Objective:To explore the effect of fragmented case teaching in the standardized training of residents in anesthesiology department.Methods:80 doctors who participated in the standardized training of residents in anest...Objective:To explore the effect of fragmented case teaching in the standardized training of residents in anesthesiology department.Methods:80 doctors who participated in the standardized training of residents in anesthesiology department from January 2021 to January 2022 were selected as the research objects,and the 80 doctors were divided into experimental groups according to the clinical teaching mode(n=40,implemented case fragmented teaching method)and the control group(n=40,traditional teaching method).The training lasted for 2 months,and the medical history collection,medical record analysis,practical operation ability,theoretical assessment results,and the degree of satisfaction towards the training of the two groups of doctors were compared.Results:After 2 months of training,the theoretical knowledge and operational ability of the doctors in the two groups have improved to a certain extent,but the medical history collection,medical record analysis,practical operation ability,theoretical assessment results and satisfaction of the doctors in the experimental group were significantly better than those in the control group(P<0.05).Conclusion:The effect of the fragmented case teaching method in the standardized training of anesthesiology residents is significantly better than the traditional teaching mode.The abilities of doctors have significantly improved after the training.Hence,the fragmented case teaching method is worthy of promotion in clinical practice.展开更多
Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 t...Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 to the end of December 2019 were selected, and divided into a control group and an observation group of 60 each according to the time sequence of admission. The control group adopted the conventional teaching mode, and the observation group adopted the WeChat platform combined PBL teaching method. The scores of theoretical knowledge and anesthesia skills operation after training, the scores of the teaching interest survey, and the satisfaction with the teaching mode between the two groups were compared. Results: The scores of theoretical knowledge and anesthesia skills operation in the observation group were significantly higher than those in the control group, and the indicators of teaching interest in the observation group were also higher than those in the control group. The differences were statistically significant (P < 0.05). The satisfaction degree of the observation group was significantly higher than that of the control group, and the difference was also statistically significant (P < 0.05). Conclusion: The WeChat platform combined with the PBL teaching method is beneficial to improve the training effect of anesthesiology residents, stimulating autonomous learning ability, ensuring the effective practice of theoretical knowledge, and promoting them to move towards a higher standard of anesthesia skills.展开更多
Time:October 12-16,2013Venue:Moscone Center,San Francisco,California,USA Website:https://www.asahq.org/Annual-Meeting.aspx The theme of ANESTHESIOLOGYTM2013 Annual Meeting is'Global Partners in Quality Outcomes an...Time:October 12-16,2013Venue:Moscone Center,San Francisco,California,USA Website:https://www.asahq.org/Annual-Meeting.aspx The theme of ANESTHESIOLOGYTM2013 Annual Meeting is'Global Partners in Quality Outcomes and Patient Safety',which offers a glimpse of what’s to come as the American Society of Anesthesiologists(ASA)hopes to share world expertise展开更多
Artificial intelligence(AI)has long been an attractive topic in medicine,especially in light of the rapid developments in digital and information technologies.AI has already provided some breakthroughs in medicine.Wit...Artificial intelligence(AI)has long been an attractive topic in medicine,especially in light of the rapid developments in digital and information technologies.AI has already provided some breakthroughs in medicine.With the assistance of AI,more precise models have been used for clinical predictions,diagnoses,and decision-making.This review defines the basic concepts of AI and machine learning(ML),and provides a simple introduction to certain frequently used algorithms in AI and ML.In addition,the review discusses the current common applications of AI and ML in the prediction of anesthesia conditions,including those for preoperative predictions of difficult airways,intraoperative predictions of adverse events and anesthetic effects,and postoperative predictions of vomiting and pain.The use of AI in anesthesiology remains in development,even without extensive promotion and clinical application;moreover,it has immense potential to maintain further development in the future.Finally,the limitations and challenges of AI development for anesthesia are also discussed,along with considerations regarding ethics and safety.展开更多
