Hasil untuk "Anesthesiology"

Santi Anchalee, Nalinee Kovitwanawong, Thitaporn Saetung et al.

Abstract Background This study aimed to evaluate the prediction of difficult intubation using ultrasonographic skin-to-vocal-cord measurements in obese Thai patients undergoing elective general anesthesia. Methods This prospective observational study was conducted from December 2020 to June 2023. Total 90 obese patients (body mass index ≥ 30 kg/m2) aged 18–60 years with an American Society of Anesthesiologists physical status classification of 2–3 requiring elective surgery under general anesthesia with oral endotracheal intubation in operating theatres were included. Anesthesiologists assessed the airway and measured the skin-to-vocal-cord distance using ultrasonography in the median coronal plane in the closed-mouth supine position. The primary outcome was difficult laryngoscopy, defined as a laryngoscopic view grade 3 or 4 on the Cormack–Lehane scale. Results The incidence of difficult laryngoscopy was 13.33% (12/90 patients). The median (interquartile range) body mass index in the difficult and easy intubation groups was 44.7 kg/m2 (34.8–47.9) and 41.7 kg/m2 (36.7–47.1), respectively (p = 0.929). The mean skin-to-vocal-cord distances (DSVC) in the difficult and easy intubation groups were 20.1 ± 7.2 mm and 16.3 ± 4.9 mm (p = 0.022), respectively. The median time for tracheal intubation in the difficult and easy intubation groups was 61.5 [50.2–120] s and 40 [30–56.8] s, respectively (p < 0.001). Multivariable logistic regression revealed that male sex and skin-to-vocal-cord distance ≥ 19.2 mm (area under the curve, 0.67) were significantly associated with difficult intubation. In sensitivity analysis excluding cases performed by anesthesiologists, DSVC ≥ 19.2 mm remained the only significant predictor of difficult intubation. Conclusions In obese Thai patients, A skin-to-vocal-cord distance of ≥ 19.2 mm measured by ultrasonography was associated with difficult laryngoscopy and remained consistent across sensitivity analyses. These factors may help predict difficult intubation. However, the modest diagnostic performance suggests that DSVC should not be used as a standalone predictor. Trial registration Thai Clinical Trials Registry (TCTR20250616007); registered on June 16, 2025.

Ayub Bagheri , Alireza Sharifi Niknafs, Bahar Farhadi et al.

Introduction: Surgical site infection (SSI) constitutes a substantial complication after knee arthroplasty, contributing to notable morbidity. This study aimed to review the existing literature on the incidence and risk factors of SSI following knee arthroplasty. Methods: A systematic search was undertaken across various international electronic databases, including Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and the Scientific Information Database. The search strategy involved the use of keywords derived from Medical Subject Headings, such as “incidence”, “Surgical wound infection”, “Surgical site infection”, and “Arthroplasty”, covering records from the earliest available up to March 17, 2024. Results: The study incorporated a collective participant group of 1,366,494 knee arthroplasty procedures from twenty-three chosen studies. The pooled incidence rate of SSI after knee arthroplasty was 1.7% (95% confidence interval (CI): 1.1% to 2.6%; I²=99.687%; P<0.001). The Odds Ratio (OR) for the incidence of SSI in males was observed to be significantly higher than that in females (OR: 1.617; 95% CI: 1.380 to 1.894; Z=5.951; P<0.001). The pooled incidence of SSI among diabetic patients was 1.3% (95% CI: 0.6% to 2.8%; I²=99.126%; P<0.001). Conclusion: Based on the main findings, SSIs continue to be a significant complication of knee arthroplasty, with an incidence of 1.1% to 2.6%. Male gender and diabetes mellitus were associated with an augmented probability of SSIs following knee arthroplasty.

Samantha N. Atkinson, Caron Dean, Victoria L. Woyach et al.

