Anesthesia and analgesia最新文献

{"title":"The Preoperative Phases of the Perioperative Cognitive Anesthesia Network for Older Adults Electing Surgery: Results From an Observational Cohort.","authors":"Catherine C Price, Juliana S Burt, Shawna Amini, Franchesca Arias, Basma Mohamed, Christoph N Seubert, Cynthia Garvan","doi":"10.1213/ANE.0000000000007448","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007448","url":null,"abstract":"<p><strong>Background: </strong>Individuals with neurodegenerative disorders are often provided the same perioperative care as unaffected peers, even though unidentified diminished preoperative \"brain health\" worsens surgical outcomes. We summarize the implementation and standardized data from a phased preoperative cognitive assessment consisting of screening tests administered by clinic staff and, on a failed screening, an immediate neuropsychological assessment from licensed neuropsychologists.</p><p><strong>Methods: </strong>The present observational study used deidentified patient data provided via an honest broker over 2 years. The data included patients aged 65 or older at the time of treatment who were triaged for an in-person preoperative clinic visit, excluding those patients who were scheduled for orthopedic surgery. The cognitive screening assessed education, frailty, clock-drawing-test to command and copy conditions, and 3-word registration and recall. The neuropsychological evaluation involved 90-minute assessments with interviews, cognitive testing, interpretation, and recommendations to the perioperative care team. Standardized data from general cognition, attention, and memory metrics are shown for this current report.</p><p><strong>Results: </strong>Of the 14,795 patients eligible for cognitive screening, 83.1% underwent screening, identifying 22.7% with atypical cognitive performance. Patients successfully screened were more often white (87.8% vs 78.4%; P < .0001), married (61.2% vs 57.9%; P < .0001), and less frail (nonfrail: 45.6% vs 20.5%; P < .0001). Of the 2790 patients referred for the comprehensive assessment, 48.9% completed the neuropsychological evaluation. Referred patients were older (74.6 ± 6.5 vs 72.9 ± 5.7 yrs; P < .0001), less educated (13.2 ± 2.9 vs 14.1 ± 2.9 yrs; P < .0001), less likely married (58.1% vs 62.8%; P < .0002), more frail (frail: 24.6% vs 16.5%; P < .0001), more likely to live in socioeconomically-deprived geographic regions (52.0% vs 47.7%; P < .0001), and had a 50% greater 1-year mortality than nonreferred patients (P < .0001). Patients who showed no impairment or had only memory impairment on the neuropsychological examination were less frail (nonfrail: 45.5% vs 30.6%; P < .0001) and only half as likely to have a canceled surgery than those who exhibited attention or combined attention and memory impairment (P = .0002).</p><p><strong>Conclusions: </strong>Findings highlight how preoperative anesthesiology and neuropsychology teams can provide cognitive screening with referrals to brain health exams, and underscore the severity of unmet cognitive health care needs in older patients electing surgery.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571509","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":"Sociodemographic and Systems Risk Factors Associated With Nil by Mouth Noncompliance and Day-of-Procedure Cancellations: A Retrospective Multicenter Case-Control Study.","authors":"Daniel J Goldstein, Nathalia Jimenez, Debra Faulk, Judith Jones, Travis Reece-Nguyen, Cheryl K Gooden, Daniel V Markowitz, Priti G Dalal","doi":"10.1213/ANE.0000000000007451","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007451","url":null,"abstract":"<p><strong>Background: </strong>Day-of-procedure cancelations are a hardship, affecting patients, families, and health care systems. One major cause of cancelations is nil by mouth (nil per os [NPO]) noncompliance. Previous single-center studies show conflicting results regarding risk factors for cancelations. The primary objective of this study was to identify demographic populations with higher-than-predicted rates of NPO noncompliance, as defined by local institutional NPO guidelines. The secondary objective was to determine whether demographic and system risk factors were associated with procedure cancelations due to NPO noncompliance.