Anesthesia & Analgesia最新文献

{"title":"The Effects of Dexamethasone in Cardiac Surgery: A Registry-Based, Real-World Data Analysis of Clinical Outcomes From the Netherlands Heart Registration.","authors":"Gijs J van Steenbergen,Ted Reniers,Ashley De Bie Dekker,Irene S Lensen,Peter G Noordzij,Thijs C D Rettig,Thomas van Brakel,Arthur Bouwman,Jules R Olsthoorn,","doi":"10.1213/ane.0000000000007541","DOIUrl":"https://doi.org/10.1213/ane.0000000000007541","url":null,"abstract":"BACKGROUNDIn cardiac surgery, modulating the inflammatory response with prophylactic steroids may reduce morbidity and mortality. We aimed to evaluate the association of dexamethasone use with clinical outcomes and its variation in clinical practice in a real-world setting.METHODSThis retrospective, population-based study evaluated data of elective and urgent to on-pump cardiac surgery patients from the Netherlands Heart Registration between 2013 and 2021. Patients who received perioperative dexamethasone were compared to those who did not. The primary outcomes were 30-day mortality and a composite of 30-day mortality, in-hospital stroke, and 30-day renal or respiratory failure. Secondary outcomes included the individual components of the composite outcome, a composite of infection-related outcomes, arrhythmias, and length of hospital stay. Propensity score matching was applied to adjust for confounders. Clinical practice variation was assessed through a national survey of Dutch cardiac anesthesiologists.RESULTSIn the study, 54,694 patients were included, with 40,891 patients (74.8%) receiving dexamethasone. After propensity score matching, dexamethasone use was associated with a lower risk of the composite clinical outcome (odds ratio [OR] 0.82, 95% confidence interval [CI], 0.72-0.92, P < .001), with a significant reduction in renal failure (OR 0.57, 95% CI, 0.47-0.70, P < .001). The length of hospital stay was significantly shorter (B -0.17, 95% CI, -0.32 to -0.02, P = .025). Other individual components of the composite outcome and secondary outcomes did not show a significant association with dexamethasone use. However, in patients >80 years, dexamethasone use was associated with increased 30-day mortality (OR 1.52, 95% CI, 1.01-2.28, P = .044). The observed benefits were consistent across other demographic and clinical subgroups. The survey indicated substantial variability in dexamethasone use across centers and anesthesiologists.CONCLUSIONSProphylactic dexamethasone during adult cardiac surgery was associated with reduced composite clinical outcomes, renal failure, and shorter hospital stays, and seemed associated with 30-day mortality in patients >80 years old.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926476","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":"Effects of Dexmedetomidine Combined With Lidocaine Topical Administration on Cough Reflex During Extubation in Thyroidectomy Patients: A Randomized Clinical Trial.","authors":"Keyan Wang,Bowen Wei,Xuanxuan Wang,Yang Gao,Yuanyuan Cao,Lei Zhang,Meng Ning,Lijian Chen","doi":"10.1213/ane.0000000000007560","DOIUrl":"https://doi.org/10.1213/ane.0000000000007560","url":null,"abstract":"BACKGROUNDCough reflex during extubation can lead to complications such as increased bleeding and hemodynamic instability, especially in thyroidectomy, therefore, effective suppression of cough reflex is clinically important. The aim of the study was to investigate the inhibitory effect of dexmedetomidine combined with lidocaine on the cough reflex during extubation in thyroidectomy.METHODSA total of 180 female patients, aged 18 to 65 years, undergoing elective thyroidectomy under general anesthesia, were randomized into 3 groups: dexmedetomidine combined with lidocaine (Dex-Lido group, n = 60), lidocaine alone (Lido group, n = 60), or normal saline (Control group, n = 60). Before tracheal intubation, patients in the Dex-Lido group received dexmedetomidine combined with 2% lidocaine spray, those in the Lido group received 2% lidocaine spray, and those in the Control group received 0.9% normal saline spray, applied to the supraglottic, glottic, and subglottic areas. The primary outcome was the incidence of cough reflex at extubation. Secondary outcomes included cough severity, postoperative sore throat, hoarseness, nausea, and vomiting, as well as the need for analgesics and antiemetics, pain levels, sedation scores, and length of hospital stay.RESULTSThe incidence of cough reflex during extubation was significantly lower in both the Dex-Lido and Lido groups compared to the Control group (23% vs 70%; odds ratio [OR], 0.13; 95% confidence