Childhood and adolescent obesity and its associated morbidities are increasing in part due to the ingestion of diets high in fat (HFD). Changes in the gastrointestinal microbiome have been associated with these morbidities, including insulin resistance, cardiovascular disease, and inflammatory states. The use of dietary probiotics may mitigate these microbiome-associated morbidities and improve health during maturation. Using our established model of obesity in rats consuming an HFD from weaning, we examined the gut microbiome with a single-strain probiotic in the drinking water [<i>Lactiplantibacillus plantarum</i> 299v (Lp299v, LP299V^®)] of adolescent and adult rats. Our main finding was a differential effect of HFD and probiotic on the gut microbiome that was associated with maturation (adolescence vs. adulthood). Specifically, probiotic treatment of adolescent rats on an HFD led to alterations in the enrichment of the gut microbiome, which were associated with the morbidities of obesity, while adult rats under the same conditions exhibited minimal changes, demonstrating differences in plasticity associated with maturation. Of particular relevance in this regard is the fact that <i>Oscillospiraceae</i> and <i>Lachnospiraceae,</i> associated with beneficial short-chain fatty acid production, were enriched in adolescent rats on an HFD and treated with Lp299v. Our data suggest that the use of probiotics in childhood and adolescence may improve health in adulthood by potentially affecting the developing gastrointestinal microbiome.

Kenichiro Kikuchi, Satoshi Kazuma, Yoshiki Masuda

Background/Objectives: Hyperlactatemia is a common predictive factor for poor post-cardiovascular surgery outcomes. However, it is not well understood whether the rapid postoperative lactate level elevation in a short period of time is associated with patient outcomes. Herein, we investigated the relationship between the degree of change in serum lactate levels and postoperative serious adverse events (PSAEs), including mortality, within 24 h of cardiovascular surgery. Methods: In this retrospective study, we evaluated the relationship between a rapid serum lactate level increase and PSAEs after open-heart and major vascular surgery. We divided the patients into those with and without PSAEs. Univariate and multivariate analyses were performed to evaluate the association between PSAEs and rapid lactate level increases. Results: We enrolled 445 patients; 16% (n = 71) had PSAEs. The peak lactate levels during the first 24 h of intensive care unit (ICU) stay were higher in patients with PSAEs than in those without. The maximum change in lactate levels between two consecutive lactate measurements during the first 24 h after ICU admission was higher in patients with PSAEs than in those without. A multivariate logistic regression analysis revealed that changes in lactate levels of 2 mmol/L or more between two consecutive lactate measurements were associated with PSAEs. ICU peak lactate levels of 3 mmol/L or more were not associated with PSAEs. Conclusions: Rapid serum lactate level increases of 2 mmol/L or more during the first 24 h of ICU admission post-cardiovascular surgery are associated with PSAEs.

Perisic Zlatko, Brkic Dusan, Micic Dusan et al.

Introduction: Pseudoaneurysms of the pancreaticoduodenal arcade are rare, accounting for approximately 2% of all visceral artery aneurysms. They typically arise as complications of chronic pancreatitis, peptic ulcer disease, trauma, pancreatic and biliary surgery, or pancreas transplantation. Diagnosis often occurs only after rupture, leading to life-threatening internal bleeding. Bleeding may occur within a pseudocyst, with blood passing through the Vater’s papilla into the digestive tract, or may result in the formation of a retroperitoneal hematoma that can rupture into the abdominal cavity, causing hemoperitoneum. The cell-saver is a tool that can be utilized for intraoperative blood cell salvage and autologous transfusions. Case Report: Our patient, a 54-year-old male, an untreated alcoholic with no prior medical history or documented treatment, presented to the Clinic for Emergency Surgery at the University Clinical Center of Serbia with a sudden onset of upper abdominal pain. A quick ultrasound of the abdomen was performed, followed by an urgent CT scan of the chest and abdomen, revealing a hematoma extending from the right retroperitoneum and mesentery of the intestine, measuring 150x109x180mm in diameter, with signs of active bleeding in the region beneath the pancreas, indicative of hemoperitoneum. Due to hemodynamic instability, accompanied by a drop in arterial blood pressure and hemoglobin levels, an urgent laparotomy was performed. Active bleeding was identified from a ruptured pseudoaneurysm originating from the pancreaticoduodenal arcade. Hemostasis was achieved followed by tamponade, and the tampons were removed 30 hours post-surgery. The patient remained hemodynamically stable thereafter, recovered well from the surgery, and was discharged home in good general condition. Intraoperatively, we utilized the Cell-saver to collect the patient’s blood and subsequently administered autologous transfusion. Conclusion: In patients with chronic pancreatitis presenting with sudden abdominal pain and hemodynamic instability accompanied by a drop in arterial pressure, hemoglobin, and hematocrit levels, the possibility of a ruptured pseudoaneurysm in the pancreatic or peripancreatic region should be considered. Timely diagnosis and prompt surgical intervention are crucial for a successful outcome. Effective collaboration among radiologists, anesthesiologists, and surgeons is essential. The utilization of the Cell-saver system significantly aids in maintaining cardiac output and hemodynamic stability in these patients.

