Hasil untuk "Anesthesiology"

Onella Athnaiel, Nicholas Davidson, Jaskaran Mangat et al.

Chronic pain, pain that lasts beyond three months, is a common finding in the elderly. It is often due to musculoskeletal conditions but can be precipitated by other factors as well. While physiological systems decline with aging, chronic pain is influenced by changes in hormone profiles as men and women enter into andropause and menopause, respectively. Research on gonadal hormones is limited, especially when it comes to their relationship with chronic pain. Women tend to experience less pain with aging compared to their premenopausal years, and this is partially explained by the fact that estrogen enhances pain sensitivity and its decline during menopause decreases it. However, hormone replacement therapy (HRT) seems to increase pain tolerance post-menopause. There is some evidence that testosterone plays a protective factor in pain perception. Men on the other hand, have higher pain tolerance as testosterone is considered to be a protective factor. With aging and decreasing testosterone, older men tend to be less tolerant to pain. This paper explores how hormonal changes with aging impact pain perception in both men and women, highlighting several pain conditions influenced by hormones. Although research remains limited, the potential of HRT as a treatment for common pain conditions is examined.

Xuyuan Ma, Maozheng Shen, JiaYu Hu et al.

Abstract Background Mitochondrial dyshomeostasis plays an important role in neuronal damage after cerebral ischemia-reperfusion, and Miro1 is a core protein that regulates mitochondrial homeostasis. In this study, we aimed to investigate the neuroprotective effects of bone marrow-derived mesenchymal stem cells (BMSCs) via mitochondrial homeostasis in rats after cardiac arrest (CA), and to clarify the role that the protein Miro1 plays in this protective efficacy. Methods The study compared the effects of BMSCs in which Miro1 was overexpressed BMSCs (BMSCs-mirohi), knocked down (BMSCs-mirolo), and unmodified BMSCs on mitochondrial homeostasis in hippocampal neurons to evaluate their neuroprotective effects of these cells in a rat model of global cerebral ischemia-reperfusion injury. Rats underwent CA modeling for 5 min and received cardiopulmonary resuscitation (CPR). Two hours after the restoration of spontaneous circulation, 1 mL of PBS or 1 mL containing 1 × 106 BMSCs (normal, mirohi, or mirolo) were injected via the femoral vein. The neurological function of rats was assessed based on Neurological Disability Score (NDS) values. Brain histopathological examination was conducted to evaluate brain injury by measuring oxidative stress levels and the apoptosis rate of hippocampal neurons. Immunoblotting and transmission electron microscopy were applied to detect the expression of mitophagy-related proteins in hippocampal neurons. Immunofluorescence was used to track the mitochondria in BMSCs and observe mitochondrial transfer. Additionally, the membrane potential level, oxidative stress level, and ATP content of mitochondria in hippocampal neurons were measured to assess the impact of transplanted BMSCs on mitochondrial quality in these hippocampal neurons. Results Immunofluorescence staining revealed the presence of mitochondria from MitoTracker-labeled BMSCs in rat hippocampal neurons post-CPR. Additionally, the fluorescence intensity of TOMM20 was notably increased following the transplantation of BMSCs. Through immunoblotting experiments, we identified that BMSCs amplified the post-CPR protein expression of LC3, p62, PINK1 and parkin in hippocampal neurons. The number of autophagosomes significantly increased in hippocampal neurons following BMSC transplantation, as observed through transmission electron microscopy. Flow cytometry, Hematoxylin and Eosin (HE) staining, and NDS scoring indicated that BMSCs effectively reduced reactive oxygen species accumulation in hippocampal neurons and mitochondria after CPR. Furthermore, they restored mitochondrial membrane potential and ATP levels in the hippocampus while decreasing apoptosis, ultimately contributing to the restoration of neurological function. Additionally, unlike BMSCs-mirolo, BMSCs-mirohi were able to significantly enhance the efficiency of BMSC-mediated mitochondrial transfer and enhance mitophagy. This amplification, in turn, was found to bolster the protective impact of BMSCs on hippocampal neurons during CPR, thereby contributing to the restoration of rat neurological function. Conclusions These analyses revealed that BMSC transplantation has a dual protective effect by facilitating healthy mitochondrial transfer and promoting the autophagic degradation of damaged mitochondria, effectively enhancing hippocampal neuronal mitochondrial function following CA while reducing neuronal apoptosis, restoring neuronal function, and alleviating neuropathological damage. Moreover, Miro1 can enhance the efficiency of mitochondrial transfer and promote BMSC-mediated mitophagy induction, thereby optimizing the therapeutic effect of BMSCs.

