Anesthesia and analgesia
-
Anesthesia and analgesia · Aug 2024
ReviewPhysician Unionization: Opportunities and Challenges for Anesthesiologists in the United States.
Physician unionization is gaining traction in the United States, with <10% of practicing physicians now members, up from historically weak support. Factors that drive interest in unions include a decreased number of independent practitioners, an increase in workloads, and the erosion of autonomy. Approximately 56% of anesthesiologists are considered employees and may be eligible for union membership. ⋯ However, they also raise concerns about patient care and professionalism. This article discusses the legal and regulatory framework governing the unionization of physicians, benefits, challenges, and potential future developments. Continued analysis and debate are necessary to determine the optimal role of physician unions in the health care industry.
-
Anesthesia and analgesia · Aug 2024
Comparative StudyClinical Knowledge and Reasoning Abilities of AI Large Language Models in Anesthesiology: A Comparative Study on the American Board of Anesthesiology Examination.
Over the past decade, artificial intelligence (AI) has expanded significantly with increased adoption across various industries, including medicine. Recently, AI-based large language models such as Generative Pretrained Transformer-3 (GPT-3), Bard, and Generative Pretrained Transformer-3 (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 reasoning abilities in a specialized medical context. ⋯ GPT-4 outperformed GPT-3 and Bard on both basic and advanced sections of the written ABA examination, and actual board examiners considered GPT-4 to have a reasonable possibility of passing the real oral examination; these models also exhibit varying degrees of proficiency across distinct topics.
-
Anesthesia and analgesia · Aug 2024
Perioperative Plasma in Addition to Red Blood Cell Transfusions Are Associated With Increased Venous Thromboembolism Risk Postoperatively.
Perioperative red blood cell (RBC) transfusions increase venous thromboembolic (VTE) events. Although a previous study found that plasma resuscitation after trauma was associated with increased VTE, the risk associated with additional perioperative plasma is unknown. ⋯ When compared with perioperative RBC transfusion, adding plasma was associated with increased 30-day postoperative mortality, VTE, PE, and DIC risk among surgical and cardiovascular surgical patients. Reducing unnecessary plasma transfusion should be a focus of patient blood management to improve overall value in health care.
-
Anesthesia and analgesia · Aug 2024
Development of an Artificial Intelligence-Based Image Recognition System for Time-Sequence Analysis of Tracheal Intubation.
Total intubation time (TIT) is an objective indicator of tracheal intubation (TI) difficulties. However, large variations in TIT because of diverse initial and end targets make it difficult to compare studies. A video laryngoscope (VLS) can capture images during the TI process. By using artificial intelligence (AI) to detect airway structures, the start and end points can be freely selected, thus eliminating the inconsistencies. Further deconstructing the process and establishing time-sequence analysis may aid in gaining further understanding of the TI process. ⋯ YOLOv3 is a powerful tool for analyzing images recorded by VLS. By using AI to detect the airway structures, the start and end points can be freely selected, resolving the heterogeneity resulting from the inconsistencies in the TIT cut points across studies. Time-sequence analysis involving the deconstruction of VLS-recorded TI images into several phases should be conducted in further TI research.
-
Anesthesia and analgesia · Aug 2024
Microglia Promote Inhibitory Synapse Phagocytosis in the Spinal Cord Dorsal Horn and Modulate Pain-Like Behaviors in a Murine Cancer-Induced Bone Pain Model.
The microglial activation has been implicated in cancer-induced bone pain. Recent studies have revealed that microglia mediate synaptic pruning in the central nervous system, where the cluster of differentiation 47-signal regulatory protein α (CD47-SIRPα) axis creates a "don't eat me" signal and elicits an antiphagocytic effect to protect synapses against elimination. To date, the synaptic phagocytosis in microglia has never been investigated in the murine cancer-induced bone pain model. The present experiments sought to explore whether microglia phagocytize synapses in mice with bone cancer pain as well as the possible mechanisms. ⋯ Microglia-mediated GABAergic synapse pruning in the spinal cord dorsal horn in bone cancer pain mice, which might be associated with the declined CD47-SIRPα signal. Our research uncovered an innovative mechanism that highlighted microglia-mediated synaptic phagocytosis in a murine cancer-induced bone pain model.