Anesthesia & Analgesia最新文献

{"title":"An Analysis of Quality Assurance Events in Nonoperating Room Anesthetizing Locations: A Qualitative Retrospective Cohort Study.","authors":"Anastasia P Piersa,A Taylor Thomas,Richard D Urman,Marc Philip T Pimentel,Rafael Vazquez","doi":"10.1213/ane.0000000000008187","DOIUrl":"https://doi.org/10.1213/ane.0000000000008187","url":null,"abstract":"BACKGROUNDNonoperating room anesthesia (NORA) poses unique challenges to the anesthesia clinician, yet existing evidence on patient safety in NORA is limited. The aim of this study was to characterize NORA quality assurance (QA) events at a large academic health system based on a validated qualitative framework to provide insights and suggest potential safety interventions.METHODSThis two-center qualitative retrospective cohort study included all adult NORA cases performed between August 1, 2018, and December 31, 2022. QA event reporting was mandatory for every anesthetic during the study. The analyzed dataset included anesthesia clinician QA event reports associated with an optional free response comment, and each comment was coded using both deductive and inductive approaches in parallel. Each QA event was categorized in an inductive fashion, and the System Engineering Initiative for Patient Safety (SEIPS) framework was used to categorize event descriptions deductively. Emerging categories and representative scenarios were summarized.RESULTSA total of 497,175 cases were performed during the study period, of which 106,476 (21.4%) were performed in NORA locations. After applying exclusion criteria, 984 QA report free-response comments were analyzed. Diverse subcategories emerged among the QA event categories (eg, employee safety concerns, patient positioning issues, unclear protocols). Some of the commonly identified SEIPS categories were \"Organization\" and \"Tools and technology.\" From deductive and inductive analyses, challenges with teamwork, communication, care processes, variability in access to equipment, and equipment malfunctions were identified in the NORA setting. In addition to patient outcomes, negative organizational and employee outcomes were described on account of NORA-specific complexities.CONCLUSIONSThis large qualitative study characterized NORA QA events across multiple dimensions. Our findings highlight that QA events in NORA are complex and often due to a combination of factors, underscoring both clinical and systems-level vulnerabilities. These findings may provide a framework for targeted quality improvement interventions.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388600","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":"Operating Room Energy Usage Assessment at a Tertiary Academic Medical Center in the United States.","authors":"Evan M Chen,Kaiyi Wang,Jacob Huth,Anna Levitt,Alexander L Clarke,Seema Gandhi","doi":"10.1213/ane.0000000000008200","DOIUrl":"https://doi.org/10.1213/ane.0000000000008200","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393596","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":"Advancing Perioperative Medication Safety: Consensus Recommendations From the 2024 Anesthesia Patient Safety Foundation Stoelting Conference.","authors":"Aubrey Samost-Williams,Elizabeth Rebello,Patricia Meyer,Arnoley Abcejo,Emily Methangkool,Dan Lovinaria,Ken B Johnson,Daniel J Cole","doi":"10.1213/ane.0000000000008203","DOIUrl":"https://doi.org/10.1213/ane.0000000000008203","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388602","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":"Patient Beliefs and Experiences of Adhering to Medical Therapies for Cardiovascular Comorbidities, Before Noncardiac Elective Surgery in South Africa: A Mixed-Methods Study.","authors":"Oluwanilo Awoloto,Hilary L Bekker,Christella Alphonsus,Simphiwe Gumede,Khulile Singata,Elzanne Jansen van Rensburg,Simon J Howell,Bruce Biccard","doi":"10.1213/ane.0000000000008110","DOIUrl":"https://doi.org/10.1213/ane.0000000000008110","url":null,"abstract":"BACKGROUNDCardiovascular comorbidities increase perioperative risk in patients undergoing noncardiac surgery. Optimizing medication adherence in this population is critical; yet adherence remains low in many low- and middle-income countries (LMICs), where health beliefs, systemic barriers, and healthcare communication bring significant challenges. This study aimed to explore the acceptability of validated patient-reported questionnaires and to investigate the beliefs and experiences influencing adherence to cardiovascular medication before surgery in a South African tertiary hospital.METHODSA mixed-methods study was conducted using semistructured interviews with 21 patients taking cardiovascular medication before vascular surgery. Participants completed four validated self-report questionnaires: Brief Illness Perception Questionnaire (BIPQ), Beliefs about Medicines Questionnaire (BMQ), SHARED decision-making questionnaire, and SURE decisional conflict scale. Questionnaire responses were summarized with descriptive statistics. Thematic analysis of interview data was conducted using Braun and Clarke's six-step framework.RESULTSMost participants perceived their illness as chronic (15/20, 75%) and their treatment as effective (18/21, 86%), yet 15 of 21 (71%) reported high concern and 9 of 21 (43%) reported emotional distress. Belief in the need for medication was strong (21/21, 100%), but 14 of 21 (67%) worried about long-term side effects and 10 of 21 (47%) described their medication as a \"mystery.