Anesthesiology最新文献

{"title":"Postoperative Delirium as a Stress Test for the Aging Brain: APOE, Ascertainment, and What Anesthesiologists Should Do Next.","authors":"Lee A Goeddel, Charles Brown, Jochen D Muehlschlegel","doi":"10.1097/ALN.0000000000006214","DOIUrl":"10.1097/ALN.0000000000006214","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"805-807"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918130","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":"Choice of Anesthesia in Microelectrode Recording-guided Deep Brain Stimulation Surgery for Parkinson's Disease (CHAMPION): A Noninferiority Randomized Controlled Trial.","authors":"Sining Xie, Lin Shi, Wei Xiong, Yifang Fan, Liang Chen, Xiangjiahui Li, Yuanyuan Tong, Anchao Yang, Fangang Meng, Anxin Wang, Jianguo Zhang, Ruquan Han","doi":"10.1097/ALN.0000000000006133","DOIUrl":"10.1097/ALN.0000000000006133","url":null,"abstract":"<p><strong>Background: </strong>Deep brain stimulation for Parkinson's disease is often performed under conscious sedation or general anesthesia. However, anesthetic agents may influence intraoperative microelectrode recording, and the optimal anesthesia method for microelectrode recording remains unclear. This study compared general anesthesia and conscious sedation in preserving microelectrode recording signal intensity during deep brain stimulation.</p><p><strong>Methods: </strong>In this prospective, noninferiority randomized controlled trial, patients with Parkinson's disease (United Kingdom Brain Bank criteria) undergoing elective bilateral surgery were randomized 1:1 to the conscious sedation or the general anesthesia group. During surgery, a desflurane anesthetic titrated against the quality of the electrophysiologic signal was applied in the general anesthesia group, whereas patients in the conscious sedation group received dexmedetomidine anesthesia. The primary outcome was the proportion of patients with high-quality microelectrode recording (normalized root mean square greater than 2.0), assessed postoperatively off-line. Secondary outcomes included operation and recording duration, 6-month clinical efficacy, and complication rates.</p><p><strong>Results: </strong>Of 188 randomized patients (94 general anesthesia, 93 conscious sedation), desflurane anesthesia was noninferior for high normalized root mean square proportion (89.4% vs . 90.3%; difference, -0.96%; 95% CI, -9.62 to 7.70). The general anesthesia group had shorter operative time (difference, -9.07 min; 95% CI, -13.99 to -4.14; P < 0.001). At 6 months, changes in Unified Parkinson's Disease Rating Scale score (difference, -2.50; 95% CI, -7.20 to 2.20; P = 0.297), levodopa equivalent daily dose (difference, -58.4 mg; 95% CI, -133.56 to 16.75; P = 0.128), and complication rates (general anesthesia: 10.9% vs . conscious sedation: 8.9%; P = 0.655) were comparable between the groups.</p><p><strong>Conclusions: </strong>General anesthesia is noninferior to conscious sedation for microelectrode-guided subthalamic nucleus deep brain stimulation, providing equivalent signal intensity and clinical outcomes while improving procedural efficiency, supporting its use as a valid clinical option.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"927-941"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855758","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 Multidepartment Investigation of Occupational Well-being, Systemic Features, and Organizational Outcomes in Anesthesiology Using the Well-Being Influencers Survey for Healthcare (WISH).","authors":"K Elliott Higgins, Maxwell Mansolf, Elizabeth W Duggan, Theodora Wingert, Amy E Vinson, Jina L Sinskey, Rebecca Margolis, Lynnie R Correll, Helen Pappas, Jenna L Swisher, Leelach Rothschild, Daniel Saddawi-Konefka, Tara Carey, Adam Was, Matthew J Durand, Anna Budd, Jose Hernandez Carcamo, Christine Park","doi":"10.1097/ALN.0000000000006186","DOIUrl":"10.1097/ALN.0000000000006186","url":null,"abstract":"<p><strong>Background: </strong>High rates of distress and intention to leave threaten workforce stability and patient care in anesthesiology. Meaningful action is believed to require evidence-based insight into the systemic origins of occupational well-being shaping these risks. However, the field has lacked large-scale insights into these systemic features and their influence on well-being and its consequences using validated tools. The Well-Being Influencers Survey for Healthcare (WISH) was developed to provide a framework and metric for understanding organizational foundations of well-being. This study evaluated WISH's generalizability across a multicenter cohort, examined the relevance of system-oriented assessment, and characterized the current profile of well-being culture in anesthesiology.</p><p><strong>Methods: </strong>Participants across 11 academic anesthesiology departments completed WISH alongside occupational well-being correlates. Mediation models examined theoretical relationships among well-being influencers, cognitive-affective states, and organizational outcomes. Analysis of variance assessed differences in WISH by influencer, department, and professional role. Psychometric techniques were used to extend validity evaluation of WISH, pooling data for higher power and using meta-analysis to assess generalizability.