Anesthesia and Analgesia

دسترسی یکساله به بیش از ۵۰۰ ژورنال روز جهان موجود در سامانه

ﻣﺪﺕ ﺯﻣﺎﻥ : 365 ﺭﻭﺯ
~~قیمت : 3,800,000 تومان~~
قیمت ویژه : 1,900,000تومان

سفارش

Super Morbid Obesity: Implications of BMI for Ambulatory Surgery

Nathan, Naveen MD

doi : 10.1213/ANE.0000000000005793

December 2021 - Volume 133 - Issue 6 - p 1365

خرید پکیج و مشاهده آنلاین مقاله

Anesthetic Technique: Influences on Discharge Destination?

Nathan, Naveen MD

doi : 10.1213/ANE.0000000000005794

December 2021 - Volume 133 - Issue 6 - p 1374

خرید پکیج و مشاهده آنلاین مقاله

Early Postoperative Outcomes of Super Morbid Obese Compared to Morbid Obese Patients After Ambulatory Surgery Under General Anesthesia: A Propensity-Matched Analysis of a National Database

Hajmohamed, Sherine MD*; Patel, Deeran MD*; Apruzzese, Patricia MS†; Kendall, Mark C. MD*; De Oliveira, Gildasio MD, MSCI, MBA*

doi : 10.1213/ANE.0000000000005770

December 2021 - Volume 133 - Issue 6 - p 1366-1373

Patients with body mass index (BMI) ?50 kg/m2, defined as super morbid obesity, represent the fastest growing segment of patients with obesity in the United States. It is currently unknown if super morbid obese patients are at greater odds than morbid obese patients for poor outcomes after outpatient surgery. The main objective of the current investigation is to assess if super morbid obese patients are at increased odds for postoperative complications after outpatient surgery when compared to morbid obese patients.

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Impact of Neuraxial Versus General Anesthesia on Discharge Destination in Patients Undergoing Primary Total Hip and Total Knee Replacement

Duque, Melissa MD*; Schnetz, Michael P. MD, PhD*; Yates, Adolph J. Jr MD†; Monahan, Amanda MD*; Whitehurst, Steven MD*; Mahajan, Aman MD, PhD, MBA*; Kaynar, A. Murat MD, MPH*,‡

doi : 10.1213/ANE.0000000000005156

December 2021 - Volume 133 - Issue 6 - p 1379-1386

Total knee replacement (TKR) and total hip replacement (THR) are 2 of the most common orthopedic surgical procedures in the United States. These procedures, with fairly low mortality rates, incur significant health care costs, with almost 40% of the costs associated with post acute care. We assessed the impact of general versus neuraxial anesthesia on discharge destination and 30-day readmissions in patients who underwent total knee and hip replacement in our health system.

خرید پکیج و مشاهده آنلاین مقاله

Enhanced Recovery Programs in an Ambulatory Surgical Oncology Center

Afonso, Anoushka M. MD*,†; McCormick, Patrick J. MD, MEng*,†; Assel, Melissa J. MS‡; Rieth, Elizabeth MD*,†; Barnett, Kara MD*,†; Tokita, Hanae K. MD*; Masson, Geema MD*; Laudone, Vincent MD§,?; Simon, Brett A. MD, PhD*,†; Twersky, Rebecca S. MD, MPH*,†

doi : 10.1213/ANE.0000000000005356

December 2021 - Volume 133 - Issue 6 - p 1391-1401

We describe the implementation of enhanced recovery after surgery (ERAS) programs designed to minimize postoperative nausea and vomiting (PONV) and pain and reduce opioid use in patients undergoing selected procedures at an ambulatory cancer surgery center. Key components of the ERAS included preoperative patient education regarding the postoperative course, liberal preoperative hydration, standardized PONV prophylaxis, appropriate intraoperative fluid management, and multimodal analgesia at all stages.