Zhou W, Hu S, Wu Y et al.

Wenyu Zhou,1,&ast; Song Hu,1,2,&ast; Yutong Wu,1,&ast; Huan Xu,1,&ast; Lina Zhu,1 Huimin Deng,1 Sheng Wang,1 Yuanli Chen,1 Huanping Zhou,1 Xin Lv,1 Quanfu Li,1 Hao Yang1 1Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China; 2Graduate School, Wannan Medical College, Wuhu, AnHui, 241002, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hao Yang, Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Road, Shanghai, 200433, People’s Republic of China, Email yanghaozunyi@sina.com Quanfu Li, Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, People’s Republic of China, Email quanfuli185@163.comBackground: Mesenchymal stem cell-derived exosomes (MSC-exosomes) have been found to effectively improve the systemic inflammatory response caused by acute lung injury and acute respiratory distress syndrome (ALI/ARDS), regulate systemic immune disorders, and help injured cells repair. The purpose of this study was to take a holistic view of the current status and trends of MSC-exosomes research in ALI/ARDS.Methods: Bibliometrix, Citespace and VOSviewer software were used for bibliometric analysis of the data. We analysed the world trends, country distribution, institution contribution, most relevant journals and authors, research hotspots, and research hotspots related to Coronavirus Disease 2019 (COVID-19) based on the data collected.Results: China possessed the largest number of publications, while the USA had the highest H-index and the number of citations. Both China and the USA had a high influence in this research field. The largest number of publications in the field of MSC-exosomes and ALI/ARDS were mainly from the University of California system. Stem Cell Research & Therapy published the largest number of papers in this scope. The author with the greatest contribution was LEE JW, and ZHU YG published an article in Stem Cell with the highest local citation score. The most frequent keyword and the latest research hotspot were “NF-κB” and “Coronavirus Disease 2019”. Furthermore, our bibliometric analysis results demonstrated that MSC-exosomes intervention and treatment can effectively alleviate the inflammatory response caused by ALI/ARDS.Conclusion: Our bibliometric study suggested the USA and China have a strong influence in this field. COVID-19-induced ALI/ARDS had become a hot topic of research.Keywords: acute respiratory distress syndrome, mesenchymal stem cells, exosome, bibliometrix, Citespace, VOSviewer

Vafi Salmasi, Theresa R. Lii, Keith Humphreys et al.

Abstract. The ability of clinical trials to inform the care of chronic pain may be limited if only an unrepresentative subset of patients are allowed to enroll. We summarize and report new insights on published studies that report on how trial exclusions affect the generalizability of their results. We conducted a PubMed search on the following terms: ((“eligibility criteria” AND generalizability) OR (“exclusion criteria” AND generalizability) OR “exclusion criteria”[ti] OR “eligibility criteria”[ti]) AND pain. We only considered studies relevant if they analyzed data on (1) the prevalence and nature of exclusion criteria or (2) the impact of exclusion criteria on sample representativeness or study results. The 4 articles that were identified reported differences in patients who were included and excluded in different clinical trials: excluded patients were older, less likely to have a paid job, had more functional limitations at baseline, and used strong opioids more often. The clinical significance of these differences remains unclear. The pain medicine literature has very few published studies on the prevalence and impact of exclusion criteria, and the outcomes of excluded patients are rarely tracked. The frequent use of psychosocial exclusions is especially compromising to generalizability because chronic pain commonly co-occurs with psychiatric comorbidities. Inclusion of more representative patients in research samples can reduce recruitment barriers and broaden the generalizability of findings in patients with chronic pain. We also call for more studies that examine the use of exclusion criteria in chronic pain trials to better understand their implications.

