Anesthesia and analgesia最新文献

{"title":"Maternal Mortality From Obstetric Hemorrhage: It Is Time to Inflate the Aortic Balloon.","authors":"Marte Irene Skille Carlsen, Jostein Rødseth Brede, Edmund Søvik, Oddvar Uleberg","doi":"10.1213/ANE.0000000000007586","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007586","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186269","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":"Walking a Few Steps Alongside.","authors":"James S Huntley","doi":"10.1213/ANE.0000000000007546","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007546","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186270","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":"Elizabeth, a Vial Cap Mosaic.","authors":"Julia Baskin McKillen","doi":"10.1213/ANE.0000000000007565","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007565","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186268","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":"Single-Syringe Total Intravenous Anesthesia With Propofol and Remifentanil: A Prospective Cohort Study.","authors":"Natalie Bennion, Thomas S Brower, Craig R Ballard, Jacob Steenblik, Ki Hwa Lee, Talmage D Egan, Jeffrey D Swenson, Nathan L Pace, Ken B Johnson","doi":"10.1213/ANE.0000000000007581","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007581","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207321","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":"Volatile Anesthetics and Climate: A More Balanced Perspective.","authors":"Peter Kranke, Jan Jakobsson, Patrick Meybohm, Graeme Sanders","doi":"10.1213/ANE.0000000000007592","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007592","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214698","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 Retrospective Study of Ultramassive Transfusion in Trauma Patients: Is There a Value After Which Additional Transfusions Are Futile?","authors":"Frank R Major, Trevor A Pickering, Kristen Stefanescu, Mandeep Singh, Damon H Clark, Kenji Inaba, Jeffry T Nahmias, Erika L Tay-Lasso, Claudia Alvarez, Joy L Chen, Farzin Ahmed, Olga Y Kaslow, Jeffrey L Tong, Jianzhou Xiao, Elizabeth Hall, Rania Elkhateb, Youssef Bahgat, Danielle Tatum, John T Simpson, Siddharth Singh, Norma J Klein, Richard L Applegate, Catherine M Kuza","doi":"10.1213/ANE.0000000000007569","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007569","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is a leading cause of preventable mortality in trauma. During times of blood shortages, it may be prudent to consider a transfusion threshold during massive transfusion after which additional transfusions are futile due to nonsurvivability. The main objective of this study is to examine outcomes associated with ultramassive transfusion (UMT; defined as ≥20 units of red blood cells [RBC] within 24 hours) and determine if there is a threshold beyond which additional transfusion efforts should cease.</p><p><strong>Methods: </strong>We performed a retrospective (2016-2022) analysis of adult trauma patients (≥ 18 years old) who underwent surgery and received blood products within 24 hours of admission at 7 US Level I trauma centers. We compared patients who received UMT and patients who received <20 units RBC and evaluated the effects of various amounts of blood products on mortality, length of stay (LOS), mechanical ventilation (MV), and complications. Segmented logistic regression analysis was performed to determine if there is a \"plateau\" effect of increasing RBC units on mortality.</p><p><strong>Results: </strong>Of 3248 patients included, 2913 (89.7%) received <20 RBC units within 24 hours, and 333 (10.3%) received ≥20 RBC units within 24 hours. Patients receiving UMT had increased 24-hour mortality (risk ratio [RR] 6.00, 95% confidence interval [CI], 4.79-7.52, P < .001) and index hospitalization mortality (RR 3.99 [3.34-4.75], P < .001). These patients also more often developed complications (RR 1.67 [1.44-1.94], P < .001) and multiple organ failure (RR 2.78 [2.20-3.52], P < .001). Compared to those receiving 20 to 29 RBC units, those receiving 30 to 44 RBC units had statistically similar associated risk of death (RR 1.32 [0.93-1.87], P = .12); however, those receiving ≥45 RBC units had an increased associated risk of death (RR 1.59, [1.12-2.25], P = .009), and additional transfusion beyond this point did not improve the probability of survival.</p><p><strong>Conclusions: </strong>In this study, patients who received UMT had higher mortality and worse outcomes than those who received fewer units. However, this study did not identify a threshold beyond which all patients died and therefore cannot justify implementing a limit on the number of RBC units transfused based on these data alone.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186267","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":"Building Trusting Health Care Teams.","authors":"D Matthew Sherrer, Courtney B Peters, Breanne A Mertz, Andrew H Morris, Brooke R Vining, Thomas R Vetter","doi":"10.1213/ANE.0000000000007588","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007588","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131769","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":"Intubation Setting and Mortality in Trauma Patients Undergoing Hemorrhage Control Surgery: A Propensity Score-Matched Analysis.","authors":"Tomer Talmy, Irina Radomislensky, Isaac Brzezinski Sinai, Ruth Shaylor, Eldad Katorza, Sami Gendler","doi":"10.1213/ANE.0000000000007542","DOIUrl":"10.1213/ANE.0000000000007542","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation is essential for airway management in trauma patients but may cause hemodynamic instability and delay critical resuscitation measures. Recent studies have suggested that emergency department (ED) intubation may be linked with higher mortality compared to operating room (OR) intubation in trauma patients. However, it remains unclear if these findings apply to broader trauma populations, including both civilian and military patients. This study uses a nationwide trauma registry to test the hypothesis that ED intubation is associated with higher in-hospital mortality among major trauma patients, compared to OR intubation.</p><p><strong>Methods: </strong>Registry-based analysis of the Israeli National Trauma Registry evaluating major trauma (Injury Severity Score [ISS] ≥16) patients requiring hemorrhage control surgery between 2016 and 2023. ED intubation was the main exposure variable with in-hospital mortality serving as the primary outcome. Multivariable logistic regression and propensity score matching were applied to adjust for confounders, including injury severity, ED vital signs, penetrating injury, and blood product administration.