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Efficiency Metrics at an Academic Freestanding Ambulatory Surgery Center: Analysis of the Impact on Scheduled End-Times

Reeves, J. Jeffery MD*; Waterman, Ruth S. MD, MS†; Spurr, Kristin R. MSN, RN-C, CPAN‡; Gabriel, Rodney A. MD, MAS†,§

doi : 10.1213/ANE.0000000000005282

December 2021 - Volume 133 - Issue 6 - p 1406-1414

Understanding the impact of key metrics on operating room (OR) efficiency is important to optimize utilization and reduce costs, particularly in freestanding ambulatory surgery centers. The aim of this study was to assess the association between commonly used efficiency metrics and scheduled end-time accuracy.

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Neuromuscular Blockade and Reversal Practice Variability in the Outpatient Setting: Insights From US Utilization Patterns

Bash, Lori D. PhD, MPH*; Black, Wynona PhD, MPH†; Turzhitsky, Vladimir PhD, MS†; Urman, Richard D. MD, MBA‡

doi : 10.1213/ANE.0000000000005657

December 2021 - Volume 133 - Issue 6 - p 1437-1450

Neuromuscular blockade (NMB) is a critical part of many surgical procedures. Data on practice patterns of NMB agents (NMBAs) and NMB reversal in recent years in the US ambulatory surgical care setting are limited.

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Urinary Neutrophil Gelatinase–Associated Lipocalin/Hepcidin-25 Ratio for Early Identification of Patients at Risk for Renal Replacement Therapy After Cardiac Surgery: A Substudy of the BICARBONATE Trial

Elitok, Saban MD*; Kuppe, Hermann MD, PhD†; Devarajan, Prasad MD‡; Bellomo, Rinaldo MD§,?,¶; Isermann, Berend MD#; Westphal, Sabine MD**; Kube, Johanna MD††; Albert, Christian MD‡‡,§§; Ernst, Martin MD*,??; Kropf, Siegfried PhD¶¶; Haase-Fielitz, Anja PharmD##,***,†††,‡‡‡; Haase, Michael MD††,??

doi : 10.1213/ANE.0000000000005741

December 2021 - Volume 133 - Issue 6 - p 1510-1519

Acute kidney injury requiring renal replacement therapy (AKI-RRT) is strongly associated with mortality after cardiac surgery; however, options for early identification of patients at high risk for AKI-RRT are extremely limited. Early after cardiac surgery, the predictive ability for AKI-RRT even of one of the most extensively evaluated novel urinary biomarkers, neutrophil gelatinase–associated lipocalin (NGAL), appears to be only moderate. We aimed to determine whether the NGAL/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of hepcidin-25) early after surgery may compare favorably to NGAL for identification of high-risk patients after cardiac surgery.

خرید پکیج و مشاهده آنلاین مقاله

Looking Forward to Progress in Perioperative Care: Anesthetic Technique and Discharge Destination After Total Joint Replacement

Davila, Victor MD*; Joshi, Girish P. MBBS, MD, FFARCSI†

doi : 10.1213/ANE.0000000000005226

December 2021 - Volume 133 - Issue 6 - p 1375-1378

خرید پکیج و مشاهده آنلاین مقاله

Enhanced Recovery in an Ambulatory Surgical Oncology Center: The Tip of the Scalpel

Vetter, Thomas R. MD, MPH*; Joshi, Girish P. MBBS, MD, FFARCSI†

doi : 10.1213/ANE.0000000000005746

December 2021 - Volume 133 - Issue 6 - p 1387-1390

خرید پکیج و مشاهده آنلاین مقاله

Causes of Delays in the Ambulatory Surgery Center Setting: A Keen Grasp of the Obvious?

Joshi, Girish P. MBBS, MD, FFARCSI*; Vetter, Thomas R. MD, MPH†

doi : 10.1213/ANE.0000000000005445

December 2021 - Volume 133 - Issue 6 - p 1402-1405

خرید پکیج و مشاهده آنلاین مقاله

Society of Cardiovascular Anesthesiologists Consensus Statement on Intraoperative Management of Extracorporeal Membrane Oxygenation: A New Instrument in the Perioperative Medicine Toolkit

Anandamurthy, Balaram MD*; Shaw, Andrew MD*; Skubas, Nikolaos J. MD, DSc, FACC, FASE†

doi : 10.1213/ANE.0000000000005792

December 2021 - Volume 133 - Issue 6 - p 1456-1458

خرید پکیج و مشاهده آنلاین مقاله

Society for Pediatric Anesthesia’s Women’s Empowerment and Leadership Initiative: A Reason to Smile More?

