Journal of Clinical Anesthesia最新文献

{"title":"Propofol versus sevoflurane anesthesia on postoperative sleep quality in older patients after major abdominal surgery: A randomized clinical trial","authors":"Na-Ping Chen M.D., Ph.D. ,&nbsp;Pei Sun M.D. ,&nbsp;Chun-Jing Li M.D. ,&nbsp;Xi-Xi Xing MBBS. ,&nbsp;Mo Li M.D., Ph.D ,&nbsp;Zhu-Jun Sun MBBS. ,&nbsp;Huai-Jin Li M.D. ,&nbsp;Dong-Liang Mu M.D. ,&nbsp;Dong-Xin Wang M.D., Ph.D.","doi":"10.1016/j.jclinane.2025.111875","DOIUrl":"10.1016/j.jclinane.2025.111875","url":null,"abstract":"<div><h3>Study objective</h3><div>Sleep disturbances are common in older patients following major surgery. Both propofol and sevoflurane are frequently used anesthetics. In this study, we compared the effect of propofol- versus sevoflurane-based anesthesia on postoperative sleep quality in this patient population.</div></div><div><h3>Design</h3><div>A randomized clinical trial.</div></div><div><h3>Setting</h3><div>A university hospital.</div></div><div><h3>Patients</h3><div>Patients aged 65 to 90 years who were scheduled for elective major abdominal surgery.</div></div><div><h3>Interventions</h3><div>Enrolled patients were randomized to receive either propofol-based intravenous anesthesia or sevoflurane-based inhalational anesthesia.</div></div><div><h3>Measurements</h3><div>Primary endpoint was total sleep time monitored by actigraphy on the first postoperative night. Secondary endpoints included plasma orexin-A concentrations at various timepoints from baseline (before anesthesia) until the second postoperative morning.</div></div><div><h3>Main results</h3><div>From May 23, 2022 to April 3, 2023, 144 patients (mean age 72.9 years; 58.3 % male) were enrolled and randomly assigned. Total sleep time on the first postoperative night was longer with propofol anesthesia (median 150 min [interquartile range 99 to 200]) than with sevoflurane anesthesia (111 min [80 to 160]; median difference 29 min [95 % CI 4 to 53]; <em>P</em> = 0.025). Plasma orexin-A concentration was lower in the propofol group at 1 h after anesthesia induction (median difference − 31.3 pg/mL [95 % CI −58.1 to −2.2]; <em>P</em> = 0.033) and 6:00 on the first postoperative morning (median difference − 29.8 pg/mL [95 % CI -58.3 to −2.3]; <em>P</em> = 0.036).</div></div><div><h3>Conclusions</h3><div>Among older patients undergoing major abdominal surgery, propofol anesthesia, compared with sevoflurane anesthesia, was associated with a longer total sleep time on the first postoperative night. This difference may be partially attributable to lowered plasma orexin-A level.</div><div>Trial registration: This randomized trial was approved by Biomedical Research Ethical Committee of Peking University First Hospital (No.2022-155) on April 26, 2022. Chinese Clinical Trial Registry (No. ChiCTR2200060120) URL: <span><span>https://www.chictr.org.cn/showproj.html?proj=169584</span><svg><path></path></svg></span>, May 19, 2022.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111875"},"PeriodicalIF":5.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190390","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":"Maximum extension and regression rate of cutaneous sensory block: superficial vs. deep parasternal intercostal plane blocks in patients undergoing open cardiac surgery","authors":"Burhan Dost M.D. ,&nbsp;Esra Turunc M.D. ,&nbsp;Cengiz Kaya M.D. ,&nbsp;Canan Asar Sahin M.D. ,&nbsp;Caner Genc M.D. ,&nbsp;Semih Murat Yucel M.D. ,&nbsp;Mustafa Kemal Demirag M.D. ,&nbsp;Deniz Karakaya M.D.","doi":"10.1016/j.jclinane.2025.111888","DOIUrl":"10.1016/j.jclinane.2025.111888","url":null,"abstract":"<div><h3>Background</h3><div>Superficial and deep parasternal intercostal plane (S-PIP and D-PIP, respectively) blocks provide effective analgesia following median sternotomy; however, data regarding their sensory distribution and regression patterns are scarce. Therefore, we compared the extent of sensory blockade 30 min following the administration of the blocks and evaluated its regression over 24 h.</div></div><div><h3>Methods</h3><div>Patients who underwent open cardiac surgery under the S-PIP or D-PIP block were included in this single-center, prospective study. Sensory assessment using cold stimulation and dermatomal mapping was conducted 30 min, 12 h, and 24 h following the administration of the blocks. The primary outcome was the proportion of the blocked thoracic area at 30 min. Opioid consumption and pain scores at 12 and 24 h were the secondary outcomes.