Anesthesia and analgesia最新文献

{"title":"Occurrence of Low Cardiac Index During Normotensive Periods in Cardiac Surgery: A Prospective Cohort Study Using Continuous Noninvasive Cardiac Output Monitoring.","authors":"Lee A Goeddel, Lily Koffman, Marina Hernandez, Glenn Whitman, Chirag R Parikh, Joao A C Lima, Karen Bandeen-Roche, Xinkai Zhou, John Muschelli, Ciprian Crainiceanu, Nauder Faraday, Charles Brown","doi":"10.1213/ANE.0000000000007206","DOIUrl":"10.1213/ANE.0000000000007206","url":null,"abstract":"<p><strong>Background: </strong>Continuous cardiac output monitoring is not standard practice during cardiac surgery, even though patients are at substantial risk for systemic hypoperfusion. Thus, the frequency of low cardiac output during cardiac surgery is unknown.</p><p><strong>Methods: </strong>We conducted a prospective cohort study at a tertiary medical center from July 2021 to November 2023. Eligible patients were ≥18 undergoing isolated coronary bypass (CAB) surgery with the use of cardiopulmonary bypass (CPB). Cardiac output indexed to body surface area (CI) was continuously recorded at 5-second intervals throughout surgery using a US Food and Drug Administration (FDA)-approved noninvasive monitor from the arterial blood pressure waveform. Mean arterial blood pressure (MAP) and central venous pressure (CVP) were also analyzed. Low CI was defined as <2 L/min/m 2 and low MAP as <65 mm Hg. We calculated time with low CI for each patient for the entire surgery, pre-CPB and post-CPB periods, and the proportion of time with low CI and normal MAP. We used Pearson correlation to evaluate the relationship between CI and MAP and paired Wilcoxon rank sum tests to assess the difference in correlations of CI with MAP before and after CPB.</p><p><strong>Results: </strong>In total, 101 patients were analyzed (age [standard deviation, SD] 64.8 [9.8] years, 25% female). Total intraoperative time (mean [SD]) with low CI was 86.4 (62) minutes, with 61.2 (42) minutes of low CI pre-CPB and 25.2 (31) minutes post-CPB. Total intraoperative time with low CI and normal MAP was 66.5 (56) minutes, representing mean (SD) 69% (23%) of the total time with low CI; 45.8 (38) minutes occurred pre-CPB and 20.6 (27) minutes occurred post-CPB. Overall, the correlation (mean [SD]) between CI and MAP was 0.33 (0.31), and the correlation was significantly higher pre-CPB (0.53 [0.32]) than post-CPB (0.29 [0.28], 95% confidence interval [CI] for difference [0.18-0.34], P < .001); however, there was substantial heterogeneity among participants in correlations of CI with MAP before and after CPB. Secondary analyses that accounted for CVP did not alter the correlation between CI and MAP. Exploratory analyses suggested duration of low CI (C <2 L/min/m 2 ) was associated with increased risk of postoperative acute kidney injury (odds ratios [ORs] = 1.09; 95% CI; 1.01-1.13; P = .018).</p><p><strong>Conclusions: </strong>In a prospective cohort of patients undergoing CAB surgery, low CI was common even when blood pressure was normal. CI and MAP were correlated modestly. Correlation was higher before than after CPB with substantial heterogeneity among individuals. Future studies are needed to examine the independent relation of low CI to postoperative kidney injury and other adverse outcomes related to hypoperfusion.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"77-86"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103621","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":"High-Sensitivity Troponin I Release After Aortic Surgery: A Mechanistic Approach with Contrast-Enhanced Magnetic Resonance Imaging (the MITEC Study).","authors":"Jean-Luc Fellahi, Arnaud Ferraris, Pascal Chiari, Yvonne Varillon, Charles De Bourguignon, Nathan Mewton","doi":"10.1213/ANE.0000000000007165","DOIUrl":"10.1213/ANE.0000000000007165","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"228-230"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520657","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":"Anatomical Location of Rib Fractures and Associated Analgesic Benefits Achieved From Serratus Anterior Plane Blocks: A Spatial Point Pattern Analysis.","authors":"Christopher Partyka, Matthew Miller, Serena Burgess, Kate Drury, Anthony Delaney, Kate Curtis","doi":"10.1213/ANE.0000000000007212","DOIUrl":"10.1213/ANE.0000000000007212","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"231-234"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456242","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":"Association of Intravenous Neostigmine and Anticholinergics or Sugammadex with Postoperative Delirium: A Retrospective Cohort Study.","authors":"Julian Rössler, Emily Abramczyk, Stephania Paredes, Nikola Anusic, Xuan Pu, Kamal Maheshwari, Alparslan Turan, Kurt Ruetzler","doi":"10.1213/ANE.0000000000006939","DOIUrl":"10.1213/ANE.0000000000006939","url":null,"abstract":"<p><strong>Background: </strong>Administration of cholinesterase inhibitors in combination with anticholinergic drugs for reversal of neuromuscular blocks may precipitate delirium through impairment of central cholinergic transmission, which could be avoided by using sugammadex. Therefore, we tested the primary hypothesis that postoperative delirium is less common when neuromuscular block is reversed with sugammadex than with neostigmine combined with glycopyrrolate or atropine.