Anesthesia and analgesia最新文献_第5页

Assessing the Utility of a Machine-Learning Model to Assist With the Assignment of the American Society of Anesthesiology Physical Status Classification in Pediatric Patients. 评估机器学习模型在协助分配美国麻醉学会儿科患者身体状况分类方面的实用性。

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2023-12-13 DOI: 10.1213/ANE.0000000000006761

Lynne R Ferrari, Izabela Leahy, Steven J Staffa, Peter Hong, Isabel Stringfellow, Jay G Berry

Background: The American Society of Anesthesiologists Physical Status Classification System (ASA-PS) is used to classify patients' health before delivering an anesthetic. Assigning an ASA-PS Classification score to pediatric patients can be challenging due to the vast array of chronic conditions present in the pediatric population. The specific aims of this study were to (1) suggest an ASA-PS score for pediatric patients undergoing elective surgical procedures using machine-learning (ML) methods; and (2) assess the impact of presenting the suggested ASA-PS score to clinicians when making their final ASA-PS assignment. The intent was not to create a new ASA-PS score but to use ML methods to generate a suggested score, along with information on how the score was generated (ie, historical information on patient comorbidities) to assist clinicians when assigning their final ASA-PS score.Methods: A retrospective analysis of 146,784 pediatric surgical encounters from January 1, 2016, to December 31, 2019, using eXtreme Gradient Boosting (XGBoost) methods to predict ASA-PS scores using patients' age, weight, and chronic conditions. SHapley Additive exPlanations (SHAP) were used to assess patient characteristics that contributed most to the predicted ASA-PS scores. The predicted ASA-PS model was presented to a prospective cohort study of 28,677 surgical encounters from December 1, 2021, to October 31, 2022. The predicted ASA-PS score was presented to the anesthesiology provider for review before entering the final ASA-PS score. The study focused on summarizing the available information for the anesthesiologist by using ML methods. The goal was to explore the potential for ML to provide assistance to anesthesiologists by highlighting potential areas of discordance between the variables that generated a given ML prediction and the physician's mental model of the patient's medical comorbidities.Results: For the retrospective analysis, the distribution of predicted ASA-PS scores was 22.7% ASA-PS I, 48.5% II, 23.6% III, 5.1% IV, and 0.04% V. The distribution of clinician-assigned ASA-PS scores was 24.3% for ASA-PS I, 44.5% for ASA-PS II, 24.9% for ASA III, 6.1% for ASA-PS IV, and 0.2% for ASA-V. In the prospective analysis, the final ASA-PS score matched the initial ASA-PS 90.7% of the time and 9.3% were revised after viewing the predicted ASA-PS score. When the initial ASA-PS score and the ML ASA-PS score were discrepant, 19.5% of the cases have a final ASA-PS score which is different from the initial clinician ASA-PS score. The prevalence of multiple chronic conditions increased with ASA-PS score: 34.9% ASA-PS I, 73.2% II, 92.3% III, and 94.4% IV.Conclusions: ML derivation of predicted pediatric ASA-PS scores was successful, with a strong agreement between predicted and clinician-entered ASA-PS scores. Presentation of predicted ASA-PS scores was associated with revis