Background: There are six Anesthesiology training centers in Thailand that are approved to operate the training program. An evidence of residents’ knowledge about pediatric postoperative pain management is needed for...Background: There are six Anesthesiology training centers in Thailand that are approved to operate the training program. An evidence of residents’ knowledge about pediatric postoperative pain management is needed for improving the program. Objective: To assess the third year anesthesiology residents’ knowledge about pediatric postoperative pain management. Materials and Methods: The questionnaire was adapted from previous studies. The questionnaire has 35 questions consisted of 17 multiple choice questions and 18 true or false questions to cover 2 domains: 1) use of age-appropriate pediatric pain assessment (10 questions) and 2) pediatric pain treatment (25 questions). Minimal passing level of the questionnaire rated by three young anesthesiology staffs was 76.2%. All 62 participants were the 3rd year anesthesiology residents from 6 training centers. Data were analyzed by descriptive statistics. Results: The response rate was 95.2%. Seventy-one percent of participants reported that they had learned about pediatric pain treatment. Of those, 55.9% rated their remaining knowledge at median level. The proportion of the correct score was 67.7% (mean 23.7 ± 2.9 SD) which was lower than the minimal passing level. The highest score was 29 and the lowest score was 16. For pain assessment domain;the mean proportion of correct score was 65% (range 90%-40%). For pain treatment domain;the mean proportion of correct score was 68.8% (range 88%-44%). Conclusion: Anesthesiology residents’ knowledge about pediatric postoperative pain management needs to be improved.展开更多
The launch of World Journal of Anesthesiology(WJA)is great news for the community of anesthesiology.Anesthesiology is a rapidly evolving medical specialty.The practice of anesthesia is broad and has an important impac...The launch of World Journal of Anesthesiology(WJA)is great news for the community of anesthesiology.Anesthesiology is a rapidly evolving medical specialty.The practice of anesthesia is broad and has an important impact on our society.Thus,it is necessary to have a multi-modal system to rapidly disseminate anesthesiology-related knowledge.WJA’s preparatory work was initiated on December 3,2010,will be published on December 27,2011.The WJA Editorial Board has now been established and consists of 121 distinguished experts from 28 countries.It will publish various formats of papers including original studies,review,commentary,guidelines,case report,book review and letters to the editor.The publication of the accepted papers will be quick and it is free of charge for readers to download and read any articles in the journal.Thus,WJA should be an excellent choice for anyone to consider publishing anesthesiology-related papers.Congratulations to the birth of WJA,a new member of World series journal family.展开更多
Artificial intelligence (AI) is the technique that enables computers to solve problems and perform tasks that traditionally require human intelligence. The availability of large amounts of medical data from electronic...Artificial intelligence (AI) is the technique that enables computers to solve problems and perform tasks that traditionally require human intelligence. The availability of large amounts of medical data from electronic medical records and powerful modern microcomputers enables the development of AI in medicine. AI has proven its applicability in many different medical areas, such as drug discovery, diagnostic radiology and pathology, as well as interventional applications in cardiology and surgery. However, until today, AI is scarcely used in the clinical practice of anesthesiology. Although there has been a significant body of research published on AI applications for anesthesiology in the literature, the number of developed robot systems for commercial use or those ready for clinical trials remains limited. The limitations of AI systems are identified and discussed, which include incorrect medical data formatting, individual patient variability, the lack of ability of current AI systems, anesthesiologist inexperience in AI usage, system unreliability, unexplainable AI conclusions and strict regulations. In order to ensure anesthesiologists’ trust in AI systems and improve their implementation in daily practice, strict quality control of the systems and algorithms should be undertaken. Further, anesthesiology personnel should play an integral role in the development of AI systems before we are able to see more AI integration in clinical anesthesiology.展开更多
Objective: To determine factors influencing anesthesiology choice among resident doctors at the medical school of Marrakech. Materials and Methods: We have conducted a descriptive cross-sectional study based on an ano...Objective: To determine factors influencing anesthesiology choice among resident doctors at the medical school of Marrakech. Materials and Methods: We have conducted a descriptive cross-sectional study based on an anonymous questionnaire. Results: A total of 406/672 questionnaires were returned, with a female/male sex ratio of 1.07. The duration of the training (OR: 3.3;CI 95%: 1.74 - 6.23;p < 0.001), intellectual challenge (OR: 3.02;CI 95%: 1.69 - 5.37;p < 0.001), doctor-patient relationship (OR: 2.22;CI 95%: 1.02 - 4.84;p: 0.04), and financial aspects (OR: 2.14;CI 95%: 1.09 - 4.21;p: 0.02) were independent factors that influenced the choice of anesthesiology. Conclusion: we recommend the succeeding: 1) Support students in their choice;2) Correct misconceptions about certain specialties;3) Promote clinical clerkship;4) Encourage mentorship;5) Increase the salary of at-risk specialties.展开更多
