Anesthesia and analgesia最新文献

{"title":"Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality.","authors":"Jean Guglielminotti, Catherine Monk, Matthew T Russell, Guohua Li","doi":"10.1213/ANE.0000000000007314","DOIUrl":"10.1213/ANE.0000000000007314","url":null,"abstract":"<p><strong>Background: </strong>Compared to neuraxial anesthesia, general anesthesia (GA) for cesarean delivery is associated with an increased risk of postpartum depression (PPD) requiring hospitalization. However, obstetric complications occurring during childbirth (eg, stillbirth) are associated with both increased use of GA and increased risk of PPD, and may account for the reported association between GA and PPD. This study assessed the association of GA for cesarean delivery with PPD requiring hospitalization, outpatient visit, or emergency department (ED) visit, accounting for obstetric complications.</p><p><strong>Methods: </strong>This retrospective cohort study included women who underwent a cesarean delivery in New York State between January 2009 and December 2017. Women were followed for 1 year after discharge for readmission, outpatient visit, or ED visit. The primary outcome was PPD requiring readmission, outpatient visit, or ED visit. The 2 secondary outcomes were (1) PPD requiring readmission, and (2) suicidality. Obstetric complications included severe maternal morbidity, blood transfusion, postpartum hemorrhage, preterm birth, and stillbirth. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of PPD, PPD requiring readmission, and suicidality associated with GA were estimated using the propensity score matching and the overlap propensity score weighting methods.</p><p><strong>Results: </strong>Of the 325,840 women included, 19,513 received GA (6.0%; 95% CI, 5.9-6.1). Complications occurred in 43,432 women (13.3%) and the GA rate for these women was 9.7% (95% CI, 9.4-10.0). The incidence rate of PPD was 12.8 per 1000 person-years, with 24.5% requiring hospital readmission, and was higher when an obstetric complication occurred (17.1 per 1000 person-years). After matching, the incidence rate of PPD was 15.5 per 1000 person-years for women who received neuraxial anesthesia and 17.5 per 1000 person-years for women who received GA, yielding an aHR of 1.12 (95% CI, 0.97-1.30). Use of GA was associated with a 38% increased risk of PPD requiring hospitalization (aHR: 1.38; 95% CI, 1.07-1.77) and with a 45% increased risk of suicidality (aHR 1.45; 95% CI, 1.02-2.05). Results were consistent when using the overlap propensity score weighting.</p><p><strong>Conclusions: </strong>Use of GA for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"618-628"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779423","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":"Anesthesia Trauma Guidelines: A Systematic Review of Global Accessibility and Quality.","authors":"Jakob E Gamboa, Ryan Turner, Noah LaBelle, Mario Villasenor, Ben Harnke, Gabriela Zavala, Lacey N LaGrone, Colby G Simmons","doi":"10.1213/ANE.0000000000007392","DOIUrl":"10.1213/ANE.0000000000007392","url":null,"abstract":"<p><p>This systematic review describes the available clinical practice guidelines (CPGs) for the anesthetic management of trauma and appraises the accessibility and quality of these resources. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted across 8 databases (MEDLINE, Embase, Web of Science, CABI Digital Library, Global Index Medicus, SciELO, Google Scholar, and National Institute for Health and Care Excellence) for guidelines from 2010 to 2023. Two independent reviewers assessed guideline eligibility and extracted data, which were audited by a third reviewer. Data regarding author demographics, accessibility, clinical topics, and quality were collected. The quality of guidelines was evaluated according to the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument. A total of 2426 articles were identified, of which 165 met eligibility criteria and were included. Guidelines were developed by 122 professional societies and authors from 51 countries. By region, Europe contributed with the most authors (61%), while Africa had the fewest (4%). Most CPGs were developed by authors from high-income countries (HIC) and only 12% had a first or last author from low- and middle-income countries (LMIC). The United States was the country with the most guideline authors. While 70% were open access, the average cost for paid access was US$36.61. Among the 8 languages identified, English was the most common. The most common topics were blood and fluid management, shock, and airway management. The overall quality of included guidelines was considered moderately high, with an average NEATS