Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2023
Five Women American Society of Anesthesiologists Presidents: Their Lives and Careers.
This article examines the only 5 women to become presidents of the American Society of Anesthesiologists (ASA) so far. Through their personal histories, these physicians tell a collective history of women in this specialty from the 1950s to today. ⋯ They shaped the specialty by creating new programs, addressing emerging professional problems, and mentoring successive generations. Simultaneously, they dealt with issues common to professional women in the twentieth and twenty-first centuries, such as balancing a demanding career and family.
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Anesthesia and analgesia · Jun 2023
The Rise and Fall of Antithrombin Supplementation in Cardiac Surgery.
Various cohort studies, both retrospective and prospective, showed that low antithrombin levels after cardiac surgery (at the arrival in the intensive care unit and during the next days) were associated with a number of adverse outcomes, including surgical reexploration and thromboembolic events, eventually leading to prolonged stay in the intensive care. Values lower than 58% to 64% of antithrombin activity were indicative of this higher morbidity with good sensitivity and specificity. The scenario generated the hypothesis that low antithrombin levels needed to be corrected by supplementation to improve postoperative outcome. ⋯ A strongly decreased thrombin activity after antithrombin correction may eventually affect the efficiency of the glomerular filtration and cause the deterioration of kidney function, but underlying biological mechanisms remain unclear. In conclusion, low levels of antithrombin activity after cardiac surgery should be considered as a marker of greater severity of the patient's conditions and/or of the complexity of the surgical procedure. There are no indications for antithrombin supplementation in cardiac surgery unless for correcting heparin resistance.
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Anesthesia and analgesia · Jun 2023
Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study.
Residual deep sedation during anesthesia recovery may predict postoperative complications. We examined the incidence and risk factors for deep sedation after general anesthesia. ⋯ Likelihood of deep sedation after recovery increased with intraoperative use of halogenated agents with higher solubility and increased further when propofol was concomitantly used. Patients who experience deep sedation during anesthesia recovery have an increased risk of opioid-induced respiratory complications on general care wards. These findings may be useful for tailoring anesthetic management to reduce postoperative oversedation.
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Anesthesia and analgesia · Jun 2023
Pro-Con Debate: Interdisciplinary Perspectives on Industry-Sponsored Research.
Pro: Nearly all new devices and drugs come from industry that provides two-thirds of the funding for medical research, and a much higher fraction of clinical research. Realistically, without corporate-funded studies, perioperative research would stagnate with little innovation and few new products. Opinions are ubiquitous and normal, but do not constitute epidemiologic bias. ⋯ The focus on success can influence the choice of a comparator, which might not be ideal among the possible alternatives, the language used in the publication, and even the ability to publish. Unpublished negative trials can result in selected information being withheld from the scientific community and the public. Appropriate safeguards are needed to ensure that research addresses the most important and relevant questions, that results are available even when they do not support the use of a product produced by the funding company, that populations studied reflect the relevant patients, that the most rigorous approaches are applied, that studies have the appropriate power to address the question posed, and that conclusions are presented in an unbiased manner.