Hasil untuk "Anesthesiology"

Jie Hu, Lu Wang, Bing Xue et al.

Abstract Background Transthoracic echocardiography can be performed under sedation in children with Down syndrome who have neurological or behavioral problems. This study aimed to compare the efficacy and safety of intranasal dexmedetomidine and oral chloral hydrate in children with Down syndrome who are undergoing transthoracic echocardiography. Methods This retrospective cohort study reviewed the electronic medical records of patients with Down syndrome who underwent transthoracic echocardiography under oral chloral hydrate or intranasal dexmedetomidine sedation between June 2014 and September 2021. The patients were divided into oral chloral hydrate and intranasal dexmedetomidine groups according to the main agents used for sedation. The primary endpoint was the outcome of single-dose sedative agents, and the groups were compared using a propensity score weighting analysis. Results In total, 149 patients (chloral hydrate group, n = 75; dexmedetomidine group, n = 74) were included in the final analysis. After propensity score weighting, 150 and 148 patients were included in the chloral hydrate and dexmedetomidine groups, respectively. The success rate of the initial sedative medication was significantly higher in the dexmedetomidine group than in the chloral hydrate group (89.1% vs. 80.7%, p = 0.0412) after adjustment for propensity score weighting. The success rate of the final sedative medication was higher in the dexmedetomidine group than in the chloral hydrate group (before propensity score weighting, 98.7% vs. 86.7%; after propensity score weighting, 98.5% vs. 86.8%; both p values < 0.01). Before and after propensity score weighting, the incidence of bradycardia during sleep was significantly higher in the dexmedetomidine group than in the chloral hydrate group. Sedation with dexmedetomidine or chloral hydrate was not associated with severe oxygen desaturation in children with Down syndrome. Conclusions Compared with oral 50 mg/kg chloral hydrate, the use of a single intranasal dose of 2 μg/kg dexmedetomidine was related to a significantly higher success rate of sedation without increasing severe hypoxic events in children with Down syndrome undergoing transthoracic echocardiography, except for the incidence of bradycardia.

Zhang K, Sun J, Zhang C et al.

Kaiwen Zhang,1,&amp;ast; Jiaoli Sun,1,&amp;ast; Caixia Zhang,2 Bo Jiao,1 Wencui Zhang,1 Shangchen Yu,1 Xueqin Cao,1 Zhiqiang Zhou,1 Guanglei Zhang,1 Xianwei Zhang1 1Department of Anesthesiology and Pain Medicine,Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Department of Anesthesiology, Wuhan No. 1 Hospital, Wuhan, People’s Republic of China&amp;ast;These authors contributed equally to this workCorrespondence: Guanglei Zhang, Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, People’s Republic of China, Email zsytd528@163.com Xianwei Zhang, Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, People’s Republic of China, Email ourpain@163.comPurpose: Effective postoperative analgesia is essential for maternal recovery following cesarean delivery. Hydromorphone and nalbuphine are commonly used opioids with differing pharmacologic properties, but direct comparisons in postcesarean patient-controlled analgesia (PCA) are limited. This study aimed to compare the analgesic efficacy and safety of hydromorphone versus nalbuphine and to develop a predictive model for inadequate analgesia.Patients and Methods: In this prospective, randomized, double-blind clinical trial conducted from December 2024 to March 2025, 212 women undergoing elective cesarean section under spinal anesthesia were randomized (1:1) to receive hydromorphone (0.1 mg/mL) or nalbuphine (1 mg/mL) via standardized intravenous PCA. The primary outcome was the incidence of inadequate analgesia within 24 hours, defined as a numerical rating scale (NRS) score ≥ 4 at rest or during movement. Secondary outcomes included adverse events, PCA consumption, and recovery indicators. Multivariable logistic regression was used to identify predictors of inadequate analgesia, and a nomogram was constructed and internally validated.Results: Nalbuphine was associated with a significantly lower incidence of inadequate analgesia than hydromorphone (14.2% vs 26.4%; P = 0.026), as well as reduced nausea and vomiting (18.9% vs 32.1%; P = 0.001) and pruritus (0% vs 5.7%; P = 0.029). Independent predictors of inadequate analgesia included PCA regimen (OR, 0.30; P = 0.026), gestational diabetes mellitus (OR, 4.40; P = 0.007), blood type AB (OR, 3.80; P = 0.043), and preoperative anxiety (OR, 0.20; P = 0.044). The predictive model showed good discrimination (AUC = 0.754).Conclusion: Nalbuphine demonstrated superior analgesia and fewer adverse effects compared with hydromorphone for postcesarean PCA. The developed predictive model may support individualized pain management by identifying patients at risk for inadequate analgesia.Keywords: postoperative analgesia, patient-controlled analgesia, hydromorphone, nalbuphine, predictive model

Piroozeh Taheri, Mohammad Taghi Beig Mohammadi, Mostafa Mohammadi et al.

