Rebecca D Margolis, Kim M Strupp, Abbie O Beacham, Myron Yaster, Thomas M Austin, Andrew W Macrae, Laura Diaz-Berenstain, Norah R Janosy
BACKGROUND: The COVID-19 pandemic has affected the personal and professional lives of all healthcare workers. Anesthesiologists frequently perform virus-aerosolizing procedures, such as intubation and extubation, that place them at increased risk of infection. We sought to determine how the initial COVID-19 outbreak affected members of the Society for Pediatric Anesthesia (SPA) on both personal and professional levels. Specifically, we examined the potential effects of gender and age on personal stress, burnout, sleep deprivation, anxiety, and depression, assessed job satisfaction, and explored financial impact...
January 12, 2021: Anesthesia and Analgesia
Vinh Pham, Le Nguyen, Riley J Hedin, Courtney Shaver, Kendall A P Hammonds, William C Culp
BACKGROUND: Use of anesthesia machines as improvised ICU ventilators may occur in locations where waste anesthesia gas suction(WAGS) is unavailable. Anecdotal reports suggest as much as 18 cmH2O positive end-expiratory pressure(PEEP) being inadvertently applied under these circumstances, accompanied by inaccurate pressure readings by the anesthesia machine. We hypothesized that resistance within closed anesthetic gas scavenging systems(AGSS) disconnected from WAGS may inadvertently increase circuit pressures...
January 12, 2021: Anesthesia and Analgesia
Christina S Boncyk, Emily Farrin, Joanna L Stollings, Kelli Rumbaugh, Jo Ellen Wilson, Matt Marshall, Xiaoke Feng, Matthew S Shotwell, Pratik P Pandharipande, Christopher G Hughes
BACKGROUND: Pharmacologic agents are frequently utilized for management of intensive care unit (ICU) delirium, yet prescribing patterns and impact of medication choices on patient outcomes are poorly described. We sought to describe prescribing practices for management of ICU delirium and investigate the independent association of medication choice on key in-hospital outcomes including delirium resolution, in-hospital mortality, and days alive and free of the ICU or hospital. METHODS: A retrospective study of delirious adult ICU patients at a tertiary academic medical center...
January 11, 2021: Anesthesia and Analgesia
Leif Saager, Kurt Ruetzler, Alparslan Turan, Kamal Maheshwari, Barak Cohen, Jing You, Edward J Mascha, Yuwei Qiu, Ilker Ince, Daniel I Sessler
BACKGROUND: Anesthesiologists typically care for patients having a broad range of procedures. Outcomes might be improved when care is provided by caregivers experienced in particular types of surgery. We tested the hypothesis that intraoperative care provided by pairs of anesthesia caregivers having significant experience with a particular type of surgery reduces a composite of in-hospital death and 6 serious complications, including bleeding, cardiac, gastrointestinal, infectious, respiratory, and urinary complications, compared to care provided by pairs of anesthesia caregivers with less experience...
January 11, 2021: Anesthesia and Analgesia
Luke J Matzek, Andrew C Hanson, Phillip J Schulte, Kimberly D Evans, Daryl J Kor, Matthew A Warner
BACKGROUND: Preoperative thrombocytopenia is associated with inferior outcomes in surgical patients, though concurrent anemia may obfuscate these relationships. This investigation assesses the prevalence and clinical significance of preoperative thrombocytopenia with thorough consideration of preoperative anemia status. METHODS: This is an observational cohort study of adults undergoing elective surgery with planned postoperative hospitalization from January 1, 2009 to May 3, 2018...
January 11, 2021: Anesthesia and Analgesia
Massimiliano Bassi, Franco Ruberto, Camilla Poggi, Daniele Diso, Marco Anile, Tiziano De Giacomo, Ylenia Pecoraro, Carolina Carillo, Francesco Pugliese, Federico Venuta, Jacopo Vannucci
No abstract text is available yet for this article.
January 8, 2021: Anesthesia and Analgesia
Brendan A McGrath, Paolo Pelosi, Michael J Brenner
No abstract text is available yet for this article.
January 8, 2021: Anesthesia and Analgesia
Yan Zhou, Huaping Sun, Ting Wang, Ann E Harman, Mark T Keegan, Alex Macario, Mohammed M Minhaj, Humayun J Chaudhry, Aaron Young, David O Warner
BACKGROUND: A temporary decrease in anesthesiology residency graduates that occurred around the turn of the millennium may have workforce implications. The aims of this study are to describe, between 2005 and 2015, (1) demographic changes in the workforce of physicians trained as anesthesiologists; (2) national and state densities of these physicians, as well as temporal changes in the densities; and (3) retention of medical licenses by mid- and later-career anesthesiologists. METHODS: Using records from the American Board of Anesthesiology and state medical and osteopathic boards, the numbers of licensed physicians aged 30-59 years who had completed Accreditation Council for Graduate Medical Education-accredited anesthesiology residency training were calculated cross-sectionally for 2005, 2010, and 2015...
January 7, 2021: Anesthesia and Analgesia
Guy L Weinberg
No abstract text is available yet for this article.
January 7, 2021: Anesthesia and Analgesia
Huaping Sun, Dandan Chen, David O Warner, Yan Zhou, Edward C Nemergut, Alex Macario, Mark T Keegan
BACKGROUND: Anesthesiology residents' experiences and perspectives about their programs may be helpful in improving training. The goals of this repeated cross-sectional survey study are to determine: (1) the most important factors residents consider in choosing an anesthesiology residency, (2) the aspects of the clinical base year that best prepare residents for anesthesia clinical training, and what could be improved, (3) whether residents are satisfied with their anesthesiology residency and what their primary struggles are, and (4) whether residents believe their residency prepares them for proficiency in the 6 Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and for independent practice...