Shanshan Zhao, Mingjiang Zhang, Anqi Li et al.

Abstract Visualization in complex, extreme environments necessitates that the imaging material/system to deliver more comprehensive information and endures external mechanical deformation. Endowing polarization, for example, helicity, in adaptable optical materials—to construct circular-polarization-enabled imaging—offers the chance to address the issue. However, retaining considerable luminescence asymmetry during processing while behaving like an elastic rubber remains challenging, resulting from unstable circularly polarized luminescence when deforming existing polarization materials. Here, we propose a covalent cross-linking strategy, combining a sustainable light generator with an optical helicity modulator, to prepare chiroptical network structures exhibiting superior mechanical-chiroptical coupling. The obtained structures provide satisfying circularly polarized luminescence with an asymmetry factor up to 1.31 alongside exceptional tensile strain tolerance, and more importantly, the asymmetry maintains a magnitude of 10−1 even with 80% deformation. We further advance our materials into wearable polarization optical sensors, practicing our developed circular polarization differential imaging in a fire scenario, showing an advancement in imaging resolution compared to other technologies such as thermal, intensity and fluorescence imaging. This covalent-bonding chiroptical network structures enable deformable optical helicity, paving a way for achieving portable imaging identification under extreme conditions.

Monica M. Diaz, Lesley A. Guareña, Bettsie Garcia et al.

Summary: Goals of care (Goals-of-care) discussions and palliative care (PC) are crucial to providing comprehensive healthcare, particularly for acute neurological conditions requiring admission to a neurological intensive care unit. We identified gaps in the literature and describe insight for future research on end-of-life discussions and PC for U.S. Latinos with acute neurological conditions. We searched 10 databases including peer-reviewed abstracts and manuscripts of hospitalized U.S. Latinos with acute neurological and non-neurological conditions. We included 44 of 3231 publications and identified various themes: PC utilization, pre-established advanced directives in Goals-of-care discussions, Goals-of-care discussion outcomes, tracheostomy or percutaneous gastrostomy tube placement rates among hospitalized Latinos. Our review highlights that Latinos appear to have lower palliative care utilization compared with non-Latino Whites and may be less likely to have pre-established advanced directives, more likely to have gastrostomy or tracheostomy placement and less likely to have do-not-resuscitate status.

Mathias Krogh Poulsen, Stephen E. Rees, John Hansen et al.

Abstract Increased ventilatory work beyond working capacity of the respiratory muscles can induce fatigue, resulting in limited respiratory muscle endurance (Tlim). Previous resistive breathing investigations all applied square wave inspiratory pressure as fatigue‐inducing pattern. Spontaneous breathing pressure pattern more closely approximate a triangle waveform. This study aimed at comparing Tlim, maximal inspiratory pressure (PImax), and metabolism between square and triangle wave breathing. Eight healthy subjects (Wei = 76 ± 10 kg, H = 181 ± 7.9 cm, age = 33.5 ± 4.8 years, sex [F/M] = 1/7) completed the study, comprising two randomized matched load resistive breathing trials with square and triangle wave inspiratory pressure waveform. Tlim decreased with a mean difference of 8 ± 7.2 min (p = 0.01) between square and triangle wave breathing. PImax was reduced following square wave (p = 0.04) but not for triangle wave breathing (p = 0.88). Higher VO2 was observed in the beginning and end for the triangle wave breathing compared with the square wave breathing (p = 0.036 and p = 0.048). Despite higher metabolism, Tlim was significantly longer in triangle wave breathing compared with square wave breathing, showing that the pressure waveform has an impact on the function and endurance of the respiratory muscles.

