Anesthesia Journals Research Articles

Vivianne Tawfik, M.D., Ph.D., a Recipient of the 2022 James E. Cottrell, M.D., Presidential Scholar Award

Vivianne Tawfik, M.D., Ph.D., a Recipient of the 2022 James E. Cottrell, M.D., Presidential Scholar Award

The Year in Thoracic Anesthesia: Selected Highlights From 2021

THIS SPECIAL ARTICLE is the fifth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors would like to thank the editor-in-chief, Dr. Kaplan; the associate editor-in-chief, Dr. Augoustides; and the editorial board for the opportunity to expand this series, the research highlights of the year that specifically pertain to the specialty of thoracic anesthesia. The highlights of this year include new developments in the preoperative assessment and prehabilitation of thoracic surgery patients, updates on the use of devices for one-lung ventilation (OLV) in adults and children, updates on the anesthetic management of these patients, including protective ventilation, regional anesthesia, and outcomes when enhanced recovery after thoracic surgery protocols are followed, as well as the use of expanding indications for extracorporeal membrane oxygenation (ECMO) and nonintubated video-assisted thoracic surgery (NIVATS).

Editorial introduction.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 16 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Vesna Jevtovic-TodorovicVesna Jevtovic-TodorovicVesna Todorovic is the inaugural CU Medicine Endowed Chair and Chair of the Department of Anesthesiology at the University of Colorado School of Medicine, USA. Dr Todorovic received her graduate education at the University of Belgrade, Serbia (MD) and the University of Illinois, Chicago (PhD), USA and completed residency training in anesthesia at the Washington University School of Medicine in St. Louis, USA. She earned an MBA from the University of Virginia, Charlottesville, Virginia, USA and received the Harold Carron Professor of Anesthesiology Endowment from the University of Virginia Health System during her time on the faculty there. Dr Todorovic is a practicing anesthesiologist and has been working simultaneously as a clinician scientist for over 25 years. Dr Todorovic has developed three major lines of research: anesthetics as neurotoxins, the management of chronic pain and the mechanisms of anesthesia-induced developmental neurodegeneration. Dr Todorovic's research is federally funded and has resulted in over 140 peer-reviewed publications and 11 patents. She has received numerous grants from organizations such as the National Institute of Health, March of Dimes, the American Heart Association and the American Diabetes Association. Dr Todorovic served as the Chair of the National Institute of Health's Surgery, Anesthesiology and Trauma study section. She also serves on the Editorial Board for the Journal of Neurosurgical Anesthesiology and the Associate Editorial Board for British Journal of Anaesthesia. In addition, she serves as an Associate Editor for Anesthesiology. Dr Todorovic was a member of the Board of Directors for the International Society for Anaesthetic Pharmacology from 2007 and served as the Chairman in 2015. In her role as a PI, Dr Todorovic has mentored and trained over 60 graduate students, medical students and post-docs. As Chair of the Department of Anesthesiology, her focus extends to the mentorship and growth of junior faculty, expanding clinical programs, increasing collaboration with the School of Medicine and surrounding community. Richard D. UrmanRichard D. UrmanRichard D. Urman, MD, MBA, FASA is a staff anesthesiologist at the Brigham and Women's Hospital Department of Anesthesiology, Perioperative and Pain medicine in Boston, Massachusetts, USA and Associate Professor of Anesthesia at Harvard Medical School, USA, where he also received his MD and MBA degrees. He serves as Associate Chair for Dana-Farber Cancer Institute, Boston, Massachusetts, USA, and as a Medical Director for Procedural Sedation Services at the Brigham and Women's Hospital. In addition, he is the founding co-Director of the Center for Perioperative Research and the Director of the Perioperative Medicine Fellowship. He has edited a dozen textbooks, including the one on non-operating room anesthesia (NORA) entitled Anesthesia Outside the Operating Room (Cambridge Press, 2018) and has published papers on NORA safety, efficiency and outcomes. He is currently funded by the NIH, NSF, AHRQ and the industry. His research interests include pharmacology, acute pain management, patient safety and efficiency in the perioperative and periprocedural setting. He also serves as the scientific reviewer for the Department of Defense and sits on the FDA Analgesics panel. He is on the editorial boards of the Journal of Clinical Anesthesia and Anesthesia & Analgesia. Dr Urman is active in the Society for Ambulatory Anesthesia, where he serves as Assistant Treasurer and member of the executive committee. He is also Treasurer of the Society for Perioperative Assessment and Quality Improvement (SPAQI) and Treasurer of the Association of Anesthesia Clinical Directors (AACD).