背景：美国麻醉医师协会身体状况分类系统（ASA-PS）用于在实施麻醉前对患者的健康状况进行分类。由于儿科患者的慢性疾病种类繁多，给儿科患者进行 ASA-PS 分级是一项挑战。本研究的具体目的是：(1) 使用机器学习（ML）方法为接受择期手术的儿科患者建议 ASA-PS 评分；(2) 评估临床医生在最终分配 ASA-PS 时提出 ASA-PS 评分建议的影响。我们的目的不是创建一个新的 ASA-PS 评分，而是使用 ML 方法生成一个建议评分，并提供有关评分生成方式的信息（即有关患者合并症的历史信息），以协助临床医生进行最终的 ASA-PS 评分：对 2016 年 1 月 1 日至 2019 年 12 月 31 日期间的 146784 例儿科手术病例进行回顾性分析，采用 eXtreme Gradient Boosting (XGBoost) 方法，利用患者的年龄、体重和慢性疾病预测 ASA-PS 评分。使用 SHapley Additive exPlanations (SHAP) 评估对 ASA-PS 预测得分贡献最大的患者特征。在一项前瞻性队列研究中，对 2021 年 12 月 1 日至 2022 年 10 月 31 日期间的 28,677 例手术进行了 ASA-PS 预测。在输入最终的 ASA-PS 评分之前，会将预测的 ASA-PS 评分提交给麻醉科医生进行审核。该研究的重点是通过使用 ML 方法为麻醉医师总结可用信息。其目的是通过强调产生特定 ML 预测的变量与医生对患者医疗合并症的心理模型之间可能存在的不一致之处，探索 ML 为麻醉医生提供帮助的潜力：在回顾性分析中，预测的 ASA-PS 评分分布为：22.7% ASA-PS I、48.5% ASA-PS II、23.6% ASA-PS III、5.1% ASA-PS IV 和 0.04% ASA-V。在前瞻性分析中，90.7% 的情况下最终的 ASA-PS 评分与最初的 ASA-PS 评分一致，9.3% 的情况下在查看预测的 ASA-PS 评分后进行了修改。当初始 ASA-PS 评分和 ML ASA-PS 评分不一致时，19.5% 的病例的最终 ASA-PS 评分与临床医生的初始 ASA-PS 评分不同。多种慢性疾病的患病率随 ASA-PS 评分的增加而增加：ASA-PS I 级占 34.9%，II 级占 73.2%，III 级占 92.3%，IV 级占 94.4%：预测的儿科ASA-PS评分的ML推导是成功的，预测的ASA-PS评分与临床医生输入的ASA-PS评分之间有很强的一致性。在十分之一的儿科患者中，预测的 ASA-PS 评分与最终评分的修改有关。

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引用次数: 0

Previous Coronavirus Disease-2019 Infection and Lung Mechanics in Surgical Patients: A Hospital Registry Study. 先前的冠状病毒 Disease-2019 感染与手术患者的肺功能：一项医院登记研究

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-07-26 DOI: 10.1213/ANE.0000000000007015

Aiman Suleiman, Ricardo Munoz-Acuna, Simone Redaelli, Elena Ahrens, Tim M Tartler, Sarah Ashrafian, May M Hashish, Abeer Santarisi, Guanqing Chen, Stefan Riedel, Daniel Talmor, Elias N Baedorf Kassis, Maximilian S Schaefer, Valerie Goodspeed

Background: Long-term pulmonary complications have been reported after a coronavirus disease-2019 (COVID-19). We hypothesized that a history of COVID-19 is associated with a measurable decrease in baseline respiratory system compliance in patients undergoing general anesthesia.

Methods: In this hospital registry study, we included adult patients undergoing general anesthesia between January 2020 and March 2022 at a tertiary health care network in Massachusetts. We excluded patients with an American Society of Anesthesiologists physical status >IV, laryngoscopic surgeries, and patients who arrived intubated. The primary exposure was a history of COVID-19. The primary outcome was baseline respiratory system compliance (mL/cmH 2 O). Effects of severity of infection, surges (Alpha 1 , Alpha 2 , Delta, and Omicron), patient demographics, and time between infection and assessment of compliance were investigated.

Results: A total of 19,921 patients were included. Approximately 1386 (7.0%) patients had a history of COVID-19. A history of COVID-19 at any time before surgery was associated with a measurably lower baseline respiratory system compliance (ratio of means adj = 0.96; 95% confidence interval [CI], 0.94-0.97; P < .001; adjusted compliance difference: -1.6 mL/cmH 2 O). The association was more pronounced in patients with a severe form of COVID-19 (ratio of means adj = 0.95; 95% CI, 0.90-0.99; P = .02, adjusted compliance difference: -2 mL/cmH 2 O). Alpha 1 , Alpha 2 , and Delta surges, but not Omicron, led to a lower baseline respiratory system compliance ( P < .001, P = .02, and P < .001). The Delta surge effect was magnified in Hispanic ethnicity ( P -for-interaction = 0.003; ratio of means adj = 0.83; 95% CI, 0.74-0.93; P = .001; adjusted compliance difference: -4.6 mL/cmH 2 O).