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study, analyzing all adult patients having general anesthesia for noncardiac surgery who received neostigmine or sugammadex from January 2016 to March 2022. Inverse propensity score weighting and propensity score calibration were used to adjust for appropriate confounders. Our primary outcome was presence of delirium within the first 4 days after surgery, defined as at least 1 positive brief Confusion Assessment Method (bCAM) screening. The secondary outcome was the presence of early delirium within 24 hours of surgery.</p><p><strong>Results: </strong>Among 49,468 cases in our analysis, 6881 received sugammadex and 42,587 received neostigmine. After propensity weighting, the incidence of delirium was 1.09% in the sugammadex group and 0.82% in the neostigmine group. The odds of postoperative delirium did not differ between the sugammadex and neostigmine groups, with an estimated odds ratio (95% confidence interval) of 1.33 (0.91-1.95), P = .147. A sensitivity analysis restricted to only include cases with at least 6 bCAM measurements over postoperative day (POD) 1 to 4 had consistent results, as sugammadex compared with neostigmine was associated with an estimated odds ratio for postoperative delirium of 1.20 (0.82-1.77), P = .346. Sugammadex was significantly associated with an increased incidence of early postoperative delirium, with an estimated odds ratio of 1.71 (1.07-2.72), P = .025. Further analysis showed no treatment-by-age interaction for either postoperative delirium ( P = .637) or postoperative early delirium ( P = .904).</p><p><strong>Conclusions: </strong>Compared to neostigmine, use of sugammadex for reversal of neuromuscular block was not associated with an increased risk of postoperative delirium in this retrospective single-center study. Though sugammadex was associated with a statistically significant increased risk of postoperative early delirium, the difference was small and not clinically relevant, and may reflect the presence of unknown confounders.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"110-118"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048519","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":"Objective and Perceived Skin Color: Consequences for the Use of Skintone Scales.","authors":"Wim Verkruysse, Ellis P Monk, Michael B Jaffe","doi":"10.1213/ANE.0000000000007215","DOIUrl":"10.1213/ANE.0000000000007215","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e2-e4"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556971","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":"Scoping Review: Anesthesiologist Involvement in Alternative Payment Models, Value Measurement, and Nonclinical Capabilities for Success in the United States of America.","authors":"Jay Sanghvi, Daniel Qian, Ezekiel Olumuyide, Deborah C Mokuolu, Aakash Keswani, Gordon H Morewood, Garrett Burnett, Chang H Park, Jonathan S Gal","doi":"10.1213/ANE.0000000000006763","DOIUrl":"10.1213/ANE.0000000000006763","url":null,"abstract":"<p><p>The US healthcare sector is undergoing significant payment reforms, leading to the emergence of Alternative Payment Models (APMs) aimed at improving clinical outcomes and patient experiences while reducing costs. This scoping review provides an overview of the involvement of anesthesiologists in APMs as found in published literature. It specifically aims to categorize and understand the breadth and depth of their participation, revolving around 3 main axes or \"Aims\": (1) shaping APMs through design and implementation, (2) gauging the value and quality of care provided by anesthesiologists within these models, and (3) enhancing nonclinical abilities of anesthesiologists for promoting more value in care. To map out the existing literature, a comprehensive search of relevant electronic databases was conducted, yielding a total of 2173 articles, of which 24 met the inclusion criteria, comprising 21 prospective or retrospective cohort studies, 2 surveys, and 1 case-control cohort study. Eleven publications (45%) discussed value-based, bundled, or episode-based payments, whereas the rest discussed non-payment-based models, such as Enhanced Recovery After Surgery (7 articles, 29%), Perioperative Surgical Home (4 articles, 17%), or other models (3 articles, 13%).The review identified key themes related to each aim. The most prominent themes for aim 1 included protocol standardization (16 articles, 67%), design and implementation leadership (8 articles, 33%), multidisciplinary collaboration (7 articles, 29%), and role expansion (5 articles, 21%). For aim 2, the common themes were Process-Based & Patient-Centric Metrics (1 article, 4%), Shared Accountability (3 articles, 13%), and Time-Driven Activity-Based Costing (TDABC) (3 articles, 13%). Furthermore, we identified a wide range of quality metrics, spanning 8 domains that were used in these studies to evaluate anesthesiologists' performance. For aim 3, the main extracted themes included Education on Healthcare Transformation and Policies (3 articles, 13%), Exploring Collaborative Leadership Skills (5 articles, 21%), and Embracing Advanced Analytics and Data Transparency (4 articles, 17%).Findings revealed the pivotal role of anesthesiologists in the design, implementation, and refinement of these emerging delivery and payment models. Our results highlight that while payment models are shifting toward value, patient-centered metrics have yet to be widely accepted for use in measuring quality and affecting payment for anesthesiologists. Gaps remain in understanding how anesthesiologists assess their direct impact and strategies for enhancing the sustainability of anesthesia practices. This review underscores the need for future research contributing to the successful adaptation of clinical practices in this new era of healthcare delivery.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"27-37"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139696815","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":"OpenBSR: An Open Algorithm for Burst Suppression Rate Concordant with the BIS Monitor.","authors":"Christopher W Connor","doi":"10.1213/ANE.0000000000007141","DOIUrl":"10.1213/ANE.0000000000007141","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"220-223"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726797","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":"James Watt, of Steam Engine Fame, Offered Inhaled Carbon Monoxide for Putative Therapeutic Action.","authors":"Olivia W Xu, Jingping Wang, Theodore A Alston","doi":"10.1213/ANE.0000000000006955","DOIUrl":"10.1213/ANE.0000000000006955","url":null,"abstract":"<p><p>James Watt (1736-1819) is remembered as a steam engine innovator and industrial magnate. A polymath, he was also a hands-on contributor to the Medical Pneumatic Institution of Thomas Beddoes. Watt recruited Humphry Davy, who there discovered analgesic action of inhaled nitrous oxide in 1799. Watt also built pneumatic equipment, and he introduced a gas mixture, dubbed hydro-carbonate, as a medical tonic. The bioactive component was carbon monoxide, a readily-lethal inhibitor of the transport and utilization of respiratory oxygen. Despite appreciable toxicity, carbon monoxide is an endogenous product of heme catabolism, and low doses of the gas are under laboratory investigation for therapeutic purposes. However, Watt's hydro-carbonate constituted a setback in the development of pharmacologically useful gases.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"197-201"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179166","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 Odyssey of Diastolic Function: No Time to Relax.","authors":"Alina Nicoara, Madhav Swaminathan","doi":"10.1213/ANE.0000000000007004","DOIUrl":"10.1213/ANE.0000000000007004","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"202-204"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454689","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":"Magnesium and Esophageal Pain After Peroral Endoscopic Myotomy of the Esophagus: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Richard K Kim, James W Kim, Timothy Angelotti, Micaela Esquivel, Ban C Tsui, Joo H Hwang","doi":"10.1213/ANE.0000000000006990","DOIUrl":"10.1213/ANE.0000000000006990","url":null,"abstract":"<p><strong>Background: </strong>Postoperative esophageal pain occurs in 67% of patients after peroral endoscopic esophageal myotomy (POEM). Magnesium can act as a smooth muscle relaxant. This study investigated whether intraoperative magnesium can reduce postoperative esophageal pain in patients undergoing POEM.</p><p><strong>Methods: </strong>In this double-blind, placebo-controlled trial, 92 patients were randomized to receive either magnesium sulfate as a 50 mg.kg -1 (total body weight) bolus followed by an infusion at 25 mg.kg -1 .hr -1 , or 0.9% saline. Intraoperative analgesia was standardized in all patients. The primary outcome was the score from a validated, modified Esophageal Symptoms Questionnaire (ESQ) in the postanesthesia care unit (PACU). Pain scores, opioid requirements, and questionnaire scores were collected through postoperative day 1.</p><p><strong>Results: </strong>ESQ scores were significantly lower in the magnesium group in the PACU (median [25th-75th], 24 [18-31] vs 35 [28-42]; median difference [95% confidence interval, CI], 10 [6-13]; P < .0001) and on postoperative day 1 (16 [14-23] vs 30 [24-35]; P < .0001). Less opioids were needed in the magnesium group in the PACU (mean ± standard deviation [SD] [99% CI], 4.7 ± 10 [1-9] mg vs 29 ± 21 [21-37] mg; P < .0001) and on postoperative day 1 (1 ± 3.7 [0-2.5] mg vs 13 ± 23 [4-23] mg; P = .0009). Pain scores were lower in the magnesium group in the PACU (0 [0-3] vs 5 [5-7]; P < .0001) and on postoperative day 1 (0 [0-2] vs 4 [3-5]; P < .0001).</p><p><strong>Conclusions: </strong>Patients undergoing POEM randomized to receive intraoperative magnesium had sustained reductions in esophageal discomfort severity and opioid requirements 24 hours after surgery.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"54-61"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141287649","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}