Zaleski, Katherine L. MD

doi : 10.1213/ANE.0000000000005777

December 2021 - Volume 133 - Issue 6 - p 1494-1496

خرید پکیج و مشاهده آنلاین مقاله

Patient Selection for Adult Ambulatory Surgery: A Narrative Review

Rajan, Niraja MD*; Rosero, Eric B. MD, MSc†; Joshi, Girish P. MBBS, MD, FFARCSI†

doi : 10.1213/ANE.0000000000005605

December 2021 - Volume 133 - Issue 6 - p 1415-1430

With migration of medically complex patients undergoing more extensive surgical procedures to the ambulatory setting, selecting the appropriate patient is vital. Patient selection can impact patient safety, efficiency, and reportable outcomes at ambulatory surgery centers (ASCs). Identifying suitability for ambulatory surgery is a dynamic process that depends on a complex interplay between the surgical procedure, patient characteristics, and the expected anesthetic technique (eg, sedation/analgesia, local/regional anesthesia, or general anesthesia). In addition, the type of ambulatory setting (ie, short-stay facilities, hospital-based ambulatory center, freestanding ambulatory center, and office-based surgery) and social factors, such as availability of a responsible individual to take care of the patient at home, can also influence patient selection. The purpose of this review is to present current best evidence that would provide guidance to the ambulatory anesthesiologist in making an informed decision regarding patient selection for surgical procedures in freestanding ambulatory facilities.

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Preoperative Care for Cataract Surgery: The Society for Ambulatory Anesthesia Position Statement

Sweitzer, BobbieJean MD, FACP, SAMBA-F, FASA*; Rajan, Niraja MD†; Schell, Dawn MD‡; Gayer, Steven MD, MBA§; Eckert, Stan MD?; Joshi, Girish P. MBBS, MD, FFARCSI¶

doi : 10.1213/ANE.0000000000005652

December 2021 - Volume 133 - Issue 6 - p 1431-1436

Cataract surgeries are among the most common procedures requiring anesthesia care. Cataracts are a common cause of blindness. Surgery remains the only effective treatment of cataracts. Patients are often elderly with comorbidities. Most cataracts can be treated using topical or regional anesthesia with minimum or no sedation. There is minimal risk of adverse outcomes. There is general consensus that cataract surgery is extremely low risk, and the benefits of sight restoration and preservation are enormous. We present the Society for Ambulatory Anesthesia (SAMBA) position statement for preoperative care for cataract surgery.

خرید پکیج و مشاهده آنلاین مقاله

Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation

Mazzeffi, Michael A. MD, MPH, MSc, FASA*; Rao, Vidya K. MD†; Dodd-o, Jeffrey MD, PhD‡; Del Rio, Jose Mauricio MD§; Hernandez, Antonio MD, MSc?; Chung, Mabel MD, MPH¶; Bardia, Amit MD#; Bauer, Rebecca M. MD**; Meltzer, Joseph S. MD††; Satyapriya, Sree MD‡‡; Rector, Raymond CCP§§; Ramsay, James G. MD??; Gutsche, Jacob MD¶¶

doi : 10.1213/ANE.0000000000005738

December 2021 - Volume 133 - Issue 6 - p 1459-1477

Extracorporeal membrane oxygenation (ECMO) is used to support patients with refractory cardiopulmonary failure. Given ECMO’s increased use in adults and the fact that many ECMO patients are cared for by anesthesiologists, the Society of Cardiovascular Anesthesiologists ECMO working group created an expert consensus statement that is intended to help anesthesiologists manage adult ECMO patients who are cared for in the operating room. In the first part of this 2-part series, technical aspects of ECMO are discussed, and related expert consensus statements are provided.

