Abstract:
:A claim of superiority of one intervention over another often depends naturally on results from several outcomes of interest. For such studies the common practice of making conclusions about individual outcomes in isolation can be problematic. For example, an intervention might be shown to improve one outcome (e.g., pain score) but worsen another (e.g., opioid consumption), making interpretation difficult. We thus advocate joint hypothesis testing, in which the decision rule used to claim success of an intervention over its comparator with regard to the multiple outcomes are specified a priori, and the overall type I error is protected. Success might be claimed only if there is a significant improvement detected in all primary outcomes, or alternatively, in at least one of them. We focus more specifically on demonstrating superiority on at least one outcome and noninferiority (i.e., not worse) on the rest. We also advocate the more general "gatekeeping" procedures (both serial and parallel), in which primary and secondary hypotheses of interest are a priori organized into ordered sets, and testing does not proceed to the next set, i.e., through the "gate," unless the significance criteria for the previous sets are satisfied, thus protecting the overall type I error. We demonstrate methods using data from a randomized controlled trial assessing the effects of transdermal nicotine on pain and opioids after pelvic gynecological surgery. Joint hypothesis testing and gatekeeping procedures are shown to substantially improve the efficiency and interpretation of randomized and nonrandomized studies having multiple outcomes of interest.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Mascha EJ,Turan Adoi
10.1213/ANE.0b013e3182504435subject
Has Abstractpub_date
2012-06-01 00:00:00pages
1304-17issue
6eissn
0003-2999issn
1526-7598pii
ANE.0b013e3182504435journal_volume
114pub_type
杂志文章abstract::We studied 60 nonophthalmologic patients, allocated to six treatment groups, to assess the effects of atracurium and vecuronium on intraocular pressure (IOP). All patients had IOP measured while awake, using pneumotonometry. In group 1, anesthesia was induced with thiopental, 5 mg/kg, and maintained with N2O, 70% in O...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1986-08-01 00:00:00
abstract::Heart transplantation remains the definitive management for end-stage heart failure refractory to medical therapy. While heart transplantation cases are increasing annually worldwide, there remains a deficiency in organ availability with significant patient mortality while on the waiting list. Attempts have therefore ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000003919
更新日期:2019-03-01 00:00:00
abstract::The hemodynamic effects of esmolol were studied in 40 patients scheduled for elective coronary artery surgery to determine whether the administration of esmolol in chronically beta-blocked patients would result in additional attenuation of sympathetically mediated hemodynamic stress responses to noxious stimuli. Patie...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1987-02-01 00:00:00
abstract:UNLABELLED:The National Institute for Occupational Safety and Health-recommended exposure levels for nitrous oxide exposure are 25 ppm as a time-weighted average over the time of exposure. The exposure limit for halogenated anesthetics (without concomitant nitrous oxide exposure) is 2 ppm. Inhaled sevoflurane provides ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199904000-00045
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:Statistical heterogeneity can increase the uncertainty of results and reduce the quality of evidence derived from systematic reviews. At present, it is uncertain what the major factors are that account for heterogeneity in meta-analyses of analgesic adjuncts. Therefore, the aim of this review was to identify...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析,评审
doi:10.1213/ANE.0000000000002237
更新日期:2018-02-01 00:00:00
abstract:INTRODUCTION:Exposure to isoflurane before and during early reperfusion protects against myocardial infarction by activating phosphatidylinositol-3-kinase (PI3K)-mediated signaling. The apoptotic protein, p53, is regulated by PI3K, and inhibition of p53 protects against ischemic injury. We tested the hypothesis that p5...
