Anesthesia & Analgesia最新文献

{"title":"The Infinite Game: Opportunities and Lessons About Possible Futures of Anesthesia Service Delivery from the United Kingdom.","authors":"D Matthew Sherrer,Kevin K Tremper,Jaideep J Pandit","doi":"10.1213/ane.0000000000007182","DOIUrl":"https://doi.org/10.1213/ane.0000000000007182","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490633","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 Hypotension Prediction: Current Methods, Controversies, and Research Outlook.","authors":"Ramakrishna Mukkamala,Michael P Schnetz,Ashish K Khanna,Aman Mahajan","doi":"10.1213/ane.0000000000007216","DOIUrl":"https://doi.org/10.1213/ane.0000000000007216","url":null,"abstract":"Intraoperative hypotension prediction has been increasingly emphasized due to its potential clinical value in reducing organ injury and the broad availability of large-scale patient datasets and powerful machine learning tools. Hypotension prediction methods can mitigate low blood pressure exposure time. However, they have yet to be convincingly demonstrated to improve objective outcomes; furthermore, they have recently become controversial. This review presents the current state of intraoperative hypotension prediction and makes recommendations on future research. We begin by overviewing the current hypotension prediction methods, which generally rely on the prevailing mean arterial pressure as one of the important input variables and typically show good sensitivity and specificity but low positive predictive value in forecasting near-term acute hypotensive events. We make specific suggestions on improving the definition of acute hypotensive events and evaluating hypotension prediction methods, along with general proposals on extending the methods to predict reduced blood flow and treatment effects. We present a start of a risk-benefit analysis of hypotension prediction methods in clinical practice. We conclude by coalescing this analysis with the current evidence to offer an outlook on prediction methods for intraoperative hypotension. A shift in research toward tailoring hypotension prediction methods to individual patients and pursuing methods to predict appropriate treatment in response to hypotension appear most promising to improve outcomes.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489414","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":"Beyond Artificial Intelligence: A Critical Appraisal From An Airway Management Perspective.","authors":"Thomas Heidegger,Amina Ghulam,Markus Bischoff,Markus M Luedi","doi":"10.1213/ane.0000000000007181","DOIUrl":"https://doi.org/10.1213/ane.0000000000007181","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451405","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":"Pro-Con Debate: Virtual Reality Compared to Augmented Reality for Medical Simulation.","authors":"Thomas J Caruso,Asheen Rama,Santiago Uribe-Marquez,John D Mitchell","doi":"10.1213/ane.0000000000007057","DOIUrl":"https://doi.org/10.1213/ane.0000000000007057","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451404","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":"Perioperative Analgesic Interventions for Reduction of Persistent Postsurgical Pain After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-analysis.","authors":"Jens Laigaard,Anders Karlsen,Mathias Maagaard,Troels Haxholdt Lunn,Ole Mathiesen,Søren Overgaard","doi":"10.1213/ane.0000000000007246","DOIUrl":"https://doi.org/10.1213/ane.0000000000007246","url":null,"abstract":"BACKGROUNDHigh pain levels immediately after surgery have been associated with persistent postsurgical pain. Still, it is uncertain if analgesic treatment of immediate postsurgical pain prevents the development of persistent postsurgical pain.METHODSWe searched MEDLINE, CENTRAL, and Embase up to September 12, 2023, for randomized controlled trials investigating perioperative analgesic interventions and with reported pain levels 3 to 24 months after total hip or knee arthroplasty in patients with osteoarthritis. The primary outcome was pain score 3 to 24 months after surgery, assessed at rest and during movement separately. Two authors independently screened, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. We conducted meta-analyses and tested their robustness with trial sequential analyses and worst-best and best-worst case analyses.RESULTSWe included 49 trials with 68 intervention arms. All but 4 trials were at high risk of bias for the primary outcome. Moreover, the included trials were heterogeneous in terms of exclusion criteria, baseline pain severity, and which cointerventions the participants were offered. For pain at rest, no interventions demonstrated a statistically significant difference between intervention and control. For pain during movement, perioperative treatment with duloxetine (7 trials with 641 participants) reduced pain scores at 3 to 24 months after surgery (mean difference -4.9 mm [95% confidence interval {CI}, -6.5 to -3.4] on the 0-100 visual analog scale) compared to placebo. This difference was lower than our predefined threshold for clinical importance of 10 mm.CONCLUSIONSWe found no perioperative analgesic interventions that reduced pain 3 to 24 months after total hip or knee arthroplasty for osteoarthritis. The literature on perioperative analgesia focused little on potential long-term effects. We encourage the assessment of long-term pain outcomes.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449320","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":"Hidden Structures: Gap Junctions, the Claustrum, and Anesthesia.","authors":"Cameron R Bosinski,Christopher W Connor","doi":"10.1213/ane.0000000000007052","DOIUrl":"https://doi.org/10.1213/ane.0000000000007052","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449322","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":"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}