Journal of Anesthesia最新文献

{"title":"New insights in cardiovascular anesthesia: a dual focus on clinical practice and research.","authors":"Takahiro Tamura, Yusuke Yoshikawa, Satoru Ogawa, Mitsuru Ida, Naoyuki Hirata","doi":"10.1007/s00540-024-03421-6","DOIUrl":"10.1007/s00540-024-03421-6","url":null,"abstract":"<p><p>Accumulation of the results of basic and clinical research has advanced the safety and quality of management in cardiovascular anesthesia. To address recent developments in this field, a symposium was held during the 71th Japanese Society of Anesthesiologists annual meetings in 2024, focusing on new advancements in both clinical and basic research in cardiovascular anesthesia. During this symposium, four experts reviewed recent findings in their respective areas of study, covering the following topics: clinical reliability and concerns regarding volatile anesthetics during cardiopulmonary bypass; novel basic and clinical findings regarding the cardioprotective effects of dexmedetomidine; advancements in optimizing blood and hemostasis management during cardiovascular surgery; and innovative strategies for managing postoperative cognitive disorders following cardiovascular and thoracic surgery. Each expert summarized recent novel findings, clinical reliability and concerns, as well as future directions in their respective topics. We believe that this special article provides valuable insights into both clinical practice and basic research in cardiovascular anesthesia while also inspiring anesthesiologists to pursue further research in this field.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"117-122"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Margin of safety for needle puncture of a radial artery in children: Recommendation for ultrasound-guided cannulation.","authors":"Kazuyoshi Furuta, Takashi Asai, Hiroaki Suzuki, Shunsuke Saima, Yasuhisa Okuda","doi":"10.1007/s00540-024-03419-0","DOIUrl":"10.1007/s00540-024-03419-0","url":null,"abstract":"<p><strong>Background: </strong>The radial artery is commonly selected for arterial puncture and cannulation, but radial nerve palsy may occur. To minimize possible damage to the nerve, needle puncture should be made within the margin of safety (between the wrist to the distal end of the radial artery and the radial nerve running in parallel). In adults, the margin of safety for radial artery puncture is approximately 6.8 cm from the wrist in men and approximately 5.4 cm in women, but the margin of safety is not known in children of different age groups.</p><p><strong>Methods: </strong>Using an ultrasound device, we measured the margin of safety in 100 anesthetized patients aged 0 months to 15 yr. Polynomial quadratic regression models were made, and the lower limit of the prediction interval was regarded as the margin of safety. These results were then compared with the results obtained in adults.</p><p><strong>Results: </strong>The margin of safety became wider as a child grows older, and the height, weight, and age were all suitable explanatory variables to predict the margin of safety, providing fairly a constant predicted margin of safety from a few millimeters in neonates to approximately 4 cm in adolescents (much narrower than in adults).</p><p><strong>Conclusions: </strong>In children and adolescents, the margin of safety for radial artery puncture is much narrower than in adults, and these findings support the recommendation to use ultrasound guidance during radial artery puncture in children and adolescents, to minimize the risk of associated complications.</p><p><strong>Clinical trial registration: </strong>jRCT1032230243.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"41-48"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Violations of protocols of non-inferiority trials occur frequently.","authors":"Raghuraman M Sethuraman","doi":"10.1007/s00540-024-03391-9","DOIUrl":"10.1007/s00540-024-03391-9","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"153-154"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasopressors for hypotension in spinal anesthesia for cesarean section.","authors":"Anna Maria Biava, Gianni Cipriani, Endrit Malja, Federico Bilotta","doi":"10.1007/s00540-024-03392-8","DOIUrl":"10.1007/s00540-024-03392-8","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"155-156"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"May fascial blocks reduce chronic pain in Uniportal-VATS? Comment on \"Uniportal video-assisted thoracic surgery versus open thoracotomy for chronic pain after surgery: a prospective cohort study\".","authors":"Punzo