Anesthesiology最新文献

{"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":"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":"Periacetabular Osteotomy Multimodal Pain Control Using Erector Spinae Plane vs 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 (PAO) 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 (ESPB), an ultrasound-guided injection or catheter insertion remote to the spinal canal. Despite high success with minimal complications, ESPB use during PAO has not been studied. This study's purpose was to retrospectively evaluate the efficacy and side effect profile of ESPB compared to epidural analgesia for PAO pain control.</p><p><strong>Methods: </strong>Patients at a single site received preoperative epidural (n=73) or ESPB (n=73) for PAO pain management. Data including pain scores, morphine equivalents, complications, and discharge details was retrospectively reviewed. Welch's t test, Glass' Delta, and Fisher exact tests were utilized, with an alpha 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 ESPB on postoperative day 0 (4.5 [CI: 4.0,4.9]) compared to epidural (3.5 [CI: 2.9,4.0]), p=0.008. Patients who received ESPB required fewer morphine equivalents than epidural patients on postoperative day 0, postoperative day 1, and postoperative day 2 (p<0.001). The epidural cohort had more weakness (16.44%), numbness (39.73%), and symptomatic hypotension (10.96%) compared to the ESPB cohort (4.11%, 9.59%, 1.37% respectively, p=0.03, p<0.001, p=0.03). Epidural patients were more likely to report adverse events (17.81% vs 43.16%, p<0.001).</p><p><strong>Conclusion: </strong>ESPB provides an effective method of pain control for PAO patients. Compared to lumbar epidurals, patients required less systemic opioids and reported fewer side effects, particularly numbness, symptomatic hypotension, and weakness. ESPB is an attractive option in multimodal pain protocol for PAO.</p>","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":"143370241","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":"Comparative methods to predict redosing of bupivacaine and ropivacaine in truncal catheters.","authors":"Brittani Bungart, Lana Joudeh, Eric S Schwenk, Christopher Chiang, Michael R Fettiplace","doi":"10.1097/ALN.0000000000005406","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005406","url":null,"abstract":"<p><strong>Background: </strong>Despite the frequent use of ropivacaine and bupivacaine, there is limited guidance on redosing of these medications following an initial bolus. Intermittent redosing is a clinical practice in the setting of nerve catheters, often utilizing large doses. Comparatively, theoretical elimination rates are available from pharmacokinetic studies, providing estimates on total body content of these drugs. We hypothesized that published redosing of bupivacaine and ropivacaine in clinical literature comported with safe elimination of the drugs based on pharmacokinetic studies.</p><p><strong>Methods: </strong>Clinical redosing of bupivacaine and ropivacaine were identified from previously published manuscripts that used intermittent bolus dosing into the transversus abdominis plane and paravertebral space. The dosing data were fit to an exponential curve using least squares regression and 1/Y2 weighting with the equation : Y = YM - (YM - Y0)* e-k*x where YM is the maximal dose (175 mg for bupivacaine, 210 mg for ropivacaine), Y0 is the dose at time zero, k is the elimination constant and x is time. Both minimal (i.e. slowest) and average pharmacokinetic elimination constants for ropivacaine and bupivacaine were identified in the published literature. Clinical redosing was compared with pharmacokinetic elimination.</p><p><strong>Results: </strong>The maximal pharmacokinetic half-lives of bupivacaine and ropivacaine were 603 minutes (range 154 - 2970 minutes, N=49) and 528 minutes (range 204 - 3276 minutes, N=39) respectively. Clinically reported redosing of bupivacaine fit to an exponential curve with kbupi(clinical) = 0.077 hrs-1 , representing the 53.5 th percentile of extracted pharmacokinetic minimal elimination constants. Clinically reported redosing of ropivacaine fit to a curve with kropi(clinical) = 0.083 hrs-1 consistent with the 52nd percentile of minimal pharmacokinetic elimination constants.</p><p><strong>Conclusions: </strong>Clinically reported redosing of bupivacaine and ropivacaine in the published literature reflect the slowest pharmacokinetic elimination based on human studies. The combined data without evidence of toxicity permit us to make practical recommendations about safe redosing of these agents.