Anesthesia & Analgesia最新文献

{"title":"Barriers to Quality Perioperative Care and Postoperative Mortality Variations in Elective Abdominal Surgery: A Mixed-Methods Study","authors":"Carolina L. Schiavo,Savio C. Passos,Stela M. Castro,Liana M.T.A. Azi,Cleiton S. Pando,Maristela B. Lopes,Eric B. Lineburger,Rupert M. Pearse,Timothy J. Stephens,Luciana C. Stefani,Collaborators","doi":"10.1213/ane.0000000000008247","DOIUrl":"https://doi.org/10.1213/ane.0000000000008247","url":null,"abstract":"BACKGROUND: Perioperative morbidity and mortality significantly affect the healthcare system. Patients undergoing surgical procedures in Latin America have an increased risk of postoperative mortality. METHODS: We used a mixed-methods design to identify barriers to quality perioperative care for elective abdominal surgery in Brazil. We used secondary data from a cohort of 107,372 patients (ExCareBR) to examine postoperative mortality risk factors revealing significant variations in the mortality rates across different hospitals. Using a rapid qualitative assessment method, data were collected through semistructured interviews, direct observations, and perioperative pathway mapping. These data were triangulated to identify process-related barriers associated with mortality variations. An analytical comparison matrix was used to compare barriers between hospitals associated with higher and lower mortality. RESULTS: Data from patients who underwent surgery at 10 hospitals across various regions were analyzed, focusing on elective abdominal surgeries. A model was used to assess the association between the surgical procedure and 30-day postoperative mortality, adjusting for patient and procedure factors (fixed factors, first level) and hospital-specific effects (second level). The median odds ratio (MOR) of 1.58 (interquartile range [IQR], 1.47–1.70) indicated significant variability attributable to hospital effects, suggesting that patients with similar characteristics in fixed factors are up to 58% more likely to experience mortality in higher-risk hospitals. Qualitative data provided context to the quantitative results and our analytical framework revealed four main barriers to quality care that collectively distinguish hospitals associated with higher mortality from those that are not: (1) lack of standardized organizational structures for postoperative care, which impedes the escalation of care; (2) nurse understaffing in surgical wards; (3) communication deficiencies across perioperative phases; and (4) fragmented perioperative patient pathways within the public health system. CONCLUSIONS: The primary challenges in delivering high-quality care were identified during the postoperative period, significantly affecting patient outcomes. Future research should focus on enhancing postoperative care processes, with particular attention to the organization of care, human resources, and communication. These components are crucial for strengthening the surgical health system in low-resource settings.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Preoperative C-Reactive Protein-to-Albumin Ratio for Predicting Postoperative Delirium: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis","authors":"Takahiro Mihara,Makiko Okazaki,Ryo Koto,Hisashi Noma,Kanako Sasaki","doi":"10.1213/ane.0000000000008292","DOIUrl":"https://doi.org/10.1213/ane.0000000000008292","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Pooled Averages: Preserving Methodological Signal in Pulse Wave Analysis Validation","authors":"Tuhin Mistry,Abhijit Sukumaran Nair","doi":"10.1213/ane.0000000000008303","DOIUrl":"https://doi.org/10.1213/ane.0000000000008303","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"163 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia Medications in the World Health Organization’s Essential Medicines List: Perspectives of Anesthesia Professionals on Relevance, Safety, and Availability","authors":"Jonathan Matias Chejfec-Ciociano,Jane Zhou,Adrian W. Gelb","doi":"10.1213/ane.0000000000008354","DOIUrl":"https://doi.org/10.1213/ane.0000000000008354","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Manual Scheduling of Resident Rosters Fails: “Schedule Gridlock” and the Case for Combinatorial Optimization","authors":"Jessica E. Hawkins,Daniel Saddawi-Konefka,Justin R. Porter","doi":"10.1213/ane.0000000000008348","DOIUrl":"https://doi.org/10.1213/ane.0000000000008348","url":null,"abstract":"BACKGROUND: