Anesthesia & Analgesia最新文献

{"title":"PACU Up!: Feasibility of an Early Mobilization Program for Children After Surgery and Anesthesia.","authors":"Samuel M Vanderhoek,Lisa Shoemaker,Yu Bin Na,Laura Prichett,Sapna R Kudchadkar","doi":"10.1213/ane.0000000000007525","DOIUrl":"https://doi.org/10.1213/ane.0000000000007525","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880188","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 Maternal Pain Management After Cesarean Delivery in a Rural Tanzanian Hospital Through Hybrid Global Health Education.","authors":"Joseph W Hodapp,Sehewa Mganga,Gabriel P Kissima,Nkeiruka Umeh,Natasha Harrison,Dipro Chakraborty,Cynthia Khoo","doi":"10.1213/ane.0000000000007520","DOIUrl":"https://doi.org/10.1213/ane.0000000000007520","url":null,"abstract":"BACKGROUNDFocused anesthesia education may be beneficial for resource-constrained settings where inadequate training along with lack of infrastructure, staff, and supplies can contribute to high anesthetic morbidity and mortality rates. Some medical outreach efforts have transitioned from short-term and service-focused \"missions\" to education-focused global health interventions to build health care capacity. The Stanford Anesthesiology Division of Global Health Equity partnered with Foundation for African Medicine and Education (FAME), a hospital in Karatu, Tanzania, to introduce regional anesthesia through virtual workshops and in-person bidirectional exchange. This study aimed to assess the translation of hybrid global health education in regional anesthesia to improvements on maternal post-cesarean delivery pain.METHODSFrom 2020 to 2023, the FAME team was trained in regional and acute pain techniques via virtual biannual 2-week workshops. The FAME head nurse anesthetist visited Stanford for a 5-week observership in October 2023, then a Stanford team traveled to Tanzania in January 2024 for 4 weeks of hands-on regional anesthesia training. The nurse anesthetists identified obstetric anesthesia as an area for application. Postsurgical pain management pathways were developed, introducing numerical pain scores and multimodal analgesia including transversus abdominis plane (TAP) blocks. Primary outcomes included maximum pain scores reported for the first 12 hours, pain scores at 12 hours and at 24 hours after C-section. Secondary outcomes included postoperative analgesic prescriptions, side effects, and hospital length of stay.RESULTSMean maximum pain scores after C-section were significantly decreased (preintervention: 7.6 ± 1.9 [mean ± standard deviation {SD}] versus postintervention: 4.5 ± 1.6, P < .001). Smaller decreases in pain scores were observed at 12 hours (2.5 ± 1.3 vs 2.2 ± 1.1, P < .05) and 24 hours (1.1 ± 0.9 vs 0.7 ± 0.9, P < .01). Multimodal analgesia was utilized with reduction in scheduled tramadol (97.9% vs 69.9%, P < .001) and reduced side effect profiles (dizziness [29.3% vs 16.8%, P < .05] and nausea/vomiting [24.3% vs 8.8%, P < .001]).CONCLUSIONSThis study demonstrates the impact of global health educational interventions, including virtual workshops and bidirectional exchange, on maternal pain outcomes in a Tanzanian hospital. Preintervention data collection fostered heightened awareness among the FAME nurse anesthetists of the severity of post-cesarean pain. The introduction of TAP blocks further improved their existing multimodal analgesic strategy with a clinically significant reduction in maximum pain scores. This educational strategy aims to advance global anesthesia goals, including building longitudinal partnership, thereby enhancing access to safe anesthesia education and promoting sustainable capacity building.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880185","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":"Electroencephalogram Correlates of Delayed Emergence After Remimazolam-Induced Anesthesia Compared to Propofol.","authors":"Yeji Lee,Sujung Park,Hyoungkyu Kim,Youngjai Park,UnCheol Lee,Jeongwook Kwon,Bon-Nyeo Koo,Joon-Young Moon","doi":"10.1213/ane.0000000000007516","DOIUrl":"https://doi.org/10.1213/ane.0000000000007516","url":null,"abstract":"BACKGROUNDDelayed emergence from anesthesia presents clinical challenges, including prolonged stays in the postanesthesia care unit (PACU). The neurobiological mechanisms underlying delayed emergence, particularly in remimazolam-induced anesthesia, remain poorly understood. This study aimed to explore patterns of brain electrical activity of delayed emergence in remimazolam-induced anesthesia by comparing dynamic changes in electroencephalogram (EEG) activity under various anesthesia states of remimazolam and propofol, focusing on the prefrontal region.METHODSForty-eight patients (age >18) who underwent laparoscopic cholecystectomy randomly received remimazolam- or propofol-induced general anesthesia. Power spectrogram analysis and functional connectivity measures, phase lag entropy (PLE) and phase lag index (PLI), were used to the prefrontal EEG data collected at baseline, unconsciousness, and emergence. Correlation between EEG