interval [CI], 0.06-0.29; P < .001 for Dex-Lido; 47% vs 70%; OR, 0.38; 95% CI, 0.18-0.79]; P = .010 for Lido), with a statistically significant difference between the Dex-Lido and Lido groups (23% vs 47%; OR, 0.35; 95% CI, 0.16-0.76; P = .007). Additionally, the severity of the cough reflex was markedly lower in the Dex-Lido group compared to the Control group (8/60 vs 26/60; OR, 0.20; 95% CI, 0.08-0.50; P < .001).CONCLUSIONSThe combination of dexmedetomidine and lidocaine laryngopharynx spray effectively suppresses the cough reflex during extubation, reduces postoperative sore throat, and stabilizes hemodynamics in female patients undergoing thyroid surgery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926477","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":"To Achieve Cultural Change in Health Care Focus on Power and Agency, Process, and Relationships.","authors":"Tanisha Jowsey,Craig S Webster,Thomas Swinburn,Jennifer M Weller","doi":"10.1213/ane.0000000000007526","DOIUrl":"https://doi.org/10.1213/ane.0000000000007526","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926478","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":"Unplanned Intensive Care Unit Admissions: Demography of a \"Not Never\" Event.","authors":"Richard P Dutton,Richard D Urman,Avery Tung","doi":"10.1213/ane.0000000000007529","DOIUrl":"https://doi.org/10.1213/ane.0000000000007529","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"289 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920995","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 \"5-Ps\" Mnemonic for Antibiotic Prophylaxis Before Surgery.","authors":"Ahmed Hasanin,Maha Mostafa","doi":"10.1213/ane.0000000000007596","DOIUrl":"https://doi.org/10.1213/ane.0000000000007596","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920993","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":"US Food and Drug Administration Approval of Suzetrigine: A Breakthrough in Nonopioid Pain Management.","authors":"Muhammad Areeb Ul Haq,Sabrina Najeeb,Wasi Junaid,Rafia Chaudhry","doi":"10.1213/ane.0000000000007550","DOIUrl":"https://doi.org/10.1213/ane.0000000000007550","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920992","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":"Emerging Technology and the Future of Perioperative Care: Perspectives and Recommendations From the 2023 Stoelting Conference of the Anesthesia Patient Safety Foundation.","authors":"Jonathan M Tan,Maxime Cannesson,Jeffrey M Feldman,Allan F Simpao,Susan P McGrath,Ashish K Khanna,John W Beard,Patricia McGaffigan,Daniel J Cole","doi":"10.1213/ane.0000000000007540","DOIUrl":"https://doi.org/10.1213/ane.0000000000007540","url":null,"abstract":"Anesthesiology has a longstanding commitment to patient safety, characterized by innovative research, quality improvement, multidisciplinary collaboration, and engineering-based approaches to care systems. The field has been instrumental in advancing technological developments across the perioperative continuum, contributing to the ongoing mission of harm reduction and risk mitigation. However, modern challenges in health care, including increasingly complex patient conditions, workforce shortages, burnout, and the overwhelming volume of health data generated, have created a more urgent and multifaceted landscape for patient safety efforts. Furthermore, with the expanding perioperative continuum, from prehabilitation to postoperative acute care at home, anesthesiology teams must now adapt to a broader role in patient care. To continue enhancing patient safety, anesthesiology must integrate emerging technologies into clinical workflows, scaling their presence and effectiveness. The 2023 Anesthesia Patient Safety Foundation Stoelting Conference highlighted the necessity for anesthesiology to embrace these innovations while recognizing the challenges they pose. Three key technological domains were emphasized: wearables and the Internet of Medical Things; big data and artificial intelligence; and clinical decision support systems coupled with advanced alarm systems. These technologies offer opportunities to improve patient safety but require careful integration into clinical practice. This report explores the potential of these technologies to reshape anesthesiology and perioperative care while focusing on their application across 4 key phases: the preanesthesia phase at home; the intraoperative phase within health systems; postanesthesia recovery; and recovery at home. By leveraging these technologies, anesthesiology can enhance decision-making, improve outcomes, and continue advancing the mission of patient safety in a rapidly evolving health care landscape.