Journal of Clinical Anesthesia最新文献

{"title":"Characteristics of anesthesia program that graduating medical students find important: A cross-sectional survey","authors":"Geoffrey Hayward ,&nbsp;Mark C. Kendall ,&nbsp;Danny Bui ,&nbsp;Zachary Gandee ,&nbsp;Tyler Jacobsen ,&nbsp;Joshua Tanzer ,&nbsp;Gildasio De Oliveira","doi":"10.1016/j.jclinane.2025.111791","DOIUrl":"10.1016/j.jclinane.2025.111791","url":null,"abstract":"<div><h3>Background</h3><div>Applying to residency programs and constructing a rank order list is a challenging process and is a vital task that fourth year medical students must undergo each year. The aim of our study was to identify common themes in what residency applicants are considering when applying to an anesthesiology program and compare them between male and female applicants.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was distributed to all 1447 medical students who applied to the Brown University Anesthesiology residency program for the 2022 National Residency Matching Program (NRMP). The survey consisted of 53 questions designed to assess the factors that candidates deem important when ranking a residency program highly. Exploratory factor analysis was performed to determine the item-factor assignment. Confirmatory analysis was done to test the associations between the average scores for each of the identified factors. Associations and average scores among male and female responders were explored.</div></div><div><h3>Results</h3><div>922 medical students completed the survey with a response rate of 63.7 %. An exploratory factor analysis (<em>n</em> = 457) performed on a random split sample (RSS) revealed a 45-item, seven-factor structure consisting of the following themes: exposure, teaching quality, gender and racial diversity, financial considerations, work life balance, prestige, and living in the same area. A confirmatory factor analysis was performed for the seven-factor model on the second RSS (<em>n</em> = 465). The model demonstrated adequate fit (Comparative Fit Index, CFI = 0.90, root mean square error of approximation [RIMSEA] = 0.085). Post hoc modification significantly improved the model fit (CFI = 0.98, RMSEA = 0.057).</div></div><div><h3>Conclusion</h3><div>Anesthesia applicants prioritize clinical exposure, teaching quality, diversity, and practical training factors like simulation and POCUS training. In addition, applicants also weigh financial considerations and work-life balance heavily in their ranking of anesthesia programs. Understanding these preferences can help anesthesia programs effectively market their programs to improve recruitment outcomes and to attract top applicants.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111791"},"PeriodicalIF":5.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns in comparing supraglottic and subglottic jet ventilation: Duration, monitoring, and patient selection matter","authors":"Xiaoyan Huang,&nbsp;Rong Qian","doi":"10.1016/j.jclinane.2025.111789","DOIUrl":"10.1016/j.jclinane.2025.111789","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111789"},"PeriodicalIF":5.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between baseline cerebral oxygenation and postoperative outcomes in older noncardiac surgical patients: An exploratory observational study","authors":"Mariana Thedim M.D. ,&nbsp;Maria J. Susano M.D., Ph.D. ,&nbsp;Francisco S. Seixas M.D. ,&nbsp;Sérgio Vide M.D., Ph.D. ,&nbsp;Susana Vacas M.D., Ph.D. ,&nbsp;Pedro Amorim M.D.","doi":"10.1016/j.jclinane.2025.111806","DOIUrl":"10.1016/j.jclinane.2025.111806","url":null,"abstract":"<div><h3>Background</h3><div>Universal risk assessment strategies are needed to enhance perioperative care, especially for vulnerable patients at increased risk for adverse postoperative outcomes. Lower baseline regional cerebral oxygen saturation (rSO₂) was previously associated with increased mortality in cardiac surgical patients. We hypothesised that lower baseline rSO₂ could be a surrogate of increased vulnerability to adverse postoperative outcomes in older noncardiac surgical patients.</div></div><div><h3>Methods</h3><div>We conducted an exploratory secondary analysis of a prospective observational cohort study. Patients over 65 years scheduled for elective noncardiac surgery between 2017 and 2019 were included. Unilateral baseline rSO₂ was measured upon admission to the surgical ward. Our primary outcomes were morbidity and mortality rates within 30 days of the surgical procedure.</div></div><div><h3>Results</h3><div>Among 254 analysed patients (median [25th percentile, 75th percentile] age 73 [68, 78], 65 % males), 17 (7 %) were readmitted to the hospital within 30 days after surgery, and five died in this period (2 %). Baseline rSO₂ values were significantly associated with readmission (mean (SD), 58 (10) vs 65 (8), <em>P</em> = 0.003) and mortality (mean (SD), 51 (15) vs 64 (8), <em>P</em> &lt; 0.001). Mortality prediction based on baseline rSO₂ revealed an AUC of 0.801 (<em>p</em> = 0.021).</div></div><div><h3>Conclusions</h3><div>The utility of baseline rSO₂ as a biomarker of adverse postoperative outcomes can potentially extend to noncardiac surgical patients, especially for older populations.