Staff scheduling is pervasive in healthcare and has profound ramifications for safety, efficiency, and morale. Resident block scheduling is particularly demanding, requiring simultaneous satisfaction of regulatory requirements, evolving clinical eligibility, programmatic priorities, and individual preferences. Despite the availability of mature and superior optimization methods, such schedules are commonly produced by hand. METHODS: We modeled the clinical base year deployment at one anesthesiology residency and solved it using the CP-SAT solver from Google’s OR-Tools, under a weighted objective function over elective and vacation preferences. We retrospectively compared solver-generated schedules against the schedule manually produced and deployed for academic year 2022–2023 (AY22–23) on preference satisfaction, distribution of strenuous rotations, and timing of formative rotations. We then prospectively deployed the system for three subsequent academic years (AY23–24 to AY25–26), characterized the structure of the solution space by enumeration, and assessed large language model (LLM) assistance for input specification. RESULTS: Our framework produced valid schedules in a median of 39 seconds (interquartile range [IQR], 22–67 seconds). Compared with the manually constructed AY22–23 schedule, which required 10 to 20 hours and violated several constraints, solver-generated schedules granted a median of 1.5 more “top priority” elective requests per resident (95% confidence interval [CI], 0.5–2.0; P < .001) and, by construction, precluded triplets of consecutive strenuous rotations—which occurred in an average of 8% of three-block windows under manual scheduling (bootstrapped 95% CI, 7–10). The solver-generated schedule deployed all 26 residents to a formative rotation within the required window (vs 23 of 26 in the manual schedule). Across 3 years of prospective use, new and evolving requirements—ranging from a delayed-visa contingency to a phased surgical intensive care unit (SICU) rotation structure—were accommodated by configuration-file changes alone in most cases; only two reusable constraint primitives required additions to the solver code. LLM-assisted configuration of AY26–27 was feasible but depended on active human review. Approximately 4.4 × 10 18 valid schedules exist per resident, yet 76% (95% CI, 73–79) of a resident’s assignments admitted no valid alternatives. We term this property “schedule gridlock.” CONCLUSIONS: An expressive constraint-specification language kept combinatorial optimization ergonomic across 3 years of evolving program requirements. Schedule gridlock—local rigidity in spite of global flexibility—helps explain why automated generation of schedules is so much more effective. The barrier to wider adoption has not been solver efficacy, which is well-established, but the burden of encoding and maintaining institutional requirements in a form amenable to optimization. This study addresses that burden.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Hypothermia on Triggering of Malignant Hyperthermia in a Mouse Model Expressing Type I Ryanodine Receptor-p.R2509C","authors":"Tsuyoshi Ikeda,Keiko Mukaida,Kenshiro Kido,Guoqiang Xia,Tomomi Ishii,Ayako Sumii,Yuko Noda,Sachiko Otsuki,Koji Ikegami,Yusuke Sotomaru,Satoru Noguchi,Toshimichi Yasuda,Yasuo M. Tsutsumi,Hirotsugu Miyoshi","doi":"10.1213/ane.0000000000008333","DOIUrl":"https://doi.org/10.1213/ane.0000000000008333","url":null,"abstract":"BACKGROUND: Although hyperthermia exacerbates the pathophysiology of malignant hyperthermia (MH), the response to hypothermia remains poorly understood. MH susceptible-swine studies suggested that hypothermia prevents MH, yet clinical cases occur during hypothermic cardiopulmonary bypass. This study aimed to elucidate whether hypothermia inhibits the MH trigger or merely decelerates the progression of the lethal metabolic cascade. METHODS: Pharmacological sensitivity of type 1 ryanodine receptor was evaluated in myotubes from heterozygous p.R2509C knock-in mice and wild-type (WT) mice by measuring the half-maximal effective concentration of caffeine at 30 °C and 40 °C. Intracellular calcium dynamics were also assessed during temperature changes. In vivo, anesthetized male and female mice were exposed to 2.5% sevoflurane at rectal temperatures