Anesthesiology最新文献

{"title":"Lost in Transition: New Evidence on the Risks of Underassisted Ventilation on the Diaphragm.","authors":"Martin Dres, Ewan C Goligher","doi":"10.1097/ALN.0000000000005420","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005420","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"787-789"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802357","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":"This Month in Anesthesiology.","authors":"","doi":"10.1097/ALN.0000000000005449","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005449","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"A1-A2"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802367","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":"Amino Acid Infusion for Kidney Protection in Cardiac Surgery Patients with Chronic Kidney Disease: A Secondary Analysis of the PROTECTION Trial.","authors":"Martina Baiardo Redaelli, Fabrizio Monaco, Nikola Bradic, Anna Mara Scandroglio, Lian Kah Ti, Alessandro Belletti, Cristina Viscido, Margherita Licheri, Fabio Guarracino, Alessandro Pruna, Antonio Pisano, Domenico Pontillo, Francesco Federici, Rosario Losiggio, Giovanni Serena, Enrico Tomasi, Simona Silvetti, Marco Ranucci, Luca Brazzi, Andrea Cortegiani, Giovanni Landoni, Pasquale Mastroroberto, Gianluca Paternoster, Mario F L Gaudino, Alberto Zangrillo, Rinaldo Bellomo","doi":"10.1097/ALN.0000000000005336","DOIUrl":"10.1097/ALN.0000000000005336","url":null,"abstract":"<p><strong>Background: </strong>In the PROTECTION trial (Intravenous Amino Acid Therapy for Kidney Protection in Cardiac Surgery), intravenous amino acids decreased the occurrence of acute kidney injury in cardiac surgery patients with cardiopulmonary bypass. Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease have diminished renal functional reserve, and amino acids may be less protective in such patients. Thus, a separate investigation of such patients is warranted.</p><p><strong>Methods: </strong>For this study chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 ml · min -1 · 1.73 m -2 , and patients with estimated glomerular filtration rates greater than or equal to 60 ml · min -1 · 1.73 m -2 served as controls. The primary outcome was the occurrence of acute kidney injury. Secondary outcomes included severity of acute kidney injury, need for and duration of renal replacement therapy, and all-cause mortality.</p><p><strong>Results: </strong>Among chronic kidney disease patients (n = 812), compared with placebo, amino acids significantly decreased the rate of acute kidney injury (43.1% vs 50.3%; relative risk, 0.86; 95% CI, 0.74 to 0.99; P = 0.041; number needed to treat = 14) with a median percentage increase in estimated glomerular filtration rate from baseline to postoperative day 3 of 12.7% versus 6.5% ( P = 0.002). In estimated glomerular filtration rate-based chronic kidney disease subgroups (30 to 39, 40 to 49, and 50 to 59 ml · min -1 · 1.73 m -2 ), the amino acid effect was similar (interaction P = 0.50). Finally, amino acid infusion decreased the occurrence of severe (stage 3) acute kidney injury (2.7% vs . 5.6%; relative risk 0.48; 95% CI, 0.24 to 0.98; P = 0.038).</p><p><strong>Conclusions: </strong>Amino acid infusion protected chronic kidney disease patients undergoing cardiopulmonary bypass from developing acute kidney injury, with an absolute risk reduction of 7% and a number needed to treat of 14 in a cohort with a greater than 45% rate of acute kidney injury. Moreover, it delivered a greater than 50% relative risk reduction in severe acute kidney injury.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"818-828"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869296","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":"Developing an Electroencephalogram-based Model to Predict Awakening after Cardiac Arrest Using Partial Processing with the BIS Engine.","authors":"Samuel B Snider, Bradley J Molyneaux, Anarghya Murthy, Quinn Rademaker, Hafeez Rajwani, Benjamin M Scirica, Jong Woo Lee, Christopher W Connor","doi":"10.1097/ALN.0000000000005369","DOIUrl":"10.1097/ALN.0000000000005369","url":null,"abstract":"<p><strong>Background: </strong>Accurate prognostication in comatose survivors of cardiac arrest is a challenging and high-stakes endeavor. The authors sought to determine whether internal electroencephalogram (EEG) subparameters extracted by the BIS monitor (Medtronic, USA), a device commonly used to estimate depth of anesthesia intraoperatively, could be repurposed to predict recovery of consciousness after cardiac arrest.</p><p><strong>Methods: </strong>In this retrospective cohort study, a three-layer neural network was trained to predict recovery of consciousness to the point of command following versus not based on 48 h of continuous EEG recordings in 315 comatose patients admitted to a single U.S. academic medical center after cardiac arrest (derivation cohort, n = 181; validation cohort, n = 134). Continuous EEGs were partially processed into subparameters using virtualized emulation of the BIS Engine ( i.e. , the internal software of the BIS monitor) applied to signals from the frontotemporal leads of the standard 10-20 EEG montage. The model was trained on hourly averaged measurements of these internal subparameters. This model's performance was compared to the modified Westhall qualitative EEG scoring framework.</p><p><strong>Results: </strong>Maximum prognostic accuracy in the derivation cohort was achieved using a network trained on only four BIS subparameters (inverse burst suppression ratio, mean spectral power density, gamma power, and theta/delta power). In a held-out sample of 134 patients, the model outperformed current state-of-the-art qualitative EEG assessment techniques at predicting recovery of consciousness (area under the receiver operating characteristics curve, 0.86; accuracy, 0.87; sensitivity, 0.83; specificity, 0.88; positive predictive value, 0.71; negative predictive value, 0.94). Gamma band power has not been previously reported as a correlate of recovery potential after cardiac arrest.