Anesthesiology (original) (raw)
This Month in Anesthesiology
Polygenic Score for the Prediction of Postoperative Nausea and Vomiting: A Retrospective Derivation and Validation Cohort Study
Douville, Nicholas J.; Bastarache, Lisa; He, Jing; Wu, Kuan-Han H.; Vanderwerff, Brett; Bertucci-Richter, Emily; Hornsby, Whitney E.; Lewis, Adam; Jewell, Elizabeth S.; Kheterpal, Sachin; Shah, Nirav; Mathis, Michael; Engoren, Milo C.; Douville, Christopher B.; Surakka, Ida; Willer, Cristen; Kertai, Miklos D. Less
Anesthesiology. 142(1):52-71, January 2025.
In Brief:
The investigators identified genetic variants associated with postoperative nausea and vomiting by performing a genome-wide association study. Based on this study, they created a polygenic risk score for postoperative nausea and vomiting in a derivation cohort; in a validation cohort, when added to traditional risk factors, the polygenic risk score only modestly augmented the prediction of postoperative nausea and vomiting. The use of this polygenic risk score did not result in a clinically meaningful improvement in postoperative nausea and vomiting prediction when added to traditional risk factors.
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High Positive End-expiratory Pressure (PEEP) with Recruitment Maneuvers versus Low PEEP during General Anesthesia for Surgery: A Bayesian Individual Patient Data Meta-analysis of Three Randomized Clinical Trials
Mazzinari, Guido; Zampieri, Fernando G.; Ball, Lorenzo; More
Mazzinari, Guido; Zampieri, Fernando G.; Ball, Lorenzo; Campos, Niklas S.; Bluth, Thomas; Hemmes, Sabrine N. T.; Ferrando, Carlos; Librero, Julian; Soro, Marina; Pelosi, Paolo; Gama de Abreu, Marcelo; Schultz, Marcus J.; Serpa Neto, Ary; for REPEAT on behalf of the PROVHILO, iPROVE, and PROBESE investigators and the PROVE Network investigators Less
Anesthesiology. 142(1):72-97, January 2025.
In Brief:
This post hoc Bayesian reanalysis of individual patient data from three large randomized clinical trials showed that using high positive end-expiratory pressure and recruitment maneuvers led to a high likelihood of a slight reduction in the probability of complications occurrence.
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Protamine Dosing for Heparin Reversal after Cardiopulmonary Bypass: A Double-blinded Prospective Randomized Control Trial Comparing Two Strategies
Jain, Pankaj; Silva-De Las Salas, Alejandra; Bedi, Kabir; More
Jain, Pankaj; Silva-De Las Salas, Alejandra; Bedi, Kabir; Lamelas, Joseph; Epstein, Richard H.; Fabbro, Michael II Less
Anesthesiology. 142(1):98-106, January 2025.
In Brief:
This is a single-center randomized trial of cardiac surgical patients. The objective of the study was to compare adequacy of heparin reversal in patients given protamine after cardiopulmonary bypass using two different approaches to protamine dosing. The protamine dose approaches were a “fixed” approach (250-mg protamine dose) and a “ratio-based” approach (1 mg protamine: 100-U heparin dose). The study’s primary outcome was postprotamine activated clotting time, and one of the secondary outcomes was 24-h chest tube output. This study found no significant difference in the post–cardiopulmonary bypass activated clotting time in the “fixed” versus “ratio-based” protamine groups and no difference in chest tube output. An additional finding was that patients who were in the “fixed” dose group received significantly lower intraoperative protamine than the group who received the ratio-based intraoperative protamine dosing. The study’s findings suggest that a lower protamine dose than that derived from the 1 mg protamine:100 U heparin strategy may be effective for heparin reversal after cardiopulmonary bypass both in terms of bleeding risk and with respect to concerns not to waste doses of protamine.