Conclusions: A history of COVID-19 infection during Alpha 1 , Alpha 2 , and Delta surges was associated with a measurably lower baseline respiratory system compliance.

背景：据报道，冠状病毒病-2019（COVID-19）后出现了长期肺部并发症。我们假设，在接受全身麻醉的患者中，COVID-19 病史与呼吸系统基线顺应性的显著下降有关：在这项医院登记研究中，我们纳入了 2020 年 1 月至 2022 年 3 月期间在马萨诸塞州一家三级医疗保健网络接受全身麻醉的成年患者。我们排除了美国麻醉医师协会身体状况>IV级的患者、喉镜手术患者和插管患者。主要接触因素为 COVID-19 病史。主要结果是基线呼吸系统顺应性（mL/cmH2O）。研究还调查了感染严重程度、涌流（Alpha1、Alpha2、Delta 和 Omicron）、患者人口统计学特征以及感染与顺应性评估之间时间的影响：共纳入 19921 名患者。约有 1386 名患者（7.0%）曾感染过 COVID-19。术前任何时候有 COVID-19 病史与基线呼吸系统顺应性明显降低有关（均值比 adj = 0.96；95% 置信区间 [CI]，0.94-0.97；P < .001；调整后的顺应性差异为-1.6 mL/cmH)-1.6毫升/厘米水）。这种关联在 COVID-19 严重型患者中更为明显（均值比 adj = 0.95；95% 置信区间 [CI]，0.90-0.99；P = .02，调整后顺应性差异：-2 mL/cmH2O）：-2 mL/cmH2O）。Alpha1、Alpha2 和 Delta 峰会导致基线呼吸系统顺应性降低，但 Omicron 峰不会（P < .001、P = .02 和 P < .001）。在西班牙裔中，Delta 激增的影响被放大（P-for-Interaction = 0.003；均值比 = 0.83；95% CI，0.74-0.93；P = .001；调整后顺应性差异：-结论：结论：Alpha1、Alpha2 和 Delta 峰期间的 COVID-19 感染史与基线呼吸系统顺应性显著降低有关。

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引用次数: 0

A Behavioral and Electroencephalographic Study of Anesthetic State Induced by MK-801 Combined with Haloperidol, Ketamine and Riluzole in Mice. MK-801 联合氟哌啶醇、氯胺酮和利鲁唑诱导小鼠麻醉状态的行为和脑电图研究

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-02-20 DOI: 10.1213/ANE.0000000000006900

Yuka Kikuchi, Masahiro Irifune, Taiga Yoshinaka, Kana Oue, Tamayo Takahashi, Aya Oda, Hisanobu Kamio, Serika Imamura, Utaka Sasaki, Eiji Imado, Yukio Ago, Yoshiyuki Okada

Background: Ketamine is an intravenous anesthetic that acts as a channel blocker on the N-methyl- d -aspartate (NMDA) receptor, a glutamate receptor subtype. MK-801 is the most potent compound among noncompetitive NMDA receptor antagonists. Ketamine induces loss of the righting reflex (LORR) in rodents, which is one of the indicators of unconsciousness, whereas high doses of MK-801 produce ataxia, but not LORR. In contrast, we previously reported that MK-801 combined with a low dose of the dopamine receptor antagonist haloperidol-induced LORR in mice. To assess a neurophysiologically distinct brain state and demonstrate unconsciousness, electroencephalograms (EEG) need to be examined together with LORR. Therefore, we herein investigated EEG changes after the systemic administration of MK-801 alone or in combination with haloperidol, and compared them with those induced by ketamine, the glutamate release inhibitor riluzole, and the γ-aminobutyric acid type A receptor agonist propofol.