Priyanka Pavithran

Tzu-Yu Hsu, Tzu-Yu Hsu, Hsin-Yi Wang et al.

The pupil constricts in response to an increase in global luminance level, commonly referred to as the pupil light reflex. Recent research has shown that these reflex responses are modulated by high-level cognition. There is larger pupil constriction evoked by a bright stimulus when the stimulus location spatially overlaps with the locus of attention, and these effects have been extended to saccade planning and working memory (here referred to as pupil local-luminance modulation). Although research in monkeys has further elucidated a central role of the frontal eye field (FEF) and superior colliculus in the pupil local-luminance modulation, their roles remain to be established in humans. Through applying continuous theta-burst transcranial magnetic stimulation over the right FEF (and vertex) to inhibit its activity, we investigated the role of the FEF in human pupil local-luminance responses. Pupil light reflex responses were transiently evoked by a bright patch stimulus presented during the delay period in the visual- and memory-delay tasks. In the visual-delay task, larger pupil constriction was observed when the patch location was spatially aligned with the target location in both stimulation conditions. More interestingly, after FEF stimulation, larger pupil constriction was obtained when the patch was presented in the contralateral, compared to the ipsilateral visual field of the stimulation. In contrast, FEF stimulation effects were absence in the memory-delay task. Linear mixed model results further found that stimulation condition, patch location consistency, and visual field significantly modulated observed pupil constriction responses. Together, our results constitute the first evidence of FEF modulation in human pupil local-luminance responses.

Claire Tardiveau, Claire Tardiveau, Guillaume Monneret et al.

Immune responses affiliated with COVID-19 severity have been characterized and associated with deleterious outcomes. These approaches were mainly based on research tools not usable in routine clinical practice at the bedside. We observed that a multiplex transcriptomic panel prototype termed Immune Profiling Panel (IPP) could capture the dysregulation of immune responses of ICU COVID-19 patients at admission. Nine transcripts were associated with mortality in univariate analysis and this 9-mRNA signature remained significantly associated with mortality in a multivariate analysis that included age, SOFA and Charlson scores. Using a machine learning model with these 9 mRNA, we could predict the 28-day survival status with an Area Under the Receiver Operating Curve (AUROC) of 0.764. Interestingly, adding patients’ age to the model resulted in increased performance to predict the 28-day mortality (AUROC reaching 0.839). This prototype IPP demonstrated that such a tool, upon clinical/analytical validation and clearance by regulatory agencies could be used in clinical routine settings to quickly identify patients with higher risk of death requiring thus early aggressive intensive care.

Alexandra M. Wesolowski, Michael P. Zaccagnino, R. Malapero et al.

Swati Chhatrapati, Summit Bloria, Nidhi Singh et al.

Background: Prevision of a potentially difficult airway in the preoperative period is imperative. The available tools are evaluation of mouth opening, Mallampati test; atlanto-occipital extension; hyomental, thyromental, and sternomental distances; and upper lip bite test; thyromental height test (TMHT) is a new indicator. Aims: To compare the effectiveness of preoperative anaesthetic airway evaluation methods of TMHT and Modified mallampati test (MMT) to predict the difficulty in intubation. Materials and Methods: A prospective observational study was aimed to compare the effectiveness of preoperative anesthetic airway evaluation methods of TMHT and modified Mallampati test (MMT) to predict the difficulty in intubation. A total of 150 subjects were included in this study. MMT and TMHT were compared, and sensitivity, specificity, predictive values, and accuracy were calculated. Results: On comparison, we found TMHT to be more sensitive (93.33%) than MMT (77.78%); both tests have high specificity (TMHT 91.43%; MMT 81.90%). Positive predictive value was 82.35% for TMHT and 64.81% for MMT. Similarly, negative predictive value was 96.97% for TMHT and 89.58% for MMT. Accuracy was 92.00% for TMHT and 80.66% for MMT. Conclusions: TMHT can predict difficult intubation better than MMT (high positive predictive value). However, both TMHT and MMT predict easy intubations effectively, their negative predictive values being high.