Objective: to observe the application effect of multi-modal teaching method in clinical anesthesiology teaching. Methods: a total of 50 anesthesiology students who practiced in our hospital from September 2020 to Augu...Objective: to observe the application effect of multi-modal teaching method in clinical anesthesiology teaching. Methods: a total of 50 anesthesiology students who practiced in our hospital from September 2020 to August 2021 were selected for research. According to different teaching methods, 25 students in the control group received conventional teaching, and 25 students in the research group received multimodal teaching, comparing students' assessment results, learning excellence rate and teaching quality assessment results. Results: the examination scores of students in the study group in anesthesia preparation, tracheal intubation, general anesthesia and local anesthesia, and anesthesia evaluation were all higher than those in the control group (P<0.05). The teaching quality evaluation results of the research group were better than those of the control group (P<0.05);the student satisfaction rate of the research group was 100.0% higher than that of the control group (84.0%) (P<0.05). Conclusion: the application of multi-mode teaching method in clinical teaching can improve the operation level of anesthesiology students and improve their comprehensive quality. The teaching quality is good, which has been widely recognized by students.展开更多
Objective: to analyze the value and effect of case fragmentation teaching in the standardized training of anesthesiology residents. Methods: from January 2020, 40 residents who implemented standardized resident traini...Objective: to analyze the value and effect of case fragmentation teaching in the standardized training of anesthesiology residents. Methods: from January 2020, 40 residents who implemented standardized resident training in the Department of Anesthesiology of our hospital to December 2020, were divided into control and observation groups based on different training modes, with 20 patients in each group. The control group gave the routine teaching, and the observation group taught the case fragmentation. Compare the academic performance of the two groups of doctors (skill level and theoretical knowledge), clinical ability test results (preoperative visit, anesthesia protocol preparation, preoperative preparation, anesthesia operation, intraoperative management, clinical competence), and teaching satisfaction (very satisfactory, general satisfaction and unsatisfactory). Results: the results of the observation group were higher than the control group, and the results of preoperative visit, anesthesia plan formulation, preoperative preparation, intraoperative management and clinical competence, with P <0.05;the teaching intervention was 95%, higher than the control group, but the difference was not obvious (P> 0.05). Conclusion: case fragmentation teaching in the standardized training of anesthesiology residents can play a remarkable role in improving the teaching effect, enhancing the doctors' clinical ability and improving the teaching satisfaction, which is worth promoting and implementing in the industry.展开更多
Objective: to observe the effect of anesthesia nurse pain management on labor analgesia by applying anesthesia nurse pain management method in the process of childbirth. Methods: 106 cases of parturient women in our h...Objective: to observe the effect of anesthesia nurse pain management on labor analgesia by applying anesthesia nurse pain management method in the process of childbirth. Methods: 106 cases of parturient women in our hospital were taken as the observation object. The observation time was in March 2020. According to the different methods of labor analgesia management, the patients were divided into two groups. Results: the incidence of grade 1 and 2 pain was 93.10% in the study group and 79.31% in the control group (χ2 = 15.684, P = 0.000). The difference was statistically significant. Conclusion: pain management by anesthesiologist during childbirth is effective, and it is worth recommending.展开更多
To bridge the gap between curriculum content and clinical needs,as well as address the insufficient quality of online educational resources in current postgraduate anesthesiology education,this study proposes a“libra...To bridge the gap between curriculum content and clinical needs,as well as address the insufficient quality of online educational resources in current postgraduate anesthesiology education,this study proposes a“library-style”network resource platform for anesthesia graduate students,grounded in the competency-based medical education framework.The platform’s primary focus is“classical knowledge module”,which covers six core domains in anesthesiology,such as clinical anesthesia management,anesthesia technical operation,and anesthesia pharmacology.The platform also integrates‘Internet+’technology,creating a multifunctional network resource to support comprehensive learning.The platform is characterized by modularized knowledge,diversified resources,dynamic updates,and universal accessibility,enabling postgraduate students to engage in independent and lifelong learning.This flexibility fosters the innovation of hybrid teaching models,combining both online and offline components.The study aims to strengthen the competency-oriented anesthesia training system,providing robust support for both clinical practice and academic research.展开更多
Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cro...Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery.We collected information of respondents’ demographic data,education background,health literacy and previous experience of anesthesia,perception of anesthesiologist’s job,the expectation on anesthesia care.Descriptive analyses,χ^2 test and multiple linear regression analysis were used for data analysis.Results Of 550 participants,521(94.7%)completed the questionnaire.In these respondents,335 (64.3%) considered anesthesiology as an independent medical discipline,225 (43.2%) believed that anesthesiology department was an independent clinical department,and 243 (46.6%) recognized anesthesiologists as qualified doctors.Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well.Younger patients (β=-0.044,P<0.001),those with higher education (β=1.200,P<0.001),or with better health literacy (β=0.781,P=0.005) had significant more knowledge about the job roles of anesthesiologists.Most patients demanded pre-anesthetic visit (80.5%),expected availability of preoperative anesthetic clinic (74.1%),wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients’ perception about anesthesiologists might be limited.Efforts should be made on education about anesthesia,especially for elderly patients and those under-educated patients.Preoperative anesthetic clinic is expected by most in-patients.展开更多
Abstract Clinical and animal studies have indicated that propofol has potential for abuse, but the specific neurobi- ological mechanism underlying propofol reward is not fully understood. The purpose of this study was...Abstract Clinical and animal studies have indicated that propofol has potential for abuse, but the specific neurobi- ological mechanism underlying propofol reward is not fully understood. The purpose of this study was to inves- tigate the role of extracellular signal-regulated kinase （ERK） signal transduction pathways in the nucleus accumbens （NAc） in propofol self-administration. We tested the expression of p-ERK in the NAc following the maintenance of propofol self-administration in rats. We also assessed the effect of administration of SCH23390, an antagonist of the D1 dopamine receptor, on the expression of p-ERK in the NAc in propofol self-administering rats, and examined the effects of intra-NAc injection of U0126, an MEK inhibitor, on propofol reinforcement in rats. The results showed that the expression of p-ERK in the NAc increased significantly in rats maintained on propofol, and pre-treatment with SCH23390 inhibited the propofol self- administration and diminished the expression of p-ERK in the NAc. Moreover, intra-NAc injection of U0126 （4 μg/ side） attenuated the propofol self-administration. The data suggest that ERK signal transduction pathways coupledwith D1 dopamine receptors in the NAc may be involved in the maintenance of propofol self-administration and its rewarding effects.展开更多
Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate seda...Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time's deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, pro-pofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been pro-hibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists world-wide.展开更多
BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane...BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.展开更多
The potential of the second wave of Artificial Intelligence (AI) to change our lives beyond recognition is both exciting and challenging. AI has been around for over three decades, and this new approach of artificial ...The potential of the second wave of Artificial Intelligence (AI) to change our lives beyond recognition is both exciting and challenging. AI has been around for over three decades, and this new approach of artificial intelligence, due to enhancements in technology, both software, and hardware, has resulted in the fact that human decision-making is considered inferior and erratic in many fields: none more so than medicine. Machine learning algorithms with access to large data sets can be trained to outperform clinicians in many respects. AI’s effectiveness in accurate diagnosis of various medical conditions and medical image interpretation is well documented. Modern AI technology has the potential to transform medicine to a level never seen before in terms of efficiency and accuracy;but is also potentially highly disruptive, creating insecurity and allowing the transfer of expert domain knowledge to machines. Anesthetics is a complex medical discipline and assuming AI can easily replace experienced and knowledgeable medical practitioners is a very unrealistic expectation. AI can be used in anesthetics to develop, in some respects, more advanced clinical decision support tools based on machine learning. This paper focuses on the complexity of both AI developments, deep learning, neural networks, etc. and opportunities of AI in anesthetics for the future. It will review current advances in AI tools and hardware technologies as well as outlining how these can be used in the field of anesthetics.展开更多
BACKGROUND Functional vocal cord disorders can be a differential diagnosis for postoperative upper airway obstruction requiring urgent intervention.However,this may be unfamiliar to anesthesiologists who would favor i...BACKGROUND Functional vocal cord disorders can be a differential diagnosis for postoperative upper airway obstruction requiring urgent intervention.However,this may be unfamiliar to anesthesiologists who would favor inappropriate airway intervention and increased morbidity.CASE SUMMARY A 61-year-old woman underwent cervical laminectomy,followed by laparoscopic cholecystectomy 10 mo later.Despite adequate reversal of neuromuscular blockade,the patient experienced repetitive respiratory difficulty with inspiratory stridor after extubation.After the second operation,the patient was diagnosed with paradoxical vocal fold motion(PVFM)by an otolaryngologist based on the clinical features and fiberoptic bronchoscopy results,and the patient was successfully treated.CONCLUSION PVFM should be considered a differential diagnosis if a patient presents with stridor after general anesthesia.展开更多
