Journal of Clinical Anesthesia最新文献

{"title":"Ultrasound assessment of the effects of three different fasting regimens of clear fluids on gastric fluid volume in children.","authors":"Xiaofang Liu, Xianjun Li, Junxia Wang, Liang Zhao, Chunhong Duan, Dongmei Li, Bin Zhang","doi":"10.1016/j.jclinane.2025.112025","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112025","url":null,"abstract":"<p><strong>Background: </strong>Two-hour minimum fasting policy for clear fluids before surgery may prolong fasting and cause negative experiences for children. One-hour minimum and/or liberal fasting policies for clear fluids can significantly shorten the fasting time. However, their effectiveness and safety remain inadequately validated. This study investigated the effects of the above three regimens on the gastric fluid volume (GFV) before anesthesia induction in children.</p><p><strong>Methods: </strong>This prospective randomized controlled trial involved 147 children (1-13 years old, ASA I or II) undergoing elective tonsillectomy and adenoidectomy and were randomly allocated to three groups: Group 2: fasting clear fluids for a minimum of 2 h, Group 1: fasting clear fluids for a minimum of 1 h, and Group 0: liberal fluid fasting. Water intake was measured within 6 h before surgery. The primary outcome was GFV before anesthesia induction. Secondary outcomes included water intake behavior and adverse events.</p><p><strong>Results: </strong>Among the three groups, there was no evidence for differences in GFVs. The total water intake volume within 6 h before surgery was 80.0 (IQR: 40.0-160.0) mL for Group 2, 150.0 (IQR: 72.5-300.0) mL for Group 1, and 85.0 (IQR: 40.0-180.0) mL for Group 0. The total number of water intake episodes was 1.0 (1.0-2.5), 2.5 (1.0-4.0), and 2.0 (1.0-3.0) for Group 2/1/0, respectively. The last water intake volume before surgery in Group 2/1/0 was 60 (IQR: 30-100) mL, 60 (IQR: 30-100) mL, and 40 (IQR: 20-60) mL, respectively. There were no increases in adverse events among groups.</p><p><strong>Conclusion: </strong>Compared to fasting with clear fluids for 2 h, the 1-h and liberal fluid fasting regimens do not increase GFV in children before induction.</p><p><strong>Trial registration: </strong>This prospective randomized controlled trial was registered at the Chinese Clinical Trial Registration (No. ChiCTR2300078309; Date: December 5, 2023).</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"112025"},"PeriodicalIF":5.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251475","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":"The association between volatile anaesthetic exposure and postoperative complications following bariatric surgery: A multicentre retrospective cohort study.","authors":"Karam Azem, Philip Heesen, Eitan Mangoubi, Sharon Orbach-Zinger, Roussana Aranbitski, Shai Fein, Benjamin Zribi","doi":"10.1016/j.jclinane.2025.112020","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112020","url":null,"abstract":"<p><strong>Background: </strong>Despite the effectiveness of bariatric surgery for severe obesity, reoperation and acute kidney injury (AKI) remain significant complications. The impact of volatile anaesthetics on postoperative outcomes is unclear, and current guidelines lack evidence-based recommendations for anaesthetic selection. We investigated the association between cumulative volatile anaesthetic exposure and postoperative complications following bariatric surgery.</p><p><strong>Methods: </strong>This multicentre retrospective study included patients undergoing laparoscopic bariatric procedures at four Israeli centres (January 2017-May 2025). Volatile anaesthetic exposure was quantified as age-adjusted minimum alveolar concentration-hours (MAC_hr). We examined associations with reoperation (within 30 days) and AKI (within 7 days) and compared agent-specific effects using mixed-effects logistic regression.</p><p><strong>Results: </strong>A total of 16,685 patients were included in the final analysis. Reoperation occurred in 122 patients (0.7 %) and AKI in 96 patients (0.6 %). Higher total MAC_hr exposure was independently associated with increased reoperation (OR 1.75, 95 % CI 1.35, 2.26; P < 0.001), and AKI (OR 1.35, 95 % CI 1.05, 1.70; P = 0.015). While isoflurane and sevoflurane showed comparable associations with reoperation risk, only sevoflurane increased AKI risk (OR 1.53, 95 % CI 1.20, 1.90; P < 0.001) versus no association with isoflurane (OR 0.89, 95 % CI 0.55, 1.38; P = 0.630), with a significant difference between these agents (P = 0.012).