Anesthesia & Analgesia最新文献

{"title":"Faculty Diversity Trends in Academic Anesthesiology by Demographics in the United States, 1977-2021.","authors":"Leena Mazhar,Jeffrey Ding,Javed Siddiqi,Sabeen Tiwana,Edward R Mariano,Omonele O Nwokolo,Mehwish Hussain,Faisal Khosa","doi":"10.1213/ane.0000000000007680","DOIUrl":"https://doi.org/10.1213/ane.0000000000007680","url":null,"abstract":"BACKGROUNDThis surveillance study sheds light on the demographic trends in academic anesthesiology and highlights the shifts that have taken place over 4 consecutive decades.METHODSThe data for academic anesthesiology faculty were self-reported and obtained from the annual Faculty Roster report of the Association of American Medical Colleges (AAMC) from 1977 to 2021. After determining the distribution of academic degrees, academic rank, chair position, and tenure status over time, the percentage composition for each category was calculated for 44 years. The temporal trends were depicted by plotting the counts and proportion changes. At the same time, the progress in terms of racial representation was illustrated by graphing the absolute changes in the percentage composition.RESULTSDespite an overall increase in absolute composition and percentage of women in academic anesthesiology from 20.8% to 35.7%, women remained underrepresented in academic degree attainment, senior academic ranks, and leadership positions. Faculty identifying as Black or African American increased from 1.3% to 4.3%, while Hispanic, Latino, or Spanish-origin faculty grew from 1.2% to 5.2%, representing modest growth in these underrepresented groups over the span of 4 decades.CONCLUSIONSDespite an increase in the count of women and underrepresented minority faculty within academic anesthesiology since the 1970s, the persistence of imbalances related to gender, ethnicity, and race was observed, in senior academic ranks and leadership roles.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777835","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":"Pharmacodynamic Modeling in Sedation Optimization: Promises and Pitfalls.","authors":"Yue Wu,Chi Pan","doi":"10.1213/ane.0000000000007669","DOIUrl":"https://doi.org/10.1213/ane.0000000000007669","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777838","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":"Emergency Trauma Anesthesia Care and Outcomes in Pediatric Firearm and Nonfirearm Injuries: 9-Year Experience From a Regional US Level 1 Trauma Center.","authors":"Meera Gangadharan,Andrew M Walters,Pudkrong Aichholz,Maeve Muldowney,Wil Van Cleve,John R Hess,L G Stansbury,M Angele Theard,Monica S Vavilala","doi":"10.1213/ane.0000000000007652","DOIUrl":"https://doi.org/10.1213/ane.0000000000007652","url":null,"abstract":"BACKGROUNDIn the United States, firearm injuries are the leading cause of pediatric injury mortality. There is little information about anesthetic care and perioperative outcomes of children with firearm injuries. This study compares clinical characteristics, anesthesia care, and perioperative survival of pediatric patients with firearm and nonfirearm injuries.METHODSWe conducted a retrospective cohort study of injured patients <18 years admitted to a regional level 1 US pediatric trauma center between 2014 and 2022 who received anesthetic care within 2 hours of hospital arrival. Differences in clinical characteristics, anesthesia care including therapeutic intensity (arterial and central venous cannulation, blood product transfusion, vasopressor use, or hemostatic agent use) and outcomes (length of stay, mortality, and disposition) were examined between firearm and nonfirearm injury groups and by age groups.RESULTSDuring the 9-year study period, pediatric firearm injury hospitalizations tripled, and 25.9% (69/266 trauma admissions) patients received emergency firearm injury anesthesia care. Six (8.8%) patients with firearm injuries were under 10 years. Polytrauma occurred in both firearm (7%) and nonfirearm injury (14%) groups. Compared to nonfirearm injuries, patients with firearm injuries were older (P < .0001), had fewer American Society of Anesthesiologists (ASA) physical status I (P = .03) and had more injuries with injury severity score (ISS) 16-25 (P < .01). Abdominal injury (P < .001) was more common than traumatic brain injury (TBI; P < .0001) across age groups but all children 1 to 4 years had profound (ISS ≥25) TBI. Time to anesthetic care was shorter (P < .001), arterial cannulation was more common (P < .02), estimated blood loss (P < .001) was greater, and massive transfusion (P < .0001) was more common during firearm injury anesthesia care. Etomidate (P = .01), midazolam (P < .01) and tranexamic acid (P < .01) use were more common and crystalloid resuscitation was larger (P < .0001) during firearm injury anesthesia care but varied by age group. Lengths of intensive care unit (P < .01) and hospital (P < .01) stay were longer in the firearm injury group. Intraoperative mortality was 1% and 2%, and mortality after the first anesthetic was 6% vs 10% in firearm and nonfirearm injury groups, respectively. All children 1 to 4 years were discharged to advanced placement.CONCLUSIONSPediatric trauma patients required high intraoperative therapeutic intensity, which was higher during firearm injury anesthesia care. Postoperative firearm injury mortality was high but less than from nonfirearm injury. Firearm injury patterns, anesthesia care and outcomes varied by age group. Operating room team readiness and provision of timely and high intensity anesthetic care are needed to save lives of injured children.