifying, correcting, and preventing erroneous conclusions from entering the academic literature and for improving the general quality of patient care.
Smoking tobacco using a waterpipe (hookah) is increasing worldwide and is remarkably common among adolescents and young adults in the United States. Contrary to misperceptions that waterpipe tobacco smoking presents fewer health risks than cigarette smoking, recent data demonstrate clearly that the smoke from a waterpipe contains many of the same toxicants that are in cigarettes, including the dependence-producing drug nicotine, cancer-causing polycyclic aromatic hydrocarbons, pulmonary disease–causing volatile aldehydes, and cardiovascular disease–causing carbon monoxide that can also lead to acute intoxication in waterpipe users. Because many anesthesia providers are likely treating waterpipe tobacco smokers, the goal of this AANA Journal Course is to describe a waterpipe, who uses a waterpipe to smoke tobacco, and the toxicants found in waterpipe smoke and waterpipe smokers. Based on available evidence, there is no indication that waterpipe tobacco smoking is any less risky to patient health than cigarette smoking. Anesthesia providers should begin to assess patients for this form of tobacco use explicitly and should consider addressing it as they do cigarette smoking, with the additional precaution of presurgery carboxyhemoglobin measurement.
Emergence agitation (EA) can be a distressing side effect of pediatric anesthesia. We observed no recurrence of EA after a low-dose ketamine infusion was added to propofol total intravenous anesthesia in a series of seven pediatric oncology patients repetitively anesthetized for radiation therapy. EA had been documented in all seven patients but did not recur in any of 122 subsequent anesthetics in which this technique was used. Based on these findings, we recommend the addition of low-dose ketamine to propofol infusions for total intravenous anesthesia in order to prevent EA in children with a history of EA.