Anesthesia & Analgesia最新文献

{"title":"Chlorhexidine Wipes with Educational Feedback Are Effective at Reducing Axilla and Groin Bacterial Contamination at the Start of Surgery.","authors":"Franklin Dexter,Randy W Loftus","doi":"10.1213/ane.0000000000007288","DOIUrl":"https://doi.org/10.1213/ane.0000000000007288","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449323","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":"Innovative Endotracheal Tube Design Reduces Laryngeal Injury with an Excellent Airway Seal and Minimal Cuff Pressures.","authors":"Pedro Luis Bravo,Francisco Gonzalez Sammarco,Daniel A Cueva Nieves,Leonardo Lorente,Jonathan Delgado,Ricardo Martinez-Ruiz","doi":"10.1213/ane.0000000000007260","DOIUrl":"https://doi.org/10.1213/ane.0000000000007260","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449325","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":"Chinese Anesthesiology Milestones in Resident Evaluation: Reliability, Validity, and Correlation with Objective Examination Scores: a Cross-sectional Study.","authors":"Xia Ruan,Xiaohan Xu,Lijian Pei,Jie Yi,Chunhua Yu,Xuerong Yu,Bo Zhu,Xiang Quan,Xu Li,Hui Jv,Yuelun Zhang,Yuguang Huang","doi":"10.1213/ane.0000000000007279","DOIUrl":"https://doi.org/10.1213/ane.0000000000007279","url":null,"abstract":"BACKGROUNDEvaluating competency acquisition during residency training is crucial. The Anesthesiology Milestones have been implemented in the United States. The China Consortium of Elite Teaching Hospitals for Residency Education has also developed the Chinese Resident Core Competency Milestone Evaluation System. Despite this, Milestones tailored for anesthesiology have yet to be implemented in China. To address this gap, we have developed Chinese Anesthesiology Milestones. This study aims to assess the reliability and validity of the Chinese Anesthesiology Milestones and their correlation with objective examinations.METHODSIn this single-center cross-sectional study, we included anesthesia residents enrolled in the standardized residency training program at our hospital during the academic year 2021 to 2022. The Chinese Anesthesiology Milestones were developed based on the American version of Anesthesiology Milestones 2.0 and the Chinese Resident Core Competency Milestone Evaluation System using the Delphi method. The Delphi panel comprised a diverse group, including education administrators, faculty from teaching hospitals, and anesthesia residents. Five attending anesthesiologists independently assessed the levels achieved by each anesthesia resident based on the Chinese Anesthesiology Milestones. Subsequently, they collaboratively discussed the ratings for each resident until a consensus was reached. The interrater reliability, internal consistency, and construct validity were assessed using Kendall's coefficient, Cronbach's α coefficient/ composite reliability, and average variance extracted, respectively. Higher values indicated better reliability or validity. The correlation between Milestone ratings and objective examination scores, including written examinations and Objective Structured Clinical Examinations, were analyzed using Pearson correlation.RESULTSThe Chinese Anesthesiology Milestones encompassed 6 competencies, including professionalism, medical knowledge and technical skills, patient care, interpersonal and communication skills, teaching ability, and life-long learning. Milestone evaluation data were available and analyzed from 66 residents. The Kendall's coefficient of concordance among raters ranged from 0.799 (95% confidence interval [CI], 0.793-0.918) to 0.942 (95% CI, 0.934-0.982). The average variance extracted, composite reliability, and Cronbach's α coefficient ranged from 0.782 to 0.920, 0.935 to 0.980, and 0.916 to 0.978, respectively. Correlations between objective examination scores and related Milestone subcompetencies were as follows: written examinations: r = 0.52 (95% CI, 0.22-0.71), technical skills stations: r = 0.51 (95% CI, 0.21-0.71), the oral test station: r = 0.66 (95% CI, 0.45-0.79), and the standardized patient station: r = 0.61 (95% CI, 0.36-0.76).CONCLUSIONSThe Chinese Anesthesiology Milestones demonstrated satisfactory interrater reliability, internal consistency, construct validity, and correlation w","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449324","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 Chronic Hepatitis C Virus on Acute Kidney Injury After Living Donor Liver Transplantation.","authors":"Jae Hwan Kim,Kyoung-Sun Kim,Hye-Mee Kwon,Sung-Hoon Kim,In-Gu Jun,Jun-Gol Song,Gyu-Sam Hwang","doi":"10.1213/ane.0000000000007253","DOIUrl":"https://doi.org/10.1213/ane.0000000000007253","url":null,"abstract":"BACKGROUNDAcute kidney injury (AKI) is one of the most common complications after liver transplantation (LT) and can significantly impact outcomes. The presence of hepatitis C virus (HCV) infection increases the risk of AKI development. However, the impact of HCV on AKI after LT has not been evaluated. The aim of this study was to assess the effect of HCV on AKI development in patients who underwent LT.METHODSBetween January 2008 and April 2023, 2183 patients who underwent living donor LT (LDLT) were included. Patients were divided into 2 groups based on the presence of chronic HCV infection. We compared LT recipients using the propensity score matching (PSM) method. Factors associated with AKI development were evaluated using multiple logistic regression analysis. In addition, 1-year mortality and graft failure were assessed using a Cox proportional regression model.RESULTSAmong 2183 patients, the incidence of AKI was 59.2%. After PSM, the patients with HCV showed a more frequent development of AKI (71.9% vs 63.9%, P = .026). In multivariate analysis after PSM, HCV was associated with AKI development (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.06-2.20, P = .022), 1-year mortality (Hazard ratio [HR], 1.98; 95% CI, 1.12-3.52, P = .019), and graft failure (HR, 2.12; 95% CI, 1.22-3.69, P = .008).CONCLUSIONSThe presence of HCV was associated with increased risk for the development of AKI, 1-year mortality, and graft failure after LT.