Anesthesia and analgesia最新文献

{"title":"A New Method for Comprehensive Analysis of Benzodiazepine, Opioid, and Propofol Interactions and Dose Selection Rationales in Gastrointestinal Endoscopy Sedation.","authors":"Jing-Yang Liou, Hsin-Yi Wang, I-Ting Kuo, Mei-Yung Tsou, Weng-Kuei Chang, Chien-Kun Ting","doi":"10.1213/ANE.0000000000007263","DOIUrl":"10.1213/ANE.0000000000007263","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to explore a new method for determining optimal dosing regimens for combinations of propofol, midazolam, and an opioid to achieve rapid on- and off-set of deep sedation.</p><p><strong>Methods: </strong>We simulated 16 published dosing regimens using a well-validated pharmacodynamic model. The study was divided into 2 parts. First, the regimen that best provided deep sedation and rapid recovery was selected. A deep sedation-time area-under-the-curve (AUC) method was used to compare published dosing regimens; a higher AUC indicated better sedation and faster recovery. Second, subgroup analysis of the best-performing dosing regimen was undertaken better to understand how each drug affected patient recovery.</p><p><strong>Results: </strong>The AUC method identified a combination of midazolam 1 mg, alfentanil 500 µg, and propofol target infusion effect-site concentration (Ce) 2 µg mL -1 as the optimal regimen ( P < .01). Propofol correlated with high probability of sedation and increased AUC (R 2 = 0.53), whereas midazolam had a significant impact on time to return of consciousness (R 2 = 0.86). Subgroup analysis indicated that regimens consisting of a fixed dose of alfentanil and either 5 µg mL -1 Ce propofol, or 1 mg midazolam with 3-5 µg mL -1 Ce of propofol, or 2 mg midazolam with 2 µg mL -1 Ce propofol provided adequate sedation and rapid recovery. Midazolam >3 mg greatly prolonged recovery.</p><p><strong>Conclusions: </strong>This study used a clinically relevant method and model simulation to determine suitable sedation regimens for use in gastrointestinal endoscopy. A balanced propofol, midazolam, and an opioid should be used. The AUC method was capable of providing objective assessments for model selection.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1168-1177"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254035","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":"Accidental Epidural Infusion of Acetaminophen (Paracetamol) During Acute Postoperative and Labor Pain Management.","authors":"Santosh Patel","doi":"10.1213/ANE.0000000000007287","DOIUrl":"10.1213/ANE.0000000000007287","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1230-1232"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942746","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":"mRNA Expression of Mineralocorticoid and Glucocorticoid Receptors in Human and Mouse Sensory Neurons of the Dorsal Root Ganglia.","authors":"Katherine A Qualls, Feni K Kadakia, Elizabeth K Serafin, Debora De Nardin Lückemeyer, Steve Davidson, Judith A Strong, Jun-Ming Zhang","doi":"10.1213/ANE.0000000000007133","DOIUrl":"10.1213/ANE.0000000000007133","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroid receptors, including mineralocorticoid receptor (MR) and glucocorticoid receptor (GR), play important roles in inflammatory pain in the dorsal root ganglion (DRG). Although it is widely known that activating the GR reduces inflammatory pain, it has recently been shown that MR activation contributes to pain and neuronal excitability in rodent studies. Moreover, little is known about the translation of this work to humans, or the mechanisms through which corticosteroid receptors regulate inflammatory pain.</p><p><strong>Methods: </strong>Corticosteroid receptor expression in human and mouse DRGs was characterized. RNAscope was used to perform high-resolution in situ hybridization for GR and MR mRNAs and to examine their colocalization with markers for nociceptors ( SCN10A , Na V 1.8 mRNA) and Aβ mechanoreceptors ( KCNS1 , Kv9.1 mRNA) in human DRG and C57BL/6J mouse DRG samples.</p><p><strong>Results: </strong>GR and MR mRNAs are expressed in almost all DRG neurons across species. The 2 receptors colocalize in 99.2% of human DRG neurons and 95.9% of mouse DRG neurons ( P = .0004, Fisher exact test). In both human and mouse DRGs, the large-diameter KCNS1+ Aβ mechanoreceptors showed a significantly higher MR/GR ratio (MR-leaning) compared to KCNS1- neurons (human: 0.23 vs 0.04, P = .0002; mouse: 0.35 vs -0.24, P < .0001; log ratios, unpaired t test), whereas small-diameter SCN10A+ nociceptive neurons showed a significantly lower MR/GR ratio (GR-leaning) compared to SCN10A- neurons (human: -0.02 vs 0.18, P = .0001; mouse: -0.16 vs 0.08, P < .0001; log ratios, unpaired t test).</p><p><strong>Conclusions: </strong>These findings indicate that mouse corticosteroid receptor mRNA expression reflects human expression in the DRG, and that mice could be a suitable model for studying corticosteroid receptor involvement in pain. Additionally, this study supports the translatability of rodent data to humans for the use of more selective corticosteroids at the DRG in pain treatments.