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Keeping the Patient at the Center of Conscientious Objection while Respecting Our Colleagues. 在尊重同事的同时将病人置于良心反对的中心。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1097/aln.0000000000005191
Jennifer Lucero,Gail A Van Norman
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引用次数: 0
Lung Ultrasound Predicts Pulmonary Complications: Comment. 肺部超声波可预测肺部并发症:评论。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1097/aln.0000000000005144
Stéphane Bar,Hervé Dupont,Daniel Lichtenstein
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引用次数: 0
Opioid-free Anesthesia on Quality of Recovery: Comment. 无阿片麻醉对康复质量的影响:评论。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1097/aln.0000000000005137
Fu-Shan Xue,Nong He,Cheng-Wen Li
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引用次数: 0
Lung Strain during Laparoscopies in Children: Reply. 儿童腹腔镜手术中的肺部负荷:回复。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1097/aln.0000000000005132
Gerardo Tusman,Cecilia M Acosta,Fernando Suarez Sipmann
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引用次数: 0
Lung Strain during Laparoscopies in Children: Comment. 儿童腹腔镜手术过程中的肺部负荷:评论。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1097/aln.0000000000005131
Dongxu Zheng,Wangning Shang-Guan,Xiaocou Wang
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引用次数: 0
Perspectives on Anesthesia and Perioperative Patient Safety: Past, Present, and Future. 麻醉与围术期患者安全的视角:过去、现在和未来。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1097/aln.0000000000005164
Megha Karkera Kanjia,C Dean Kurth,Daniel Hyman,Eric Williams,Anna Varughese
During the past 70 years, patient safety science has evolved through four organizational frameworks known as Safety-0, Safety -1, Safety-2, and Safety-3. Their evolution reflects the realization over time that blaming people, chasing errors, fixing one-offs, and regulation would not create the desired patient safety. In Safety-0, the oldest framework, harm events arise from clinician failure; event prevention relies on better staffing, education, and basic standards. In Safety-1, used by hospitals, harm events arise from individual and/or system failures. Safety is improved through analytics, workplace culture, high reliability principles, technology, and quality improvement. Safety-2 emphasizes clinicians' adaptability to prevent harm events in an everchanging environment, using resilience engineering principles. Safety-3, used by aviation, adds system design and control elements to Safety-1 and Safety-2, deploying human factors, design-thinking, and operational control or feedback to prevent and respond to harm events. Safety-3 represents a potential way for anesthesia and perioperative care to become safer.
在过去的 70 年中,患者安全科学经历了四个组织框架的演变,分别称为安全-0、安全-1、安全-2 和安全-3。它们的演变反映出,随着时间的推移,人们逐渐认识到,指责人、追逐错误、解决一次性问题和监管并不能创造理想的患者安全。在最古老的 "安全-0 "框架中,伤害事件源于临床医生的失误;事件预防依赖于更好的人员配备、教育和基本标准。在医院使用的 "安全-1 "框架中,伤害事件源于个人和/或系统故障。通过分析、工作场所文化、高可靠性原则、技术和质量改进来提高安全性。安全-2 强调临床医生的适应能力,在不断变化的环境中利用复原力工程原则预防伤害事件。航空业使用的 "安全-3 "在 "安全-1 "和 "安全-2 "的基础上增加了系统设计和控制元素,利用人为因素、设计思维和操作控制或反馈来预防和应对伤害事件。安全-3 是麻醉和围手术期护理变得更加安全的潜在途径。
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引用次数: 0
Tactics versus Strategy in Trauma Resuscitation. 创伤复苏中的战术与策略。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1097/aln.0000000000005189
Richard P Dutton
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引用次数: 0
The Notes Are for Us. 我们的笔记
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-30 DOI: 10.1097/ALN.0000000000005203
Lealani Mae Y Acosta
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引用次数: 0
Chewing gum to treat postoperative nausea and vomiting in female patients: a multicenter randomized trial. 用口香糖治疗女性患者术后恶心和呕吐:一项多中心随机试验。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-30 DOI: 10.1097/ALN.0000000000005283
Jai N Darvall, Anurika P De Silva, Britta von Ungern-Sternberg, David A Story, Andrew J Davidson, Megan L Allen, An Tran-Duy, Cindy Schultz-Ferguson, Vi Ha, Sabine Braat, Kate Leslie

Background: Postoperative nausea and vomiting (PONV) is common after general anesthesia, with consequences for patient outcomes, satisfaction with care and healthcare costs. Our aim was to compare a new treatment, chewing gum, with a widely-used intravenous agent, ondansetron, to treat PONV in female patients in the post anesthesia care unit (PACU).

