Anesthesia and analgesia最新文献

Background: Postoperative nausea and vomiting (PONV) remain a significant consideration in perioperative care; however, the incidence and risk factors of PONV in transgender patients are poorly understood. This study investigated the rates of PONV in transgender patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients. We postulate that exogenous testosterone GAHT reduces the risk of PONV while exogenous estrogen GAHT increases the risk of PONV.

Methods: This retrospective cohort study was conducted using the TriNetX database. Patients were divided into 2 groups: transgender and cisgender. Separate analyses were performed for hysterectomies (transgender male [assigned female at birth, AFAB] versus cisgender female), orchiectomies (transgender female [assigned male at birth, AMAB] versus cisgender male), and augmentation mammoplasties (transgender female [AMAB] versus cisgender female). Propensity score matching was performed for age, race, and ethnicity (White, Black, Hispanic, or Latino), which were treated as social and demographic variables as recorded in the database, nicotine dependence, and tobacco use. The primary outcome was the administration of a rescue antiemetic, defined as droperidol, promethazine, dimenhydrinate, metoclopramide, and prochlorperazine, on the day of or day following surgery.

Results: Following hysterectomy, there was a significant difference in the risk of rescue antiemetic use between transgender males (AFAB) taking testosterone GAHT (62.11%, 1031 of 1660) and cisgender females (65.90%, 1094 of 1660) (P = .0227). Following orchiectomy, there was a significant difference in the risk of rescue antiemetic use between transgender females (AMAB) taking estrogen GAHT (51.15%, 445 of 870) and cisgender males (36.78%, 320 of 870) (P < .0001). Following augmentation mammoplasty, there was a significant difference in the risk of rescue antiemetic use between transgender females (AMAB) taking estrogen GAHT (53.29%, 356 of 668) and cisgender females (43.71%, 292 of 668) (P = .0005).

Conclusions: Transgender female (AMAB) patients on estrogen GAHT required rescue antiemetics more often than cisgender males and cisgender females after orchiectomies and augmentation mammoplasties. Transgender male (AFAB) patients on testosterone GAHT required rescue antiemetics less often than cisgender females after hysterectomies. These findings underscore the need for individualized perioperative care and antiemetic prophylaxis to promote equitable anesthetic care for transgender patients. This study's retrospective design limits causal inference and is subject to coding errors and residual confounding. Prospective studies with detailed perioperative and hormonal data are needed to validate these findings and clarify how the timing, dosage, and duration of GAHT influence PONV risk.

Background: The population of patients with congenital heart disease has grown, but the supply of pediatric cardiac anesthesiologists has not kept pace. The Pediatric Anesthesia Leadership Council (PALC) and the Congenital Cardiac Anesthesia Society (CCAS) formed a task force to evaluate the current state of the specialty of pediatric cardiac anesthesia, including staffing, work environment, education, compensation, and career development.

Methods: Five task force working groups developed survey questions that explored 5 different aspects of a pediatric cardiac anesthesiologist's career. Surveys were completed by CCAS member faculty volunteers, division chiefs/directors of pediatric cardiac anesthesia programs, program directors of pediatric cardiac anesthesia fellowships, and fellowship graduates from the past 10 years.

Results: Survey completion rates were 77% (n = 86) for CCAS faculty, 52% (n = 58) for pediatric cardiac anesthesiology directors/division chiefs, 91% (n = 21) for pediatric cardiac anesthesiology fellowship directors, and 53% (n = 65) for 2013-2022 pediatric cardiac anesthesia fellowship graduates. Of CCAS faculty respondents, 31.4% (n = 27) are considering leaving pediatric cardiac anesthesia for a less stressful field. While most respondents reported being involved in academic activities, 34% (n = 29) do not receive nonclinical time. Only 35.3% (n = 30) of respondents receive formal mentorship and 44.7% (n = 38) of participants have been sponsored for leadership positions, research opportunities, or speaking engagements. The total number of anticipated hires in the next 5 years is 129; that number goes up to 194 in 10 years. The challenge in hiring was graded as 8/10 with 10 being the most challenging.

Conclusions: This survey provides important data about the current state of pediatric cardiac anesthesiology and the need to address staffing and academic support. With nearly one-third of those practicing in the field considering leaving the pediatric cardiac subspecialty and with the decreasing number of fellows per year, there is a significant cause for concern for staffing, especially when the demand for practitioners in this field is increasing. In addition, even though the majority of faculty reported being involved in academic activities, many do not receive academic time for these activities and less than half receive formal mentorship or have been sponsored for leadership positions, publications, research opportunities, or speaking engagements. Further work to recruit, retain, and develop pediatric cardiac anesthesiologists is warranted.