Glucose control in patient admitted to the intensive care unit has been a topic of much debate over the past 20 years.The harmful effects of uncontrolled hyperglycemia and hypoglycemia in critically ill patients is we...Glucose control in patient admitted to the intensive care unit has been a topic of much debate over the past 20 years.The harmful effects of uncontrolled hyperglycemia and hypoglycemia in critically ill patients is well established.Although a large clinical trial in 2001 demonstrated significant mortality and morbidity benefits with tight glucose control in this patient population,the results could not be replicated by other investigators.The“Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation”trial in 2009 established that tight glucose control was not only of no benefit,but in fact harmful due to the significant risk of hypoglycemia.The current guidelines suggest a moderate approach with the initiation of intravenous insulin therapy in critically ill patients when the blood glucose level is above 180 mg/dL.The most important factor that underpins glycemic management in intensive care unit patients is the consequent prevention of hypoglycemia.Robust glucose monitoring strategies and insulin protocols need to be implemented in order to achieve this goal.展开更多
文摘Objective:To explore the effect of fragmented case teaching in the standardized training of residents in anesthesiology department.Methods:80 doctors who participated in the standardized training of residents in anesthesiology department from January 2021 to January 2022 were selected as the research objects,and the 80 doctors were divided into experimental groups according to the clinical teaching mode(n=40,implemented case fragmented teaching method)and the control group(n=40,traditional teaching method).The training lasted for 2 months,and the medical history collection,medical record analysis,practical operation ability,theoretical assessment results,and the degree of satisfaction towards the training of the two groups of doctors were compared.Results:After 2 months of training,the theoretical knowledge and operational ability of the doctors in the two groups have improved to a certain extent,but the medical history collection,medical record analysis,practical operation ability,theoretical assessment results and satisfaction of the doctors in the experimental group were significantly better than those in the control group(P<0.05).Conclusion:The effect of the fragmented case teaching method in the standardized training of anesthesiology residents is significantly better than the traditional teaching mode.The abilities of doctors have significantly improved after the training.Hence,the fragmented case teaching method is worthy of promotion in clinical practice.
文摘Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 to the end of December 2019 were selected, and divided into a control group and an observation group of 60 each according to the time sequence of admission. The control group adopted the conventional teaching mode, and the observation group adopted the WeChat platform combined PBL teaching method. The scores of theoretical knowledge and anesthesia skills operation after training, the scores of the teaching interest survey, and the satisfaction with the teaching mode between the two groups were compared. Results: The scores of theoretical knowledge and anesthesia skills operation in the observation group were significantly higher than those in the control group, and the indicators of teaching interest in the observation group were also higher than those in the control group. The differences were statistically significant (P < 0.05). The satisfaction degree of the observation group was significantly higher than that of the control group, and the difference was also statistically significant (P < 0.05). Conclusion: The WeChat platform combined with the PBL teaching method is beneficial to improve the training effect of anesthesiology residents, stimulating autonomous learning ability, ensuring the effective practice of theoretical knowledge, and promoting them to move towards a higher standard of anesthesia skills.
文摘Time:October 12-16,2013Venue:Moscone Center,San Francisco,California,USA Website:https://www.asahq.org/Annual-Meeting.aspx The theme of ANESTHESIOLOGYTM2013 Annual Meeting is'Global Partners in Quality Outcomes and Patient Safety',which offers a glimpse of what’s to come as the American Society of Anesthesiologists(ASA)hopes to share world expertise
基金the Interdisciplinary Program of Shanghai Jiao Tong University(No.ZH2018ZDA14)the Clinical Research Plan of the Shenkang Hospital Development Center(No.SHDC2020CR3043B)。
文摘Artificial intelligence(AI)has long been an attractive topic in medicine,especially in light of the rapid developments in digital and information technologies.AI has already provided some breakthroughs in medicine.With the assistance of AI,more precise models have been used for clinical predictions,diagnoses,and decision-making.This review defines the basic concepts of AI and machine learning(ML),and provides a simple introduction to certain frequently used algorithms in AI and ML.In addition,the review discusses the current common applications of AI and ML in the prediction of anesthesia conditions,including those for preoperative predictions of difficult airways,intraoperative predictions of adverse events and anesthetic effects,and postoperative predictions of vomiting and pain.The use of AI in anesthesiology remains in development,even without extensive promotion and clinical application;moreover,it has immense potential to maintain further development in the future.Finally,the limitations and challenges of AI development for anesthesia are also discussed,along with considerations regarding ethics and safety.
