Vasudha Goel, Benedict Moran, Alexander M Kaizer, Eellan Sivanesan, Amol M Patwardhan, Mohab Ibrahim, Jacob C DeWeerth, Clarence Shannon, Hariharan Shankar
BACKGROUND: Pain medicine physicians (PMP) are a group of physicians with background training in various primary specialties with interest and expertise in managing chronic pain disorders. Our objective is to analyze prescription drug (PD) claims from the Medicare Part D program associated with PMP to gain insights into patterns, associated costs, and potential cost savings areas. METHODS: The primary data source for Part D claims data is the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse, which contains Medicare Part D prescription drug events (PDE) records received through the claims submission cutoff date...
January 15, 2021: Anesthesia and Analgesia
Adam C Adler, Anna Daszkowski, Joy C Tan, Anna D Poliner, Eric Z Wei, Brian H Nathanson, Arvind Chandrakantan
BACKGROUND: Dexmedetomidine is used to reduce opioid consumption in pediatric anesthesia. However, there is conflicting evidence in pediatric adenotonsillectomy literature regarding the total perioperative opioid-sparing effects of dexmedetomidine. The aim of this study was to examine the association between dexmedetomidine and total perioperative opioid consumption in children undergoing adenotonsillectomy. METHODS: This was a retrospective cohort study of the children undergoing adenotonsillectomy surgery at Texas Children's Hospital between November 2017 and October 2018...
January 15, 2021: Anesthesia and Analgesia
Raheleh Baharloo, Jose C Principe, Roger B Fillingim, Margaret R Wallace, Baiming Zou, Paul L Crispen, Hari K Parvataneni, Hernan A Prieto, Tiago N Machuca, Xinlei Mi, Steven J Hughes, Gregory J A Murad, Parisa Rashidi, Patrick J Tighe
BACKGROUND: Evidence suggests that increased early postoperative pain (POP) intensities are associated with increased pain in the weeks following surgery. However, it remains unclear which temporal aspects of this early POP relate to later pain experience. In this prospective cohort study, we used wavelet analysis of clinically captured POP intensity data on postoperative days 1 and 2 to characterize slow/fast dynamics of POP intensities and predict pain outcomes on postoperative day 30...
January 15, 2021: Anesthesia and Analgesia
Ira S Hofer, Drew Cheng, Tristan Grogan
BACKGROUND: The introduction of electronic health records (EHRs) has helped physicians access relevant medical information on their patients. However, the design of EHRs can make it hard for clinicians to easily find, review, and document all of the relevant data, leading to documentation that is not fully reflective of the complete history. We hypothesized that the incidence of undocumented key comorbid diseases (atrial fibrillation [afib], congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], diabetes, and chronic kidney disease [CKD]) in the anesthesia preoperative evaluation was associated with increased postoperative length of stay (LOS) and mortality...
January 15, 2021: Anesthesia and Analgesia
Vincent C Hsieh, Julie Niezgoda, Margaret M Sedensky, Charles L Hoppel, Philip G Morgan
BACKGROUND: Children with mitochondrial disease undergo anesthesia for a wide array of surgical procedures. However, multiple medications used for their perioperative care can affect mitochondrial function. Defects in function of the mitochondrial electron transport chain (ETC) can lead to a profound hypersensitivity to sevoflurane in children. We studied the sensitivities to sevoflurane, during mask induction and maintenance of general anesthesia, in children presenting for muscle biopsies for diagnosis of mitochondrial disease...
January 15, 2021: Anesthesia and Analgesia
Eun-Ah Cho, Jin Huh, Sung Hyun Lee, Kyoung-Ho Ryu, Jae-Geum Shim, Yun-Byeong Cha, Mi Sung Kim, Taejong Song
BACKGROUND: Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group. METHODS: Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32)...
January 15, 2021: Anesthesia and Analgesia
Mohammed Taghi Mansouri, Paul S GarcĂ­a
BACKGROUND: Attaining a rapid and smooth return to consciousness after general anesthesia is a goal for clinical anesthesiologists. This study aimed to investigate the effects of repeated anodal transcranial direct current stimulation (atDCS) on emergence and recovery from isoflurane anesthesia in rats. METHODS: Four days after surgery for atDCS socket implantation, rats received either sham stimulation or repetitive anodal direct electrical current of 0.2 mA intensity applied to the right motor cortex for 20 minutes/d for 10 consecutive days...
January 15, 2021: Anesthesia and Analgesia
Ben Safa, Brendan Flynn, Paul G McHardy, Alex Kiss, Lynn Haslam, Patrick D Henry, Lilia Kaustov, Stephen Choi
BACKGROUND: Bupivacaine and ropivacaine are the preferred long-acting local anesthetics for peripheral nerve blocks as they provide prolonged analgesia in the postoperative period. No studies have directly compared the analgesic duration of these commonly used local anesthetics in the setting of low-volume ultrasound-guided interscalene block (US-ISB). This study was designed to determine which local anesthetic and concentration provides superior analgesia (duration and quality) for low-volume US-ISB...
January 15, 2021: Anesthesia and Analgesia
Vigneshwar Subramanian, Edward J Mascha, Michael W Kattan
Researchers often convert prediction tools built on statistical regression models into integer scores and risk classification systems in the name of simplicity. However, this workflow discards useful information and reduces prediction accuracy. We, therefore, investigated the impact on prediction accuracy when researchers simplify a regression model into an integer score using a simulation study and an example clinical data set. Simulated independent training and test sets (n = 1000) were randomly generated such that a logistic regression model would perform at a specified target area under the receiver operating characteristic curve (AUC) of 0...
January 15, 2021: Anesthesia and Analgesia
Guy Ludbrook, Fangqiong Li, Jamie Sleigh, Yong Liang
BACKGROUND: Onset and duration of effects and pharmacokinetics of the novel anesthesia medication HSK3486 were examined after a single intravenous injection to evaluate its usefulness as a potential alternative to propofol. METHODS: Phase Ia (male-only, blinded) and Ib (female-only, open-label) trials were both prospective randomized, dose escalation trials of a single intravenous injection of HSK3486 or either placebo or propofol. The primary aim of this first-in-human trial was safety through measurements of dose-related effects on cardiorespiratory functions, the central nervous system, laboratory parameters, and reported adverse events...
January 15, 2021: Anesthesia and Analgesia
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
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