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Recovery and discharge time between remimazolam tosylate and propofol in hysteroscopy anesthesia: a randomized controlled study medRxiv. Anesth. Pub Date : 2024-04-12 Xiangyi Lin, Shengjie Chen, Huiyan Liang
Background Hysteroscopy is considered the gold standard for the evaluation and treatment of uterine and endometrial lesions, but the operation is accompanied by severe pain, so it needs to be performed under anesthesia. Currently, a new sedative drug, remimazolam tosilate, can be used in digestive endoscopy and bronchoscopy. We will study its effect on hysteroscopy and its impact on patient recovery
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Splitting ratio in sevoflurane vapouriser-a relook on calculations medRxiv. Anesth. Pub Date : 2024-04-12 D Girijanandan Menon, Manjit George, Salih V Salim, R. Sreekumar, Sam Philip, Roshin K Mathew, Princymol Bju, Merin Helen Mathai
Textbooks of anaesthesia describe in detail the calculations associated with splitting ratios created in variable bypass vapourisers. These calculations are based on assumptions of carrier gas flow (eg:assume 150 ml) as practised with measured flow vaporizers[1,2]. Carrier gas flow in a variable bypass vaporizer is agent specific,dynamic,unknown and operator independent.Therefore assuming carrier gas
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The Current State & Sentiment of Artificial Intelligence in North American Anesthesiology Residency Programs medRxiv. Anesth. Pub Date : 2024-04-06 Tyler V Elliott, Joseph C Goldstein, Heidi V Goldstein
Purpose This study aims to investigate the current state and sentiment of artificial intelligence (AI) training in North American anesthesiology residency programs, assessing existing AI education landscapes, identifying barriers to implementation, and understanding program directors’ expectations for AI’s impact on the field.
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Predictors of Postoperative pharyngeal complaints in children undergoing surgery under general anesthesia at Hawassa university comprehensive specialized hospital, a prospective observational study medRxiv. Anesth. Pub Date : 2024-04-01 Adanech Shifarew Legasse, Addisu Mossie, Aschalew Besha, Nesra Mohammed
Background Postoperative pharyngeal complaints are common but minor complications following surgery and are commonly reported during postoperative visits. These complaints includes sore throat, dysphagia, and hoarseness, which can significantly impact a child’s comfort, overall well-being and satisfaction after surgery. Identifying and understanding the predictors of these postoperative pharyngeal
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Preoperative activation of the Renin–Angiotensin system and myocardial injury in noncardiac surgery: Post Hoc Analysis of the SPACE randomised controlled Trial medRxiv. Anesth. Pub Date : 2024-03-26 Ana Gutierrez del Arroyo, Tom. E. F. Abbott, Akshaykumar Patel, Salma Begum, Priyanthi Dias, David Brealey, Rupert M. Pearse, Vikas Kapil, Gareth L. Ackland, the SPACE trial investigators
Background Hypertension therapy in older adults is often suboptimal, in part due to inadequate suppression of the renin-angiotensin-aldosterone system (RAAS). We hypothesised that distinct endotypes of RAAS activation before noncardiac surgery are associated with increased risk of myocardial injury.
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A signal processing tool for extracting features from arterial blood pressure and photoplethysmography waveforms medRxiv. Anesth. Pub Date : 2024-03-15 Ravi Pal, Akos Rudas, Kim Sungsoo, Jeffrey Chiang, Maxime Cannesson
Arterial blood pressure (ABP) and photoplethysmography (PPG) waveforms contain valuable clinical information and play a crucial role in cardiovascular health monitoring, medical research, and managing medical conditions. The features extracted from PPG waveforms have various clinical applications ranging from blood pressure monitoring to nociception monitoring, while features from ABP waveforms can
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Advanced and more advanced revascularization in STEMI patients: which is better? medRxiv. Anesth. Pub Date : 2024-03-14 Yahui Li, Chunxia Zhao, Ling Zhou, Xindi Yue, Dao Wen Wang, Feng Wang
Objective To compare the long-term prognosis of patients who experienced acute ST-segment elevation myocardial infarction and underwent either late percutaneous coronary intervention (PCI) within a period of 2 days to less than 1 week or more advanced PCI within 1 week to less than 1 month. Methods We enrolled 198 patients from Tongji Hospital of Tongji Medical College, Huazhong University of Science
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Graph connection Laplacian allows for enhanced outcomes of consumer camera based photoplethysmography imaging medRxiv. Anesth. Pub Date : 2024-03-09 Stefan Borik, Hau-Tieng Wu, Kirk H. Shelley, Aymen A. Alian
Object: This work aims to introduce a novel method to mitigate the global phase deviation inherent in photoplethysmography imaging (PPGI) due to hemodynamics. Method: We model the facial vascular network captured by a consumer camera as a two-dimensional manifold, where the complex dynamics of the vascular tree lead to intricate phase variations across skin sites. Utilizing PPGI, we sample the vector