journal_title:Anesthesia and analgesia
pub_type: 社论
doi:10.1213/01.ane.0000240903.63832.d8e
更新日期:2006-12-01 00:00:00
abstract::Increased attention has been directed at the quality of randomized controlled trials (RCTs) and how they are being reported. We examined leading anesthesiology journals to identify if there were specific areas for improvement in the design and analysis of published clinical studies. All RCTs that appeared between Janu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000150612.71007.A3
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Cigarette smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and poor wound healing. In this study, we sought to determine whether a pragmatic perioperative smoking cessation intervention designed for a busy preadmission clinic would be su...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e318298a6b0
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:The Chinese health care system must meet the needs of 19% of the world's population. Despite recent economic growth, health care resources are unevenly distributed. This creates the potential for job stress and burnout. We therefore conducted a survey among anesthesiologists in the Beijing-Tianjin-Hebei regi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002776
更新日期:2018-03-01 00:00:00
abstract:UNLABELLED:As medical costs continue to escalate, there is willingness to consider the role played by nontraditional factors in health. We investigated the usefulness of tape-recorded hypnosis instruction on perioperative outcome in surgical patients in a prospective, randomized, and partially blinded study. Sixty pati...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200001000-00016
更新日期:2000-01-01 00:00:00
abstract:UNLABELLED:We tested the hypothesis that an insulin infusion would effectively treat bupivacaine-induced cardiac depression in dogs. In 24 mongrel dogs anesthetized with pentobarbital (5 mgkg(-1)h(-1), IV), 0.5% bupivacaine was administrated at a rate of 0.5 mgkg(-1)min(-1) until the mixed venous oxygen saturation decr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200011000-00010
更新日期:2000-11-01 00:00:00
abstract::In recent years the off-label use of recombinant activated factor VII (rFVIIa) has markedly increased, particularly in pediatric cardiac surgery patients, and practitioners differ widely in their usage of the drug. In 2009, the Congenital Cardiac Anesthesia Society (CCAS) assembled a task force to review the literatur...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e31825aff10
更新日期:2012-08-01 00:00:00
abstract::Either epidural analgesia or femoral nerve blockade improves analgesia and rehabilitation after total knee arthroplasty. No study has evaluated the combination of femoral nerve blockade and epidural analgesia. In this prospective, randomized, blinded study we investigated combining femoral nerve blockade with epidural...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000159150.79908.21
更新日期:2005-09-01 00:00:00
abstract:UNLABELLED:Propofol (Diprivan(TM); AstraZeneca, Wilmington, DE) is a commonly used drug for the induction of general anesthesia in the ambulatory setting. With the availability of a new bisulfite-containing generic formulation of propofol, questions have arisen regarding its cost effectiveness and safety compared with ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200010000-00019
更新日期:2000-10-01 00:00:00
abstract::This study investigated the use of propofol in swine genetically susceptible to malignant hyperthermia (MH). Thirteen animals were exposed to 2% halothane in inspired air, a propofol infusion of 12 mg.kg-1.hr-1 for up to 45 min, or a combination of both. When MH was triggered the animals were treated with dantrolene. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-06-01 00:00:00
abstract:BACKGROUND:Prolonged continuous oxytocin administration during labor may induce oxytocin receptor desensitization, which attenuates the response of the myometrium to further oxytocin, increasing the risk of postpartum hemorrhage. The literature comparing pulsatile (intermittent) versus continuous oxytocin administratio...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002834
更新日期:2019-04-01 00:00:00
abstract::The respiratory variations in the plethysmographic (PLET) waveform of the pulse oximeter during mechanical ventilation can be automatically quantified as the PLET variation index (PVI(®)). Like other dynamic variables, the PVI may provide useful information about fluid responsiveness but only when the patient is recei...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000378
更新日期:2014-12-01 00:00:00
abstract::There are quantitative deficiencies in the coagulation system for at least the first 6 mo of life. Clinical experience, however, does not indicate an increased risk of excessive bleeding during surgical procedures. Thrombelastography, a test providing a functional evaluation of coagulation, was used to assess the hemo...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199704000-00008
更新日期:1997-04-01 00:00:00
