Anesthesia and analgesia最新文献

{"title":"The \"TASK\" of Breathing: Anesthetic Relevance of Background Two-Pore Domain Potassium Channels as Therapeutic Targets for Respiratory Control.","authors":"Ann Y Lin, Christopher D Turnbull, Jaideep J Pandit","doi":"10.1213/ANE.0000000000007365","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007365","url":null,"abstract":"<p><p>Background (leak) potassium (K+) currents, the main contributors to resting membrane potential in excitable cells, are mediated by channels of the 2-pore domain (K2P) family. In the respiratory system, the TWIK-related acid-sensitive K+ channel (TASK) subfamily is proposed to mediate key functions in the carotid body type I glomus cells, central chemoreceptors and respiratory center, pulmonary arteries, and upper airway musculature. K2P channels are also located throughout the central nervous system, notably in the hypoglossal motor neurone pool, regions involved in sleep-wake regulation and pain perception. Being sensitive to general anesthetics, K2P channels may mediate both the adverse respiratory effects and hypnotic actions of many anesthetics. Therefore, they offer potential as pharmacological targets to reverse postoperative respiratory depression, ameliorate anesthetic risks of obstructive sleep apnea, improve ventilation-perfusion matching, and even assist in the active recovery from hypnotic effects of anesthesia during emergence from surgery.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412915","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":"Global Burden of Complex Regional Pain Syndrome in At-Risk Populations: Estimates of Prevalence From 35 Countries Between 1993 and 2023.","authors":"Ryan S D'Souza, Johana Klasova, Chandan Saini, Albert Chang, Stephen Music, Jay D Shah, Praveen Reddy Elmati, Ahish Chitneni, Jimmy To, Larry J Prokop, Nasir Hussain","doi":"10.1213/ANE.0000000000007421","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007421","url":null,"abstract":"<p><strong>Background: </strong>Complex regional pain syndrome (CRPS) is a debilitating and painful condition accompanied by sensory, autonomic, trophic, and/or motor abnormalities. Although CRPS is rare in the general population, the prevalence among individuals at higher risk, particularly posttraumatic and postsurgical patients, remains unknown. This study aims to provide a benchmark that quantifies CRPS prevalence in high-risk groups, and offers insights on potential predictors of developing CRPS.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis to identify studies reporting prevalence of CRPS after an inciting event (eg, fracture, surgery), specifically 12-month and 24-month prevalence (primary outcomes), as well as 3-month and 6-month prevalence (secondary outcomes). Estimates from individual studies were transformed using double-arcsine transformation, and the resulting estimates with 95% confidence interval (CI) were pooled in a meta-analysis using a random-effects model.</p><p><strong>Results: </strong>We included 214 articles with data from 2491,378 participants worldwide (35 countries), of which 16,873 had CRPS. The pooled 12-month and 24-month global prevalence was 3.04% (95% CI, 2.64-3.48) and 6.46% (95% CI, 5.46-7.53), respectively. Subgroup analysis and meta-regression were performed to understand the impact of population-dependent (mechanism of injury, type of CRPS), contextual-dependent (socioeconomic status), and methodological-dependent (study design, publication year) factors. The 12-month prevalence was higher in countries with a high human development index (HDI) compared to those with a medium or very high HDI, was higher in participants with a traumatic inciting injury only versus those with surgical injury only or traumatic/surgical injury, and was higher in prospective versus retrospective studies. Meta-regression analysis showed that publication year was a significant moderator, with more recent articles reporting lower 12-month prevalence.</p><p><strong>Conclusions: </strong>This study provides a benchmark of the global prevalence of CRPS, which anesthesiologists and pain specialists can use to prioritize early diagnosis and identify those at the highest risk for CRPS.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397974","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 Randomized Controlled Trial of Sublingual Sufentanil in Early Management of Pain in Trauma.","authors":"Francis X Guyette, Prasanna Chaudhary, Laura E Vincent, Emily T Love, DonavanP Brubaker, Matthew D Neal, Joshua B Brown, Jeffrey Rixe, David J Barton, Adam Yates, Stephen R Wisniewski, Jason L Sperry","doi":"10.1213/ANE.0000000000007384","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007384","url":null,"abstract":"<p><strong>Background: </strong>Pain management is essential in trauma. Sufentanil is a potent sublingual opioid analgesic with no active metabolites and rapid onset relative to oral medications. We hypothesize that compared to standard care, Sufentanil reduces the verbally administered numerical pain scale (VNRS) at 30 minutes.</p><p><strong>Methods: </strong>We performed a prospective multicenter, open-label, randomized trial utilizing level-1 trauma centers from within the Linking Investigator in Trauma and Emergency Services (LITES) network. Participants were randomly assigned in a 1:1 ratio to either sublingual sufentanil or standard care. We enrolled 150 patients from July 2022 to January 2024. The study was approved by the human subjects research protection offices of the University of Pittsburgh and the Department of Defense. Subjects were eligible if they had a trauma evaluation, were 18 to 70, had a VNRS (0-100) score ≥50, and remained in the ED for at least 30 minutes. We excluded patients who were prisoners, pregnant, allergic to opioids, required airway management, body mass index (BMI) >40, significant respiratory depression, suspected gastrointestinal obstruction, or other contraindication to analgesics. The primary outcome was the VNRS for clinical pain measurement (0-100) at 30 minutes after treatment. Secondary outcomes included adverse events (hypoxia, hypotension, need for airway management) and the incidence of nausea/vomiting/headache/dizziness requiring treatment. We hypothesize that sublingual sufentanil as compared to emergency department standard care, will reduce the VNRS at 30 minutes.