Background: Exploring risk factors for the development of COVID-19 in vital organs of the body is necessary to improve patient survival and reduce disability and morbidity due to disease progression. By identifying these underlying risk factors and controlling them, it is possible to prevent extra-pulmonary involvement and even alleviate pulmonary involvement in patients, resulting in a significant reduction in mortality and morbidity rates. This study aimed to identify the underlying risk factors associated with pulmonary and extrapulmonary organ complications of COVID-19. Methods: This study was a cross-sectional descriptive-analytical study. Patients with a definitive diagnosis of COVID-19 who were admitted to the intensive care unit of Imam Khomeini Hospital in Tehran due to respiratory distress and poor clinical condition were included in the study population and were clinically followed up on. Patients' information was collected by reviewing patients' records and the hospital information system. Results: A total of 123 patients were included in the study (63.4% were male, mean age = 58.87 ± 12.37). Using ROC curve analysis, the calculated risk score is considered statistically significant for diagnostic accuracy (AUC = 0.862 [0.797–0.927], P value < value<0.001). A risk score cutoff greater than 1.5 (sensitivity 89.9%, specificity 38.9%) favors an increased likelihood of in-hospital mortality. According to multiple linear regression (F (9,93).369, P value=0.001), chronic obstructive pulmonary disease, asthma, diabetes, SOFA score on days 2 & 3, and ventilation support were predictors of ICU length of stay. Conclusion: A history of chronic heart failure with renal impairment, liver cirrhosis with liver complication, and any underlying disease are associated with pulmonary complications in COVID-19 patients.

Syed Ameen Ahmad, Olivia Liu, Amy Feng et al.

Abstract Background There is an emerging understanding of the increased risk of stroke in patients with immune thrombocytopenic purpura (ITP) and immune thrombotic thrombocytopenic purpura (iTTP). We aimed to determine the prevalence and characteristics of acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) in patients with ITP and iTTP in a systematic review and meta-analysis. Methods We used PubMed, Embase, Cochrane, Web of Science, and Scopus using text related to ITP, iTTP, stroke, AIS, and ICH from inception to 11/3/2023. Our primary outcome was to determine prevalence of AIS and/or ICH in a cohort of ITP or iTTP patients (age > 18). Our secondary outcomes were to determine stroke type associated with thrombopoietin receptor agonists (TPO-RAs) in ITP patients, as well as risk factors associated with stroke in ITP and iTTP patients. Results We included 42 studies with 118,019 patients (mean age = 50 years, 45% female). Of those, 27 studies (n = 116,334) investigated stroke in ITP patients, and 15 studies (n = 1,685) investigated stroke in iTTP patients. In all ITP patients, the prevalence of AIS and ICH was 2.1% [95% Confidence Interval (CI) 0.8-4.0%] and 1.5% (95% CI 0.9%-2.1%), respectively. ITP patients who experienced stroke as an adverse event (AE) from TPO-RAs had an AIS prevalence of 1.8% (95% CI 0.6%-3.4%) and an ICH prevalence of 2.0% (95% CI 0.2%-5.3%). Prevalence of stroke did not significantly differ between all ITP patients and those treated with TPO-RAs. iTTP patients had a prevalence of AIS and ICH of 13.9% (95% CI 10.2%-18.1%) and 3.9% (95% CI 0.2%-10.4%), respectively. Subgroup analysis revealed the prevalence of AIS and ICH was greater in iTTP patients vs. all ITP patients (p < 0.01 and p = 0.02, respectively). Meta-regression analysis revealed none of the collected variables (age, sex, history of diabetes or hypertension) were risk factors for stroke in all ITP patients, although there were high levels of data missingness. Conclusions Prevalence of different stroke types was lower in all ITP patients vs. iTTP patients. Additionally, ITP patients experienced a similar prevalence of stroke regardless of if they were specifically denoted to have been treated with TPO-RAs or not, supporting the continued use of TPO-RAs in management. Risk factors for stroke remain unclear, and future studies should continue to investigate this relationship.