خرید پکیج و مشاهده آنلاین مقاله

Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part II, Intraoperative Management and Troubleshooting

doi : 10.1213/ANE.0000000000005733

December 2021 - Volume 133 - Issue 6 - p 1478-1493

In the second part of the Society of Cardiovascular Anesthesiologists Extracorporeal Membrane Oxygenation (ECMO) working group expert consensus statement, venoarterial (VA) and venovenous (VV) ECMO management and troubleshooting in the operating room are discussed. Expert consensus statements are provided about intraoperative monitoring, anesthetic drug dosing, and management of intraoperative problems in VA and VV ECMO patients.

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Empowering Women as Leaders in Pediatric Anesthesiology: Methodology, Lessons, and Early Outcomes of a National Initiative

Schwartz, Jamie McElrath MD*; Markowitz, Scott D. MD†; Yanofsky, Samuel D. MD, MSEd‡; Tackett, Sean MD, MPH§; Berenstain, Laura K. MD, FASA?; Schwartz, Lawrence I. MD¶; Flick, Randall MD, MPH#; Heitmiller, Eugenie MD**; Fiadjoe, John MD††; Lee, Helen H. MD, MPH‡‡; Honkanen, Anita MD, MS, FAAP§§; Malviya, Shobha MD??; Cladis, Franklyn P. MD, FAAP¶¶; Lee, Jennifer K. MD*; Deutsch, Nina MD**

doi : 10.1213/ANE.0000000000005740

December 2021 - Volume 133 - Issue 6 - p 1497-1509

Research has shown that women have leadership ability equal to or better than that of their male counterparts, yet proportionally fewer women than men achieve leadership positions and promotion in medicine. The Women’s Empowerment and Leadership Initiative (WELI) was founded within the Society for Pediatric Anesthesia (SPA) in 2018 as a multidimensional program to help address the significant career development, leadership, and promotion gender gap between men and women in anesthesiology. Herein, we describe WELI’s development and implementation with an early assessment of effectiveness at 2 years. Members received an anonymous, voluntary survey by e-mail to assess whether they believed WELI was beneficial in several broad domains: career development, networking, project implementation and completion, goal setting, mentorship, well-being, and promotion and leadership. The response rate was 60.5% (92 of 152). The majority ranked several aspects of WELI to be very or extremely valuable, including the protégé-advisor dyads, workshops, nomination to join WELI, and virtual facilitated networking. For most members, WELI helped to improve optimism about their professional future. Most also reported that WELI somewhat or absolutely contributed to project improvement or completion, finding new collaborators, and obtaining invitations to be visiting speakers. Among those who applied for promotion or leadership positions, 51% found WELI to be somewhat or absolutely valuable to their application process, and 42% found the same in applying for leadership positions. Qualitative analysis of free-text survey responses identified 5 main themes: (1) feelings of empowerment and confidence, (2) acquisition of new skills in mentoring, coaching, career development, and project implementation, (3) clarification and focus on goal setting, (4) creating meaningful connections through networking, and (5) challenges from coronavirus disease 2019 (COVID-19) and the inability to sustain the advisor-protégé connection. We conclude that after 2 years, the WELI program has successfully supported career development for the majority of protégés and advisors. Continued assessment of whether WELI can meaningfully contribute to attainment of promotion and leadership positions will require study across a longer period. WELI could serve as a programmatic example to support women’s career development in other subspecialties.

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Improving Anesthesia Capacity for Ambulatory Surgery in Low- and Middle-Income Countries: Current Scenario and Future Prospects

Puri, Sunaakshi MD; Bandyopadhyay, Anjishnujit MD; Ashok, Vighnesh FRCA

doi : 10.1213/ANE.0000000000005764

December 2021 - Volume 133 - Issue 6 - p 1451-1455

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Current Practice Issues in Thoracic Anesthesia

Cohen, Edmond MD, FASA

doi : 10.1213/ANE.0000000000005707

December 2021 - Volume 133 - Issue 6 - p 1520-1531

This review discusses the present strategies in lung separation, the various types of double-lumen tubes (DLTs), and the use of bronchial blockers (BBs). Methods of selecting the correct DLT size and the role of videolaryngoscopy in placing a DLT are reviewed. Mechanisms whereby inhaled anesthetics may be protective during one-lung ventilation (OLV) are highlighted. The risk and prevention of fire during thoracic procedures are discussed.

