Variation in Patient-Reported Advance Care Preferences in the Preoperative Setting.


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.


Anesth Analg


Anesthesia and analgesia


Udelsman BV,Govea N,Cooper Z,Chang DC,Bader A,Meyer MJ




Has Abstract


2021-01-01 00:00:00














  • Oxygen Reserve Index: Validation of a New Variable.

    abstract:BACKGROUND:Pulse oximetry-derived oxygen saturation is typically >97% in normoxia and hyperoxia, limiting its clinical use. The new Oxygen Reserve Index (ORi), a relative indicator of the partial pressure of oxygen dissolved in arterial blood (PaO2) in the range of 100-200 mm Hg, may allow additional monitoring of oxyg...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Vos JJ,Willems CH,van Amsterdam K,van den Berg JP,Spanjersberg R,Struys MMRF,Scheeren TWL

    更新日期:2019-08-01 00:00:00

  • The effects of general anesthesia and surgery on basal and interferon stimulated natural killer cell activity of humans.

    abstract:UNLABELLED:Natural killer (NK) cells can lyse certain tumor cells as well as virally infected cells without prior sensitization. Animal studies have shown that general anesthesia (GA) alone or GA followed by surgery decreases both basal NK cytotoxicity and enhancement of NK activity by interferon (IFN). The purpose of ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Kutza J,Gratz I,Afshar M,Murasko DM

    更新日期:1997-10-01 00:00:00

  • Intracellular mechanism of action of isoflurane and halothane on striated muscle of the rabbit.

    abstract::Studies were conducted on the effects of isoflurane and halothane on intracellular mechanisms of striated muscle contraction: Ca2+ activation of the contractile proteins and Ca2+ uptake and release from the sarcoplasmic reticulum. Functionally skinned muscle fibers (sarcolemma disrupted by homogenization) from isolate...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Su JY,Bell JG

    更新日期:1986-05-01 00:00:00

  • Body temperature change during anesthesia for electroconvulsive therapy: implications for quality incentives in anesthesiology.

    abstract:BACKGROUND:The American Society of Anesthesiologists has announced that perioperative normothermia is a "Quality Incentive in Anesthesiology." We examined whether we could meet this quality incentive in a simple population: patients undergoing anesthesia for electroconvulsive therapy (ECT). METHODS:We compared infrare...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Modell JH,Gravenstein N,Morey TE

    更新日期:2008-11-01 00:00:00

  • Nitrous oxide exposure in the operating room.

    abstract::One-hundred and eight-five pairs of gas samples were collected from inspired gas (10 cm behind the head at nose level) and end-tidal gas of persons administering anesthesia in 3 operating rooms during daily routine anesthesia. Mean operating-room N2O concentrations from 22 to 144 ppm (volume/volume [V/V]) were measure...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Beynen FM,Knopp TJ,Rehder K

    更新日期:1978-03-01 00:00:00

  • The effect of lidocaine on early postoperative cognitive dysfunction after coronary artery bypass surgery.

    abstract:UNLABELLED:We investigated the effect of lidocaine on the incidence of cognitive dysfunction in the early postoperative period after cardiac surgery. One-hundred-eighteen patients undergoing elective coronary artery bypass surgery with cardiopulmonary bypass (CPB) were randomized to receive either lidocaine (1.5 mg/kg ...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Wang D,Wu X,Li J,Xiao F,Liu X,Meng M

    更新日期:2002-11-01 00:00:00

  • Anesthetic management of patients with Takayasu's arteritis: a case series and review.

    abstract:UNLABELLED:Takayasu's arteritis is a rare, chronic progressive panendarteritis involving the aorta and its main branches. Anesthesia for patients with Takayasu's arteritis is complicated by their severe uncontrolled hypertension, end-organ dysfunction resulting from hypertension, stenosis of major blood vessels affecti...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Kathirvel S,Chavan S,Arya VK,Rehman I,Babu V,Malhotra N,Bhukal I,Chari P

    更新日期:2001-07-01 00:00:00

  • Case report: bilateral angle closure glaucoma after general anesthesia.

    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


    authors: Gayat E,Gabison E,Devys JM

    更新日期:2011-01-01 00:00:00

  • Population pharmacokinetics of dexmedetomidine in infants after open heart surgery.

    abstract:BACKGROUND:Dexmedetomidine is a highly selective alpha(2)-agonist with hypnotic, analgesic, and anxiolytic properties. In adults, it provides sedation while preserving respiratory function facilitating extubation. Only limited pharmacokinetic data are available for pediatric patients. The primary aim of this study was ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Su F,Nicolson SC,Gastonguay MR,Barrett JS,Adamson PC,Kang DS,Godinez RI,Zuppa AF

    更新日期:2010-05-01 00:00:00

  • Validating the Physiologic Model HumMod as a Substitute for Clinical Trials Involving Acute Normovolemic Hemodilution.