January 7, 2021: Anesthesia and Analgesia
Michael G Fitzsimons, Mark J Rice, Keith Baker
No abstract text is available yet for this article.
January 7, 2021: Anesthesia and Analgesia
Leonore Schopfer, Walid Habre, Isabelle Pichon, Gergely H Fodor
BACKGROUND: Mechanical ventilation interferes with cerebral perfusion via changes in intrathoracic pressure and/or as a consequence of alterations in CO2. Cerebral vascular vasoreactivity is dependent on CO2, and hypocapnia can potentially lead to vasoconstriction and subsequent decrease in cerebral blood flow. Thus, we aimed at characterizing whether protective ventilation with mild permissive hypercapnia improves cerebral perfusion in infants. METHODS: Following ethical approval and parental consent, 19 infants were included in this crossover study and randomly assigned to 2 groups for which the initial ventilation parameters were set to achieve an end-tidal carbon dioxide (Etco2) of 6...
January 6, 2021: Anesthesia and Analgesia
Xue-Fei Li, Jian-Rong Hu, Yan Wu, Ying Chen, Meng-Qiu Zhang, Hai Yu
BACKGROUND: The effect of general anesthetics (propofol and volatile anesthetics) on pulmonary outcome after lung resection surgery with one-lung ventilation (OLV) is yet undetermined. We evaluated the effect of intravenous anesthesia (propofol) and volatile anesthesia (sevoflurane or desflurane) regimens on postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. METHODS: This prospective, randomized controlled trial enrolled 555 adult patients scheduled for lung resection surgery with OLV...
January 6, 2021: Anesthesia and Analgesia
Lauren M Van Decar, Emily G Reynolds, Emily E Sharpe, Monica W Harbell, Heidi E Kosiorek, Molly B Kraus
Diabetes insipidus (DI) is an uncommon perioperative complication that can occur secondary to medications or surgical manipulation and can cause significant hypovolemia and electrolyte abnormalities. We reviewed and evaluated the current literature and identified 24 cases of DI related to medications commonly used in anesthesia such as propofol, dexmedetomidine, sevoflurane, ketamine, and opioids. This review summarizes the case reports and frequency of DI with each medication and presents possible pathophysiology...
January 6, 2021: Anesthesia and Analgesia
Robert S Isaak, Lavinia M Kolarczyk, Samuel Blacker, Peggy P McNaull, Harendra Arora, David A Zvara
No abstract text is available yet for this article.
December 31, 2020: Anesthesia and Analgesia
Eric B Rosero, John Corbett, Ted Mau, Girish P Joshi
Tracheotomy is a surgical procedure through which a tracheostomy, an opening into the trachea, is created. Indications for tracheostomy include facilitation of airway management during prolonged mechanical ventilation, treatment of acute upper airway obstruction when tracheal intubation is unfeasible, management of chronic upper airway obstructive conditions, and planned airway management for major head and neck surgery. Patients who have a recent or long-term tracheostomy may present for a variety of surgical or diagnostic procedures performed under general anesthesia or sedation/analgesia...
December 24, 2020: Anesthesia and Analgesia
Julien Cobert, Reginald Lerebours, Sarah B Peskoe, Alexander Gordee, Tracy Truong, Vijay Krishnamoorthy, Karthik Raghunathan, Leila Mureebe
BACKGROUND: Anesthesiologists caring for patients with do-not-resuscitate (DNR) orders may have ethical concerns because of their resuscitative wishes and may have clinical concerns because of their known increased risk of morbidity/mortality. Patient heterogeneity and/or emphasis on mortality outcomes make previous studies among patients with DNR orders difficult to interpret. We sought to explore factors associated with morbidity and mortality among patients with DNR orders, which were stratified by surgical subgroups...
December 23, 2020: Anesthesia and Analgesia
Tianyu Liu, Shiya Zou, Lulu Guo, Zheng Niu, Min Wang, Chao Xu, Xiuxiu Gao, Zeshu Shi, Xiaowei Guo, Hanbing Xiao, Dunyi Qi
BACKGROUND: The intraoperative 15° left-tilt position during cesarean delivery has more recently been questioned regarding its effect on fetal acid-base balance and is a frequent source of complaints by surgeons. We hypothesized that a 30° left-tilt position during surgical preparation could improve the acid-base balance of the fetus compared with the 15° left-tilt or supine position during surgical preparation. METHODS: Women undergoing elective cesarean delivery under combined spinal epidural anesthesia were randomized to a supine position, 15° left-lateral tilt position or 30° left-lateral tilt position; the position was changed to supine before the incision...
December 21, 2020: Anesthesia and Analgesia
Robert G Hahn, Markus Zdolsek, Camilla Krizhanovskii, Stelia Ntika, Joachim Zdolsek
BACKGROUND: Preclinical experiments show that an inflammatory reaction causes degradation of the endothelial glycocalyx layer and accelerated capillary leakage of albumin and fluid. The hypothesis in the present study was that elevated plasma concentrations of glycocalyx degradation products are associated with greater capillary leakage in humans. METHODS: This open clinical trial involved administration of an intravenous infusion of 20% albumin at 3 mL/kg over 30 minutes to 15 postburn patients who showed an activated inflammatory response...
December 21, 2020: Anesthesia and Analgesia
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