Anesthesiology最新文献

{"title":"Anesthesiologist Training in Empathetic Communication for Obstetric Emergencies Improves Patient-reported Outcomes.","authors":"Okechukwu U Aloziem, Andrew L Thurston, Ryan C Romeo, Jeanette R Bauchat, Priya Gopalan, C Tyler Smith, Grace Lim","doi":"10.1097/ALN.0000000000005353","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005353","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412996","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":"Biventricular Response to Positive End-expiratory Pressure in Swine: Assessment Based on Beat-to-beat Pressure Waveform Analysis.","authors":"Joaquin Araos, Felix Glocker, Clark G Owyang, Felipe Teran, Jiwon Kim, Gary Nieman, Paul M Heerdt","doi":"10.1097/ALN.0000000000005363","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005363","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413000","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":"Effects of lung expansion on global and regional pulmonary blood volume in a sheep model of acute lung injury.","authors":"Mingyang Zang, Congli Zeng, David Lagier, Nan Leng, Kira Grogg, Gabriel Motta-Ribeiro, Andrew F Laine, Tilo Winkler, Marcos F Vidal Melo","doi":"10.1097/ALN.0000000000005412","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005412","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary capillary blood volume is a major determinant of lung gas transport efficiency, and also potentially related to ventilator-induced lung injury. Yet, knowledge on how lung expansion influences pulmonary blood volume in injured lungs is scant. We hypothesize that lung expansion produced by positive end-expiratory pressure (PEEP) modulates the global and regional spatial distribution of pulmonary blood volume.</p><p><strong>Methods: </strong>In a lung injury model exposed to distinct lung expansion within clinical range (PEEP=5-20 cmH2O), we aimed to determine whole-lung and regional blood volume, their dynamic changes, and association with gas volume changes. Seven healthy sheep were subjected to 3h of low-lung volume mechanical ventilation at PEEP=0 cmH2O and systemic endotoxemia. PEEP=5 (low), 20 (high), and 12 (intermediate) cmH2O were applied to produce distinct lung expansion. Respiratory-gated positron emission tomography with 11C-labelled carbon monoxide and 4-dimensional computed tomography were obtained to quantify blood volume and aeration.</p><p><strong>Results: </strong>Transpulmonary pressures were lowest at PEEP=12 cmH2O. Changes in whole-lung blood volume correlated with gas volume changes between PEEP=5 and 12 cmH2O at end-expiration (P<0.001) and end-inspiration (P<0.001), but not between PEEP=12 and 20 cmH2O. Tissue-normalized blood volume (VBtissue) was heterogeneously distributed, with mean values in non-dependent regions (VBtissue=0.116±0.055) approximately 7-times smaller than those in mid-dependent regions (VBtissue=0.832±0.132). PEEP=12 cmH2O resulted in the most homogeneous VBtissue distribution, with largest means in mid-dependent regions and inspiratory 10th-percentile, a measure of lowest values, throughout the lung. VBtissue increased with inspiration at PEEP=5 and 12 cmH2O but decreased with PEEP=20 cmH2O in mid-nondependent regions.</p><p><strong>Conclusions: </strong>During low-volume mechanical ventilation and systemic endotoxemia, lung blood volume is markedly heterogeneously distributed, and modulated by PEEP. Nondependent regions are susceptible to low blood volume and capillary closure. Recruitment of pulmonary vascular blood volume with gas volume is nonlinear, limited at intermediate PEEP indicating its advantage to spatial distribution of blood volume.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413019","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":"Preoperative Electroencephalography Biomarkers to Identify Children at Risk for Emergence Delirium.","authors":"Xuan Li, Dezhao Liu, Niannian Chen, Zheng Li, Xiaoli Li, Tianyi Zhou","doi":"10.1097/ALN.0000000000005334","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005334","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397767","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":"Dr. Benjamin Rush: The Founding Father Who Healed a Wounded Nation.","authors":"Kathryn E McGoldrick","doi":"10.1097/ALN.0000000000005317","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005317","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397672","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":"A Quantitative Analysis on Depictions of Chronic Pain Generated via DALL-E 3, a Text-to-Image Artificial Intelligence Tool.","authors":"Morgan King, Serena Zahra, Ethan Patterson","doi":"10.1097/ALN.0000000000005364","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005364","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397669","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":"With.","authors":"Grace S Kao","doi":"10.1097/ALN.0000000000005319","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005319","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389705","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":"Leading with Harmony: Lessons in Leadership from Music Theory for Anesthesiologists.","authors":"Rafael Ortega, Soobin Song","doi":"10.1097/ALN.0000000000005365","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005365","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389698","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":"Neuromuscular Blockade and Antagonism in Patients with Renal Impairment: A Multicenter Retrospective Cross Sectional Study.","authors":"Rania Elkhateb, Davis L Campbell, Xinyi Zhao, Graciela Mentz, Nadir El Sharawi, Sathish Kumar, Jill M Mhyre, Sachin Kheterpal, Douglas A Colquhoun","doi":"10.1097/ALN.0000000000005411","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005411","url":null,"abstract":"<p><strong>Background: </strong>Current practice guidelines do not address the use of neuromuscular blocking and antagonism agents in patients with renal impairment. The FDA label for sugammadex advises against use in patients with severe renal impairment (eGFR < 30 ml/min). Using a multicenter electronic health record registry, we sought to understand the modern use of neuromuscular blockade and antagonism agents in patients with significant renal impairment (eGFR < 60 ml/min).</p><p><strong>Methods: </strong>Data was obtained from the Multicenter Perioperative Outcomes Group (MPOG) registry, for adult patients (>18yrs) with an estimated glomerular filtration rate (eGFR) < 60ml/min, based on most recent serum creatinine, receiving general anesthesia for a non-renal transplant procedure with an endotracheal tube between January 1st 2016 and July 31st 2022. Patients were classified into three mutually exclusive blockade and reversal strategies: rocuronium-sugammadex, cisatracurium-neostigmine and rocuronium-neostigmine. Adjusted incidence of each blockade reversal strategy was established by a multinomial mixed effects model. The contribution of institution, anesthesiologist, and patient/case factors to variation to strategy choice was assessed by multilevel mixed effects models.</p><p><strong>Results: </strong>In 243,944 cases across 5,133 anesthesiologists and 48 institutions, adjusted use of rocuronium-sugammadex increased from 4.4% to 95.2% and rocuronium-neostigmine decreased from 84.7% to 4.3% and cisatracurium-neostigmine decreased from 10.9% to 0.5%. In patients with an eGFR <15ml/min, rocuronium-sugammadex use increased from 0.5% to 86.9%. 30.1% of the variation in choice of rocuronium-sugammadex vs cisatracurium-neostigmine, was attributed to the institution, 22.7% to the attending anesthesiologist and 47.2% to patient/case factors or was unexplained. The adjusted median odds ratio for this choice was 2.5 for clinicians and 3.1 for institutions.</p><p><strong>Conclusion: </strong>Rocuronium-sugammadex is the primary neuromuscular blockade-antagonism strategy for patients with moderate and severe renal impairment. Variation in choice is significantly impacted by the institution and attending anesthesiologist providing care.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389704","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":"Airway Injury during Double-lumen Endotracheal Intubation.","authors":"Elisa C Walsh, Paul H Alfille, Xiaodong Bao","doi":"10.1097/ALN.0000000000005357","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005357","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370239","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}