Journal of Clinical Anesthesia最新文献

{"title":"Evaluation of the information content of individual items' scores in the anesthesiologist supervision instrument using Cochran's Q tests and McNemar's tests to provide specific feedback to ratees in addition to reliable evaluation of clinical performance","authors":"Franklin Dexter MD PhD FASA ,&nbsp;Bradley J. Hindman MD ,&nbsp;Kokila N. Thenuwara MD, MBBS, MME, MHCDS","doi":"10.1016/j.jclinane.2025.111946","DOIUrl":"10.1016/j.jclinane.2025.111946","url":null,"abstract":"<div><h3>Background</h3><div>Annual professional practice evaluations (i.e., peer review) are mandatory for anesthesiologists in many practice settings. The de Oliveira Filho clinical anesthesia supervision instrument is a valid and psychometrically reliable tool suitable for these high-stakes assessments. We studied item-specific feedback to anesthesiologists to increase their scores.</div></div><div><h3>Methods</h3><div>The retrospective cohort study used all 11 academic years for which the studied department used the supervision instrument, July 2013 through June 2024. There were 55,195 evaluations of 715 combinations of anesthesiologist and year by 242 rating trainees (e.g., anesthesia residents), each evaluation with 9-items scored 4=always, 3=frequently, 2=rarely, or 1=never.</div></div><div><h3>Results</h3><div>The 9-item supervision instrument had Cronbach alpha 0.96 and functioned as a binary (4 vs ≤3) multivariate array. Consequently, the 87% (47,859/55,195) of evaluations with all 9 items 4=always, or all 9 items ≤3, provided information about the quality of performance of the anesthesiologists, but no potentially useful item-specific information for feedback to anesthesiologists. Cochran Q tests were performed for each of the 715 combinations of anesthesiologist and year using the remaining 7336 evaluations. There were 17% (124/715) of the combinations of anesthesiologist and year with adjusted <em>P</em> &lt; 0.05, showing one or more of the items' scores differed significantly from the other items' scores. The 17% of combinations represented 6.0% (3311/55,195) of evaluations. For each of those 124 combinations of anesthesiologist and year, 36 McNemar tests were performed, comparing the 1st item to the 2nd, …, 8th item to 9th. Among those pairwise comparisons that were statistically significant, the directions of odds ratios were examined. The items about teaching quality accounted for 19% and 26% of the odds ratios &lt;1 (i.e., low scores), respectively, while the other seven items each accounted for ≤5%.</div></div><div><h3>Conclusions</h3><div>Earlier it was known that anesthesiologists' annual professional practice evaluations can be provided along with education regarding good teaching attributes associated with high quality intraoperative supervision and greater supervision scores. Our results show that also providing analyses of individual item scores could benefit, at most, &lt;20% of the faculty anesthesiologists.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111946"},"PeriodicalIF":5.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superficial vs. deep serratus anterior plane block for analgesia in patients undergoing single-port video-assisted thoracoscopic surgery: A randomized prospective trial","authors":"Gaige Meng,&nbsp;Wen Chen,&nbsp;Dewen Shi,&nbsp;Bin Mei,&nbsp;Xuesheng Liu","doi":"10.1016/j.jclinane.2025.111950","DOIUrl":"10.1016/j.jclinane.2025.111950","url":null,"abstract":"<div><h3>Study objective</h3><div>Postoperative pain following thoracic surgery is often severe, and serratus anterior plane block (SAPB) is widely used for perioperative analgesia in such patients. Local anesthetics injected on the surface of the serratus anterior muscle are called superficial SAPB (SSAPB), while those injected on the deep surface are called deep SAPB (DSAPB). We observed the differences in analgesic effects of two variants of SAPB (superficial and deep) on patients receiving single-port video-assisted thoracoscopic surgery (VATS).</div></div><div><h3>Design</h3><div>A randomized prospective trial.</div></div><div><h3>Setting</h3><div>Single university teaching hospital.</div></div><div><h3>Patients</h3><div>Eighty patients who underwent single-port VATS under general anesthesia.</div></div><div><h3>Interventions</h3><div>Eighty patients who received single-port VATS were randomly assigned to Group S (patients who received SSAPB) and Group D (patients who received DSAPB).</div></div><div><h3>Measurements</h3><div>The primary outcome was opioid consumption within 24 h after surgery. Secondary outcomes were pain scores at rest and on coughing before surgery, immediately after surgery, 6, 12, and 24 h after surgery.</div></div><div><h3>Main results</h3><div>Within 24 h after surgery, the total opioid consumption of patients in Group S was lower than that of patients in Group D (<em>P</em> = 0.001). The pain scores of patients in Group S were lower than those in Group D at rest or coughing 6 h after surgery (<em>P</em> = 0.000, <em>P</em> = 0.000). The pain score on coughing in Group S was lower than that in Group D at 12 h after surgery (<em>P</em> = 0.000), and there was no difference in postoperative pain scores between the two groups at other time points.</div></div><div><h3>Conclusion</h3><div>For patients undergoing single-port VATS lobectomy, SSAPB was associated with reduced opioid consumption and lower pain scores compared to DSAPB.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111950"},"PeriodicalIF":5.