</p><p><strong>Conclusion: </strong>Cumulative volatile anaesthetic exposure was independently associated with increased postoperative complications following bariatric surgery. The association with reoperation rate appears to be a class effect, while sevoflurane, but not isoflurane, is associated with an increased risk of AKI. However, these observational associations may be influenced by residual confounding. These hypothesis-generating findings require prospective validation before clinical recommendations can be made.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"112020"},"PeriodicalIF":5.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251339","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":"Precision sedation with novel single syringe multimodal opioid or non-opioid 6-2-2 mixtures.","authors":"Zhuang T Fang, Christine Nguyen-Buckley, Tristan Grogan, Alan Zamora, Natalia MacDougall, Theodora Wingert","doi":"10.1016/j.jclinane.2025.112013","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112013","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study is to determine the efficacy and safety of sedation/analgesia using mixtures of propofol, opioids or non-opioid sedatives, and lidocaine or etomidate in one single syringe.</p><p><strong>Design: </strong>A retrospective case review was undertaken.</p><p><strong>Setting: </strong>University outpatient surgical center.</p><p><strong>Patients: </strong>1,376 adult patients undergoing ophthalmic surgery with ocular blocks and monitored anesthesia care were studied.</p><p><strong>Intervention: </strong>The 6 opioid-based mixtures contained 6 portions of propofol, 2 portions of opioid (alfentanil, fentanyl, a combination of alfentanil and fentanyl, or alfentanil and hydromorphone), and 2 portions of lidocaine or ketamine in a single syringe, in a 6:2:2 volume ratio. The non-opioid mixture contained 6 portions of propofol, 2 portions of ketamine, and 2 portions of etomidate. A bolus dose for all mixtures was calculated based on the patient's age and weight: < 40 yr, 1.2 mL/10 kg; 40-59 yr, 1 mL/10 kg; 60-69 yr, 0.8 mL/10 kg; 70-84 yr, 0.6 mL/10 kg; ≥85 yr, 0.5 mL/10 kg, and delivered by hand push or infusion pump intravenously (IV). For patients with a body mass index (BMI) >25, the adjusted weight for dosing (AWFD) was used: AWFD = ideal body weight (IBW) + 0.3 x (Actual weight [AW] - IBW). Ocular blocks were performed when patients reached a moderate level of sedation. Blood pressure (BP), heart rate (HR), oxygen saturation, clinical signs of sedation, responses to blocks, apnea and need for airway support, and recall were recorded.</p><p><strong>Measurement and main results: </strong>91 %-98 % of all patients had no pain during ocular blocks and 98-99 % had no head movement, except in the KE6-2-2 without K10 (bolus only) group. The readiness time was 46-51 s for the opioid groups and 36- 43 s for the non-opioid groups. In the opioid groups, 97 %-99 % had no apnea and 88 %-94 % had no oxygen desaturation, while 99 % had no apnea and 96 % had no oxygen desaturation in the non-opioid groups. Heart rate and blood pressure decreased <10 % in the opioid groups while there was nearly no change in the non-opioid groups.</p><p><strong>Conclusion: </strong>Adjusted for age and weight, the bolus dose of the 6-2-2 mixture met the sedation requirements for ocular blocks in most patients with favorable outcomes and minimal airway or hemodynamic compromise regardless of which mixture was used.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"112013"},"PeriodicalIF":5.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251394","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":"Integrating entrustable professional activities (EPAs) into anesthesiology education.","authors":"Terrie Vasilopoulos, Brenda G Fahy","doi":"10.1016/j.jclinane.2025.112028","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112028","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112028"},"PeriodicalIF":5.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244416","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":"Combining large language models enhances screening sensitivity in systematic reviews","authors":"Alessandro De Cassai M.D ,&nbsp;Burhan Dost M.D ,&nbsp;Yunus Emre Karapinar M.D ,&nbsp;Esra Turunc M.D ,&nbsp;Annalisa Boscolo M.D ,&nbsp;Paolo Navalesi M.D","doi":"10.1016/j.jclinane.2025.112030","DOIUrl":"10.1016/j.jclinane.2025.112030","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112030"},"PeriodicalIF":5.