After sedation with midazolam, induction of anesthesia with propofol was attempted in a patient taking modafinil. However, even after administration of a total of 6 mg/kg propofol IV, the patient continued to respond to tactile stimulation. Concurrently, the bispectral index was 72. Subsequent administration of low concentration sevoflurane by facemask induced an anesthetic depth that allowed unproblematic insertion of a laryngeal mask airway. Anesthesia for ophthalmologic surgery was maintained with sevoflurane. Modafinil may have caused resistance to propofol because of its effect on neural pathways that activate consciousness. The concentration of sevoflurane required to induce or maintain anesthesia remained unaltered.

Timothy N. Harwood

A & A Case Reports

A & A Case Reports, our new online journal publishing Case Reports, related Editorial Commentary, and Correspondence. Anesthesia & Analgesia 1 and Anesthesiology 2 recently announced that they were suspending publication of Case Reports. One reason is that Case Reports typically reduce the Impact Factor of a journal because they are rarely cited. Regardless of the merits of Impact Factor as a metric of journal worth, journals and their editors necessarily consider Impact Factor in strategic planning.    At the same time, Case Reports are appreciated by readers for describing “real life” management of difficult or unusual cases not often encountered by practitioners. In a recent issue of Anesthesia & Analgesia, Steven Shafer1 identified many Case Reports whose publication launched productive careers dedicated to solving the puzzle posed by an unusual observation in a single patient.

A & A Case Reports is a new online journal dedicated to publishing case reports, related editorial commentary, and correspondence. Anesthesia & Analgesia and Anesthesiology recently announced the suspension of case report publications, citing that case reports typically reduce a journal's impact factor due to their infrequent citations. Regardless of the debate surrounding the impact factor as a measure of a journal's worth, journals and their editors must consider it in strategic planning. At the same time, case reports are valued by readers for their depiction of the 'real-life' management of difficult or unusual cases that practitioners may not frequently encounter. In a recent issue of Anesthesia & Analgesia, Steven Shafer identified numerous case reports whose publication has launched productive careers aimed at solving the puzzles posed by unusual observations in single patients.

《A & A Case Reports》是一本新的在线期刊，专注于发表病例报告、相关的编辑评论和通讯。麻醉与镇痛（Anesthesia & Analgesia）和麻醉学（Anesthesiology）最近宣布暂停发表病例报告，原因之一是病例报告通常会降低期刊的影响因子，因为它们很少被引用。尽管影响因子作为期刊价值的指标存在争议，期刊及其编辑在战略规划中仍然必须考虑影响因子。同时，病例报告因其描述了临床实践中不常见的复杂或特殊病例而受到读者的欢迎。在《麻醉与镇痛》的最近一期中，Steven Shafer指出，许多病例报告的发表开启了致力于解决单一患者所提出的特殊观察难题的职业生涯。

Resistance to Propofol Induction in a Patient Taking Modafinil

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