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448025","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":"Clinical Performance of a Bispectral Index Controlled Closed-Loop Administration System for Simultaneous Administration of Propofol and Remifentanil.","authors":"Michele Schiavo,Massimiliano Paltenghi,Antonio Visioli,Nicola Latronico","doi":"10.1213/ane.0000000000007289","DOIUrl":"https://doi.org/10.1213/ane.0000000000007289","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448057","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":"Developing a Wearable Sensor-Based Digital Biomarker of Opioid Dependence.","authors":"Stephanie Carreiro,Pravitha Ramanand,Washim Akram,Joshua Stapp,Brittany Chapman,David Smelson,Premananda Indic","doi":"10.1213/ane.0000000000007244","DOIUrl":"https://doi.org/10.1213/ane.0000000000007244","url":null,"abstract":"BACKGROUNDRepeated opioid exposure leads to a variety of physiologic adaptations that develop at different rates and may foreshadow risk of opioid-use disorder (OUD), including dependence and withdrawal. Digital pharmacovigilance strategies that use noninvasive sensors to identify physiologic adaptations to opioid use represent a novel strategy to facilitate safer opioid prescribing. This study aims to identify wearable sensor-derived features associated with opioid dependence by comparing opioid-naïve individuals to chronic opioid users with acute pain and developing a machine-learning model to distinguish between the 2 groups.METHODSUsing a longitudinal observational study design, continuous physiologic data were collected on participants with acute pain receiving opioid analgesia. Monitoring continued throughout hospitalization and for up to 7 days posthospital discharge. Opioid administration data were obtained from electronic health record (EHR) and participant self-report. Participants were classified as belonging to 1 of 3 categories based on opioid use history: naïve, occasional, or chronic use. Thirty features were derived from sensor data, and an additional 9 features were derived from participant demographic and treatment characteristics. Physiologic feature behavior immediately postopioid use was compared among naïve and chronic participants, and subsequently features were used to generate machine learning models which were validated using cross-validation and holdout data.RESULTSForty-one participants with a combined total of 169 opioid administrations were ultimately included in the final analysis. Four interpretable decision tree-based machine learning models with 14 sensor-based and 5 clinical features were developed to predict class membership on the level of a given observation (dose) and on the participant level. Ranges for model metrics on the participant level were as follows: accuracy 70% to 90%, sensitivity 67% to 100%, and specificity 67% to 100%.CONCLUSIONSWearable sensor-derived digital biomarkers can be used to predict opioid use status (naïve versus chronic) and the differentiating features may be detecting opioid dependence. Future work should be aimed at further delineating the phenomenon identified in these models (including opioid dependence and/or withdrawal) and at identifying transition states where an individual changes from 1 profile to another with repetitive opioid exposure.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448058","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":"Environmental Effects of Propofol Versus Sevoflurane for Maintenance Anesthesia.","authors":"Alain Frederic Kalmar,Steffen Rex,Hugo Vereecke,An Teunkens,Geertrui Dewinter,Michel M R F Struys","doi":"10.1213/ane.0000000000007248","DOIUrl":"https://doi.org/10.1213/ane.0000000000007248","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448060","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":"Minimum Estimated Time to Wakeup: In Search of an Approvable Alternative to Target-Controlled Infusion for US Clinical Practice.","authors":"Christopher W Connor","doi":"10.1213/ane.0000000000007241","DOIUrl":"https://doi.org/10.1213/ane.0000000000007241","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443715","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":"Preemptive Methocarbamol to Prevent Muscle Spasm After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.","authors":"Lloyd Halpern,De-An Zhang,K T Perrins,Clark J Kogan,Kirk A Ryan","doi":"10.1213/ane.0000000000007242","DOIUrl":"https://doi.org/10.1213/ane.0000000000007242","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443689","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":"Proposed Quality Metrics for Congenital Cardiac Anesthesia: A Scoping Review.","authors":"Morgan L Brown,Anna Dorste,Phillip S Adams,Lisa A Caplan,Stephen J Gleich,Jennifer L Hernandez,Lori Q Riegger,","doi":"10.1213/ane.0000000000007208","DOIUrl":"https://doi.org/10.1213/ane.0000000000007208","url":null,"abstract":"Congenital cardiac anesthesiologists practice in a unique environment with high risk for morbidity and mortality. Quality metrics can be used to focus clinical initiatives on evidence-based care and provide a target for local quality improvement measures. However, there has been no comprehensive review on appropriate quality metrics for congenital cardiac anesthesia to date. Members of the Quality and Safety Committee for the Congenital Cardiac Anesthesia Society proposed 31 possible candidate topics for metrics. Using a scoping review strategy, 3649 abstracts were reviewed with 30 articles meeting final criteria. Of these, 5 candidate metrics were unanimously proposed for local collection and national benchmarking efforts: use of a structured handover in the intensive care unit, use of an infection prevention bundle, use of blood conservation strategies, early extubation of cardiopulmonary bypass cases, and cardiac arrest under the care of a cardiac anesthesiologist. Many metrics were excluded due to a lack of primary data and perceived complexity beyond the scope of cardiac anesthesia practice. There is a need to develop more primary data including linking process measures with outcomes, developing risk-stratification for our patients, and collecting national data for benchmarking purposes.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"193 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443692","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}