Anesthesia and analgesia最新文献

{"title":"Running Late.","authors":"Allison M Fernandez, Vidya T Raman","doi":"10.1213/ANE.0000000000007105","DOIUrl":"10.1213/ANE.0000000000007105","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"930"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316593","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":"Anesthetic Management of Parturients With Achondroplasia During Labor and Delivery: A Narrative Review.","authors":"Catalina I Dumitrascu, Peace N Eneh, Audrey A Keim, Molly B Kraus, Emily E Sharpe","doi":"10.1213/ANE.0000000000007397","DOIUrl":"10.1213/ANE.0000000000007397","url":null,"abstract":"<p><p>Achondroplasia accounts for approximately 70% of all forms of dwarfism. Cesarean delivery is often required in parturients with achondroplasia due to cephalopelvic disproportion. There is no consensus on the optimal management for cesarean delivery considering the difficulties in both general and regional anesthesia in patients with achondroplasia. The aim of this study was to explore the literature for prior case reports and series to determine the optimum anesthetic management for cesarean delivery in achondroplastic patients. We conducted a review of the literature using Embase, Medline, Scopus, and Web of Science database searches for case series and case reports on achondroplasia and pregnancy through January 2024. Conference abstracts >3 years old were excluded, as well as data on forms of dwarfism other than achondroplasia, patients taller than 147 cm, and non-English language papers. Extracted data included demographic information, anesthetic management, and reported complications. The literature review resulted in 57 manuscripts with a total of 80 anesthetics. Anesthetic management consisted of planned general anesthesia (n = 16), single injection spinal (n = 28), epidural (n = 17), combined spinal-epidural (n = 12), and intrathecal catheter (n = 1). Six patients required conversion from neuraxial anesthesia to general anesthesia due to failed neuraxial placement (n = 3), inadequate blockade (n = 2), and high neuraxial block (n = 1). Reduced dose of intrathecal bupivacaine was common in this population. Complications such as hypotension (4 in 64), inadvertent dural puncture (1 in 64), and transient paresthesia (3 in 64) during neuraxial technique were reported but were infrequent. Neuraxial anesthesia is more common and a viable option in carefully selected parturients with achondroplasia. We recommend reduction of intrathecal local anesthetic as part of a titratable neuraxial technique (ie, combined spinal-epidural) that minimizes the risk of hypotension, high spinal, and emergent intubation.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"779-792"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187920","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":"Mapping Perioperative Care Randomized Controlled Trials in Sub-Saharan Africa: A Scoping Review.","authors":"Laila Collier, Ameer S-J Hohlfeld, Bruce M Biccard","doi":"10.1213/ANE.0000000000007460","DOIUrl":"10.1213/ANE.0000000000007460","url":null,"abstract":"<p><p>The World Health Organization has recognized surgical and anesthesia care as integral components of universal health coverage. In sub-Saharan Africa (SSA), 93% of the population lacks access to essential surgical services. Postsurgery mortality in Africa is double the global average. The involvement of anesthesia providers is crucial for improved outcomes. Perioperative research can produce context-specific solutions to challenges faced in the perioperative period. SSA conducts fewer randomized controlled trials (RCTs) than high-income countries, limiting its contribution to global evidence. Our primary objectives were to document the geographical distribution of included RCTs, describe their characteristics, and evaluate the reporting quality using the Consolidated Standards of Reporting Trials (CONSORT)-2010 checklist. We followed the PRISMA Scoping Reviews (PRISMAScR) Checklist. We searched MEDLINE, the Cochrane Library, and Scopus. We identified perioperative care RCTs within SSA published from 2000 to 2022. Two independent reviewers screened potential studies and extracted data in duplicate, with disagreements resolved through consensus or a third reviewer. Quantitative analysis was done with STATA 16, and data were summarized narratively. We compared RCT quality pre-CONSORT-2010 to post-CONSORT-2010, using Pearson's χ 2 test or Fisher exact test (as applicable), considering P < .05 as statistically significant. Of 3319 records, 169 eligible RCTs were identified, randomizing 45,376 participants, with a mean sample size of 98. Between the years 2000 and 2022, there was an exponential trend towards an increasing number of RCTs in SSA ( y = 1,5619e 0,1051x ). The RCTs were from 16 countries in SSA. Most studies were single-country, single-center, led by authors from Nigeria (63/169, 37.3 %) and South Africa (41/169, 24.3%). Most interventions were conducted intraoperatively (n = 125/169, 74%). Pharmacotherapy interventions were most investigated (n = 64/169, 37.9%), followed by analgesic interventions (n = 42/169, 24.9%). The surgical discipline most investigated was obstetrics (n = 51/169, 30.2%). The reporting quality was generally poor, with most RCTs not adhering to CONSORT guidelines and failing to register on a trial registry. This scoping review provides a comprehensive overview of perioperative care RCTs in SSA, highlighting limitations such as small sample sizes, under-representation of high surgical burden disciplines, and poor outcome reporting. Clinical trial capacity is limited to a few countries and institutions, and methodological quality remains poor despite reporting guidelines. There is an opportunity to enhance context-appropriate RCTs in SSA by prioritizing high-quality research through collaborative efforts. Our findings serve as a resource for researchers, funders, and policymakers in perioperative care research in Africa to improve future RCT designs and reporting.