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An algorithm to detect dicrotic notch in arterial blood pressure and photoplethysmography waveforms using the iterative envelope mean method medRxiv. Anesth. Pub Date : 2024-03-07 Ravi Pal, Akos Rudas, Sungsoo Kim, Jeffrey Chiang, Anna Barney, Maxime Cannesson
Background and Objective: Detection of the dicrotic notch (DN) within a cardiac cycle is essential for assessment of cardiac output, calculation of pulse wave velocity, estimation of left ventricular ejection time, and supporting feature-based machine learning models for noninvasive blood pressure estimation, and hypotension, or hypertension prediction. In this study, we present a new algorithm based
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Local Anesthetic Systemic Toxicity in Pregnancy: A Retrospective Cohort Analysis medRxiv. Anesth. Pub Date : 2024-02-27 Micah K de Valle, Michael Adkison, Ruhi Maredia, Cooper Stevenson, Shobana Murugan
Introduction Local Anesthetic Systemic Toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnancy from nonpregnant
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Pulmonary Hypertension and the Risk of 30-day Postoperative Pulmonary Complications after Gastrointestinal Surgical or Endoscopic Procedures: A Retrospective Propensity Score Weighted Cohort Analysis. medRxiv. Anesth. Pub Date : 2024-02-22 Yoshio Tatsuoka, Zyad James Carr, Sachidhanand Jayakumar, Hung-Mo Lin, Zili He, Adham Farroukh, Paul M. Heerdt
Background: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPC). Methods: A single-center propensity score overlap weighting (OW) retrospective cohort study of 164 patients with mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of procedure and a control cohort
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An evaluation of the i-gel Plus supraglottic airway device in elective patients: the interim results from a prospective international multicentre study medRxiv. Anesth. Pub Date : 2024-02-18 Jakub Werner, Olga Klementova, Jan Bruthans, Jaromir Macoun, Tomasz Gaszynski, Tomas Henlin, Will Donaldson, Erik Lichnovsky, Shiva Arava, Ana M Lopez, Raquel Berge, Pavel Michalek
The i-gel Plus supraglottic airway represents the next generation of the i-gel device. The aim of this international multicentre prospective cohort study was to evaluate its performance in adult patients during elective procedures in various surgical disciplines under general anaesthesia. The primary outcome of the study was the overall success rate of insertion allowing effective airway management
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EEG signatures at different propofol vs sevoflurane concentrations medRxiv. Anesth. Pub Date : 2024-01-30 Chris Sun, Agnes Rigouzzo, Isabelle Constant, David holcman
The depth of anesthesia is contingent upon the concentration of administered hypnotics, but establishing an exact relationship proves challenging, given its variability among individual patients. To elucidate the connection between the depth of anesthesia and hypnotic concentration, we leverage transient EEG patterns specifically, isoelectric suppressions and power distributions within the alpha and
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Extended Reality for Neuraxial Anesthesia and Pain Procedures: A Scoping Review medRxiv. Anesth. Pub Date : 2024-01-30 James S Cho, Devaunsh M Thaker, Rohan Jotwani, David Hao
Background Extended reality technology, encompassing augmented reality, mixed reality, and virtual reality, has the potential to enhance the teaching and performance of neuraxial procedures. The diverse applications of extended reality include immersive simulations and novel modes of procedural navigation. Objectives This scoping review aims to explore the preclinical, clinical, and educational applications
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An Open-label Clinical Study of Brief Submaximal Cardiopulmonary Testing in Pre-surgical Evaluation: Feasibility of implementation medRxiv. Anesth. Pub Date : 2024-01-26 Zyad James Carr, Daniel Agarkov, Judy Li, Jean Charchaflieh, Andres Brenes-Bastos, Jonah Freund, Jill Zafar, Robert B Schonberger, Paul Heerdt
Objectives: We tested the logistic feasibility of integrating brief submaximal cardiopulmonary exercise testing (smCPET) in a pre-surgical evaluation (PSE) clinic. Design: Prospective open-label clinical device trial. Setting: Pre-surgical evaluation clinic. Participants: 43 participants who met criteria of i) age > 60 years old, ii) revised cardiac risk index of <2, iii) self-reported metabolic equivalents
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Ratios Of Submitted Charge Amounts To Medicare Allowed Amounts Have Variably Worsened For Anesthesiologists And Certified Registered Nurse Anesthetists Serving Medicare Beneficiaries Across The United States During 2013-2021 Period medRxiv. Anesth. Pub Date : 2024-01-17 Deepak Gupta, Yara Ismaeil
Background Interstate variations among anesthesia providers in terms of their submitted charge amounts with corresponding Medicare allowed amounts have not been recently explored.