Lalisa Saeaeh, Pornprom Sitthivethayanont, Theerawat Chalacheewa et al.

Abstract Background The 15-item Quality of Recovery scale (QoR-15), a short form of the QoR-40, is a widely used self-reported tool for measuring the postoperative quality of recovery. It has been translated into many languages. In this study, we aimed to validate a translated Thai version of the QoR-15 in patients undergoing elective abdominal surgery under general anesthesia. Methods This was a single-center observational cohort study. The QoR-15 was translated into Thai and culturally adapted, which led to the items on severe and moderate pain being merged, yielding a 14-item scale: the QoR-14-Thai. Next, the QoR-14-Thai, a checklist measuring the patients’ activities of daily living (ADL), and a 100-mm visual analog scale for assessing their global health (VAS-GH) were administered to the study patients before and 24 h after their abdominal surgery. The validity, reliability, responsiveness, and feasibility of the QoR-14-Thai were assessed. Results Among 166 patients, 140 completed the questionnaires, achieving a questionnaire completion rate of 100%. We observed moderate convergent validity between the postoperative QoR-14-Thai and the VAS-GH (r = 0.54, p < 0.001) and ADL checklist (r = 0.50, p < 0.001). The QoR-14-Thai was negatively correlated with the length of hospital stay (r = − 0.23, p < 0.006) and postoperative admission to the intensive care unit (r = − 0.85, p = 0.001). The QoR-14-Thai had excellent internal consistency (Cronbach’s alpha = 0.869), split-half reliability (0.913), test–retest reliability (0.94), and high responsiveness (Cohen’s effect size: 1.01, standardized response mean: 0.73). The median time to complete the questionnaire was 2 min (interquartile range: 1–2). Conclusions The QoR-14-Thai was deemed a valid, reliable, and convenient tool for evaluating the quality of recovery after elective abdominal surgery. Trial registration This study was registered prospectively on the Thai Clinical Trials Registry, identifier TCTR20210326009, on March 26, 2021.

Pradeep K. Bhatia, Ghansham Biyani

Jillian C. Belrose, R. Noppens

BackgroundThe impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction.Main bodyThis review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer’s disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment.ConclusionsFuture research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.

Uppala Radhakrishna, Uppala Ratnamala, Devendrasinh D. Jhala et al.

BackgroundHidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects hair follicles in areas with apocrine sweat glands, such as the underarms, groin, and buttocks. The pathogenesis of HS is not fully understood, but considering the key role played by the biological clock in the control of immune/inflammatory processes the derangement of circadian and ultradian pathways could be hypothesized.MethodsWe analyzed genome-wide DNA methylation patterns in peripheral blood from 24 HS cases and 24 controls using the Infinium HumanMethylation450 BeadChip array (Illumina), followed by bioinformatics and statistical analyses.ResultsWe found that several circadian and ultradian genes were differentially methylated in HS patients, predominantly exhibiting hypomethylation. These genes were enriched in pathways such as MAPK and WNT cascades, acute phase response, cytokine release, inflammation, innate immune response, xenobiotic detoxification, and oxidative stress response.ConclusionAltered DNA methylation patterns of genes related to circadian and ultradian pathways could contribute to immune system derangement and inflammatory processes chronicization in addition to other comorbidities hallmarking HS onset and progression, at the same time representing possible druggable targets.