Junko Akiyama, Mina Imai, Keisuke Yamaguchi

Abstract A 56‐year‐old woman presented with a 2 months history of patulous eustachian tube. She had sudden weight loss after developing a cold, after which she had been experiencing disabling autophony and a sensation of blockage in the ear. She underwent stellate ganglion block in 8 months; her symptoms resolved subsequently.

Tong Tan, Peijian Wei, Yanjun Liu et al.

Abstract Background Pure aortic valve disease is common and has been treated with sternotomy aortic valve replacement for decades. Minimally invasive cardiac surgery has been widely used in atrioventricular valve lesions, but totally thoracoscopic aortic valve replacement has rarely been reported. Method The profiles of 9 patients who were diagnosed with severe aortic valve diseases and treated with two-port thoracoscopic aortic valve replacement between February 2021 and February 2022 were retrospectively reviewed. The clinical data, including baseline characteristics, operative data, postoperative complications, and short-term outcomes, were reported. Results All nine patients successfully underwent two-port thoracoscopic aortic valve replacement, with a cardiopulmonary bypass time of 137.56 ± 27.99 min and an aortic cross-clamp time of 95.33 ± 17.96 min. Seven (77.78%) patients underwent mechanical valve replacement, and two (22.22%) patients underwent bioprosthetic valve replacement. Two (22.22%) patients underwent a concomitant aortic root enlargement procedure. There were no intraoperative or postoperative deaths. The incidence of procedural complications was 0%, while the results of ventilation time, intensive care unit stay length, blood transfusion, chest tube drainage, and kidney function were satisfactory. Conclusion Two-port thoracoscopic aortic valve replacement is a safe and effective surgical treatment option for carefully selected patients with pure aortic valve diseases.

Samuel M. Galvagno, Charles E. Smith, A. Varon et al.

Akiko Tomita-Kobayashi, Tomoko Fujimoto, Shoko Takada et al.

Abstract Background Symptomatic sick sinus syndrome is one of the indications for pacemaker implantation, and we have to consider to program the pacemaker to an asynchronous pacing mode during an operation. Case presentation We reported two cases with a pacemaker implanted for sick sinus syndrome undergoing cardiac operation. We changed programming of the pacemaker to an asynchronous pacing mode (DOO) and modulated the programmed atrioventricular delay to avoid ventricular pacing, resulting in better hemodynamic condition. Although we observed premature ventricular contraction, no lethal arrhythmias induced by the R-on-T phenomenon were noted. Conclusion Programming of the pacemaker to an asynchronous pacing mode and modulation of the programmed atrioventricular delay to avoid ventricular pacing may be an option for pacemaker management during an operation.

