Anesthesiology最新文献

{"title":"Continuing Anesthesia Services in the Face of a Prolonged Digital Health System Outage.","authors":"Eric C Cheon, Samantha Shaffer, Kailey McCarthy, Olga Leavitt, Shivali Mukerji, Courtney Hardy","doi":"10.1097/ALN.0000000000005508","DOIUrl":"10.1097/ALN.0000000000005508","url":null,"abstract":"<p><p>In today's digitized healthcare environment, electronic health records (EHRs) and other electronic systems are key to daily hospital operations, patient care, and compliance. The authors' institution underwent a prolonged EHR system outage that caused the Department of Pediatric Anesthesiology to rely on established downtime procedures. While the intraoperative EHR is lost, this is only one of many domains that can be affected by an outage. In fact, all aspects of care, from patient identification materials to operating room schedules to in-house communication, can be significantly affected. Anesthesia providers must be ready to revert to preestablished downtime protocols to continue safe care while also maintaining financial sustainability. The following narrative review details the department's operational responses and outlines how safe and quality health care continued to be delivered, providing recommendations for other hospitals that may face similar challenges.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"266-274"},"PeriodicalIF":9.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We Can Dream: Comment.","authors":"Harrison B Smith, Joseph Kellen, Andrea Lorenz","doi":"10.1097/ALN.0000000000005530","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005530","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 2","pages":"476"},"PeriodicalIF":9.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We Can Dream: Comment.","authors":"Manuela Jaramillo Arias, Addison M Yee, Ayesha Vohra","doi":"10.1097/ALN.0000000000005529","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005529","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 2","pages":"475"},"PeriodicalIF":9.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric Anesthesia Workforce Survey: Forty-year Update.","authors":"Brenda A Bucklin, Joy L Hawkins, Nancy L Asdigian, Victoria Kennerley, Jack Pattee, Andrea J Traynor","doi":"10.1097/ALN.0000000000005507","DOIUrl":"10.1097/ALN.0000000000005507","url":null,"abstract":"<p><strong>Background: </strong>For 40 yr, Obstetric Anesthesia Workforce Surveys have been used every decade to assess trends in obstetric anesthesia practice and potential areas for improvement. Anesthesia providers from U.S. hospitals were surveyed in 2022 to 2023 to provide data for their hospitals from 2021. The primary hypothesis was that obstetric anesthesia services have changed in the last decade.</p><p><strong>Methods: </strong>Previous workforce surveys were used to develop the 32-question survey about contemporary obstetric anesthesia practice. A hospital sample (n = 1,180) was generated based on number of births per year and U.S. census region. Using web-push survey methodology, a QR code was assigned to the \"Chief of Anesthesiology\" at each hospital. A link to an online Research Electron Data Capture survey was emailed to individuals along with reminder communications. Nonresponding hospitals received paper surveys and self-addressed stamped envelopes for survey return. The results were analyzed using R statistical package at a significance level of P < 0.05.</p><p><strong>Results: </strong>There were 284 (24%) responses to the survey. Hospitals providing obstetric care have decreased 50% over four decades. Of all the respondents, 77% work in nonacademic hospitals without residency programs. Comparing academic to nonacademic hospitals, academic providers are less likely to have other clinical responsibilities: 35% versus 62%, respectively. The weighted overall rate of neuraxial labor analgesia is 84%. Elective cesarean deliveries are usually performed with spinal anesthesia (85%). Neuraxial anesthesia is used in 86% of urgent cesareans, while 14% use general anesthesia.</p><p><strong>Conclusions: </strong>Despite stable annual birth rates in the United States, the number of hospitals providing obstetric care decreased by 50% over the last 40 yr. This study describes nonacademic practice and not just academic teaching hospitals. Increased access to neuraxial labor analgesia is a dramatic step toward reducing in-hospital maternal mortality and improving healthcare disparities.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"330-344"},"PeriodicalIF":9.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serratus Anterior Plane Block for Lung Resection: Comment.","authors":"Keqin Wang, Yuqi Zhang, Ziqian Zhang, Yan Wu, Xinghe Wang, Xiaoyi Chen, Junda Chen, Linlin Zhao, Su Liu","doi":"10.1097/ALN.0000000000005539","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005539","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 2","pages":"480-481"},"PeriodicalIF":9.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Use of Activated Prothrombin Complex Concentrates.","authors":"Anil K Panigrahi, Joseph R Shaw","doi":"10.1097/ALN.0000000000005515","DOIUrl":"10.1097/ALN.0000000000005515","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"412-423"},"PeriodicalIF":9.