文摘Background: There are six Anesthesiology training centers in Thailand that are approved to operate the training program. An evidence of residents’ knowledge about pediatric postoperative pain management is needed for improving the program. Objective: To assess the third year anesthesiology residents’ knowledge about pediatric postoperative pain management. Materials and Methods: The questionnaire was adapted from previous studies. The questionnaire has 35 questions consisted of 17 multiple choice questions and 18 true or false questions to cover 2 domains: 1) use of age-appropriate pediatric pain assessment (10 questions) and 2) pediatric pain treatment (25 questions). Minimal passing level of the questionnaire rated by three young anesthesiology staffs was 76.2%. All 62 participants were the 3rd year anesthesiology residents from 6 training centers. Data were analyzed by descriptive statistics. Results: The response rate was 95.2%. Seventy-one percent of participants reported that they had learned about pediatric pain treatment. Of those, 55.9% rated their remaining knowledge at median level. The proportion of the correct score was 67.7% (mean 23.7 ± 2.9 SD) which was lower than the minimal passing level. The highest score was 29 and the lowest score was 16. For pain assessment domain;the mean proportion of correct score was 65% (range 90%-40%). For pain treatment domain;the mean proportion of correct score was 68.8% (range 88%-44%). Conclusion: Anesthesiology residents’ knowledge about pediatric postoperative pain management needs to be improved.
文摘The launch of World Journal of Anesthesiology(WJA)is great news for the community of anesthesiology.Anesthesiology is a rapidly evolving medical specialty.The practice of anesthesia is broad and has an important impact on our society.Thus,it is necessary to have a multi-modal system to rapidly disseminate anesthesiology-related knowledge.WJA’s preparatory work was initiated on December 3,2010,will be published on December 27,2011.The WJA Editorial Board has now been established and consists of 121 distinguished experts from 28 countries.It will publish various formats of papers including original studies,review,commentary,guidelines,case report,book review and letters to the editor.The publication of the accepted papers will be quick and it is free of charge for readers to download and read any articles in the journal.Thus,WJA should be an excellent choice for anyone to consider publishing anesthesiology-related papers.Congratulations to the birth of WJA,a new member of World series journal family.
文摘Artificial intelligence (AI) is the technique that enables computers to solve problems and perform tasks that traditionally require human intelligence. The availability of large amounts of medical data from electronic medical records and powerful modern microcomputers enables the development of AI in medicine. AI has proven its applicability in many different medical areas, such as drug discovery, diagnostic radiology and pathology, as well as interventional applications in cardiology and surgery. However, until today, AI is scarcely used in the clinical practice of anesthesiology. Although there has been a significant body of research published on AI applications for anesthesiology in the literature, the number of developed robot systems for commercial use or those ready for clinical trials remains limited. The limitations of AI systems are identified and discussed, which include incorrect medical data formatting, individual patient variability, the lack of ability of current AI systems, anesthesiologist inexperience in AI usage, system unreliability, unexplainable AI conclusions and strict regulations. In order to ensure anesthesiologists’ trust in AI systems and improve their implementation in daily practice, strict quality control of the systems and algorithms should be undertaken. Further, anesthesiology personnel should play an integral role in the development of AI systems before we are able to see more AI integration in clinical anesthesiology.
文摘Objective: To determine factors influencing anesthesiology choice among resident doctors at the medical school of Marrakech. Materials and Methods: We have conducted a descriptive cross-sectional study based on an anonymous questionnaire. Results: A total of 406/672 questionnaires were returned, with a female/male sex ratio of 1.07. The duration of the training (OR: 3.3;CI 95%: 1.74 - 6.23;p < 0.001), intellectual challenge (OR: 3.02;CI 95%: 1.69 - 5.37;p < 0.001), doctor-patient relationship (OR: 2.22;CI 95%: 1.02 - 4.84;p: 0.04), and financial aspects (OR: 2.14;CI 95%: 1.09 - 4.21;p: 0.02) were independent factors that influenced the choice of anesthesiology. Conclusion: we recommend the succeeding: 1) Support students in their choice;2) Correct misconceptions about certain specialties;3) Promote clinical clerkship;4) Encourage mentorship;5) Increase the salary of at-risk specialties.
