Anesthesia & Analgesia最新文献

{"title":"Renal Vein Stasis Index in Cardiac Surgery: Imaging the Left Renal Vein.","authors":"Nagarjuna Panidapu,Praveen K Neema,Barsha Sen","doi":"10.1213/ane.0000000000007637","DOIUrl":"https://doi.org/10.1213/ane.0000000000007637","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603793","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 Empty Crib: Female Feticide, Abandonment, and Ultrasound Use in India.","authors":"Harmandeep S Boparai","doi":"10.1213/ane.0000000000007621","DOIUrl":"https://doi.org/10.1213/ane.0000000000007621","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603798","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 Myth of the Phase I Block After Succinylcholine in Clinical Practice.","authors":"Michael M Todd","doi":"10.1213/ane.0000000000007638","DOIUrl":"https://doi.org/10.1213/ane.0000000000007638","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603792","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":"Perioperative Dexamethasone to Regulate Inflammation: Not For Everyone?","authors":"Chad W Oughton,Jan M Dieleman","doi":"10.1213/ane.0000000000007634","DOIUrl":"https://doi.org/10.1213/ane.0000000000007634","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603795","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":"Looking at History, Planning for the Future: \"An Unexpected Emergency\".","authors":"Guillermo Lema","doi":"10.1213/ane.0000000000007636","DOIUrl":"https://doi.org/10.1213/ane.0000000000007636","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603789","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":"How Well Do Accreditation Council for Graduate Medical Education Milestones Track Readiness for Anesthesiology Certifying Examinations in a National Resident Cohort?","authors":"Huaping Sun,John D Mitchell,Stacie G Deiner,Michael H Andreae,Arna Banerjee,Tianpeng Ye,Laura Edgar,Adam I Levine,Ann E Harman,Matthew B Weinger","doi":"10.1213/ane.0000000000007597","DOIUrl":"https://doi.org/10.1213/ane.0000000000007597","url":null,"abstract":"BACKGROUNDMilestones evaluation is mandated by the Accreditation Council for Graduate Medical Education (ACGME) to help training programs measure residents' progress toward competency and identify specific areas for trainee improvement. Data from training programs raised concerns that Milestones ratings may reflect the year of training more than resident progress toward competency. We examined the relationship between residents' Milestones ratings toward the end of residency training and their performance on the American Board of Anesthesiology (ABA) examinations, widely considered as the gold standard of competency.METHODSWe compared Milestones 2.0 ratings and board scores of all anesthesiologists who completed an ACGME-accredited residency program between July 2021 and June 2022 (AY22) and had their first-time ABA ADVANCED Examination (written), Standardized Oral Examination (SOE) and Objective Structured Clinical Examination (OSCE) performance available by 2023. We first assessed the correlation between the average rating achieved across all 23 Milestones during the last 6 months of residency training and the Z-scores of these three examinations among first-time takers. Then, we evaluated the correlations between 9 specific Milestones and their conceptually related domains tested by the ADVANCED, the SOE, and the OSCE; we calculated Pearson and polychoric correlation coefficients for continuous and ordinal data, respectively.RESULTSAll 23 Milestones 2.0 AY22 ratings were available for 1849 Post Graduate Year (PGY)-4, Clinical Anesthesia Year 3 (CA-3) residents. These were matched to 1799 first-time ADVANCED and 1383 first-time SOE and OSCE takers. The average ACGME Milestones ratings across all competencies were significantly correlated with examination Z-scores (all P < .001)-the ADVANCED (r = 0.135 [95% confidence interval {CI}, 0.089-0.180], the SOE (r = 0.117 [0.065-0.169]), and the OSCE (r = 0.112 [0.060-0.164]). For the domain-specific comparisons, scores on the ADVANCED Examination correlated modestly with the Medical Knowledge Milestone domain (r = 0.289, P < .001), but there were no statistically significant associations between SOE task ratings and their related Milestones domains (ρ = 0.027 to 0.091, P = .31 to 0.81). In comparisons of similar domains evaluated by OSCE stations and the Milestones, 2 were statistically significantly correlated with a weak magnitude (Interpretation of Monitors and Echocardiograms [ρ = 0.093, P = .031] and Ethical Issues [ρ = 0.049, P = .003]) while 2 others were not statistically significant (Application of Ultrasonography [ρ = 0.052, P = .775] and Communication with other Professionals [ρ = 0.052, P = .086]).CONCLUSIONSThere was a modest correlation between the last Medical Knowledge Milestone achieved and the ADVANCED Examination. However, the weak correlations between residency Milestones and the SOE or OSCE performance suggest that the Milestones system, as currently implemented by anesthesiology ","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603791","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":"Ambulatory Surgery During Intravenous Fluid Shortage-A Potential Cost Saving and Sustainable Strategy for the Future?","authors":"Abigail F Schirmer,Nina Sharifi,Olga C Nin,Laurie K Davies,Joseph R AbuRahma,Lauren C Berkow","doi":"10.1213/ane.0000000000007630","DOIUrl":"https://doi.org/10.1213/ane.0000000000007630","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603796","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":"Age-Dependent Entropic Features During Propofol Anesthesia in Developing Brain.","authors":"Yue Zhang,Zhen-Hu Liang,Xin Wang,Ning Zhang,Hui-Ting Zhu,Dong-Xin Wang,Xiang-Yang Guo,Xiao-Li Li,Lin-Lin