Anesthesia and analgesia最新文献

{"title":"In Response.","authors":"Cosmo Fowler, Simar Chawla, Lauren Chism, Stephen M Pastores, Dennis H Auckley","doi":"10.1213/ANE.0000000000007370","DOIUrl":"10.1213/ANE.0000000000007370","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e73-e74"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051333","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":"Multi-Institutional Study of Multimodal Analgesia Practice, Pain Trajectories, and Recovery Trends After Spine Fusion for Idiopathic Scoliosis.","authors":"Lisa M Einhorn, Constance L Monitto, Arjunan Ganesh, Qing Duan, Jiwon Lee, Radhamangalam J Ramamurthi, Kristi Barnett, Lili Ding, Vidya Chidambaran","doi":"10.1213/ANE.0000000000007351","DOIUrl":"10.1213/ANE.0000000000007351","url":null,"abstract":"<p><strong>Background: </strong>Posterior spinal fusion (PSF) surgery for correction of idiopathic scoliosis is associated with chronic postsurgical pain (CPSP). In this multicenter study, we describe perioperative multimodal analgesic (MMA) management and characterize postoperative pain, disability, and quality of life over 12 months after PSF in adolescents and young adults.</p><p><strong>Methods: </strong>Subjects (8-25 years) undergoing PSF were recruited at 6 sites in the United States between 2016 and 2023. Data were collected on pain, opioid consumption (intravenous morphine milligram equivalents (MME)/kg), and use of nonopioid analgesics through postoperative days (POD) 0 and 1. Pain descriptors, functional disability, and quality of life were assessed preoperatively, 2 to 6 and 10 to 12 months after surgery using questionnaires (PainDETECT, Functional Disability Inventory [FDI], and Pediatric Quality of Life Inventory [PedsQL]). Descriptive analyses of analgesic use across and within sites (by preoperative pain and psychological diagnoses), acute postoperative pain and yearly in-hospital analgesic trends are reported. Pain trajectories over 12 months were analyzed using group-based discrete mixture. CPSP (defined as pain score >3/10 beyond 2 months postsurgery), and associated FDI and PedsQL were analyzed.</p><p><strong>Results: </strong>In this cohort (343 patients, median [interquartile range {IQR}] 15.2 (13.7-16.6) years, 71.1% female), perioperative use of opioids and nonopioid analgesics significantly varied across sites ( P < .001). Preoperatively, gabapentinoids were administered to 48.2% (157/343). Intraoperatively, opioid use included remifentanil (264/337 [78.3%]) and fentanyl (73/337 [21.7%]) infusions, and methadone boluses (159/338 [47%]). Postoperatively, patient-controlled analgesia was commonly used (342/343 [99.9%]). Within sites MMA use did not appear to differ by preoperative pain or psychological comorbidities. Median in-hospital opioid use declined over time (-0.08 [standard error {SE} 0.02] MME/kg/POD 0 to 1 per year, P < .001) while increased use of ketamine ( P < .001), methadone ( P < .001), dexmedetomidine ( P < .001), and regional analgesia ( P = .015) was observed. Time spent in moderate-to-severe pain on POD 0 to 1 was ≈33%. CPSP was reported by 24.2% (64/264) with ~17% reporting ongoing neuropathic/likely neuropathic pain. Four postsurgical pain trajectories were identified; 2 (71%) showed resolving pain and 2 (29%) showed persistent mild and moderate-to-severe pain. Although FDI and PedsQL improved over time in both CPSP and non-CPSP groups ( P < .001), FDI was higher ( P < .001) and PedsQL lower ( P = .001) at each time point in the CPSP versus the non-CPSP group.</p><p><strong>Conclusions: </strong>MMA strategies showed site-specific variability and decreasing yearly trends of in-hospital opioid use without changes in acute or chronic pain after PSF. There was a high incidence of persistent pain associate","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1137-1148"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling Postpartum Recovery After Scheduled Cesarean Delivery With Neuraxial Anesthesia: A Longitudinal Cohort Study.","authors":"Emily E Sharpe, Hans P Sviggum, Brendan Carvalho, Nan Guo, Katherine W Arendt, Anita D Stoltenberg, Angeliki G Tinaglia, Vanessa E Torbenson, Pervez Sultan","doi":"10.1213/ANE.0000000000007476","DOIUrl":"10.1213/ANE.0000000000007476","url":null,"abstract":"<p><strong>Background: </strong>Childbirth can have a substantial impact on maternal health-related quality of life. Cesarean delivery is the most performed inpatient operation, yet little is known about normal postpartum recovery profiles. The primary aim of our study was to longitudinally evaluate global health visual analog scale (GHVAS; 0-100) scores up to 12 weeks after scheduled cesarean delivery and identify the time to plateau of scores. The secondary aims were to evaluate different domains of postpartum recovery using validated patient-reported outcome measures (Obstetric Quality of Recovery score [ObsQoR-10] and 5-level 5-dimensional EuroQol questionnaire [EQ-5D]).