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1216-1226"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982121","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":"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":"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 χ 2 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":"1140-1148"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","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":"Erratum: The Role of Sleep Apnea in Postoperative Neurocognitive Disorders Among Older Noncardiac Surgery Patients: A Prospective Cohort Study.","authors":"Michael J Devinney, Andrew R Spector, Mary C Wright, Jake Thomas, Pallavi Avasarala, Eugene W Moretti, Jennifer E Dominguez, Patrick J Smith, Heather E Whitson, Sigrid C Veasey, Joseph P Mathew, Miles Berger","doi":"10.1213/ANE.0000000000007445","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007445","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"140 5","pages":"e62"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973027","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":"Electroencephalographic Measures of Delirium in the Perioperative Setting: A Systematic Review.","authors":"Maria J Bruzzone, Benjamin Chapin, Jessie Walker, Marcos Santana, Yue Wang, Shawna Amini, Faith Kimmet, Estefania Perera, Clio Rubinos, Franchesca Arias, Catherine Price","doi":"10.1213/ANE.0000000000007079","DOIUrl":"10.1213/ANE.0000000000007079","url":null,"abstract":"<p><p>Postoperative delirium (POD) is frequent in older adults and is associated with adverse cognitive and functional outcomes. In the last several decades, there has been an increased interest in exploring tools that easily allow the early recognition of patients at risk of developing POD. The electroencephalogram (EEG) is a widely available tool used to understand delirium pathophysiology, and its use in the perioperative setting has grown exponentially, particularly to predict and detect POD. We performed a systematic review to investigate the use of EEG in the pre-, intra-, and postoperative settings. We identified 371 studies, and 56 met the inclusion criteria. A range of techniques was used to obtain EEG data, from limited 1-4 channel setups to complex 256-channel systems. Power spectra were often measured preoperatively, yet the outcomes were inconsistent. During surgery, the emphasis was primarily on burst suppression (BS) metrics and power spectra, with a link between the frequency and timing of BS, and POD. The EEG patterns observed in POD aligned with those noted in delirium in different contexts, suggesting a reduction in EEG activity. Further research is required to investigate preoperative EEG indicators that may predict susceptibility to delirium.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1127-1139"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874000","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":"Gender and Pathways to Leadership in Academic Anesthesiology: A Qualitative Content Analysis of US Chairpersons' Curricula Vitae.","authors":"Meghan B Lane-Fall, Maya J Hastie, Melanie Kleid, Varun Yarabarla, Andrea N Miltiades, Jeanine P Wiener-Kronish, May C Pian-Smith","doi":"10.1213/ANE.0000000000006821","DOIUrl":"10.1213/ANE.0000000000006821","url":null,"abstract":"<p><strong>Background: </strong>Women are underrepresented in medicine and academic anesthesiology, and especially in leadership positions. We sought to characterize career achievement milestones of female versus male academic anesthesiology chairs to understand possible gender-related differences in pathways to leadership.</p><p><strong>Methods: </strong>We conducted a retrospective observational cross-sectional analysis. In November 2019, curricula vitae (CVs) were requested from then-current members of the US Association of Academic Anesthesiology Chairs. Data reflecting accomplishments up to the time of chair appointment were systematically extracted from CVs and analyzed using a mixed methods approach with qualitative content analysis supplemented by descriptive statistics and bivariate statistical testing. Missing data were not imputed.</p><p><strong>Results: </strong>Seventy-two CVs were received from eligible individuals (response rate 67.3%). The respondent sample was 12.5% women (n = 9), 87.5% men (n = 63), and no transgender or nonbinary people; this is similar to the known gender balance in anesthesiology chairs in the United States. No statistically significant differences in objective markers of academic achievement at the time of chair appointment were evident for female versus male chairs, including time elapsed between the first faculty appointment and assumption of the chair role (median 25 vs 18 years, P = .06), number of publications at the time the chair was assumed (101 vs 69, P = .28), or proportion who had ever held a National Institutes of Health (NIH) grant as principal investigator (44.4% vs 25.4%, 0.25). Four phenotypes of career paths were discernible in the data: the clinician-administrator, the educator, the investigator, and the well-rounded scholar; these did not differ by gender.</p><p><strong>Conclusions: </strong>Female chairpersons who were members of the Association of Academic Anesthesiology Chairs in the United States demonstrated similar patterns of academic achievement as compared to male chairpersons at the time the position of chair was assumed, suggesting that they were equally qualified for the role as compared to men. Four patterns of career achievements were evident in the chairperson group, suggesting multiple viable pathways to this leadership position.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1051-1059"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641496","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":"Preoperative Multivariable Model for Risk Stratification of Hypoxemia During One-Lung Ventilation.","authors":"Andres Zorrilla-Vaca, Michael C Grant, Laura Mendez-Pino, Muhammad J Rehman, Pankaj Sarin, Sula Nasra, Dirk Varelmann","doi":"10.1213/ANE.0000000000007306","DOIUrl":"10.1213/ANE.0000000000007306","url":null,"abstract":"<p><strong>Background: </strong>Hypoxemia occurs with relative frequency during one-lung ventilation (OLV) despite advances in airway management. Lung perfusion scans are thought to be one of the most accurate methods to predict hypoxemia during OLV, but their complexity and costs are well-known limitations. There is a lack of preoperative stratification models to estimate the risk of intraoperative hypoxemia among patients undergoing thoracic surgery. Our primary objective was to develop a risk stratification model for hypoxemia during OLV based on preoperative clinical variables.