E. Brogi, F. Marino, P. Bertini et al.

Abstract Cardiac complications in patients with COVID-19 have been described in the literature with an important impact on outcome. The primary objective of our systematic review was to describe the kind of cardiac complications observed in COVID-19 patients and to identify potential predictors of cardiovascular events. The secondary aim was to analyze the effect of cardiac complications on outcome. We performed this systematic review according to PRISMA guidelines using several databases for studies evaluating the type of cardiac complications and risk factors in COVID-19 patients. We also calculated the risk ratio (RR) and 95% CI. A random-effects model was applied to analyze the data. The heterogeneity of the retrieved trials was evaluated through the I 2 statistic. Our systematic review included 49 studies. Acute cardiac injury was evaluated in 20 articles. Heart failure and cardiogenic shock were reported in 10 articles. Myocardial infarction was evaluated in seven of the papers retrieved. Takotsubo, myocarditis, and pericardial effusion were reported in six, twelve, and five articles, respectively. Arrhythmic complications were evaluated in thirteen studies. Right ventricular dysfunction was evaluated in six articles. We included 7 studies investigating 2115 patients in the meta-analysis. The RR was 0.20 (95% CI: 0.17 to 0.24; P < 0.00001, I 2 = 0.75). Acute cardiac injury represented the prevalent cardiac complications observed in COVID-19 patients (from 20 to 45% of the patients). Patients with acute cardiac injury seemed to be significantly older, with comorbidities, more likely to develop complications, and with higher mortality rates. Acute cardiac injury was found to be an independent risk factor for severe forms of SARS-CoV-2 infection and an independent predictor of mortality. Due to the scarce evidence, it was not possible to draw any conclusion regarding Takotsubo, myocarditis, pleural effusion, and right ventricular dysfunction in COVID-19 patients. Noteworthy, possible arrhythmic alterations (incidence rate of arrhythmia from 3 to 60%) in COVID-19 patients have to be taken into account for the possible complications and the consequent hemodynamic instabilities. Hypertension seemed to represent the most common comorbidities in COVID-19 patients (from 30 to 59.8%). The prevalence of cardiovascular disease (CVD) was high in this group of patients (up to 57%), with coronary artery disease in around 10% of the cases. In the majority of the studies retrieved, patients with CVD had a higher prevalence of severe form, ICU admission, and higher mortality rates.

Zeena-Carola Sinno, Denys Shay, Jochen Kruppa et al.

Abstract Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15–5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16–1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19–1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10–1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13–1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18–1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13–1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.

Toutin Dias G, Schatman ME

Gabriela Toutin Dias,1 Michael E Schatman2– 4 1Psychology Assessment Center, Massachusetts General Hospital, Boston, MA, USA; 2Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU School of Medicine, New York, NY, USA; 3Division of Medical Ethics, NYU School of Medicine, New York, NY, USA; 4School of Social Work, North Carolina State University, Raleigh, NC, USACorrespondence: Michael E SchatmanDepartment of Anesthesiology, Perioperative Care and Pain Medicine, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USATel +1 425-647-4880Email Michael.Schatman@NYULangone.org

S. Dabir, M. Hoseinzadeh, F. Mosaffa et al.

Background The ultimate result of patient care is one of the most important outcomes in medical education. Several methods, including the direct observation of procedural skills (DOPS), have been proposed to assess professional competencies in clinical practice. Objectives This study aimed to assess the effects of the Repeated DOPS (R-DOPS) method on the performance of procedural skills in anesthesiology residents. Methods The procedural skill performance of anesthesiology residents was assessed using a standard DOPS protocol from May to October 2019. Their scores were then objectively recorded, and the satisfaction rates regarding the 2 DOPS exams were assessed. Results We found a considerable improvement in anesthesiology residents’ procedural skill performance, especially in the anesthesiology residency curriculum’s basic items. Besides, anesthesiology residents’ satisfaction was significantly improved after the 2nd DOPS. Conclusions R-DOPS leads to improved training outcomes, including assessing the procedural skills, time to feedback to trainees, and trainee satisfaction.

B. Mahoney, Elizabeth Luebbert

Simulation has played a critical role in medicine for decades as a pedagogical and assessment tool. The labor and delivery unit provides an ideal setting for the use of simulation technology. Prior reviews of this topic have focused on simulation for individual and team training and assessment. The COVID-19 pandemic has provided an opportunity for educators and leaders in obstetric anesthesiology to rapidly train health care providers and develop new protocols for patient care with simulation. This review surveys new developments in simulation for obstetric anesthesiology with an emphasis on simulation use during the COVID-19 pandemic.

P. Toledo, C. Lewis, E. Lange

The demographics of the United States is changing with 51% of the population being female, and 32% of the population identifying as an underrepresented minority (URM, ie, African American/black, Hispanic/Latino, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Women and URMs have been historically underrepresented in medicine and in academic anesthesiology. This article provides an overview of the current status of women and URM faculty in academic anesthesiology and provides a framework for academic advancement. Throughout the text, the terms woman/women are used, as opposed to female, as the terms woman/women refer to gender, and female refers to biological sex.