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"723-731"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623243","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":"Rescue Echocardiography and Point-of-Care Ultrasound.","authors":"Kenneth T Shelton, Stephan Hain, Aranya Bagchi, Shu Lu","doi":"10.1213/ANE.0000000000007667","DOIUrl":"10.1213/ANE.0000000000007667","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e55-e56"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783274","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":"Risk of Venous Thromboembolism After Total Knee Arthroplasty in Patients with Obstructive Sleep Apnea: Results from a National Cohort.","authors":"Cosmo Fowler, Simar Chawla, Lauren Chism, Stephen M Pastores, Dennis H Auckley","doi":"10.1213/ANE.0000000000007167","DOIUrl":"10.1213/ANE.0000000000007167","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is a prevalent condition associated with many comorbidities. However, establishing the independent impact of OSA on specific health outcomes can be challenging without access to a substantial patient cohort. This study aimed to investigate whether a diagnosis of OSA was independently associated with venous thromboembolism (VTE) after total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>In this retrospective cohort study, we interrogated the TriNetX Analytics Research Network, a large database comprising the billing claims and electronic health record-derived data of >117 million patients. Using Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, we identified US adult patients who underwent TKA between January 1, 2013 and January 1, 2023, with and without preexisting OSA (and ≥2 OSA occurrences overall). We then analyzed the 1-month postoperative incidence of VTE as a composite outcome of deep vein thrombosis (DVT) and pulmonary embolism (PE) incidence, as well as cerebrovascular accident (CVA), myocardial infarction (MI), and DVT and PE individually. Baseline demographic and comorbidity covariates were incorporated into a 1:1 propensity score-matched analysis to clarify the independent effect of OSA.</p><p><strong>Results: </strong>During the 10-year study period, a total of 197,460 patients underwent TKA. Of these, 27,976 met the criteria for inclusion in the OSA cohort, while 150,830 had no documented history of OSA. In the initial analysis, OSA was significantly associated with the primary outcome (DVT/PE) as well as all secondary outcomes (CVA, MI, and individually with DVT and PE) at 1 month postsurgery. After generating propensity score matched cohorts, DVT/PE remained significantly associated with OSA, with an absolute risk difference of 0.7% (odds ratio [OR], 1.19, confidence interval [CI], 1.1-1.3, P < .001), as were the secondary outcomes of DVT (OR, 1.11, CI, 1.0-1.2, P = .030) and PE (OR, 1.41, CI, 1.2-1.6, P < .001).</p><p><strong>Conclusions: </strong>In this study encompassing a nationally representative sample of TKA patients, OSA was associated with increased incidence of VTE at 1 month postoperatively, an association that persisted after the generation of matched cohorts. While limitations related to the lack of patient-level data, disease severity, and therapy adherence should be acknowledged, our large sample size enabled us to factor many baseline characteristics into our analysis, reinforcing the association of these findings. Prospective work is needed on the impact of modulating factors such as anticoagulation regimen and positive airway pressure therapy on these outcomes.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"828-835"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279335","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":"Ecodesign in Health Care: Reducing Environmental, Economic, and Social Impacts: A Case Study on Venous Port Insertion.","authors":"Laure Bonnet, Frédéric Berthier, Jean Catineau, Anne Forestier, Jane Muret","doi":"10.1213/ANE.0000000000007513","DOIUrl":"10.1213/ANE.0000000000007513","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"915-917"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727563","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":"Marginal Inequities in Perioperative Medicine.","authors":"Adam J Milam, Brittany N Burton, A Steven Bradley, Felicity T Enders, Anjali A Dixit, Edward R Mariano","doi":"10.1213/ANE.0000000000007778","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007778","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205027","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":"Bridging the Gap: The Challenge of Conducting Clinical Trials in Sub-Saharan Africa.","authors":"Arthur Kwizera, Laura A Hobbs, Daphne Kabatoro, Tom Bashford","doi":"10.1213/ANE.0000000000007461","DOIUrl":"10.1213/ANE.0000000000007461","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"718-722"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623242","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":"The Impact of Program and Geographic Signaling on Anesthesia Residency Applications, Interviews, and the Match.","authors":"Andrea P Dutoit, Emily G Teeter, Jed T Wolpaw, Timothy W Martin, Crystal M Manohar, Timothy R Long, A Elisabeth Abramowicz, David L Stahl, Valerie K Shostrom, Julie T Hoffman, Susan M Martinelli","doi":"10.1213/ANE.0000000000007443","DOIUrl":"10.1213/ANE.0000000000007443","url":null,"abstract":"<p><strong>Background: </strong>Increased specialty competitiveness, alongside the inception of virtual interviews, has increased the number of applications submitted to the Electronic Residency Application Service (ERAS) in anesthesiology. ERAS introduced signals to provide applicants with a means to demonstrate interest in a select group of residency programs. In the 2023 to 2024 application cycle, anesthesiology applicants had the opportunity to send 5 gold and 10 silver signals in a tiered system.