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920994","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- and Institution-Level Factors Associated With Intraoperative Cardiac Arrest During Major Noncardiac Surgery.","authors":"Shamieh Banihani,Troy N Coaston,Vikram Fielding-Singh,Esteban Aguayo,Joseph S Meltzer,Peyman Benharash","doi":"10.1213/ane.0000000000007571","DOIUrl":"https://doi.org/10.1213/ane.0000000000007571","url":null,"abstract":"BACKGROUNDIntraoperative cardiac arrest (IOCA) is a rare but catastrophic event with significant morbidity, mortality, and health care costs. This study aimed to characterize the frequency, risk factors, and outcomes of IOCA.METHODSAdults undergoing noncardiac surgery were identified in the 2016 to 2021 National Inpatient Sample. IOCA events were identified using the relevant International Classification of Diseases code. Multivariable regression models examined factors independently associated with IOCA and in-hospital mortality. The significance of temporal trends was calculated using Cuzick's nonparametric test.RESULTSAmong 2671,834 noncardiac surgical admissions, 1294 (0.05%) experienced IOCA. The incidence increased from 0.05% to 0.06% during the study period, coinciding with an increase in nonelective operations during the coronavirus disease-2019 (COVID-19) pandemic. IOCA was associated with a 39.3% in-hospital mortality rate and increases in length of stay and hospitalization costs. Key risk factors for IOCA included advanced age, male sex, Black race (adjusted odds ratio [AOR] 1.40, 95% CI, 1.20-1.65), low-income status (AOR 1.21, 95% CI, 1.02-1.43), treatment at government nonfederal hospitals (AOR 1.22, 95% CI, 1.08-1.50), high-risk surgical procedures, and significant comorbidities such as congestive heart failure, cardiac arrhythmias, and valvular disease.CONCLUSIONSDespite the initial reduction in the incidence of IOCA, this study highlights a temporal increase coinciding with the COVID-19 pandemic and an increase in nonelective surgeries. Future research should explore more granular predictors of IOCA and its outcomes to develop targeted interventions for at-risk populations and tailor guidelines to manage emerging challenges in population health.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920998","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":"A Randomized Controlled Trial of Sugammadex versus Neostigmine for Reversal of Rocuronium on Gastric Emptying in Adults Undergoing Elective Colorectal Surgery.","authors":"Brandon M Togioka,Shauna K Rakshe,Shangyuan Ye,Praveen Tekkali,Vassiliki Liana Tsikitis,Sandy H Fang,Daniel O Herzig,Kim C Lu,Michael F Aziz","doi":"10.1213/ane.0000000000007518","DOIUrl":"https://doi.org/10.1213/ane.0000000000007518","url":null,"abstract":"BACKGROUNDGastrointestinal function is mediated by the cholinergic pathway, which is impacted by neostigmine and glycopyrrolate, but not sugammadex. We hypothesized that sugammadex is associated with earlier gastric emptying in adults undergoing colorectal surgery, compared to neostigmine-glycopyrrolate.METHODSPatients were enrolled in a pragmatic, single-center, patient and assessor-blinded, randomized, controlled trial. At skin closure, subjects were randomized to sugammadex 2 mg/kg or neostigmine 0.07 mg/kg and glycopyrrolate (0.2 mg per 1 mg of neostigmine). The primary end point, gastric emptying, was assessed with the paracetamol absorption test, with greater area under the curve representing faster gastric emptying. Secondary end points included time to first bowel movement, time to achieve adequate reversal (train-of-four ratio ≥0.9), gastrointestinal complications, hospital length of stay, and postanesthesia care unit recovery time. The analysis was intention-to-treat.RESULTSAll 60 patients randomized to sugammadex received the allocated intervention. Of 60 patients randomized to neostigmine-glycopyrrolate, 56 received neostigmine-glycopyrrolate, 2 received sugammadex, and 2 received both agents. Gastric emptying did not differ significantly between sugammadex (mean [standard deviation {SD}] area under the curve {AUC} 1118 [122]) and neostigmine (AUC 1130 [117], P = .58). Sugammadex treatment was associated with shorter time to first bowel movement (44.3 hours [33.8] vs 61.0 hours [43.0]; difference = 16.7 hours, 95% confidence interval {CI}, [2.3-31.1], P = .02) and time to adequate reversal (5.2 minutes [6.3] vs 17.5 minutes [10.1]; difference = 12.3 minutes, 95% CI, [9.2-15.4], P < .001). Neostigmine-glycopyrrolate treatment was not associated with a