Anesthesia and analgesia最新文献

{"title":"The Current State of Pediatric Cardiac Anesthesiology Staffing in the United States.","authors":"Nina Deutsch, Stephanie Grant, Luis Zabala, Steven J Staffa, Jennifer Lau, Dean Andropoulos, Jeremy Geiduschek, C Dean Kurth, Viviane G Nasr","doi":"10.1213/ANE.0000000000007440","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007440","url":null,"abstract":"<p><strong>Background: </strong>The population of patients with congenital heart disease has grown, but the supply of pediatric cardiac anesthesiologists has not kept pace. The Pediatric Anesthesia Leadership Council (PALC) and the Congenital Cardiac Anesthesia Society (CCAS) formed a task force to evaluate the current state of the specialty of pediatric cardiac anesthesia, including staffing, work environment, education, compensation, and career development.</p><p><strong>Methods: </strong>Five task force working groups developed survey questions that explored 5 different aspects of a pediatric cardiac anesthesiologist's career. Surveys were completed by CCAS member faculty volunteers, division chiefs/directors of pediatric cardiac anesthesia programs, program directors of pediatric cardiac anesthesia fellowships, and fellowship graduates from the past 10 years.</p><p><strong>Results: </strong>Survey completion rates were 77% (n = 86) for CCAS faculty, 52% (n = 58) for pediatric cardiac anesthesiology directors/division chiefs, 91% (n = 21) for pediatric cardiac anesthesiology fellowship directors, and 53% (n = 65) for 2013-2022 pediatric cardiac anesthesia fellowship graduates. Of CCAS faculty respondents, 31.4% (n = 27) are considering leaving pediatric cardiac anesthesia for a less stressful field. While most respondents reported being involved in academic activities, 34% (n = 29) do not receive nonclinical time. Only 35.3% (n = 30) of respondents receive formal mentorship and 44.7% (n = 38) of participants have been sponsored for leadership positions, research opportunities, or speaking engagements. The total number of anticipated hires in the next 5 years is 129; that number goes up to 194 in 10 years. The challenge in hiring was graded as 8/10 with 10 being the most challenging.</p><p><strong>Conclusions: </strong>This survey provides important data about the current state of pediatric cardiac anesthesiology and the need to address staffing and academic support. With nearly one-third of those practicing in the field considering leaving the pediatric cardiac subspecialty and with the decreasing number of fellows per year, there is a significant cause for concern for staffing, especially when the demand for practitioners in this field is increasing. In addition, even though the majority of faculty reported being involved in academic activities, many do not receive academic time for these activities and less than half receive formal mentorship or have been sponsored for leadership positions, publications, research opportunities, or speaking engagements. Further work to recruit, retain, and develop pediatric cardiac anesthesiologists is warranted.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522490","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":"Presidential Anesthetics and the 25th Amendment.","authors":"Robert Johnstone, Oluwakemi Tomobi, David L Hepner, Ronald Harter","doi":"10.1213/ANE.0000000000007432","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007432","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522488","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":"Design and Staged Implementation of a Multidisciplinary Preoperative Anemia Clinic at a Tertiary Care Medical Center.","authors":"Ethan H Crispell, Claire E Cassianni, Jennifer M Burt, Jessica A Gonzalez, Jamie L Petsch, Andrew C Hanson, Kellie A Robbins, Ronald S Go, Juan A Crestanello, Adam K Jacob, Daryl J Kor, Matthew A Warner","doi":"10.1213/ANE.0000000000007435","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007435","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anemia is common and associated with adverse outcomes in surgical patients. There is limited information to guide the design and implementation of preoperative anemia clinics (PAC), which represents a critical barrier to entry for many practices.</p><p><strong>Methods: </strong>This is a descriptive observational study highlighting the design and implementation of a multidisciplinary PAC, including key steps in planning, stakeholder engagement, organizational structure, identification of target populations, establishing anemia treatments, information technology and electronic health record integration, provider training, and data infrastructure. Demographic and clinical characteristics, laboratory results, and anemia treatments for individuals evaluated in the PAC from November 4, 2019 through September 15, 2023 are enumerated. Patient-reported outcomes (PROs) assessing changes in anemia symptoms and well-being after surgery are evaluated for 2 subsets of patients (one before PAC implementation [pre-PAC], another after PAC implementation [post-PAC]), without formal statistical comparison given limited sample sizes.</p><p><strong>Results: </strong>The PAC was initiated as a multidisciplinary effort under support from a Mayo Clinic Practice Transformation Award in 2019, including broad representation from anesthesiology, surgery, and medical practices, along with institutional project management support (eg, project manager, information technologists, systems engineers). While initially limited to cardiac surgery patients, the PAC underwent planned incremental expansion to include other surgical services. Over the study period, 1188 PAC consultations across 1159 unique patients met eligibility criteria, with a median age of 66 (57-73) years and 58.1% women. The most common etiology of anemia was iron deficiency (69.1%) followed by anemia related to cancer (17.3%). Anemia-directed therapies were recommended in 1038 (87.4%) encounters, with 730 (70.3%) of those receiving recommended treatment preoperatively. Seven hundred nine (97.1%) treatments included intravenous iron and 146 (20.0%) included erythropoiesis-stimulating agents. Fifteen pre-PAC and 38 post-PAC implementation patients completed PROs. PAC implementation was accompanied by earlier resolution of anemia symptoms and less pronounced declines in postoperative well-being scores.