Methods: We conducted a multicenter, randomized, controlled non-inferiority trial in 17 hospitals in Australia and New Zealand. Female patients aged ≥12 years undergoing volatile anesthetic-based general anesthesia for laparoscopic or breast surgery were enrolled. Protocolized anti-emetic prophylaxis was administered. Patients who developed PONV in the PACU were randomized to either 15 min of chewing gum or 4 mg of intravenous ondansetron. The primary outcome was cessation of nausea, retching or vomiting, with no recurrence nor rescue medication for 2 h after administration of the randomized intervention (i.e., complete response).

Results: Of 865 enrolled patients, 218 were randomized. In a per-protocol analysis, 50 of 105 (47.6%) ondansetron-treated patients compared with 31 of 103 (30.1%) chewing gum-treated patients achieved the primary outcome (absolute risk difference [95% confidence interval (CI)] -17.3 [-30.4 to -4.3] %), not reaching our prespecified non-inferiority limit. Time to complete response was longer for patients randomized to chewing gum (hazard ratio [95% CI] 0.53 [0.34, 0.83]), and they were more likely to receive antiemetics in the 24 h after surgery (absolute risk difference [95% CI] 14.07 [1.65, 26.49]).

Conclusions: Chewing gum cannot be recommended as an alternative to ondansetron for treatment of PONV in female patients administered antiemetic prophylaxis.

背景:术后恶心和呕吐(PONV)是全身麻醉后的常见症状,会影响患者的预后、对护理的满意度和医疗成本。我们的目的是比较一种新疗法口香糖和一种广泛使用的静脉注射药物昂丹司琼,以治疗麻醉后护理病房(PACU)女性患者的 PONV:我们在澳大利亚和新西兰的 17 家医院开展了一项多中心随机对照非劣效性试验。年龄≥12岁、因腹腔镜手术或乳房手术而接受挥发性麻醉药全身麻醉的女性患者均被纳入试验范围。患者均按规定接受了止吐预防治疗。在 PACU 中出现 PONV 的患者被随机分配到咀嚼口香糖 15 分钟或静脉注射 4 毫克昂丹司琼的治疗方案中。主要结果是患者停止恶心、反胃或呕吐,且在接受随机干预后 2 小时内不再复发或服用抢救药物(即完全反应):在 865 名登记患者中,218 人接受了随机干预。在按方案进行的分析中,105 例昂丹司琼治疗患者中有 50 例(47.6%)与 103 例口香糖治疗患者中有 31 例(30.1%)相比达到了主要结果(绝对风险差异[95% 置信区间 (CI)]-17.3[-30.4 至 -4.3]%),未达到我们预先规定的非劣效性限值。随机接受口香糖治疗的患者完全应答时间更长(危险比[95% CI] 0.53 [0.34, 0.83]),术后24小时内接受止吐药的可能性更大(绝对风险差异[95% CI] 14.07 [1.65, 26.49]):结论:不建议用口香糖替代昂丹司琼治疗接受止吐药预防的女性患者的PONV。
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引用次数: 0
Four-factor Prothrombin Complex Concentrate Use for Bleeding Management in Adult Trauma. 使用四因子凝血酶原复合物浓缩物治疗成人创伤出血。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-30 DOI: 10.1097/ALN.0000000000005230
Lidia Mora, Marc Maegele, Oliver Grottke, Andreas Koster, Philipp Stein, Jerrold H Levy, Gabor Erdoes
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引用次数: 0
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Anesthesiology
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