Methods: All drugs were intraperitoneally administered to adult male ddY mice (n = 168). General anesthesia was evaluated based on the righting reflex test. Animals who exhibited no righting for more than 30 seconds were considered to have LORR. In a separate group of mice, EEG of the primary visual cortex was recorded before and after the administration of MK-801 (3.0 mg/kg) alone or in combination with haloperidol (0.2 mg/kg), ketamine (150 mg/kg), riluzole (30 mg/kg), or propofol (240 mg/kg). The waveforms recorded were analyzed using EEG power spectra and spectrograms.

Results: The high dose of MK-801 alone did not induce LORR, whereas MK-801 combined with haloperidol produced LORR in a dose-dependent manner. Ketamine, riluzole, and propofol also dose-dependently induced LORR. In the EEG study, MK-801 alone induced a significant increase in δ power, while MK-801 plus haloperidol exerted similar effects on not only δ, but also θ and α power during LORR, suggesting that increases in δ, θ, and α power were necessary for LORR. The results obtained on MK-801 plus haloperidol were similar to those on ketamine in the behavioral and EEG studies, except for an increase in γ power by ketamine during LORR. Propofol significantly increased δ, θ, α, and β power during LORR. However, the EEG results obtained using riluzole, which produced a unique pattern of lower amplitude activity spanning most frequencies, markedly differed from those with the other drugs.

Conclusions: This study revealed differences in EEG changes induced by various sedatives. The results obtained on MK-801 alone and MK-801 plus haloperidol suggest the importance of dopamine transmission in maintaining the righting reflex.

背景：氯胺酮是一种静脉麻醉剂，可作为谷氨酸受体亚型 N-甲基-d-天冬氨酸（NMDA）受体的通道阻断剂。MK-801 是非竞争性 NMDA 受体拮抗剂中最有效的化合物。氯胺酮会诱导啮齿类动物丧失向右转反射（LORR），这是昏迷的指标之一，而高剂量的 MK-801 会产生共济失调，但不会丧失向右转反射。相反，我们以前曾报道过 MK-801 与低剂量多巴胺受体拮抗剂氟哌啶醇联合使用可诱导小鼠出现 LORR。为了评估神经生理学上不同的大脑状态并证明昏迷，脑电图（EEG）需要与 LORR 一起检查。因此，我们在此研究了单独或与氟哌啶醇联合全身给药 MK-801 后的脑电图变化，并将其与氯胺酮、谷氨酸释放抑制剂利鲁唑和γ-氨基丁酸 A 型受体激动剂丙泊酚诱导的脑电图变化进行了比较：给成年雄性 ddY 小鼠（n = 168）腹腔注射所有药物。根据右旋反射测试评估全身麻醉情况。超过30秒不右转的小鼠被视为LORR。在另一组小鼠中，在单独或与氟哌啶醇（0.2 毫克/千克）、氯胺酮（150 毫克/千克）、利鲁唑（30 毫克/千克）或异丙酚（240 毫克/千克）联合使用 MK-801（3.0 毫克/千克）之前和之后，记录初级视觉皮层的脑电图。记录的波形使用脑电图功率谱和频谱图进行分析：结果：单独使用高剂量的 MK-801 不会诱导 LORR，而 MK-801 与氟哌啶醇联合使用则会以剂量依赖的方式产生 LORR。氯胺酮、利鲁唑和异丙酚也能以剂量依赖的方式诱导 LORR。在脑电图研究中，单用 MK-801 可显著增加δ功率，而 MK-801 加氟哌啶醇不仅对 LORR 期间的δ功率，还对θ和α功率产生类似的影响，这表明δ、θ和α功率的增加是 LORR 的必要条件。在行为和脑电图研究中，除了氯胺酮增加了 LORR 期间的 γ 功率外，使用 MK-801 加氟哌啶醇的结果与使用氯胺酮的结果相似。丙泊酚能明显增加 LORR 期间的 δ、θ、α 和 β 功率。然而，使用利鲁唑所获得的脑电图结果与使用其他药物所获得的结果明显不同，利鲁唑产生了一种跨越大多数频率的低振幅活动的独特模式：本研究揭示了各种镇静剂诱导的脑电图变化的差异。单用 MK-801 和 MK-801 加氟哌啶醇的结果表明，多巴胺传递在维持右旋反射中的重要性。