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Assessing the Incidence of Postoperative Diabetes in Gastric Cancer Patients: A Comparative Study of Roux-en-Y Gastrectomy and Other Surgical Reconstruction Techniques medRxiv. Anesth. Pub Date : 2024-01-15 Tatsuki Onishi
Study objective Sleeve gastrectomy is effective in morbid obesity, and it improves glucose homeostasis. In gastric cancer patients with type 2 diabetes mellitus, gastrectomy, including total gastrectomy (TG), is beneficial for glycaemic control. However, the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative diabetes in gastric cancer patients are unclear
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Beyond Pain Control: Exploring Regional Anaesthesia’s Potential to Improve Gastric Cancer Surgery Survival Rates: A Retrospective Cohort Study medRxiv. Anesth. Pub Date : 2024-01-13 Onishi Tatsuki, Yoshika Onishi
Background Gastric cancer management remains fraught with high morbidity and mortality rates owing to surgical interventions. Postoperative complications and extended hospitalisation profoundly affect patient survival, with elderly and medically compromised patients facing greater risks. We hypothesised that regional anaesthesia may reduce the surgical stress response and thus mortality. Hence, this
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Preoperative atelectasis in patients with obesity undergoing bariatric surgery: a cross-sectional study medRxiv. Anesth. Pub Date : 2024-01-12 Javier Mancilla-Galindo, Jesus Elias Ortiz-Gomez, Orlando Rubén Pérez-Nieto, Audrey De Jong, Diego Escarramán-Martínez, Ashuin Kammar-García, Luis Carlos Ramírez Mata, Adriana Mendez Díaz, Manuel Alberto Guerrero-Gutiérrez
Background Atelectasis are present even before surgery in patients with obesity. No study has reported the prevalence of preoperative atelectasis in obese patients to date. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery, and the extent to which atelectasis mediate preoperative SpO2 values.
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Bronchoscopy in children with diffuse alveolar hemorrhage under general anesthesia with spontaneous respiration by face mask ventilation medRxiv. Anesth. Pub Date : 2023-12-06 Ruimin Yang, Qing Wei, Xun Chen, Jing Liu, Yan Li, Jingchen Liu
Purpose: To improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). Methods: A retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. Results: 1. Thirty-four children
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Brain mineralization in postoperative delirium and cognitive decline medRxiv. Anesth. Pub Date : 2023-12-03 Florian Lammers-Lietz, Friedrich Borchers, Insa Feinkohl, Stefan Hetzer, Cicek Kanar, Gunnar Lachmann, Claudia Chien, Claudia Spies, Georg Winterer, Laszlo Zaborszky, Norman Zacharias, Friedemann Paul
Delirium is a severe postoperative complication associated with poor overall and especially neurocognitive prognosis. Altered brain mineralization is found in neurodegenerative disorders but has not been studied in postoperative delirium and postoperative cognitive decline. We hypothesized that mineralization-related hypointensity in susceptibility-weighted magnetic resonance imaging (SWI) is associated
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Bilateral jaw thrust usage is neither universally prevalent during laryngeal mask airway placement nor universally prevalent during anesthesia mask ventilation before laryngoscopy for endotracheal tube placement: A single anesthesia worksite observation medRxiv. Anesth. Pub Date : 2023-11-22 Deepak Gupta, Kaya Chakrabortty, Mohamed Ismaeil
Background While placing two hands on the mask during manual or mechanical ventilation on unsecured airways, providers are not always providing bilateral jaw thrust for maintaining airway patency especially when focusing only on ensuring a good mask seal.
