Anesthesiology最新文献

{"title":"Ventilation/Perfusion and Pulmonary Complications: Comment.","authors":"Lennart Edmark, Erland Östberg","doi":"10.1097/ALN.0000000000005361","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005361","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"962-963"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802369","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":"Longitudinal Reliability of Milestones Learning Trajectories during Anesthesiology Residency.","authors":"Ting Sun, Yoon Soo Park, Fei Chen, Sean O Hogan, Pedro Tanaka","doi":"10.1097/ALN.0000000000005388","DOIUrl":"10.1097/ALN.0000000000005388","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal Milestones data reported to the Accreditation Council for Graduate Medical Education provide a structured framework for assessing the developmental progression of residents in key competencies and subcompetencies. This study aims to investigate the previously underexplored longitudinal reliability of Milestones data, with the goal of identifying patterns in learning trajectories that can inform targeted interventions for residents and programs.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted with national anesthesiology Milestones data collected from 2014 to 2020. Mixed-effects growth curve models were fit to model residents' growth trajectories. Longitudinal reliability was assessed using the indices of growth rate reliability and growth curve reliability. This study also examined variance components attributable to the factors at both the learner and program levels. Latent class growth analyses were performed to identify latent groups of learners with different learning trajectories.</p><p><strong>Results: </strong>The study included a total of 682,475 ratings for 4,976 learners in 140 programs. Growth curve model results indicated that the mean baseline Milestone rating across the 25 subcompetencies was 2.05 (95% CI, 1.96 to 2.14), with an average increase of 0.49 (95% CI, 0.48 to 0.51) units per reporting period. The growth rate reliability (mean ± SD, 0.58 ± 0.03) suggested a moderate capability of anesthesiology Milestones to detect individual differences in the growth of latent competency. Growth curve reliability estimates (mean ± SD, 0.71 ± 0.02) suggested acceptable overall reliability of Milestones across all the six assessment points. Significant variability was observed at both the program and learner levels ( P < 0.001). Latent class growth analyses identified 3 to 4 latent groups of learners with distinct learning trajectories across the 25 subcompetencies.</p><p><strong>Conclusions: </strong>The study indicated that the anesthesiology Milestones provide moderately reliable information for tracking individual progress over time. The findings underscore the importance of using a multifaceted approach to assessment and providing individualized learning plans to support resident development.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"918-928"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051400","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":"Attaining Anesthesiology Clinical Competence during Graduate Medical Education: Can We Rely on What We See?","authors":"Justin L Lockman, Alan Jay Schwartz","doi":"10.1097/ALN.0000000000005408","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005408","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"790-792"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802347","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: Reply.","authors":"Shiri Zarour, Yotam Weiss, Barak Cohen","doi":"10.1097/ALN.0000000000005387","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005387","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"968-970"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802352","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: Reply.","authors":"Simon J Davies, Zhongping Jian, Monty Mythen, Feras Hatib","doi":"10.1097/ALN.0000000000005344","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005344","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"960-962"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802355","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":"Science, Medicine, and the Anesthesiologist.","authors":"","doi":"10.1097/ALN.0000000000005451","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005451","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"A15-A17"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802363","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":"Sharing Anesthetic Records with Patients: An Opportunity to Embrace Transparency.","authors":"James Xie, Daniel Gessner, Priya Ramaswamy, Jonathan M Tan, Patrick Guffey, Julia Gálvez Delgado, Hannah Lonsdale, Meredith Kato, Brad M Taicher, De-An Zhang, Matthew Wecksell, Daniel Asher, Allan F Simpao, Ellen Wang, Seshadri C Mudumbai, Vikas O'Reilly-Shah","doi":"10.1097/ALN.0000000000005391","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005391","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"950-951"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802364","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":"Impact of Underassisted Ventilation on Diaphragm Function and Structure in a Porcine Model.","authors":"Mathieu Capdevila, Joris Pensier, Audrey De Jong, Boris Jung, July Beghin, Thomas Laumon, Yassir Aarab, Lucas Deffontis, Thomas Sfara, Ambre Cuny, Julie Carr, Nicolas Molinari, Jean-Yves Le Guennec, Fabrice Raynaud, Stefan Matecki, Laurent Brochard, Alain Lacampagne, Samir Jaber","doi":"10.1097/ALN.0000000000005390","DOIUrl":"10.1097/ALN.0000000000005390","url":null,"abstract":"<p><strong>Background: </strong>Long-term controlled mechanical ventilation in the intensive care unit induces ventilator-induced diaphragm dysfunction (VIDD). The transition from controlled mechanical ventilation to assisted mechanical ventilation is a challenge that requires clinicians to balance overassistance and underassistance. While the effects of overassistance on the diaphragm are well known, the authors aimed to assess the impact of underassistance on diaphragm function and structure in a piglet model with preexisting VIDD (after long-term controlled mechanical ventilation) or without VIDD (short-term controlled mechanical ventilation).</p><p><strong>Methods: </strong>Twenty-two Large White female piglets were anesthetized, ventilated, and separated into two groups: a VIDD group (n = 10) with long-term 72-h controlled mechanical ventilation, and a no-VIDD group (n = 12) with short-term 2-h controlled mechanical ventilation. After sedation reduction at the end of the controlled mechanical ventilation period, each piglet was switched to underassisted ventilation for 2 h. Diaphragm function (supramaximal diaphragm pressure-generating capacity assessed by negative tracheal pressure after transvenous phrenic nerve stimulation) and diaphragm structure (mini-invasive in vivo biopsies) were assessed before and after underassisted ventilation.</p><p><strong>Results: </strong>In the VIDD group, supramaximal diaphragm pressure-generating capacity decreased by 22% from (mean ± SD) 69.9 ± 12.7 to 54.9 ± 19.7 cm H 2 O ( P = 0.04) after 72 h of controlled mechanical ventilation evidencing VIDD, then dropped by a further 29% from 54.9 ± 19.7 to 38.9 ± 15.5 cm H 2 O ( P < 0.01) after 2 h of underassisted ventilation. Diaphragm pressure-generating capacity remains stable from 55.3 ± 22.7 to 58.2 ± 24 cm H 2 O ( P = 0.24) in the no-VIDD group. Diaphragm structure showed that sarcomeric injuries increase from 13 ± 10% to 24 ± 19% ( P < 0.01) and lipid droplets decrease from 14 ± 8% to 11 ± 6% ( P = 0.03) of the total micrograph area after 2 h of underassisted ventilation in the VIDD group. Sarcomeric injuries and lipid droplets accounted, respectively, for 17 ± 16% and 2 ± 3% of the total micrograph area after underassisted ventilation in the no-VIDD group.</p><p><strong>Conclusions: </strong>In this porcine model, a short 2-h exposure of underassisted ventilation induces impairment of diaphragm function with damage to the diaphragm structure in intensive care unit condition with preexisting VIDD.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"896-906"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031855","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":"Analgesic Effect of Liposomal Bupivacaine: Reply.","authors":"Stanley Sau Ching Wong, Fengfeng Wang, Christian Xinshuo Fang, Timmy Chi Wing Chan","doi":"10.1097/ALN.0000000000005385","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005385","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"966-967"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802343","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.0000000000005459","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005459","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"A9-A11"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802344","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}