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Effect of Intravenous Acetaminophen on Mean Arterial Blood Pressure: A Post Hoc Analysis of the EFfect of Intravenous ACetaminophen on PosToperative HypOxemia After Abdominal SurgeRy Trial

Bravo, Mauro MD*; Bakal, Omer MD*; Rivas, Eva MD, PhD*,†; Mascha, Edward J. PhD*,‡; Pu, Xuan MS*,‡; Mosteller, Lauretta MS*; Rodriguez-Patarroyo, Fabio MD*; Essber, Hani MD*; AlGharrash, Ahmed MD*; Turan, Alparslan MD*,§

doi : 10.1213/ANE.0000000000005429

December 2021 - Volume 133 - Issue 6 - p 1532-1539

Acetaminophen is commonly used as part of multimodal analgesia for acute pain. The intravenous formulation offers a more predictable bioavailability compared to oral and rectal acetaminophen. There have been reports of hypotension with intravenous acetaminophen attributable to centrally mediated and vasodilatory effects. We tested the hypothesis that in adults having abdominal surgery the use of intravenous acetaminophen versus placebo for postoperative pain management is associated with a decrease in mean arterial pressure (MAP) after its administration.

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Rapid Sequence Induction With a Standard Intubation Dose of Rocuronium After Magnesium Pretreatment Compared With Succinylcholine: A Randomized Clinical Trial

Czarnetzki, Christoph MD, MBA*,†,‡; Albrecht, Eric MD§,?; Masouyé, Philippe MD*; Baeriswyl, Moira MD§; Poncet, Antoine MS¶; Robin, Matthias MD*; Kern, Christian MD§,?; Tramèr, Martin R. MD, DPhil*,‡

doi : 10.1213/ANE.0000000000005324

December 2021 - Volume 133 - Issue 6 - p 1540-1549

Succinylcholine remains the muscle relaxant of choice for rapid sequence induction (RSI) but has many adverse effects. High-dose rocuronium bromide may be an alternative to succinylcholine for RSI but recovery times are nearly doubled compared with a standard intubating dose of rocuronium. Magnesium sulfate significantly shortens the onset time of a standard intubating dose of rocuronium. We set out to investigate whether intravenous (IV) pretreatment with MgSO4 followed by a standard intubating dose of rocuronium achieved superior intubation conditions compared with succinylcholine.

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Analgesia After Cesarean Delivery in the United States 2008–2018: A Retrospective Cohort Study

Reed, Sydney E. MD*; Tan, Hon Sen MD, MMed†; Fuller, Matthew E. MS*,‡; Krishnamoorthy, Vijay MD*,‡; Ohnuma, Tetsu MD*,‡; Raghunathan, Karthik MD*,‡; Habib, Ashraf S. MBBCh, MSc, MHSc, FRCA*

doi : 10.1213/ANE.0000000000005587

December 2021 - Volume 133 - Issue 6 - p 1550-1558

Optimizing analgesia after cesarean delivery is a priority and requires balancing adequate pain relief with the risk of analgesics-associated adverse effects. Current recommendations are for use of a multimodal, opioid-sparing analgesic regimen that includes neuraxial morphine combined with scheduled nonsteroidal anti-inflammatory drugs (NSAIDs) and scheduled acetaminophen. Furthermore, recent studies recommend scheduled acetaminophen with as-needed opioids in lieu of acetaminophen-opioid combination drugs to reduce opioid consumption and optimize analgesia. However, the extent of utilization of this recommended regimen in the United States is unclear. We therefore performed this retrospective study to evaluate postoperative analgesic regimens utilized after cesarean delivery under neuraxial anesthesia, examine variability across institutions, evaluate changes over time in postoperative analgesic practice, and examine factors associated with the use of neuraxial morphine and of multimodal analgesia.

