Anesthesia & Analgesia最新文献

{"title":"Three-Dimensional Echocardiographic Approach to Mitral Valve After Transcatheter Edge-to-Edge Repair.","authors":"Rishi Kumar,Serena S Dasani,Kara G Fields,Gabriela M Querejeta Roca,Lauren Cornella,Douglas C Shook,Charles B Nyman,Sula Nasra,Chinyere A Archie,Pinak B Shah,Stanton K Shernan,Sergey Karamnov","doi":"10.1213/ane.0000000000007756","DOIUrl":"https://doi.org/10.1213/ane.0000000000007756","url":null,"abstract":"BACKGROUNDEvaluation of the mitral valve during transcatheter edge-to-edge repair (TEER) for management of mitral regurgitation is commonly guided by intraprocedural interventional transesophageal echocardiography (TEE). The risk of iatrogenic mitral stenosis (MS) remains a concern, particularly in patients requiring multiple clips, since the mitral valve orifice area (MVA) is reduced. The value of conventional flow-based echocardiographic methods to rule out MS is limited by intraprocedural and general anesthesia (GA)-induced hemodynamic variability. This retrospective study introduces the novel adaptation of a 3-dimensional (3D) Orifice Area (3DOA) technique to evaluate post-TEER MVA. We evaluated the degree of agreement between MVAs derived via TEE 3DOA, TEE pressure half-time (PHT), and postprocedure transthoracic echocardiography (TTE) PHT with patients awake.METHODSTEE and TTE images from 20 adult patients with severe mitral regurgitation undergoing a TEER (MitraClip, Abbott) procedure were retrospectively reviewed. MVAs obtained by MTEE 3DOA and TEE PHT under GA were compared to those acquired with TTE PHT with patients awake. Agreement was assessed via calculation of Bland-Altman 95% limits of agreement and Lin's concordance correlation coefficients, both with 95% confidence intervals (CIs).RESULTSThere was good agreement between TEE 3DOA-derived MVA measurements under GA and TTE PHT-derived MVA measurements in awake patients, as reflected by Bland-Altman (lower limit of agreement: -.0.45 [95% CI, -.58 to -.31] and upper limit of agreement: 0.26 [95% CI, 0.12-0.4]), and an excellent concordance correlation coefficient value (0.95 [95% CI, 0.86-0.98]). In contrast, agreement between TEE PHT-derived MVA and TTE PHT-derived MVA was weak, with much broader limits of agreement (lower limit of agreement: -1.6 [95% CI, -2.19 to -1.02] and upper limit of agreement: 1.43 [95% CI, 0.84-2.01]) and a weak concordance correlation coefficient value (0.46 [95% CI, 0.02-0.75]).CONCLUSIONSIn this retrospective cohort study, we demonstrated excellent agreement between TEE-3DOA-derived MVA under GA and TTE PHT-derived MVA in awake patients, but not between TEE versus TTE PHT. These findings warrant further validation in larger patient datasets to assess the utility of 3D echocardiographic approaches in evaluating MVA after TEER.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":"85-92"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759997","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":"Editorial: Esmolol as a Part of Perioperative Multimodal Analgesia Regimen: A Pretender or the Real McCoy?","authors":"Angelica Faith Tiongco,Anuj Bhatia","doi":"10.1213/ane.0000000000007901","DOIUrl":"https://doi.org/10.1213/ane.0000000000007901","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752565","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":"Implementation and Outcomes of a Scholarly Activity Requirement in an Accreditation Council for Graduate Medical Education Pediatric Anesthesiology Training Program.","authors":"Mary Lyn Stein,Gloria M Al Karaki,Katie Dillon,Katelin Collins,Benjamin Paret,Gwen Owens,Michael Hernandez,Robert Holzman,Viviane G Nasr","doi":"10.1213/ane.0000000000007885","DOIUrl":"https://doi.org/10.1213/ane.0000000000007885","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752574","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 the Margin: Reevaluating Noninferiority and Safety Thresholds in Intraoperative High-Flow Nasal Oxygen Trials.","authors":"Ching-Yuan Yeh,Shu-Yueh Cheng,Ming-Hui