Giovanni, Nachira Dania","doi":"10.1007/s00540-024-03382-w","DOIUrl":"10.1007/s00540-024-03382-w","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"147-148"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative hypoxic biomarkers and postoperative delirium in patients with obstructive sleep apnea.","authors":"Martin Breitkopf, Elena Ahrens, Matthias L Herrmann, Stephanie Heinemann, Olivia Kuester, Haobo Ma, Andreas Walther, Christine Thomas, Gerhard W Eschweiler, Christine A F von Arnim, Soeren Wagner","doi":"10.1007/s00540-024-03417-2","DOIUrl":"10.1007/s00540-024-03417-2","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative delirium (POD) in patients with obstructive sleep apnea (OSA) is associated with increased mortality and healthcare costs. In this study, we investigated the association of OSA risk, serum biomarkers for central nervous ischemia (S100B and NSE), and POD.</p><p><strong>Methods: </strong>After research ethics approval, patients completed the STOP BANG assessment before undergoing elective surgery. Blood was drawn for S100B and NSE measurement, and cognitive performance was tested using the Montreal Cognitive Assessment (MoCA) at study admission and postoperatively at discharge. Delirium assessment was performed using the Nursing Delirium Screening Scale (NuDESC) and the Confusion Assessment Method (CAM).</p><p><strong>Results: </strong>One hundred twenty-four enrolled patients were separated into three OSA-risk groups based on STOP BANG score testing (low risk, n = 22; intermediate risk, n = 67; high risk, n = 35). Preoperative NSE values increased with OSA risk (NSE in ng/ml; mean [range]; low risk: 15.6 [9.2-44.3]; intermediate risk: 21.8 [7.6-114.1]; high risk: 29.2 [10.1-151]; p = 0.039). Postoperative MoCA and NuDESC assessments were not different between the OSA-risk groups. We found a decreasing incidence for POD with increasing OSA risk (positive CAM: low risk: 18.1%, intermediate risk: 12.0%; high risk: 11.5%, p = 0.043). However, this was no longer detectable in a complete case analysis. In patients with POD, postoperative ischemic biomarker values were not different between OSA-risk groups.</p><p><strong>Conclusion: </strong>We found a trend of decreasing POD incidence with increasing OSA risk, which was not robust in a complete case analysis. Our results possibly support the phenomenon of hypoxic preconditioning.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"31-40"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of low-dose sevoflurane with propofol-based anesthesia on motor-evoked potentials in infants: a single-arm crossover pilot study.","authors":"Taiki Kojima, Hirofumi Nakahari, Makoto Ikeda, Michihiro Kurimoto","doi":"10.1007/s00540-024-03436-z","DOIUrl":"10.1007/s00540-024-03436-z","url":null,"abstract":"<p><strong>Purpose: </strong>The influence of anesthetic interactions on motor-evoked potentials in infants has rarely been reported. In infants, adding a small dose of sevoflurane to propofol-based total intravenous anesthesia is reasonable for reducing propofol administration. We collected preliminary data regarding the effect of low-dose sevoflurane in propofol-based total intravenous anesthesia on motor-evoked potentials in infants.</p><p><strong>Methods: </strong>This pilot interventional study included 10 consecutive infants requiring motor-evoked potentials between January 2023 and March 2024. The motor-evoked potential amplitudes in the upper and lower extremities were recorded twice when general anesthesia was maintained using (1) propofol-based total intravenous anesthesia and (2) 0.1-0.15 age-adjusted minimum alveolar concentration sevoflurane + propofol-based total intravenous anesthesia.</p><p><strong>Results: </strong>The motor-evoked potential amplitude in the right upper extremity was not significantly different after the addition of a small dose of sevoflurane [192 (75.3-398) μV, 121 (57.7-304) μV, P = 0.19]. All the motor-evoked potential amplitudes in the right lower extremity (quadriceps femoris, anterior tibialis, and gastrocnemius muscles) were significantly attenuated by adding a small dose of sevoflurane (median [interquartile range]: 47.9 [35.4-200] μV, 25.2 [12.4-55.3] μV, P = 0.014; 74.2 [51.9-232] μV, 31.2 [2.7-64] μV, P = 0.0039; 29.8 [20-194] μV, 9.9 [3.8-92.4] μV, P = 0.0039, respectively). Similar results were observed in the left lower extremities.</p><p><strong>Conclusion: </strong>Adding even 0.1-0.15 age-adjusted minimum alveolar concentration sevoflurane to propofol-based total intravenous anesthesia attenuated the motor-evoked potential amplitudes in the lower extremities. A further prospective interventional study with an appropriate sample size is required to investigate the study hypothesis.