score of 3.13 of 5. Quality scores were lowest for involvement of patient perspectives, plans for updating, and presence of a methodologist. On logistic regression analysis, the involvement of a methodological expert was the only predictor of having a high-quality NEATS score, with no association observed with open accessibility, English language, society endorsement, first author from a HIC, or a multidisciplinary group composition. Though many countries and societies have contributed to the development of anesthesia CPGs for trauma, there has been a disproportionate lack of representation from LMICs, where the burden of trauma mortality is highest. In this study, we identify barriers to accessibility and areas for improving future guideline quality. We recommend ongoing efforts to incorporate perspectives from diverse settings and to increase the availability of high-quality, open-access guidelines to improve worldwide health outcomes in trauma.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"560-569"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031778","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":"Inspired Oxygen Concentration During the Re-initiation of Two-Lung Ventilation in Thoracic Surgery: A Post Hoc Analysis of Data From the Multicenter Perioperative Outcomes Group.","authors":"Nicholas J Douville, Michael Mathis, Mark E Smolkin, Linda W Martin, Wanda M Popescu, Randal S Blank","doi":"10.1213/ANE.0000000000007479","DOIUrl":"10.1213/ANE.0000000000007479","url":null,"abstract":"<p><strong>Background: </strong>A recent multicenter study suggested that the duration of single-lung ventilation, and not the intensity of the hyperoxia (ie, inspired oxygen fraction) during this period, contributes to the development of postoperative pulmonary complications. However, lung reinflation, at the cessation of single-lung ventilation, is a period of particular susceptibility to hyperoxic injury, and the impact of alveolar hyperoxia during this period on postoperative pulmonary complications has not been specifically assessed.</p><p><strong>Methods: </strong>Clinical practice surrounding the inspired oxygen fraction at lung reinflation and potential clinical implications of alveolar hyperoxia occurring during this period were assessed in this secondary analysis of data from a multicenter retrospective cohort study.</p><p><strong>Results: </strong>On multivariable logistic regression, average inspired oxygen fraction during the period of lung reinflation was independently associated with postoperative pulmonary complications (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI], 1.01-1.29, P = .032; unit: 10% FiO 2 increment). The duration of single-lung ventilation (in hours) also remained significant in this model (aOR: 1.21, 95% CI, 1.03-1.42, P = .020).</p><p><strong>Conclusions: </strong>The results of this study suggest a unique sensitivity to alveolar hyperoxia at the time of lung reinflation and raise the possibility that restricting the inspired oxygen fraction during lung reinflation could reduce injury and related sequelae. Our findings imply that a 10% increase in FiO 2 during the reinflation period (eg, increasing FiO 2 from 80% to 90%) would be associated with 14% greater odds of developing a postoperative pulmonary complication. However, they should be viewed as hypothesis-generating due to the retrospective nature of the study and serve as justification for prospective investigation of this association.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"667-670"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596086","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":"A Survey of Practice and Attitudes Toward \"Do Not Resuscitate\" Orders Among Practicing Anesthesiologists in the United States.","authors":"Rachel A Hadler, Saundra E Curry, Joseph M Hendrix, Maria Michaelis, Beth Minzter, Pete Pelletier, James M West, Michael J Souter","doi":"10.1213/ANE.0000000000007450","DOIUrl":"10.1213/ANE.0000000000007450","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"485-488"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497938","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":"10.1213/ANE.0000000000007471","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"531-535"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","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":"Valar Morghulis (\"All Men Must Die\"): Anesthesiologists' Familiarity With Recommendations for Management of Do Not Resuscitate Orders.","authors":"Richard P Dutton","doi":"10.1213/ANE.0000000000007517","DOIUrl":"10.1213/ANE.0000000000007517","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"482-483"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708165","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":"Handoff