Use of Pearson and Spearman correlation testing in Indian anesthesia journals: An audit.

Correct usage and interpretation of biostatistical tests is imperative. Aim of the present article was to evaluate the use of "correlation test" for biostatistical analysis in two leading Indian journals of anesthesia and sensitize the readers regarding its correct usage. A prospective analysis was done for all original articles using the correlation test (Pearson or Spearman) that were published in "Indian Journal of Anaesthesia" (IJA) or "Journal of Anaesthesiology and Clinical Pharmacology" (JOACP) in the years 2019 and 2020. Amongst all included original studies, correlation test were used in 6% (JOACP) and 6.5% (IJA) respectively (averaged for the years 2019 and 2020). Correlation test was usedinappropriately) for evaluating an aim of prediction/agreement/comparison, rather than association, in 25% and 10% instances each (JOACP and IJA). In both JOACP and IJA, there were high rates of using and interpreting results without citing 95% confidence intervals (CIs) of correlation coefficient (88% and 90%, respectively), P value for significance of the association (50% and 90%, respectively), or coefficient of discrimination (88% and 70%, respectively). In majority of the instances, test to ascertain presence of mandatory prerequisites such as normal distribution of data could not be found (62% and 90%, respectively). The complete potential of correlation test in exploring research questions is probably underappreciated. Further, even when used, its application and interpretation are prone to errors. We hope that the present analysis and narrative is a well-timed appropriate step in bridging the gaps in existing knowledge regarding use of correlation test in national anesthesia literature.

Commentary on the article “Atypically extended post-traumatic stricture of the bulbous urethra a teenager”

Commentary on the article Ladygina EA, Nikolaev VV, Demin NV Atypically extended post-traumatic stricture of the bulbous urethra a teenager published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(2):201209. (In Russ.) DOI: https://doi.org/10.17816/psaic1231

Commentary on the article “Algorithm for predicting sepsis in newborns with respiratory pathology and perinatal lesions of the central nervous system, who are on mechanical ventilation”

Commentary on the article Pukhtinskaya M.G., Estrin V.V. Algorithm for predicting sepsis in newborns with respiratory pathology and perinatal lesions of the central nervous system, who are on mechanical ventilation published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(2):119130. (In Russ.) DOI: https://doi.org/10.17816/psaic1242

Women of the First Anesthesia Journal.

This special article briefly discusses the role of women as the new journal Current Researches in Anesthesia and Analgesia (now Anesthesia & Analgesia [A&A]) began in 1922. It was a time of a few women physicians, and they were usually isolated from the world of mainstream medicine and its predominantly male practitioners The journal's founders, Frank McMechan and his wife Laurette of Cincinnati, were committed to developing an organization for everyone, and women physicians were welcomed early on. Three women physicians even served as the presidents of various anesthesia organizations early in the formation of the present national organization. This acceptance of women was to change as medical education and practice evolved to embrace scientific medicine, after the Flexner Report of 1910 documented the deficiencies of American medicine. Mrs McMechan made the most important contributions by a woman because she cared totally for Dr McMechan, after he experienced disabling and very severe arthritis. He became dependent on his wife for most activities, including the simple act of eating. He could not function without her; she kept him going physically for another 27 years after the onset of his very debilitating illness. After her husband's death in 1939, Mrs McMechan served an executive function, keeping the organization going and maintaining production of the journal. This article also briefly discusses the life of the first woman physician to publish an article in A&A, Frances Edith Haines, MD, of Chicago. Haines published several articles in the journal; the first was in 1922, in the second journal issue. She was the president of the Mid-Western Association of Anesthetists, an affiliated organization, in 1926. She also served in World War I as a contract physician anesthetist for the US Army; she was the first woman contract surgeon to go overseas, to Limoges, France. Her adventure-filled and bold life changed as she aged and developed financial problems. She tried, but failed, to get financial help from the government and the military for her war service, and she died in 1966. These women are examples of women physicians involved with the journal, as it began in 1922. As the number of women physicians has increased recently, some past problems, such as difficulty with getting admitted to medical schools, for example, have improved. However, there are still many issues for women in medicine, including in our specialty.

