Anesthesia & Analgesia最新文献

{"title":"Feasibility Study of an Indicator of Equivalent Potency of Multiple Anesthetics Normalized by Minimum Alveolar Concentration Derived From Response Surface Models.","authors":"Haopeng Zhang,Jiuxiang Zhang,Xin Li,Shan He,Zhuomin Deng,Li Wang,Yi Wang,Xiaohui Wang,Congying Wan,Fan Huang,Zhenghua Zhu,Hailong Dong","doi":"10.1213/ane.0000000000007514","DOIUrl":"https://doi.org/10.1213/ane.0000000000007514","url":null,"abstract":"BACKGROUNDMinimum alveolar concentration (MAC) is used as the standard measure of potency for volatile anesthetic agents. However, there is a lack of effective and quantitative indicator of the combined potency of multiple coadministered inhalation and intravenous anesthetics. We hypothesized that an indicator of equivalent potency of multiple anesthetics, normalized by MAC and derived from response surface models as a fraction (abbreviated as eMAC fraction), can reflect the total potency of multiple anesthetics.METHODFifty-three patients receiving general anesthesia were enrolled. A random dose combination of propofol and remifentanil was administrated before a tetanic electric stimulus which was used to simulate incision. The vital signals and responses of patients were recorded to tetanic stimulus and in turn used to calculate the prediction probability (Pk) of the response, using the eMAC fraction and the bispectral index (BIS). After induction, the doses administered during anesthesia maintenance were entirely determined by anesthesiologists. During emergence, the anesthesiologists facilitated the awakening of patients through a combination of auditory and tactile stimuli at eMAC fraction levels of 0.8, 0.6, 0.4, and 0.2, or every 2 minutes after the certain level was reached, whichever arrived first.RESULTSThe eMAC fraction for predicting the loss of movement response to tetanic electric stimulus yielded a mean ± standard deviation (SD) Pk of 0. 80 ± 0.06, which was higher than the Pk of the BIS value for predicting the loss of movement response to tetanic electric stimulus (0.71 ± 0.07, P < .001). During maintenance of anesthesia, the eMAC fraction showed changes related to anesthetic dose and surgical phase. In all patients, approximately 71.9% of eMAC fraction values were within the range of 1.3 to 2.6. During emergence, the mean eMAC fraction values at awakening were 0. 30 ± 0.15.CONCLUSIONSThe eMAC fraction showed a superior performance in indicating the loss of response to electric stimulus compared to BIS. Anesthesiologists are familiar with the clinical use range of MAC fraction, and the distribution of eMAC fraction values during maintenance is similar to this range. This similarity allows anesthesiologists to easily use eMAC fraction in practice. These results indicate that the eMAC fraction has the potential to assist anesthesiologists in titrating multiple anesthetics to estimate the depth of anesthesia during general anesthesia, and should further be evaluated in clinical studies.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849366","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":"Fine-Mapping the Association of Acute Kidney Injury With Mean Arterial and Central Venous Pressures During Coronary Artery Bypass Surgery.","authors":"Lee A Goeddel,Marina Hernandez,Lily Koffman,Zachary Murphy,Ashish K Khanna,Michael Robich,Glenn Whitman,Xinkai Zhou,Karen Bandeen-Roche,John Muschelli,Chirag R Parikh,Joao A C Lima,Ciprian M Crainiceanu,Charles Brown,Nauder Faraday","doi":"10.1213/ane.0000000000007500","DOIUrl":"https://doi.org/10.1213/ane.0000000000007500","url":null,"abstract":"BACKGROUNDPrior studies identified thresholds for mean arterial pressure (MAP <65 mm Hg) and central venous pressure (CVP >12 mm Hg) beyond which risk for cardiac surgery-associated acute kidney injury (AKI) increases. Optimal hemodynamic targets-that is, where active protection from AKI is observed-are unclear; however, current guidelines suggest maintaining MAP >65 and CVP 8 to 12. The aim of this study was to identify hemodynamic ranges associated with both increased and decreased risk of AKI by evaluating narrow ranges of MAP, CVP, and joint exposure to MAP and CVP concurrently.METHODSIn a retrospective cohort study of adults undergoing coronary artery bypass surgery, we fine-mapped the association between AKI and the total number of minutes spent in each of the following narrow hemodynamic ranges: 14 MAP ranges in increments of 5 mm Hg (45-115), 10 CVP ranges in increments of 2 mm Hg (0-20), and 70 joint MAP/CVP ranges. Separate multivariable regression models estimated adjusted odds ratios (aOR) for each range including