Anesthesia and analgesia
-
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.
-
Anesthesia and analgesia · Jan 2025
Comparative StudyAssociation of Intravenous Neostigmine and Anticholinergics or Sugammadex with Postoperative Delirium: A Retrospective Cohort Study.
Administration of cholinesterase inhibitors in combination with anticholinergic drugs for reversal of neuromuscular blocks may precipitate delirium through impairment of central cholinergic transmission, which could be avoided by using sugammadex. Therefore, we tested the primary hypothesis that postoperative delirium is less common when neuromuscular block is reversed with sugammadex than with neostigmine combined with glycopyrrolate or atropine. ⋯ Compared to neostigmine, use of sugammadex for reversal of neuromuscular block was not associated with an increased risk of postoperative delirium in this retrospective single-center study. Though sugammadex was associated with a statistically significant increased risk of postoperative early delirium, the difference was small and not clinically relevant, and may reflect the presence of unknown confounders.
-
Anesthesia and analgesia · Jan 2025
A Cognitive Load Theory Perspective of the Undergraduate Anesthesia Curricula in South Africa.
Safe anesthesia is indispensable to achieve global safe surgery and equitable health care access. The disease burden and lack of specialists in South Africa (SA) require junior, nonspecialist doctors to be fit-for-purpose from day 1 when they provide anesthetic services in peripheral hospitals with limited supervision. Graduating students report low self-perceived preparedness for administering anesthesia, but it is not known how their curricular experiences influence their learning. Cognitive load theory defines intrinsic, extraneous, and germane cognitive loads (subtypes). Intrinsic load relates to learning tasks, extraneous load to distractions, and germane load to students' learning processes. This study used a cognitive load theory lens to explore SA students' experiences of their undergraduate anesthesia training. ⋯ Cognitive load theory provided a useful theoretical basis for understanding students' curricular experiences. The COLOAD framework suggests a microlevel interrelatedness of the constituting elements of the 3 cognitive load subtypes. This has implications for curriculum design, pedagogy, and student support. Learning outcomes development and curriculum mapping are important to ensure a lean curriculum, but measures to enhance germane cognitive load might be equally important to achieve competence. Attention to the hidden curriculum and active promotion of reflective practice might reduce cognitive load in complex learning environments such as anesthesia training.
-
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.