Journal of Anesthesia最新文献

{"title":"Letter to the article by Saito et al.","authors":"Xiaoli Zhao, Yi Deng","doi":"10.1007/s00540-026-03675-2","DOIUrl":"10.1007/s00540-026-03675-2","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"863-864"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085832","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":"Dexmedetomidine reduces acute kidney injury in high-risk but not low-risk patients after non-cardiac surgery: secondary analysis of a randomized controlled trial.","authors":"Xin-Quan Liang, Mei-Lin Li, Chun-Jing Li","doi":"10.1007/s00540-026-03661-8","DOIUrl":"10.1007/s00540-026-03661-8","url":null,"abstract":"<p><strong>Purpose: </strong>Acute kidney injury (AKI) is a significant postoperative complication associated with poor long-term outcomes. Dexmedetomidine, a selective α₂-adrenergic agonist with anti-inflammatory properties, may protect the kidney during non-cardiac surgery. This study examined whether intraoperative dexmedetomidine reduces AKI in both high-risk and low-risk patients.</p><p><strong>Methods: </strong>This was a secondary analysis of a randomized double-blind placebo-controlled trial. Patients aged ≥ 60 years scheduled for elective non-cardiac surgery expected to last ≥ 2 h under general anesthesia were enrolled and classified as low-risk or high-risk using the General Surgery Acute Kidney Injury Risk Index. Participants were randomly allocated to receive intraoperative dexmedetomidine (loading dose 0.6 μg/kg over 10 min before induction, followed by 0.5 μg/kg/h until 1 h before surgery end) or normal saline. The primary endpoint was AKI incidence within 7 postoperative days.</p><p><strong>Results: </strong>Among high-risk patients, AKI occurred in 12.6% (13/103) of the dexmedetomidine group versus 23.4% (25/107) of controls (RR 0.54, 95% CI 0.29 to 1.00, P = 0.043); after multivariable adjustment, dexmedetomidine remained independently associated with lower AKI risk (OR 0.44, 95% CI 0.20 to 0.98, P = 0.045). In contrast, low-risk patients showed no significant difference with or without dexmedetomidine (7.9% vs 9.6%; RR 0.82, 95% CI 0.44 to 1.55, P = 0.543; adjusted OR 0.65, 95% CI 0.30 to 1.38, P = 0.260). Urological surgery was an independent predictor of AKI across the entire cohort.</p><p><strong>Conclusion: </strong>Intraoperative dexmedetomidine was associated with lower risk of AKI in high-risk but not in low-risk patients undergoing non-cardiac surgery.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"726-736"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989435","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":"Reply to the letter by Xiaoli Zhao and Yi Deng.","authors":"Kurumi Saito, Hirotaka Kinoshita, Junichi Saito","doi":"10.1007/s00540-026-03702-2","DOIUrl":"10.1007/s00540-026-03702-2","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"865-866"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348376","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":"Development and validation of a clinical prediction model for postpartum hemorrhage after elective cesarean section.","authors":"Yuto Makino, Takeyuki Kiguchi, Itsuki Makino, Tomoaki Fujii, Yusuke Ota, Atsushi Terazawa, Kazumasa Hayashi, Noriko Kato, Daichi Kawaguchi, Hirokazu Uehara, Taku Iwami","doi":"10.1007/s00540-026-03671-6","DOIUrl":"10.1007/s00540-026-03671-6","url":null,"abstract":"<p><strong>Purpose: </strong>Predicting postpartum hemorrhage risk can be useful in clinical settings. We aimed to develop and validate a clinical prediction model for postpartum hemorrhage in patients who undergo elective cesarean section.</p><p><strong>Methods: </strong>This retrospective observational study included patients who underwent elective cesarean section between January 2008 and September 2021. The primary outcome to be predicted was postpartum hemorrhage, defined as blood loss of ≥ 1500 mL during surgery. We used data prior to January 2018 for the development cohort and after for the validation cohort. We then constructed a multivariate logistic regression model. The model performance, including discrimination and calibration, was evaluated and its diagnostic ability was assessed.</p><p><strong>Results: </strong>Of the 4070 patients, 860 (21.0%) had postpartum hemorrhage. The predictors were twin pregnancy, benign uterine disease, assisted reproduction, gestational diabetes mellitus, placenta previa, nulliparity, and neonatal weight > 3000 g. In the validation cohort, the prediction model C-statistic was 0.780 (95% confidence interval [CI] 0.745-0.816). We developed a simple scoring system to divide the patients into three risk groups (low, moderate, and high). If the cut-off risk score was set to moderate, the negative likelihood ratio was low (0.221, 95% CI 0.108-0.374); conversely, if the cut-off risk score was set to high, the positive likelihood ratio was high (5.882, 95% CI 3.750-9.333).