Binyamin Ben Avraham, Marisa Generosa Crespo‐Leiro, Gerasimos Filippatos et al.

Abstract The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD‐supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD‐supported patients. The expected and non‐expected device‐related and patient–device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD‐supported patients, mainly those supported with the ‘destination therapy’ indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD‐supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non‐LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non‐LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast‐growing population of LVAD‐supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD‐supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD‐supported patients.

Alice Blet, Benjamin Deniau, Karine Santos et al.

Abstract Background Dipeptidyl peptidase 3 (DPP3) is a cytosolic enzyme involved in the degradation of various cardiovascular and endorphin mediators. High levels of circulating DPP3 (cDPP3) indicate a high risk of organ dysfunction and mortality in cardiogenic shock patients. Methods The aim was to assess relationships between cDPP3 during the initial intensive care unit (ICU) stay and short-term outcome in the AdrenOSS-1, a prospective observational multinational study in twenty-four ICU centers in five countries. AdrenOSS-1 included 585 patients admitted to the ICU with severe sepsis or septic shock. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by the Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use and need for renal replacement therapy. cDPP3 levels were measured upon admission and 24 h later. Results Median [IQR] cDPP3 concentration upon admission was 26.5 [16.2–40.4] ng/mL. Initial SOFA score was 7 [5–10], and 28-day mortality was 22%. We found marked associations between cDPP3 upon ICU admission and 28-day mortality (unadjusted standardized HR 1.8 [CI 1.6–2.1]; adjusted HR 1.5 [CI 1.3–1.8]) and between cDPP3 levels and change in renal and liver SOFA score (p = 0.0077 and 0.0009, respectively). The higher the initial cDPP3 was, the greater the need for organ support and vasopressors upon admission; the longer the need for vasopressor(s), mechanical ventilation or RRT and the higher the need for fluid load (all p < 0.005). In patients with cDPP3 > 40.4 ng/mL upon admission, a decrease in cDPP3 below 40.4 ng/mL after 24 h was associated with an improvement of organ function at 48 h and better 28-day outcome. By contrast, persistently elevated cDPP3 at 24 h was associated with worsening organ function and high 28-day mortality. Conclusions Admission levels and rapid changes in cDPP3 predict outcome during sepsis. Trial Registration ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015.

Jacopo Lucchetti, Francesca Fumagalli, Davide Olivari et al.

Background Brain injury and neurological deficit are consequences of cardiac arrest (CA), leading to high morbidity and mortality. Peripheral activation of the kynurenine pathway (KP), the main catabolic route of tryptophan metabolized at first into kynurenine, predicts poor neurological outcome in patients resuscitated after out‐of‐hospital CA. Here, we investigated KP activation in hippocampus and plasma of rats resuscitated from CA, evaluating the effect of KP modulation in preventing CA‐induced neurological deficit. Methods and Results Early KP activation was first demonstrated in 28 rats subjected to electrically induced CA followed by cardiopulmonary resuscitation. Hippocampal levels of the neuroactive metabolites kynurenine, 3‐hydroxy‐anthranilic acid, and kynurenic acid were higher 2 hours after CA, as in plasma. Further, 36 rats were randomized to receive the inhibitor of the first step of KP, 1‐methyl‐DL‐tryptophan, or vehicle, before CA. No differences were observed in hemodynamics and myocardial function. The CA‐induced KP activation, sustained up to 96 hours in hippocampus (and plasma) of vehicle‐treated rats, was counteracted by the inhibitor as indicated by lower hippocampal (and plasmatic) kynurenine/tryptophan ratio and kynurenine levels. 1‐Methyl‐DL‐tryptophan reduced the CA‐induced neurological deficits, with a significant correlation between the neurological score and the individual kynurenine levels, as well as the kynurenine/tryptophan ratio, in plasma and hippocampus. Conclusions These data demonstrate the CA‐induced lasting activation of the first step of the KP in hippocampus, showing that this activation was involved in the evolving neurological deficit. The degree of peripheral activation of KP may predict neurological function after CA.