Eun-Hee Kim, Jung-Bin Park, Jin-Tae Kim

Cerebral blood flow (CBF) plays a vital role in delivering cerebral oxygen, and the accurate assessment of CBF is crucial for the intraoperative management of critically ill infants. Although the direct measurement of CBF is challenging, CBF velocity (CBFV) can be assessed using transcranial Doppler. Recent advances in point-of-care ultrasound have introduced brain ultrasound as a feasible intraoperative option, in which transfontanelle ultrasonography (TFU) has been applied to measure the CBFV through the anterior fontanelle. However, the intraoperative application of TFU in pediatric patients remains limited. The present review highlights the procedural aspects and clinical applications of TFU for anesthetic and intensive care management in pediatric patients.TFU facilitates the visualization of cerebral vessels and allows a noninvasive assessment of cerebral hemodynamics. The clinical significance of TFU involves its usefulness in various clinical scenarios, including monitoring CBF during cardiac surgery, assessing fluid responsiveness, and estimating intracranial pressure. TFU also enables the detection of cerebral emboli and the evaluation of anatomical abnormalities such as hydrocephalus or intracranial hemorrhage.TFU has demonstrated potential as an invaluable tool in pediatric care, despite limited familiarity among anesthesiologists. Additional research is needed to explore the associations between CBF and clinical outcomes, focusing on autoregulation, the impact of physiological changes, the associations of TFU findings with other brain monitoring tools such as electroencephalography, cerebral oximetry, and the implications of microemboli. TFU is a significant advancement and valuable tool for noninvasively assessing cerebral hemodynamics and CBF in pediatric patients with open fontanelles.

Ethan R. Roy, Sanming Li, Sepideh Saroukhani et al.

Abstract Background Aging significantly elevates the risk of developing neurodegenerative diseases. Neuroinflammation is a universal hallmark of neurodegeneration as well as normal brain aging. Which branches of age-related neuroinflammation, and how they precondition the brain toward pathological progression, remain ill-understood. The presence of elevated type I interferon (IFN-I) has been documented in the aged brain, but its role in promoting degenerative processes, such as the loss of neurons in vulnerable regions, has not been studied in depth. Methods To comprehend the scope of IFN-I activity in the aging brain, we surveyed IFN-I-responsive reporter mice at multiple ages. We also examined 5- and 24-month-old mice harboring selective ablation of Ifnar1 in microglia to observe the effects of manipulating this pathway during the aging process using bulk RNA sequencing and histological parameters. Results We detected age-dependent IFN-I signal escalation in multiple brain cell types from various regions, especially in microglia. Selective ablation of Ifnar1 from microglia in aged mice significantly reduced overall brain IFN-I signature, dampened microglial reactivity, lessened neuronal loss, restored expression of key neuronal genes and pathways, and diminished the accumulation of lipofuscin, a core hallmark of cellular aging in the brain. Conclusions Overall, our study demonstrates pervasive IFN-I activity during normal mouse brain aging and reveals a pathogenic, pro-degenerative role played by microglial IFN-I signaling in perpetuating neuroinflammation, neuronal dysfunction, and molecular aggregation. These findings extend the understanding of a principal axis of age-related inflammation in the brain, one likely shared with multiple neurological disorders, and provide a rationale to modulate aberrant immune activation to mitigate neurodegenerative process at all stages.

Jaffrey Kalaiselvan, Rohan Magoon, Ramesh C. Kashav et al.

Jong-Hyuk Lee, Chan-Sik Kim, Hyungtae Kim et al.

Background The preemptive visceral analgesic effect of regional nerve block has not been adequately investigated to date. We evaluated the preemptive visceral analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing laparoscopic cholecystectomy (LC) in whom pre-incisional rectus sheath block (RSB) was used to minimize somatic surgical pain. Methods In this prospective, randomized, assessor-blind study, 70 patients scheduled for elective LC were randomly assigned to the pre-TPVB (n = 35) or the post-TPVB (n = 35) group. Both groups received pre-incisional RSB, and patients in the pre-TPVB group received TPVB before skin incision while those in the post-TPVB group received TPVB after skin closure. The primary outcome was the total rescue analgesic consumption (morphine equianalgesic dose) during the 24 h post-surgery. The secondary outcomes were the cumulative analgesic consumption and pain intensity for 24 h after surgery, and adverse events. Results Pre-TPVB significantly reduced total rescue analgesic consumption (estimated mean [95% CI]) during the 24 h after surgery than post-TPVB (16.9 [14.5, 19.3] vs. 25.3 [22.8, 27.7] mg, estimated difference: −8.3 [−11.8, −4.9], P < 0.001). The cumulative rescue analgesic consumption was significantly lower in the pre-TPVB group from 2–24 h after surgery (P < 0.001). The postoperative pain intensity was significantly lower in the pre-TPVB group as well at 0.5–6 h after surgery. There were no adverse events in both groups. Conclusions Pre-incisional TPVB conferred a significant preemptive visceral analgesic effect in patients undergoing LC, and significantly reduced the amount of postoperative opioid consumption.