\" Shared decision-making appeared limited: only 7 of 21 (33%) recalled being asked for their views. Thematic analysis revealed seven major themes: understanding illness and treatment, health professional interactions, service access, social support, individual factors, routines, and habits.CONCLUSIONSPatient-reported tools were acceptable and highlighted complex, interrelated factors associated with adherence. Integrating these tools into preoperative care may help identify at-risk patients and support person-centered perioperative planning in LMICs.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365583","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 Epidural-Related Maternal Fever on Neonatal Outcomes: A Single-Center Retrospective Case-Control Study Excluding Confirmed Histological Chorioamnionitis.","authors":"Yu Yamazaki,Shunsuke Hyuga,Hitoshi Isohata,Hiroyuki Goto,Yoshihiro Yoshimura,Kyoko Hattori,Takao Shimaoka,Hiroaki Kondo,Tomoe Fujita,Jun Oikawa,Yoko Onishi,Daigo Ochiai","doi":"10.1213/ane.0000000000008176","DOIUrl":"https://doi.org/10.1213/ane.0000000000008176","url":null,"abstract":"BACKGROUNDMaternal fever during labor analgesia may arise from infectious causes (such as chorioamnionitis) or noninfectious causes (such as epidural-related maternal fever [ERMF]). While chorioamnionitis is associated with neonatal outcomes, the impact of isolated ERMF remains controversial. This is due, in part, to the potential for occult intrauterine infection, which may not be clinically apparent during labor. Consequently, inadequate consideration of histological chorioamnionitis has limited the scope and validity of previous studies. This study aimed to evaluate the effects of ERMF on neonatal outcomes by excluding confirmed histological chorioamnionitis and minimizing suspected infection using predefined clinical criteria.METHODSThis retrospective study included women with singleton term deliveries under labor analgesia between January 2017 and July 2023. Cases with fetal anomalies or growth restriction were excluded. Placental pathological examination was performed when any of the predefined risk-based criteria were met, irrespective of maternal fever: clinical suspicion of chorioamnionitis, prolonged rupture of membranes, and neonatal asphyxia. Among febrile cases, short-term neonatal outcomes were first compared between those with and without histological chorioamnionitis. Subsequently, outcomes were compared between mothers with intrapartum fever (≥38 °C) and those without fever using propensity score matching. Long-term infant development was assessed using a Maternal and Child Health Handbook-based questionnaire.RESULTSOverall, 186 matched pairs were included. All matched covariate standardized mean differences were <0.1, confirming acceptable balance. Compared with the nonfever group, the fever group had longer mean ± standard deviation durations from rupture of membranes to delivery (12.9 ± 9.4 vs 8.7 ± 10.9 hours; difference 4.2 hours; 95% confidence interval [CI], 2.17-6.33), first stage of labor (13.2 ± 6.7 vs 9.6 ± 6.3 hours; difference 3.6 hours; 95% CI, 2.32-4.99), and duration of labor analgesia (14.9 ± 9.6 vs 8.6 ± 6.7 hours; difference 6.3 hours; 95% CI, 4.62-8.01), along with a higher incidence of fetal tachycardia (36.0 vs 10.7%; absolute risk difference 25.3%; 95% CI, 12.3-37.2). In contrast, maternal fever was not associated with adverse neonatal outcomes, including umbilical artery pH <7.2, Apgar score <7 at 1 and 5 minutes, or neonatal intensive care unit admission. Growth and developmental milestones assessed at long-term follow-up using the Maternal and Child Health Handbook questionnaire were within the normal range in both groups.CONCLUSIONSFollowing exclusion of histological chorioamnionitis, ERMF was associated with prolonged labor and fetal tachycardia but was not associated with adverse short-term neonatal outcomes or impaired long-term development.