Journal of Clinical Anesthesia最新文献

{"title":"Reworking the maximum surgical blood ordering schedule 50 years later.","authors":"Roya Saffary, Steven M Frank, Nadia B Hensley","doi":"10.1016/j.jclinane.2026.112224","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112224","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112224"},"PeriodicalIF":5.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838736","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":"Closed-loop versus manual vasopressor titration for blood pressure control in surgical and critically ill patients: A systematic review and meta-analysis of randomised trials.","authors":"Katie Chiou, Philip Patrick, Ishita Srivastava, Edgard Engelman, Joseph Rinehart, Alexandre Joosten, Sean Coeckelenbergh","doi":"10.1016/j.jclinane.2026.112230","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112230","url":null,"abstract":"<p><strong>Background: </strong>Perioperative hypotension is associated with myocardial injury, acute kidney injury, and mortality, yet manual vasopressor titration frequently results in suboptimal blood pressure (BP) control. Closed-loop vasopressor (CLV) systems use automated feedback algorithms to maintain predefined BP targets and may reduce haemodynamic variability while decreasing provider workload.</p><p><strong>Methods: </strong>We conducted a PRISMA-guided systematic review and meta-analysis on PubMed, CENTRAL, EMBASE, and Web of Science from inception to June 2025. Randomised controlled trials of adults receiving CLV or manual vasopressor titration in perioperative and critical care settings were included. The primary outcome was time below target; secondary outcomes included time within and above target, time in hypotension (MAP <65 mmHg), vasopressor consumption, and length of stay.</p><p><strong>Results: </strong>Eight trials with 640 patients were analysed, including five trials conducted in the operating room and three trials in the ICU. Compared with manual titration, CLV significantly reduced time below target (mean difference [MD] = -15.81%; 95% CI = -20.38 to -11.25%; p < 0.001; n = 176), increased time in target (MD = 30.18%; 95% CI = 21.91 to 38.44%; p < 0.001; n = 216), reduced time in hypotension (SMD = -0.90; 95% CI = -1.64 to -0.17; p = 0.02; I² = 79%), and hospital length of stay (MD = -1.12 days; 95% CI = -2.21 to -0.04 days; p = 0.04; I² = 0%; n = 158). The length of post-anaesthesia care unit-intensive care unit stay (MD = -0.05 min, 95% CI = -1.10 to 1.00 min; p = 0.93; I² = 0%; n = 198) did not differ between the two groups.</p><p><strong>Conclusion: </strong>In surgical and critically-ill patients, closed-loop systems were associated with improved adherence to predefined blood pressure targets with reduced time below target and increased time in target compared to manual vasopressor titration. Whether these haemodynamic improvements translate into beneficial impact on patient outcomes will require confirmation in large multicentre randomised trials.</p><p><strong>Systematic review protocol: </strong>PROSPERO (CRD420251000124).</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"112230"},"PeriodicalIF":5.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838684","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":"Anesthetic risk, mitochondrial variants and genetic ancestry: The need for proportionality in emerging evidence.","authors":"Luis D'Marco, Dionilux Gamero","doi":"10.1016/j.jclinane.2026.112231","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112231","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"112231"},"PeriodicalIF":5.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856260","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":"Predicting postoperative atrial fibrillation after cardiac surgery using machine learning.","authors":"Youn Joung Cho, Jang Ho Ahn, Jin-Woo Park, Hyeonhoon Lee, Karam Nam, Jae-Woo Ju, Jaeyeon Chung, In Jung Kim, Hyung-Chul Lee, Yunseok Jeon","doi":"10.1016/j.jclinane.2026.112229","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112229","url":null,"abstract":"<p><strong>Background: </strong>Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery that is associated with increased morbidity. However, existing risk scores have limited accuracy, highlighting the need for more effective prediction models. In this study, we developed and validated a machine-learning (ML) model predicting new-onset POAF following cardiac surgery using various perioperative variables.