of 34 °C or 36 °C. Survival time, heart rate, arterial blood gas analysis, and muscle ultrastructure were compared. RESULTS: Compared with WT myotubes, R2509C myotubes showed a leftward shift in the caffeine dose–response curve and a lower half-maximal effective concentration at both 30 °C (estimated treatment effects = 2.0 mM, 95% confidence interval [CI], 0.5–3.6 mM, P = .020) and 40 °C (estimated treatment effects = 2.1 mM, 95% CI, 0.5–3.7 mM, P = .029). Cooling myotubes from 36 °C to 34 °C significantly reduced relative intracellular Ca 2 + fluorescence in R2509C myotubes. In vivo, all mutant mice developed MH and went into cardiac arrest regardless of temperature. Survival time was significantly longer at 34 °C compared to 36 °C (mean difference = 45.0 minutes, 95% CI, 20.9–69.1 minutes, P = .002). Typical signs such as tachycardia were absent at 34 °C. Despite masked clinical signs, progressive hypercapnia, metabolic acidosis, hyperkalemia, and characteristic mitochondrial swelling occurred in hypothermia. CONCLUSIONS: Hypothermia decelerates the clinical progression of MH but does not prevent triggering or lethality in mouse models. The caffeine-hypersensitivity of R2509C myotubes was detectable even under the lower-temperature assay condition. Mitochondrial swelling was identified as an ultra-early pathological change, suggesting that muscle damage is not solely driven by thermal injury. Clinicians should be aware that hypothermia may mask tachycardia and body temperature elevation, leaving hypercapnia and acidosis as critical early indicators.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"479 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149022336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Universal Irradiation of Packed Red Blood Cells With Increased Transfusion-Associated Hyperkalemia: A Single-Center Observational Cohort Study","authors":"Ryan Wang,Lara Shqair,Edward Mathney,Natalie Smith,Suzanne Arinsburg,Daniel Katz","doi":"10.1213/ane.0000000000008350","DOIUrl":"https://doi.org/10.1213/ane.0000000000008350","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Hoarseness After General Anesthesia Referred for Otolaryngological Consultation: A 10-Year Retrospective Study","authors":"Qing Xie,Heng-Chao Chen,Jing-Jing Chu,Bi Jiang,Yong-Xing Yao,Peng-Fei Yin,Qiu-Shuang Liang,Zhi-Ying Feng,Xian-Hui Kang,Dian-San Su","doi":"10.1213/ane.0000000000008300","DOIUrl":"https://doi.org/10.1213/ane.0000000000008300","url":null,"abstract":"BACKGROUND: Patients referred to otolaryngologists due to postoperative hoarseness often require further treatment, prolonging hospitalization and impairing their quality of life; however, this uncommon complication remains understudied. We retrospectively examined the data from patients referred to our Otolaryngology Department to determine its incidence, associated factors, and prognosis. METHODS: At our hospital, 676,641 patients underwent general anesthesia between October 2015 and September 2025. Of these, 1185 were referred to the Otolaryngology Department with postoperative laryngopharyngeal complaints, 958 of whom were diagnosed with hoarseness. Postoperative hoarseness referred for otolaryngological consultation was the primary outcome of our study. We determined its incidence and used multivariable logistic regression to identify factors distinguishing hoarseness from other referred complaints. Secondary outcomes included hoarseness-related vocal fold injury identified during consultation and patient prognosis. The former was analyzed using ordinal logistic regression to determine associated factors. For the latter, recovery trajectories among patients with postoperative hoarseness were compared using Kaplan–Meier curves and log-rank tests, and associated factors were identified using Cox regression. An expanded-cohort sensitivity analysis (n = 1438; 480 controls) assessed the primary finding’s robustness. RESULTS: The incidence of postoperative hoarseness referred for otolaryngological consultation was 958/676,641 (0.142%). Within the referral cohort, nasogastric tube placement (odds ratio [OR] = 2.34, 95% confidence interval [CI], 1.63–3.38, P < .001) and transesophageal echocardiography (TEE) (OR = 1.84, 95% CI, 1.15–3.02, P = .014) were independently associated with hoarseness versus other laryngopharyngeal complaints. In this cohort, greater vocal