Anesthesia & Analgesia最新文献

{"title":"A Double-Blinded Randomized Trial Comparing Dexamethasone to Ondansetron as the First-Line Antiemetic After Cesarean Delivery","authors":"Amnon A. Berger,Maria C. Borrelli,Maria Patrocinio,Samantha L. Armstrong,Andrew J. Sprowell,Yunping Li,Philip E. Hess","doi":"10.1213/ane.0000000000008321","DOIUrl":"https://doi.org/10.1213/ane.0000000000008321","url":null,"abstract":"BACKGROUND: Postoperative nausea and vomiting is a common adverse outcome after cesarean delivery. Both ondansetron and dexamethasone are effective prophylactic medications; however, dexamethasone has also been shown to decrease pain medication use after cesarean delivery. We hypothesize that dexamethasone may be preferred as the first-line agent due to the dual benefit of reduced nausea and opioid consumption. METHODS: Prospective randomized, double-blinded, controlled trial comparing dexamethasone 8 mg to ondansetron 4 mg. Patients received spinal anesthesia including morphine150 µg, and an enhanced recovery after cesarean protocol with scheduled nonopioid analgesic medications. The main outcome was the total number of medications for the treatment of any nausea and vomiting, pain, or pruritus in the first 24 hours following cesarean. RESULTS: One hundred patients were enrolled and 95 completed the trial. We found no difference in the mean (95% confidence interval of the mean) number of postoperative medications (ondansetron 0.23 [0.11–0.35], dexamethasone 0.40 [0.20–0.61] medications per patient per 24 hours; P = .337). Differences in the use of supplemental pain medications and pain scores were not statistically significant over the 24-hour period. Similarly, differences in nausea and pruritus scores were not statistically significant over 24 hours. CONCLUSIONS: We found no differences in the number of medications used to treat pain, nausea, or pruritus in the first 24 hours after cesarean delivery between women who received either ondansetron or dexamethasone. We also found no difference in pain despite prior research showing improvement with dexamethasone, which may be due to the low pain scores and rate of breakthrough postoperative pain in our study.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"172 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923117","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":"Invisible Threats to Perioperative Patient Safety: The 2026 Alan G. Sieroty APSF/SOCCA Lecture: Creating Systemic Protections Against Pathogen Transmission from Anesthesia Workspace Reservoirs to Surgical Site Infection","authors":"Randy W. Loftus","doi":"10.1213/ane.0000000000008310","DOIUrl":"https://doi.org/10.1213/ane.0000000000008310","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"379 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923119","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 Staphylococcus aureus Phenotypic Screening to Detect Chlorhexidine Tolerance and Strength of Biofilm Formation for Optimization of Surgical Site Infection Preventive Measures","authors":"Randy W. Loftus,Franklin Dexter,Hetal M. Patel,Michelle C. Parra,Jonathan E. Charnin,Jeremiah R. Brown","doi":"10.1213/ane.0000000000008315","DOIUrl":"https://doi.org/10.1213/ane.0000000000008315","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923118","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":"Early Mobilization in Children After Anesthesia: A Quality Improvement Study on Recovery Metrics and Family Satisfaction","authors":"Samuel M. Vanderhoek,Lisa Hwang,Kameryn Atkinson,Laura Prichett,Sapna R. Kudchadkar","doi":"10.1213/ane.0000000000008294","DOIUrl":"https://doi.org/10.1213/ane.0000000000008294","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923122","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":"Maintaining Scientific Integrity: The Many Faces of Fraud","authors":"Jaideep J. Pandit","doi":"10.1213/ane.0000000000008245","DOIUrl":"https://doi.org/10.1213/ane.0000000000008245","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923121","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":"From Iron Deficiency to Delivery and Beyond: Rethinking Antenatal Patient Blood Management","authors":"Vernon J. Louw,Bernd Froessler","doi":"10.1213/ane.0000000000008282","DOIUrl":"https://doi.org/10.1213/ane.0000000000008282","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923123","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":"Loss and Return of Sensation After Axillary Brachial Plexus Nerve Block: Distally or Proximally?","authors":"Hagen Bomberg,David Lorenzana,Neeti Sharma,Corsin Poltera,Urs Eichenberger","doi":"10.1213/ane.0000000000008175","DOIUrl":"https://doi.org/10.1213/ane.0000000000008175","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552643","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":"Bleeding Disorders Among Tonsillectomy Patients: Prevalence, Hemostatic Agent Use, and Sex-Related Differences.","authors":"Anna L Miller,Amir L Butt,Kenichi A Tanaka,Kenneth E Stewart","doi":"10.1213/ane.0000000000008233","DOIUrl":"https://doi.org/10.1213/ane.0000000000008233","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552680","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":"Making the Surgical Safety Checklist Even Safer: A Team Timeout Checklist to Improve Information Exchange and Interprofessional Communication Before Skin Incision.","authors":"Mona Weiss,Claudius Reimer,Alexander Budnitskiy,Christian Kleber,Sebastian N Stehr,Tobias Piegeler","doi":"10.1213/ane.0000000000008224","DOIUrl":"https://doi.org/10.1213/ane.0000000000008224","url":null,"abstract":"BACKGROUNDThe