Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2025
Randomized Controlled TrialPostoperative Innate Immune Dysregulation, Proteomic, and Monocyte Epigenomic Changes After Colorectal Surgery: A Substudy of a Randomized Controlled Trial.
Colorectal surgery is associated with moderate-to-severe postoperative complications in over 25% of patients, predominantly infections. Monocyte epigenetic alterations leading to immune tolerance could explain postoperative increased susceptibility to infections. This research explores whether changes in monocyte DNA accessibility contribute to postoperative innate immune dysregulation. ⋯ These findings illuminate the complex epigenetic modulation influencing monocytes' response to surgical stress, shedding light on potential biomarkers for immune dysregulation. Our results advocate for further research into the role of anesthesia in these molecular pathways and the development of personalized interventions to mitigate immune dysfunction after surgery.
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Anesthesia and analgesia · Jan 2025
Multicenter StudyAnesthesia Providers' Knowledge of Medication Interference with Hormonal Contraception: A Multisite Survey.
Sugammadex, aprepitant, and fosaprepitant are increasingly used perioperatively. These medications may interfere with the effectiveness of hormonal contraception. This study assessed anesthesia providers' use of sugammadex and aprepitant, their knowledge of interactions with hormonal birth control, and patient counseling practices to identify possible knowledge gaps or opportunities for practice improvement. ⋯ The results of this study highlight the need for increased education and awareness among anesthesia providers regarding drug interactions with HCs during the perioperative period. To facilitate SDM, it is imperative that providers discuss alternative medications and the potential need for additional contraception methods after drug administration and communicate the risks with patients preoperatively to enable informed and SDM. The patient's preferences should be accounted for, especially if they are unwilling or unable to use an alternative contraceptive for 7 to 30 days, thereby avoiding the complexities and burdens of altering birth control methods.
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Anesthesia and analgesia · Jan 2025
Capacity of Anesthesiology Residency Programs in Four East African Countries: Can Supply Meet the Demand?
By 2015, 4 East African countries (Kenya, Uganda, Rwanda, and Burundi) had identified a deficit in the number of anesthesiologists, with a mean density of 0.30 physician anesthesia providers (PAP) per 100,000 population, which was significantly lower than the World Federation of Societies of Anaesthesiologists (WFSA) recommended minimum of 5.0/100,000 population. This workforce shortfall has been recognized as 1 factor that may negatively affect surgical outcomes. This survey sought to assess the capacity of anesthesia residency programs to meet recommended human resource standards in these countries. ⋯ The PAP workforce deficits significantly outstripped the annual output of all residency programs. Anesthesia societies need to raise awareness about this deficit and engage policymakers to increase investment in anesthesia training, including providing scholarships and employment of PAP in training institutions. Integrating nonuniversity-based residency programs may support an increased output. The attainability of the 2030 workforce goals will need review. National strategies are needed to increase the total anesthesia workforce, which includes nonphysician anesthesia providers (NPAPs) as part of the task-sharing framework.
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Anesthesia and analgesia · Jan 2025
Blood Pressure Estimation Using Explainable Deep-Learning Models Based on Photoplethysmography.
Due to their invasiveness, arterial lines are not typically used in routine monitoring, despite their superior responsiveness in hemodynamic monitoring and detecting intraoperative hypotension. To address this issue, noninvasive, continuous arterial pressure monitoring is necessary. We developed a deep-learning model that reconstructs continuous mean arterial pressure (MAP) using the photoplethysmograhy (PPG) signal and compared it to the arterial line gold standard. ⋯ Our deep-learning model noninvasively estimates arterial pressure with high accuracy. This model may show potential as a decision-support tool in operating-room settings, particularly in scenarios where invasive blood pressure monitoring is unavailable.
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Anesthesia and analgesia · Jan 2025
Optimal Maternal Ventilation During Laparotomy with General Anesthesia in Pregnancy in the Ovine Model.
General anesthesia during pregnancy is not uncommon, for example, for trauma surgery, cerclage, or cesarean delivery. Current recommendations are to maintain maternal partial pressure of carbon dioxide in arterial blood (paCO2) at 30 mm Hg, which is based solely on the average maternal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia. Maternal paCO2 can affect uterine blood flow, affinity of hemoglobin for oxygen, and fetal CO2 elimination. In this study, a range of potential targets of maternal paCO2 was investigated in the ovine model, aiming to determine which target is most conducive to physiological fetal blood gas values during laparotomy with general anesthesia. ⋯ This study provides experimental support for the clinical recommendation to maintain maternal paCO2 close to the physiologic value of 30 mm Hg during general anesthesia for maternal laparotomy in pregnancy as it is conducive to physiological fetal blood gas values. Given the lower bound of the 95% confidence interval, the possibility that a lower maternal paCO2 would improve fetal gas exchange cannot be excluded.