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220760","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":"Ultrasound-detected postoperative diaphragmatic dysfunction and its association with pulmonary complications. A systematic review and meta-analysis","authors":"Jose D. Jimenez-Santana ,&nbsp;Danila Azzolina ,&nbsp;Gaetano Scaramuzzo ,&nbsp;Guido Mazzinari ,&nbsp;Martin Dres ,&nbsp;Alberto Fogagnolo ,&nbsp;Gianmaria Cammarota ,&nbsp;Carlo A. Volta ,&nbsp;Savino Spadaro","doi":"10.1016/j.jclinane.2025.112027","DOIUrl":"10.1016/j.jclinane.2025.112027","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative diaphragmatic dysfunction (PDD) is a common complication following major surgeries, contributing to adverse clinical outcomes. Ultrasound-based assessment has emerged as the preferred method for evaluating PDD. We aimed to assess the association between PDD and postoperative pulmonary complications (PPCs) and their relationship with pneumonia.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus, and Embase for clinical studies assessing PDD via ultrasound. The inclusion period ranged from January 10th, 2025, to March 20th, 2025. Two authors independently selected the investigations according to the following criteria: [1] observational study or randomized clinical trials enrolling adult patients undergoing cardiac, thoracic, or abdominal surgery [2] evaluation of PDD using diaphragmatic excursion (DE) or diaphragmatic thickening fraction (DTF) after surgery, and [3] report an association between PDD and PPCs or pneumonia as clinical outcomes. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Two authors independently performed data extraction. The Methodological Index for Nonrandomized Studies (MINORS) assessed study quality. The primary outcome was the association between PDD and PPCs. The secondary outcomes evaluated prevalence of PDD and pneumonia as an individual component of PPCs when it was reported separately, and its association with PDD.</div></div><div><h3>Results</h3><div>The systematic review included 19 studies, and six studies met the criteria for meta-analysis. PDD was significantly associated with higher odds of PPCs (OR 2.99, 95 % CI: 2.01–4.45) and pneumonia (OR 5.41, 95 % CI: 2.36–12.42). No significant publication bias was detected. Heterogeneity was low for both outcomes.</div></div><div><h3>Conclusion</h3><div>Ultrasound-assessed postoperative diaphragmatic dysfunction is significantly associated with higher odds of postoperative pulmonary complications, including pneumonia, highlighting its clinical relevance at the bedside. <del>PDD, assessed via ultrasound, is strongly associated with an increased risk of PPCs and pneumonia in postoperative patients. These findings underscore the importance of routine postoperative diaphragmatic assessment and the potential for targeted interventions to mitigate PDD-related complications. However, the current evidence is constrained by methodological variability and the absence of standardized diagnostic criteria. Future studies should focus on establishing consensus definitions for PDD and ensuring consistent assessment of key clinical outcomes.</del></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112027"},"PeriodicalIF":5.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212691","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":"Safety and feasibility of intraoperative high PEEP titrated to the lowest driving pressure during anesthesia for minimally invasive abdominal surgery – Interim analysis of GENERATOR","authors":"Tom D. Vermeulen ,&nbsp;Galina Dorland ,&nbsp;Liselotte Hol ,&nbsp;Sunny Nijbroek ,&nbsp;Ary Serpa Neto ,&nbsp;Arthur R.A. Bouwman ,&nbsp;Chiara Robba ,&nbsp;Denise Battaglini ,&nbsp;Francesca Rubulotta ,&nbsp;Guido Mazzinari ,&nbsp;Idit Matot ,&nbsp;John G. Laffey ,&nbsp;Joseph S.H.A. Koopman ,&nbsp;Lorenzo Ball ,&nbsp;Lukas Gasteiger ,&nbsp;Patrick Schober ,&nbsp;Markus W. Hollmann ,&nbsp;Marcus J. Schultz ,&nbsp;Sabrine N.T. Hemmes ,&nbsp;David M.P. van Meenen ,&nbsp;Wouter Bos","doi":"10.1016/j.jclinane.2025.112014","DOIUrl":"10.1016/j.jclinane.2025.112014","url":null,"abstract":"<div><h3>Background</h3><div>The optimal level of positive end–expiratory pressure (PEEP) during minimally invasive abdominal surgery is uncertain. Intraoperative ventilation with individualized high PEEP and recruitment maneuvers can be used to keep the driving pressure (ΔP) low, but can also lead to hypotension. In addition, the resulting ΔP and feasibility of individualized high PEEP in minimally invasive abdominal surgery is unclear.</div></div><div><h3>Methods</h3><div>Planned interim analysis on safety and feasibility of ‘Driving Pressure During General Anesthesia for Minimally Invasive Abdominal Surgery’ (GENERATOR), an ongoing randomized clinical trial that compares individualized high PEEP, titrated to the lowest ΔP, with a standard low PEEP ventilation strategy with respect to postoperative pulmonary complications. The primary endpoint for this analysis was the proportion of patients with intraoperative hypotension. Secondary endpoints were other intraoperative complications, ventilation variables and feasibility parameters.