measures and Patient State Index (PSI) at PACU, as well as time to Aldrete 9, were compared.RESULTSDuring emergence from anesthesia, EEG power revealed that the remimazolam group had higher powers than the propofol group in theta band during eyes-open (EO) (mean of 2.933 [standard deviation of 5.762] vs -2.342 [4.869]; P-value of 0.018 with independent 2-sample t test), and in the alpha band during eyes-closed (EC) (5.821 [7.35] vs -2.399 [4.53]; P < .001) and EO (4.84 [6.411] vs -3.613 [4.556]; P < .001). Conversely, the functional connectivity result showed lower PLE in the alpha band during EC (0.619 [0.0338] vs 0.684 [0.0392]; P < .0001) and EO (0.651 [0.0358] vs 0.692 [0.0428]; P = .015), and in the beta band during EC (0.682 [0.0308] vs 0.712 [0.0236]; P = .016) and EO (0.695 [0.0236] vs 0.725 [0.0195]; P < .001). In line with this, the remimazolam group had lower PSI values at PACU during EC (65.10 [14.67] vs 82.40 [6.678]; P < .0001) and EO (72.35 [12.55] vs 83.53 [6.632]; P = .006) and were slower to reach Aldrete score of 9 (median difference of 17.5; interquartile range of [0.0-21.0]; P < .001). Delayed consciousness recovery (time to Aldrete 9) under remimazolam was significantly correlated with PLE (Pearson's correlation = -.78, P < .0001) and PLI (Pearson's correlation =.69, P = .028) in the alpha band during deep anesthesia.CONCLUSIONSDynamic changes in prefrontal EEG during recovery and the correlation analyses show the potential of EEG in reflecting distinct consciousness recovery profiles between 2 drugs-slower recovery under remimazolam anesthesia. This suggests an association of EEG parameters with a unique behavioral profile of remimazolam, especially reflecting progressive changes in cerebral activity during recovery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880186","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":"Global Access to Clinical Office-Based Surgical and Anesthesia Practices.","authors":"Steven Young,Michelle Mathew,Elizabeth Keene,Mikayla Lebo,Rajbir Sooch,Tae-Yop Kim,Denise Battaglini,Gustavo Norte,Federico Puera-Martinez,Juan Jose Puerta-Martinez,Igor Abramovich,Romeo Leiva,Tarika Srinivasan,David Shaye,Fred E Shapiro","doi":"10.1213/ane.0000000000007521","DOIUrl":"https://doi.org/10.1213/ane.0000000000007521","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880181","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":"Empowering Clinicians: A Comprehensive Guide to Navigating Pain Management for Peripartum Opioid-Use Disorder.","authors":"Courtney D Townsel,Mark C Bicket,Kristin K Martin,Benjamin G Cobb","doi":"10.1213/ane.0000000000007533","DOIUrl":"https://doi.org/10.1213/ane.0000000000007533","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880203","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 Electroencephalographic Trajectory During Anesthesia Emergence on the Indices Monitoring the Hypnotic Component.","authors":"David P Obert,Robin Taetow,Stephan Kratzer,Falk von Dincklage,Paul S García,Gerhard Schneider,Matthias Kreuzer","doi":"10.1213/ane.0000000000007499","DOIUrl":"https://doi.org/10.1213/ane.0000000000007499","url":null,"abstract":"BACKGROUNDPostoperative neurocognitive disorders (PNDs) are frequent and serious complications that cause an enormous social and economic burden. A previous study demonstrated that certain electroencephalographic (EEG) patterns during emergence from general anesthesia are associated with a higher risk for PND. Compared to patients demonstrating the most favorable trajectory (Traj Ref: delta-dominant slow-wave anesthesia (ddSWA)→spindle-dominant SWA (sdSWA)→non-SWA (nSWA)→wake), patients presenting Traj Abrupt (ddSWA→wake) had 4-fold increased odds to develop PND and patients with Traj High (nSWA→wake) had 8-fold increased odds of developing PND. We hypothesized that commonly used neuromonitoring devices (state entropy [SE], quantium consciousness index [qCON], bispectral index [BIS], and Patient State Index [PSI]) can differentiate between the various trajectories.METHODSFrom the original database of the study by Hesse et al, we analyzed 59 EEGs from patients emerging from general anesthesia. They were selected according to their trajectory. We included 19 patients who had shown the most favorable trajectory (Traj Ref), 20 who had demonstrated Traj Abrupt, and 20 who had followed Traj High. To evaluate the performance of the neuromonitoring devices, we replayed the patients' EEGs to the monitors using an EEG player. We compared the index values for the 3 different trajectories (Traj Ref, Traj Abrupt, and Traj High) generated by the different monitoring devices, respectively. Additionally, we evaluated the correlation between the monitoring devices.RESULTSSE and PSI were able to resolve significant differences between Traj Ref and Traj Abrupt during a major part of emergence. Traj Ref showed an almost linear increase of index values, whereas Traj Abrupt led to an episode of low index values followed by a sudden increase. However, when comparing Traj Ref vs Traj High, qCON, PSI, and BIS were the indices showing significant differences, especially at the beginning of emergence. Patients representing Traj Ref patterns had significantly lower index values than those depicting Traj High. Due to the Traj High cases starting in nSWA, their indices were already high at the start of emergence.CONCLUSIONSOur analysis revealed that the course of the different indices reflects spectral EEG patterns during the emergence from general anesthesia. Considering certain emergence trajectories associated with a higher risk of developing PND, our approach might enable the anesthetist to identify patients particularly susceptible to PND by observing the course of index values before admission to the postanesthesia care unit.