Anesthesia & Analgesia最新文献

{"title":"An Ether Observation by Joseph Priestley Pertaining to the Second Gas Effect.","authors":"Theodore A Alston","doi":"10.1213/ane.0000000000007020","DOIUrl":"https://doi.org/10.1213/ane.0000000000007020","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321032","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":"An Analysis of Patients Undergoing Cricothyrotomy Within US Central Command: A Transportation Command Regulating and Command & Control Evacuation System Study.","authors":"Daniel K O'Conor,Shubhro Bose,Brit J Long,Joseph K Maddry,Michael D April,Steven G Schauer","doi":"10.1213/ane.0000000000006920","DOIUrl":"https://doi.org/10.1213/ane.0000000000006920","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321226","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":"Agents That Came in From the Cold: Enflurane, Isoflurane, Desflurane, and Sevoflurane.","authors":"Raymond C Roy","doi":"10.1213/ane.0000000000007017","DOIUrl":"https://doi.org/10.1213/ane.0000000000007017","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321031","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":"Obstetric Anesthesia Quality Metrics: Performance, Pitfalls, and Potential.","authors":"Kelly A Fedoruk,Pervez Sultan","doi":"10.1213/ane.0000000000007054","DOIUrl":"https://doi.org/10.1213/ane.0000000000007054","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321299","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":"Improving Obstetric Anesthesia Care Through Teaming and Improvement Science.","authors":"Beth Ann Clayton,Andrea Girnius","doi":"10.1213/ane.0000000000007002","DOIUrl":"https://doi.org/10.1213/ane.0000000000007002","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324925","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":"\"Safety Monitoring\" Behavior and Technology: Reflections From the Anesthesia Patient Safety Foundation 2023 E. C. Pierce, MD, Memorial Lecture.","authors":"John H Eichhorn","doi":"10.1213/ane.0000000000007023","DOIUrl":"https://doi.org/10.1213/ane.0000000000007023","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324923","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":"Point-of-Care Lung Ultrasound to Evaluate Lung Isolation During One-Lung Ventilation in Children: A Blinded Observational Feasibility Study.","authors":"Alok Moharir,Yoshikazu Yamaguchi,Jennifer H Aldrink,Andrea Martinez,Mauricio Arce-Villalobos,Sibelle Aurelie Yemele Kitio,Julie Rice-Weimer,Joseph D Tobias","doi":"10.1213/ane.0000000000007155","DOIUrl":"https://doi.org/10.1213/ane.0000000000007155","url":null,"abstract":"BACKGROUNDMinimally invasive thoracic surgical techniques require effective lung isolation using one-lung ventilation (OLV). Verification of lung isolation may be confirmed by auscultation, visual confirmation using fiberoptic bronchoscopy (FOB), or more recently, point-of-care ultrasound (POCUS). The aim of this study was to prospectively compare lung ultrasound with clinical auscultation to confirm OLV before thoracic surgery in pediatric patients.METHODSThis prospectively blinded feasibility study included 40 patients ranging in age from 0 to 20 years. After confirmation of lung separation by the primary anesthesia team using FOB, the sonographer and the auscultator, both blinded to the laterality of surgery and lung separation, entered the operating room. The sonographer evaluated for pleural lung sliding and the auscultator listened for breath sounds. Successful lung separation was definitively confirmed by direct visualization of lung collapse during the operation.RESULTSIn confirming effective single-lung ventilation, lung ultrasound had a diagnostic accuracy of 95% (95% confidence interval [CI], 82.7%-98.5%). In contrast, auscultation could only reliably confirm lung isolation with 68% accuracy (95% CI, 51.5%-80.4%). The McNemar test showed a statistically significant difference between the use of lung ultrasound and auscultation (P < .001). The median time to perform ultrasonography was 67 seconds (interquartile range [IQR], 46-142) and the median time to perform auscultation was 21 seconds (IQR, 10-32).CONCLUSIONSBased on the initial results of our feasibility trial, lung ultrasound proved to be a fast and reliable method to verify single-lung ventilation in pediatric patients presenting for thoracic surgery with a high degree of diagnostic accuracy.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233281","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":"Preoperative Multidisciplinary Team Huddle Improves Communication and Safety for Unscheduled Cesarean Deliveries: A System Redesign Using Improvement Science.","authors":"Andrea Girnius,Candice Snyder,Heather Czarny,Thomas Minges,Michael Stacey,Tamara Supinski,John Crowe,Judith Strong,Sean A Josephs,Muhammad A Zafar","doi":"10.1213/ane.0000000000006905","DOIUrl":"https://doi.org/10.1213/ane.0000000000006905","url":null,"abstract":"BACKGROUNDOptimal communication between care teams is a critical component in providing safe, timely, and appropriate patient care. Labor and delivery (L&D) units experience rapidly changing clinical scenarios often requiring escalation in care and unplanned cesarean deliveries (CDs). The University of Cincinnati Medical Center (UCMC) is a 550-bed academic level 4 maternal care center with a 13-bed L&D unit in Cincinnati, OH. There are approximately 2500 deliveries/y with a CD rate of 33%. The L&D unit is staffed with dedicated anesthesia personnel 24 hours a day. In our L&D unit, there was widespread dissatisfaction with multidisciplinary communication surrounding unscheduled CD. Near-miss safety