Anesthesia & Analgesia最新文献

{"title":"Anesthesiology Milestones 1.0: Residents' Learning Trajectories and Training Outcomes.","authors":"Tianpeng Ye,Huaping Sun,Ann E Harman,Stacie G Deiner,John D Mitchell,Alex Macario","doi":"10.1213/ane.0000000000007693","DOIUrl":"https://doi.org/10.1213/ane.0000000000007693","url":null,"abstract":"BACKGROUNDThe Accreditation Council for Graduate Medical Education (ACGME) requires anesthesiology training programs to submit Milestones ratings for each resident every 6 months, starting in the 2014 to 2015 academic year. We aimed to understand how anesthesiology residents progress through the Milestones evaluations from residency entry to graduation.METHODSAnesthesiology Milestones 1.0 included 25 subcompetencies in 6 core competencies of Patient Care, Medical Knowledge, Systems-Based Practice, Practice-Based Learning & Improvement, Professionalism, and Interpersonal & Communication Skills. Milestones data from all anesthesiology residency programs from July 2015 to June 2019 were used to (1) assess the prevalence of straight-lining (ie, percentage of residents who received the same rating for all 25 subcompetencies for each program per reporting period), (2) describe residents' progression trajectories in each subcompetency, including the baseline at 6-month training, growth rate (ie, rate increase every 12 months), and outcomes on graduation (ie, percentage of residency graduates who received at least 1 Level 4 [target for graduation] or above subcompetency rating, and percentage of graduates who did not reach Level 4 for at least 1 subcompetency), and (3) use 3-level linear mixed-effect models to examine individual resident growth in each subcompetency over time while accounting for clustering effect of residency programs.RESULTSThe analyses included 11,691 residents from 153 training programs. Among 6696 clinical anesthesia year 3 residents, 98.3% received at least 1 Level 4 or above rating on graduation; 28.8% to 36.8% of the graduating cohort did not reach Level 4 for at least 1 subcompetency among the 6 core competencies. One hundred and thirty-six programs (88.9% of 153) had straight-lining for at least 1 reporting period. For the multilevel linear mixed-effect models, the fixed intercept estimates were close to 1.0 for Professionalism and Interpersonal & Communication Skills subcompetencies while those for Patient Care subcompetencies were <0.75; the fixed slope estimates were near 1.0 for all 25 subcompetencies. Across all subcompetencies, residency programs accounted for 63% to 84% of between-resident variability in the baseline ratings and 60% to 92% of between-resident variability in the growth rates.CONCLUSIONSWe found a high prevalence of straight-lining in Anesthesiology Milestones 1.0 ratings. This raises concerns about whether Milestones evaluations reflect individual resident performance in specific domains. The programs explained most of the between-resident variability in both baseline ratings and growth rates. Future studies are needed to promote standardization and consistency of Milestones evaluations, allowing learners to track their progress and target specific areas to improve performance.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851250","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":"Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiovascular Outcomes After Cardiac Surgery: A Pilot Study.","authors":"François Labaste,Vincent Pey,Bertrand Marcheix,Fabrice Ferre,Fanny Vardon,Vincent Minville","doi":"10.1213/ane.0000000000007705","DOIUrl":"https://doi.org/10.1213/ane.0000000000007705","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"174 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802531","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 Randomized Noninferiority Split Face Trial of Transpore Versus Tegaderm for Eyelid Protection During Anesthesia.","authors":"Dan M Drzymalski,Cendal Atkins,Evan Liu,Sogand Goudarzi,Victoria Billero,Sarah Robinson,Joyce Hoot","doi":"10.1213/ane.0000000000007708","DOIUrl":"https://doi.org/10.1213/ane.0000000000007708","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802534","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":"Pro-Con Debate: Opioids and Perioperative Organ Injury-Friend or Foe?","authors":"Detlef Obal,Andrew Notarianni,Loren E Smith,Eric R Gross","doi":"10.1213/ane.0000000000007707","DOIUrl":"https://doi.org/10.1213/ane.0000000000007707","url":null,"abstract":"In this pro-con, we discuss the topic of opioids and organ protection. With the recent shift in providing opioid-sparing surgeries, it is imperative to understand whether opioids, administered routinely for surgeries over the past several decades, provide an added benefit of organ protection. This is an area of debate, as the possible benefits of opioid-mediated organ protection must be carefully weighed against the potential drawbacks of acute opioid administration, such as immunosuppression, hyperalgesia, and constipation.