adjustments for correlations and multiple comparisons across ranges. Joint MAP/CVP ranges were grouped into 5 hemodynamic zones based on contiguity of the ranges and similarity of ORs observed across ranges in a color-coded heatmap. The 5 MAP/CVP zones were included in a single regression model to assess risk for AKI associated with time spent in each hemodynamic zone, independent of time spent in other zones.RESULTSIn 1199 participants, incidence of AKI was 28%. For every 5-minute spent in each hemodynamic range, risk of AKI was significantly increased in MAP range 45 to 50 (aOR 1.18; P = .002), 50 to 55 (aOR 1.13; P = .001), and 55 to 60 mm Hg (aOR 1.06; P = .001); and significantly decreased in MAP range 90 to 95 mm Hg (aOR 0.85; P <.001). Risk of AKI was significantly increased in CVP range 16 to 18 mm Hg (aOR 1.07; P = .002) and significantly decreased in CVP range 4 to 6 mm Hg (aOR 0.97; P = .025). In joint analyses, both MAP and CVP contributed to AKI risk estimates; risk decreased as CVP decreased within every MAP range and was significantly lower for joint ranges of CVP <8 and MAP >75. In analyses containing all 5 MAP/CVP hemodynamic zones, risk estimates suggested protection from AKI in zone 1 (high MAP/low CVP) and increased risk of AKI in zones 3 to 5 (low MAP/high CVP).CONCLUSIONSFine-mapping identified narrow ranges of MAP, CVP, and joint MAP/CVP associated with both AKI risk and protection. This report is among the first to characterize the association between joint MAP/CVP and AKI. Contrary to current guidelines, there was no evidence for protection associated with MAP 65 to 75 or CVP 8 to 12 mm Hg.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849369","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":"Tube Tip In Pharynx Ventilation-Single-Handed, Always Available, Occasionally Lifesaving.","authors":"Sandra Ellefsen,Michael S Kristensen","doi":"10.1213/ane.0000000000007535","DOIUrl":"https://doi.org/10.1213/ane.0000000000007535","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849469","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":"Confirming Correct Tracheal Tube Placement: Examining the Project for the Universal Management of Airways Guideline.","authors":"Andy Higgs,Jan Hansel,Tim M Cook,Nick Chrimes","doi":"10.1213/ane.0000000000007538","DOIUrl":"https://doi.org/10.1213/ane.0000000000007538","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849368","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":"Blood Health: The Ultimate Aim of Patient Blood Management.","authors":"Sherri Ozawa,James P Isbister,Shannon L Farmer,Axel Hofmann,Joshua Ozawa-Morriello,Irwin Gross,Aryeh Shander","doi":"10.1213/ane.0000000000007528","DOIUrl":"https://doi.org/10.1213/ane.0000000000007528","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822682","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":"Publication Bias in Leading Anesthesiology Journals: A Systematic Review.","authors":"Adam Khan,Jeanie Marchbanks,Riley Hedin,Matt Vassar","doi":"10.1213/ane.0000000000007527","DOIUrl":"https://doi.org/10.1213/ane.0000000000007527","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822681","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":"Ode to the Narrative (and Their Authors)","authors":"David B. Waisel","doi":"10.1213/ane.0000000000006643","DOIUrl":"https://doi.org/10.1213/ane.0000000000006643","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627504","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":"Is There Still a Role For Neuraxial Analgesia in Cancer Surgery?","authors":"Lauren K. Dunn, Michael C. Grant, Tong J. Gan","doi":"10.1213/ane.0000000000006847","DOIUrl":"https://doi.org/10.1213/ane.0000000000006847","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627506","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":"Anesthesiology and Perioperative Care of the Cancer Patient: Enhancing Lives and Improving Outcomes","authors":"Vijaya Gottumukkala, Tong J. Gan","doi":"10.1213/ane.0000000000007416","DOIUrl":"https://doi.org/10.1213/ane.0000000000007416","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627505","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":"End-Tidal Control Versus Manual Control of Inhalational Anesthesia Delivery: A Randomized Controlled Noninferiority Trial: Erratum","authors":"Melissa D. McCabe, Guy de L. Dear, Matthew A. Klopman, Kritika Garg, Melinda S. Seering","doi":"10.1213/ane.0000000000007398","DOIUrl":"https://doi.org/10.1213/ane.0000000000007398","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627742","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}