</div></div><div><h3>Results</h3><div>Thirty patients were included in this study (<em>n</em> = 15 per group). The total blocked area at 30 min in the S-PIP and D-PIP groups was similar (48.48 ± 9.50 % vs. 46.51 ± 10.01 %, <em>p</em> = 0.584). Both blocks provided consistent coverage of the T2–T6 nerves, with additional involvement of T1 and T7 in some patients. Significant sensory blockade persisted at 12 h and partially regressed after 24 h. No significant differences were observed between the groups in terms of postoperative opioid consumption (10 [5] mg vs. 9 [3] mg, <em>p</em> = 0.121) or pain scores.</div></div><div><h3>Conclusion</h3><div>The S-PIP and D-PIP blocks provided comparable and extensive sensory coverage of the anterior thorax. Consistent dermatomal involvement between T2 and T6 was observed, with occasional spread to T1 and T7.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111888"},"PeriodicalIF":5.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169744","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":"Oliceridine for postoperative pain and opioid-related complications: The intravenous oliceridine and opioid-related complications (VOLITION) prospective cohort study","authors":"Daniel I. Sessler MD ,&nbsp;Sabry Ayad MD ,&nbsp;Omer Bakal MD ,&nbsp;Nataya S. Disher BS ,&nbsp;Jorge Araujo Duran MD ,&nbsp;Toby N. Weingarten MD ,&nbsp;Albert Dahan MD, PhD ,&nbsp;Mark A. Demitrack MD ,&nbsp;Jessica Kim MS ,&nbsp;Ashish K. Khanna MD, MS ,&nbsp;the VOLITION Study Team","doi":"10.1016/j.jclinane.2025.111870","DOIUrl":"10.1016/j.jclinane.2025.111870","url":null,"abstract":"<div><h3>Background</h3><div>Oliceridine is a G protein-selective μ-opioid receptor agonist with reduced β-arrestin activation that may produce fewer opioid-related adverse effects (ORAEs) than traditional opioids. The VOLITION prospective cohort study evaluated oliceridine for management of postoperative pain and evaluated ORAEs.</div></div><div><h3>Methods</h3><div>We enrolled 204 patients scheduled for major noncardiac surgery. Our primary aim was to quantify the proportion of patients having respiratory compromise over the initial two postoperative days. Cardiorespiratory function was continuously monitored with pulse oximetry, capnography, and plethysmography. Our composite of clinically meaningful respiratory events was defined by an end-tidal (Et) CO₂ ≤ 15 mmHg for ≥3 min, respiratory rate ≤ 5 breaths/min for ≥3 min, oxygen saturation ≤ 85 % for ≥3 min, apnea lasting &gt;30 s, or any life-threatening respiratory events. All potential respiratory events were adjudicated by two independent expert reviewers. On an exploratory basis we evaluated the proportion of patients achieving a complete gastrointestinal response (no vomiting and no rescue antiemetic use). Central nervous system compromise was evaluated with the Richmond Agitation-Sedation Scale, the Pasero Opioid-Induced Sedation Scale, and the 3-min Diagnostic Confusion Assessment Method.</div></div><div><h3>Results</h3><div>Among 203 patients in the safety population (mean age 57 years, 52 % women; mean duration of surgery: 5 h), 197 patients had cardiorespiratory data available for analysis. The median cumulative oliceridine dose was 33 mg (range 1.5–75 mg). There were 174 adjudicated episodes of respiratory compromise in 45 patients (23 %) but no deaths or oliceridine-related serious adverse events. Naloxone opioid reversal was never required. There were 107 (53 %) patients who had a complete gastrointestinal response, and eight met screening criteria for delirium.</div></div><div><h3>Conclusion</h3><div>Nearly one quarter of patients experienced a respiratory compromise with oliceridine analgesia, none of which was life-threatening. A randomized trial needs to determine whether oliceridine produces fewer overall ORAEs than conventional opioids.</div><div>The study was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT04979247</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111870"},"PeriodicalIF":5.