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"93-100"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of restrictive versus liberal fluid therapy for laparoscopic gastric surgery on postoperative complications: a randomized controlled trial.","authors":"Yusuke Kusaka, Takeshi Ueno, Toshiaki Minami","doi":"10.1007/s00540-024-03439-w","DOIUrl":"10.1007/s00540-024-03439-w","url":null,"abstract":"<p><strong>Purpose: </strong>Currently, laparoscopic surgery is a standard technique in the field of abdominal surgery. However, the most adequate fluid regimen during laparoscopic surgery remains unclear. The aim of this trial is to compare a restricted fluid therapy with a liberal fluid therapy for laparoscopic abdominal surgery. Our hypothesis was that restrictive fluid therapy would reduce postoperative complications better than liberal fluid therapy.</p><p><strong>Method: </strong>In this randomized controlled trial, patients scheduled for laparoscopic gastric surgery were randomized to either the liberal group (receiving 7-10 ml/kg/h of crystalloid) or the restrictive group (receiving 1-2 ml/kg/h of crystalloid) for each stratum of surgical procedure from April 2017 to March 2019. For both groups, blood loss was replaced by an equal volume of hydroxyethyl starch. The primary endpoint was postoperative complications up to 30 days after surgery, according to the Clavien-Dindo classification.</p><p><strong>Results: </strong>We enrolled 148 patients, and 140 of these were randomized to either the liberal or the restrictive group after exclusion. As a result, 69 cases were included in the liberal group for analysis, and 67 patients composed the restrictive group. Median fluid administration for the liberal and restrictive groups was 2950 ml and 800 ml, respectively. As well, overall complications in the liberal and restrictive groups were 27.5% and 19.4%, respectively (risk ratio 0.71, 95% confidence interval 0.38-1.31, p value = 0.264).</p><p><strong>Conclusion: </strong>Restricted fluid therapy and liberal fluid therapy did not show any statistical differences in postoperative complications after laparoscopic gastric surgery.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"101-110"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesia mode after cesarean section: PCEA or EM?","authors":"Liang Sun, Xiaoning Li, Yanchao Yang, Yi Feng","doi":"10.1007/s00540-024-03381-x","DOIUrl":"10.1007/s00540-024-03381-x","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"146"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of frailty on opioid consumption after total knee arthroplasty.","authors":"Mehmet Sargin, Sinan Degirmencioglu, Mehmet S Uluer, Faruk Cicekci, İnci Kara","doi":"10.1007/s00540-024-03420-7","DOIUrl":"10.1007/s00540-024-03420-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the effects of frailty on postoperative opioid consumption in elderly patients.</p><p><strong>Methods: </strong>Patients aged 65 and older scheduled for unilateral primary total knee arthroplasty under spinal anesthesia were included. A blinded anesthesiologist assessed patients using the FRAIL scale during the preoperative visit, classifying them into robust (Group I), pre-frail (Group II), and frail (Group III) categories. The main outcome measure was total opioid consumption over 24 h. Opioid consumption was recorded at 6 (T1), 12 (T2) and 24 (T3) hours postoperatively. Secondary outcomes included visual analog pain scores (VAS) at rest (VAS-R) and during 45° knee flexion (VAS-F), as well as postoperative nausea and vomiting.</p><p><strong>Results: </strong>Seventy-five patients were included in the study, with seventy-three completing it and two being excluded. Total opioid consumption was significantly higher in Groups II and III compared to Group I (p < 0.001 for both). There were no significant differences in VAS-R scores between groups at T0, T1, T2, and T3 (p = 0.659, p = 0.425, p = 0.994, and p = 0.689, respectively), and no significant differences in VAS-F scores at the same time points (p = 0.580, p = 0.739, p = 0.322, and p = 0.679, respectively).</p><p><strong>Conclusion: </strong>Our study results indicate that frailty, easily assessed preoperatively in elderly surgical patients, is a significant predictor of postoperative opioid consumption.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"49-55"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}