Song","doi":"10.1213/ane.0000000000007608","DOIUrl":"https://doi.org/10.1213/ane.0000000000007608","url":null,"abstract":"BACKGROUNDPrecise monitoring of anesthetic depth in children receiving propofol anesthesia is crucial. Commercial depth of anesthesia monitoring devices do not account for age-related changes in brain states and provide misleading information regarding the actual depth in young children. Entropy analysis, a typical complexity methodology, has been demonstrated to be a simple and robust tool for monitoring consciousness levels during anesthesia in adults. The validity of entropic measures for depth of anesthesia monitoring in children receiving general anesthesia remains largely unexplored. The age-related entropic feature dynamics during propofol anesthesia are still not clear.METHODSWe prospectively studied frontal electroencephalogram (EEG) recordings from subjects aged 1 to 18 years receiving propofol anesthesia. We calculated spectral power, permutation entropy (PeEn), sample entropy (SampEn), beta ratio, and bispectral index (BIS) from EEG segments obtained during wakefulness, maintenance, and recovery. PeEn quantifies the randomness of a time series and SampEn quantifies its unpredictability. Both measures convey complexity information on local connectivity within neural circuits for an EEG signal. The accuracy of these EEG measures to distinguish between propofol-induced unresponsiveness and clinical recovery was assessed. The changes in entropic feature dynamics with age during propofol anesthesia were investigated.RESULTSSeventy-seven subjects were included for analysis. Propofol induced a significant decrease in frontal PeEn (from a median [interquartile range] of 0.75 [0.71-0.78] during wakefulness to 0.61 [0.57-0.63] during maintenance, P < .001), which returned to wakefulness levels during recovery (0.75 [0.71-0.79]), contrasting with BIS, which remained lower. A significant increase in SampEn was noted from wakefulness to maintenance (0.04 [0.04-0.06] vs 0.25 [0.20-0.28], P < .001). PeEn provided excellent performance for distinguishing between unresponsiveness and clinical recovery at an optimal classification threshold of 0.67 with the accuracy of 96.6%. The distinguishing capability of PeEn appeared superior in toddlers compared to BIS (accuracy: 94.7% vs 88.9%). SampEn also exhibited good distinguishing accuracy of 81.1% at an optimal threshold of 0.18. Frontal PeEn and SampEn, indicating information amount of intracortical neural circuits connectivity, decreased with age during propofol maintenance (P = .017 and .026, respectively). The adolescents exhibited significantly lower frontal power, PeEn, and SampEn values during propofol administration.CONCLUSIONSThe frontal PeEn served as an excellent indicator for distinguishing propofol-induced unresponsiveness from recovery in children. Frontal complexity, represented by PeEn and SampEn, decreased with age during propofol maintenance, which was hypothesized to reflect sequential neurophysiological development in frontal cortex, particularly its maturation during adolescence.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603797","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":"Erector Spinae Plane Block in Multimodal Analgesia After Lumbar Spinal Fusion Surgery: A Blinded Randomized Placebo-Controlled Trial.","authors":"Ilse H van de Wijgert,Maaike G E Fenten,Akkie Rood,Regina L M van Boekel,Miranda L van Hooff,Kris C P Vissers","doi":"10.1213/ane.0000000000007611","DOIUrl":"https://doi.org/10.1213/ane.0000000000007611","url":null,"abstract":"BACKGROUNDPostoperative pain after lumbar spine surgery is often severe, necessitating multimodal analgesic regimens that include opioids. Locoregional anesthesia, such as the Erector Spinae Plane Block (ESPB), may be effective in reducing postoperative pain and opioid use. This study evaluated the effect of bilateral ESPB on early postoperative pain and opioid use after lumbar spinal fusion surgery.METHODSA single-center, randomized, blinded, placebo-controlled trial included 76 patients undergoing elective lumbar spinal fusion. Participants received either bilateral ESPB with ropivacaine or placebo (normal saline) after surgery. The primary outcome was pain intensity 1-hour postanesthesia, measured using the Numeric Rating Scale (NRS). Secondary outcomes included opioid consumption in the first 12 hours, time to first opioid use, quality of recovery, and pain intensity and opioid use at 30 days. Statistical significance was set at P < .05.RESULTSThe mean NRS 1-hour postanesthesia did not differ significantly between the ropivacaine and placebo group (3.8 ± 3 vs 4. 2 ± 2.6, P = .56). The median 12-hour opioid consumption was 11.3mg [2.5-21.5] vs 12.5 mg [5.1-22.4], median time to first opioid use 64 [22-171.5] vs 41 [21.3-89.5] minutes, and mean quality of recovery on day 1: 90. 7 ± 36 vs 102. 8 ± 20.5 and day 3: 108. 3 ± 21.2 vs 112. 5 ± 22.7, for the ropivacaine and placebo group, respectively. At 30 days, the mean NRS was 3. 4 ± 2.4 vs 3. 6 ± 2.5. Opioid use at 30 days occurred in 12 patients (16.2%) of the ropivacaine and in 15 (20.3%) of the placebo group.CONCLUSIONSBilateral ESPB with ropivacaine did not reduce early postoperative pain or opioid use in patients undergoing lumbar spinal fusion. Its overall benefits in a multimodal analgesic regimen appear limited and application of bilateral ESPB in all patients undergoing lumbar spine surgery is not recommended.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547853","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 Single Child With a Single Ventricle.","authors":"Rohan Magoon","doi":"10.1213/ane.0000000000007524","DOIUrl":"https://doi.org/10.1213/ane.0000000000007524","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547848","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}