</p><p><strong>Methods: </strong>A total of 6859 adult patients who underwent cardiac surgery at Seoul National University Hospital (SNUH) or Seoul National University Bundang Hospital (SNUBH) between October 2004 and October 2021 were included. Top 20 perioperative variables were input to develop a prediction model based on extreme gradient boosting. The final model was internally validated using 516 patients from the SNUH test set and externally validated in 1701 patients from the SNUBH cohort. The areas under the receiver operating characteristic curve (AUROC) and precision recall curve (AUPRC), and 95% confidence intervals (CIs) were evaluated to assess model performance.</p><p><strong>Results: </strong>The incidence of new-onset POAF after cardiac surgery was 37.2%. The AUROC and AUPRC were 0.891 (95% CI, 0.859-0.920) and 0.861 (95% CI, 0.819-0.898), respectively, for internal validation and 0.726 (95% CI, 0.700-0.751) and 0.646 (95% CI, 0.607-0.684) for external validation. The negative predictive values were 0.867 and 0.773 for internal and external validation, respectively, supporting the model's utility in identifying low-risk patients.</p><p><strong>Conclusions: </strong>A ML model developed with perioperative data demonstrated strong performance in predicting new-onset POAF after cardiac surgery. This approach may enable risk-stratified postoperative monitoring while providing the basis for improved perioperative decision-making.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"112229"},"PeriodicalIF":5.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838668","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":"24-h movement behaviors and the association of chronic pain with venous thromboembolism risk.","authors":"Xiao Huang, Darui Gao, Mengmeng Ji, Yanyu Zhang, Yiwen Dai, Yang Pan, Yuling Liu, Anshi Wu, Fanfan Zheng, Wuxiang Xie","doi":"10.1016/j.jclinane.2026.112227","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112227","url":null,"abstract":"<p><strong>Study objective: </strong>Chronic pain (CP) has been linked to multiple health complications, but its association with venous thromboembolism (VTE) remains unclear. We aimed to investigate the associations between CP and VTE risk, and the potential mediating role of 24-h movement behaviors.</p><p><strong>Design: </strong>A prospective cohort study.</p><p><strong>Setting: </strong>Population-based study using data from the UK Biobank.</p><p><strong>Interventions: </strong>Not applicable; this was an observational study analyzing exposure to CP.</p><p><strong>Measurements: </strong>CP was assessed as the main exposure, and incident VTE as the primary outcome. Exploratory analyses were conducted to examine the role of 24-h movement behaviors, including sedentary behavior (SB), light-intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA), and sleep, in relation to CP and VTE. Multivariate-adjusted Cox proportional hazards regression, compositional mediation analysis, and isotemporal substitution Cox regression were applied to evaluate these associations.</p><p><strong>Participants: </strong>A total of 453,289 individuals were included in the analytic cohort, with 88,675 participants in the accelerometer sub-cohort for analyses of movement behaviors.</p><p><strong>Main results: </strong>Compared to the pain-free group, participants with limited chronic pain (LCP, HR: 1.13, 95% CI: 1.08-1.19, P < 0.001) and multisite chronic pain (MCP, HR: 1.32, 95% CI: 1.24-1.41, P < 0.001) showed increased VTE risk in the total cohort. In exploratory analyses within the accelerometer sub-cohort, 24-h movement behaviors showed a contribution to the MCP-VTE association (indirect effect HR = 1.03 [1.01-1.05]; total effect HR = 1.25 [1.02-1.48]; 12.8% mediated). Among MCP participants, hypothetical reallocation models suggested that reallocating one hour/day from sleep to LIPA (HR = 0.87, 95% CI: 0.76-0.99) or MVPA (HR = 0.59, 95% CI: 0.35-0.98) was associated with lower VTE risk.</p><p><strong>Conclusions: </strong>CP was associated with an increased risk of VTE. In participants with MCP, 24-h movement behaviors showed a potential association that may contribute to this relationship. However, these findings are exploratory and do not support causal or prescriptive interpretation.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"112227"},"PeriodicalIF":5.