</p><p><strong>Results: </strong>The study population had a mean age of 48 years (standard deviation [SD] 15) and was 32% female. The mechanism of injury was mostly blunt (96%). The VNRS at 30 minutes was 67 (SD 25) for the entire cohort, 66 (SD 23) in the sufentanil group, and 68 (SD 27) in the standard care group (P = .37). The Health care Professional Global Assessment (HPGA) at 30 minutes showed decreased pain scores in the standard care group compared to sufentanil, with standard care having more patients scored as good or excellent (P = .009). There was no difference in the incidence of nausea, vomiting, headache, dizziness, hypoxia, hypotension, or need for an advanced airway.</p><p><strong>Conclusions: </strong>In this cohort of trauma patients with moderate to severe pain, the VNRS at 30 minutes after administration of analgesics did not differ between sublingual sufentanil and standard care. Adverse events did not differ between the groups suggesting the sublingual sufentanil in this population.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370148","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":"External Validation of the Simple Postoperative Acute Kidney Injury Risk Index in Patients Admitted to the Intensive Care Unit After Noncardiac Surgery.","authors":"Nan Li, Jinwei Wang, Weijie Zhou, Shuangling Li, Li Yang","doi":"10.1213/ANE.0000000000007320","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007320","url":null,"abstract":"<p><strong>Background: </strong>The Simple Postoperative AKI Risk (SPARK) index is a novel model for predicting risk of postoperative acute kidney injury (PO-AKI) among patients after noncardiac surgery. However, the performance of the index has been inconsistent partly due to heterogeneity in case mix and effects of the involved clinical features. To clarify potential reasons for poor performance, we tested the SPARK index in a cohort of high-risk patients requiring intensive care unit (ICU) care after noncardiac surgery and examined whether model modification by refitting coefficients of clinical features could optimize model performance.</p><p><strong>Methods: </strong>This was a single-center prospective cohort study. Preoperative variables of the SPARK index were extracted from electronic medical records. PO-AKI was defined by an increase in sCr ≥26.5 mmol/L within 48 hours or 150% compared with the preoperative baseline value within 7 days after surgery, whereas critical AKI was defined as AKI stage 2 or greater and/or any AKI connected to postoperative death or requiring renal replacement therapy during the hospital stay. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by the Hosmer-Lemeshow χ2 test and calibration plot. Model modification was performed by rebuilding the model with the original variables of the SPARK index through proportional odds logistic regression among participants in the earlier study period and was validated in the later one.</p><p><strong>Results: </strong>A total of 973 patients were enrolled, among whom 79 (8.1%) PO-AKI cases and 14 (1.4%) critical AKI cases occurred. Our study participants demonstrated a higher SPARK risk score than the SPARK discovery cohort (eg, 8.02% vs 1.20% allocated in the highest risk group), and the incidence of both outcomes increased through the classes of the score (incidence proportion of PO-AKI increased from 2.56% in the lowest risk group to 25.64% in the highest risk group). The AUCs for PO-AKI and critical AKI were 0.703 (95% confidence interval [CI], 0.641-0.765) and 0.699 (95% CI, 0.550-0.848), respectively. The sensitivity, specificity, negative predictive value and positive predictive value were 68.35%, 57.49%, 95.36%, and 12.44%, respectively, when using 10% of predicted probability of PO-AKI as threshold. Calibration plots suggested acceptable consistency between the predicted and actual risk. After model modification, external validation demonstrated a significantly improved AUC for PO-AKI.</p><p><strong>Conclusions: </strong>The SPARK index showed fair discrimination and calibration among patients admitted to the ICU after noncardiac surgery. Modification of the model improved the performance of the model in terms of predicting PO-AKI.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370183","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":"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":"https://doi.org/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":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","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":"Requesting a Seat at the Table: Fibrin Stabilizing Factor.","authors":"Ruchik Sharma","doi":"10.1213/ANE.0000000000007413","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007413","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370232","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":"Checklists, Mnemonics, and the Avoidance of Cargo-Cult Science.","authors":"Craig S Webster, Jennifer M Weller","doi":"10.1213/ANE.0000000000007422","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007422","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370167","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":"Thinking of Obstructive Sleep Apnea in the Causal Pathway: Cause or Mediator?","authors":"Brad Luo, Amir L Butt, Kenichi A Tanaka, Kenneth E Stewart","doi":"10.1213/ANE.0000000000007369","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007369","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370234","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":"Absence of Movement to Command With a Pseudo-\"Isolated Forearm Technique\" in Nonparalyzed, Spontaneously Breathing Patients Monitored With Bispectral Index.","authors":"Jaideep J Pandit","doi":"10.1213/ANE.0000000000007442","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007442","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370165","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":"Examining the Impact of the Human Microbiome in the Perioperative Setting.","authors":"Huang Huang, Julie Mani, Thomas R Vetter, Tong Joo Gan","doi":"10.1213/ANE.0000000000007382","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007382","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363548","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}