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169743","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":"Chemical hip denervation using phenol via Pericapsular Nerve Group (PENG) block in palliative non-operative management for frail older hip fracture patients: A multicenter retrospective cohort study","authors":"Thamar Kroes MD ,&nbsp;Hugo H. Wijnen MD ,&nbsp;Koen Bos MD ,&nbsp;Lennart G. Wasmoeth MD ,&nbsp;Glenn van de Vossenberg MD ,&nbsp;Bart Spaetgens MD PhD ,&nbsp;Rachel J.H. Smits MD ,&nbsp;Henk Jan Schuijt MD PhD ,&nbsp;Hanna C. Willems MD PhD","doi":"10.1016/j.jclinane.2025.111872","DOIUrl":"10.1016/j.jclinane.2025.111872","url":null,"abstract":"<div><div>Effective analgesia is critical yet challenging in non-operative management (NOM) of hip fractures for frail older patients in the palliative setting. Chemical hip denervation with phenol via PEricapsular Nerve Group (PENG) block has been applied to improve pain management. This is the first multicenter retrospective study that evaluated pain experience, opioid consumption and mobility in this population.</div><div>The study included 185 patients, aged 70 years or older, who received chemical hip denervation with phenol via PENG block in the context of NOM from January 2022 until August 2023 in six hospitals across the Netherlands. Patient data were extracted from electronic health records.</div><div>Patients were aged median 87 years (p25 - p75 82–91) with multiple comorbidities, the majority suffered from cognitive impairment (74 %) and depended on daily care (88 %). Phenol was mostly used with a concentration of 6 % (70 % of patients) or 10 % (23 % of patients) and a median volume of 10 ml (p25 - p75 8–10). Post procedural pain was experienced as acceptable in the majority of patients (89 % rest-related, 65 % care-related). The secondary outcomes of pain on a numeric rating scale (NRS) and morphine milligram equivalents (MME) were low. However, mobility remained limited. Median survival was 9 days (p25 - p75 4–22). Significant differences were observed in fracture type and hospital location. No complications or adverse treatment effects were reported.</div><div>Chemical hip denervation with phenol via PENG block may be a viable analgesic option in selected frail older hip fracture patients as part of person-centered, multidisciplinary palliative care. Study limitations included its retrospective design with unavailable data on quality of life. Future prospective studies should evaluate patient outcomes. Further research is necessary to define optimal techniques, phenol percentage and volumes and reduce practice variability.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111872"},"PeriodicalIF":5.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138384","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":"Refining the modified Brice questionnaire: Patient perspectives and clarity enhancement","authors":"Miguel A. Valdez ,&nbsp;Bethany R. Tellor Pennington ,&nbsp;Mary C. Politi ,&nbsp;Swisher Laura ,&nbsp;Melissa M. Wurst ,&nbsp;Hugo de O. Campos ,&nbsp;Linda Zukowski ,&nbsp;Michael S. Avidan","doi":"10.1016/j.jclinane.2025.111876","DOIUrl":"10.1016/j.jclinane.2025.111876","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111876"},"PeriodicalIF":5.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138385","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":"Evaluating the differential effects of various substances on postoperative fall risk: Letter to the editor, “the impact of substance use disorders on postoperative falls in major noncardiac surgery: A retrospective cohort analysis”","authors":"Uzay Cagatay ,&nbsp;Matthew Matute ,&nbsp;Salman Nayyer ,&nbsp;Jasjeet Dhaliwal","doi":"10.1016/j.jclinane.2025.111877","DOIUrl":"10.1016/j.jclinane.2025.111877","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111877"},"PeriodicalIF":5.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138386","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 daily, weekly, and seasonal surgical timing on postoperative outcomes in high-risk patients undergoing elective non-cardiac surgery: A retrospective, single-center study","authors":"Ji-Hoon Sim PhD ,&nbsp;Yong-Seok Park PhD ,&nbsp;Bumwoo Park PhD ,&nbsp;Yeseul Choi MSc ,&nbsp;Joon Seo Lim PhD ,&nbsp;Seungil Ha PhD ,&nbsp;Joung Uk Kim PhD","doi":"10.1016/j.jclinane.2025.111879","DOIUrl":"10.1016/j.jclinane.2025.111879","url":null,"abstract":"<div><h3>Background</h3><div>Limited knowledge exists on the impact of surgical start timing on outcomes in high-risk patients. This study assessed its association with mortality, morbidity, and healthcare resource utilization in elective non-cardiac surgery.