文摘Objective: to observe the application effect of multi-modal teaching method in clinical anesthesiology teaching. Methods: a total of 50 anesthesiology students who practiced in our hospital from September 2020 to August 2021 were selected for research. According to different teaching methods, 25 students in the control group received conventional teaching, and 25 students in the research group received multimodal teaching, comparing students' assessment results, learning excellence rate and teaching quality assessment results. Results: the examination scores of students in the study group in anesthesia preparation, tracheal intubation, general anesthesia and local anesthesia, and anesthesia evaluation were all higher than those in the control group (P<0.05). The teaching quality evaluation results of the research group were better than those of the control group (P<0.05);the student satisfaction rate of the research group was 100.0% higher than that of the control group (84.0%) (P<0.05). Conclusion: the application of multi-mode teaching method in clinical teaching can improve the operation level of anesthesiology students and improve their comprehensive quality. The teaching quality is good, which has been widely recognized by students.
文摘Objective: to analyze the value and effect of case fragmentation teaching in the standardized training of anesthesiology residents. Methods: from January 2020, 40 residents who implemented standardized resident training in the Department of Anesthesiology of our hospital to December 2020, were divided into control and observation groups based on different training modes, with 20 patients in each group. The control group gave the routine teaching, and the observation group taught the case fragmentation. Compare the academic performance of the two groups of doctors (skill level and theoretical knowledge), clinical ability test results (preoperative visit, anesthesia protocol preparation, preoperative preparation, anesthesia operation, intraoperative management, clinical competence), and teaching satisfaction (very satisfactory, general satisfaction and unsatisfactory). Results: the results of the observation group were higher than the control group, and the results of preoperative visit, anesthesia plan formulation, preoperative preparation, intraoperative management and clinical competence, with P <0.05;the teaching intervention was 95%, higher than the control group, but the difference was not obvious (P> 0.05). Conclusion: case fragmentation teaching in the standardized training of anesthesiology residents can play a remarkable role in improving the teaching effect, enhancing the doctors' clinical ability and improving the teaching satisfaction, which is worth promoting and implementing in the industry.
文摘Objective: to observe the effect of anesthesia nurse pain management on labor analgesia by applying anesthesia nurse pain management method in the process of childbirth. Methods: 106 cases of parturient women in our hospital were taken as the observation object. The observation time was in March 2020. According to the different methods of labor analgesia management, the patients were divided into two groups. Results: the incidence of grade 1 and 2 pain was 93.10% in the study group and 79.31% in the control group (χ2 = 15.684, P = 0.000). The difference was statistically significant. Conclusion: pain management by anesthesiologist during childbirth is effective, and it is worth recommending.
基金supported by Planning Project of Shanghai Higher Education Association(2QYB24158)Collaborative Education Project of the Ministry of Education of China(250101414020206).
文摘To bridge the gap between curriculum content and clinical needs,as well as address the insufficient quality of online educational resources in current postgraduate anesthesiology education,this study proposes a“library-style”network resource platform for anesthesia graduate students,grounded in the competency-based medical education framework.The platform’s primary focus is“classical knowledge module”,which covers six core domains in anesthesiology,such as clinical anesthesia management,anesthesia technical operation,and anesthesia pharmacology.The platform also integrates‘Internet+’technology,creating a multifunctional network resource to support comprehensive learning.The platform is characterized by modularized knowledge,diversified resources,dynamic updates,and universal accessibility,enabling postgraduate students to engage in independent and lifelong learning.This flexibility fosters the innovation of hybrid teaching models,combining both online and offline components.The study aims to strengthen the competency-oriented anesthesia training system,providing robust support for both clinical practice and academic research.
文摘Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery.We collected information of respondents’ demographic data,education background,health literacy and previous experience of anesthesia,perception of anesthesiologist’s job,the expectation on anesthesia care.Descriptive analyses,χ^2 test and multiple linear regression analysis were used for data analysis.Results Of 550 participants,521(94.7%)completed the questionnaire.In these respondents,335 (64.3%) considered anesthesiology as an independent medical discipline,225 (43.2%) believed that anesthesiology department was an independent clinical department,and 243 (46.6%) recognized anesthesiologists as qualified doctors.Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well.Younger patients (β=-0.044,P<0.001),those with higher education (β=1.200,P<0.001),or with better health literacy (β=0.781,P=0.005) had significant more knowledge about the job roles of anesthesiologists.Most patients demanded pre-anesthetic visit (80.5%),expected availability of preoperative anesthetic clinic (74.1%),wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients’ perception about anesthesiologists might be limited.Efforts should be made on education about anesthesia,especially for elderly patients and those under-educated patients.Preoperative anesthetic clinic is expected by most in-patients.