</p><p><strong>Methods: </strong>After institutional review board approval, this single-center, prospective longitudinal study enrolled healthy women scheduled for cesarean delivery. Women were excluded for gestational age <32 weeks, neonatal demise, neonatal intensive care unit admission, inability to read or understand English, and if general anesthesia was used. Women completed baseline surveys before delivery and then at 24 and 48 hours after delivery. After hospital discharge, women completed surveys (including GHVAS, OBsQoR-10, EQ-5D, Edinburgh Postnatal Depression Scale, and activities of daily living) at 1 week, 3 weeks, 6 weeks, and 12 weeks postpartum. One-way repeated measures analysis of variance (ANOVA) was used to detect the difference in GHVAS and postpartum recovery outcomes with different follow-up time points.</p><p><strong>Results: </strong>We enrolled 66 parturients and 3 were withdrawn. Response rates were 95%, 84%, 83%, and 76% at 1, 3, 6, and 12 weeks, respectively. Mean ± standard deviation [SD] GHVAS scores were 78 ± 16 at baseline, 64 ± 17 at 24 hours, 69 ± 15 at 48 hours, 75 ± 19 at 1 week, 88 ± 11 at 3 weeks, 88 ± 15 at 6 weeks, and 90 ± 12 at 12 weeks postpartum ( P < .001). The global health VAS improved up until week 3 and then plateaued close to the maximum score between 3 weeks and 12 weeks postpartum. Mean ± SD ObsQoR-10 scores were 75 ± 15 at 24 hours, 85 ± 10 at 48 hours, and 81 ± 28 at 1 week postpartum ( P = .003). The mean ± SD EQ-5D composite scores improved at 6 weeks (4.9 ± 2.9) and 3 months (4.2 ± 2.6) compared to baseline (6.5 ± 1.8) with usual activities ( P = .001) and pain/discomfort ( P < .001) showing significant improvement over time. ObsQoR-10 score at 24 hours correlated with ObsQoR-10 scores at 48 hours (r = 0.629, P < .001) and 1 week (r = 0.429, P < .001) but did not correlate with EQ-5D scores at 6 weeks and 12 weeks.</p><p><strong>Conclusions: </strong>Our study demonstrates that GHVAS after scheduled CD plateaus at week 3. This data can be used to inform patients about the anticipated trajectory of key postpartum recovery domains up to 12 weeks postpartum.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1089-1096"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Variable Ventilation on Gas Exchange in an Experimental Model of Capnoperitoneum: A Randomized Crossover Study.","authors":"Álmos Schranc, Roberta Südy, John Daniels, Fabienne Fontao, Ferenc Peták, Walid Habre, Gergely Albu","doi":"10.1213/ANE.0000000000007418","DOIUrl":"10.1213/ANE.0000000000007418","url":null,"abstract":"<p><strong>Background: </strong>The rapid advancement of minimally invasive surgical techniques has made laparoscopy a preferred alternative because it reduces postoperative complications. However, inflating the peritoneum with CO 2 causes a cranial shift of the diaphragm decreasing lung volume and impairing gas exchange. Additionally, CO 2 absorption increases blood CO 2 levels, further complicating mechanical ventilation when the lung function is already compromised. Standard interventions such as lung recruitment maneuvers or increasing positive end-expiratory pressures can counteract these effects but also increase lung parenchymal strain and intrathoracic pressure, negatively impacting cardiac output. The application of variability in tidal volume and respiratory rate during mechanical ventilation to mimic natural breathing has shown benefits in various respiratory conditions. Therefore, we aimed to evaluate the short-term benefits of variable ventilation (VV) on gas exchange, respiratory mechanics, and hemodynamics during and after capnoperitoneum, compared to conventional pressure-controlled ventilation (PCV).</p><p><strong>Methods: </strong>Eleven anaesthetized rabbits were randomly assigned to PCV or VV. Oxygenation index (Pa o2 /FiO 2 ), arterial partial pressure of carbon dioxide (Pa co2 ), and respiratory mechanical parameters were assessed after a 15-minute-long ventilation period before, during, and after capnoperitoneum. According to a crossover design, after measurements at the 3 different stages, the ventilation mode was changed, and the entire sequence was repeated.</p><p><strong>Results: </strong>Capnoperitoneum compromised respiratory mechanics, decreased oxygenation, and caused CO 2 -retention compared to baseline measurements under both ventilation modalities ( P < .05, for all). Application of VV resulted in lower Pa o2 /FiO 2 (405. 5 ± 34.1 (mean ± standard deviation [SD]) vs 370. 5 ± 44.9, P < .001) and higher Pa co2 (48. 4 ± 5.1 vs 52. 8 ± 6.0 mm Hg, P = .009) values during capnoperitoneum compared to PCV. After abdominal deflation and a lung recruitment maneuver, VV proved more beneficial for CO 2 removal than PCV (41. 0 ± 2.3 vs 44. 6 ± 4.3mmHg, P = .027). No significant difference was observed in the respiratory mechanical or hemodynamic parameters between the ventilation modalities under the same conditions.</p><p><strong>Conclusions: </strong>The detrimental effects of capnoperitoneum on gas exchange were more pronounced with VV. However, after the release of capnoperitoneum, VV significantly improved CO 2 clearance. Therefore, VV could possibly be considered as an alternative ventilation modality to restore physiological gas exchange after, but not during, capnoperitoneum.