John C Alexander, B. Romito, M. Çobanoğlu

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Eric N. Esslinger, Michael Van der Westhuizen, S. Jalal et al.

Purpose Despite increasing numbers of women entering anesthesiology training, women remain underrepresented in senior academic positions and leadership roles. This study aims to determine the extent of gender disparity in Canadian departments of anesthesiology. In addition, we explore the correlation between publication productivity and academic rank in this cohort. Methods The Canadian Residency Matching Service (CaRMS) was queried to identify 17 training programs for anesthesiology. Department websites were searched to determine the names of faculty members, as well as gender, leadership roles, and academic ranks. The SCOPUS© database was used to generate the number of publications, number of citations, publication range, and h-index of each faculty member. Results In our study cohort of 1404 academic anesthesiologists, 30.1% were women. Women held a minority of 130 leadership positions (27%, n = 35). With increasing academic rank female representation decreased (p = 0.009), such that 21% of full professors were women. Overall, male anesthesiologists had a higher h-index, number of publications, and number of citations (p = 0.001, p = 0.001, and p = <0.001, respectively) than women. Conclusion Despite growing numbers of women entering the academic workforce, women are underrepresented in senior academic ranks and leadership positions. In addition, men and women have significant differences in measures of publication productivity. This study underscores the importance of directed efforts to promote equity in career outcomes.

Dongwoo Chae

Machine learning (ML) is revolutionizing anesthesiology research. Unlike classical research methods that are largely inference-based, ML is geared more towards making accurate predictions. ML is a field of artificial intelligence concerned with developing algorithms and models to perform prediction tasks in the absence of explicit instructions. Most ML applications, despite being highly variable in the topics that they deal with, generally follow a common workflow. For classification tasks, a researcher typically tests various ML models and compares the predictive performance with the reference logistic regression model. The main advantage of ML lies in its ability to deal with many features with complex interactions and its specific focus on maximizing predictive performance. However, emphasis on data-driven prediction can sometimes neglect mechanistic understanding. This article mainly focuses on the application of supervised ML to electronic health record (EHR) data. The main limitation of EHR-based studies is in the difficulty of establishing causal relationships. However, the associated low cost and rich information content provide great potential to uncover hitherto unknown correlations. In this review, the basic concepts of ML are introduced along with important terms that any ML researcher should know. Practical tips regarding the choice of software and computing devices are also provided. Towards the end, several examples of successful ML applications in anesthesiology are discussed. The goal of this article is to provide a basic roadmap to novice ML researchers working in the field of anesthesiology.

A. Dabbagh, H. Elyassi, A. Sabouri et al.

Background National Board of Anesthesiology (NBA) pass rate is an important and critical step in clinical residency programs. Objectives This study was designed to assess the relationship between an integrative educational intervention (IEI) and the relative annual pass rate (RAPR). RAPR is defined as ratio of NBA pass rate of Shahid Beheshti University of Medical Sciences (SBMU) to the NBA pass rate of all the anesthesiology residency programs across Iran. Methods In a descriptive-analytic retrospective study from 2012 to 2019, RAPR was calculated. IEI was implanted in the latter 4years period of this time interval includes: (1) individualized mentorship for residents by faculty members; (2) monthly in-training examination (ITE) in written; and (3) periodical mocked OSCE exam. Spearman’s correlation coefficient was used to assess correlation between integrative educational intervention and RAPR results. P value less than 0.05 was considered statistically significant. Results There was a statistically significant relationship between “integrative educational intervention program” and the RAPR results: Spearman’s correlation coefficient = 0.655 (P value = 0.039). Conclusions The IEI package of Anesthesiology Department, SBMU showed a significant relationship with improvements in successfulness for anesthesiology residents in the National Board Exam (RAPR trend). More prolonged studies could prevail further aspects of these interventions.

S. Pouwels, M. Buise, P. Twardowski et al.