abstract:BACKGROUND:We determined whether whole blood impedance aggregometry using the Multiplate detects the effects of antiplatelet drugs as reliably as does classical light transmission aggregometry (LTA) or the platelet function analyzer PFA-100(R). METHODS:Multiplate (M) assays, measuring changes in electrical resistance ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31818524c1
更新日期:2008-12-01 00:00:00
abstract::The swallowing reflex is depressed by anesthetics. During recovery from anesthesia the rapid return of laryngeal and upper airway reflexes is important to protect the lower airway from aspiration. This study measures the recovery of the swallowing reflex after propofol anesthesia. Fifteen patients undergoing a colonos...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199411000-00007
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Although music is frequently used to promote a relaxing environment during labor and delivery, the effect of its use during the placement of neuraxial techniques is unknown. Our study sought to determine the effects of music use on laboring parturients during epidural catheter placement, with the hypothesis ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000001656
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Modulation of γ-aminobutyric acid type A receptors (GABAARs) by general anesthetics may contribute to their ability to produce amnesia. Receptors containing α5 subunits, which mediate tonic and slow synaptic inhibition, are co-localized with β3 and γ2 subunits in dendritic layers of the hippocampus and are s...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000423
更新日期:2014-12-01 00:00:00
abstract::Qualitative arterial waveform analysis has been in existence for millennia; quantitative arterial waveform analysis techniques, which can be traced back to Euler's work in the 18th century, have not been widely used by anesthesiologists and other clinicians. This is likely attributable, in part, to the widespread use ...
journal_title:Anesthesia and analgesia
pub_type: 历史文章,杂志文章,评审
doi:10.1213/ANE.0b013e31822773ec
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:In this prospective study, we compared the relationship between propofol concentrations and bispectral index (BIS) in children versus young adults anesthetized with target-controlled infusion (TCI) of propofol. METHODS:Forty-five prepubertal subjects (children) and 45 postpubertal subjects (adults) were stu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318164f388
更新日期:2008-04-01 00:00:00
abstract::Intraocular pressure (IOP) measurements in children are usually performed under nitrous oxide and halothane anesthesia. We studied the effects of both time and end-tidal halothane concentration on IOP in 80 children (mean age +/- SD = 4.5 +/- 2.9 yr), to determine the most optimal time to make such measurements in ane...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199008000-00011
更新日期:1990-08-01 00:00:00
abstract::Availability of physiologic monitoring equipment to ensure the safe administration of anesthesia is an expected standard in many parts of the world. Many hospitals in China may not have an adequate quantity and variety of anesthesia delivery and patient monitoring equipment to assure safe administration of anesthesia ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31825018cf
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Blood hemoglobin can be monitored continuously and noninvasively with a noninvasive spectrophotometric sensor (Masimo SpHb). The perfusion index (PI) of the finger is directly related to the clinical accuracy of SpHb. We evaluated those variables that influence PI without the influences of surgery and anesth...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000000144
更新日期:2014-04-01 00:00:00
abstract::Sevoflurane reduces autonomic neural control, which plays a significant role in cerebral autoregulation. Therefore, we hypothesized that sevoflurane influences cerebral autoregulation. We investigated the effects of sevoflurane on dynamic cerebral blood flow (CBF) autoregulation by using spectral and transfer function...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000189056.96273.48
更新日期:2006-02-01 00:00:00
abstract:UNLABELLED:Previous studies of samples from cranial meninges have created doubts about the existence of a virtual subdural space. We examined the ultrastructure of spinal meninges from three human cadavers immediately after death to see whether there is a virtual subdural space at this level. The arachnoid mater had tw...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200204000-00040
更新日期:2002-04-01 00:00:00
abstract::Both epidural and general anesthetics alter autonomic balance. However, the relative differences between epidural (EA) and general anesthetics (GA) with regard to cardiac and peripheral sympathovagal balance have not been described. Twenty consecutive patients scheduled for radical retropubic prostatectomy were random...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199407000-00031
更新日期:1994-07-01 00:00:00