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The Prevalence of Difficult Airway in Children With Beckwith-Wiedemann Syndrome: A Retrospective Cohort Study

Sequera-Ramos, Luis MD*; Duffy, Kelly A. MPH†; Fiadjoe, John E. MD*; Garcia-Marcinkiewicz, Annery G. MD*; Zhang, Bingqing MPH‡; Perate, Alison MD*; Kalish, Jennifer M. MD, PhD†,§

doi : 10.1213/ANE.0000000000005536

December 2021 - Volume 133 - Issue 6 - p 1559-1567

Beckwith-Wiedemann syndrome (BWS) is the most common congenital overgrowth disorder with an incidence of approximately 1 in 10,000 live births. The condition is characterized by lateralized overgrowth, abdominal wall defects, macroglossia, and predisposition to malignancy. Historically, children with BWS have been presumed to have difficult airways; however, most of the evidence to support this has been anecdotal and derived from case reports. Our study aimed to determine the prevalence of difficult airway in patients with BWS. We hypothesized that most patients with BWS would not have difficult airways.

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Comparison of Oral Loading Dose to Intravenous Acetaminophen in Children for Analgesia After Tonsillectomy and Adenoidectomy: A Randomized Clinical Trial

Lammers, Cathy R. MD*; Schwinghammer, Amy J. PharmD†; Hall, Brent PharmD†; Kriss, Robert Scott DO*; Aizenberg, Debbie A. MD‡; Funamura, Jamie L. MD, MPH‡; Senders, Craig W. MD‡; Nittur, Vinay BS§; Applegate, Richard L. II MD*

doi : 10.1213/ANE.0000000000005678

December 2021 - Volume 133 - Issue 6 - p 1568-1576

Acetaminophen is a frequently used adjunct analgesic in pediatric patients undergoing tonsillectomy and adenoidectomy. We compared opioid administration following preoperative intravenous (IV) or oral acetaminophen in addition to a standard multimodal regimen to test the hypothesis that 1 loading dose approach would provide superior opioid sparing effects among pediatric surgical patients undergoing tonsillectomy and adenoidectomy.

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The Strength of Alpha Oscillations in the Electroencephalogram Differently Affects Algorithms Used for Anesthesia Monitoring

Weyer, Clara BS*; Prötzl, Eva BS*; Kinateder, Thomas MS*; Nowak, Fabian*; Husemann, Cornelius MD*,†; Hautmann, Hubert MD†,‡; Kratzer, Stephan MD*; Schneider, Gerhard MD*; Kreuzer, Matthias PhD*

doi : 10.1213/ANE.0000000000005704

December 2021 - Volume 133 - Issue 6 - p 1577-1587

Intraoperative patient monitoring using the electroencephalogram (EEG) can help to adequately adjust the anesthetic level. Therefore, the processed EEG (pEEG) provides the anesthesiologist with the estimated anesthesia level. The commonly used approaches track the changes from a fast- and a low-amplitude EEG during wakefulness to a slow- and a high-amplitude EEG under general anesthesia. However, besides these changes, another EEG feature, a strong oscillatory activity in the alpha band (8–12 Hz), develops in the frontal EEG. Strong alpha-band activity during general anesthesia seems to reflect an appropriate anesthetic level for certain anesthetics, but the way the common pEEG approaches react to changes in the alpha-band activity is not well explained. Hence, we investigated the impact of an artificial alpha-band modulation on pEEG approaches used in anesthesia research.