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at a tertiary medical center, including 14,394 high-risk patients (ASA ≥ 3) undergoing elective non-cardiac surgery from 2012 to 2021. Patients were grouped by surgical start time into detailed time intervals (8:00–11:00 a.m., 11:00 a.m.–1:00 p.m., 1:00–3:00 p.m., 3:00–6:00 p.m.) and broader periods (morning vs. afternoon). Weekly (Monday–Wednesday vs. Thursday–Friday) and seasonal (spring, summer, fall, winter) variations were analyzed. Cox and logistic regression models assessed mortality, complications, and healthcare utilization.</div></div><div><h3>Results</h3><div>Afternoon surgeries were associated with higher mortality at 90 days (adjusted hazard ratio [aHR]: 1.28, 95 % confidence interval [CI]: 1.05–1.57, <em>P</em> = 0.016), 180 days (aHR: 1.30, 95 % CI: 1.12–1.51, <em>P</em> &lt; 0.001), and 1 year (aHR: 1.26, 95 % CI: 1.13–1.40, P &lt; 0.001), as well as overall mortality (aHR: 1.16, 95 % CI: 1.09–1.23, <em>P</em> &lt; 0.001). Afternoon surgeries were also linked to higher composite complications (adjusted odds ratio [aOR]: 1.21, 95 % CI: 1.11–1.33, <em>P</em> &lt; 0.001) along with higher intensive care unit admission (aOR: 1.40, 95 % CI: 1.28–1.52, P &lt; 0.001) and red blood cell transfusion (aOR: 1.40, 95 % CI: 1.22–1.61, <em>P</em> &lt; 0.001). Surgeries starting between 3:00 and 6:00 p.m. had the highest risk of 1-year mortality (aHR: 1.33, 95 % CI: 1.15–1.54, <em>P</em> &lt; 0.001) and composite complications (aOR: 1.32, 95 % CI: 1.17–1.50, P &lt; 0.001). Seasonal analysis showed higher 30-day (aHR: 1.80, 95 % CI: 1.08–2.99, <em>P</em> = 0.023) and 90-day mortality (aHR: 1.32, 95 % CI: 1.00–1.74, <em>P</em> = 0.048) in summer, and higher overall mortality (aHR: 1.10, 95 % CI: 1.01–1.19, <em>P</em> = 0.030) in winter. Subgroup analyses revealed variability by surgical type.</div></div><div><h3>Conclusions</h3><div>Surgical start timing was significantly associated with postoperative outcomes in high-risk patients, underscoring the need for strategic scheduling.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111879"},"PeriodicalIF":5.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134088","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":"Management of SGLT2i-associated perioperative ketoacidosis (SAPKA) / Euglycemic Diabetic Ketoacidosis (EDKA)","authors":"Louise Y. Wen M.D","doi":"10.1016/j.jclinane.2025.111854","DOIUrl":"10.1016/j.jclinane.2025.111854","url":null,"abstract":"<div><h3>Background</h3><div>This infographic reviews the risk of perioperative euglycemic diabetic ketoacidosis (EKDA) associated with sodium-glucose co-transporter 2 inhibitor (SGLT2i), which is more specifically called SGLT2i-associated perioperative ketoacidosis (SAPKA)<span><span>¹</span><svg><path></path></svg></span>. The incidence of SAPKA/perioperative EDKA is estimated to be 0.17 % for nonemergent procedures and 1.1 % for emergent procedures<span><span>²</span><svg><path></path></svg></span>. The goal is to guide both anesthesia and surgery teams regarding the perioperative management of SGLT2i's to mitigate the risk of SAPKA/EDKA.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111854"},"PeriodicalIF":5.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130869","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":"Proceedings from the 2025 Association of Anesthesia Clinical Directors Perioperative Leadership Summit","authors":"Thomas E. Schule MD ,&nbsp;Chinyere A. Archie MBBS ,&nbsp;D. Matthew Sherrer MD, MBA, FAACD ,&nbsp;Richard Urman MD, MBA ,&nbsp;Mitchell H. Tsai MD, MMM, FASA, FAACD ,&nbsp;Andrew D. Franklin MD, MBA, FAACD, FASA","doi":"10.1016/j.jclinane.2025.111835","DOIUrl":"10.1016/j.jclinane.2025.111835","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"104 ","pages":"Article 111835"},"PeriodicalIF":5.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105420","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":"Addressing the role of diabetes progression and GLP-1 analog usage in perioperative aspiration risk","authors":"Uzay Cagatay ,&nbsp;Matthew Matute ,&nbsp;Michael Bickford ,&nbsp;Salman Nayyer ,&nbsp;Jonathan Elias","doi":"10.1016/j.jclinane.2025.111867","DOIUrl":"10.1016/j.jclinane.2025.111867","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"104 ","pages":"Article 111867"},"PeriodicalIF":5.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071107","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}