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365582","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 Administrative Indices: Allostatic Load and Autonomic Dyshomeostasis as Biological Mediators of Intraoperative Cardiac Arrest.","authors":"Yi Shen,Weiqin Huang","doi":"10.1213/ane.0000000000008204","DOIUrl":"https://doi.org/10.1213/ane.0000000000008204","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365605","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":"Incomplete Recovery of Diaphragmatic Mechanics at a Train-of-Four Ratio of 0.90 to <0.95 Assessed by Dynamic Digital Radiography: A Proof-of-Concept Case Series.","authors":"Ryo Wakabayashi,Yuki Mogitate,Takamitsu Ikeda,Ayako Hirai,Masaki Iwakiri,Kanji Uchida","doi":"10.1213/ane.0000000000008220","DOIUrl":"https://doi.org/10.1213/ane.0000000000008220","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"200 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365580","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":"Patients' Perspectives and Experiences of Participating in Anesthesia Research: A Qualitative Study.","authors":"Bethany R Tellor Pennington,Allison M Janda,Shayna Rosen,Nora Alrubaie,Jennifer Percich,Sathish Kumar,Sachin Kheterpal,Michael S Avidan,Mary C Politi","doi":"10.1213/ane.0000000000008173","DOIUrl":"https://doi.org/10.1213/ane.0000000000008173","url":null,"abstract":"BACKGROUNDExploring participants' experiences in comparative effectiveness anesthesia clinical trials offers valuable insights for improving trial design, conduct, and outcome measures while identifying factors that may hinder trial success. The challenges and opportunities of conducting comparative effectiveness trials are distinct from classic explanatory trials. To optimize and conduct a full-scale comparative effectiveness trial, we interviewed patients to identify barriers and facilitators to study participation and offer strategies to improve the recruitment and retention of participants in anesthesia comparative effectiveness clinical trials.METHODSWe conducted qualitative semi-structured interviews using constructs from the Consolidated Framework for Implementation Research. Interviews assessed barriers and facilitators to study participation in an anesthesia clinical trial comparing outcomes after receiving either total intravenous anesthesia (TIVA) or inhaled volatile anesthesia (INVA). Interview guides were co-developed with a multidisciplinary team, including patient partners, and addressed study participation, acceptability of the study procedures, and prior experiences with anesthesia. Participants were recruited at two large academic medical centers. Two coders used a standardized codebook to code each interview, achieving &gt; 95% agreement. Interview transcripts were analyzed using thematic analysis.RESULTSNinety-one patients were approached, 43 agreed to participate, and 35 interviews were conducted until we reached thematic saturation. Patients found participation in the anesthesia research study to be positive, straightforward, and non-intrusive. Study-related barriers to enrollment and participation included survey language, blinding, randomization, and concerns for breach of confidentiality. Patient-related barriers included fear and mistrust of research and discomfort with technology. Study-related facilitators included the safety and non-experimental nature of both general anesthesia techniques, use of digital technology, minimal time burden, trust and clear communication by the study staff, and compensation. Patients were motivated to participate by altruistic values. Adaptable barriers were addressed, and solutions were implemented to improve study procedures and staff responsibilities, aimed at enhancing participation and ensuring positive experiences for patients in future anesthesia comparative effectiveness clinical trials.CONCLUSIONSKey elements to consider when designing and conducting a comparative effectiveness anesthesia trial include promoting participant comfort and trust, ensuring clear communication, highlighting the safety and clinical equipoise of the trial comparators, supportive behaviors from the clinical team, minimizing time burden, and using simple-to-learn digital technology. Findings of this study were used to refine the full-scale pragmatic, comparative effectiveness, randomized controlled trial eval","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365581","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":"Elevating Anesthesia Choices for Cesarean Delivery: A Roadmap for Patient-Centered Research and Solutions With Key Findings and Recommendations From the ELEVATE Project.","authors":"Grace Lim,Karen Crowley,Sharee Livingston,Emily McGahey,Jill Mhyre,Mark D Neuman,Heather Nixon,Cheryl Parker,May C M Pian-Smith,T Flint Porter,Susanna Stanford,Rachel Somerstein,Mark Zakowski, ","doi":"10.1213/ane.0000000000008018","DOIUrl":"https://doi.org/10.1213/ane.0000000000008018","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498994","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":"Ketamine Infusion and Risk of Postoperative Nausea and Vomiting and Adverse Outcomes in Surgical Patients: A Secondary Analysis of the IMPAKT Randomized Trial.","authors":"Jacob C Clifton,Britany L Raymond,Robert E Freundlich,Brian F S Allen,Ellen G Stallings,Miklos D Kertai","doi":"10.1213/ane.0000000000008205","DOIUrl":"https://doi.org/10.1213/ane.0000000000008205","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348840","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}