Abstract:
BACKGROUND:High-quality shared decision-making for patients undergoing elective surgical procedures includes eliciting patient goals and treatment preferences. This is particularly important, should complications occur and life-sustaining therapies be considered. Our objective was to determine the preoperative care preferences of older higher-risk patients undergoing elective procedures and to determine any factors associated with a preference for limitations to life-sustaining treatments. METHODS:Cross-sectional survey conducted between May and December 2018. Patients ≥55 years of age presenting for a preprocedural evaluation in a high-risk anesthesia clinic were queried on their desire for life-sustaining treatments (cardiopulmonary resuscitation, mechanical ventilation, dialysis, and artificial nutrition) as well as tolerance for declines in health states (physical disability, cognitive disability, and daily severe pain). RESULTS:One hundred patients completed the survey. The median patient age was 68. Most patients were Caucasian (87%) and had an American Society of Anesthesiologists (ASA) score of III (88%). The majority of patients (89%) desired cardiopulmonary resuscitation. However, most patients would not accept mechanical ventilation, dialysis, or artificial nutrition for an indefinite period of time. Similarly, most patients (67%-81%) indicated they would not desire treatments to sustain life in the event of permanent physical disability, cognitive disability, or daily severe pain. CONCLUSIONS:Among older, higher-risk patients presenting for elective procedures, most patients chose limitations to life-sustaining treatments. This work highlights the need for an in-depth goals of care discussion and establishment of advance care preferences before a procedure or operative intervention.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Udelsman BV,Govea N,Cooper Z,Chang DC,Bader A,Meyer MJdoi
10.1213/ANE.0000000000004617subject
Has Abstractpub_date
2021-01-01 00:00:00pages
210-216issue
1eissn
0003-2999issn
1526-7598pii
00000539-202101000-00029journal_volume
132pub_type
杂志文章abstract:BACKGROUND:Xenon has many characteristics that make it very attractive as an anesthetic and therapeutic drug. Unfortunately, the supply of xenon is fixed, and therefore reclamation and recovery from even the most efficient breathing circuits is desirable. We built and evaluated a cryogenic device to recover xenon from ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000278148.56305.72
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:Aspects of intraoperative management (eg, hypotension) are associated with acute kidney injury (AKI) in noncardiac surgery patients. However, it is unclear if and how the addition of intraoperative data affects a baseline risk prediction model for postoperative AKI. METHODS:With institutional review board (...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000005057
更新日期:2021-02-01 00:00:00
abstract:BACKGROUND:Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facemas...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003678
更新日期:2018-10-01 00:00:00
abstract::To determine whether nalbuphine might replace fentanyl as the principal opioid for anesthesia during coronary artery bypass surgery, 20 patients undergoing myocardial revascularization were anesthetized with flunitrazepam and with a continuous infusion of either nalbuphine (an opioid agonist-antagonist) or fentanyl (a...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-199111000-00002
更新日期:1991-11-01 00:00:00
abstract::Monitoring with pulse oximetry might improve patient outcome by enabling an early diagnosis and, consequently, correction of perioperative events that might otherwise cause postoperative complications or even death. The aim of the study was to clarify the effect of perioperative monitoring with pulse oximetry and to i...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析
doi:10.1097/00000539-200302000-00024
更新日期:2003-02-01 00:00:00
abstract:UNLABELLED:The isolated effects of hypothermia on hemostasis have not been investigated in healthy humans. We cooled 16 anesthetized patients scheduled for elective intracranial surgery to 32 degrees C body core temperature and assessed prothrombin time (PT), activated partial thromboplastin time, thrombelastogram (TEG...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000062520.65192.c9
更新日期:2003-06-01 00:00:00
abstract::We designed a randomized, double-blind study to assess the analgesic efficacy and safety of perioperative ketorolac infusion in 95 patients undergoing cholecystectomy. The ketorolac group (n = 48) received premedication, combined with ketorolac 30 mg intramuscularly (IM), followed by a ketorolac continuous infusion (2...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199403000-00017
更新日期:1994-03-01 00:00:00
abstract::Local anesthetics have been used clinically for more than a century, but new insights into their mechanisms of action and their interaction with biological systems continue to surprise researchers and clinicians alike. Next to their classic action on voltage-gated sodium channels, local anesthetics interact with calci...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000002665
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a "lighter" depth of sedation. Among these strategies are "analgosedation" protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001393
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Dexmedetomidine, a selective α2-adrenergic agonist currently approved for continuous intensive care unit sedation, is being widely evaluated for its role as a potential anesthetic. The closed-loop anesthesia delivery system (CLADS) is a method to automatically administer propofol total intravenous anesthesia...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003470
更新日期:2019-07-01 00:00:00
abstract::This randomized, prospective clinical study investigated the effects of supplemental inspired oxygen on arterial hemoglobin desaturation and myocardial ischemia in premedicated patients who have critical coronary artery stenosis, identified predictors for these adverse events, and examined the temporal relationship be...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199305000-00006
更新日期:1993-05-01 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
abstract::Mice continuously exposed to 50% nitrous oxide for 2 weeks or more become tolerant to nitrous oxide, as measured by an 8% to 19% increase in their nitrous oxide ED50 (the dose required to abolish the righting reflex in 50% of the animals). Control mice tolerant to nitrous oxide were given intraperitoneal injections of...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1981-03-01 00:00:00