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Ketamine Alleviates Depressive Symptoms in Patients Undergoing Intracranial Tumor Resection: A Randomized Controlled Trial

Zhou, Yang MD*; Sun, Wanchen MD*; Zhang, Guofu MD†,‡; Wang, Anxin PhD§; Lin, Song MD, PhD?; Chan, Matthew T. V. MB, BS, PhD¶; Peng, Yuming MD, PhD*; Wang, Gang MD, PhD†,‡; Han, Ruquan MD, PhD*

doi : 10.1213/ANE.0000000000005752

December 2021 - Volume 133 - Issue 6 - p 1588-1597

Depressive symptoms occur in over 40% of neurosurgical patients during the perioperative period. However, no measure has been suggested to have a rapid effect on depressive surgical patients during increasingly shorter stays in the hospital. This study aimed to determine whether ketamine could improve depressive symptoms rapidly and safely during the hospital stay.

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Perioperative Electroencephalogram Spectral Dynamics Related to Postoperative Delirium in Older Patients

Koch, Susanne MD, PhD*,†; Windmann, Victoria MD*; Chakravarty, Sourish PhD‡; Kruppa, Jochen PhD†,§; Yürek, Fatima MD, PhD*; Brown, Emery N. MD, PhD‡,?; Winterer, Georg MD, PhD*; Spies, Claudia MD, PhD*

doi : 10.1213/ANE.0000000000005668

December 2021 - Volume 133 - Issue 6 - p 1598-1607

Intraoperative electroencephalography (EEG) signatures related to the development of postoperative delirium (POD) in older patients are frequently studied. However, a broad analysis of the EEG dynamics including preoperative, postinduction, intraoperative and postoperative scenarios and its correlation to POD development is still lacking. We explored the relationship between perioperative EEG spectra-derived parameters and POD development, aiming to ascertain the diagnostic utility of these parameters to detect patients developing POD.

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Surgical, Obstetric, and Anesthetic Mortality Measurement at a Ugandan Secondary Referral Hospital

Firth, Paul G. MBChB, BA*; Mushagara, Rhina BA†; Musinguzi, Nicholas MSc†; Liu, Charles MD‡; Boatin, Adeline A. MD§; Mugabi, Walter BSc†; Kayaga, Dorothy BSc†; Naturinda, Phionah BSc†; Twesigye, Deus MBChB, MMed?; Sanyu, Frank BSc¶; Mugyenyi, Godfrey MBChB, MMed#; Ngonzi, Joseph MBChB, MMed#; Ttendo, Stephen S. MBChB, MMed**

doi : 10.1213/ANE.0000000000005734

December 2021 - Volume 133 - Issue 6 - p 1608-1616

The health care systems of low-income countries have severely limited capacity to treat surgical diseases and conditions. There is limited information about which hospital mortality outcomes are suitable metrics in these settings.

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Preparing Anesthesiology Residents for Operating Room Communication Challenges: A New Approach for Conflict Resolution Training

Birnbach, David J. MD, MPH*; Rosen, Lisa F. MA†; Fitzpatrick, Maureen MSN, APRN-BC†; Shekhter, Ilya MBA, MS, CHSE‡; Arheart, Kristopher L. EdD§

doi : 10.1213/ANE.0000000000005561

December 2021 - Volume 133 - Issue 6 - p 1617-1623

The hierarchical culture in high-stake areas such as operating rooms (ORs) may create volatile communication challenges. This unfunded exploratory study sought to establish whether a conflict resolution course was effective in preparing anesthesiology residents to handle and deescalate disagreements that may arise in the clinical environment, especially when challenging a surgeon.

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Impact of Bilateral Subcostal Plus Lateral Transversus Abdominis Plane Block on Quality of Recovery After Laparoscopic Cholecystectomy: A Randomized Placebo-Controlled Trial

Jung, Jaewoong MD*; Jung, Woohyun MD†; Ko, Eun Young MD*; Chung, Yang-Hoon MD, PhD*; Koo, Bon-Sung MD, PhD*; Chung, Jun Chul MD, PhD‡; Kim, Sang-Hyun MD, PhD*

doi : 10.1213/ANE.0000000000005762

December 2021 - Volume 133 - Issue 6 - p 1624-1632

Previous research has not evaluated the potential effect of transversus abdominis plane (TAP) block on quality of recovery following laparoscopic cholecystectomy. Therefore, we investigated whether addition of the bilateral subcostal and lateral TAP (bilateral dual TAP [BD-TAP]) blocks to multimodal analgesia would improve the quality of recovery as assessed with the Quality of Recovery-40 (QoR-40).