Malignant Hyperthermia and Absence of Ryanodine Receptors in a Child Presenting for Ptosis Repair

Introduction: Malignant hyperthermia (MH) is a hypermetabolic condition caused by a genetic cell membranes channel disruption leading to increased calcium release from the sarcoplasmic reticulum after exposure to triggering agents. Central Core Disease (CCD) is a rare inherited neuromuscular disorder with a wide spectrum of phenotypic presentations. Clinically, there is muscle weakness of variable degree and histopathologically there is evidence of core formation in the muscle fibers. Additional features may occur, including skeletal abnormalities such as foot deformities, scoliosis, or hip displacement. Association of CCD with a mutation of the ryanodine receptor RYR1 and MH is high. If not properly treated, MH could be fatal. Purpose: This study aims towards increasing the awareness of pediatricians, surgeons and anesthesiologists about possible occurrence of MH in patients presenting with only mild “clinical” signs of congenital myopathies such as CCD. Careful diagnostic investigations should be performed prior to surgical interventions and extreme caution during anesthesia. Material and Methods: We report the case of a 3 years old girl, with a history of ptosis, scoliosis, and good muscle tone, who developed unexpected MH during the surgical repair of her ptosis. The critically ill child was transferred to Pediatric Intensive Care Unit (PICU) for management of her MH. The management was done following the guidelines of the European Malignant Hyperthermia Group published in the British Journal of Anesthesia 2010. The patient responded well to treatment. She had a muscle biopsy done after recovery. Discussion: Early management and dantrolene administration are the most important factors to minimize MH morbidity and mortality. MH susceptibility is known in patients carrying mutations in the RYR1 receptors. In our case, RYR1 staining was negative on the muscle biopsy specimen suggesting abnormal or absent RYR1 function, with the presence of occasional cores. These findings, in addition to the ophthalmological and orthopedic history were diagnostic of CCD. In Vitro Contracture Testing (IVCT) was not done because it was not available. Genetic testing was refused by the parents due to financial reasons. Conclusion: In patients presenting with symptoms suggestive of muscle weakness, such as ptosis and scoliosis, and variable muscle tone; congenital myopathies should be considered. CCD and RYR1 receptors deficiency or mutation, if present, may lead to a possible risk of fatal MH, which can be prevented.

Female Representation in Academic Medicine in Pakistan: A 15-Year Overview.

Objective: To determine the proportion of female authors publishing in Pakistan and their representation in academic anesthesiology. Design, place, and duration of study: This study was a cross-sectional retrospective analysis. We reviewed all volumes and issues of the Journal of the College of Physicians and Surgeons Pakistan (JCPSP) published from 2007 to 2021. All original articles, clinical practice articles (CPAs), reviews, and editorials were included. The first and last authors publishing in JCPSP were the study subjects.Main outcome measures: Gender of the first and last authors was determined by (a) a general review of the author’s first, middle, and last names, (b) an internet search of the author’s name, and a review of photographs on their social media, or (c) an online search of the author’s first name for typical gender assignment. The research field of the first author was noted to determine the contribution of different medical specialties. Article type and the number of citations were noted to determine the relationship with the gender of the author.Results: Around 1549 papers were published by Pakistani authors, of which, 82.6% were original articles, 9.8% were editorials, 5.5% were CPAs, and 2.1% were reviews. Around 56.2% of the first authors and 70.9% of the last authors were males. Most article types had a majority of male first and last authors (<0.001). The median (interquartile range) citation rate was two (0-19), with no difference in citations between gender. Male-male author pairing remained the most common (45.6%). The majority of the papers published belonged to the field of medicine (27.2%) and surgery (21%), with only 3.1% contributed by anesthesiology (females: 41.3%; males: 58.6%).Conclusion: Female representation in academia in Pakistan is at par with developed countries. The academic contribution from anesthesiology remains low, which corresponds to a lower percentage of the anesthesia workforce in the country. There is a need for a national indexed journal of anesthesia to evaluate the true representation of female authors in the country.