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802536","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":"Presynaptic Neurotransmission: A Bottleneck to Recovery From General Anesthesia?","authors":"André A J van Zundert,Drew M Cylinder,Bruno van Swinderen","doi":"10.1213/ane.0000000000007695","DOIUrl":"https://doi.org/10.1213/ane.0000000000007695","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802537","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":"Change Delayed is Change Denied: The Challenge of Patient Blood Management Implementation.","authors":"Irwin Gross,Linda Shore-Lesserson,Shannon L Farmer","doi":"10.1213/ane.0000000000007692","DOIUrl":"https://doi.org/10.1213/ane.0000000000007692","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802542","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":"Central Venous Pressure in Critical Care: The Forgotten Variable.","authors":"Giles Coverdale,Mathew Patteril","doi":"10.1213/ane.0000000000007703","DOIUrl":"https://doi.org/10.1213/ane.0000000000007703","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802532","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 Effect of Sleep Disorder Interventions in Patients With Obstructive Sleep Apnea Undergoing Solid-Organ Transplants: A Systematic Review.","authors":"Bijal Desai,Xiaole Li,Joshua Andrusiak,Terry Cho,Austin Lam,Ameya Pappu,Marina Englesakis,Mandeep Singh,Justyna Bartoszko","doi":"10.1213/ane.0000000000007694","DOIUrl":"https://doi.org/10.1213/ane.0000000000007694","url":null,"abstract":"Poor sleep results in a wide range of health consequences, and is prevalent among patients undergoing solid-organ transplant, who have high rates of obstructive sleep apnea (OSA). Our objective was to synthesize the evidence examining the impact of OSA therapies such as continuous positive airway pressure (CPAP) on outcomes in the solid-organ transplant setting. We conducted a systematic review registered via PROSERO (CRD42024512577) and reported in accordance with PRISMA guidelines. Databases searched included: MEDLINE, MEDLINE ePubs Ahead of Print and In-process Citations, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. Included studies were those investigating interventions used in adult patients (≥18 years) with OSA undergoing solid-organ transplantation. A total of 1407 studies were identified, with screening identifying 38 studies for full-text review, and only 3 were eligible for data extraction. Only 1 study in heart transplant patients evaluated changes in sleep parameters, and demonstrated that the implementation of nasal CPAP led to significant improvements in Apnea-Hypopnea Index, Arousal Index, and total sleep time with oxygen saturation <90%. Patients with untreated OSA were more likely to develop graft dysfunction earlier than patients with treated or no OSA. There was no detectable impact of CPAP on 1-year mortality or 5-year overall survival after adjustment. Future studies, namely RCTs, should be conducted to assess the tolerability, compliance, and effectiveness of CPAP in this at-risk population. Additional studies should focus on optimizing sleep in solid-organ transplant populations by providing interventions and education that best match individual patient needs, with engagement from patient partners.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"697 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802535","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 Artificial Intelligence Transparent: Why Explainability Matters in Perioperative Medicine.","authors":"Victor Fogagnoli A Almeida,Berk B Ozmen,Manoela Dantas","doi":"10.1213/ane.0000000000007691","DOIUrl":"https://doi.org/10.1213/ane.0000000000007691","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857706","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":"Who Cares for the Leader? Toward a Sustainable and Shared Model of Leadership in Anesthesiology.","authors":"Rodrigo Poves-Álvarez,Mario Lorenzo-López,Estefanía Gómez-Pesquera,Eduardo Tamayo","doi":"10.1213/ane.0000000000007687","DOIUrl":"https://doi.org/10.1213/ane.0000000000007687","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857709","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}