</p><p><strong>Methods: </strong>A multicenter retrospective case-control study was conducted of children <18 years of age presenting for elective procedures requiring adherence to local institutional NPO guidelines. Data collected included sociodemographic characteristics (age, sex, race-ethnicity, language of care, and medical insurance type) and systems factors (time of day for the scheduled procedure and communication modalities used to share NPO guidelines). The primary outcome was the occurrence of noncompliance of local institutional NPO guidelines. The secondary outcome was a cancelation of the elective procedure due to NPO noncompliance. A χ2 goodness-of-fit test and multivariable logistic regression were used for statistical analyses.</p><p><strong>Results: </strong>Among 164,147 pediatric patients across 10 institutions, a total of 1208 instances of NPO noncompliance were identified (0.74%). Of the patients who experienced an NPO noncompliance event, 52% had their procedure delayed to a later time of the day, and 48% had their procedure canceled. Risk factors for NPO noncompliance included being younger than <4 years old, belonging to minority race-ethnicity groups, having Spanish as the primary language of care, and having public health insurance. In the multivariable analysis, the odds of cancelation after an NPO noncompliance event were 46% higher for children whose preprocedure phone call was not answered, 62% higher for children over 4 years old, 80% higher for non-Hispanic African American/Black children, 88% higher for children with public health insurance, and twice as high for procedures scheduled in the afternoon.</p><p><strong>Conclusions: </strong>This multicenter study identified age, race-ethnicity, language of care, and health insurance type as factors associated with the occurrence of NPO noncompliance. Certain demographic and system risk factors were linked to higher rates of day-of-procedure cancelations due to NPO noncompliance. These findings raise concerns regarding disparities in access to care especially in minority populations already at an increased risk of inadequate health care access. Identifying these risk factors can help drive the development of strategies to address inequities and improve access to health care.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555559","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":"Office-Based Anesthesia: An Update on Current Trends and Practice.","authors":"Justin Talluto, Vikranth R Chinthareddy, Brian M Osman, Fred E Shapiro","doi":"10.1213/ANE.0000000000007457","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007457","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555558","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":"Electroencephalogram Correlates of Infant Spinal Anesthesia.","authors":"Chang Amber Liu, Johanna M Lee, Ashlee Holman, Grant Heydinger, Emmett E Whitaker, Jerry Y Chao","doi":"10.1213/ANE.0000000000007396","DOIUrl":"10.1213/ANE.0000000000007396","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982363","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":"Modeling Phase I Postanesthesia Care Unit Patient Transport Times Among Multiple Destinations.","authors":"Paul Cover, Franklin Dexter, Yasser Ms El-Hattab","doi":"10.1213/ANE.0000000000007455","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007455","url":null,"abstract":"<p><strong>Background: </strong>Although the importance of transporter availability to the operating room and phase I postanesthesia care unit workflow has been known since Marcon et al Anesth & Analg 2003, no detailed data have been published about patient transport times. Nearly all facilities know the times of postanesthesia care unit (PACU) discharges, but transport time through when the transporter returns consumes porter resources.</p><p><strong>Methods: </strong>Epic's Rover was implemented to track all PACU transports, 22,846 from July 2022 through April 2024. Destinations were grouped based on distance traveled. Transport counts and total times were calculated by 4-hour period and day of the week. χ2 and Kruskal-Wallis tests were used for inference. Number of staff starting shifts, transports per transporter per hour, and transport time per transporter per 4-hour period were determined, with χ2 and Kruskal-Wallis tests for inference. Bland-Altman plots compared (i) total transport time for each day and 4-hour period with (ii) estimates from the product of PACU discharges and the overall mean time per transport. Delayed transports were identified and evaluated for successive delays. Standardized normal probability plots and Shapiro-Wilk tests of normality were used to examine the probability distribution of total transport time among workday for 4-hour periods.