FAKTOR RISIKO DENGAN ANGKA KEJADIAN POST OPERATIVE NAUSEA AND VOMITING PADA PASIEN YANG DILAKUKAN ANESTESI SPINAL DI RSUD DR. M. HAULUSSY AMBON DAN RS BHAYANGKARA AMBON TAHUN 2022

Introduction: Postoperative Nausea and Vomiting (PONV) is a side effect that often occurs after anesthesia. PONV is associated with various factors, these factors are categorized into risk factors related to patient, surgery, and anesthesia. PONV can occur in men and women of all ages. Although it is not known for certain, smoking is believed to prevent the occurrence of PONV. In addition, prophylactic administration of ondansetron can also prevent the occurrence of PONV. Objective: This study aims to determine the relationship between risk factors and the incidence of PONV in patients undergoing spinal anesthesia at Dr. M. Haulussy Ambon and Bhayangkara Hospital Ambon in 2022. Methods: This study is an observational analytic study with a cross sectional approach which was conducted in February-March 2022 by using a total sampling technique of 43 patients who underwent lower abdominal surgery and underwent spinal anesthesia at Dr. Hospital. M. Haulussy Ambon and Bhayangkara Hospital Ambon. The instrument used is a questionnaire taken from the article “Simplified Postoperative Nausea and Vomiting Impact Scale for Audit and Post-Discharge Review in the British Journal of Anaesthesia” that has been modified. Data were analyzed using the Chi-Square test to determine the relationship between risk factors and the incidence of PONV in patients undergoing spinal anesthesia. Results: The results showed that there was a significant relationship between age (P=0.027), gender (P=0.008), smoking history (P=0.011), and history of ondansetron prophylaxis (P=0.005) with the incidence of PONV in patients after lower abdominal surgery. with spinal anesthesia. Conclusions: This study shows the importance of knowing the risk factors to be aware of the occurrence of PONV after lower abdominal surgery with spinal anesthesia at Dr. M. Haulussy Ambon and Bhayangkara Hospital Ambon.

The Year in Graduate Medical Education: Selected Highlights From 2021

This special article is the first in a planned annual series for the Journal of Cardiothoracic and Vascular Anesthesia that will highlight significant literature from the world of graduate medical education (GME) that was published over the past year. The major themes selected for this inaugural review are the educational value of simulation and training workshops, the expanding role of social media and other information technologies in GME and recruitment, the state of residency and fellowship training before the COVID-19 pandemic, and the inevitable effects COVID-19 has had on graduate medical education. The authors would like to thank the editorial board for allowing us to shine a light on a small subset of the writing and research produced in this field, so that educators may understand how best to educate and train the next generation of anesthesiologists.

Trends in country and gender representation on editorial boards in anaesthesia journals: a pooled cross-sectional analysis.

SummaryEvidence exists that women and people from low‐ and middle‐income countries are under‐represented on the editorial boards of medical journals. This may adversely influence the journal output. We conducted a pooled, cross‐sectional evaluation of the editorial board membership of anaesthesia journals. We collected data on members of editorial boards from the founding year and at 5‐yearly intervals until 2020. For each editor, we recorded gender, country of affiliation, World Bank income classification (1990 onwards) and editorial role (2020 only). The composite editorial board diversity score was calculated for each editorial board. We obtained complete data for the composition of editorial boards from all 30 journals for 2020, but for only 171 out of 304 editorial boards (56%) over the time period examined. In 2020, 409 out of 1973 (21%) were women (range across the editorial boards 0–39%) and 139 out of 1982 (7%) were from low‐, low‐middle‐ and upper‐middle‐income countries (range across the editorial boards 0–71%). In 2020, of editorial board positions with known seniority status, 109 out of 259 (42%) of women and 306 out of 960 (32%) of men were in senior roles. In the same year, 397 out of 1115 (36%) of people from high‐income countries were in senior roles, compared with 19 out of 93 (20%) of people from upper‐middle‐income countries and 0 out of 14 (0%) people from lower‐middle‐income countries. The median composite editorial board diversity score was 4 (range 2–6) in 2020 – 5 or less suggests poor diversity, while 8 or more suggests good diversity. Women and people from low‐ and middle‐income countries are under‐represented on anaesthesia journal editorial boards. The editorial boards do not reflect the anaesthesia workforce and may act as a barrier to the publication of research produced by these groups. Urgent action is required to improve diversity.

Commentary on the article “Comparative analysis of the use of one-stage and two-stage urethroplasty in the treatment of children with proximal forms of hypospadias. Flap or graft?”

Commentary on the article Surov R.V., Kagantsov I.M., Shmyrov O.S., Sizonov V.V., Volkova A.A., Zadykyan R.S., Kulaev A.V., Lasishvili M.N., Velskaya Yu.I. Comparative analysis of the use of one-stage and two-stage urethroplasty in the treatment of children with proximal forms of hypospadias. Flap or graft?, published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(4):437444. (In Russ.) DOI: https://doi.org/10.17816/psaic968

The Year in Perioperative Echocardiography: Selected Highlights From 2021

This article is the sixth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series. In most cases, these were research articles that were targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but, in some cases, these articles targeted the use of perioperative echocardiography in general.