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Genetic Factors Associated with Intraoperative Minimum Alveolar Concentration Ratio: A Single-center Retrospective Cohort and Genome-wide Association Study.","authors":"Nicholas J Douville, Elizabeth S Jewell, Xinyi Zhao, Douglas A Colquhoun, Emily Bertucci-Richter, Sebastian Zöllner, Ryan P Davis, Sathish S Kumar, George A Mashour","doi":"10.1097/ALN.0000000000005602","DOIUrl":"10.1097/ALN.0000000000005602","url":null,"abstract":"<p><strong>Background: </strong>Minimum alveolar concentration (MAC) is a standard dosing metric for general anesthesia. Although influences of MAC have been identified in controlled studies, the determinants of clinical delivery of MAC ratio are largely unknown. To address this knowledge gap, the authors performed this single-center retrospective study. The primary objective was to understand factors associated with MAC ratio, as indexed by the end-tidal volatile anesthetic concentration, for a given case. It was hypothesized that mean arterial pressure (MAP) was strongly associated with anesthetic delivery; a secondary objective was to perform a genome-wide association study to identify genetic variants associated with MAC ratio in clinical practice.</p><p><strong>Methods: </strong>The primary outcome was mean age-adjusted MAC ratio during the maintenance phase of anesthesia. The primary exposure variable was mean MAP during the same time window. The correlation between the outcome, exposure, and a variety of demographic, laboratory, procedural, and anesthetic covariates was assessed in adjusted multivariable linear regressions. Next, the authors performed two genome-wide association studies of clinically delivered MAC ratio.</p><p><strong>Results: </strong>Of the 30,125 cases included in the final dataset, mean ± SD age-adjusted MAC ratio was 1.066 ± 0.173, and mean MAP was 82 ± 10 mmHg. MAP was associated with MAC ratio in the overall model (β = 0.0028; 95% CI, 0.0024 to 0.0032; P < 0.0001). A variety of demographic ( e.g. , female sex: β = -0.0182; 95% CI, -0.0219 to -0.0144; P < 0.0001), laboratory, surgical, and anesthetic factors were also associated with anesthetic agent concentration. Eight variants located near six genes ( DPH6 , CPM , EEFSEC , SGSM1 , CDH9 , and DISC1 ) reached the lower suggestive threshold ( P < 1 × 10 -6 ) in one but not both models; none exceed the threshold for genome-wide significance ( P < 5 × 10 -8 ).</p><p><strong>Conclusions: </strong>The hypothesis was verified that MAP was associated with clinical delivery of MAC ratio. The authors also characterized practice patterns of inhalational anesthetic management and identified numerous covariates that need to be accounted for when modeling anesthetic requirements. Female patients received lower doses of anesthetic, despite evidence that they have a higher requirement. While genome-wide association studies failed to identify novel variants at the level of genome-wide significance ( P < 5 × 10 -8 ), multiple mechanistically plausible genes were suggested. Notably, the DISC1 gene has been shown to impact resting-state brain activations under general anesthesia with isoflurane and has been linked to abnormal sleep/wake patterns.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The pain and suffering are just too great for me to manage\": A qualitative study of emotional distress among anesthesiologists after challenging clinical events.","authors":"Courtney J Burns,Maedeh Marzoughi,Laura Sinko,Daniel Saddawi-Konefka,Kelcey Stratton,Matthew Sigakis,Matthew Wixson,Stefanie Simmons,Melissa Ramirez,Sachin Kheterpal,Adam Was","doi":"10.1097/aln.0000000000005660","DOIUrl":"https://doi.org/10.1097/aln.0000000000005660","url":null,"abstract":"BACKGROUNDAnesthesiologists manage acute clinical events that can cause emotional distress. These experiences can lead to mental health challenges and affect clinicians' ability to provide care. However, the literature regarding specific factors of clinical events that cause emotional distress is limited, and their impact remains understudied. The objectives were to explore elements within anesthesiologists' practice environment contributing to distress associated with clinical events and elicit emotions and symptoms regarding clinical events that are distressing long-term.METHODSAnesthesiology faculty members at an academic institution were invited to engage in 30-minute individual qualitative interviews. They were prompted to reflect on a clinical event that caused them lasting emotional distress. Questions were based on risk factors for post-traumatic stress disorder, focusing on two time periods: during the event and after it. To maintain study rigor, a trustworthiness framework was used that emphasized four components: transferability, dependability, credibility, and confirmability. A thematic analysis approach with two coders followed, with an audit trail maintained throughout.RESULTSTwenty anesthesiology faculty members representing nine anesthesiology subspecialties were interviewed. Risk factors leading to emotional distress represented three areas: the clinical event, context, and patient. Clinical-related risk factors included clinical errors, a physician's first time encountering a clinical scenario, lack of adequate clinical support, and unexpected outcomes. Contextual risk factors involved legal and professional repercussions, mistreatment by non-anesthesiology colleagues, personal stress, and unsupportive leadership. Patient-related risk factors included having developed a close relationship with the patient, a patient's similarity to the clinician or their loved ones, and young patient age. Participants described emotions such as sadness, guilt, shame, helplessness, and self-doubt, and physical symptoms of emotional stress, flashbacks, and intrusive thoughts.CONCLUSIONSAnesthesiologists experience profound and lasting emotional impacts from challenging clinical events. Future research should evaluate interventions to mitigate these impacts on anesthesiologists' mental health and career longevity.