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880183","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":"Mentor/Mentee Office-Based Anesthesia Experience and Curriculum 2024.","authors":"Patrick M Connell,Devon M Evanovich,Cassie C Dietrich,Fred E Shapiro","doi":"10.1213/ane.0000000000007515","DOIUrl":"https://doi.org/10.1213/ane.0000000000007515","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851062","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":"Association Between Neuromuscular Blockade and Its Reversal With Postoperative Delirium in Older Patients: A Hospital Registry Study.","authors":"Elena Ahrens,Luca J Wachtendorf,Denys Shay,Theresa Tenge,Béla-Simon Paschold,Maíra I Rudolph,Simone Redaelli,Lars Kaiser,Aiman Suleiman,Haobo Ma,Philipp J Fassbender,Maximilian S Schaefer","doi":"10.1213/ane.0000000000007489","DOIUrl":"https://doi.org/10.1213/ane.0000000000007489","url":null,"abstract":"BACKGROUNDNondepolarizing neuromuscular blocking agents (ND-NMBAs) are dose-dependently associated with residual paralysis, delayed recovery, and prolonged hospitalization, factors that can predispose patients to postoperative delirium. We hypothesized that neuromuscular blockade is associated with a higher risk of delirium after surgery, and that this can be mitigated by administration of reversal agents.METHODSIn total, 53,772 adult hospitalized patients aged ≥60 years who underwent general anesthesia for noncardiac, nonneurosurgical, nontransplant procedures between 2008 and 2024 at a tertiary health care network in Massachusetts, were included. The exposure was the intraoperative administration of ND-NMBAs. The primary outcome was 7-day delirium, identified from nursing and physician charts using a keyword-based search strategy paired with manual chart review, Confusion Assessment Method assessments, and International Classification of Diseases (9th/10th Revision, Clinical Modification) diagnostic codes.RESULTSIn total, 43,723 (81.3%) patients received neuromuscular blockade. Approximately 2259 (4.2%) patients developed delirium, 1884 (4.3%) with, and 375 (3.7%) without ND-NMBA administration. In adjusted analyses, administration of ND-NMBAs was dose-dependently associated with a higher risk of postoperative delirium (adjusted odds ratio [ORadj] 1.15; 95% confidence interval [CI], 1.01-1.31; P = .038 and 1.09; 95% CI, 1.06-1.12; P < .001 per each unit increase in the effective dose required to achieve a 95% twitch reduction). 38,143 (87.2%) patients who received ND-NMBAs also received a reversal agent, which was associated with a lower risk of impaired neuromuscular recovery (preextubation train-of-four ratio <95; ORadj 0.60; 95% CI, 0.49-0.74; P < .001) and delirium (ORadj 0.73; 95% CI, 0.64-0.83; P < .001), compared to no reversal. The adverse effect of ND-NMBAs on delirium risk was eliminated by reversal agent administration (ORadj 1.07; 95% CI, 0.94-1.23; P = .30 with and ORadj 1.52; 95% CI, 1.28-1.79; P < .001 without reversal agent administration). There was no association between administration of neostigmine, compared to sugammadex, with postoperative delirium (ORadj 0.91; 95% CI, 0.73-1.12; P = .36).CONCLUSIONSNeuromuscular blockade during general anesthesia is dose-dependently associated with a higher risk of postoperative delirium. The administration of reversal agents mitigates this risk and might help reduce the occurrence of delirium after surgery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851063","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":"Application of Cisgender Anesthesia Clinical Scoring Systems in the Transgender and Gender-Diverse Populations.","authors":"Megan F Hunt,Olivia Lansinger,Shivali Mukerji,David Hepner,Angela Bader,Martha Cordoba Amorocho","doi":"10.1213/ane.0000000000007487","DOIUrl":"https://doi.org/10.1213/ane.0000000000007487","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851064","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":"Intraoperative Blood Pressure and Hypotension in Two Public Anesthesiology Datasets.","authors":"Markus Huber,Maxime Cannesson,Hyung-Chul Lee,Patrick Y Wuehtrich","doi":"10.1213/ane.0000000000007505","DOIUrl":"https://doi.org/10.1213/ane.0000000000007505","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851061","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}