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Statistics From A (Agreement) to Z (z Score): A Guide to Interpreting Common Measures of Association, Agreement, Diagnostic Accuracy, Effect Size, Heterogeneity, and Reliability in Medical Research

Schober, Patrick MD, PhD, MMedStat*; Mascha, Edward J. PhD†; Vetter, Thomas R. MD, MPH‡

doi : 10.1213/ANE.0000000000005773

December 2021 - Volume 133 - Issue 6 - p 1633-1641

Researchers reporting results of statistical analyses, as well as readers of manuscripts reporting original research, often seek guidance on how numeric results can be practically and meaningfully interpreted. With this article, we aim to provide benchmarks for cutoff or cut-point values and to suggest plain-language interpretations for a number of commonly used statistical measures of association, agreement, diagnostic accuracy, effect size, heterogeneity, and reliability in medical research. Specifically, we discuss correlation coefficients, Cronbach’s alpha, I2, intraclass correlation (ICC), Cohen’s and Fleiss’ kappa statistics, the area under the receiver operating characteristic curve (AUROC, concordance statistic), standardized mean differences (Cohen’s d, Hedge’s g, Glass’ delta), and z scores. We base these cutoff values on what has been previously proposed by experts in the field in peer-reviewed literature and textbooks, as well as online statistical resources. We integrate, adapt, and/or expand previous suggestions in attempts to (a) achieve a compromise between divergent recommendations, and (b) propose cutoffs that we perceive sensible for the field of anesthesia and related specialties. While our suggestions provide guidance on how the results of statistical tests are typically interpreted, this does not mean that the results can universally be interpreted as suggested here. We discuss the well-known inherent limitations of using cutoff values to categorize continuous measures. We further emphasize that cutoff values may depend on the specific clinical or scientific context. Rule-of-the thumb approaches to the interpretation of statistical measures should therefore be used judiciously.

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John Snow: Anesthesiologist, Epidemiologist, Scientist, and Hero

Holzman, Robert S. MD

doi : 10.1213/ANE.0000000000005586

December 2021 - Volume 133 - Issue 6 - p 1642-1650

A 19th century physician was crucial to the establishment of 2 medical specialties—anesthesiology and public health. Everyone whose interest in public health has increased in the last year will be amazed at Dr John Snow’s career in anesthesiology. Those who recognize him as the first full-time physician anesthetist will be struck by his development of medical mapping during the Cholera Pandemic of 1848, resulting in one of the fundamental techniques of epidemiology and public health that has continued through today. Snow’s accomplishments in anesthesiology and epidemiology reflected a concatenation of science, focus, and creativity. His training in the early 19th century integrated science, medicine, and his keen interest in respiratory physiology. His early clinical exposure to colliery workers in Newcastle was likely influenced by the earlier development of pneumatic medicine. He was committed to the notion that chemistry, especially the use of medicinal gases, would be transformative for medicine. Thus, he was “primed” when the news of the American anodyne ether reached London in 1846. When the third cholera pandemic reached London shortly thereafter, in the fall of 1848, his academic and practical understanding of gas chemistry and pharmacology, respiratory physiology, and anesthetic agents led him to question the popularly promulgated miasma-based theories of transmission. His methodical investigations, research, and perseverance were mirrored in his scholarly work, numerous presentations, and public advocacy. He articulated many scientific principles essential to the early practice of anesthesia—anesthetic potency, quantitative dosing of anesthetic agents, engineering principles required for conserving the latent heat of vaporization, and minimizing the contribution of anesthetic equipment to airway resistance. He moved easily and methodically between these worlds of physiology, chemistry, engineering, clinical medicine, and public health. In his role as the first medical epidemiologist, Snow understood the power of medical mapping and the graphic presentation of data. He was a pioneer in 2 nascent fields of medicine that were historically and remain contemporarily connected.

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