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111806"},"PeriodicalIF":5.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of prone positioning in patients undergoing extracorporeal membrane oxygenation (ECMO): A systematic review and meta-analysis","authors":"Po-Huang Chen M.D ,&nbsp;Cho-Hao Lee M.D ,&nbsp;Wei-Ting Yen M.D ,&nbsp;Chiao-Chin Lee M.D ,&nbsp;Hong-Jie Jhou M.D ,&nbsp;Chen-Shu Wu M.D ,&nbsp;Wen-Yu Lin M.D","doi":"10.1016/j.jclinane.2025.111786","DOIUrl":"10.1016/j.jclinane.2025.111786","url":null,"abstract":"<div><h3>Background</h3><div>Acute respiratory distress syndrome (ARDS) is a severe lung condition characterized by diffuse alveolar damage and hypoxemia. Venovenous extracorporeal membrane oxygenation (vv-ECMO) supports gas exchange and reduces ventilator-induced injury, while prone positioning (PP) improves oxygenation by optimizing ventilation-perfusion matching.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis, following PRISMA guidelines, using MEDLINE, Embase, and the Cochrane Library. Studies included were on adult ARDS patients undergoing vv-ECMO with PP. Outcomes measured were survival rates, ECMO weaning, duration of ECMO support, mechanical ventilation, ICU and hospital stays, and complications.</div></div><div><h3>Results</h3><div>Seventeen studies met inclusion criteria. While ECMO+PP improved 30-day and hospital survival rates, there was no significant improvement in 60-day survival, 90-day survival, ICU survival, or ECMO weaning rates. ECMO+PP significantly enhanced oxygenation parameters and reduced PaCO2 levels. Earlier and more frequent PP sessions shortened mechanical ventilation and ICU stays. Non-COVID patients had better 30-day survival with ECMO+PP than COVID patients.</div></div><div><h3>Conclusions</h3><div>Combining PP with ECMO improves early but not long-term survival in severe ARDS, especially in non-COVID patients, while extending duration of mechanical support and stays. Further prospective randomized trials are needed to confirm these findings.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111786"},"PeriodicalIF":5.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probiotics as a possible novel therapeutic option to mitigate perioperative neurocognitive disorders: A review exploring the latest research findings","authors":"Smita Horill,&nbsp;Xiao-Kai Zhou,&nbsp;Wenjie Jin","doi":"10.1016/j.jclinane.2025.111801","DOIUrl":"10.1016/j.jclinane.2025.111801","url":null,"abstract":"<div><div>Perioperative neurocognitive disorders (PND) refer to a constellation of symptoms that primarily affect the elderly and typically manifest as common complications after exposure to surgery and anesthesia. PND is associated with high morbidity, mortality, and progression to neurodegenerative diseases, thus exerting significant financial strains on families as well as the healthcare system. Given that an ageing global population is an inevitable trend and, with the latest advances in the healthcare system, an ever-growing number of elderly people present for surgery and anesthesia, PND is of prominent concern.</div><div>The two-way communication between the intestinal flora and the brain, also known as the microbiota-gut-brain axis, plays an important role in central nervous system development, and multiple studies have highlighted the influence exerted by gut microbiome in both health and disease. Pertinent studies have corroborated the fact that anesthesia and surgery disrupt the harmony of the gut ecology, which sets off a cascade of events that initiate neuroinflammation, eventually leading to PND. Probiotics, which are live microorganisms that promote the host's health, have been shown as a viable option to restore or minimise the disruption of gut flora. Evidence exists that probiotics exhibit immunomodulatory and anti-inflammatory benefits. Given the effectiveness of probiotics in reducing neuroinflammation, research has also focused on their impact on the development of PND.</div><div>This review aims to compile the data from relevant clinical trials focusing on the influence of probiotics on PND to determine whether the derived findings might be applied for the prevention and treatment of PND.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111801"},"PeriodicalIF":5.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on “Postoperative delirium under general anesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomised controlled trials”","authors":"Hsiu-Lan Weng,&nbsp;Ping-Hsin Liu","doi":"10.1016/j.jclinane.2025.111788","DOIUrl":"10.1016/j.jclinane.2025.111788","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111788"},"PeriodicalIF":5.0,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(25)00055-8","DOIUrl":"10.1016/S0952-8180(25)00055-8","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111795"},"PeriodicalIF":5.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The framework of chronic pain management: Redefining the outcomes","authors":"Lisa Goudman Ph.D ,&nbsp;Maarten Moens M.D. Ph. D","doi":"10.1016/j.jclinane.2025.111799","DOIUrl":"10.1016/j.jclinane.2025.111799","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111799"},"PeriodicalIF":5.