</p><p><strong>Conclusion: </strong>The model we developed can stratify the risk of postpartum hemorrhage and assist in clinical decision-making. Future studies are required to validate the performance of our model.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"771-779"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052104","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":"Comments on \"Comparison of preoperative neutrophil-percentage-to-albumin ratio, systemic immune-inflammatory index, and neutrophil-to-lymphocyte ratio for predicting postoperative delirium in patients undergoing head and neck free-flap reconstruction surgery: a retrospective observational study\" by Saito et al.","authors":"Eylem Yaşar, Ali İhsan Uysal, Ozlem Sen","doi":"10.1007/s00540-026-03659-2","DOIUrl":"10.1007/s00540-026-03659-2","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"853-854"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046796","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":"Xiaofeng Granules alleviate intrathecal morphine-induced pruritus via inhibiting the NR2B/PKC/CAMK II signaling pathway.","authors":"Qiao Wang, Ming Yan, Xu Jing, Jian Sun, Weiqian Tian","doi":"10.1007/s00540-026-03663-6","DOIUrl":"10.1007/s00540-026-03663-6","url":null,"abstract":"<p><strong>Purpose: </strong>The administration of intrathecal morphine frequently induces pruritus as an adverse reaction. Xiaofeng Granules (XF) is a compound preparation improved from the ancient formula \"Xiaofeng Powder\". It has been proven to relieve skin itching caused by various reasons in clinical practice. The aim of the study was to evaluate the effect of XF on pruritus caused by intrathecal morphine and possible mechanism.</p><p><strong>Methods: </strong>Male C57BL/6 mice were intrathecally injected with morphine to induce scratching behavior. The effects of XF on intrathecal morphine-induced pruritus and analgesia were evaluated. The number of scratching response was counted within 30 min after morphine injection. The warm-water tail immersion test was conducted to measure the tail flick latency (TFL) within 120 min after morphine injection. The maximum possible effect percentage (%MPE) and area under the curve (AUC) were calculated based on TFL to evaluate the analgesic effect. Western blot was performed to evaluate the phosphorylation levels of NR2B, PKC and CAMK II in the dorsal horn of the lumbar spinal cord of mice.</p><p><strong>Results: </strong>Compared with control treatment, intrathecal morphine elicited obvious scratching response when providing analgesic effect in a dose dependent manner. Gavage administration of XF can significantly reduce intrathecal morphine-induced scratching behavior without affecting its analgesic efficiency; besides, XF can inhibit the phosphorylation of NR2B, PKC, and CAMK II induced by intrathecal morphine, which can be reversed by intrathecal injection of NMDA.</p><p><strong>Conclusions: </strong>XF can relieve intrathecal morphine-induced pruritus and may be related to the inhibition of the NR2B/PKC/CAMK II signaling pathway.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"737-748"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994429","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":"Surgical smoke exposure to patients and to healthcare workers in the operating room: a quantitative assessment.","authors":"Shuse Matsuyama, Takashi Asai, Tomoyuki Saito, Tomoki Kiyono, Yasuhisa Okuda","doi":"10.1007/s00540-026-03672-5","DOIUrl":"10.1007/s00540-026-03672-5","url":null,"abstract":"<p><strong>Background: </strong>Surgical smoke produced by the use of an electrosurgical unit may have a negative effect to patients and healthcare workers in the operating room, but studies on this problem are insufficient.</p><p><strong>Methods: </strong>In 100 situations in which patients were undergoing four types of surgery under general anesthesia, the count of airborne particles (in 1.415 L) was measured using a particle counter to see possible differences at the patients and at the anesthesiologists, during different types of surgery, and at several locations.