Anesthesia & Analgesia最新文献

{"title":"Patients' Experiences With Opioid Tapering in Noncancer Pain: A Systematic Review and Meta-synthesis.","authors":"Sophie A Young,Shania Liu,Asad E Patanwala,Justine M Naylor,Jennifer Stevens,Jonathan Penm","doi":"10.1213/ane.0000000000007417","DOIUrl":"https://doi.org/10.1213/ane.0000000000007417","url":null,"abstract":"Tapering opioids is an effective strategy to reduce the risks associated with long-term opioid therapy. However, patients' experience with tapering can influence the success of this treatment. Understanding patients' experiences with opioid tapering will allow for patient-centered approaches to be adopted to tailor interventions to achieve safe and successful taper outcomes. This paper aims to synthesize qualitative data capturing patients' experiences with opioid tapering for noncancer pain. Qualitative studies in English that explored patients' experiences with opioid tapering in noncancer pain were included. MEDLINE, Embase, Scopus, and PsycINFO were searched from inception to March 2023. Two authors independently selected the studies, extracted data, and assessed the quality of included studies using the Critical Appraisal Skills Programme. A meta-synthesis allowed for overarching themes to be identified to form a new interpretation of the data in the context of past literature. From 5714 articles identified, 10 studies were included that met the inclusion criteria after title/abstract screening and full-text review. These studies involved 218 patients with experience tapering opioids. Three key themes guiding the new meta-synthesis were identified: (1) patient-provider interactions, (2) individualized care, and (3) tactics to manage the opioid tapering process. This review demonstrated the role that patient-provider interactions, tailored care, and effective tapering strategies play in facilitating a favorable patient experience during the opioid tapering process. Future research should incorporate the themes identified in this review to optimize the patient's taper experience.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056975","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":"Pillar[6]MaxQ and Sugammadex Enhance Recovery From Rocuronium- and Vecuronium-Mediated Neuromuscular Blockade With Similar Effects in Isoflurane-Anesthetized Rats.","authors":"Joseph F Cotten,Lyle Isaacs","doi":"10.1213/ane.0000000000007336","DOIUrl":"https://doi.org/10.1213/ane.0000000000007336","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056971","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":"Epidural Morphine for Vaginal Delivery: Determining Benefit.","authors":"Fu S Xue,Dan F Wang,Xiao C Zheng","doi":"10.1213/ane.0000000000007258","DOIUrl":"https://doi.org/10.1213/ane.0000000000007258","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991727","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":"Machine Perfusion for Liver Transplant: What Are the Challenges?","authors":"Bryant W Tran,Ezekiel D Egan,Duncan J McLean,Ricardo A Serrano","doi":"10.1213/ane.0000000000007361","DOIUrl":"https://doi.org/10.1213/ane.0000000000007361","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991728","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":"Effect of Treatment With Balanced Crystalloids Versus Normal Saline on the Mortality of Critically Ill Patients With and Without Traumatic Brain Injury: A Systematic Review and Meta-Analysis.","authors":"José C Diz,Pedro Luna-Rojas,Pablo Díaz-Vidal,Uxía Fernández-Vázquez,Cristina Gil-Casado,Eva Diz-Ferreira","doi":"10.1213/ane.0000000000007368","DOIUrl":"https://doi.org/10.1213/ane.0000000000007368","url":null,"abstract":"BACKGROUNDSome studies suggest that balanced solutions may improve outcomes in critical care patients. However, in patients with traumatic brain injury (TBI) existing data indicate that normal saline may be preferred. We hypothesized that mortality in critically ill patients with and without TBI would differ with the use of balanced salt solutions versus normal saline.METHODSWe conducted a systematic review and meta-analysis to investigate the impact of balanced crystalloids versus normal saline on 90-day mortality in adult critical care patients with and without TBI. Secondary outcomes included length of hospital stay, renal complications, need for vasopressors or mechanical ventilation, and mortality in critically ill patients with sepsis. We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) statement and estimated the odds ratio (OR) and 95% confidence interval (CI) with a random-effects model.RESULTSWe included 15 clinical trials involving 35,207 patients. The OR of mortality with balanced solutions versus saline in patients without TBI was 0.93 (95% CI, 0.87-0.98; P = .01; I2 = 0%), while the OR for mortality in patients with TBI was 1.31 (95% CI, 1.03-1.65; P = .03; I2 = 0%). We found no differences in secondary outcomes due to fluid choice although data were unavailable to calculate pooled estimates for some of the secondary outcomes for TBI patients. In patients with sepsis, the OR of mortality with balanced solutions was 0.92 (95% CI, 0.83-1.02; I2 = 0%).CONCLUSIONSIn comparison to normal saline, balanced solutions were associated with a reduction in mortality in critical care patients without TBI. However, balanced solutions were associated with an increase in mortality in patients with TBI. These findings suggest that the effect of fluid choice on intensive care unit (ICU) outcomes may depend partially on the type of critical illness and in particular in patients with TBI.