</div></div><div><h3>Results</h3><div>From December 2023 to July 2024, 181 patients were enrolled. Data for analysis were available for 177 patients, of which 87 patients were randomized to individualized high PEEP and 90 to standard low PEEP. Intraoperative hypotension was similar between the individualized high PEEP vs standard low PEEP group (11.5 vs 11.1 %, relative risk ratio 1.0 [95 % CI 0.5–2.4], <em>p</em> = 1.00), while vasopressor use was higher in the intervention group. The median difference in ΔP between both groups was 6 cm H₂O. Protocol compliance was 81.6 % in the individualized high PEEP group vs 97.8 % in the standard low PEEP group; most instances of non–compliance in the individualized high PEEP group concerned a level of PEEP that was too high.</div></div><div><h3>Discussion</h3><div>In minimally invasive abdominal surgery, a ventilation strategy using individualized high PEEP was not associated with a higher incidence of hypotension, but did show an increased use of vasopressors. The intervention was highly feasible, and led to a lower ΔP. These interim findings warrant confirmation in the main analysis of GENERATOR.</div></div><div><h3>Funding</h3><div>This research was funded by ZonMW, grant number 10390012110091.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112014"},"PeriodicalIF":5.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206514","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":"Impact of neoadjuvant chemotherapy on the efficacy of sugammadex for neuromuscular block reversal in ovarian cancer patients: A prospective cohort study","authors":"Xi Huang ,&nbsp;Xiaolan Gu ,&nbsp;Lingxi Xing ,&nbsp;Qinyu Bao ,&nbsp;Rong Gao ,&nbsp;Lianbing Gu","doi":"10.1016/j.jclinane.2025.112012","DOIUrl":"10.1016/j.jclinane.2025.112012","url":null,"abstract":"<div><h3>Study objective</h3><div>To investigate the impact of neoadjuvant chemotherapy (NAC) on the efficacy of sugammadex for neuromuscular block reversal in ovarian cancer patients.</div></div><div><h3>Design</h3><div>This is a prospective cohort study.</div></div><div><h3>Setting</h3><div>Operating room, post-anesthesia care unit (PACU), and wards of a university-affiliated teaching hospital.</div></div><div><h3>Patients</h3><div>Among the 43 patients who underwent cytoreductive surgery, 21 patients received 3 to 6 cycles of NAC with paclitaxel and carboplatin and were classified as the “Chemo group”, while 22 patients did not receive NAC before surgery and were classified as the “Non-chemo group”.</div></div><div><h3>Intervention</h3><div>During the surgery, intermittent injections of rocuronium were given based on the quantitative monitoring results of neuromuscular block. After the surgery, the patient was transferred to the PACU. Upon the reappearance of the second twitch response in train-of-four stimulation (T2), both Chemo group and Non-chemo group were given an intravenous dose of 2 mg/kg of sugammadex to reverse the rocuronium-induced neuromuscular block.</div></div><div><h3>Measurements</h3><div>The primary outcome of the study is the time from sugammadex administration to train-of-four ratio (TOFr) ≥ 0.9. The secondary outcomes include: onset time, clinical duration, recovery index, extubation time, duration of PACU stay, the average dosage of rocuronium.</div></div><div><h3>Main results</h3><div>After the administration of sugammadex, the time to TOFr ≥0.9 was longer in Chemo group compared to Non-chemo group(5.87 ± 2.20 vs 3.22 ± 1.34 min, <em>p</em> &lt; 0.001). The recovery index [2.25 (1.38, 3.00) vs 1.38 (0.75, 2.06) min, <em>p</em> = 0.020] and extubation time [7.50 (5.34, 10.22) vs 4.45 (4.83, 6.61) min, <em>p</em> = 0.002] were also longer in Chemo group. In the Chemo group, the onset time [2.5 (2.0, 4.75) vs 1.75 (1.44, 2.31) min, <em>p</em> = 0.001] was prolonged, the clinical duration [(39.29 ± 10.29 vs 46.23 ± 5.91 min, <em>p</em> = 0.011)] was shortened, and the average dosage of rocuronium (10.35 ± 2.27 vs 8.51 ± 0.69 μg·kg⁻¹·min⁻¹, <em>P</em> = 0.002) was increased compared to Non-chemo group. There was no significant difference in the duration of PACU stay between the two groups.</div></div><div><h3>Conclusion</h3><div>The study indicated that in patients who underwent NAC, the time from sugammadex administration to TOFr ≥0.9, the recovery index, and the extubation time were prolonged. Additionally, these patients experienced an textended onset time, a shortened clinical duration, and an increased average dosage of rocuronium.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112012"},"PeriodicalIF":5.