</p><p><strong>Results: </strong>The airborne particles during the use of an electrosurgical unit were significantly higher than before its use, both at the patient's head (median: 56/L vs 3,514/L; 95%CI for the median difference: 769-7,699/L) and at the anesthesiologist's position (230/L vs 6,907/L; 95%CI for the median difference: 2,945-13,196/L) (p < 0.0001). The airborne particles were significantly higher during cardiovascular surgery than during open abdominal surgery (median difference in increase: 8,439/L), significantly higher during open abdominal surgery than during head and neck surgery (2,654/L), and significantly higher during head and neck surgery than during laparoscopic surgery (1,442/L) (all p < 0.0001), and were high anywhere in the operating room and even outside the operating room door (always > 2,000/L).</p><p><strong>Conclusions: </strong>During the use of an electrosurgical unit, both the patients and healthcare workers are at increased risk of being exposed to high concentrations of airborne particles derived from surgical smoke.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"780-789"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085851","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":"Dynamic parameter-guided goal-directed fluid therapy and postoperative acute kidney injury in non-cardiac surgery: a meta-analysis of 11 randomized controlled trials.","authors":"Xiaohua Sun, Yanfang Liu, Wanlu Ren","doi":"10.1007/s00540-026-03844-3","DOIUrl":"10.1007/s00540-026-03844-3","url":null,"abstract":"<p><p>The efficacy of goal-directed fluid therapy (GDFT) in preventing postoperative acute kidney injury (AKI) remains controversial. This meta-analysis specifically examined dynamic parameter-guided GDFT using fluid challenges alone in non-cardiac, non-transplant surgery. We systematically searched PubMed, Embase, and the Cochrane Library from inception to December 25, 2025. Randomized controlled trials comparing dynamic index-guided GDFT (SVV, PPV, or PVI) with conventional fluid management in adults undergoing major non-cardiac surgery were included. The primary outcome was postoperative AKI. Subgroup analyses by surgical site and monitoring device invasiveness were pre-specified. The GRADE framework was used to assess evidence certainty. Eleven RCTs comprising 1698 patients were included. Overall, GDFT did not significantly reduce postoperative AKI compared with conventional management (OR 0.93; 95%CI 0.59-1.45; low certainty evidence). No significant differences were observed in 180-day mortality (OR 1.30; 95%CI 0.28-5.99; very low certainty evidence) or ICU length of stay (MD -0.20 days; 95%CI -1.72 to 1.31; very low certainty evidence). GDFT was associated with significantly higher intraoperative colloid administration (MD 167.51 mL; 95% CI 36.02-299.01; very low certainty evidence), though with substantial heterogeneity. Subgroup analysis by surgical site showed no significant differences between groups. A pre-specified subgroup analysis by monitoring device invasiveness showed a significant interaction: invasive devices showed no benefit (OR 1.10; 95%CI 0.78-1.55; very low certainty evidence), while minimally invasive/non-invasive devices were associated with reduced AKI risk (OR 0.13; 95%CI 0.02-0.79; very low certainty evidence), though based on only two small studies. In this meta-analysis, dynamic parameter-guided GDFT did not significantly reduce postoperative AKI in non-cardiac, non-transplant surgery compared with conventional management (low certainty evidence). The substantial heterogeneity in colloid administration highlights variability in GDFT protocols across studies. Trial Registration: PROSPERO Registration, CRD420251274571.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"838-847"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850459","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":"Carotid flow time: a new surrogate for fluid responsiveness?","authors":"Koichi Suehiro","doi":"10.1007/s00540-026-03713-z","DOIUrl":"10.1007/s00540-026-03713-z","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"685-687"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147457536","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":"Catheter placement to the distal radial artery: its performance and clinical assessment in retrospective study.","authors":"Katsuhide Masui, Kei Takahashi, Takashi Asai","doi":"10.1007/s00540-026-03676-1","DOIUrl":"10.1007/s00540-026-03676-1","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"867-868"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275667","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}