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of regional anesthesia techniques for hypospadias surgery: A systematic review","authors":"Hiroki Nakamura MD ,&nbsp;Kensuke Shimada MD, MPH ,&nbsp;Masao Iwagami MD, PhD ,&nbsp;Tatsuhiko Masue MD, PhD ,&nbsp;Nanako Tamiya MD, MSc, PhD ,&nbsp;Ryota Inokuchi MD, PhD","doi":"10.1016/j.jclinane.2025.111792","DOIUrl":"10.1016/j.jclinane.2025.111792","url":null,"abstract":"<div><h3>Objectives</h3><div>Regional anesthesia is commonly used in hypospadias surgery; however, the optimal timing, drugs, and types of blocks remain controversial. Therefore, we conducted a systematic review to identify superior regional-anesthesia techniques for hypospadias surgery.</div></div><div><h3>Methods</h3><div>This systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42023431583). The following databases were utilized: MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar. We included randomized controlled trials (RCTs) published until June 3, 2023, which evaluated any regional anesthesia method for hypospadias surgery and investigated pain and complications.</div></div><div><h3>Results</h3><div>This review included 44 RCTs that compared: (i) types of regional anesthesia, (ii) timing of regional anesthesia (before and after surgery), (iii) drugs used, (iv) regional anesthesia with or without additional interventions, and (v) a composite comparison of the above comparisons. In studies comparing types of regional anesthesia, pudendal nerve block was found to be superior for hypospadias surgery compared to other types, including caudal and penile blocks. No advantage was observed in administering regional anesthesia post-surgery compared to pre- or both pre- and post-surgery. However, a meta-analysis was not feasible due to differing pain scales used across studies.</div></div><div><h3>Discussion</h3><div>The pudendal nerve block could provide better analgesia than other regional anesthesia methods in terms of pain scales and analgesia duration. Regional anesthesia administered before or both pre- and post-surgery may be more effective than that post-surgery based on pain scales and analgesia duration. A standardized pediatric pain scale is warranted to unify study results.</div><div><strong>PROSPERO ID:</strong> CRD42023431583.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111792"},"PeriodicalIF":5.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of surgical pleth index-guided analgesia versus conventional analgesia technique in general anesthesia surgeries: A systematic review and meta-analysis","authors":"Xi Xu ,&nbsp;Xue-Feng Zhang ,&nbsp;Zi-Hang Yu ,&nbsp;Jian Liu ,&nbsp;Liang Nie ,&nbsp;Jian-Li Song","doi":"10.1016/j.jclinane.2025.111800","DOIUrl":"10.1016/j.jclinane.2025.111800","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study is to investigate whether the use of surgical pleth index (SPI)-guided intraoperative analgesia can result in a reduction in opioid consumption, intraoperative circulatory fluctuations, and the incidence of postoperative adverse reactions when compared to conventional analgesia techniques.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from the inception of these databases to November 2024. The objective was to identify randomized controlled trials that compared the use of SPI-guided analgesia with conventional analgesia practices in adult patients who underwent general anesthesia. The primary outcome was the intraoperative consumption of opioids, while intraoperative circulatory fluctuations, postoperative opioid consumption, pain scores, and adverse events served as secondary outcomes. Standardized mean differences (SMDs), weighted mean differences (WMDs) or pooled risk ratios (RRs) along with the corresponding 95 % confidence intervals (CIs) were employed for analysis.</div></div><div><h3>Results</h3><div>Fourteen studies were included in our meta-analysis. The pooled results indicated no significant difference in intraoperative opioid consumption between the SPI-guided analgesia group and the control group (SMD = 0.16, 95 % CI: −0.15 to 0.47, <em>p</em> = 0.33). However, SPI-guided analgesia was found to reduce intraoperative propofol dosage (SMD = −0.31, 95 % CI: −0.54 to −0.08, <em>p</em> = 0.008), prevent intraoperative tachycardia (RR = 0.50, 95 % CI: 0.30 to 0.85, <em>p</em> = 0.011), and significantly shorten the eye-opening time (WMD = −1.89, 95 % CI: −2.47 to −1.31, <em>p</em> &lt; 0.001). No statistically significant differences were observed in extubation time, postoperative nausea and vomiting, pain scores, or postoperative opioid consumption.</div></div><div><h3>Conclusions</h3><div>Compared to the conventional analgesia group, SPI-guided analgesia does not reduce intraoperative opioid consumption in adult patients undergoing general anesthesia.</div><div>Trial registration: The protocol for this meta-analysis has been registered in PROSPERO (CRD42024611690).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111800"},"PeriodicalIF":5.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}