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HRAD ± and the future of perioperative emotional assessment in children","authors":"Pouria Farahani ,&nbsp;Ali Hosseini","doi":"10.1016/j.jclinane.2025.111949","DOIUrl":"10.1016/j.jclinane.2025.111949","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111949"},"PeriodicalIF":5.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor, “Association between intravenous 5 % albumin administration and acute kidney injury after partial nephrectomy. A retrospective study”.","authors":"Zhe Peng ,&nbsp;Long Zhang ,&nbsp;Lili Jiang","doi":"10.1016/j.jclinane.2025.111944","DOIUrl":"10.1016/j.jclinane.2025.111944","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111944"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to “Overdiagnosis of catheter-related thrombosis: When intensive screening detects clinically irrelevant findings”","authors":"Sebastian Gibb,&nbsp;Sebastian Engelhardt,&nbsp;Falk von Dincklage,&nbsp;Sven-Olaf Kuhn","doi":"10.1016/j.jclinane.2025.111941","DOIUrl":"10.1016/j.jclinane.2025.111941","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111941"},"PeriodicalIF":5.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical relevance of opioid-free anesthesia on quality of recovery: Methodological considerations","authors":"Wei-Hung Chen ,&nbsp;Wan-Jung Cheng ,&nbsp;Ming Yew","doi":"10.1016/j.jclinane.2025.111948","DOIUrl":"10.1016/j.jclinane.2025.111948","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111948"},"PeriodicalIF":5.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal fluid proteome of patients with persistent pain and/or postpartum depression after elective cesarean delivery: An exploratory prospective cohort study: Reply","authors":"Mary Yurashevich MD, MPH,&nbsp;Ashraf S. Habib MBBCh, MSc, MHSc, FRCA,&nbsp;Miles Berger MD, PhD","doi":"10.1016/j.jclinane.2025.111943","DOIUrl":"10.1016/j.jclinane.2025.111943","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111943"},"PeriodicalIF":5.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations of large language models in dynamic clinical decision making","authors":"Tianyue Zhang ,&nbsp;Yuedong He","doi":"10.1016/j.jclinane.2025.111942","DOIUrl":"10.1016/j.jclinane.2025.111942","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111942"},"PeriodicalIF":5.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of early high flow nasal oxygen on diaphragmatic function and pulmonary complications after thoracic surgery: A randomized clinical trial","authors":"Alberto Fogagnolo MD ,&nbsp;Salvatore Grasso (Professor) ,&nbsp;Martin Dres (Professor) ,&nbsp;Danila Azzolina Professor, PhD ,&nbsp;Francesca Dalla Corte MD ,&nbsp;Giampiero Dolci MD ,&nbsp;NIcola Tamburini MD ,&nbsp;Giovanni De Paoli MD ,&nbsp;Francesco Murgolo MD ,&nbsp;Emma Pedarzani MA ,&nbsp;Arianna Andalò MD ,&nbsp;Carlo Alberto Volta Professor (Professor) ,&nbsp;Spadaro Savino Associate Professor, PhD","doi":"10.1016/j.jclinane.2025.111945","DOIUrl":"10.1016/j.jclinane.2025.111945","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pulmonary complications (PPCs) are common after thoracic surgery, particularly in patients that develop postoperative diaphragmatic dysfunction. High-flow nasal cannula (HFNC) oxygen therapy decreases postoperative work of breathing and provides a positive end-expiratory pressure (PEEP) effect. As a result, it may decrease the occurrence of diaphragmatic dysfunction and PPCs after thoracic surgery.</div></div><div><h3>Methods</h3><div>Single-centre, open-label, randomized controlled trial. Patients undergoing video-assisted thoracoscopic lobectomy were randomized to receive conventional oxygen therapy (COT) or high flow nasal cannula oxygen therapy. In both groups, inspiratory oxygen fraction was titrated to reach a peripheral oxygen saturation of &gt;94 %. Diaphragmatic displacement (DD) and diaphragmatic thickening fraction (TF%) were measured 2 and 24 h after surgery. Diaphragmatic dysfunction was identified by DD &lt;10 mm. PPCs occurring within 7 days after study enrollment were recorded.</div></div><div><h3>Results</h3><div>We analyzed 116 patients in the study. Postoperative diaphragmatic dysfunction occurred in 17/58 patients (29 %) in the HFNC group compared to 21/58 (36 %) in the COT group (<em>p</em> = 0.55). The rate of PPCs was similar between the two groups: 32/58 (55 %) in the HFNC group and 37/58 (64 %) in the COT group (<em>p</em> = 0.449). Patients who developed postoperative diaphragmatic dysfunction experienced fewer PPCs when treated with HFNC (20/37; 54 %) compared to COT (17/21; 81 %) (<em>p</em> = 0.037). A post hoc mixed-model analysis confirmed that HFNC reduced the risk of PPCs in patients with diaphragmatic dysfunction (OR 0.16, 95 % CI 0.02–0.83).</div></div><div><h3>Conclusions</h3><div>Early HFNC support does not decrease the rate of postoperative diaphragmatic dysfunction rate or respiratory complications. In patients who develop postoperative diaphragmatic dysfunction, HFNC may play a role in mitigating the risk of PPCs.</div><div><strong>Clinical trial registration:</strong> <span><span>NCT05532033</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111945"},"PeriodicalIF":5.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the use of single-lead EEG for delirium diagnosis after cardiac surgery","authors":"Ahmet Rıdvan Doğan","doi":"10.1016/j.jclinane.2025.111939","DOIUrl":"10.1016/j.jclinane.2025.111939","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111939"},"PeriodicalIF":5.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}