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777837","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":"Burnout Syndrome Among Perioperative Healthcare Providers in Rwanda.","authors":"Eugene Tuyishime,Chilombo Bould,Daniel I MacIsaac,Charles Nkurunziza,Christophe Mpirimbanyi,Felix Nduhuye,Matthew Pereira,Heather O'Reilly,M Dylan Bould","doi":"10.1213/ane.0000000000007672","DOIUrl":"https://doi.org/10.1213/ane.0000000000007672","url":null,"abstract":"BACKGROUNDMany studies address health care provider burnout in high-income countries; however, there is little data on burnout in low-income countries. Our objectives were (1) to estimate the prevalence of burnout among perioperative health care providers and (2) to explore factors associated with burnout among perioperative health care providers in Rwandan public hospitals.METHODSA cross-sectional study using a survey was conducted among perioperative health care providers working in 22 public hospitals across Rwanda. We used a purposive sampling method to represent all regions (4 provinces and the capital Kigali) and types of public hospitals in Rwanda conducting surgery, excluding major teaching centers. We used the Maslach Burnout Inventory Human Services Survey (MBI_HSS), a validated 22-item survey including 3 dimensions of burnout: (1) emotional exhaustion (EE), (2) depersonalization (DP), and (3) personal achievement (PA). We estimated the prevalence of burnout using Wilson's method and we identified factors associated with burnout using a multivariate analysis.RESULTSThere were 221 responses from 402 surveys sent with a response rate of 53.7% including nurses 106 (47.9%), general practitioners 36 (16.3%), nonphysician anesthetists 33 (14.9%), midwives 25 (11.3%), and specialist surgeons and anesthesiologists 4 (1.8%). Forty-7 (21.3, 95% CI 16.1-27.3)% participants had burnout, 95 (42.9, 95 CI 36.6-49.6)% had high emotional exhaustion, 57 (25.8, 95 CI 20.5-31.9)% had low personal accomplishment, 15 (6.8, 95 CI 4.2-10.9)% had high depersonalization). Three major burnout profiles were identified among participants, including the overextended group 84 (38%), the engaged group 83 (37.6%), and the ineffective group 39 (17.6%). Among postulated predictors of burnout, only a lack of having the right equipment was strongly associated with burnout (adj-OR, 3.21; 95 CI, 1.18-8.73, P = .02).CONCLUSIONSOne in 5 perioperative health care providers in Rwanda report having burnout, which is consistent with previous data. This suggests that burnout is widespread across the Rwandan health care system, across different perioperative professions. The only factor that was associated with burnout was lack of access to essential equipment; however, other factors that have been identified in the literature, which are not statistically significant in this study, should not be overlooked. Addressing equipment shortages may reduce the risk of burnout among perioperative health care providers in low-resource settings, in addition to directly impacting the quality of care.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778181","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":"Desflurane's Effect on the Environment: Climate and Much More ….","authors":"Lyndia Dernis,Quentin Gobert,Laurent Zieleskiewicz","doi":"10.1213/ane.0000000000007668","DOIUrl":"https://doi.org/10.1213/ane.0000000000007668","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777839","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":"Reconsidering Iron Substitution for Anemia After Cardiac Surgery.","authors":"Sebastian B Rasmussen,Yuliya Boyko,Christen L Andersen,Hanne B Ravn","doi":"10.1213/ane.0000000000007675","DOIUrl":"https://doi.org/10.1213/ane.0000000000007675","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763476","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":"Effect of Anesthetics on the Occurrence of Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery Under General Anesthesia: A Systematic Review.","authors":"Nicolas Herzog,Julia Salomé,Marc Danguy Des Deserts,Damien Claverie,Olivier Huet,Philippe Ariès","doi":"10.1213/ane.0000000000007666","DOIUrl":"https://doi.org/10.1213/ane.0000000000007666","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763241","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":"Evaluation of a Novel, Image-Guided Robotic Intubation Platform for Difficult Airways: A Prospective Observational Study.","authors":"Vladimir Nekhendzy,Aurika Karbonskienė,Diana Bilskienė,Jurgita Borodičienė,Lina Kalibatienė","doi":"10.1213/ane.0000000000007658","DOIUrl":"https://doi.org/10.1213/ane.0000000000007658","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777841","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":"Widefield Imaging Reveals Distinct Whole-Cortex Dynamics During Anesthetic-Induced Unconsciousness.","authors":"Muchao Xia,Chengyu Wang,Ling Jiang,Kai Wang,Changhong Miao,Chao