</p><p><strong>Conclusions: </strong>In patients comatose after cardiac arrest, four EEG features calculated internally by the BIS Engine were repurposed by a compact neural network to achieve a prognostic accuracy superior to the current clinical qualitative accepted standard, with high sensitivity for recovery. These features hold promise for assessing patients after cardiac arrest.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"806-817"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942906","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":"Every Deep-drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU.","authors":"Megan Russell, May Hua","doi":"10.1097/ALN.0000000000005402","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005402","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"974-975"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802349","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":"Hypotension Prediction Index Revalidation: Comment.","authors":"Johannes Enevoldsen, Simon T Vistisen","doi":"10.1097/ALN.0000000000005342","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005342","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"956-958"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802353","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":"Periacetabular Osteotomy Multimodal Pain Control Using Erector Spinae Plane versus Epidural Catheter: A Retrospective Cohort Analysis.","authors":"Anna K Fiedler, Jacob J Siahaan, Alexis H Aboulafia, Angel A Ham, Alfred A Mansour","doi":"10.1097/ALN.0000000000005409","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005409","url":null,"abstract":"<p><strong>Background: </strong>Periacetabular osteotomy is an established treatment for symptomatic developmental hip dysplasia. Epidural analgesia is traditionally used for perioperative pain management but may have negative secondary effects, including distal motor and sensory deficits, and hypotension, which delays rehabilitation and prolongs discharge. One alternative is erector spinae plane block, an ultrasound-guided injection or catheter insertion remote to the spinal canal. Despite high success with minimal complications, erector spinae plane block use during periacetabular osteotomy has not been studied. This study's purpose was to retrospectively evaluate the efficacy and side effect profile of erector spinae plane block compared to epidural analgesia for periacetabular osteotomy pain control.</p><p><strong>Methods: </strong>Patients at a single site received preoperative epidural (n = 73) or erector spinae plane block (n = 73) for periacetabular osteotomy pain management. Data including pain scores, morphine equivalents, complications, and discharge details were retrospectively reviewed. Welch's t test, Glass's δ, and Fisher exact tests were utilized, with an α level of 0.05 to indicate statistical significance.</p><p><strong>Results: </strong>There were no significant differences in patient populations, catheter use duration, or length of stay between groups ( P > 0.05). Patients reported slightly more pain with erector spinae plane block on postoperative day 0 (mean pain score of 4.5 [CI, 4.0 to 4.9]) compared to epidural (3.5 [CI, 2.9 to 4.0]; P = 0.008). Patients who received erector spinae plane block required fewer morphine equivalents than epidural patients on postoperative days 0, 1, and 2 ( P < 0.001). The epidural cohort had more weakness (16.44%), numbness (39.73%), and symptomatic hypotension (10.96%) compared to the erector spinae plane block cohort (4.11, 9.59, and 1.37%, respectively; P = 0.03, P < 0.001, and P = 0.03, respectively). Epidural patients were more likely to report adverse events (17.81% vs. 43.16%; P < 0.001).</p><p><strong>Conclusions: </strong>Erector spinae plane block provides an effective method of pain control for periacetabular osteotomy patients. Compared to lumbar epidurals, patients required less systemic opioids and reported fewer side effects, particularly numbness, symptomatic hypotension, and weakness. Erector spinae plane block is an attractive option in multimodal pain protocol for periacetabular osteotomy.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"907-915"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810400","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":"Anesthesiology.","authors":"","doi":"10.1097/ALN.0000000000005481","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005481","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"A3-A8"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802345","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":"Hypotension and Postoperative Delirium: Comment.","authors":"Michal Pruc, Lukasz Szarpak","doi":"10.1097/ALN.0000000000005386","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005386","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"967-968"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802351","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":"Hypotension Prediction Index Revalidation: Comment.","authors":"Ramakrishna Mukkamala, Michael Schnetz, Aman Mahajan","doi":"10.1097/ALN.0000000000005343","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005343","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"958-960"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802354","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}