F. Alam, C. Matava

Immersive virtual environments (IVEs), including virtual reality (VR) and augmented reality (AR), have gained immense popularity in medical education health care.1 Over the last 10 years, the expansion of gaming and development platforms, such as Unreal Engine and Unity, along with head-mounted displays (HMDs), has been fueled by major commercial interests, such as Meta, Microsoft, and Google, with huge investments in this immersive reality market. The immersive reality market is currently valued at 6.1 billion US dollars (USD) and is predicted to reach >20 billion USD by 2025.2 This commercial expansion has led to the rapid advancement of affordable, accessible, high-powered VR/AR technology and development tools supporting IVEs in medical education including anesthesia. IVEs date back to the early 19th century with the advent of the stereoscope. This ingenious device allowed 2 separate images, taken at slightly different angles, to be viewed as a single image with depth. The stereoscope led to the creation of a children’s toy: the View-Master (View-Master Ideal Group, Inc), a pioneer for modern-day VR. Subsequently, the invention of the microchip represented a significant leap, leading to a myriad of devices and technologies that make up IVEs today. Virtual environments have been described in 2 domains: immersive (HMD-based) and nonimmersive (desktop-based). Nonimmersive, desktop-based virtual environments do not use an HMD, but instead, the participant controls and manipulates the virtual environment on a screen with a traditional keyboard and mouse or a joystick.3,4 Playing a video game on one’s television screen using popular hardware such as the Sony PlayStation or the Microsoft Xbox is a basic example of desktop-based VR. In medical education, the American Society of Anesthesiologists (ASA) recently partnered with CAE Healthcare to create desktop-based virtual environments for managing anesthesia emergencies,5 which, when completed, fulfill the American Board of Anesthesiology Maintenance of Certification in Anesthesiology (MOCA) 2.0 Part 2 and 4 requirements.6 Although nonimmersive desktop-based virtual environments have been popular for decades and are an important part of our current medical education system, the focus of this article is on HMD-based IVEs. HMD-based IVEs have been described as “typically multi-modal in nature by providing a sense of immersion in the environment through 360° visuals by aid of an HMD, auditory stimulation through the use of earphones, and increasing the proprioception of limbs by way of controllers and tracking.”4 Using HMDs, IVEs “transport” users to alternate simulated environments while creating a sense of immersion. Imagine From the *Department of Anesthesia, Sunnybrook Health Sciences Centre and †Sunnybrook Simulation Centre, Toronto, Ontario, Canada; ‡Wilson Centre for Research in Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; §Canadian Anesthesiologists’ Society—Simulation and Education Section, Toronto, Ontario, Canada; ∥Collaborative Human ImmerSive Interaction Laboratory, Toronto, Ontario, Canada; and ¶Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; #Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.

Mofya S. Diallo, Jonathan M. Tan, E. Heitmiller et al.

Anesthesiology and anesthesiologists have a tremendous opportunity and responsibility to eliminate health disparities and to achieve health equity. We thus examine health disparity and health equity through the lens of anesthesiology and the perspective of anesthesiologists. In this paper, we define health disparity and health care disparities and provide tangible, representative examples of the latter in the practice of anesthesiology. We define health equity, primarily as the desired antithesis of health disparity. Finally, we propose a framework for anesthesiologists, working toward mitigating health disparity and health care disparities, advancing health equity, and documenting improvements in health care access and health outcomes. This multilevel and interdependent framework includes the perspectives of the patient, clinician, group or department, health care system, and professional societies, including medical journals. We specifically focus on the interrelated roles of social identity and social determinants of health in health outcomes. We explore the foundational role that clinical informatics and valid data collection on race and ethnicity have in achieving health equity. Our ability to ensure patient safety by considering these additional patient-specific factors that affect clinical outcomes throughout the perioperative period could substantially reduce health disparities. Finally, we explore the role of medical journals and their editorial boards in ameliorating health disparities and advancing health equity.

Martha Bissing, E. Lange, Wilmer F. Davila et al.