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1159-1167"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Anesthesia Providers' Knowledge of Medication Interference with Hormonal Contraception: A Multisite Survey.","authors":"Madeline Whitney, Emily E Sharpe, Monica W Harbell, Skye Buckner-Petty, Molly B Kraus","doi":"10.1213/ANE.0000000000007733","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007733","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"141 5","pages":"e91"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336244","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":"In Response.","authors":"Shiyun Jin, Shufang He, Ye Zhang","doi":"10.1213/ANE.0000000000007624","DOIUrl":"10.1213/ANE.0000000000007624","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e76-e77"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493470","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":"Anesthesiology Resident Demographics and the BASIC Examination Pass Rates.","authors":"Huaping Sun, Ann E Harman, John D Mitchell, Robert R Gaiser, Stacie G Deiner","doi":"10.1213/ANE.0000000000007490","DOIUrl":"10.1213/ANE.0000000000007490","url":null,"abstract":"<p><strong>Background: </strong>The BASIC Examination was added to the US examination system for anesthesiology certification in 2014. The American Board of Anesthesiology conducted retrospective analyses to assess whether resident demographics, program characteristics, and/or prior examination performance were associated with first-time BASIC pass rates.</p><p><strong>Methods: </strong>Anesthesiology residents who took the BASIC Examination for the first time from July 2014 to November 2022 were eligible to participate, and they had at least 2 more attempts (or opportunities to attempt) through December 2023. First-time and eventual pass rates (ie, based on up to 3 attempts) were calculated for each demographic group. For those residents who had the clinical base year in-training examination (CBY ITE) scores available, demographic group performance differences on this examination were first examined. Mixed-effects logistical regression models assessed how resident demographics, program characteristics, and/or prior CBY ITE scores were associated with the odds of passing the BASIC the first time.</p><p><strong>Results: </strong>The analyses included 17,286 examination attempts from 15,789 residents. The majority of residents were male (65.8%), non-Hispanic or Latino (76.2%), White (47.8%), and US medical school graduates (87.4%). Differences in the first-attempt BASIC pass rates included male (92.7%) vs female (88.1%), non-Hispanic or Latino (92.0%) vs Hispanic or Latino (85.8%), Asian (92.6%) and White (92.4%) vs Black/African American (81.9%), respectively, and US (91.5%) vs international (88.6%) medical school graduates. Females had significantly lower odds of passing the BASIC the first time than males (odds ratio [OR] = 0.53, 95% confidence interval [CI], 0.47-0.60); Black/African American residents (OR = 0.41, 95% CI, 0.33-0.51) and Middle Eastern or North African residents (OR = 0.64, 95% CI, 0.46-0.91) had lower odds of passing the BASIC on first attempt than White residents; Hispanic or Latino residents had lower odds of passing the BASIC initially than non-Hispanic or Latino residents (OR = 0.52, 95% CI, 0.42-0.64). Nevertheless, all demographic subgroups' eventual pass rates were >99%.Male and White residents outperformed female and Black/African American residents, respectively, in CBY ITEs. The gender and race performance gaps in the first-time BASIC pass rates were attenuated but not eliminated after controlling for their CBY ITE scores-compared to male and White residents, respectively, the odds of passing the BASIC the first time changed from 46% to 56% for female residents, and from 41% to 53% for Black/African American residents.</p><p><strong>Conclusions: </strong>Female and nonwhite residents had lower first-time BASIC Examination pass rates. Almost all trainees passed by their up-to-third attempts. Future studies are needed to understand the basis of these differences and identify opportunities for improvement.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"988-994"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727561","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":"Notice of Retraction.","authors":"Bayram Güleryüz, Feride Karacaer, Ebru Biricik, Demet Tunay, Murat Ilginel, Müge Can, Samet Kara, Kübra Akillioğlu, Sait Polat","doi":"10.1213/ANE.0000000000007750","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007750","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"141 5","pages":"e92"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336247","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":"A Little Blue Butterfly.","authors":"Justin C Cordova","doi":"10.1213/ANE.0000000000007185","DOIUrl":"10.1213/ANE.0000000000007185","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1198"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589980","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":"Data-Driven Change Starts with Data.","authors":"Shannon L Farmer, Axel Hofmann","doi":"10.1213/ANE.0000000000007271","DOIUrl":"10.1213/ANE.0000000000007271","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"938-940"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412897","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}