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"52 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gabapentin for pain management following major surgery: a placebo controlled, double blind, randomized clinical trial (The GAP Study).","authors":"Sarah Baos,Mandy Lui,Terrie Walker-Smith,Maria Pufulete,David Messenger,Reyad Abbadi,Tim Batchelor,Gianluca Casali,Mark Edwards,Nick Goddard,Mohammed Abu Hilal,Aiman Alzetani,Marius Vaida,Petr Martinovsky,Palinikumar Saravanan,Tim Cook,Rajiv Malhotra,Anna Simpson,Ross Little,Sarah Wordsworth,Elizabeth Stokes,Jingjing Jiang Eu-Hem,Barnaby Reeves,Lucy Culliford,Laura Collett,Rachel Maishman,Nilesh Chauhan,Liz McCullagh,Holly McKeon,Samantha Abbs,Jenny Lamb,Anna Gilbert,Chloe Hughes,David Wynick,Gianni Angelini,Mike Grocott,Ben Gibbison,Chris A Rogers, ","doi":"10.1097/aln.0000000000005655","DOIUrl":"https://doi.org/10.1097/aln.0000000000005655","url":null,"abstract":"BACKGROUNDGabapentin is an anticonvulsant medication with approval for use in neuropathic pain and epileptic disorders. It is frequently added to multimodal analgesic regimens during and after surgery to reduce opioid use while controlling pain effectively. There is little evidence to show its effectiveness in major surgery.METHODSIn this multicenter, double blinded, randomized controlled trial, adults undergoing major cardiac, thoracic or abdominal surgery were randomized to receive either gabapentin (600mg before surgery, 300mg twice daily for 2 days after surgery) or placebo. The primary outcome was length of hospital stay. Secondary outcomes included acute and chronic pain, total opioid use, adverse health events and health related quality of life. Patients were followed up daily in-hospital until discharge and then at 4-weeks and 4 months after surgery.RESULTS1196 participants were randomized (500 underwent cardiac, 346 thoracic and 350 abdominal surgery); 596 were allocated to placebo and 600 were allocated to gabapentin. Median length of hospital stay was similar in the two groups (gabapentin 5.94 (IQR 4.08-8.04) days, placebo 6.15 (IQR 4.22 - 8.97) days; hazard ratio 1.07, 95%CI 0.95-1.20, p=0.26). Overall, 384 participants experienced one or more serious adverse events (gabapentin 189/596, 31.7%; placebo 195/599, 32.6%), with some variation across surgical specialties.CONCLUSIONSAmong patients undergoing major cardiac, thoracic and abdominal surgery, adding gabapentin to multimodal analgesic regimes did not alter the length of hospital stay, or the number of serious adverse events.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"666 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head Strikes Among Perioperative Personnel in the United States: A Mixed Methods Study.","authors":"Anastasia P Piersa,Karina M Chan,Allison Doney,Martin S Copenhaver,Rajshri M Gartland,Wilton C Levine,Lynn G Collier,May C M Pian-Smith,Lia E Tron","doi":"10.1097/aln.0000000000005657","DOIUrl":"https://doi.org/10.1097/aln.0000000000005657","url":null,"abstract":"BACKGROUNDHealthcare workers face major occupational hazards. While various workplace safety risks for anesthesiologists have been documented, head injuries remain an underrecognized hazard. This study aimed to determine the frequency and characteristics of head strikes among anesthesiologists and perioperative nurses, examine reporting practices, and identify potential preventive strategies.METHODSIn this mixed-methods, cross-sectional national study, a 22-question survey was distributed to U.S.-based anesthesiologists and perioperative nurses in February and March of 2024. The survey, developed by a multidisciplinary team, included multiple-choice and free-response questions. The primary outcome measure was whether the individual had experienced a head strike in an operating or procedural room in the prior 12 months. Secondary outcome measures included the number of head strikes; source, timing, and head location of the strike; the amount of time taken off from work; whether a safety report was filed; and free-text responses for contributing factors, suggested changes to reduce risk, and challenges in reporting injuries. Qualitative responses were coded by investigator pairs using two collectively developed codebooks with themes and subthemes emerging inductively.RESULTSOf the 1,549 anesthesiologists (6.6% response rate) and 287 nurses (2.7% response rate), 1,441 (78.5%) reported at least one head strike in the preceding year. Common sources included monitors (73.4% of respondents), light heads (37.4%), and boom-mounted equipment (33.4%). Most (948, 65.8%) incidents occurred intraoperatively. Causes of head strikes were multifactorial, frequently a combination of equipment placement, clinician movement, and tasks occurring under time pressure. Only 69 (4.8%) filed a safety report following a head strike. Barriers to reporting included time constraints, perception of strikes as minor incidents, and fear of negative consequences.CONCLUSIONSHead strikes are a common but underreported occupational hazard in perioperative and periprocedural settings. Multi-faceted interventions addressing equipment design, workspace organization, and reporting culture are needed to reduce such risks.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"10 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}