Anesthesia and analgesia最新文献

{"title":"Predictive Validity of Anesthesiologists' Quality of Clinical Supervision and Nurse Anesthetists' Work Habits Assessed by Their Associations With Operating Room Times.","authors":"Franklin Dexter, Richard H Epstein, Dawn Dillman, Bradley J Hindman, Rashmi N Mueller","doi":"10.1213/ANE.0000000000007076","DOIUrl":"10.1213/ANE.0000000000007076","url":null,"abstract":"<p><strong>Background: </strong>At all Joint Commission-accredited hospitals, the anesthesia department chair must report quantitative assessments of anesthesiologists' and nurse anesthetists' (CRNAs') clinical performance at least annually. Most metrics lack evidence of usefulness, cost-effectiveness, reliability, or validity. Earlier studies showed that anesthesiologists' clinical supervision quality and CRNAs' work habits have content, convergent, discriminant, and construct validity. We evaluated predictive validity by testing for (expected) small but statistically significant associations between higher quality of supervision (work habits) and reduced probabilities of cases taking longer than estimated.</p><p><strong>Methods: </strong>Supervision quality of each anesthesiologist was evaluated daily by assigned trainees using the 9-item de Oliveira Filho scale. The work habits of each CRNA were evaluated daily by assigned anesthesiologists using a 6-item scale. Both are scored binary, 1 if all items are rated the maximum, 0 otherwise. From 40,718 supervision evaluations and 53,722 work habit evaluations over 8 fiscal years, 16 mixed-effects logistic regression models were estimated, with raters as fixed effects and ratees (anesthesiologists or CRNAs) as random effects. Empirical Bayes means in the logit scale were obtained for 561 anesthesiologist-years and 605 CRNA-years. The binary-dependent variable was whether the case took longer than estimated from the historical mean time for combinations of scheduled procedures and surgeons. From 264,060 cases, 8 mixed-effects logistic regression models were fitted, 1 per fiscal year, using ratees as random effects. Predictive validity was tested by pairing the 8 one-year analyses of clinical supervision, and the 8 one-year analyses of work habits, by ratee, with the 8 one-year analyses of whether OR time was longer than estimated. Bivariate errors in variable linear least squares linear regressions minimized total variances.</p><p><strong>Results: </strong>Among anesthesiologists, 8.2% (46/561) had below-average supervision quality, and 17.7% (99/561), above-average. Among CRNAs, 6.3% (38/605) had below-average work habits, and 10.9% (66/605) above-average. Increases in the logits of the quality of clinical supervision were associated with decreases in the logits of the probabilities of cases taking longer than estimated, unitless slope = -0.0361 (SE, 0.0053), P < .00001. Increases in the logits of CRNAs' work habits were associated with decreases in the logits of probabilities of cases taking longer than estimated, slope = -0.0238 (SE, 0.0054), P < .00001.</p><p><strong>Conclusions: </strong>Predictive validity was confirmed, providing further evidence for using supervision and work habits scales for ongoing professional practice evaluations. Specifically, OR times were briefer when anesthesiologists supervised residents more closely, and when CRNAs had better work habits.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"723-731"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589481","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":"Rodney A Gabriel","doi":"10.1213/ANE.0000000000007363","DOIUrl":"10.1213/ANE.0000000000007363","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e21-e22"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021885","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":"Impact of Sugammadex Versus Neostigmine Reversal on Postoperative Recovery Time in Patients With Obstructive Sleep Apnea Undergoing Bariatric Surgery: A Double-Blind, Randomized Controlled Trial.","authors":"Olawale Ajetunmobi, David Wong, Anahi Perlas, Wesley Rajaleelan, Stella Wang, Ella Huszti, Timothy Jackson, Frances Chung, Jean Wong","doi":"10.1213/ANE.0000000000007013","DOIUrl":"10.1213/ANE.0000000000007013","url":null,"abstract":"<p><strong>Background: </strong>Residual neuromuscular blockade can be associated with serious postoperative complications. Sugammadex is a newer neuromuscular blocking drug (NMBD) reversal agent that rapidly and completely reverses rocuronium. Whether sugammadex has any advantages over neostigmine in morbidly obese patients with obstructive sleep apnea (OSA) is unclear. We investigated whether sugammadex would reduce discharge time from the operating room (OR) compared with neostigmine in morbidly obese patients with OSA undergoing bariatric surgery.</p><p><strong>Methods: </strong>This was a prospective, double-blinded randomized controlled superiority trial with 2 parallel groups. Patients were randomized 1:1 into reversal of NMBD with sugammadex or neostigmine. Our inclusion criteria were morbidly obese adult patients with OSA undergoing elective bariatric surgery under general anesthesia. Our exclusion criteria were allergy to rocuronium, sugammadex or neostigmine, malignant hyperthermia, hepatic or renal insufficiency, neuromuscular diseases, and an inability to give consent. The primary outcome was the time from administration of the NMBD reversal agent to discharge from the OR. Secondary outcomes included the time from administration of the NMBD reversal agent to the time the patient opened eyes to command, and the time to extubation. The Mann-Whitney test was used to compare the outcomes between treatment groups.</p><p><strong>Results: </strong>We randomized 120 patients into 2 groups of 60 patients. Overall median body mass index (BMI) was 48.1 kg/m 2 ([interquartile range, IQR]) [43.0-53.5]. The time from drug administration to discharge from OR was 13.0 minutes [10.0-17.0] in the sugammadex group and 13.5 minutes [11.0-18.3] in the neostigmine group ( P = .27). The treatment effect estimate with a bootstrapped 95% confidence interval [CI] for time from admission to discharge from OR was -0.5 [-2.5 to 3]. No differences were observed in postoperative complications and other secondary outcomes.