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"13 15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991725","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":"Comparing General Anesthesia-Based Regimens for Endovascular Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis.","authors":"Eric Plitman,Ayman Mohammed,Wesley Rajaleelan,Rodrigo Nakatani,Marina Englesakis,Jai Shankar,Lashmi Venkatraghavan,Tumul Chowdhury","doi":"10.1213/ane.0000000000007357","DOIUrl":"https://doi.org/10.1213/ane.0000000000007357","url":null,"abstract":"BACKGROUNDTotal intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy.METHODSWe conducted a systematic literature search across MEDLINE, Embase, Cochrane, CINAHL, Web of Science, and Scopus. We identified English language studies including adult acute ischemic stroke patients managed with endovascular therapy under general anesthesia delineable into TIVA only and/or volatile only, and obtained categorical data for favorable functional outcomes using the modified Rankin scale (mRS ≤2), at 90 days after endovascular therapy. Odds ratios (OR) and standardized mean differences were calculated to inform a network meta-analysis approach, which permitted the inclusion of studies comparing a form of general anesthesia (ie, TIVA only or volatile only) to conscious sedation.RESULTSThe search rendered 6235 articles, of which 15 met inclusion criteria. Three studies directly investigated TIVA versus volatile, whereas 12 studies compared general anesthesia to conscious sedation. The total number of subjects was 3015 (conscious sedation: n = 1067; general anesthesia: n = 1948 [TIVA: n = 1212, volatile: n = 736]). No significant differences were identified between TIVA and volatile groups in 90-day neurological outcome (OR = 1.25, 95% confidence interval [CI], 0.81-1.91; P = .31), 90-day mortality (OR = 0.72, 95% CI, 0.42-1.24; P = .24), successful recanalization (OR = 1.33, 95% CI, 0.70-2.52; P = .39), or recanalization time (standardized mean difference = 0.03, 95% CI, -0.35 to 0.41; P = .88). Additionally, no significant differences were identified between the conscious sedation group and the TIVA group in 90-day neurological outcome (OR = 1.14, 95% CI, 0.84-1.53; P = .40), 90-day mortality (OR = 0.87, 95% CI, 0.62-1.23; P = .43), successful recanalization (OR = 0.76, 95% CI, 0.52-1.10; P = .15), or recanalization time (standardized mean difference = -0.18, 95% CI, -0.47 to 0.11; P = .23), and between the conscious sedation group and the volatile group in 90-day neurological outcome (OR = 1.42, 95% CI, 0.92-2.17; P = .11), 90-day mortality (OR = 0.63, 95% CI, 0.36-1.12; P = .11), successful recanalization (OR = 1.01, 95% CI, 0.52-1.94; P = .98), or recanalization time (standardized mean difference = -0.15, 95% CI, -0.52 to 0.23; P = .44).CONCLUSIONSThis network meta-analysis showed that the perioperative use of either general anesthesia-based regimen, or sedation, did not significantly impact various endovascular therapy-related outcomes. However, the current work was underpowered to detect differences in anesthetic agents, clinico-demographic characteristics, or procedural factors.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"38 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991726","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 Involvement of Anesthesiologists in Alternative Payment Models, Value-Based Care, and Care-Redesign: Myth or Reality","authors":"Zeev N. Kain, Thomas R. Vetter","doi":"10.1213/ane.0000000000006980","DOIUrl":"https://doi.org/10.1213/ane.0000000000006980","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831974","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":"Magnesium and Its Emerging Role in Perioperative Pain Management","authors":"Andrzej P. Kwater, Michael C. Grant, Tong J. Gan","doi":"10.1213/ane.0000000000007121","DOIUrl":"https://doi.org/10.1213/ane.0000000000007121","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831972","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":"Preoperative Anemia and Patient Vulnerability","authors":"Naveen Nathan","doi":"10.1213/ane.0000000000007335","DOIUrl":"https://doi.org/10.1213/ane.0000000000007335","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831975","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":"Optimal Maternal Ventilation During Laparotomy with General Anesthesia in Pregnancy in the Ovine Model","authors":"Tom Bleeser, Luc Joyeux, Simen Vergote, David Basurto, Ignacio Valenzuela, Talia Rose Hubble, Yada Kunpalin, Doaa Emam, Marc Van de Velde, Sarah Devroe, Jan Deprest, Steffen Rex","doi":"10.1213/ane.0000000000006872","DOIUrl":"https://doi.org/10.1213/ane.0000000000006872","url":null,"abstract":"rnal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia. Maternal paCO2 can affect uterine blood flow, affinity of hemoglobin for oxygen, and fetal CO2 elimination. In this study, a range of potential targets of maternal paCO2 was investigated in the ovine model, aiming to determine which target is most conducive to physiological fetal blood gas values during laparotomy with general anesthesia. METHODS: Ten time-mated pregnant Swifter ewes with a gestational age of 93 to 104 days were used. During the first phase of the experiment, anesthesia was induced, all ewes were ventilated to target a physiological maternal paCO2 of 30 mm Hg, a maternal laparotomy was performed, and a fetal microcatheter was inserted surgically to enable blood sampling from the fetal aorta. Thereafter, in the second phase of the experiment, the 10 pregnant ewes were randomized to 10 different targets of maternal paCO2 between 27 and 50 mm Hg (1 target for each ewe), and maternal ventilation was adjusted accordingly. Forty-five minutes later, maternal and fetal arterial blood gas samples were analyzed. Linear regression models were used to estimate maternal paCO2 enabling physiologic fetal parameters, including fetal paCO2 (primary outcome). RESULTS: A maternal paCO2 of 27.4 mm Hg (95% confidence interval, 23.1–30.3) enabled physiological fetal paCO2. Each increase in maternal paCO2 by 1 mm Hg, on average, increased fetal paCO2 by 0.94 mm Hg (0.69–1.19). This relationship had a strong correlation (r² = 0.906). No fetuses died during the experiment. CONCLUSIONS: This study provides experimental support for the clinical recommendation to maintain maternal paCO2 close to the physiologic value of 30 mm Hg during general anesthesia for maternal laparotomy in pregnancy as it is conducive to physiological fetal blood gas values. Given the lower bound of the 95% confidence interval, the possibility that a lower maternal paCO2 would improve fetal gas exchange cannot be excluded....","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"223 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831967","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}