    abstract:BACKGROUND:Blood conservation strategies and transfusion guidelines remain a heavily debated clinical topic. Previous investigational trials have shown that acute isovolemic hemodilution does not limit adequate oxygen delivery; however, a true critical hemoglobin level has never been investigated or defined due to safe...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Sims CR 3rd,Delima LR,Calimaran A,Hester R,Pruett WA

    更新日期:2018-01-01 00:00:00

  • Pulmonary gas exchange in coronary artery surgery patients during sevoflurane and isoflurane anesthesia.

    abstract:UNLABELLED:As the surgical population ages, the number of patients presenting with coronary artery disease and age-related loss of pulmonary recoil will increase. Although their influence on gas exchange in this population remains unknown, sevoflurane and isoflurane are used for an increasing variety of surgical proced...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Loeckinger A,Keller C,Lindner KH,Kleinsasser A

    更新日期:2002-05-01 00:00:00

  • The analgesic effect of epidural clonidine after spinal surgery: a randomized placebo-controlled trial.

    abstract:BACKGROUND:Clonidine is an alpha(2) adrenoreceptor and imidazoline receptor agonist, which has analgesic, sedative, and minimum alveolar anesthetic concentration-sparing effects. It has been used orally, IV, and epidurally. In spinal surgery, there is a reluctance to use local anesthetic-based epidural analgesia postop...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验


    authors: Farmery AD,Wilson-MacDonald J

    更新日期:2009-02-01 00:00:00

  • FOCUS: the Society of Cardiovascular Anesthesiologists' initiative to improve quality and safety in the cardiovascular operating room.

    abstract::The Society of Cardiovascular Anesthesiologists (SCA) introduced the FOCUS initiative (Flawless Operative Cardiovascular Unified Systems) in 2005 in response to the need for a rigorous scientific approach to improve quality and safety in the cardiovascular operating room (CVOR). The goal of the project, which is suppo...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Barbeito A,Lau WT,Weitzel N,Abernathy JH 3rd,Wahr J,Mark JB

    更新日期:2014-10-01 00:00:00

  • Dolasetron for preventing postanesthetic shivering.

    abstract:UNLABELLED:We designed this study to assess the efficacy of dolasetron compared with clonidine and placebo in prophylaxis of postanesthetic shivering. We included 90 patients undergoing elective abdominal or urologic surgery. The patients were randomly assigned to one three groups (each group n = 30) using a double-bli...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验,收录出版


    authors: Piper SN,Röhm KD,Maleck WH,Fent MT,Suttner SW,Boldt J

    更新日期:2002-01-01 00:00:00

  • Distribution of Extreme Vital Signs and Complete Blood Count Values of Healthy Parturients: A Retrospective Database Analysis and Review of the Literature.

    abstract:BACKGROUND:The impact of physiological adjustments throughout pregnancy on maternal vital signs and laboratory values has yet to be fully defined. The present study was designed to determine the normal range of these parameters among healthy pregnant women during the peripartum period. METHODS:This is a retrospective ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审


    authors: Gat R,Hadar E,Orbach-Zinger S,Shochat T,Kushnir S,Einav S

    更新日期:2019-12-01 00:00:00

  • Intrathecal injection of the peptide myr-NR2B9c attenuates bone cancer pain via perturbing N-methyl-D-aspartate receptor-PSD-95 protein interactions in mice.

    abstract:BACKGROUND:N-methyl-D-aspartate receptor (NMDARs)-dependent central sensitization plays an important role in cancer pain. Binding of NMDAR subunit 2B (NR2B) by postsynaptic density protein-95 (PSD-95) can couple NMDAR activity to intracellular enzymes, such as neuronal nitric oxide synthase (nNOS), facilitate downstrea...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Liu Y,Cui X,Sun YE,Yang X,Ni K,Zhou Y,Ma Z,Gu X

    更新日期:2014-06-01 00:00:00

  • A Predictive Model for Extended Postanesthesia Care Unit Length of Stay in Outpatient Surgeries.

    abstract:BACKGROUND:A predictive model that can identify patients who are at an increased risk for prolonged postanesthesia care unit (PACU) stay could help optimize resource utilization and case sequencing. Although previous studies identified some predictors, there is not a model that only utilizes various patients demographi...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Gabriel RA,Waterman RS,Kim J,Ohno-Machado L

    更新日期:2017-05-01 00:00:00

  • Subblocking concentrations of local anesthetics: effects on impulse generation and conduction in single myelinated sciatic nerve axons in frog.

    abstract::Phenomena seen in axons exposed to subblocking doses serve as the basis for interpreting clinical and behavioral observations during onset and recovery of peripheral nerve block. To delineate the changes in excitability and in impulse conduction caused by subblocking concentrations of local anesthetics (LAs) in myelin...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Raymond SA

    更新日期:1992-12-01 00:00:00

  • The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-Induced Contractility of Human Myometrium In Vitro.