{"title":"A Behavioral and Electroencephalographic Study of Anesthetic State Induced by MK-801 Combined with Haloperidol, Ketamine and Riluzole in Mice.","authors":"Yuka Kikuchi, Masahiro Irifune, Taiga Yoshinaka, Kana Oue, Tamayo Takahashi, Aya Oda, Hisanobu Kamio, Serika Imamura, Utaka Sasaki, Eiji Imado, Yukio Ago, Yoshiyuki Okada","doi":"10.1213/ANE.0000000000006900","DOIUrl":"10.1213/ANE.0000000000006900","url":null,"abstract":"Background: Ketamine is an intravenous anesthetic that acts as a channel blocker on the N-methyl- d -aspartate (NMDA) receptor, a glutamate receptor subtype. MK-801 is the most potent compound among noncompetitive NMDA receptor antagonists. Ketamine induces loss of the righting reflex (LORR) in rodents, which is one of the indicators of unconsciousness, whereas high doses of MK-801 produce ataxia, but not LORR. In contrast, we previously reported that MK-801 combined with a low dose of the dopamine receptor antagonist haloperidol-induced LORR in mice. To assess a neurophysiologically distinct brain state and demonstrate unconsciousness, electroencephalograms (EEG) need to be examined together with LORR. Therefore, we herein investigated EEG changes after the systemic administration of MK-801 alone or in combination with haloperidol, and compared them with those induced by ketamine, the glutamate release inhibitor riluzole, and the γ-aminobutyric acid type A receptor agonist propofol.Methods: All drugs were intraperitoneally administered to adult male ddY mice (n = 168). General anesthesia was evaluated based on the righting reflex test. Animals who exhibited no righting for more than 30 seconds were considered to have LORR. In a separate group of mice, EEG of the primary visual cortex was recorded before and after the administration of MK-801 (3.0 mg/kg) alone or in combination with haloperidol (0.2 mg/kg), ketamine (150 mg/kg), riluzole (30 mg/kg), or propofol (240 mg/kg). The waveforms recorded were analyzed using EEG power spectra and spectrograms.Results: The high dose of MK-801 alone did not induce LORR, whereas MK-801 combined with haloperidol produced LORR in a dose-dependent manner. Ketamine, riluzole, and propofol also dose-dependently induced LORR. In the EEG study, MK-801 alone induced a significant increase in δ power, while MK-801 plus haloperidol exerted similar effects on not only δ, but also θ and α power during LORR, suggesting that increases in δ, θ, and α power were necessary for LORR. The results obtained on MK-801 plus haloperidol were similar to those on ketamine in the behavioral and EEG studies, except for an increase in γ power by ketamine during LORR. Propofol significantly increased δ, θ, α, and β power during LORR. However, the EEG results obtained using riluzole, which produced a unique pattern of lower amplitude activity spanning most frequencies, markedly differed from those with the other drugs.Conclusions: This study revealed differences in EEG changes induced by various sedatives. The results obtained on MK-801 alone and MK-801 plus haloperidol suggest the importance of dopamine transmission in maintaining the righting reflex.","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139911840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-10-21 DOI: 10.1213/ANE.0000000000007146

Harvey K Rosenbaum, Vincent Van den Eynde, Peter Kenneth Gillman

引用次数: 0

Effect of Changing Estimated Glomerular Filtration Rate Formula on Sugammadex Use and Pulmonary Complications for African American and non-African American Patients. 改变估算肾小球滤过率公式对非裔美国人和非裔美国人患者使用舒降之痛和肺部并发症的影响。

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-10-21 DOI: 10.1213/ANE.0000000000006896

Milo Engoren, Michael Heung

Background: Sugammadex is associated with fewer postoperative pulmonary complications than is neostigmine reversal of neuromuscular blockade. However, the Food and Drug Administration-approved package insert states that its use is "not recommended" in severe renal impairment, separately defined as creatinine clearance <30 mL/min. Recently, the formula for estimating glomerular filtration rate (GFR) was updated to remove the race variable. Compared to the prior formula, the new consensus equation lowers the estimated GFR for African American patients and raises it for everyone else. We sought to determine how this change could differently impact the use of sugammadex, and thus the rate of pulmonary complications, for both African American and non-African American patients.