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A Randomized Controlled Trial Comparing Erector Spinae Plane and Transversus Abdominis Plane Blocks for Postoperative Analgesia after Elective Caesarean Section medRxiv. Anesth. Pub Date : 2023-10-28 Aidan Eksteen, Janine Wagner, Thomas Kleyenstuber, Peter Kamerman
Abstract Background: Peripheral abdominal nerve blocks contribute to multimodal postoperative analgesia that enhances early recovery after caesarean sections. The transversus abdominis plane (TAP) block is an established technique that offers somatic abdominal analgesia. The erector spinae plane (ESP) block is a novel fascial plane block that may offer additional visceral analgesic effects. This study
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Perioperative Enteral Fasting Duration Scores In Double Digits: A Seven-Year Long Cross-Sectional Retrospect By A Single Institution Among Its Patients Undergoing Extracapsular Cataract Extraction With Intraocular Lens Implantation medRxiv. Anesth. Pub Date : 2023-10-19 Deepak Gupta
Background: Perioperative fasting period can be very variable which must be quantified at institutional level so that the institutions can re-formulate their local policies while adapting to updated national and international guidelines. Objective: The purpose of this retrospective study was to ascertain the total duration of perioperative fasting among patients who underwent extracapsular cataract
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Safety of hyperbaric oxygen therapy in patients with heart failure: a retrospective review. medRxiv. Anesth. Pub Date : 2023-10-14 Simone Schiavo, Connor T. A. Brenna, Lisa Albertini, George Djaiani, Anton Marinov, Rita Katznelson
Background: Hyperbaric oxygen therapy (HBOT) has several hemodynamic effects including increases in afterload (due to vasoconstriction) and decreases in cardiac output. This, along with rare reports of pulmonary edema during emergency treatment, has led providers to consider HBOT relatively contraindicated in patients with reduced left ventricular ejection fraction (LVEF). However, there is limited
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Sleep and circadian biomarkers of postoperative delirium: protocol for a prospective, observational cohort study medRxiv. Anesth. Pub Date : 2023-09-23 Elizabeth Sugg, Elizabeth Gleeson, Sarah N Baker, Peng Li, Chenlu Gao, Airel Louise Mueller, Hao Deng, Shiqian Shen, Esteban Franco Garcia, Richa Saxena, Erik Musiek, Oluwaseun Johnson-Akeju, Zhongcong Xie, Kun Hu, Lei Gao
Surgical patients over 70 experience postoperative delirium (POD) complications in up to 50% of procedures. Sleep/circadian disruption has emerged as a potential risk factor for POD in epidemiological studies. However, the relationship remains unclear in a clinical setting. This protocol presents a single-site, prospective, noninvasive observational study designed to examine the relationship between
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Deep brain stimulation surgery under ketamine induced conscious sedation: a double blind randomized controlled trial medRxiv. Anesth. Pub Date : 2023-08-28 Evgeniya Kornilov, Halen Baker Erdman, Eilat Kahana, Shlomo Fireman, Omer Zarchi, Michal Israelashvili, Johnathan Reiner, Amir Glik, Penina Weiss, Rony Paz, Hagai Bergman, Idit Tamir
Background. The gold standard anesthesia for deep brain stimulation (DBS) surgery is the "awake" approach, using local anesthesia alone. While it offers high-quality microelectrode recordings and clinical assessment of the stimulation therapeutic window, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. However, the alternative of general anesthesia or
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Optimal tracheal tube rotation patterns for navigating through the glottis: an in-silico quantification. medRxiv. Anesth. Pub Date : 2023-08-24 Erich B Schulz, Lucy E Carra Schulz
Seeking to unpack some of the anaesthetists' "knack" for intubation, this study examines the effect of various orientations of the tracheal tube on the anterior movement of the tube tip using a computerised 3D model of intubation. The model used sets of coordinates for the upper incisor tip, lower incisor tip and vallecula extracted from mean values reported in a study of 16 volunteers predicted to
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Radiologically Visible Intraspinal Air Was Very Common After Epidural Access Attempts Among Our Peripartum Patients Who Had Undergone Radiological Examinations medRxiv. Anesth. Pub Date : 2023-08-16 Deepak Gupta
Background: The incidence of intracranial air after neuraxial access attempts was recently quantified. Therefore, the incidence of intraspinal air after neuraxial access attempts needs to be quantified. Objective: To ascertain how common was radiologically visible intraspinal air per computed tomography/magnetic resonance imaging (CT/MR) of spine among our peripartum patients. Methods: For a seven-year
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Patient self-reported pain and nausea via smartphone following daycare surgery, first year results: An observational cohort study medRxiv. Anesth. Pub Date : 2023-08-09 Bram Thiel, Jamey Blaauboer, Chiem Seesing, Jamshid Radmanesh, Seppe Koopman, Cor Kalkman, Marc Godfried