基金supported in part by the National Natural Science Foundation of China(81271469 and 81471350)the Natural Science Foundation of Zhejiang Province,China(Z2101211 and Y20140692)a Medical Health Project of Zhejiang Province, China(2014KYB161)
文摘Abstract Clinical and animal studies have indicated that propofol has potential for abuse, but the specific neurobi- ological mechanism underlying propofol reward is not fully understood. The purpose of this study was to inves- tigate the role of extracellular signal-regulated kinase （ERK） signal transduction pathways in the nucleus accumbens （NAc） in propofol self-administration. We tested the expression of p-ERK in the NAc following the maintenance of propofol self-administration in rats. We also assessed the effect of administration of SCH23390, an antagonist of the D1 dopamine receptor, on the expression of p-ERK in the NAc in propofol self-administering rats, and examined the effects of intra-NAc injection of U0126, an MEK inhibitor, on propofol reinforcement in rats. The results showed that the expression of p-ERK in the NAc increased significantly in rats maintained on propofol, and pre-treatment with SCH23390 inhibited the propofol self- administration and diminished the expression of p-ERK in the NAc. Moreover, intra-NAc injection of U0126 （4 μg/ side） attenuated the propofol self-administration. The data suggest that ERK signal transduction pathways coupledwith D1 dopamine receptors in the NAc may be involved in the maintenance of propofol self-administration and its rewarding effects.
文摘Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time's deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, pro-pofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been pro-hibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists world-wide.
基金Supported by Key Research and Development(R&D)Projects of Shanxi Province,China,No.201803D31135.
文摘BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.
文摘The potential of the second wave of Artificial Intelligence (AI) to change our lives beyond recognition is both exciting and challenging. AI has been around for over three decades, and this new approach of artificial intelligence, due to enhancements in technology, both software, and hardware, has resulted in the fact that human decision-making is considered inferior and erratic in many fields: none more so than medicine. Machine learning algorithms with access to large data sets can be trained to outperform clinicians in many respects. AI’s effectiveness in accurate diagnosis of various medical conditions and medical image interpretation is well documented. Modern AI technology has the potential to transform medicine to a level never seen before in terms of efficiency and accuracy;but is also potentially highly disruptive, creating insecurity and allowing the transfer of expert domain knowledge to machines. Anesthetics is a complex medical discipline and assuming AI can easily replace experienced and knowledgeable medical practitioners is a very unrealistic expectation. AI can be used in anesthetics to develop, in some respects, more advanced clinical decision support tools based on machine learning. This paper focuses on the complexity of both AI developments, deep learning, neural networks, etc. and opportunities of AI in anesthetics for the future. It will review current advances in AI tools and hardware technologies as well as outlining how these can be used in the field of anesthetics.
文摘BACKGROUND Functional vocal cord disorders can be a differential diagnosis for postoperative upper airway obstruction requiring urgent intervention.However,this may be unfamiliar to anesthesiologists who would favor inappropriate airway intervention and increased morbidity.CASE SUMMARY A 61-year-old woman underwent cervical laminectomy,followed by laparoscopic cholecystectomy 10 mo later.Despite adequate reversal of neuromuscular blockade,the patient experienced repetitive respiratory difficulty with inspiratory stridor after extubation.After the second operation,the patient was diagnosed with paradoxical vocal fold motion(PVFM)by an otolaryngologist based on the clinical features and fiberoptic bronchoscopy results,and the patient was successfully treated.CONCLUSION PVFM should be considered a differential diagnosis if a patient presents with stridor after general anesthesia.
文摘Glucose control in patient admitted to the intensive care unit has been a topic of much debate over the past 20 years.The harmful effects of uncontrolled hyperglycemia and hypoglycemia in critically ill patients is well established.Although a large clinical trial in 2001 demonstrated significant mortality and morbidity benefits with tight glucose control in this patient population,the results could not be replicated by other investigators.The“Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation”trial in 2009 established that tight glucose control was not only of no benefit,but in fact harmful due to the significant risk of hypoglycemia.The current guidelines suggest a moderate approach with the initiation of intravenous insulin therapy in critically ill patients when the blood glucose level is above 180 mg/dL.The most important factor that underpins glycemic management in intensive care unit patients is the consequent prevention of hypoglycemia.Robust glucose monitoring strategies and insulin protocols need to be implemented in order to achieve this goal.