events in our obstetric unit were attributed to preoperative communication failures. Initial surveys identified challenges in preoperative communication among nursing, anesthesiology, and obstetric teams leading to potential risk for compromised care.METHODUsing the UC Health Performance Improvement Way, we first sought to understand the process leading up to unscheduled CD. Change ideas were developed based on observed failures in communication. Interventions were tested and refined through iterative plan-do-study-act (PDSA) cycles. One key intervention was the introduction of a bedside, multidisciplinary, patient-centered, pre-CD huddle attended by nursing, anesthesia, and obstetrics representatives using a standard checklist for critical information. Qualitative patient feedback was elicited to inform change efforts. We compared patient and procedure characteristics from the baseline and huddle implementation phases.MEASURESOur primary outcome measure was the satisfaction of care team members with communication around unscheduled CD. A secondary outcome was the general anesthesia (GA) rate for unscheduled CD. Our key process measure was adherence to the preoperative huddle. We tracked decision-to-incision interval (DTI) as a balancing measure.RESULTSHuddle adherence reached 96% for unscheduled CD within 6 months of testing and implementation. A combined survey of anesthesia, nursing, and obstetrics showed that satisfaction scores related to unscheduled CD communication improved from 3.3/5 to 4.7/5 after huddle implementation. The rate of GA use and the median DTI remained unchanged. Patients felt more engaged and reported positive experiences by being a part of the huddle discussion.CONCLUSIONSIn an academic obstetric unit, communication failures surrounding unscheduled CD were identified as a contributor to staff dissatisfaction and perception of safety risk. Implementation of a bedside multidisciplinary pre-CD huddle improved communication between teams and contributed to creating a culture of safety without causing significant delays in care.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233278","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":"Oxygen-Sparing Anesthesia with Electrically Controlled Ventilators: A Bench Study with Implications for Clinical Practice and Resource Management.","authors":"Vito Torrano,Francesco Zadek,Abbiati Giacomo,Chiara Deli,Roberto Fumagalli,Thomas Langer","doi":"10.1213/ane.0000000000007270","DOIUrl":"https://doi.org/10.1213/ane.0000000000007270","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233279","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":"An Exploratory Analysis of ChatGPT Compared to Human Performance With the Anesthesiology Oral Board Examination: Initial Insights and Implications.","authors":"Samuel N Blacker,Fei Chen,Daniel Winecoff,Benjamin L Antonio,Harendra Arora,Bryan J Hierlmeier,Rachel M Kacmar,Anthony N Passannante,Anthony R Plunkett,David Zvara,Benjamin Cobb,Alexander Doyal,Daniel Rosenkrans,Kenneth Bradbury Brown,Michael A Gonzalez,Courtney Hood,Tiffany T Pham,Abhijit V Lele,Lesley Hall,Ameer Ali,Robert S Isaak","doi":"10.1213/ane.0000000000006875","DOIUrl":"https://doi.org/10.1213/ane.0000000000006875","url":null,"abstract":"BACKGROUNDChat Generative Pre-Trained Transformer (ChatGPT) has been tested and has passed various high-level examinations. However, it has not been tested on an examination such as the American Board of Anesthesiology (ABA) Standardized Oral Examination (SOE). The SOE is designed to assess higher-level competencies, such as judgment, organization, adaptability to unexpected clinical changes, and presentation of information.METHODSFour anesthesiology fellows were examined on 2 sample ABA SOEs. Their answers were compared to those produced by the same questions asked to ChatGPT. All human and ChatGPT responses were transcribed, randomized by module, and then reproduced as complete examinations, using a commercially available software-based human voice replicator. Eight ABA applied examiners listened to and scored the topic and modules from 1 of the 4 versions of each of the 2 sample examinations. The ABA did not provide any support or collaboration with any authors.RESULTSThe anesthesiology fellow's answers were found to have a better median score than ChatGPT, for the module topics scores (P = .03). However, there was no significant difference in the median overall global module scores between the human and ChatGPT responses (P = .17). The examiners were able to identify the ChatGPT-generated answers for 23 of 24 modules (95.83%), with only 1 ChatGPT response perceived as from a human. In contrast, the examiners thought the human (fellow) responses were artificial intelligence (AI)-generated in 10 of 24 modules (41.67%). Examiner comments explained that ChatGPT generated relevant content, but were lengthy answers, which at times did not focus on the specific scenario priorities. There were no comments from the examiners regarding Chat GPT fact \"hallucinations.\"CONCLUSIONSChatGPT generated SOE answers with comparable module ratings to anesthesiology fellows, as graded by 8 ABA oral board examiners. However, the ChatGPT answers were deemed subjectively inferior due to the length of responses and lack of focus. Future curation and training of an AI database, like ChatGPT, could produce answers more in line with ideal ABA SOE answers. This could lead to higher performance and an anesthesiology-specific trained AI useful for training and examination preparation.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233280","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}