Mnemonics Used in Perioperative Handoff Intervention Studies: A Systematic Review.","authors":"Sabina M Patel, Sarah Fuller, Meghan M Michael, Emma C O'Hagan, Elizabeth H Lazzara, Lee Ann Riesenberg","doi":"10.1213/ANE.0000000000007261","DOIUrl":"10.1213/ANE.0000000000007261","url":null,"abstract":"<p><strong>Background: </strong>Perioperative handoffs are known to present unique challenges to safe and effective patient care. Numerous national accrediting bodies have called for standardized, structured handoff processes. Handoff mnemonics provide a memory aid and standardized structure, as well as promote a shared mental model. We set out to identify perioperative handoff intervention studies that included a handoff mnemonic; critically assess process and patient outcome improvements that support specific mnemonics; and propose future recommendations.</p><p><strong>Methods: </strong>We conducted a systematic review of the English language perioperative handoff intervention literature designed to identify handoff mnemonic interventions. A comprehensive protocol was developed and registered (CRD42022363615). Searches were conducted using PubMed, Scopus, ERIC (EBSCO), Education Full Text (EBSCO), EMBASE (Elsevier), and Cochrane (January 1, 2010 to May 31, 2022). Pairs of trained reviewers were involved in all phases of the search and extraction process.</p><p><strong>Results: </strong>Thirty-seven articles with 23 unique mnemonics met the inclusion criteria. Most articles were published after 2015 (29/37; 78%). Situation, Background, Assessment, Recommendation (SBAR), and SBAR variants were used in over half of all studies (22/37; 59%), with 45% (10/22) reporting at least 1 statistically significant process improvement. Seventy percent of handoff mnemonics (26/37) were expanded into lists or checklists. Fifty-seven percent of studies (21/37) reported using an interdisciplinary/interprofessional team to develop the intervention. In 49% of all studies (18/37) at least 1 measurement tool was either previously published or the authors conducting some form of measurement tool validation. Forty-one percent of process measurement tools (11/27) had some form of validation. Although most studies used training/education as an implementation strategy (36/37; 97%), descriptions tended to be brief with few details and no study used interprofessional education. Twenty-seven percent of the identified studies (10/37) measured perception alone and 11% (4/37) measured patient outcomes.</p><p><strong>Conclusions: </strong>While the evidence supporting one handoff mnemonic over others is weak, SBAR/SBAR variants have been studied more often in the perioperative environment demonstrating some process improvements. A key finding is that 70% of included studies converted their handoff mnemonic to a list or checklist. Finally, given the essential nature of effective handoffs to perioperative patient safety, it is crucial that handoff interventions are well developed, implemented, and evaluated. We propose 8 recommendations for future perioperative handoff mnemonic clinical interventions and research.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"468-481"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724731","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":"Postoperative Ataxic Breathing: A New Tool for Early Diagnosis of Opioid-Induced Respiratory Depression?","authors":"Satya Krishna Ramachandran","doi":"10.1213/ANE.0000000000007341","DOIUrl":"10.1213/ANE.0000000000007341","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"502-506"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805977","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":"Quantified Ataxic Breathing Can Detect Opioid-Induced Respiratory Depression Earlier in Normal Volunteers Infused with Remifentanil.","authors":"Robert J Farney, Ken B Johnson, Sean C Ermer, Joseph A Orr, Talmage D Egan, Alan H Morris, Lara M Brewer","doi":"10.1213/ANE.0000000000007124","DOIUrl":"10.1213/ANE.0000000000007124","url":null,"abstract":"<p><strong>Background: </strong>Ataxic breathing (AB) is a well-known manifestation of opioid effects in animals and humans, but is not routinely included in monitoring for opioid-induced respiratory depression (OIRD). We quantified AB in normal volunteers receiving increasing doses of remifentanil. We used a support vector machine (SVM) learning approach with features derived from a modified Poincaré plot. We tested the hypothesis that AB may be found when bradypnea and reduced mental status are not present.