Adverse events of sugammadex that occurred in a Korean population

BackgroundWith increasing use, the incidence of adverse events associated with sugammadex, a neuromuscular blockade reverser, is increasing. This study aimed to identify and analyze cases of adverse events caused by sugammadex reported in Korean population.MethodsOut of a total of 12 cases detected using various keywords in the Korean Journal of Anesthesia, Anesthesia and Pain Medicine (Seoul), KoreaMed, PubMed, EMBASE, Web of Science, and The Cochrane Library-CENTRAL from 2013 to December 2020, 10 cases directly associated with sugammadex were selected.ResultsAdverse events included five cases of anaphylaxis, one case of cardiac arrest, one case of profound bradycardia, one case of negative pressure pulmonary edema, and two cases of incomplete recovery. Three patients had American Society of Anesthesiologists physical status ≥ 3, two had emergency surgery, and two had a history of allergic reaction. Neuromuscular monitoring was applied in nine cases. The average dose of sugammadex was 2.87 mg/kg, and there were six cases in which one full vial was used, regardless of the state of neuromuscular recovery. Sugammadex was administered immediately after surgery in two cases, at train of four (TOF) 0 in four cases, at TOF 3 in one case, and after evaluation of the clinical signs only with no neuromuscular monitoring in one case.ConclusionsEven with neuromuscular monitoring, an excessive dose of sugammadex was observed. Given that adverse events tend to occur within 10 min of administration, continuous monitoring is important even after administration.

A practical guide to the American Society of Anesthesiologists-physical status classification (ASA-PS).

Sir, We read the brief communication, “Reliability of American Society of Anaesthesiologists physical status classification” by Nicola Parenti in the Indian Journal of Anaesthesia with great interest.[1] This systematic review on the reliability of the American Society of Anesthesiologists physical status (ASA-PS) classification showed a wide inter-rated agreement range and suggested a reliability test for the users before using it for general communication. We are of the opinion that the training on ASA-PS classification system should be uniform, up to date and standardised for the results of reliability tests to be commendable. The ASA-PS classification was amended on December 13, 2020 (original approval: October 15, 2014) and it includes the paediatric and obstetric examples.[2] We intend to highlight the salient features of this amendment to improve the understanding and ultimately narrow the gap in the variability of its use. The purpose of the ASA-PS classification is pre-operative assessment and communication of the patients’ medical condition.[2] In combination with other factors like type of surgery and frailty, it can imply perioperative risks and complications, though stand-alone it does not predict perioperative risks.[23] Currently, there is tremendous emphasis on improving the perioperative assessment and ultimately patient outcomes using the ever-advancing healthcare information technology.[45] The definitions and examples of the ASA-PS classification serve as guidelines for the clinicians to follow. The clinicians may develop their institution-specific ASA classification allocation examples incorporated into their health care information technology system. ASA-PS assessment is done during each preanesthetic visit. The final assessment is done after the evaluation of the patient on the day of anaesthesia care by the anaesthesiologist in-charge. The status of the patient at the time of operation is important e.g., presence of rhonchi in a previously well-controlled chronic mild lung disease patient at the time of operation. There are mainly five points to consider for assigning ASA-PS classification. i) presence of co-morbidities like diabetes, hypertension, asthma, and other systemic diseases with or without functional limitations, ii) social habits like smoking, alcohol use iii) whether the patient is pregnant or not, iv) body mass index (BMI) of the patient, and v) whether the operation belongs to the elective or emergency category. For instance, a 21-year-old man who is an active smoker and posted for emergency acute appendicectomy, would be assigned ASA-PS II E in view of being an ‘active smoker’ and emergency nature of the operation. Similarly, a 50-year-old lady who is posted for elective mesh hernioplasty and has well controlled diabetes mellitus on regular medication with no functional limitations, would be assigned ASA-PS II in view of the well-controlled diabetes. Likewise, a 21-year-old primigravida, with a BMI of 50, posted for emergency lower segment caesarean section for cord prolapse with no known medical illness, would be ASA-PS III E, in view of a BMI of 50. Though pregnancy is ASA-PS II, a BMI >39 is ASA-PS III, and thus, a higher class is assigned. Furthermore, a 19-year-old boy with polytrauma with massive intraabdominal bleeding in hypotensive shock, posted for emergency exploratory laparotomy, would be ASA-PS V E because he is not expected to survive without operation. Also, a 50-year-old man who is a known case of chronic obstructive airway disease on regular medication, posted for knee arthroscopy and is currently having rhonchi on examination, would be ASA-PS III in view of the active rhonchi. The ASA-PS classification does not consider the age of the patient, the risk of difficult airway, Mendelson syndrome, intraoperative bleeding, and complexity of the operation. These factors can significantly increase the perioperative morbidity and mortality. There is considerable variation in ASA-PS classification allocation due to the inconsistent understanding of the definitions.[6] Nevertheless, despite its limitations, the ASA-PS classification is widely used in anaesthesia practice. This insight is worth an evaluation for simplified training and teaching of ASA-PS classification. The uniform and standardised teaching can prompt reduction in inter-user variance and improve reliability. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Publications trends in major anesthesiology journals: A 20-year analysis of five top-ranked journals in the field