Liang","doi":"10.1213/ane.0000000000007649","DOIUrl":"https://doi.org/10.1213/ane.0000000000007649","url":null,"abstract":"BACKGROUNDAnesthesia-induced loss of consciousness (LOC) is associated with alterations in cortical synchronization and desynchronization in various cortical regions. However, the precise spatiotemporal dynamics across the entire cortex and their role in the LOC remain unclear. This study utilized advanced imaging techniques to investigate these cortical dynamics under the action of different anesthetics.METHODSWe used Thy1-GCaMP6s mice with surgically prepared transparent skulls to observe cortical Ca2+ signals using widefield microscopy. Functional connectivity analysis was performed, and the primary spatial representations of the different frequency signal components were examined under anesthesia induced by ketamine, propofol, and isoflurane.RESULTSAll drugs enhanced 1.5 to 2.5 Hz signal oscillations in the retrosplenial cortex (RSC), making the 1.5 to 2.5 Hz signal oscillation power in the retrosplenial cortex significantly higher than that in other cortical regions (ketamine (mean ± SD: 1. 58 ± 0.06 vs 0. 27 ± 0.10, -0. 44 ± 0.02 and -0. 36 ± 0.06 for the retrosplenial cortex (RSC) vs the primary motor cortex (MOp), the primary somatosensory cortex (SSp) and the primary visual cortex (VISp), P< .001; propofol: 1. 36 ± 0.06 vs 0. 50 ± 0.09, -0. 34 ± 0.04 and -0. 20 ± 0.11 isoflurane: 1. 39 ± 0.12 vs 0. 30 ± 0.07, -0. 14 ± 0.19 and -0. 20 ± 0.14). Moreover, ketamine and isoflurane was associated with a structured signaling pattern.CONCLUSIONSThe general anesthetics induced unique cortical signal patterns, with the RSC emerging as a key region in which specific oscillatory patterns manifested. The observed 1.5 to 2.5 Hz oscillations in the RSC under different anesthetic conditions suggest a common underlying mechanism for anesthesia-induced LOC. Understanding these spatiotemporal patterns can help improve the monitoring and management of anesthesia.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756086","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 Methadone Versus Other Opioids: A Retrospective Review of Postoperative Outcomes in Pediatric Surgeries.","authors":"Stephanie J Pan,Elizabeth De Souza,T Anthony Anderson","doi":"10.1213/ane.0000000000007653","DOIUrl":"https://doi.org/10.1213/ane.0000000000007653","url":null,"abstract":"BACKGROUNDFindings of randomized controlled trials indicate that intraoperative methadone administration reduces postoperative pain and opioid consumption compared to other opioids in many patient populations. While concerns about potential risks persist, large retrospective studies may be able to assess risks from methadone versus other opioids. Recent retrospective studies in adult patients found no association between methadone administration and adverse outcomes. Similar studies in pediatric patients are lacking. This retrospective study investigates the association of intraoperative methadone with postanesthesia care unit (PACU) pain scores and other relevant postoperative outcomes compared to other opioids.METHODSWe conducted a retrospective cohort study of pediatric patients (≤18 years of age) undergoing 1 of 6 surgeries from January 1, 2018 to February 29, 2024: spinal fusion for scoliosis, laparoscopic sleeve gastrectomy, bilateral mastectomy with nipple reconstruction, knee surgeries, Nuss repair for pectus excavatum, and cleft palate repair. The primary outcome was maximum PACU pain scores in patients receiving intraoperative methadone versus other opioids. Secondary outcomes were the incidence of moderate-severe PACU pain, opioid consumption, naloxone administration, emergence delirium, postoperative nausea and vomiting (PONV), and PACU length of stay (LOS). Results were analyzed using regression models, controlled for appropriate variables including procedure, age, sex, American Society of Anesthesiologists (ASA) score, body mass index (BMI), the number of pre/intraoperative adjuvants, and the use of regional anesthesia. Predefined subgroup analyses were conducted to compare patients who received methadone versus other opioids in the setting of (1) receiving preincision regional anesthesia; (2) receiving an intraoperative remifentanil infusion; and (3) in the methadone group, receiving a methadone dose ≥0.15 mg kg-1.RESULTS1794 patients were included; 528 received methadone. Patients receiving methadone had a lower maximum PACU pain score (3.9 [95% confidence interval {CI}, 3.6-4.2] vs 4.5 [95% CI 4.3-4.6]; P = .007), decreased PACU opioid consumption (0.06 vs 0.09 MEU kg-1; P < .001), decreased emergence delirium (9.60% vs 16.90%; P < .001), and no statistically significant difference in naloxone administration, PONV, and PACU LOS compared to the other-opioid group.CONCLUSIONSIn this large, single-center retrospective study, intraoperative methadone administered to pediatric patients was found to be associated with reduced postoperative pain scores, opioid consumption, and emergence delirium. Larger studies are needed to achieve the necessary power to assess adverse events in pediatric surgical patients who receive methadone versus other opioids.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756152","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}