Hung","doi":"10.1213/ane.0000000000007897","DOIUrl":"https://doi.org/10.1213/ane.0000000000007897","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752612","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":"Filling the Data Gap: A Call for Research on Women and Gender Workforce Issues in Anesthesia, Emergency Medicine, and Critical Care in Africa.","authors":"Aubrie Ford,Gaston Nyirigira,Menelas Nkeshimana,Belise Uwurukundo,Alice Nsengiyumva,Amanda Rurangwa,Mallika Manyapu,Jackson Kwizera Ndekezi,Vanessa Nadine Ineza,Appolinaire Manirafasha,Tsion Firew,Kara L Neil","doi":"10.1213/ane.0000000000007899","DOIUrl":"https://doi.org/10.1213/ane.0000000000007899","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752572","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":"Time to Consider the Environmental Impact of Viscoelastic Hemostatic Assays.","authors":"Jadon Kind,Kaitlyn Kulesus","doi":"10.1213/ane.0000000000007895","DOIUrl":"https://doi.org/10.1213/ane.0000000000007895","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752575","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":"Treating Patients, Treating Our Planet: Extending the Moral Imperative Beyond Desflurane.","authors":"Ying-Yu Wang,Yi-Han Peng,Ming-Hui Hung","doi":"10.1213/ane.0000000000007904","DOIUrl":"https://doi.org/10.1213/ane.0000000000007904","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752616","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":"Rethinking Steroid Strategies in Cardiac Surgery.","authors":"Minghao Luo","doi":"10.1213/ane.0000000000007892","DOIUrl":"https://doi.org/10.1213/ane.0000000000007892","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752567","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":"The Evolving Pharmacogenomic Toolbox in Anesthesiology.","authors":"Ken B Johnson,Ryan Nelson,Sharmeen Roy","doi":"10.1213/ane.0000000000007751","DOIUrl":"https://doi.org/10.1213/ane.0000000000007751","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728515","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 Comparison of the Analgesia Nociception Index and Nociception Level Index Under General Anesthesia With Propofol and Remifentanil.","authors":"Hanna Kempe,Matthias Kreuzer,Gerhard Schneider,Pedro Gambús,Sérgio Vide","doi":"10.1213/ane.0000000000007886","DOIUrl":"https://doi.org/10.1213/ane.0000000000007886","url":null,"abstract":"BACKGROUNDAdequate analgesia during general anesthesia is fundamental to minimize stress responses and optimize perioperative outcomes. Traditional monitoring based on nonspecific autonomic responses may be confounded by nonnociceptive factors. Newer nociception monitors, including the Analgesia Nociception Index (ANI) and the Nociception Level Index (NOL), offer alternative approaches, yet direct comparisons in the same patient population remain limited.METHODSIn this prospective study, 30 adult patients undergoing general anesthesia with propofol and remifentanil target-controlled infusion were monitored concurrently with ANI and NOL. Recorded values were categorized into insufficient, adequate, or excessive analgesia according to manufacturer thresholds. Agreement between monitors was evaluated. A 1-category disagreement was where monitors disagreed by one level (eg, insufficient vs adequate or adequate versus excessive). A 2-category disagreement was where they disagreed by 2 levels (eg, insufficient versus excessive).RESULTSAcross more than 38 hours of time-matched recordings, the monitors agreed in 43.7% of the monitoring time. One-category and 2-category disagreements were observed in 37.1% and 8.7% of recordings, respectively. Excessive analgesia was noted in 37.6% (ANI) and 38.1% (NOL) of surgical time. Each monitor reported \"optimal analgesia\" on around 31% of the time and insufficient analgesia 25% of the time.CONCLUSIONSThe modest agreement between ANI and NOL underscores discrepancies likely stemming from their different methodological approaches. These findings suggest that a multimodal strategy integrating various monitoring modalities may enhance intraoperative analgesic management.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728514","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}