Journal of Anesthesia最新文献

{"title":"Comments on the article \"Relationship between age and blood pressure reduction during induction of general anesthesia with remimazolam: an observational study\" by Osawa et al.","authors":"Yueh-Hsun Chuang, Wei-Ling Chang, Ming-Hui Hung","doi":"10.1007/s00540-026-03886-7","DOIUrl":"10.1007/s00540-026-03886-7","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897178","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":"Interpreting perioperative oliguria during sevoflurane anesthesia: excretory physiology, fluid responsiveness, and renal endpoints.","authors":"Éverton Victor Belmiro da Silva, Luiggi Kevin Virgino Brandão, Lara Reis Gomes de Mello Queiroz, Gabriel Rian Mazur, Gabriela Wander Fossati, Giovana Custódio Molinari, Gustavo Henrique Biondo de Oliveira, Camilla Cristina Silva Fernandes, Guilherme Cerqueira Colombo, Lucas Maciel de Almeida Corrêa","doi":"10.1007/s00540-026-03847-0","DOIUrl":"https://doi.org/10.1007/s00540-026-03847-0","url":null,"abstract":"<p><p>Perioperative oliguria is a renal signal during anesthesia, but its automatic interpretation as acute kidney injury may misclassify renal endpoints in anesthetic research. The available evidence is strongest for sevoflurane rather than for volatile anesthetics as a homogeneous class. Small mechanistic and randomized clinical studies suggest that sevoflurane can reduce urine output and natriuresis and increase renin activity compared with propofol-based total intravenous anesthesia, consistent with renal sympathetic and renin-angiotensin-aldosterone system-mediated sodium and water retention. However, these excretory differences have not been consistently accompanied by parallel increases in tubular injury biomarkers or by uniform differences in creatinine-defined or patient-centered kidney outcomes. Therefore, sevoflurane-associated oliguria should be interpreted as a context-dependent renal signal rather than as either benign physiology or definite kidney injury. This narrative review proposes a layered approach that separates excretory physiology, creatinine-defined functional acute kidney injury, tubular stress or injury biomarkers, and patient-centered kidney outcomes. The framework is intended as an analytical aid, not as a validated diagnostic or treatment algorithm. Its practical implication is that oliguria during sevoflurane anesthesia should prompt reassessment of perfusion, venous congestion, anesthetic exposure, baseline kidney risk, and postoperative trajectory before reflexive fluid administration or automatic labeling as acute kidney injury.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887666","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":"Central venous catheter tip position and risk of mechanical complications: a systematic review and meta-analysis.","authors":"Eriya Imai, Hiromu Okano, Mitsutaka Edanaga, Yoshimasa Takeda, Michiaki Yamakage, Joho Tokumine","doi":"10.1007/s00540-026-03883-w","DOIUrl":"https://doi.org/10.1007/s00540-026-03883-w","url":null,"abstract":"<p><p>The optimal central venous catheter (CVC) tip position remains controversial. Shallow placement above the pericardial reflection was recommended to avoid cardiac tamponade, whereas recent practice has favored positioning near the cavo-atrial junction (CAJ) to reduce risks of thrombosis and catheter dysfunction. We compared complications across tip positions: Zone A (CAJ/lower superior vena cava [SVC]/upper right atrium), Zone B (upper SVC), and Zone C (left brachiocephalic vein). We searched MEDLINE, Embase, CENTRAL, Ichushi-Web, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to January 2026. We included randomized and non-randomized studies comparing CVC tip positions in adults. Two reviewers screened studies and assessed risk of bias. Random-effects meta-analyses synthesized adjusted odds ratios (ORs) and crude risk ratios (RRs). Certainty was assessed using GRADE. Fifteen studies (9,589 participants; 9,815 catheters) were included. Compared with Zone B, Zone A probably reduces catheter-related thrombosis in adjusted analyses (OR 0.17; 95% confidence interval [CI] 0.05-0.59) and may reduce thrombosis in crude analyses (RR 0.14; 95% CI 0.03-0.55). Zone A may also reduce the risk of catheter occlusion or dysfunction compared with Zone B (RR 0.44; 95% CI 0.23-0.82). For thrombosis, Zone C may show little-to-no difference compared with Zone B, whereas the comparison between Zones C and A is highly uncertain. Mortality and cardiac tamponade were not estimable. CAJ positioning (Zone A) may lower thrombosis and catheter dysfunction compared with upper SVC positioning (Zone B). Evidence on rare severe complications remains uncertain. TRIAL REGISTRATION: PROSPERO (CRD420261292506).</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891645","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 predictive performance of the Marsh model for propofol target-controlled infusion during laparoscopic surgery with liver retraction.","authors":"Takuya Ogawa, Shinju Obara, Keisuke Kuwana, Satoki Inoue","doi":"10.1007/s00540-026-03887-6","DOIUrl":"10.1007/s00540-026-03887-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate whether CO₂ pneumoperitoneum and liver retraction affect predictive performance of the Marsh pharmacokinetic model for propofol target-controlled infusion (TCI) during laparoscopic or robot-assisted gastrectomy.