Articles: cations.
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Anesthesia and analgesia · Oct 2024
The Utility of Electroencephalograhy in Guiding General Anesthesia in Children.
Traditional pediatric anesthetic dosing using pharmacokinetic estimates based on age and weight is often imprecise, frequently leading to oversedation. Intraoperative electroencephalography (EEG) allows visualization of the brain's response to anesthetic agents in real time, facilitating precise titration of anesthetic drug doses optimized for the individual child. The goal of EEG-guided anesthesia management is to maintain an optimal state of hypnosis during various stages of the procedure while minimizing hemodynamic instability and other adverse effects of anesthesia. ⋯ We describe the use of nonproprietary EEG parameters in guiding anesthesia in children for various clinical end points including laryngoscopy, surgical incision, and maintenance of anesthesia, as well as sedation. We illustrate these principles with various case examples commonly encountered during pediatric anesthesia. Lastly, we discuss strategies to expand intraoperative EEG monitoring in children through education and training programs, as well as advocate for further research to assess clinical outcomes associated with EEG guidance to support its routine use in clinical care.
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Women represent ∼20% of the national neurosurgical resident cohort but only ∼10% of academic neurosurgeons in the United States. Recognizing that the publication of scientific literature contributes to academic advancement, we measured authorship trends of academic neurosurgeons to query publication differences as an explanation for the discrepancy of female representation in academic positions. ⋯ These data suggest that women publish earlier but have fewer first-author publications at -1 year, the timepoint of peak publication for both genders. There was no significant gender difference in rates of the first author and all publications over the years 0 to 10. The ratio of publications to the h-index did not differ significantly but showed a trend suggesting that women produce higher-impact articles and may need fewer publications to achieve the same change in the h-index.
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Anesthesia and analgesia · Oct 2024
Variations in Current Practice and Protocols of Intraoperative Multimodal Analgesia: A Cross-Sectional Study Within a Six-Hospital US Health Care System.
Multimodal analgesia (MMA) aims to reduce surgery-related opioid needs by adding nonopioid pain medications in postoperative pain management. In light of the opioid epidemic, MMA use has increased rapidly over the past decade. We hypothesize that the rapid adoption of MMA has resulted in variation in practice. This cross-sectional study aimed to determine how MMA practices have changed over the past 6 years and whether there is variation in use by patient, provider, and facility characteristics. ⋯ In a large integrated US health care system, approximately 50% of noncardiac surgery patients received MMA. Still, there was wide variation in MMA use by patient and procedure characteristics and across hospitals and anesthesiologists. Our findings highlight a need for further research to understand the reasons for these variations and guide the safe and effective adoption of MMA into routine practice.