    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


    authors: Talati C,Carvalho JCA,Luca A,Balki M

    更新日期:2019-04-01 00:00:00

  • The effect of concomitant radiofrequency ablation and surgical technique (repair versus replacement) on release of cardiac biomarkers during mitral valve surgery.

    abstract::All patients undergoing heart surgery experience a certain amount of nonspecific myocardial injury documented by the release of cardiac biomarkers and associated with poor outcome. We investigated the role of unipolar radiofrequency ablation of atrial fibrillation on the release of cardiac biomarkers in 71 patients un...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Zangrillo A,Crescenzi G,Landoni G,Benussi S,Crivellari M,Pappalardo F,Dorigo E,Pappone C,Alfieri O

    更新日期:2005-07-01 00:00:00

  • Balloon versus conventional laryngoscopy: a comparison of laryngoscopic findings and intubation difficulty.

    abstract::We compared laryngeal aperture (LA) exposure and endotracheal intubation difficulty scale (IDS) scores between balloon-assisted and conventional laryngoscopy. Thirty-two anesthetized and paralyzed elective surgery patients underwent laryngoscopy with a standard number 4 and a modified number 4 curved blade carrying a ...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Mentzelopoulos SD,Romana CN,Corolanoglou DS,Tzoufi MJ,Karamichali EA

    更新日期:2000-12-01 00:00:00

  • Anatomical landmarks for femoral nerve block: a comparison of four needle insertion sites.

    abstract:UNLABELLED:The site for needle insertion in femoral nerve block varies significantly among various descriptions of the technique. To determine the site with the highest likelihood of needle-femoral nerve contact, femoral nerve block was simulated in a human cadaver model (17 femoral triangles from 9 adult cadavers). Fo...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Vloka JD,Hadzić A,Drobnik L,Ernest A,Reiss W,Thys DM

    更新日期:1999-12-01 00:00:00

  • A model for evaluating droperidol's effect on the median QTc interval.

    abstract:UNLABELLED:Controversy surrounds the use of the antiemetic droperidol, because of the Food and Drug Administration-imposed "black box" warning alleging that even small doses of the drug can lead to serious (even fatal) arrhythmias when it is used for antiemetic prophylaxis during the perioperative period. We used mathe...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Zhang Y,Luo Z,White PF

    更新日期:2004-05-01 00:00:00

  • Urodynamic studies after intrathecal fentanyl and buprenorphine in the dog.

    abstract::Cystometrograms (CMG) and urethral pressure profiles (UPP) were used in six anesthetized dogs to study the urodynamic effects of intrathecal (IT) injections of fentanyl and buprenorphine. The CMG and UPP were examined for each of the two drugs in all dogs (four experiments per animal). The measurements were performed ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Drenger B,Magora F

    更新日期:1989-09-01 00:00:00

  • A response algorithm for the low-pressure alarm condition.

    abstract::A response algorithm consists of a logical sequence of maneuvers to be performed in response to a specific condition. With the advent of alarm-equipped monitors that alert anesthesiologists to the presence of potentially hazardous clinical conditions, a need has arisen to develop the corresponding alarm-oriented respo...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Raphael DT,Weller RS,Doran DJ

    更新日期:1988-09-01 00:00:00

  • Anesthetic considerations for cerebral computer tomography.

    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


    authors: Ferrer-Brechner T,Winter J

    更新日期:1977-05-01 00:00:00

  • Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine.

    abstract:UNLABELLED:Patients receiving effective thoracic epidural analgesia for postthoracotomy pain may still complain of severe ipsilateral shoulder pain. The etiology of this pain is unclear. In this randomized, double-blinded, placebo-controlled study, we investigated the effect of phrenic nerve infiltration with lidocaine...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Scawn ND,Pennefather SH,Soorae A,Wang JY,Russell GN

    更新日期:2001-08-01 00:00:00

  • The influence of p38 mitogen-activated protein kinase inhibitor on synthesis of inflammatory cytokine tumor necrosis factor alpha in spinal cord of rats with chronic constriction injury.

    abstract:BACKGROUND:Tumor necrosis factor alpha (TNF-alpha) could trigger p38 mitogen-activated protein kinase (MAPK) activation. Conversely phosphorylated p38 (p-p38) could induce the upregulation of TNF-alpha. In this study, we examined the hypothesis that chronic constrictive injury (CCI) of the sciatic nerve could promote s...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Xu L,Huang Y,Yu X,Yue J,Yang N,Zuo P

    更新日期:2007-12-01 00:00:00

  • The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion.

    abstract::The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five-point scale) were asse...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Mogensen T,Scott NB,Lund C,Bigler D,Hjortsø NC,Kehlet H

    更新日期:1988-08-01 00:00:00

  • Control of intraoperative hypertension with isoflurane in patients with coronary artery disease: effects on regional myocardial blood flow and metabolism.

    abstract::The effect of isoflurane on regional myocardial metabolism and blood flow, when used as an adjunct to fentanyl-nitrous oxide anesthesia, to control intraoperative hypertension was investigated. Twenty-two patients with two- or three-vessel coronary artery disease with an ejection fraction greater than 0.5 and on beta-...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Sahlman L,Milocco I,Appelgren L,William-Olsson G,Ricksten SE

    更新日期:1989-02-01 00:00:00