Background: With the intention to quantify the importance of a medical journal, the impact factor (IF) was introduced. It has become a de facto fictive rating instrument of the importance of medical journals. Also, it is often used to assess the value of the individual publications within the specific journal. The aim of the present study was to analyze publication trends over 20 years in five high-ranked anesthesiology journals. Methods: The Medline (NCBI) database PubMed was used for analysis which was restricted to the following journals: 1. Anesthesiology; 2. British Journal of Anaesthesia; 3. Journal of Neurosurgical Anesthesiology; 4. Anesthesia &amp; Analgesia; and 5. Anaesthesia. Specific publication parameters (IFs, number of pages and authors, etc.) were retrieved using the PubMed download function and imported into Microsoft Excel for further analysis. Results: The mean IF of the five journals analyzed increased significantly within the study period (1991 vs. 2010; +61.81%). However, the absolute number of case reports decreased significantly by 54.7% since 1991. The journals Br J Anaesth (12.2%), J Neurosurg Anesthesiol (51.9%), and Anesth Analg (57.2%) showed significant increases in the number of publications per year. The mean number of authors increased significantly in all the journals from 1991 to 2010 (3.0 vs. 4.3; +43.3%). Conclusions: The IF, as well as the number of articles per year and the number of authors per article, increased significantly. In contrast, the number of pages per article remained comparable during the period analyzed.

Inaugural Editorial to Journal of Oral and Maxillofacial Anesthesia

Inaugural Editorial to Journal of Oral and Maxillofacial Anesthesia

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2021

AbstractThis review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from 2021 (January–December 2021). The journals reviewed include anesthesia journals, critical care medicine journals, neurology, and neurosurgical journals as well as high-impact medical journals such as the Lancet, Journal of American Medical Association, New England Journal of Medicine, and Stroke. This summary of important articles will serve to update the knowledge of anesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical care patients. In addition, some of the important narrative reviews that are of interest to neuroanesthesiologists are also listed.

Patient Preferences for Outcomes Associated With Labor Epidural Analgesia.

PurposePatient preferences for labor epidural analgesia (LEA) have been incompletely evaluated. This study aimed to determine the importance of various LEA outcomes to both antenatal and postpartum patients.MethodsThis was a cross-sectional study approved by the institutional ethics board. Questionnaires were distributed to two separate and distinct cohorts screened for eligibility: pregnant patients at an antenatal visit and postpartum patients during childbirth admission. A list of common LEA outcomes was compiled using research published in leading anesthesia journals. Participants ranked the outcomes according to perceived importance. They assigned each a number from 1 to 10 (priority ranking; 1 indicated the highest priority outcome and 10 the least). They were also asked to ‘spend’ $100 towards the outcomes (relative value scale), allocating more money to outcomes more important to them.ResultsTwo hundred twenty questionnaires were completed (105 antenatal, 115 postpartum). ‘Achieving desired pain relief’ was the most important outcome for both cohorts. It was valued more by the postpartum cohort (Median $50 (25 - 60) vs $30 (18 - 50)). ‘Overall satisfaction with the pain management,’ ‘experiencing a short time to achieve pain relief,’ and ‘experiencing a short duration of labor’ received more money than avoiding various LEA-related side effects. The postpartum cohort ranked ‘experiencing a short time to achieve pain relief’ as more important than the antenatal cohort (Median 5 (3 - 7) vs 3 (2 - 5)).ConclusionsAchieving the desired pain relief was the highest LEA outcome preference for both antenatal and postpartum patients. Avoiding side effects was less important relative to pain-related outcomes.