</p><p><strong>Methods: </strong>This is a single-center, retrospective cohort study including 3228 patients who underwent lung resections with OLV from 2017 to 2022, at a tertiary academic health care center in the United States. Vital signs and ventilator settings were retrieved minute by minute. Intraoperative hypoxemia was defined as an episode of oxygen desaturation (Sp o2 <90%) for at least 5 minutes. Demographic and clinical characteristics were included in a stepwise logistic regression, which was used for the selection of predictors of the risk score model. All patients included in this cohort underwent elective lung surgery in lateral decubitus position, with double lumen tube and placement confirmation with fiberoptic bronchoscopy. Our model was validated internally using area under the receiver operating curves (AUC) with bootstrapping correction.</p><p><strong>Results: </strong>The incidence of hypoxemia during OLV was 8.9% (95% confidence interval [CI], 8.0-10.0). Multivariable logistic regression identified 9 risk factors with their corresponding scoring: preoperative Sp o2 <92% (15 points), hemoglobin <10 g/dL (6 points), age >60 years old (4 points), male sex (4 points), body mass index >30 kg/m 2 (8 points), diabetes mellitus (4 points), congestive heart failure (7 points), hypertension (3 points), and right-sided surgery (3 points). The AUC of the model after bootstrap correction was 0.708 (95% CI, 0.676-0.74). Based on the highest Youden index, the optimal score for predicting intraoperative hypoxemia was 13. The risk of hypoxemia increased from 4.7% in the first quartile of scores (0-13 points), to 32% in the third quartile (27-39 points), and 83.3% in the fourth quartile (>39 points). At scores of 20 or greater, the specificity of the model exceeded 90% and reached a positive predictive value of 80%.</p><p><strong>Conclusions: </strong>The risk of hypoxemia during OLV can be stratified preoperatively using accessible clinical variables. Our risk model is well calibrated but showed moderate discrimination for predicting intraoperative hypoxemia. The accuracy of preoperative models for risk stratification of hypoxemia during OLV should be explored in prospective studies.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1029-1036"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942764","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":"Kristina Siemens, Beverley J Hunt, Shane M Tibby","doi":"10.1213/ANE.0000000000007464","DOIUrl":"10.1213/ANE.0000000000007464","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e60-e61"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466814","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 Medicaid Expansion on Congenital Heart Surgery Outcomes: Data From the Society of Thoracic Surgeons Database.","authors":"Faith J Ross, Yuen Lie Tjoeng, Titus Chan, Jonathan M Tan, Waylon Howard, Nathalia Jimenez","doi":"10.1213/ANE.0000000000007319","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007319","url":null,"abstract":"<p><strong>Background: </strong>The Affordable Care Act expanded Medicaid eligibility and increased public insurance coverage for children across the United States. As only a subset of states adopted expansion of coverage, disparities in insurance coverage between expansion and nonexpansion states emerged. We examined the association between Medicaid expansion and cardiac surgery outcomes to understand the impact of Medicaid expansion in a medically complex pediatric population. We hypothesized that expansion of Medicaid eligibility would be associated with greater improvement in surgical outcomes.</p><p><strong>Methods: </strong>The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate perioperative outcomes for children 0 to 18 years undergoing cardiac surgery between January 2010 and December 2019. We used a difference-in-differences (DiD) design to estimate the impact of Medicaid expansion on surgical outcomes by comparing changes in outcomes between individuals in expansion states and those in nonexpansion states, both before and after the expansion. Outcomes included operative mortality, major complications and postoperative length of stay (PLOS).</p><p><strong>Results: </strong>The interaction between Medicaid expansion and time period post- vs preexpansion was not significant for any of the outcome variables. The odds ratio (OR) for mortality related to the Medicaid expansion was 1.12 (confidence interval [CI], 0.95-1.32, P = .161). For major complications, the OR was 0.99 (CI, 0.90-1.09, P = .770). For PLOS, the incidence rate ratio was 1.02 (CI, 0.99-1.05, P = .141).</p><p><strong>Conclusions: </strong>There was an overall decline in congenital heart surgery mortality over time; however, states that expanded Medicaid eligibility did not experience a greater improvement in mortality relative to states that did not expand eligibility. Similarly, there was no significant difference in major complications or PLOS related to Medicaid expansion. Further studies are needed to examine long-term outcomes and the larger spectrum of accessibility to congenital cardiac care which may benefit from insurance coverage.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"140 5","pages":"1195-1204"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960797","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}