</p><p><strong>Results: </strong>Transports to the phase II recovery were faster than to other common transport destinations (all adjusted P ≤ .0001). Number of transports and total hours of transport time differed among 4-hour periods and destination categories (all P < .0001). Weekday was inconsequential. Approximately half of all 4-hour periods had ≥1 delay, and runs of delays were significant (P < .0001). Prediction of transport workload using the count of transports for each combination of day and 4-hour period multiplied by the overall mean time per transport proved insufficient, differing from actual time by -1.04 to +1.05 hours per 4-hour period. Total hours of transport time per 4-hour period were normally distributed for the busiest 2 periods (Shapiro-Wilk W > 0.99), allowing the mean plus the standard deviation to be used to choose the number of transporters needed for each period.</p><p><strong>Conclusions: </strong>PACU transport times differed significantly among destinations. Therefore, when >1 patient is waiting for transport, target the patient who will have the briefest transport, especially if to the phase II PACU. Approximation of transport workload based on the distribution of PACU discharges by time of day is insufficient for accurate staffing. Instead, rely on the mean and standard deviation of the workday's total transport times during the period.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555557","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":"Early Postoperative Intravenous Iron Versus Oral Iron for the Treatment of Anemia Following Cardiac Surgery: A Randomized Controlled Trial.","authors":"Michael Kremke, Camilla Nyboe, Martin R Jørgensen, Hjördís Ó Atladóttir, Ivy S Modrau","doi":"10.1213/ANE.0000000000007414","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007414","url":null,"abstract":"<p><strong>Background: </strong>Postoperative anemia is a common complication after cardiac surgery, often persisting for months and substantially affecting patient recovery. Despite its prevalence, optimal treatment strategies are lacking. We aimed to evaluate whether early postoperative intravenous (IV) iron is more effective than daily oral iron in correcting anemia after cardiac surgery.</p><p><strong>Methods: </strong>This single-center, pragmatic randomized controlled trial enrolled 110 cardiac surgery patients with moderate postoperative anemia (hemoglobin 8-11 g/dL). Participants were randomized 1:1 to receive either a single infusion of 20 mg/kg ferric derisomaltose on postoperative day 1 (IV iron group, n = 57) or 100 mg oral ferrous sulfate twice daily for 4 weeks (oral iron group, n = 53). All outcomes were assessed at 4 weeks postrandomization. The primary composite outcome aimed to measure treatment success, defined as the proportion of participants who were (a) no longer anemic (per World Health Organization criteria) and (b) neither had received allogeneic red blood cell (RBC) transfusions after randomization. Secondary end points included differences in hemoglobin levels, RBC transfusion rates, iron metrics, 6-minute walk test distances, hospital length of stay, and patient-reported outcomes.</p><p><strong>Results: </strong>Primary outcome data were available for 53 participants in the IV iron group and 51 in the oral iron group. The proportion of participants who achieved the primary end point did not differ significantly between groups (28% vs 16%; risk difference 13%, 95% confidence interval [CI], -3% to 28%; P = .121). No statistically significant differences were observed in anemia prevalence (66% vs 82%; P = .058) or RBC transfusion rates (17% vs 33%; P = .054). Mean hemoglobin levels (± standard deviation) were higher in the IV iron group (12.0 ± 1.1 g/dL vs 11.4 ± 1.3 g/dL; P = .013). None of the participants in the IV iron group had ferritin levels <100 µg/L, compared to 26% in the oral iron group (P < .001, accounting for 95% CI for 0 numerators). No significant differences were observed in the 6-minute walk test, hospital length of stay, or patient-reported outcomes. Notably, no serious adverse events related to ferric derisomaltose were reported.</p><p><strong>Conclusions: </strong>Early postoperative IV iron did not demonstrate superiority over oral iron for the primary outcome. However, secondary end points suggest it may improve hemoglobin levels and reduce the prevalence of postoperative iron deficiency. These findings warrant further investigation in larger trials to confirm the clinical effectiveness of early postoperative IV iron.