significant increase in gastrointestinal complications (32% vs 17%; OR = 2.3, 95% CI, [0.9-6.2], P = .09), a longer hospital length of stay (7.8 days [19.8] vs 4.8 days [4.9]; difference = 3 days, 95% CI, [-2.2 to 8.3], P = .27), or a difference in postanesthesia care unit recovery time (108 minutes [56.4] vs 115 minutes [50.3]; difference= -6.9 minutes, 95% CI, [-26.4 to 12.6], P = .48). Adverse events were similar between groups.CONCLUSIONSSugammadex treatment was not associated with faster gastric emptying (primary end point). Regarding prespecified secondary end points, sugammadex treatment was associated with a 12.3-minute shorter time to adequate reversal in real-life practice conditions, but it did not benefit the proportion of subjects with a gastrointestinal complication, hospital length of stay, or postanesthesia care unit recovery time. Further studies are needed to confirm our finding that sugammadex is associated with a clinically significant 16.7-hour shorter time to first bowel movement, and to establish the role of sugammadex in colorectal surgery enhanced recovery protocols.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915216","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":"Spectral Differences of Anesthetic Agents: Addressing Fundamental Problems With New Methods.","authors":"Srdjan Z Dragovic,Julian Ostertag,Niklas Baumann,Paul S García,Stephan Kratzer,Gerhard Schneider,Stefan Schwerin,Jamie Sleigh,Matthias Kreuzer","doi":"10.1213/ane.0000000000007530","DOIUrl":"https://doi.org/10.1213/ane.0000000000007530","url":null,"abstract":"BACKGROUNDProcessed electroencephalography parameters are used to guide anesthesia to adequate levels for surgical procedures. Despite known spectral differences between anesthetics, studies often assume similar anesthetic states when titrating to the same target values, presupposing a reductive one-size-fits-all approach for all anesthetic agents. We hypothesize this may introduce bias and aim to characterize the differences using conventional and new approaches.METHODSFor this retrospective study, we included 108 patients undergoing surgery under general anesthesia with either fluranes or propofol. We analyzed steady-state frontal electroencephalography during surgery. Conventional approaches were compared with \"fitting oscillations & one-over-f\" and \"variational mode decomposition\" at clinically guided hypnotic and analgesic levels. After comparing the hypnotic drugs at the group level, we used 2 distinct ranges of spectral edge frequency (SEF) for further analyses (8-15 Hz vs 15-21 Hz).RESULTSSevoflurane and desflurane (\"flurane\") demonstrated similar spectral patterns using both conventional methods and \"fitting oscillations & one-over-f\" and \"variational mode decomposition.\" \"Variational mode decomposition\" presented a 1.5 Hz higher central frequency (area under the receiver operating characteristic [AUC]: 0.88, 95% confidence interval [CI], 0.81-0.94, P < .001) in the propofol group (10.8 Hz [10.4-11.6]), compared to the flurane group (9.26 Hz [8.51-9.41]). \"Fitting oscillations & one-over-f\" produced a 2.04 Hz higher center frequency (AUC: 0.82, 95% CI, 0.72-0.91, P < .001) in the propofol group (10.6 [9.8-11.3]) compared to the flurane group (8.56 [8.02-9.69]). The exponent was 0.26 Hz-1 lower (AUC: 0.76, 95% CI, 0.67-0.85, P < .001) in the propofol group (2.45 Hz-1 [2.45-2.71]) compared to the flurane group (2.71 Hz-1 [2.50-2.93]). At the lower SEF range, \"variational mode decomposition\" presented a 1.5 Hz higher central frequency (AUC: 0.83, 95% CI, 0.70-0.94, P < .001) in the propofol group (10.4 Hz [9.7-10.9]), compared to the flurane group (8.92 Hz [8.03-9.45]). \"Fitting oscillations & one-over-f\" produced a 1.5 Hz higher center frequency (AUC: 0.83, 95% CI, 0.68-0.95, P = .002) in the propofol group (10.3 [10.0-10.8]) compared to the flurane group (8.78 [7.63-9.66]). The exponent was 0.31 Hz-1 lower (AUC: 0.79, 95% CI, 0.65-0.91, P = .002) in the propofol group (2.57 Hz-1 [2.44-2.70]) compared to the flurane group (2.88 Hz-1 [2.66-3.05]). Similar differences were found in the higher SEF group. However, no significant difference was found in the exponent between the groups.CONCLUSIONSDifferences between the electroencephalographic (EEG) spectral patterns under propofol anesthesia compared to anesthesia using fluranes were sensitively captured by 2 recent approaches to EEG analysis. This could potentially lead to establishing agent-specific anesthetic indices.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914920","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}