</p><p><strong>Conclusions: </strong>No difference was observed in OR discharge time in morbidly obese patients with OSA when sugammadex was administered instead of neostigmine.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"568-576"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141287648","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":"In Response.","authors":"Dan E Berkowitz, D Matthew Sherrer, Thomas R Vetter","doi":"10.1213/ANE.0000000000007214","DOIUrl":"10.1213/ANE.0000000000007214","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e20"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118769","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":"Jonathan GE Hinkle, Alkaform, and Dental Anesthesia Apparatus: A New Discovery, and Perhaps the First Practitioner of Conscious Sedation?","authors":"David J Wilkinson","doi":"10.1213/ANE.0000000000007118","DOIUrl":"10.1213/ANE.0000000000007118","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"590-595"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456243","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 Bibliometric Study of Patient Registries in Anesthesia.","authors":"Julia Maria Olsen, Casey Li, John Fiadjoe, Britta S von Ungern-Sternberg, Jason T Maynes, David M Polaner, Paul Stricker, Samuel Wasserman, Thomas Engelhardt, Clyde T Matava","doi":"10.1213/ANE.0000000000007243","DOIUrl":"10.1213/ANE.0000000000007243","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"736-739"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520752","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":"Pediatric Ambulatory Anesthesia: Confronting Challenges, Embracing Opportunities.","authors":"Samuel M Vanderhoek, Anna M Varughese, Sapna R Kudchadkar","doi":"10.1213/ANE.0000000000007169","DOIUrl":"10.1213/ANE.0000000000007169","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"596-598"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520660","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":"Neostigmine: Incompletely Understood and Perhaps Incorrectly Utilized.","authors":"Stephan R Thilen, Ken B Johnson","doi":"10.1213/ANE.0000000000007296","DOIUrl":"10.1213/ANE.0000000000007296","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"564-567"},"PeriodicalIF":4.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920593","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":"Inclusive Pathways in Anesthesiology: Addressing Structural and Cultural Barriers on International Women's Day.","authors":"Sarah Saxena, Mia Gisselbaek, Joana Berger-Estilita, Francesca Rubulotta","doi":"10.1213/ANE.0000000000007471","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007471","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527843","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 Probability Distribution of Times to Awakening From Sevoflurane Anesthesia, Among a Homogeneous Group of Cases With the Same Age-Adjusted Minimum Alveolar Concentration Fraction.","authors":"Franklin Dexter, Joel I Berger, Richard H Epstein, Rashmi N Mueller","doi":"10.1213/ANE.0000000000007438","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007438","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Human studies of awakening from general anesthesia inform understanding of neural mechanisms underlying recovery of consciousness. Probability distributions of times for emergence from anesthesia provide mechanistic information on whether putative biological models are generalizable. Previously reported distributions involved nonhomogenous groups, unsuitable for scientific comparisons. We used a retrospective cohort to identify surgeon-procedure combinations of homogeneous groups of patients and anesthetics to assess the probability distribution of extubation times to inform scientific studies of awakening from anesthesia. We hypothesized an acceptable fit to a log-normal distribution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Extubation times were recorded by anesthesia practitioners using an event button in the electronic health record. From 2011 through 2023, there were 182,374 cases with general anesthesia, not positioned prone, tracheal intubation after operating room entrance, interval from start to end of surgery ≥1 hour, and inhalational agent mean minimum alveolar concentration (MAC) fraction measured from case start through surgery end ≥0.6. We applied joint criteria of the same primary surgeon, surgical procedure, MAC fraction of each inhalational agent in 0.1 increments, and binary categories of adult, trainee finishing the anesthetic, bispectral index (BIS) monitor, N2O, sugammadex, and neostigmine. We considered all combinations of categories with ≥40 cases. We used Gas Man simulation to infer the probability distribution of volatile agent concentrations in the vessel-rich group (ie, brain).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 48 cases among patients having oral surgery extractions by 1 surgeon, without anesthesia trainees, sevoflurane anesthesia with 0.3 MAC fraction at surgery end, without N2O, BIS monitor, or neuromuscular block reversal. Their extubation times followed a log-normal distribution (Shapiro-Wilk W = 0.98, P = .68). For the computer simulations, we assumed that patients differed solely in their binary threshold of vessel-rich group sevoflurane concentration at awakening (eg, patients with an awakening threshold of 0.26% would be unconscious for 0.1 to 14.8 minutes as sevoflurane is exhaled but the concentration remains ≥0.26%, and abruptly transition to consciousness at 15 minutes when the concentration reaches 0.25%). Expected awakening times would appear to be a log-normal distribution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A homogeneous patient population had a log-normal distribution of extubation times. Generalizable models of awakening should have that distribution. Clinicians change awakening times by their choice of agent and its MAC fraction at surgery end. Simulation suggests that the normal distribution in the log time scale for awakening, among patients with similar conditions, can represent a relatively uniform distribution among patients in the vessel-rich group (brain) partia","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527831","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}