Methods: We used Monte Carlo simulation models to estimate the difference in pulmonary complications that would be suffered by patients when the change in creatine clearance calculated from the estimated GFR (using the old race-based and new race-neutral Chronic Kidney Disease Epidemiology Collaboration formulas) crossed the 30 mL/min threshold, which would require a change in sugammadex or neostigmine use.

Results: We found that 0.22% (95% confidence interval 0.14%-0.36%) of African American patients' creatinine clearance would drop from above to below 30 mL/min making sugammadex not recommended and 0.19% (0.16%-0.22%) of non-African American patients would have creatinine clearance increase to >30 mL/min making sugammadex now recommended. Based on our model, we estimate that African American patients would suffer (count [95% confidence interval]) 3 [0.4-6] more pulmonary complications per 100,000 African American patients who received rocuronium or vecuronium through the change from sugammadex to neostigmine reversal to comply with labeling recommendations. Conversely, the same change in formulas would reduce the number of non-African American patients suffering pulmonary complications by 3 [2-4] per 100,000.

Conclusions: The recent change in GFR formulas may potentially be associated with an increase in postoperative pulmonary complications in African American patients and a decrease in postoperative pulmonary complications in non-African American patients through GFR-driven changes in sugammadex use.

背景：与新斯的明逆转神经肌肉阻滞相比，舒甘麦得的术后肺部并发症更少。然而，美国食品和药物管理局批准的包装说明书指出，"不建议 "在严重肾功能损害（肌酐清除率单独定义）的情况下使用舒格迈司：我们使用蒙特卡洛模拟模型来估算当根据估算的 GFR（使用基于种族的旧公式和基于种族中立的慢性肾脏病流行病学协作组织新公式）计算出的肌酸清除率变化超过 30 mL/min 临界值时，患者所患肺部并发症的差异，这将需要改变苏甘麦丁或新斯的明的使用：我们发现，0.22%（95% 置信区间为 0.14%-0.36%）的非裔美国患者的肌酐清除率将从高于 30 毫升/分钟降至低于 30 毫升/分钟，因此不推荐使用苏麦丁，0.19%（0.16%-0.22%）的非裔美国患者的肌酐清除率将升至高于 30 毫升/分钟，因此现在推荐使用苏麦丁。根据我们的模型，我们估计每 100,000 名接受罗库溴铵或维库溴铵治疗的非裔美国患者中，如果为遵守标签建议而将苏加麦司改为新斯的明逆转，非裔美国患者的肺部并发症将增加 3 [0.4-6] 例（计数[95% 置信区间]）。相反，同样的配方改变会使每 10 万名非裔美国人患者中出现肺部并发症的人数减少 3 [2-4]：结论：近期 GFR 计算公式的变化可能与非裔美国人患者术后肺部并发症的增加有关，而非裔美国人患者术后肺部并发症的减少则与 GFR 驱动的舒格迈司使用变化有关。