</p><p><strong>Methods: </strong>This multicenter, cross-sectional (exempt) research survey was created by members of the executive council of the Association of Anesthesiology Core Program Directors (AACPD) and housed and distributed through REDCap and the University of Nebraska Medical Center. Publicly available contact information of anesthesiology core program directors was obtained from the Accreditation Council for Graduate Medical Education (ACGME) website and membership roster of the AACPD. In total, 174 anesthesiology programs were identified. A survey invitation was distributed on March 12, 2024, to all programs via e-mail with reminders. The survey closed on April 30, 2024. Survey responses were collected anonymously, with instructions to provide 1 response per program. All statistical summaries and analyses were performed using SAS 9.3 (SAS Institute).</p><p><strong>Results: </strong>The survey was sent to all 174 identified programs, with a response rate of 48.9%. Small programs were defined as having <44 residents, medium 44 to 62 residents, and large >62 residents. Small programs received significantly fewer applications (median 1255) than medium (1420) and large (1558) programs ( P = .0005). There was a statistically significant difference in the number of gold signals received based on program size, with large programs receiving significantly more than medium (169 vs 116, P = .0238) or small programs (168 vs 71, P < .0001). Applicants sending gold signals were more likely to receive an interview compared to those who sent silver signals (56.7% vs 31%, P ≤ .0001). Of the those interviewed, applicants who sent gold signals comprised 42% (28.7%-52.6%), whereas applicants who sent silver signals comprised 45.5% (33%-54.7%). Applicants who did not send a program signal but signaled geographically made up a smaller portion of the interview group at 3% (0%-15.4%). The percentage of matched residents sending gold signals made up 66.7% (47.1%-82.4%) of a program's match list, whereas those sending silver signals were 25% (11.1%-33.3%) of the matched cohort.</p><p><strong>Conclusions: </strong>Anesthesiology applicants who sent program signals were selected for a large majority of available interview positions, and interviewed applicants who submitted gold and silver signals comprised the vast majority of matched resident cohorts.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"876-883"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370233","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":"Right Ventricle-Pulmonary Artery Coupling and Major Morbidity and Operative Mortality After Cardiac Surgery.","authors":"Katherine W Sun, Yi-Ju Li, Hui Huang, Anne D Cherry, Daryl Kerr, Crosby M Culp, Fawaz Alenezi, Mihai V Podgoreanu, Brittany A Zwischenberger, Alina Nicoara","doi":"10.1213/ANE.0000000000007582","DOIUrl":"10.1213/ANE.0000000000007582","url":null,"abstract":"<p><strong>Background: </strong>The right ventricle-pulmonary artery (RV-PA) coupling ratio provides an assessment of RV function indexed to PA afterload. A low preoperative RV-PA ratio has been associated with increased mortality after transcatheter procedures. In patients undergoing cardiac surgery, we hypothesized that a lower preoperative RV-PA ratio is independently associated with a higher risk of major morbidity and operative mortality (MMOM).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult patients who underwent coronary artery bypass graft and/or valve surgery (aortic, mitral, and tricuspid). The RV-PA ratio was calculated using the ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP). The primary outcome was MMOM as defined by the Society of Thoracic Surgeons (STS). The Youden index was used to determine the optimal cutoff to classify into low versus high TAPSE/PASP ratio groups. Multivariable analysis was performed to test the association of TAPSE/PASP ratio with MMOM and other clinical outcomes with P- value <0.05 used for statistical significance.</p><p><strong>Results: </strong>One hundred and twenty-four (14.3%) of the 868 patients who met inclusion criteria had the primary outcome of MMOM. Patients in the low TAPSE/PASP group were more likely to have MMOM (90 (22.0%) vs 34 (7.4%); P < .001) as well as longer intensive care unit length of stay (ICU-LOS), hospital LOS (H-LOS), and mechanical ventilation time (MVT). By multivariable analysis, TAPSE/PASP ratio <0.52 mm/mm Hg was associated with a significant increase in the risk of MMOM (odds ratio [OR] 1.77, 95% confidence interval [CI], 1.10-2.83, P = .018). In the analyses of secondary outcomes, for every 0.1 mm/mm Hg increase in TAPSE/PASP ratio, there was a 4% reduction in ICU-LOS and MVT, and a 3% reduction in H-LOS.</p><p><strong>Conclusions: </strong>TAPSE/PASP ratio <0.52 mm/mm Hg was associated with a significant increase in the risk of MMOM. Low preoperative TAPSE/PASP ratio was also associated with longer ICU-LOS, H-LOS, and MVT, even when adjusting for STS risk score for MMOM and cardiopulmonary bypass time.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"793-800"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282015","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}