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838738","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":"Retraction notice to 'A comparative study between propofol and dexmedetomidine as sedative agents during performing transcatheter aortic valve implantation' [Journal of Clinical Anesthesia 32 (2016) 242-247].","authors":"Mohamed Khalil, Ahmed Al-Agaty, Osama Asaad, Mohsen Mahmoud, Amr S Omar, Ahmed Abdelrazik, Mohamed Mostafa","doi":"10.1016/j.jclinane.2026.112176","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112176","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112176"},"PeriodicalIF":5.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772816","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":"“Further studies are needed”: Scientific convention or editorial evasion? A critical appraisal of an overused phrase in medical publishing","authors":"Zeynep Kayhan MD ,&nbsp;Elvin Kesimci MD, PhD","doi":"10.1016/j.jclinane.2026.112141","DOIUrl":"10.1016/j.jclinane.2026.112141","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"111 ","pages":"Article 112141"},"PeriodicalIF":5.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125000","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 different doses of remifentanil on postoperative pain and hyperalgesia: a prospective randomized controlled study and genotypic analysis","authors":"Zixuan Xu MD ,&nbsp;Jiayi Zhang MD ,&nbsp;Linyao Chen MD ,&nbsp;Jianwen Ye MD ,&nbsp;Yanan Wang MD ,&nbsp;Lei Tan MD ,&nbsp;Jiehao Sun MD","doi":"10.1016/j.jclinane.2026.112198","DOIUrl":"10.1016/j.jclinane.2026.112198","url":null,"abstract":"<div><h3>Background</h3><div>Remifentanil is commonly used for perioperative analgesia, but its role in postoperative pain and hyperalgesia is still debated. This study investigated the effect of different remifentanil doses on postoperative pain and hyperalgesia and the influence of SCN9A genetic variants on these outcomes.</div></div><div><h3>Methods</h3><div>A total of 268 patients who underwent laparoscopic surgery were included in the study. Eligible patients were randomly assigned to one of three groups: a high dose of remifentanil (Group H), a low dose of remifentanil (Group L), or no remifentanil (Group N). Postoperative pain intensity and mechanical pain thresholds were assessed after surgery, and side effects were recorded during follow-up. The single-nucleotide polymorphisms of SCN9A, rs16851799 and rs6746030, were also analyzed.</div></div><div><h3>Results</h3><div>There were no differences in postoperative pain scores among the three groups with different remifentanil doses (<em>P</em> = 0.969). However, the mechanical pain thresholds were significantly lower in Group H compared with the other groups postoperatively (<em>P</em> &lt; 0.001). The A allele of rs6746030 was associated with higher pain scores (<em>P</em> = 0.002) and increased postoperative analgesic requirements (<em>P</em> = 0.013).</div></div><div><h3>Conclusions</h3><div>While high doses of remifentanil significantly induced detectable hyperalgesia in a laboratory phenomenon, RIH had zero clinical impact on the patient's actual pain experience or analgesic requirements after surgery. Additionally, the exploratory findings revealed that rs6746030 in SCN9A was a genetic marker for severe postoperative pain.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"111 ","pages":"Article 112198"},"PeriodicalIF":5.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592524","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":"Expression of Concern to: \"Hydroxyethyl starch (HES) does not directly affect renal function in patients with no prior renal impairment\" [Journal of Clinical Anesthesia, Volume 13, Issue 2, March 2001, Pages 103-111].","authors":"","doi":"10.1016/j.jclinane.2026.112177","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112177","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"111 ","pages":"112177"},"PeriodicalIF":5.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772822","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":"Corrigendum to “Unmasking the silent threat: Navigating the myocardial injury in oncological surgery” [Journal of Clinical Anesthesia 108 (2026) 112063]","authors":"Zhen-Zhen Xu,&nbsp;Dong-Liang Mu","doi":"10.1016/j.jclinane.2025.112111","DOIUrl":"10.1016/j.jclinane.2025.112111","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"111 ","pages":"Article 112111"},"PeriodicalIF":5.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843801","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}