World Health Organization surgical safety checklist (WHO SSC) provides a standardized framework for preoperative safety procedures. However, studies have revealed substantial variation in adherence, with items being skipped or misunderstood and nurses likely to be less involved than other operating room (OR) professional groups. We introduce a 16-item team timeout checklist (TTOC) that clarifies and adds safety-critical items to the existing WHO before skin incision timeout and is led by nurses to improve information exchange, closed-loop communication, and encouraging participation of all professional groups.METHODSUsing a prospective pre-post interventional design, we live-coded all team communication during on-site observations in the OR focusing on the pre-incision phase. Surgical teams were first observed during a pre-intervention period without the TTOC checklist and subsequently during a post-intervention period after implementation of the TTOC checklist. The TTOC was evaluated on four communication outcomes critical for patient safety: information exchange of checklist items, measured as the percentage of the 16 items that were verbally communicated among team members (eg, team introduction, surgical site, allergies), participation rates of different professional groups, frequency of explicit coordination behaviors (eg, instruction, information request, speaking up) and the frequency of closed-loop communication sequences, defined as information request followed by information upon request within 30 seconds.RESULTSA total of 155 teams were observed, including 78 teams in the pre-intervention phase without TTOC use and 77 teams in the post-intervention phase using the TTOC, resulting in 13,127 coded communication events. The median information exchange increased from 62.5% (interquartile range [IQR] 50-68.8) in the pre-intervention phase to 100% (IQR 100-100) in the post-intervention phase (P < .001). For 15 of all 16 subitems, the odds of exchanging information were significantly higher after TTOC implementation than before TTOC implementation (odds ratios range 10.8-1896, all 95% confidence intervals [CIs] excluded 1). Participation rates increased for circulating nurses, scrub nurses, surgical residents, and anesthesia (all P < .05) but not for lead surgeons. Mean (standard deviation [SD]) closed-loop communication patterns per operation were more frequent with (20.4 [10.7]) than without the TTOC (16.4, [7.24]), P = .004.CONCLUSIONSIn our study, the nurse-led TTOC significantly improved the exchange of safety-critical items during the pre-incision phase, facilitated closed-loop communication, and empowered the participation of various professional groups. These findings suggest integrating the TTOC with the WHO SSC before-incision protocol may have important advantages.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552642","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":"Sonorheometry Quantra QPlus Characteristics in Adult Cardiac Surgical Patients: An Observational Cohort Study.","authors":"Ziyad O Knio,Charbel A Marche,Jenna Khan,John S McNeil,Karen E Singh,Michael A Mazzeffi","doi":"10.1213/ane.0000000000008139","DOIUrl":"https://doi.org/10.1213/ane.0000000000008139","url":null,"abstract":"BACKGROUNDValidation of the Quantra QPlus sonorheometry cartridge (Hemosonics Corporation) in cardiac surgical patients is limited. The primary aim of our study was to quantify the accuracy of the Quantra QPlus cartridge in detecting derangements in traditional coagulation tests. Secondarily, we explored whether the relationship between platelet contribution to clot stiffness (PCS) and platelet count was modified by cardiopulmonary bypass (CPB) and hypofibrinogenemia.METHODSWe performed a retrospective observational study of 511 cardiac surgical patients at a single academic medical center during the first year of routine sonorheometry application during and after cardiac surgery (2024-2025). Receiver operating characteristics were applied to the following Quantra QPlus parameters, with paired reference laboratory assays sampled in a 15-minute interval: clot time heparinase (CTH), fibrinogen contribution to clot stiffness (FCS), and PCS. A multivariable linear regression model was used to determine whether the relationship between PCS and platelet count was modified by CPB or hypofibrinogenemia.RESULTSA CTH value of 153 seconds discriminated elevated international normalized ratio (INR) values post-CPB, with an area under the curve (AUC) from 0.78 to 0.84 depending on the INR cutoff. An FCS of 1.5 to 2.3 hPa discriminated hypofibrinogenemia post-CPB with an AUC from 0.88 to 0.97 depending on the fibrinogen cutoff. A PCS of 6.9 to 12.2 hPa detected thrombocytopenia post-CPB with an AUC from 0.90 to 0.97, depending on the platelet cutoff. In contrast, a PCS of 9.1 to 12.1 hPa detected the same degree of thrombocytopenia on-CPB with an AUC of 0.92 to 0.98. Platelet count was observed to be higher for a given PCS during CPB (β, 1.51) and in hypofibrinogenemic states (β, 3.13 and 4.04 for FCS 1.6-2.3 hPa and ≤1.5 hPa, respectively).CONCLUSIONSCTH, PCS, and FCS demonstrated high discriminative accuracy for abnormalities in corresponding laboratory assays. CPB and hypofibrinogenemia modified the relationship between PCS and platelet count, with a higher platelet count observed for a given PCS during CPB and when fibrinogen was low.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552400","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}