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206504","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":"Postoperative erector spinae plane block does not reduce morphine consumption after lumbar spinal fusion: A randomized controlled trial","authors":"Diana Zamudio (M.D.),&nbsp;Laura Fernández (M.D.),&nbsp;Andrea Rodríguez (M.D.),&nbsp;David Delgado (M.D.)","doi":"10.1016/j.jclinane.2025.112022","DOIUrl":"10.1016/j.jclinane.2025.112022","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain management following spinal fusion surgery remains challenging, with opioids being the mainstay of treatment despite their potential adverse effects. The erector spinae plane block (ESPB) has emerged as a promising regional anesthetic technique, but its efficacy in lumbar spinal fusion surgery remains controversial.</div></div><div><h3>Methods</h3><div>In this randomized, double-blind, controlled trial, we enrolled adult patients undergoing elective open posterior lumbar arthrodesis between December 2021 and July 2024. Patients were randomized to receive either bilateral ultrasound-guided ESPB with levobupivacaine (ESPB group) or no block (control group) at the end of surgery. The primary outcome was morphine consumption during the first 24 postoperative hours. Secondary outcomes included 48-h morphine consumption, pain scores at different time points, functional recovery milestones, opioid-related side effects and block complications.</div></div><div><h3>Results</h3><div>Ninety-three patients completed the study. No significant differences in 24-h (18 mg [IQR 11–28] vs 21 mg [IQR 13–34], <em>P</em> = 0.258) or 48-h morphine consumption were observed between the ESPB and control groups. The ESPB group demonstrated lower pain scores at initial evaluation, 6 h, and 12 h postoperatively, as well as earlier initial mobilization, shorter urinary catheter duration, and reduced incidence of dizziness. Subgroup analyses revealed superior pain control and earlier mobilization with ESPB in transforaminal lumbar interbody fusion procedures and multilevel surgeries. No block-related complications were reported.</div></div><div><h3>Conclusions</h3><div>Although postoperative bilateral ultrasound-guided ESPB provided statistically significant improvements in early pain scores and mobilization, these differences did not translate into reduced morphine consumption or meaningful clinical benefits in patients undergoing lumbar spinal fusion surgery. The optimal role of this technique in spine surgery remains to be determined.</div></div><div><h3>Trial registration</h3><div>EudraCT 2020–000135-47.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112022"},"PeriodicalIF":5.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145155352","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":"Theoretical and practical perioperative considerations protective ventilation in lung transplantation","authors":"Julien Fessler ,&nbsp;Wenting Ma ,&nbsp;Archer K. Martin ,&nbsp;Brandi Bottiger ,&nbsp;Arne Neyrinck ,&nbsp;Sebastien Jacqmin ,&nbsp;Morgan Le Guen ,&nbsp;Nandor Marczin","doi":"10.1016/j.jclinane.2025.112026","DOIUrl":"10.1016/j.jclinane.2025.112026","url":null,"abstract":"<div><div>Protective ventilation is a cornerstone of perioperative management during lung transplantation. However, its current clinical approach is mainly based on literature from intensive care and elective surgery with one-lung ventilation. This review summarizes the pathophysiology of each of the four main end-stage lung diseases and how mechanical power affects the energy exerted on the lungs during the different surgical steps, first on the host and then on the grafts. Each pathology presents specific parenchymal characteristics, and there is great heterogeneity in pulmonary compliance within and between patients. Recognizing these regional heterogeneities in compliance is fundamental to personalizing ventilator settings and avoiding increasing ventilator-induced lung injury.</div><div>Furthermore, we explored the concept of the multiple-hits model of lung allograft injury. It highlights the consequences over time (additive or synergic) of all the risk factors cumulated on allograft injury, from the donor before harvesting, to the transport, and finally after implantation. Additionally, we discussed the novel opportunity that ex-vivo lung perfusion offers in the assessment of graft quality using various parameters, as well as mechanical power to guide different modes and settings to optimize ventilation. This experimental model could be used to develop new specific ventilation strategies to optimize the mechanical energy exerted on the lungs without a chest wall. Finally, we advocate for early extubation to reduce ventilation-induced lung injury and promote early rehabilitation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112026"},"PeriodicalIF":5.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145155424","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}