BACKGROUND: Gender inequity is still prevalent in today’s medical workforce. Previous studies have investigated the status of women in academic anesthesiology. The objective of this study is to provide a current update on the status of women in academic anesthesiology. We hypothesized that while the number of women in academic anesthesiology has increased in the past 10 years, major gender disparities continue to persist, most notably in leadership roles. METHODS: Medical student, resident, and faculty data were obtained from the Association of American Medical Colleges. The number of women in anesthesiology at the resident and faculty level, the distribution of faculty academic rank, and the number of women chairpersons were compared across the period from 2006 to 2016. The gender distribution of major anesthesiology journal editorial boards and data on anesthesiology research grant awards, among other leadership roles, were collected from websites and compared to data from 2005 and 2006. RESULTS: The number (%) of women anesthesiology residents/faculty has increased from 1570 (32%)/1783 (29%) in 2006 to 2145 (35%)/2945 (36%) in 2016 (P = .004 and P < .001, respectively). Since 2006, the odds that an anesthesiology faculty member was a woman increased approximately 2% per year, with an estimated odds ratio of 1.02 (95% confidence interval, 1.014–1.025; P < .001). In 2015, the percentage of women anesthesiology full professors (7.4%) was less than men full professors (17.3%) (difference, −9.9%; 95% confidence interval of the difference, −8.5% to −11.3%; P < .001). The percentage of women anesthesiology department chairs remained unchanged from 2006 to 2016 (12.7% vs 14.0%) (P = .75). To date, neither Anesthesia & Analgesia nor Anesthesiology has had a woman Editor-in-Chief. The percentage of major research grant awards to women has increased significantly from 21.1% in 1997–2007 to 31.5% in 2007–2016 (P = .02). CONCLUSIONS: Gender disparities continue to exist at the upper levels of leadership in academic anesthesiology, most importantly in the roles of full professor, department chair, and journal editors. However, there are some indications that women may be on the path to leadership parity, most notably, the growth of women in anesthesiology residencies and faculty positions and increases in major research grants awarded to women.

D. Sharma, M. Rasmussen, R. Han et al.

The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.

Danny Bui, Andrew Winegarner, M. Kendall et al.

STUDY OBJECTIVE A high prevalence of burnout, depression and suicidal ideation has been reported among anesthesiology trainees. Over the last decade, there has been a significant emphasis on the development of wellness programs in academic departments to mitigate the prevalence and effects of burnout during anesthesiology training. Therefore, we aimed to reevaluate the prevalence of burnout and depression in anesthesiology trainees in the United States. DESIGN Cross-sectional survey. SETTING Anesthesiology Department. PATIENTS A nationally representative sample of 1000 anesthesiology trainees in the United States. MEASUREMENTS A 33-item questionnaire consisting of 1) burnout, 2) depression, 3) job satisfaction, 4) family support, 5) work characteristics, 6) demographic factors, 7) self-reported errors, and 8) impact of COVID-19 pandemic. RESULTS We received 384 responses. Twenty-four percent (91/384) of the respondents met the criteria for high burnout risk and 58/384 (15%) of the respondents screened positive for depression. Multivariable analysis revealed that: (1) hours per week > 70, (odds ratio [OR; 95% confidence interval {CI}] = 3.1 [1.4-6.8], P=0.005 and (2) overnight calls per month > 7 (OR [95% CI] = 2.5 [1.0- 6.0], P=0.03 were independent factors for increased odds of burnout whereas the presence of (3) married/domestic partnership (OR [95% CI} = 0.52 [0.32-0.85], P=0.01 was associated with lower odds of burnout and/or depression. Ten percent (4/40) of high burnout/depression residents reported that they often times fall short in the quality of care provided to patients compared to 0.36% (1/275) residents with low burnout/depression scores, P < 0.001. Similarly, 22% (9/40) of high burnout/depression residents reported that they often times did not have enough attention to their patients compared to 4% (11/275) residents with low burnout/depression scores, P < 0.001. CONCLUSIONS We report a still concerning but significantly lower rate of burnout and depression in anesthesiology trainees than previously reported a decade ago. This suggests that efforts on wellness implemented by academic programs have positively impacted the work experience of anesthesia trainees.