</p><p><strong>Methods: </strong>Adult patients undergoing elective laparoscopic or robot-assisted gastrectomy were enrolled. Arterial blood samples were collected at predefined intraoperative time points, and plasma propofol concentration (Cp) was measured by high-performance liquid chromatography. Performance error (PE), median PE (MDPE), median absolute PE (MDAPE), wobble, and divergence were calculated. Associations between PE and procedural factors, time after anesthetic induction, and cardiac index (CI) were evaluated using linear mixed-effects models. Finally, an exploratory PE-correction equation was internally evaluated by leave-one-patient-out cross-validation.</p><p><strong>Results: </strong>A total of 155 measurements from 16 patients were analyzed. The overall MDPE and MDAPE were 10.2 and 20.4%, respectively. In the fully adjusted model, liver retraction was associated with a 10.0-percentage-point higher PE (95% confidence interval, 1.3 to 18.7), whereas each 1 L/min/m2 decrease in CI was associated with a 16.4-percentage-point increase in PE (95% confidence interval, 6.1 to 26.6). PE decreased by 3.3 percentage points/h after anesthetic induction. Pneumoperitoneum and head-up positioning were not independently associated with PE. The exploratory PE-correction equation improved prediction metrics in internal validation.</p><p><strong>Conclusion: </strong>The Marsh model showed an overall positive bias within conventional MDPE and MDAPE thresholds. Higher PE was associated with liver retraction, lower CI, and earlier time after anesthetic induction, whereas pneumoperitoneum was not independently associated with PE after adjustment.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880567","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":"Comment on \"Esketamine versus dexmedetomidine fora oxygenation and postoperative quality of recovery in thoracoscopic surgery: a randomized, double‑blind, non-inferiority controlled trial\" by Feng et al.","authors":"Jie Liu, Zhimin Sheng","doi":"10.1007/s00540-026-03882-x","DOIUrl":"10.1007/s00540-026-03882-x","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880521","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":"Neuromuscular blockade during pulsed field ablation: interpreting peripheral neuromuscular monitoring and PFA-synchronous respiratory waveforms.","authors":"Tomoyuki Saito","doi":"10.1007/s00540-026-03885-8","DOIUrl":"https://doi.org/10.1007/s00540-026-03885-8","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874041","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":"Airway-derived mechanical power and postoperative pulmonary complications in obese adults undergoing laparoscopic bariatric surgery: a secondary analysis of a randomised trial.","authors":"Ke Chen, Cunyan Dou, Suli Wang, Zihui Xu, Lianjie Dou, Yonghong Zhang, Yao Lu","doi":"10.1007/s00540-026-03880-z","DOIUrl":"https://doi.org/10.1007/s00540-026-03880-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine the associations of participant-level mean airway-derived total and dynamic mechanical power with postoperative pulmonary complications (PPCs) after laparoscopic bariatric surgery in adults with obesity, and to characterise the intraoperative trajectories of power components.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a secondary analysis of a single-centre, parallel-group randomised trial in 160 adults with obesity undergoing laparoscopic bariatric surgery. Mechanical power was calculated at four predefined intraoperative timepoints (T1-T4). Mean dynamic mechanical power (MP_dynamic) was the primary exposure and mean total mechanical power (MP_total) was the key secondary exposure. For both exposures, the primary analysis used multivariable logistic regression across quartiles, with Q1 as the reference. Quartile-based modelling was selected after exploratory assessment indicated departure from linearity and because quartile categories provide clinically interpretable event rates and adjusted odds ratios. This analytic hierarchy was not prespecified in the parent-trial protocol and was defined post hoc after assessment of the observed exposure-outcome form. Restricted cubic spline analysis of mean MP_dynamic was supportive, and continuous per-standard-deviation models for both exposures were sensitivity analyses of a linear association. Models were adjusted for randomised group, age, sex, BMI, surgery duration, smoking status, diagnosed obstructive sleep apnoea (OSA), and asthma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The individualised strategy reduced mean MP_dynamic (6.42 ± 1.21 vs 6.99 ± 1.11 J/min; mean difference -0.57, 95% CI -0.93 to -0.21; p = 0.002) and increased mean MP_total (12.61 ± 2.48 vs 11.79 ± 1.96 J/min; mean difference +0.82, 95% CI +0.12 to +1.51; p = 0.022). PPCs occurred in 36/160 patients (22.5%). MP_dynamic quartiles showed no statistically significant association with PPCs (global p = 0.575). Mean MP_total showed an inverted U-shaped association: adjusted PPC odds were higher in Q2 (OR 4.74, 95% CI 1.32-17.01; p = 0.017) and Q3 (OR 3.91, 95% CI 1.12-13.60; p = 0.032) than in Q1, with no further increase in Q4 (OR 2.39, 95% CI 0.63-9.13; p = 0.201; global p = 0.061). Continuous sensitivity analyses showed no linear association for mean MP_dynamic (OR 1.10 per SD, 95% CI 0.73-1.65) or mean MP_total (OR 1.15 per SD, 95% CI 0.76-1.73).