</p><p><strong>Conclusions: </strong>This report highlights the key steps for successful PAC implementation. Treatment is possible for most patients and may be accompanied by improvements in patient-important outcomes.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522487","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 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":"https://doi.org/10.1213/ANE.0000000000007450","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","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":"National Survey to Investigate Airway Management in Trauma Bays and Emergency Medicine Bays at Academic Centers.","authors":"Kyle H Chan, Meghan Brennan, Richa Wardhan, Patrick Tighe, Ronald Ison, Chris Giordano, Joshua W Sappenfield","doi":"10.1213/ANE.0000000000007449","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007449","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497940","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":"Society of Anesthesia and Sleep Medicine Opinion Paper: High-Flow Nasal Oxygen Therapy for Early Postoperative Management of Patients With Sleep-Disordered Breathing.","authors":"Ameya Pappu, Dennis Auckley, Tom Cloward, Jennifer Dominguez, Kara Dupuy-McCauley, Bhargavi Gali, Peter Gay, David Hillman, Sarah McConville, Olubukola Nafiu, Christine Won, Mandeep Singh","doi":"10.1213/ANE.0000000000007424","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007424","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497941","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 Power of Education to Reduce the Carbon Footprint of Volatile Anesthetics in Clinical Practice.","authors":"Arne Schwiethal, Sascha Treskatsch, Jannis Michael, Moritz Höft, Claudia D Spies, Susanne Koch","doi":"10.1213/ANE.0000000000007375","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007375","url":null,"abstract":"<p><strong>Background: </strong>Due to their chemical nature as fluorinated hydrocarbon compounds, volatile anesthetics are highly potent greenhouse gases, with desflurane having by far the largest CO2-equivalent (CO2e) footprint. In everyday clinical practice, the CO2e footprint can easily be reduced through the increased use of propofol or sevoflurane as well as low- and minimal-flow techniques or through the more frequent use of regional anesthesia techniques. We wanted to assess to what extent educational measures on sustainability aspects of the use of volatile anesthetics had an impact on daily practice in anesthesiology departments and to what extent this influenced the hospital's CO2e emissions.</p><p><strong>Methods: </strong>We conducted an observational data analysis of the consumption of anesthetics (sevoflurane, desflurane, isoflurane, and propofol) at all 3 clinical Charité campuses in the period from 2015 to 2023. The CO2e emissions were calculated for sevoflurane, desflurane, and isoflurane. External and internal (top-down or bottom-up) educational measures focusing on sustainability in anesthesia took place from September 2018 on. Shifts in CO2e emissions related to the educational measures are shown in a run chart. The number of surgeries, surgery duration, and purchasing costs were included in the analysis.</p><p><strong>Results: </strong>CO2e emissions of volatile anesthetics were reduced by 90.3% from the baseline epoch (years 2015-2017) before educational interventions took place to 2023: CO2e 1470 tons (mean 2015-2017), to 191 tons (2022) to 142 tons (2023). This change was brought about by the phasing out of desflurane and the use of propofol or sevoflurane and regional anesthesia where appropriate. The fastest and most sustainable changes were seen after internal top-down measures. The total cost of anesthetics also fell over the period under review (from €541,102/$594,238 in 2015 to €281,646/$309,303 in 2023).</p><p><strong>Conclusions: </strong>Educational measures for anesthesiologists about the climate-damaging effects of volatile anesthetics-especially desflurane-can significantly reduce CO2e emissions in anesthesia clinics. On the positive side, these measures have also reduced the annual costs for anesthetics.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497942","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 Pilot Study of Remimazolam During Neuraxial Placement for Scheduled Cesarean Deliveries on Parturient Experience Recall.","authors":"Benjamin Hyers, Alexander Tran, Anusha Reddy, Talia Strulowitz, Alexander Meshel, Daniel Katz","doi":"10.1213/ANE.0000000000007454","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007454","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497937","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":"Clarity in Hemodynamics and End-Organ Perfusion: Pulsatility, Patient Phenotype, and the Pressure Field as a Novel Approach.","authors":"StephenF Woodford, Joseph Rinehart, Philip Peyton, Bernhard Riedel","doi":"10.1213/ANE.0000000000007465","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007465","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497939","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":"Unraveling Insulin Resistance Mechanisms During Cardiopulmonary Bypass.","authors":"Luai Zakaria, Sreekanth R Cheruku, Nikolaos J Skubas, Marta Kelava","doi":"10.1213/ANE.0000000000007276","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007276","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472059","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}