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539968","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 Dark Side of the Moon: Awe and Our Well-Being.","authors":"K Elliott Higgins, Jasmine A Macias, Maxime P Cannesson","doi":"10.1213/ANE.0000000000007213","DOIUrl":"10.1213/ANE.0000000000007213","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e19"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118770","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 Palonosetron Versus Ondansetron for Nausea, Vomiting, and Pruritus in Cesarean Delivery with Intrathecal Morphine.","authors":"Tarvit Worravitudomsuk, Somrat Charuluxananan, Wasin Sukumpanumet, Pin Sriprajittichai","doi":"10.1213/ANE.0000000000007091","DOIUrl":"10.1213/ANE.0000000000007091","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Spinal anesthesia is the preferred anesthetic technique for cesarean deliveries. Postoperative nausea and vomiting (PONV) and pruritus occur in up to 80% and 83% of patients, respectively, after cesarean delivery with intrathecal opioids. Ondansetron is the recommended medication for PONV prophylaxis, but palonosetron, a second-generation 5-HT3 receptor antagonist, has a higher receptor affinity and a longer half-life. However, studies on palonosetron use in cesarean deliveries are limited. This study aimed to determine whether palonosetron was more effective than ondansetron in preventing intrathecal morphine-induced PONV and pruritus in cesarean deliveries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Parturients who underwent cesarean delivery under spinal anesthesia were randomized into 3 groups: P (palonosetron 0.075 mg), O (ondansetron 4 mg), and N (normal saline). The study drug was intravenously administered after the umbilical cord was clamped. The primary outcome measures were the 48-hour incidence of PONV and pruritus. The secondary outcome measures were the PONV and pruritus scores at the postanesthesia care unit (PACU) and ward, rescue medications, satisfaction scores, and adverse events. Ordinal data were analyzed using the Kruskal-Wallis test. Continuous and categorical data were analyzed using a 1-way analysis of variance, Kruskal-Wallis test, and Pearson's χ 2 test, respectively. A value of P &lt; .05 was considered significant. Post hoc analysis pairwise comparisons with Bonferroni correction were also performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 300 parturients were enrolled, and 297 parturients completed the study. One patient in the P group and 2 in the O group were excluded because of conversion to general anesthesia after failed spinal anesthesia. The baseline patient characteristics were comparable between the groups. The PONV incidence rates in the P, O, and N groups were 26.3% (95% confidence interval [CI], 17.4-35.1), 34.7% (95% CI, 25.1-44.3), and 50.0% (95% CI, 40.0-59.9), respectively ( P = .002). The incidence rates of pruritus in the P, O, and N groups were 69.7% (95% CI, 60.5-78.9), 76.5% (95% CI, 67.9-85.1), and 87.0% (95% CI, 80.3-93.7), respectively ( P = .013). Pairwise comparisons revealed significantly lower incidences of PONV and pruritus in the P group than in the N group ( P &lt; .001 and P = .003, respectively). However, no significant differences were observed between the P and O groups or between the O and N groups. Additionally, the P group required significantly less nalbuphine rescue for pruritus than the N group ( P = .004 and P = .005 for the PACU and ward, respectively). PONV rescue, satisfaction scores, and adverse events were not significantly different among the 3 groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Palonosetron effectively prevents intrathecal morphine-induced PONV and pruritus during cesarean delivery. However, the efficacy of palonosetron is not significantly dif","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"628-635"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543200","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":"When the Drip Stops: The Intravenous Fluid Shortage.","authors":"Soobin Song, MaKayla Hoggard, Rafael Ortega","doi":"10.1213/ANE.0000000000007372","DOIUrl":"10.1213/ANE.0000000000007372","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e22-e23"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051369","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":"Capillary Refill Time After Induction of General Anesthesia: A Pilot Study.","authors":"Zbigniew Putowski, Szymon Czajka, Anna Szczepańska, Wojciech Szczeklik, Eduardo Kattan, Glenn Hernández","doi":"10.1213/ANE.0000000000007257","DOIUrl":"10.1213/ANE.0000000000007257","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"743-745"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520754","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}