Contact with the hospital is usually limited for patients after daycare surgery. Dedicated smartphone applications can improve communication and possibly enhance outcomes. The objective of this retrospective study was to evaluate patients’ self-reported pain and nausea and assess the success of routine implementation of a smartphone application for outcome reporting. During preoperative assessment
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Antiemetic effect of pregabalin in breast reconstruction surgery in patients after bariatric surgery: Prospective, randomized, double-blind study medRxiv. Anesth. Pub Date : 2023-07-24 Rafael Reis Fernandes, Marcello Fonseca Salgado-Filho, Guilherme Bracco Graziosi, André Nery, Flávio Távora, Alice Ramos Oliveira Da Silva, Caio Pontes De Azevedo, Nubia Verçosa, Isma Lima Cavalcanti
Introduction Postoperative nausea and vomiting (PONV) is a common complication after general anesthesia. Pregabalin may reduce its incidence. The objective of this study was to evaluate the adjuvant antiemetic effect of pregabalin in the first 24 hours after surgery in patients undergoing breast reconstruction after bariatric surgery. Materials and Methods This prospective, randomized, double-blind
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Comparison of Adverse Effects Related to the Use of Epidural Anesthesia versus Spinal Anesthesia in Cesarean Section Patients at the Plaza de la Salud General Hospital in Santo Domingo, Dominican Republic, During the Period January-December 2021: A Retrospective Study medRxiv. Anesth. Pub Date : 2023-07-08 Alba Rebecca Hernandez Guzman, Mariam Alcantara
Objectives: This study aimed to investigate the two different types of regional anesthesia for a cesarean section and to analyze the various perioperative and postoperative side effects related to them. Design: We retrospectively included those patients who required a cesarean section under regional anesthesia. Setting: Hospital General Plaza de la Salud from January 2021 to December 2021. Participants:
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Artificial Intelligence for Anatomical Structure Identification on Ultrasound in Regional Anaesthesia: A Scoping Review Protocol medRxiv. Anesth. Pub Date : 2023-07-05 James S Bowness, David Metcalfe, Kariem El-Boghdadly, Neal Thurley, Megan Morecroft, Alison Noble, Helen Higham
BACKGROUND Ultrasound is the most common form of guidance for regional anaesthesia. There is increasing interest in developing supporting technology, particularly in the form of artificial intelligence (AI), to aid in the acquisition and interpretation of optimal ultrasound views for these procedures. However, this is a broad field, with academia, clinical practice, and industry all providing disparate
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Comparison of ChatGPT vs. Bard to Anesthesia-related Queries medRxiv. Anesth. Pub Date : 2023-06-30 Sourav S Patnaik, Ulrike Hoffmann
We investigated the ability of large language models (LLMs) to answer anesthesia related queries prior to surgery from a patient′s point of view. In the study, we introduced textual data evaluation metrics, investigated ″hallucinations″ phenomenon, and evaluated feasibility of using LLMs at the patient-clinician interface. ChatGPT was found to be lengthier, intellectual, and effective in its response
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Observation Of Laryngopharyngeal Reflux During Video-Laryngoscopy Was Common Per Our Single Observer Single Institution Experience medRxiv. Anesth. Pub Date : 2023-06-12 Ewelina Suchocki, Wael Saasouh, Deepak Gupta
Background: Video-laryngoscopy gives an opportunity to objectively document the peri-operative incidence of laryngopharyngeal reflux. Materials and Methods: To quantify the local real-world incidence of laryngopharyngeal reflux, a single observer observed 100 adult patients undergoing elective video-laryngoscopy for their elective surgical procedures in the operating rooms at a single institution.
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Global Analysis of Adequacy of Prescription Opioid Consumption across 214 Countries and Territories medRxiv. Anesth. Pub Date : 2023-06-01 Shirish Rao, Siddhesh Zadey
Background Inadequate access to pain management has consequences for perioperative care. Access to perioperative care globally is critical for equitable surgical, obstetric, trauma, and anesthesia (SOTA) care. Adequacy of prescription opioid consumption (AOC) can fill this gap. This study aimed to use the AOC index to assess global adequacy using recent data across 214 countries and territories, World
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Inferior vena cava ultrasound versus passive leg raising test in guiding fluid administration in surgical patients prior to spinal anaesthesia: a post-hoc analysis of the ProCRHYSA randomized trial medRxiv. Anesth. Pub Date : 2023-05-25 Samuele Ceruti, Andrea Glotta, Mathieu Favre, Edoardo Tasciotti, Giovanni Bona, Antonietta Petrusic, Alain Borgeat, José Aguirre, Andrea Saporito
Background Spinal anaesthesia is commonly used for many surgical procedures. One of its potential complications is arterial hypotension, which is nowadays prevented by an empirical fluid administration without any hemodynamic status assessment. However, this practice could increase the risk of volume overload in cardiovascular high-risk patients. Two non-invasive tests are performed to identify fluid-responsiveness:
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The experiences and perceptions of working with Anaesthesia Associates: a survey of UK anaesthetists in training medRxiv. Anesth. Pub Date : 2023-05-24 Ben Evans, Leyla M Turkoglu, James Brooks, Jeevakan Subramaniam, Stuart Edwardson, Roopa McCrossan, Naomi Freeman, Danny J. N. Wong
The future and sustainability of the anaesthetic workforce is a growing concern with a projected shortfall of 11,000 anaesthetists by 2040. The supply of anaesthetists able to provide safe anaesthesia care does not meet the rising demand of surgical waiting lists. In recent years, changes to recruitment and curricula for anaesthetic specialty training have resulted in significant bottlenecks to training
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Clinical Knowledge and Reasoning Abilities of AI Large Language Models in Anesthesiology: A Comparative Study on the ABA Exam medRxiv. Anesth. Pub Date : 2023-05-16 Mirana C. Angel, Joseph B. Rinehart, Maxime P. Canneson, Pierre Baldi
Over the past decade, Artificial Intelligence (AI) has expanded significantly with increased adoption across various industries, including medicine. Recently, AI’s large language models such as GPT-3, Bard, and GPT-4 have demonstrated remarkable language capabilities. While previous studies have explored their potential in general medical knowledge tasks, here we assess their clinical knowledge and
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A Role for Blood-brain Barrier Dysfunction in Delirium following Non-Cardiac Surgery in Older adults medRxiv. Anesth. Pub Date : 2023-05-10 Michael J. Devinney, Megan K. Wong, Mary Cooter Wright, Edward R. Marcantonio, Niccolò Terrando, Jeffrey N. Browndyke, Heather E. Whitson, Harvey J. Cohen, Andrea G. Nackley, Marguerita E. Klein, E. Wesley Ely, Joseph P. Mathew, Miles Berger, the MADCO-PC & INTUIT Study Groups
Objective Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients.
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Predicting sensitivity to general anesthesia: Bispectral index versus Checkpoint-Decomposition Algorithm medRxiv. Anesth. Pub Date : 2023-05-05 C. Sun, I. Constant, D. Holcman
Despite a large effort in EEG signal processing, classification algorithms, deep-learning approach, predicting the sensitivity to general anesthesia (GA) remains a daunting hurdle. We compare here the ability of the Bispectral Index™ (BIS™), developed more that twenty years ago to monitor the depth of anesthesia, with the real-time checkpoint-decomposition algorithm (CDA) to evaluate the patient sensitivity
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The clinical outcomes of acute kidney injury substages based on serum cystatin C in pediatric patients undergoing cardiac surgery medRxiv. Anesth. Pub Date : 2023-05-04 Yinan Li, Dongyun Bie, Chao Xiong, Sheng Shi, Zhongrong Fang, Zhongyuan Lu, Jianhui Wang
Background Multiple biomarkers have been identified by previous studies to diagnose acute kidney injury (AKI). Moreover, combination of biomarkers with conventional criteria to define AKI substages so that we can identify high-risk patients and improve diagnostic accuracy were recommended. Our study aimed to explore the incidence of AKI substages defined by serum cystatin C (CysC), determine whether
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Anaesthesia delivery systems in low and lower-middle-income Asian countries: a scoping review of capacity and effectiveness medRxiv. Anesth. Pub Date : 2023-05-04 Sumbal Shahbaz, Natasha Howard
Background Literature on anaesthesia systems in low and lower middle-income countries is limited, focused on the Africa region, and provides minimal data on anaesthesia or associated disciplines within intensive care, pain management and emergency medicine. We thus conducted a review of primary and secondary research literature on low and lower middle-income countries in the Asia region from 2000-2021
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PEACH in Asia: PEri-Anesthetic morbidity in CHildren in Asia: A prospective multinational multicenter observational study to investigate epidemiology of severe critical events in pediatric anesthesia in Asia medRxiv. Anesth. Pub Date : 2023-05-01 Soichiro Obara, Choon Looi Bong, Norifumi Kuratani, Zehra Serpil Ustalar Ozgan, Mahin Seyedhejazi, Shemila Abbasi, Ekta Rai, Elsa Varghese, Evangeline K Villa, Andi Ade W Ramlan, Ina Ismiarti Shariffuddin, Patcharee Sriswasdi, Pheakdey Nhoung, Vivian Yuen, Hyo-Jin Byon, Josephine S K Tan
Background Despite the introduction of better structured programs for pediatric anesthesia training and the development of some recommendations for pediatric anesthesia services, the incidence of severe critical events in children is still unknown in Asia. Considering that the major life threatening complications following general or regional anesthesia are uncommon, it is therefore crucial to consider
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Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives medRxiv. Anesth. Pub Date : 2023-04-17 Sumbal Shahbaz, Rubeena Zakar, Natasha Howard
Background Anaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of quality anaesthesia services for surgical support in Pakistan’s Punjab province.