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Mean MP_dynamic showed no statistically significant association with PPCs. In contrast, mean MP_total showed an inverted U-shaped association with PPC risk, with higher adjusted odds in the second and third quartiles and no further increase in the highest quartile. This pattern may partly reflect the opposing physiological implications of potentially injurious dynamic energy and PEEP-related energy delivered during lung-protective recruitment. MP_total combines components with different and potentially opposing physiological i","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874115","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":"Association between body mass index z-score and hypoxemia during pediatric dental sedation: a retrospective cohort study.","authors":"Ali Sevgili, Sinan Değirmencioğlu","doi":"10.1007/s00540-026-03879-6","DOIUrl":"https://doi.org/10.1007/s00540-026-03879-6","url":null,"abstract":"<p><strong>Purpose: </strong>Evidence regarding the effect of body habitus on respiratory safety during pediatric dental sedation remains limited. This study investigated the association between age- and sex-standardized body mass index (BMI) z-score and new-onset intraoperative hypoxemia in children undergoing dental treatment under deep sedation.</p><p><strong>Methods: </strong>We retrospectively reviewed children aged 2-10 years who underwent comprehensive dental treatment under propofol-ketamine-based deep sedation at a single dental hospital between July 2024 and February 2026. The primary outcome was new-onset intraoperative hypoxemia, defined as a sustained decrease in SpO₂ to <95% for ≥10 s. Multivariable logistic regression was used to evaluate the association between BMI z-score category and hypoxemia.</p><p><strong>Results: </strong>The final analysis included 512 children; 273 (53.3%) developed new-onset intraoperative hypoxemia. Compared with normal-weight children, overweight/obese children had higher odds of hypoxemia in the multivariable model (odds ratio [OR] 3.393, 95% confidence interval [CI] 1.596-7.213; p = 0.002). Underweight status was not associated with hypoxemia. Longer procedure duration was also associated with higher odds of hypoxemia (OR 1.116, 95% CI 1.083-1.150; p < 0.001). Ketamine and total propofol doses were not associated with the primary outcome. A post hoc sensitivity analysis using a more stringent definition of hypoxemia (SpO₂ <90%) yielded consistent results.</p><p><strong>Conclusion: </strong>Overweight/obese status was independently associated with new-onset intraoperative hypoxemia during pediatric dental sedation. Longer procedure duration also emerged as an associated procedural factor. These findings may support individualized respiratory vigilance in children with increased body mass during shared-airway dental sedation.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849943","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":"High-flow nasal oxygen in a sedated patient with hypoxemia undergoing balloon kyphoplasty in the prone position.","authors":"Reika Koganei, Kei Takahashi, Katsuhide Masui, Takashi Asai","doi":"10.1007/s00540-026-03874-x","DOIUrl":"https://doi.org/10.1007/s00540-026-03874-x","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793082","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":"Efficacy of suprapubic hot compress in preventing emergence agitation in patients with indwelling urinary catheters under general anesthesia: a randomized controlled trial.","authors":"Zhipeng Xu, Yiting Wang, Min You, Lei Dai, Shiwei Tang, Jing You, Peng Jiang","doi":"10.1007/s00540-026-03872-z","DOIUrl":"https://doi.org/10.1007/s00540-026-03872-z","url":null,"abstract":"<p><strong>Purpose: </strong>Catheter-related bladder discomfort (CRBD), a major trigger of emergence agitation (EA), is common in patients with indwelling urinary catheters under general anesthesia, with limited effective non-pharmacological options. This study evaluated whether suprapubic hot compress reduces CRBD and EA in this population.</p><p><strong>Methods: </strong>In this prospective single-center randomized controlled trial, elective surgery patients with intraoperative urinary catheterization were randomly assigned to the hot compress group or control group. The intervention group received 20 min of continuous suprapubic hot compress at 40-50 °C postoperatively; controls received an identical room-temperature placebo pack at the same site. The primary outcome was CRBD score (4-point scale, assessed at 30 min and 2 h after awakening). Secondary outcomes included EA incidence (Riker Sedation-Agitation Scale ≥ 5), comfort score, shivering, awakening duration, urine output, and catheter-related complications.</p><p><strong>Results: </strong>A total of 217 patients were included (109 in hot compress group, 108 in controls). CRBD scores at 30 min and 2 h were significantly lower in the hot compress group (both P < 0.001). EA incidence was 7.3% in the intervention group versus 56.5% in controls (P < 0.001). Hot compress improved post-extubation comfort scores at 20 min and 2 h (both P < 0.001) and reduced shivering incidence (0% vs 7.4%, P = 0.011). No significant between-group differences were found in awakening duration, urine output, or 24-h catheter-related complications.</p><p><strong>Conclusion: </strong>Suprapubic hot compress relieves CRBD symptoms, reduces EA incidence, improves early postoperative comfort, and prevents shivering after general anesthesia. This simple, safe non-pharmacological intervention is suitable for widespread clinical use.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793489","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}