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Bioequivalence and Pharmacokinetics of Intravenous Calcium during Cesarean Delivery
Ansari, Jessica R.; Conti, Daniel J.; Michel, Guillermina; More
Ansari, Jessica R.; Conti, Daniel J.; Michel, Guillermina; Yarmosh, Alla; Cole, Naida M.; Shafer, Steven L. Less
Anesthesiology. 142(1):121-131, January 2025.
In Brief:
A bioequivalence (dose ratio) study of calcium gluconate and calcium chloride was conducted in parturients randomly assigned to receive intravenous infusions of one or the other after umbilical cord clamping. A 3-g dose of intravenously administered calcium gluconate was bioequivalent to a 1-g dose of calcium chloride. A population pharmacokinetic analysis was also conducted; the peak increase in serum ionized calcium concentrations after a 10-min intravenous infusion of 1 g calcium chloride or 3 g calcium gluconate was 0.4 mM. The increase in serum ionized calcium concentration 30 min after beginning the calcium infusion was half of the peak increase.
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Ultrasound-guided Superficial Cervical Plexus Blocks for Persistent Pain after Suboccipital Craniotomies: A Randomized Trial
Zeng, Min; Zheng, Maoyao; Ren, Yue; More
Zeng, Min; Zheng, Maoyao; Ren, Yue; Yin, Xueke; Li, Shu; Zhao, Yan; Wang, Dexiang; Zhang, Liyong; Guan, Xiudong; Li, Deling; Sessler, Daniel I.; Peng, Yuming Less
Anesthesiology. 142(1):166-175, January 2025.
In Brief:
This randomized, blinded, placebo-controlled trial assessed superficial cervical plexus block for prevention of persistent incisional pain in 292 patients having suboccipital craniotomies. In patients assigned to superficial cervical plexus block with 0.5% ropivacaine, the incidence of incisional pain 3 months after surgery was 36% versus 53% in those randomized to saline (relative risk, 0.69; 95% CI, 0.53 to 0.90; P = 0.005). Mild incisional pain (1 to 3) at 3 months was reported by 29% of the ropivacaine group versus 42% of the saline group, and moderate to severe pain (4 to 10) was reported by 5% of the ropivacaine group versus 9% of the saline group.
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Perioperative Acute Kidney Injury: Diagnosis, Prediction, Prevention, and Treatment
Douville, Nicholas J.; Mathis, Michael; Kheterpal, Sachin; More
Douville, Nicholas J.; Mathis, Michael; Kheterpal, Sachin; Heung, Michael; Schaub, Jennifer; Naik, Abhijit; Kretzler, Matthias Less
Anesthesiology. 142(1):180-201, January 2025.
In Brief:
In this review, the authors define acute kidney injury in the perioperative setting, describe the epidemiologic burden, discuss procedure-specific risk factors, detail principles of management, and highlight areas of ongoing controversy and research.
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2025 American Society of Anesthesiologists Practice Advisory for Perioperative Care of Older Adults Scheduled for Inpatient Surgery
Sieber, Frederick; McIsaac, Daniel I.; Deiner, Stacie; More
Sieber, Frederick; McIsaac, Daniel I.; Deiner, Stacie; Azefor, Tangwan; Berger, Miles; Hughes, Christopher; Leung, Jacqueline M.; Maldon, John; McSwain, Julie R.; Neuman, Mark D.; Russell, Marcia M.; Tang, Victoria; Whitlock, Elizabeth; Whittington, Robert; Marbella, Anne M.; Agarkar, Madhulika; Ramirez, Stephanie; Dyer, Alexandre; Friel Blanck, Jaime; Uhl, Stacey; Grant, Mark D.; Domino, Karen B. Less
Anesthesiology. 142(1):22-51, January 2025.
In Brief:
This advisory provides evidence-based recommendations on the management of older adults undergoing inpatient surgery. The advisory focuses on aspects of preoperative, intraoperative, and postoperative care of specific relevance to older adults (i.e., 65 yr or older), and it addresses approaches to minimizing complications of anesthesia common among older patients.