abstract::Cardiac output characteristically decreases during trimethaphan infusion but is well maintained or increased during sodium nitroprusside infusion. We postulated that at similar levels of mean arterial pressure, sodium nitroprusside might be associated with greater blood loss than trimethaphan due to the increase in ca...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1980-03-01 00:00:00
abstract:BACKGROUND:Long-term exposure to opiates induces tolerance to the analgesic effect. The neurobiological mechanism of this phenomenon is not completely clear. In this study, we evaluated the effects of central administration of minocycline (a tetracycline derivative) and riluzole (an antiglutamatergic drug) on morphine-...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181ae5f13
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Unanticipated hospital admission is regarded as a measure of adverse perioperative patient care. However, previously published studies for risk prediction after ambulatory procedures are sparse compared to those examining readmission after inpatient surgery. We aimed to evaluate the incidence and reasons for...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000004852
更新日期:2020-08-01 00:00:00
abstract::Cerebral computer tomography is a recently introduced neuroradiologic procedure involving tomographic x-rays of horizontal brain sections. Although most adults undergo the procedure without anesthesia, children and uncooperative adults must be given general anesthesia for absolute immobility. Of 84 procedures under ge...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197705000-00005
更新日期:1977-05-01 00:00:00
abstract:BACKGROUND:Vital sign monitors and ventilator/anesthesia workstations are equipped with multiple alarms to improve patient safety. A high number of false alarms can lead to a "crying wolf" phenomenon with consecutively ignored critical situations. Systematic data on alarm patterns and density in the perioperative phase...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181fcc504
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Recently, we reported a new technique to augment motor-evoked potentials (MEPs) under general anesthesia, posttetanic MEP (p-MEP), in which tetanic stimulation of the peripheral nerve before transcranial stimulation enlarged amplitudes of MEPs from the muscle innervated by the nerve subjected to tetanic stim...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318177082e
更新日期:2008-07-01 00:00:00
abstract::Early first-stage labor pain is primarily visceral in origin. Increasing pain intensity and transition to somatic nociceptive input characterizes late first- and second-stage labor pain. The effect of this change in nociceptive input on the duration of intrathecal labor analgesia has not been well studied. This prospe...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199705000-00028
更新日期:1997-05-01 00:00:00
abstract::In this study we attempted to define the minimal dosage of alfentanil (AF) needed in combination with nitrous oxide to provide satisfactory anesthetic conditions for lower abdominal gynecologic surgery. General anesthesia was induced in 12 women with AF (150 micrograms X kg-1) and 66% N2O in O2. An infusion of AF was ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1983-11-01 00:00:00
abstract::In a double-blind, single-dose study hydroxyzine combined with morphine was administered intramuscularly to postoperative patients to determine the efficacy of this combination in the relief of postoperative pain, and to compare its effect to that produced by morphine alone. Eighty-two patients received morphine (5 or...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1980-09-01 00:00:00
abstract::We studied 49 patients of ASA physical status I to determine cerebral anesthetic concentration on awakening calculated with end-tidal anesthetic concentration, when the end-tidal concentration decreased spontaneously. We also attempted to explain the difference in the average of the bracketing alveolar anesthetic conc...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199311000-00024
更新日期:1993-11-01 00:00:00
abstract:UNLABELLED:This study examines the effect of spinal ibuprofen on the behavioral manifestations associated with the opioid abstinence syndrome. Rats (n = 8 per group) were infused for 5 days with morphine and then pretreated with a spinal bolus dose of ibuprofen before systemic naloxone antagonism (300 microg). Groups i...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200008000-00035
更新日期:2000-08-01 00:00:00
abstract:UNLABELLED:A synergistic effect of nonselective cyclooxygenase (COX) inhibitors on morphine-induced decrease of isoflurane minimum alveolar concentration (MAC(ISO)) has been observed in the rat. We studied the influence of specific COX-2 inhibitors on this decrease of MAC. Sixty-four female rats were anesthetized with ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000097849.18820.c4
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:Tissue factor pathway inhibitor (TFPI) is a 40-kDa, endogenous protein that inhibits tissue factor (TF)-initiated coagulation by bonding with activated factor X (FXa). The TFPI/FXa complex then subsequently binds with TF/activated factor VII (FVIIa) complex, ultimately inhibiting thrombin generation. Heparin...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000237285.40106.1e
更新日期:2006-10-01 00:00:00
abstract::The efficacy of lidocaine during myocardial reperfusion in coronary artery bypass surgery was evaluated in 20 patients randomly assigned to a control group (n = 10) or to receive lidocaine, 1 mg/kg intravenously 5 min before aortic unclamping and cardiac reperfusion, followed by infusion at 40 micrograms X kg-1 X min-...
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:1986-04-01 00:00:00
abstract:BACKGROUND:Women laboring with epidural analgesia experience fever much more frequently than do women who chose other forms of analgesia, and maternal intrapartum fever is associated with numerous adverse consequences, including brain injury in the fetus. We developed a model of noninfectious inflammatory fever in the ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002479
更新日期:2017-12-01 00:00:00
abstract::In the past, it was common practice to use a high tidal volume (VT) during intraoperative ventilation, because this reduced the need for high oxygen fractions to compensate for the ventilation-perfusion mismatches due to atelectasis in a time when it was uncommon to use positive end-expiratory pressure (PEEP) in the o...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000005187
更新日期:2020-12-01 00:00:00
abstract::Acute angle closure glaucoma is a rare complication of general anesthesia. However, in case of delayed diagnosis, it may lead to blindness. We present a case of bilateral acute angle closure glaucoma after cervical spine surgery under general anesthesia in a hypermetropic patient. In this case, the most likely trigger...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182009ad6
更新日期:2011-01-01 00:00:00