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Comparison of the carotid corrected flow time and tidal volume challenge for assessing fluid responsiveness in robot-assisted laparoscopic surgery medRxiv. Anesth. Pub Date : 2023-04-12 Xixi Tang, Qi Chen, Zejun Huang, Ran An, Jingqiu Liang, Hongliang Liu
Purpose We aimed to evaluate the ability of carotid corrected flow time assessed by ultrasound to predict fluid responsiveness in patients undergoing robot-assisted laparoscopic gynecological surgery in the modified head-down lithotomy position.
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Construction of a risk prediction model of postoperative delirium in older patients undergoing spinal surgery: Protocol of a single-center observational cohort study medRxiv. Anesth. Pub Date : 2023-04-10 Qian Liu, Meng Jiao, Ke Huang, Xuexin Feng, Tianlong Wang
Background Delirium is an acute mental disorder and a common postoperative complication. Age is an independent marker of the development of postoperative delirium. In older patients, delirium leads to numerous detrimental effects. We will mainly explore the incidence and potential risk variables of postoperative delirium in older patients undergoing spinal surgery, focusing on some preoperative and
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Medication administration errors during general anesthesia – a systematic review of prospective studies medRxiv. Anesth. Pub Date : 2023-03-29 Bradley P Murphy, Gayatri Sivaratnam, Jean Wong, Frances Chung, Amir Abrishami
Introduction The incidence of medication error in anesthesia can be variable among different studies likely due to recall bias in retrospective studies. In prospective survey studies, questionnaires are sent to anesthesia care providers to facilitate self-reports of medication errors during a pre-planned follow-up period. This systematic review investigates all prospective survey studies of medication
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Pilot randomized clinical trial of virtual reality pain management during adult burn dressing changes: lessons learned medRxiv. Anesth. Pub Date : 2023-03-17 Megan Armstrong, Rebecca Coffey, John Luna, Henry Xiang
Opioids are the most frequently used pain medications by US burn centers to control severe procedural pain during wound care. Concerns for long-term opioid use have prompted the exploration of non-pharmaceutical interventions, such as virtual reality (VR), for procedural pain management. The primary objective of this pilot study was to evaluate the feasibility and efficacy of VR pain alleviation treatment
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The impact of female sex on anaesthetic awareness, depth and emergence: A systematic review and meta-analysis medRxiv. Anesth. Pub Date : 2023-03-15 Hannah Braithwaite, Thomas Payne, Nicholas Duce, Jessica Lim, Tim McCulloch, John Loadsman, Kate Leslie, Angela Webster, Robert Sanders
Background: Accumulating evidence supports sex differences in pharmacodynamic and pharmacokinetic drug profiles. However, recommended anaesthetic drug doses are not sex-adjusted, likely due to limited studies comparing sexes. Our objective was to systematically synthesise studies of anaesthetic key performance indicators (anaesthesia awareness), and markers of relatively lighter anaesthesia, time to
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The safety and efficacy of remimazolam tosylate combined with propofol in upper gastrointestinal endoscopy: a multicenter, randomized clinical trial medRxiv. Anesth. Pub Date : 2023-03-01 MengCHang Yang, Ai Wei, Shijin Ma, Yuzhe Dou, Xiaojun Wang, Jianxiong Wu, Shuzhi Zhou, Yanfang Deng, Xinquan Liu, Dongming Li
Introduction: Hypotension is the most common adverse event under propofol-mediated sedation and is possible to cause varying degrees of damage to patients. Whereas remimazolam has a poorer sedative effect than propofol. Aim: The aim of this study was to explore the advantages of the combination of remimazolam tosylate and propofol. Methods: 304 patients were divided into the remimazolam tosylate group
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Is the Patient State Index Recorded with the Sedline Sedation Monitor Correlated with the Duration of Emergence After Pediatric Surgery: An Exploratory, Single-center, Blinded, Prospective Cohort Study medRxiv. Anesth. Pub Date : 2023-03-01 Ludmil Mitrev, Stuart Pasch, Ian Brotman, Bharathi Gourkanti, Fatima Habib, Michael Schwartz, Noud van Helmond
Introduction Following surgery with general anesthesia, some children experience a prolonged emergence. We designed a prospective observational study in children undergoing general anesthesia who were monitored with the SedLine® Sedation Monitoring system (Masimo Corporation, Irvine, CA) to explore the hypothesis that the Patient State Index (PSI) obtained with this monitor could be inversely correlated
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Effects of low versus high inspired oxygen fraction on myocardial injury after transcatheter aortic valve implantation: A randomized clinical trial medRxiv. Anesth. Pub Date : 2023-01-19 Youn Joung Cho, Cheun Hyeon, Karam Nam, Seohee Lee, Jae-Woo Ju, Jeehoon Kang, Jung-Kyu Han, Hyo-Soo Kim, Yunseok Jeon