</p><p><strong>Methods: </strong>Twenty-six healthy volunteers (13 female) received escalating target effect-site concentrations of remifentanil with a low baseline dose of propofol to simulate typical breathing patterns in drowsy patients who had received parenteral opioids. We derived respiratory rate (RR) from respiratory inductance plethysmography, mental alertness from the Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S), and AB severity on a 0 to 4 scale (categories ranging from none to severe) from the SVM. The primary outcome measure was sensitivity and specificity for AB to detect OIRD.</p><p><strong>Results: </strong>All respiratory measurements were obtained from unperturbed subjects during steady state in 121 assessments with complete data. The sensitivity of AB for detecting OIRD by the conventional method was 92% and specificity was 28%. As expected, 69 (72%) of the instances not diagnosed as OIRD using conventional measures were observed to have at least moderate AB.</p><p><strong>Conclusions: </strong>AB was frequently present in the absence of traditionally detected OIRD as defined by reduced mental alertness (MOAA/S score of <4) and bradypnea (RR <8 breaths/min). These results justify the need for future trials to explore replicability with other opioids and clinical utility of AB as an add-on measure in recognizing OIRD.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"507-515"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142043836","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":"3-Dimensional Virtual Reality Versus 2-Dimensional Video for Distraction During the Induction of Anesthesia in Children to Reduce Anxiety: A Randomized Controlled Trial.","authors":"Sarah Samnakay, Britta S von Ungern-Sternberg, Daisy Evans, Aine C Sommerfield, Neil D Hauser, Emily Bell, R Nazim Khan, David L Sommerfield","doi":"10.1213/ANE.0000000000007119","DOIUrl":"10.1213/ANE.0000000000007119","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is common in children. It can contribute to negative experiences with anesthetic induction and may cause adverse physiological and psychological effects. Virtual reality (VR) and electronic tablet devices are 2 audiovisual distraction tools that may help to reduce anxiety and enhance the preoperative experience. This study aimed to compare the use of an immersive 3-dimensional (3D) VR to 2-dimensional (2D) video on anxiety in children during induction of general anesthesia.</p><p><strong>Methods: </strong>Two hundred children (4-13 years) undergoing elective or emergency surgery under general anesthesia were enrolled in this randomized, controlled trial. Participants were randomized to use either the 3D VR goggles (intervention) or 2D video tablet (control) during anesthetic induction. Anxiety, the primary outcome, was measured using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) at 2 time points: in the preoperative holding area before randomization (T1) and during induction of general anesthesia (T2). The primary outcome was analyzed using a linear regression model, including demographic and other covariates, to investigate any differences in anxiety scores. Secondary outcomes included evaluating compliance during the anesthetic induction (Induction Compliance Checklist), emergence of delirium (Cornell Assessment of Pediatric Delirium), perceived usefulness of the device, and child satisfaction.</p><p><strong>Results: </strong>Participant characteristics were similar between the 3D VR (n = 98) and 2D video (n = 90) groups, with a mean (±standard deviation) age 8. 8 ± 2.8 years. The median (lower quartile, upper quartile) mYPAS-SF scores for the 3D VR group at the preoperative holding area were 22.9 (22.9, 35.4), then 29.2 (24.0, 41.7) during induction. For the 2D Video group, the scores were 27.1 (22.9, 35.4) and then 30.2 (22.9, 41.1). No significant difference was observed in the increase in mYPAS-SF scores between groups ( P = .672). Children in the 3D VR group were less likely to be rated as having a perfect induction ( P = .039). There was no evidence of a difference between the groups in emergence delirium. Both devices were rated highly for usefulness and patient satisfaction. Children preferred VR, while anesthesiologists and parents felt the 2D was more useful.</p><p><strong>Conclusions: </strong>This randomized controlled trial demonstrated that preoperative anxiety was equally low and induction compliance high with both 3D VR and 2D video distraction in children with parental presence during anesthetic induction.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"629-638"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142043830","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}