Kenanga Marwan Sikumbang, Ardik Lahdimawan

Meningokel adalah kondisi kegagalan fusi selubung saraf medulla spinalis yang umum ditemui pada pasien pediatrik. Koreksi meningokel dilakukan dalam posisi prone yang memerlukan tatalaksana anestesi yang hati-hati. Fisiologi neonatus dan infant berbeda dengan orang dewasa, karena fungsi fisiologis system organ masih imatur dan menyebabkan safety margin terbatas, sehingga pilihan obat adalah yang metabolismenya tidak tergantung pada fungsi hati dan ginjal normal. Dalam bidang neuroanestesi pediatrik, penggunaan remifentanil semakin luas, karena onset cepat, efek analgesik poten dan eliminasi cepat. Seorang bayi laki-laki, usia 7 bulan dengan berat badan 7 kg, diagnosis meningokel lumbosacral dilakukan tindakan eksisi meningokel. Pasien diberikan remifentanil 1 mcg/kgbb selama 1 menit dilanjutkan dengan remifentanil kontinyus 0.05-1mcg/kgbb/mnt. Induksi dengan propofol, diberikan atracurium sebelum intubasi. Selama operasi kondisi stabil, tidak terjadi episode bradikardi dan pascaoperasi pasien langsung diekstubasi. Penggunaan remifentanil menjadi pilihan karena onset cepat, efek analgesik poten, eliminasi cepat dan memberikan stabilitas hemodinamik selama operasi. Operasi dengan posisi prone pada pasien pediatrik memerlukan kehati-hatian terutama saat memposisikan pasien, dimana harus yakin pipa ett tidak mengalami dislokasi atau kinking, mencegah  efek penekanan pada mata dan pencegahan terjadinya neuropati perioperatif. Pemakaian remifentanil pada kasus ini memberikan stabilitas hemodinamik yang baik dan pulih sadar yang cepat.   Using Remifentanyl For Pediatrik Patient With Meningocele Underwent Meningocelectomy Under General Anesthesia Abstract Meningocele is failure of the neural tube to close during first trimester pregnancy which is the most common conditions in pediatrik patient. Correction is performed under prone position with carefull anesthestic procedure. The physiology of neonates and infants are different from that of adults. Immaturity of their vital organ systems narrows the safety margin of perioperative management including anesthesia. Remifentanil is becoming increasingly popular for this purpose. Remifentanil has favorable characteristics for anesthesia in neonates such as rapid onset, potent analgesic effect, and rapid elimination. A baby boy 7 months old, 7 kg, with meningocele lumbosacral underwent meningocelectomy. The patient was given remifentanil 1 mcg/kgbw/iv in one minute and continuous 0.05-0.1 mcg/kgbw/mnt. Induction with propofol iv, atracurium before intubation. Stability hemodynamic during the operation, no episode of bradycardia and patient extubated early after the operation. Remifentanil is an ultra-short-acting opioid, with rapid onset, produces profound analgesia, rapid offset and good stability of hemodynamic during the operation. The operations are carried out prone, careful positioning is paramount to avoid complications like dislodging or kinking of the endotracheal tube, corneal abrasion or perioperative neuropathy. Using remifentanyl in this case report given good hemodynamic stability dan rapid emergence.