Background Oxygen therapy is used in various clinical situation, but its clinical outcomes are inconsistent. The relationship between the fraction of inspired oxygen (FIO2) during transcatheter aortic valve implantation (TAVI) and clinical outcomes has not been well studied. We investigated the association of FIO2 (low vs. high) and myocardial injury in patients undergoing TAVI. Methods Adults undergoing
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Multivariate Analysis for the Influence of Ejection Fraction Value on Propofol Anesthesia Induction Requirement and its Pharmacodynamic Properties in Cardiopulmonary Bypass Surgery (Observational Study based on the Clinical Outcomes) medRxiv. Anesth. Pub Date : 2022-11-30 Dias Permeisari
Background : The majority of propofol utilization as an induction anesthetic in cardiac surgery, particularly in cardiopulmonary bypass surgery led to several risks to the patient. The most common risk is dropped mean arterial pressure, even with the high risk of cardiac arrest. Objective : Determining the influences of ejection fraction value on the amount of propofol requirement as an induction agent
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Repurposing EEG monitoring of general anaesthesia for building biomarkers of brain ageing: An exploratory study medRxiv. Anesth. Pub Date : 2022-10-12 David Sabbagh, Jerome Cartailler, Cyril Touchard, Jona Joachim, Alexandre Mebazaa, Fabrice Vallee, Etienne Gayat, Alexandre Gramfort, Denis A Engemann
Background: EEG is a common tool for monitoring anaesthetic depth but is rarely reused at large for biomedical research. This study sets out to explore repurposing of EEG during anaesthesia to learn biomarkers of brain ageing in the absence of consciousness. Methods: We focused on brain age estimation as an example. Using machine learning, we reanalysed 4-electrodes EEG of 323 patients under propofol
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Risk Ratio (Relative Risk) And Odds Ratio For Radiologically Visible Intracranial Air After Neuraxial Access Attempts Among Our Peri-Partum Patients Were Undefined Although One In Forty Of Them Had Radiologically Visible Intracranial Air On CT/MR Of Head/Brain medRxiv. Anesth. Pub Date : 2022-10-04 Deepak Gupta
Background: During neuraxial access attempts, loss-of-resistance technique with air may inadvertently become injection-of-air technique potentially leading to intracranial air. Objective: The purpose of this retrospective study was to ascertain the incidence of radiologically visible intracranial air among peri-partum patients admitted to local Womens Hospital who underwent computed tomography/magnetic
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The Association of Postoperative Anaemia with Outcomes in Cardiac Surgical Patients Eligible for Patient Blood Management: A Single Institution Retrospective Cohort Study medRxiv. Anesth. Pub Date : 2022-08-22 Justyna Bartoszko, Michelle Li, Jeannie Callum, Sujung Yi, Maral Ouzounian, Stuart A. McCluskey, Sarah Miles, Yulia Lin, Keyvan Karkouti
Background Anaemia is prognostically important and affects 30-40% of cardiac surgical patients. The objective of this study was to examine the association of pre- and postoperative anaemia with outcomes in cardiac surgical patients.
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PREOPERATIVE CLINICAL PRACTICE GUIDELINES FOR ELECTIVE SURGERY. METHODOLOGICAL AND QUALITY APPRAISAL STUDY medRxiv. Anesth. Pub Date : 2022-07-29 Gustavo Angel, Cristian Trujillo, Mario Mallama, Pablo Alonso-Coello, Markus Klimek, Jose A. Calvache
Background Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decrease the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown.
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Perioperative changes in oxygen consumption: estimations from minimal-invasive cardiac output and a-cvO2 difference parallel to indirect calorimetry medRxiv. Anesth. Pub Date : 2022-07-21 Julia Jakobsson, Carl Norén, Eva Hagel, Magnus Backheden, Sigridur Kalman, Erzsébet Bartha
Feasible estimations of perioperative changes in oxygen consumption could enable larger studies of its role in postoperative outcomes. Current methods, by pulmonary artery catheterisation or breathing gas analysis, are often regarded as either invasive or technically requiring. In this pilot study, we investigated the relationship between estimations of oxygen consumption, based on minimal-invasive
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The Analgesic Efficacy of Different Techniques Surrounding Regional Anesthesia of the Lumbar Plexus and its Terminal Branches for Hip Fracture Surgeries medRxiv. Anesth. Pub Date : 2022-06-23 Abnoos Mosleh-Shirazi, Brian O’Donnell
ABSTRACT Background Research is limited in comparing the analgesic efficacy of the various types of blocks with one another for hip fracture surgeries. Due to the rapid pace in the development of these new techniques in blocking the lumbar plexus and its terminal branches, uncertainty exists in literature and in practice regarding the definition and efficacy of one technique in comparison to another