{"title":"Effect of Changing Estimated Glomerular Filtration Rate Formula on Sugammadex Use and Pulmonary Complications for African American and non-African American Patients.","authors":"Milo Engoren, Michael Heung","doi":"10.1213/ANE.0000000000006896","DOIUrl":"10.1213/ANE.0000000000006896","url":null,"abstract":"Background: Sugammadex is associated with fewer postoperative pulmonary complications than is neostigmine reversal of neuromuscular blockade. However, the Food and Drug Administration-approved package insert states that its use is \"not recommended\" in severe renal impairment, separately defined as creatinine clearance <30 mL/min. Recently, the formula for estimating glomerular filtration rate (GFR) was updated to remove the race variable. Compared to the prior formula, the new consensus equation lowers the estimated GFR for African American patients and raises it for everyone else. We sought to determine how this change could differently impact the use of sugammadex, and thus the rate of pulmonary complications, for both African American and non-African American patients.Methods: We used Monte Carlo simulation models to estimate the difference in pulmonary complications that would be suffered by patients when the change in creatine clearance calculated from the estimated GFR (using the old race-based and new race-neutral Chronic Kidney Disease Epidemiology Collaboration formulas) crossed the 30 mL/min threshold, which would require a change in sugammadex or neostigmine use.Results: We found that 0.22% (95% confidence interval 0.14%-0.36%) of African American patients' creatinine clearance would drop from above to below 30 mL/min making sugammadex not recommended and 0.19% (0.16%-0.22%) of non-African American patients would have creatinine clearance increase to >30 mL/min making sugammadex now recommended. Based on our model, we estimate that African American patients would suffer (count [95% confidence interval]) 3 [0.4-6] more pulmonary complications per 100,000 African American patients who received rocuronium or vecuronium through the change from sugammadex to neostigmine reversal to comply with labeling recommendations. Conversely, the same change in formulas would reduce the number of non-African American patients suffering pulmonary complications by 3 [2-4] per 100,000.Conclusions: The recent change in GFR formulas may potentially be associated with an increase in postoperative pulmonary complications in African American patients and a decrease in postoperative pulmonary complications in non-African American patients through GFR-driven changes in sugammadex use.","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139721241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lost in Translation: Cognitive Screening and Outcomes. 翻译中的迷失：认知筛查与结果。

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-10-21 DOI: 10.1213/ANE.0000000000007266

Naveen Nathan

引用次数: 0

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IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-08-21 DOI: 10.1213/ANE.0000000000007197

George T Blike, Susan P McGrath, Michelle A Ochs Kinney, Bhargavi Gali

引用次数: 0

Exploring the Potential of Evidence-Based Practice on Mitigating Health Care Disparities. 探索循证实践在减少医疗差距方面的潜力。

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-06-06 DOI: 10.1213/ANE.0000000000006999

Brittany N Burton, TimethiaJ Bonner, Abimbola O Faloye, Steven A Bradley, David O Warner, Jean-Francois Pittet, Lisa M McElroy, Adam J Milam

引用次数: 0

Anesthesiology Residency Matching - A DEI Perspective. 麻醉学住院医师配对--DEI 的视角。

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-10-21 DOI: 10.1213/ANE.0000000000007267

Naveen Nathan

引用次数: 0

Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients' Satisfaction With Pain Management During Cesarean Delivery. 患者与麻醉团队之间的种族和民族一致性以及患者对剖腹产期间疼痛管理的满意度。

IF 4.6 2区医学 Q1 ANESTHESIOLOGY

Anesthesia and analgesia

Pub Date : 2024-11-01 Epub Date: 2024-05-20 DOI: 10.1213/ANE.0000000000006764

Jose Sanchez, Rohan Prabhu, Jean Guglielminotti, Ruth Landau

Background: Racial and ethnic concordance between patients and health care providers increases patient satisfaction but has not been examined in obstetric anesthesia care. This study evaluated the association between racial and ethnic concordance and satisfaction with management of pain during cesarean delivery (PDCD).

Methods: This was a secondary analysis on a cohort of patients undergoing cesarean deliveries under neuraxial anesthesia that examined PDCD. The outcome was satisfaction, recorded within 48 hours after delivery using the survey question, "Overall, how satisfied are you with the anesthesia care during the C-section as it relates to pain management?" Using a 5-point Likert scale, satisfaction was defined with the answer "very satisfied." Participants were also asked, "If you have another C-section, would you want the same anesthesia team?" The exposure was racial and ethnic concordance between the patient and anesthesia team members (attending with a resident, nurse anesthetist, or fellow) categorized into full concordance, partial concordance, discordance, and missing. Risk factors for satisfaction were identified using a multivariable analysis.