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188097","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":"Measuring Well-Being Influencers: Development and Validation of the WISH Inventory.","authors":"K Elliott Higgins, Theodora Wingert, Elizabeth W Duggan, Maxwell Mansolf, Jose Hernandez Carcamo, Christine Park","doi":"10.1097/ALN.0000000000005401","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005401","url":null,"abstract":"<p><strong>Background: </strong>Improving healthcare professional well-being and reducing burnout requires improving work ecosystems and cultures. Current well-being metrics focus on distal outcomes within individuals (e.g., professional fulfillment or burnout). In this study, we developed and evaluated the performance of an inventory measuring perceptions of modifiable workplace dimensions-termed influencers-that shape healthcare professionals' well-being.</p><p><strong>Methods: </strong>A core team developed the Well-Being Influencers Survey for Healthcare (WISH), an inventory designed to measure these systemic, occupational well-being influencers (e.g., leadership support, psychological safety, working conditions). Following content validation and refinement, 223 healthcare professionals from an academic department of anesthesiology completed WISH alongside established well-being measures, including the Maslach Burnout Inventory (MBI), Professional Fulfillment Index (PFI), Perceived Stress Scale (PSS), PROMIS short forms for meaning, purpose, and life satisfaction, as well as standard items of affective commitment (AC, a measure of engagement) and a standard item assessing intention to leave (ITL). Factor analysis was used to assess WISH's internal structure, while correlation and regression analyses assessed its criterion-related validity using the above established measures.</p><p><strong>Results: </strong>WISH showed expected relationships with established well-being measures, and outperformed established metrics in predicting AC and ITL after adjusting for those measures and/or covariates. Factor analysis indicated that most WISH variance reflects a single common factor, supporting the use of an instrument-level score. Unique variance at the influencer level highlights the added value of examining influencer scores.</p><p><strong>Conclusions: </strong>WISH fills a key gap in healthcare professional well-being improvement science by assessing causal factors of well-being and burnout, rather than the conditions themselves. Here, we established initial validity of this unique inventory and further reinforce the relevance of system-level and cultural factors in influencing healthcare professionals' well-being. WISH is well suited to assist healthcare professional well-being improvement efforts driven by system-improvement mindsets.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122005","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":"Gwathmey's Anesthesia: Ode to a Daring New Science.","authors":"","doi":"10.1097/ALN.0000000000005335","DOIUrl":"10.1097/ALN.0000000000005335","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 2","pages":"297"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977111","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":"Central Venous Catheter-associated Venous Thrombosis in Neonates: \"Seek and You Shall Find\".","authors":"Paul G Davies","doi":"10.1097/ALN.0000000000005305","DOIUrl":"10.1097/ALN.0000000000005305","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 2","pages":"260-262"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977148","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":"Hemodynamics Effects of the Left Lateral Decubitus Position in Pregnancy as Assessed by Simultaneous Internal Jugular and Common Carotid Doppler Ultrasound.","authors":"Leonard J Soloniuk, Christopher Baker, William Mao","doi":"10.1097/ALN.0000000000005254","DOIUrl":"10.1097/ALN.0000000000005254","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 2","pages":"349-350"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977156","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":"Safe or Skip? Association Between Intraoperative Midazolam in Elderly Patients and Rates of Postop Delirium.","authors":"Andrew Klein, Holly B Ende, Jonathan P Wanderer","doi":"10.1097/ALN.0000000000005345","DOIUrl":"10.1097/ALN.0000000000005345","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 2","pages":"A16"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977198","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":"The Notes Are for Us.","authors":"Lealani Mae Y Acosta","doi":"10.1097/ALN.0000000000005203","DOIUrl":"10.1097/ALN.0000000000005203","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 2","pages":"403"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977265","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}