</p><p><strong>Results: </strong>Newly collected responses from 1,470 health workers were analyzed. Multidimensional psychometric models met fit criteria. In meta-analytic summaries of departmental-level estimates, WISH significantly predicted intention to leave ( b = -0.45) and affective commitment ( b = 0.81), including after controlling for well-being correlates. Mediation results were consistent with a model in which WISH influencers are upstream of cognitive-affective states and, in turn, organizational outcomes; of the total association between WISH and organizational outcomes, most (53% for intention to leave, 64% for affective commitment) was attributable to WISH directly. Analysis of variance identified significant differences between WISH influencers: organizational justice scored lowest, whereas perceived social support, psychological safety, and inclusion and belonging scored highest.</p><p><strong>Conclusions: </strong>WISH identifies systemic features associated with well-being and its consequences, including intention to leave. Multicenter findings extend validation evidence for WISH, clarify the relevance of system-oriented assessment, and characterize the profile of well-being culture in academic anesthesiology.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"902-917"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148090","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":"Magnetic Resonance Imaging Measures of Brain Health: Powerful Tools for an Important Problem.","authors":"Keith M Vogt, James W Ibinson","doi":"10.1097/ALN.0000000000006255","DOIUrl":"10.1097/ALN.0000000000006255","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"812-814"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918118","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":"Medicare's 2026 to 2030 Transforming Episode Accountability Model (TEAM): Implications for Anesthesiologists.","authors":"Anjali K Ghoshal, Robert S Kaplan, Angela M Bader, David L Hepner","doi":"10.1097/ALN.0000000000006231","DOIUrl":"10.1097/ALN.0000000000006231","url":null,"abstract":"<p><p>Medicare's Transforming Episode Accountability Model (TEAM) represents a significant shift in surgical care reimbursement. TEAM's bundled payment introduces episode-level accountability for cost and outcomes, replacing fee-for-service for discrete activities. TEAM's risk-sharing payments will reshape the clinical and financial environment in which anesthesiologists practice, as their reimbursement is included within the bundle. Their role in perioperative decision-making can strongly influence the performance of hospitals operating under TEAM's risk-sharing arrangements. This article outlines TEAM's structure and examines how episode-based payment models elevate aspects of anesthesiology practice that have traditionally been undervalued under fee-for-service reimbursement. The article also describes the expanded roles for anesthesiologists to prevent complications and to optimize perioperative care. Finally, the article discusses the growing need for anesthesiologists to define, measure, and report outcomes that reflect their contribution to patient recovery and resource utilization. As payment models evolve, aligning anesthesiology practice with episode-level metrics will demonstrate its value for delivering accountable surgical care.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"848-856"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918151","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":"Journal-related Activities and Other Special Activities at the 2026 American Society of Anesthesiologists Annual Meeting.","authors":"","doi":"10.1097/ALN.0000000000006243","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006243","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"841"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944059","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":"Reassessing Local Anesthetic and Adjuvant Mixtures: Comment.","authors":"Brian A Williams, Marsha E Ritter, Michael S Patzkowski","doi":"10.1097/ALN.0000000000006247","DOIUrl":"10.1097/ALN.0000000000006247","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"1073-1075"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918069","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":"Intraoperative Hypotension and Postoperative Complications: When a Simple Story Becomes Complex.","authors":"Duminda N Wijeysundera, Michael R Mathis","doi":"10.1097/ALN.0000000000006240","DOIUrl":"10.1097/ALN.0000000000006240","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"808-811"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918074","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":"Reassessing Local Anesthetic and Adjuvant Mixtures: Reply.","authors":"Lukas Gasteiger, Philipp Lirk, Peter Marhofer, Elisabeth Gasteiger, Markus W Hollmann, Ottokar Stundner","doi":"10.1097/ALN.0000000000006251","DOIUrl":"10.1097/ALN.0000000000006251","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"1077-1079"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918083","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 Management Risks in Pediatric Anesthesia: Reply.","authors":"Taiki Kojima","doi":"10.1097/ALN.0000000000005989","DOIUrl":"10.1097/ALN.0000000000005989","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1057-1058"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508768","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}