Results: Among 403 participants, 305 (78.2%; 95% confidence interval [CI], 73.8-82.1) were "very satisfied," and 358 of 399 (89.7%; 95% CI, 86.3-92.5) "would want the same anesthesia team." Full concordance occurred in 18 (4.5%) cases, partial concordance in 117 (29.0%), discordance in 175 (43.4%), and missing in 93 (23.1%). Satisfaction rate was 88.9% for full concordance, 71.8% for partial concordance, 81.1% for discordance, and 78.5% for missing ( P value = .202). In the multivariable analysis, there was insufficient evidence for an association of concordance with satisfaction. Compared to full concordance, partial concordance was associated with a nonsignificant 57% (95% CI, -113 to 91) decrease in the odds of being satisfied, discordance with a 29% (95% CI, -251 to 85) decrease, and missing with a 39% (95% CI, -210 to 88) decrease. Risk factors for not being "very satisfied" were PDCD, anxiety disorders, pregnancy resulting from in vitro fertilization, intravenous medication administration, intrapartum cesarean with extension of labor epidural, having 3 anesthesia team members (instead of 2), and a higher intraoperative blood loss.

Conclusions: Our inability to identify an association between concordance and satisfaction is likely due to the high satisfaction rate in our cohort (78.2%), combined with low proportion of full concordance (4.5%). Addressing elements such as PDCD, anxiety, intravenous medication administration, and use of epidural anesthesia for cesarean delivery, and a better understanding of the interplay between concordance and satisfaction are warranted.

背景：患者与医疗服务提供者之间的种族和民族一致性可提高患者的满意度，但在产科麻醉护理方面尚未进行过研究。本研究评估了种族和民族一致性与剖宫产疼痛管理（PDCD）满意度之间的关系：这是对在神经麻醉下进行剖宫产的一组患者进行的二次分析，对 PDCD 进行了检查。结果是满意度，在产后 48 小时内使用调查问题记录："总体而言，您对剖腹产期间与疼痛管理相关的麻醉护理的满意度如何？满意度采用 5 点李克特量表，答案为 "非常满意"。参与者还被问到："如果您再次进行剖腹产，您是否会想要同一个麻醉团队？患者与麻醉团队成员（主治医师与住院医师、麻醉师或研究员）之间的种族和民族一致性被暴露出来，分为完全一致、部分一致、不一致和缺失。通过多变量分析确定了满意度的风险因素：在 403 名参与者中，有 305 人（78.2%；95% 置信区间 [CI]，73.8-82.1）"非常满意"，399 人中有 358 人（89.7%；95% 置信区间 [CI]，86.3-92.5）"想要同一个麻醉团队"。完全一致的有 18 例（4.5%），部分一致的有 117 例（29.0%），不一致的有 175 例（43.4%），缺失的有 93 例（23.1%）。完全一致的满意率为 88.9%，部分一致的满意率为 71.8%，不一致的满意率为 81.1%，缺失的满意率为 78.5%（P 值 = .202）。在多变量分析中，没有足够的证据表明一致性与满意度有关。与完全一致相比，部分一致与 "满意 "几率下降 57% （95% CI，-113-91）、不一致与 "满意 "几率下降 29% （95% CI，-251-85）和缺失与 "满意 "几率下降 39% （95% CI，-210-88）无显著关系。不 "非常满意 "的风险因素包括PDCD、焦虑症、体外受精导致的妊娠、静脉用药、产中剖宫产并延长产程硬膜外麻醉、有3名麻醉团队成员（而不是2名）以及术中失血较多：我们无法确定一致性与满意度之间的关系，这可能是因为我们队列中的满意度较高（78.2%），而完全一致的比例较低（4.5%）。我们需要解决诸如PDCD、焦虑、静脉用药、剖宫产硬膜外麻醉的使用等因素，并更好地理解一致性和满意度之间的相互作用。

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引用次数: 0