E. Brandford, Tammy Wang, Clarice Nguyen et al.

OBJECTIVES Combined pediatrics-anesthesiology programs uniquely prepare residents to care for critically ill children, but trainees in these combined programs face challenges as residents within two specialties. Social belonging predicts motivation and achievement and protects against burnout. The objective of our study was to evaluate sense of belonging and self-identified professional identity of current combined pediatrics-anesthesiology residents. METHODS All current residents in combined pediatrics-anesthesiology programs were invited to participate in an anonymous survey assessing sense of belonging and professional identity. Open-ended responses were qualitatively analyzed using an inductive coding process and thematic analysis. Likert questions were analyzed using paired t-tests. RESULTS 32/36 residents completed the survey (89% response rate). 92% of respondents had a lower sense of belonging in pediatrics than anesthesiology (3.32 vs 3.94) and more self-identified as anesthesiologists than pediatricians. Thematic analysis yielded five themes: (1) the team-based nature of pediatrics results in strong initial bonds, but feelings of isolation as training pathways diverge; (2) the individual nature of anesthesiology results in less social interaction within daily work, but easier transitions in and out of anesthesiology; (3) divergent training timelines result in feeling left behind socially and academically; (4) residents identify different professional and personal characteristics of pediatricians and anesthesiologists that impact their sense of belonging; and (5) the structure of the combined program results in experiences unique to combined residents. CONCLUSIONS Most residents in combined pediatrics-anesthesiology programs had a higher sense of belonging and self-identification in anesthesiology than pediatrics. Program structure and autonomy had significant impacts.

Shyam Patel, K. Lin, Adam J. Milam et al.

Background: Historically in medicine, women and minorities have been underrepresented. This trend is especially significant in the anesthesiology workforce. Objective: The goals of this study were to quantify the current state of diversity by race/ethnicity, gender, and sexual orientation among anesthesiology residents. Methods: An institutionally reviewed and validated survey was delivered through Qualtrics to 130 anesthesiology program directors. Topics addressed included gender identity, sexual orientation, racial and ethnic background, rationale for pursuing anesthesiology, and medical training experiences. The study was administered from February to April 2021; 135 anesthesiology residents responded to the survey. Results: The sample was 44.4% white (n = 60), 54.1% male (n = 73), and 83.7% (n = 113) of respondents self-reported as straight or heterosexual. Respondents indicated that role models/mentors were somewhat or very important in their desire to pursue anesthesiology (n = 85; 67.2%), 42% reported that having women/diverse faculty was somewhat or very important in their decision to pursue anesthesiology. Discrimination during the anesthesiology residency application process or as a resident ranged from 4.4% due to sexual orientation to 18.7% due to gender/gender identity and race/ethnicity. Conclusions: Experiences of discrimination based on race/ethnicity, gender, and gender identity continues to be a concern among anesthesiology trainees. Creating an environment that is inclusive and supportive of all trainees regardless of race/ethnicity, gender/gender identity, and sexual orientation is needed. Interventions and strategies to create an inclusive environment may improve diversity within anesthesiology.

Andy Omega, Andi Ade Wijaya Ramlan, R. Soenarto et al.

ABSTRACT Introduction Clinical reasoning is a core competency for physicians. In the field of anesthesia, many situations require residents to use their clinical reasoning to make quick and appropriate decisions such as during emergency airway cases. The Script Concordance Test (SCT) is a test developed in recent years and validated that objectively assess clinical reasoning ability. However, studies involving SCT to assess clinical reasoning in airway management is scarce. Aim To evaluate SCT in assessing clinical reasoning for airway management in anesthesiology residents. Method A cross-sectional study involving residents and anesthesiology consultants from the Department of Anesthesiology and Intensive Care, Faculty of Medicine Universitas Indonesia was conducted to complete SCT. A panel of five anesthesiology consultants with more than 15 years of work experience constructed 20 SCT vignettes based on prevalent airway cases in our center from the past 10 years. Each SCT has three nested questions, with a total of 60 questions, to be answered within 120 min. Results The SCT of 20 case vignettes with three nested questions were tested on 99 residents from the junior, intermediate, and senior residents, compared to answers from the expert group consisting of ten anesthesiology consultants with more than 5 years of experience. There were significant differences in mean SCT scores in the junior, intermediate, senior and expert groups, 59.3 (46.1–72.8), 64.7 (39.9–74.9), 67.5 (50.6–78.3), and 79.6 (78.4–84.8); p < 0,001 consecutively. Cronbach Alpha 0.69 was obtained, indicating good reliability. Conclusion Our SCT was proven to be a valid and reliable test instrument to assess the clinical reasoning in airway management for anesthesiology residents. SCT was able to discriminate between groups of different clinical experiences and should be included to evaluate airway competencies in anesthesiology residents.