</p><p><strong>Results: </strong>The study included 975 patients, 470 (48.2%) of whom were intubated in the ED. ED-intubated patients had significantly higher ISS and higher proportion of profound shock compared to those intubated in the OR. In-hospital mortality was more common among patients intubated in the ED (22.6%) as compared with those intubated in the OR (8.5%). In the unadjusted logistic regression, ED intubation was associated with higher odds of in-hospital mortality (OR: 3.13, 95% confidence interval [CI], 2.15-4.62). However, after adjusting for several potential confounders, the association became nonsignificant and was persistent across sensitivity subgroup analyses. Propensity score matching resulted in 1:1 matching of 271 patients in each group, balancing characteristics such as ISS, profound shock, Glasgow Coma Scale, and penetrating injury. After matching, the mortality rate was similar between groups (12.5% for ED intubation vs 12.2% for OR intubation). In the matched cohort, logistic regression demonstrated no significant association between ED intubation and in-hospital mortality (OR: 0.97, 95% CI, 0.58-1.61). ED intubation was associated with a greater than 2-fold increase in odds of ICU admission in adjusted and propensity score-matched analyses.</p><p><strong>Conclusions: </strong>ED intubation was not significantly associated with increased in-hospital mortality after controlling for injury severity and shock. These findings suggest that while ED intubation may be more frequent in severely injured patients, its independent impact on mortality in patients undergoing emergent surgery remains unclear, warranting further prospective investigation.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075541","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":"Brain Health Screening in Older Surgical Patients: A Multicenter, Retrospective, Observational Analysis and Survey.","authors":"Alexander T Abess, Nirav J Shah, Elizabeth L Whitlock, Hedwig Schroeck, Donna Ron, Sandra Becker Rozek, Pablo Martinez-Camblor, Anne L Donovan, Katie J Schenning, Stacie G Deiner","doi":"10.1213/ANE.0000000000007557","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007557","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend routine screening perioperatively for cognitive impairment, frailty, and delirium for patients at risk. Capturing these 3 geriatric screening variables in multicenter databases would also enable much-needed large-scale pragmatic research. Our primary hypothesis was that the well-curated Multicenter Perioperative Outcomes Group (MPOG) database would have a low rate of retrievable geriatric screening variables. Our secondary hypothesis was that multiple barriers exist that impede clinical implementation of recommended screenings as well as the digital capture of these variables into the MPOG database.</p><p><strong>Methods: </strong>This was a 2-component study. The first component was a retrospective observational analysis using the MPOG database to identify geriatric screening variables in patients over the age of 65 undergoing nonemergent inpatient surgery. The second component was a survey sent to MPOG participant sites (49 institutions) to assess actual screening practices and perspectives.</p><p><strong>Results: </strong>Of the 908,158 relevant patient records only 8054 (0.89%) were identified as having a preoperative cognitive screen, and 123,114 (13.6%) were identified as having a postoperative delirium screening. No frailty screenings were observed. Forty-3 survey responses (88% response rate) were received. Approximately half of the respondents indicated their institutions perform cognitive screening (n=22; 51.2%), frailty screening (n=17; 44.7%), or delirium screening (n = 16; 45.7%). Only 10 institutions (23.2%) reported performing all 3, and 13 (30.2%) institutions reported performing none. Multiple barriers were identified. The most common significant barrier reported was a lack of available standard screening tools for the electronic health record.</p><p><strong>Conclusions: </strong>This study identified minimal data collection related to neurocognitive disorders which appears incongruous with clinical practice guidelines. Challenges related to capturing this data locally and in multi-center datasets were identified. Overcoming those barriers may facilitate future pragmatic research studies related to this important public health priority.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207320","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":"Perioperative Health Care Disparities in the United States: A Systematic Review.","authors":"A Steven Bradley, Timethia J Bonner, Mohanad R Youssef, Brittany N Burton, David O Warner, Abimbola O Faloye, Paloma Toledo, Adam J Milam","doi":"10.1213/ANE.0000000000007510","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007510","url":null,"abstract":"<p><p>Perioperative health inequities remain a critical issue, contributing to unequal patient outcomes and financial costs despite increasing awareness and efforts to address these disparities. This systematic review evaluated anesthesiology literature from 2010 to 2023 on perioperative health care disparities related to race, ethnicity, gender, and socioeconomic status. The review aimed to identify gaps and propose research and opportunities for intervention. A comprehensive literature search was conducted using PubMed, Embase, Scopus, and Web of Science, with studies included if they focused on perioperative disparities in the United States, were published in anesthesiology journals, and met criteria for methodological rigor. The review was registered with International Prospective Register of Systematic Reviews (PROSPERO); data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and study quality was assessed with the Newcastle-Ottawa scale. Out of 1050 abstracts screened, 116 articles were reviewed for full text, with 59 studies meeting inclusion criteria. Included studies comprised retrospective cohort studies, cross-sectional analyses, a case-control study, and a randomized controlled trial, covering various surgical procedures and sample sizes from 100 to over 21 million patients. Disparities were noted in peripartum management (n = 14), mortality (n = 12), complications (n = 8), regional anesthesia use (n = 6), and pain management (n = 3), with evidence of poorer outcomes in Black and Hispanic women, older adolescents, and patients who were uninsured or on Medicaid. This review highlights the persistence of significant perioperative disparities and identifies gaps, such as limited exploration of the causes of these disparities, limited examination of disparities during the preoperative and intraoperative period, and few interventions to address these identified disparities. Reducing these disparities requires stakeholder engagement, multifaceted approaches, culturally agile training for health care teams, enhanced decision support tools, and a more diverse health care workforce. Continued research and targeted interventions at individual, community, and societal levels are essential for improving perioperative outcomes.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961079","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}