fold injury severity was associated with nasogastric tube placement (OR = 2.11, 95% CI, 1.61–2.78, P < .001), TEE (OR = 1.61, 95% CI, 1.15–2.25, P = .006), longer surgical duration (OR = 1.10/h, 95% CI, 1.03–1.18, P = .003), double-lumen tube (OR = 1.55, 95% CI, 1.04–2.31, P = .033), and female sex (OR = 1.41, 95% CI, 1.11–1.80, P = .005). Among referred patients with hoarseness, delayed first consultation (≥6 days after symptom onset) and greater vocal fold injury severity were associated with slower recovery (both P < .001). The primary association between nasogastric tube placement and hoarseness persisted in the expanded-cohort sensitivity analysis (OR = 4.20, 95% CI, 3.00–5.95, P < .001). CONCLUSIONS: The incidence of postoperative hoarseness referred for otolaryngological consultation was ~1.5/1000. Within the referral cohort, nasogastric tube placement was most strongly associated with hoarseness versus other laryngopharyngeal complaints and, together with TEE, longer surgical duration, double-lumen tube insertion, and female sex, was associated with greater vocal fold ","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149022337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on a Decade as Chair of an Academic Anesthesiology Department: Ten Simple Maxims for Successful Leaders","authors":"Talmage D. Egan","doi":"10.1213/ane.0000000000008345","DOIUrl":"https://doi.org/10.1213/ane.0000000000008345","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"199 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multivariable Model of the Association Between Postoperative Complications and 30-Day In-Hospital Mortality in the African Surgical Outcome Study Cohort","authors":"Caroline Simons,Frissiano E. Honwana,Freedom Gumedze,Gareth Simons,Landon Myer,Hyla-Louise Kluyts,Bernard Mbwele,Janat T. Tumukunde,Farai D. Madzimbamuto,Abdulaziz M. Elkhogia,Andrew K. Ndonga,Zipporah W. Ngumi,Akinyinka O. Omigbodun,Eugène Zoumenou,Apollo Basenero,Dolly M. Munlemvo,Coulibaly Youssouf,Akwasi Antwi-Kusi,Veekash Gobin,Patrice Forget,Sylvia Rakatoarison,Ahmadou L. Samateh,Ryad Mehyaoui,Ushmaben Patel-Mujajati,Chaibou M. Sani,Rupert M. Pearse,Bruce M. Biccard,ASOS Collaborators","doi":"10.1213/ane.0000000000008290","DOIUrl":"https://doi.org/10.1213/ane.0000000000008290","url":null,"abstract":"BACKGROUND: The perioperative mortality rate in Africa is twice the global average. Postoperative complications independently associated with postoperative mortality have not been explored in this region and can provide insight into failure to rescue. The aim of this study was to determine which severe postoperative complications are independently associated with postoperative mortality in Africa and calculate the attributable fraction (AtF) for 30-day mortality for each complication. METHODS: Data from an African prospective observational study of perioperative adult patients conducted in 2016 were analyzed. We used a logistic mixed-effects model to assess the strength of association, expressed as an odds ratio (OR), between severe postoperative complications and 30-day postoperative mortality, adjusting for known patient and surgical factors. This model was used to calculate the AtF of death for each complication, representing the proportion of mortality due to that complication. RESULTS: We included 10,748 patients, of whom 222 (2.07%) died in hospital within the 30-day postoperative period. The severe postoperative complications with the highest adjusted ORs for mortality were pulmonary embolism (OR, 484; 95% confidence interval [CI], 85.2–2744; P < .001), pulmonary edema (OR, 53.5; 95% CI, 6.59–434; P < .001) and bloodstream infections (OR, 34.3; 95% CI, 16.3–72.3; P < .001). The highest AtF for 30-day postoperative mortality was severe bloodstream infections (average AtF 13.7%; 95% CI, 10–18.1). CONCLUSIONS: The AtF is a measure that can identify the complications with the greatest contribution to postoperative mortality and can guide prioritization. In this African cohort, pulmonary embolism, pulmonary edema, and bloodstream infections were most strongly associated with death, while severe bloodstream infections accounted for the largest proportion of 30-day mortality. Managing bloodstream infections is an important complication to address to improve postoperative outcomes in Africa.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}