A quest to increase safety of anesthetics by advancements in anesthesia monitoring: scientometric analysis

Abstract

The aim of this study was to assess progress in the field of anesthesia monitoring over the past 40 years using scientometric analysis. The following scientometric indexes were used: popularity indexes (general and specific), representing the proportion of articles on either a topic relative to all articles in the field of anesthetics (general popularity index, GPI) or the subfield of anesthesia monitoring (specific popularity index, SPI); index of change (IC), representing the degree of growth in publications on a topic from one period to the next; and index of expectations (IE), representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed. Publications on 33 anesthesia-monitoring topics were assessed. Our analysis showed that over the past 40 years, the rate of rise in the number of articles on anesthesia monitoring was exponential, with an increase of more than eleven-fold, from 296 articles over the 5-year period 1974-1978 to 3,394 articles for 2009-2013. This rise profoundly exceeded the rate of rise of the number of articles on general anesthetics. The difference was especially evident with the comparison of the related GPIs: stable growth of the GPI for anesthesia monitoring vs constant decline in the GPI for general anesthetics. By the 2009-2013 period, among specific monitoring topics introduced after 1980, the SPI index had a meaningful magnitude (≥1.5) in 9 of 24 topics: Bispectral Index (7.8), Transesophageal Echocardiography (4.2), Electromyography (2.8), Pulse Oximetry (2.4), Entropy (2.3), Train-of-four (2.3), Capnography (1.9), Pulse Contour (1.9), and Electrical Nerve Stimulation for neuromuscular monitoring (1.6). Only one of these topics (Pulse Contour) demonstrated (in 2009-2013) high values for both IC and IE indexes (76 and 16.9, respectively), indicating significant recent progress. We suggest that rapid growth in the field of anesthetic monitoring was one of the most important developments to compensate for the intrinsically low margins of safety of anesthetic agents.

Keywords: anesthesia-related morbidity; anesthesia-related mortality; anesthetics; general anesthesia; regional anesthesia.

Figure 1

Five-year growth of all articles on anesthesia monitoring. Notes:^↑Indicates the time of initial growth in publications on a related specific topic of anesthesia monitoring. *Indicates the topic of electrical nerve stimulation for neuromuscular monitoring.

Figure 2

Ten-year changes* of GPI for two fields of publications: general anesthetics and anesthesia monitoring. Notes: GPI represents the share of articles in a field relative to all articles on anesthetics during a 10-year period. *Compared to GPI for the same field over the previous 10 years. Abbreviation: GPI, general popularity index.

Figure 3

General topics of anesthesia monitoring introduced before 1980. Note: SPI represents the share of articles on a topic relative to all articles on anesthesia monitoring during a 5-year period. Abbreviation: SPI, specific popularity index.

Figure 4

Most prominent specific topics of anesthesia monitoring introduced after 1980. Note: SPI represents the share of articles on a topic relative to all articles on anesthesia monitoring during a 5-year period. Abbreviation: SPI, specific popularity index.