A. Dabbagh, Seyyedeh Narjes Ahmadizadeh, Sogol Asgari et al.

Background COVID-19 was a worldwide pandemic with international health emergencies and great challenges; health care personnel shortage and physician burnout is a potential major challenge that should be planned and managed; especially in those countries with a high COVID-19 occurrence. Objectives This study was designed to assess the attitudes of 3rd-year anesthesiology residents toward an independent one month-length clinical care course for patients with COVID-19. Methods A closed self-administered questionnaire was developed to assess the attitudes of 3rd-year clinical anesthesiology residents. A self-administered closed questionnaire was developed. Cronbach’s alpha was calculated to measure the reliability of the questionnaire; added with a factor analysis process. Results All 19 clinical anesthesiology residents took part in the study, with a 100% response rate. Cronbach’s alpha for the reliability of the questionnaire was 0.678. The eigenvalue for 8 factors was equal to 1; however, further assessment led us to 7 factors. Conclusions This one-month period could improve the competencies of the 3rd year clinical anesthesiology residents based on their viewpoints. Since the COVID-19 pandemic is ongoing health and social problem worldwide, 3rd-year anesthesiology residents could help the health system to recover health care delivery faults regarding manpower; a promising point for crisis preparedness in the COVID-19 pandemic. Besides, there were many constructive results for the clinical anesthesiology residents regarding their training and clinical service delivery.

A. Dabbagh, Parissa Sezari, Soodeh Tabashi et al.

Background Accreditation Council for Graduate Medical Education (ACGME) has been used to evaluate the residents’ competency; however, the thriving of residents needs especial training methods and techniques. Small group learning has been used for this propose. Objectives This study assessed the attitudes of CA-1 to CA-3 anesthesiology residents toward level-specific small-group blended learning. Methods Anesthesiology residents from Department of Anesthesiology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran participated in this cross-sectional attitude assessment descriptive-analytical study throughout the 2nd academic semester (May-October 2019). They took part in a level-specific small-group blended learning program and filled out an attitude assessment questionnaire. The questionnaire included eight closed questions and was filled out anonymously. Results The residents believed that this program made important contributions to their theory training and clinical skills of anesthesia; while created a greater sense of solidarity. In addition, nearly the majority of the respondents did not believe that participating in the classes made interference in their clinical duties or was a difficult task. Instead, the majority of residents believed that these classes were in favor of reducing their burnout. The reliability of the questionnaire based on Cronbach’s Alpha was 0.885. Conclusions Anesthesiology residents are in favor of small-group learning, especially when considering their clinical setting and the degree of burnout they tolerate.

Meghan B. Lane-Fall, V. Bedell, R. Eckenhoff

Research in anesthesiology spans the translational spectrum and reflects the breadth of clinical settings in which anesthesia providers now practice. The goal of this paper is to summarize the diversity of scholarship in anesthesiology, discuss challenges to anesthesiology research, and to highlight the bright potential of anesthesiology research. Given that most research in anesthesiology is carried out by scientists with MD/DO or PhD degrees (or both), our commentary is focused on these investigators.

Mohammad Chehrazi, Zahra Geraili, Seyed Mozafar Rabiei et al.

Abstract Background Cataract surgery is most commonly done under local anesthesia with anesthesia and sedation controlled. Anesthetic depth and awareness monitoring during surgery frequently lead to irregular-timed observations. Inappropriate choice of working correlation structure in generalized estimating equations (GEE) may lead to inefficient estimation of parameters. The aim of this study was to apply the two new criteria to the anesthesia data for cataract surgery, to select and compare different candidates for working structure. Methods In this randomized controlled trial, anesthesia depth and hemodynamic changes were considered to be the primary outcome. The first group received propofol at a dose of 50‑75 μg/kg/min and the second group received 1% isoflurane. We developed a GEE regression model based on several candidates for the working correlation framework and then evaluated it according to CEBIC (Constraint Empirical Bayesian Information Criterion) and CEAIC (Constraint Empirical Akaike Information Criterion) criteria. Data analysis was performed using the R software 3.6.1. Results The mean age of the propofol group was 67.46 years (SD = 12.46 years) and 64.53 years for the isoflurane group (SD = 13.77 years). The mean BIS in isoflurane was higher among all time points than the propofol group, but only the difference between the two groups was statistically significant in 3 min after surgery (P = 0.04). On the basis of the CEAIC and CEBIC criteria, an independent working correlation was the best structure for the BIS outcome. In addition, the best structure was the unstructured correlation for HR. The MAP (mean arterial pressure) parameter estimate results revealed that the AR (1) structure was a good choice. Conclusion In comparison to CIC and QIC, two CEAIC and CEBIC criteria have chosen a different structure for the working correlation between repeated measurements of anesthetic indices obtained during cataract surgery.