Journal of Clinical Anesthesia最新文献

{"title":"Pericapsular nerve group (PENG) block compared to intrathecal morphine for analgesic efficacy in total hip arthroplasty: A placebo-controlled randomized double-blind non-inferiority trial","authors":"Krešimir Oremuš ,&nbsp;Vladimir Trkulja ,&nbsp;Giorgina Gasparini ,&nbsp;Siniša Šoštarić ,&nbsp;Nikola Čičak ,&nbsp;Miroslav Hašpl ,&nbsp;Slobodan Mihaljević","doi":"10.1016/j.jclinane.2025.111921","DOIUrl":"10.1016/j.jclinane.2025.111921","url":null,"abstract":"<div><h3>Background</h3><div>We hypothesized that pericapsular nerve group (PENG) block was non-inferior to intrathecal (IT) morphine regarding analgesia after total hip arthroplasty (THA) with no untoward effects on the motor function.</div></div><div><h3>Methods</h3><div>In a double-blind placebo-controlled non-inferiority trial, patients undergoing unilateral THA under spinal anesthesia were randomized to receive a PENG block (20 mL 0.5 % levobupivacaine +2 mg dexamethasone) or IT morphine (100 μg). They received multimodal oral postoperative analgesia with rescue intravenous morphine for breakthrough pain, and were repeatedly evaluated for pain over the first 48 postoperative hours using a 0–10 numerical rating scale (NRS), and for the straight leg raise test at 4, 6 and 12 h. Co-primary outcomes were (i) maximum pain at rest and (ii) at active hip flexion – estimated for the overall period based on three consecutive scores – and (iii) milligram morphine equivalents (MME) delivered over 48 h. Non-inferiority margins for the PENG block – IT morphine differences were 0.75 NRS points for the pain scores, and 10 for the cumulative MME (corresponds to one 4 mg intravenous morphine rescue dose).</div></div><div><h3>Results</h3><div>All randomized patients (<em>N</em> = 60, 1:1 ratio) completed all trial procedures. PENG block – IT morphine differences in the maximum pain at rest (difference = 0.182, 95 %CI -0.218 to 0.582) and at hip flexion (difference = −0.270, 95 %CI -0.990 to 0.453) were well below 0.75 NRS points, and the difference in MME (difference = −2.1, 95 %CI -6.5 to 1.9) was well below 10 MME. Age-adjusted straight leg raise test failure rates were similar in the two groups (11.7 % vs. 12.8 %, difference = −1.1, 95 %CI -9.7 to 7.5).</div></div><div><h3>Conclusion</h3><div>Compared to IT morphine, PENG block provides non-inferior analgesia after THA under spinal anesthesia without additional compromise of the motor function.</div><div>Trial registration number: <span><span>NCT05308420</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111921"},"PeriodicalIF":5.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523387","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":"Letter to the editor: “Cerebrospinal fluid proteome of patients with persistent pain and/or postpartum depression after elective cesarean delivery: An exploratory prospective cohort study”","authors":"Weijia Du,&nbsp;Zhihao Sheng,&nbsp;Zhiqiang Liu","doi":"10.1016/j.jclinane.2025.111915","DOIUrl":"10.1016/j.jclinane.2025.111915","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111915"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518379","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)00190-4","DOIUrl":"10.1016/S0952-8180(25)00190-4","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111929"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656945","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 regarding methodology in the publication “flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation – A randomized controlled trial”","authors":"Matthias Thoma ,&nbsp;Erich Moresco","doi":"10.1016/j.jclinane.2025.111919","DOIUrl":"10.1016/j.jclinane.2025.111919","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111919"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523389","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":"Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility","authors":"Rafi Khandaker BA ,&nbsp;Karuna Wongtangman MD ,&nbsp;Marcus Frank ,&nbsp;Felix Borngaesser MD ,&nbsp;Richard V. Smith MD ,&nbsp;Linda Nie BA ,&nbsp;Shweta Garg MS ,&nbsp;Bilal Tufail MD ,&nbsp;Jeffrey Freda MD, MBA ,&nbsp;Preeti Anand MD ,&nbsp;Adela Aguirre-Alarcon MD ,&nbsp;Matthias Eikermann MD, PhD ,&nbsp;Carina P. Himes MD","doi":"10.1016/j.jclinane.2025.111918","DOIUrl":"10.1016/j.jclinane.2025.111918","url":null,"abstract":"<div><h3>Background</h3><div>We developed a simple questionnaire that the surgeon's office uses when meeting with their patients to book a case. In this study, we used these questions to evaluate their predictive value for mortality and adverse discharge to a nursing facility in comparison with the American Society of Anesthesiologists Physical Status [ASA-PS] and other risk assessment scores.</div></div><div><h3>Methods</h3><div>We analyzed data from adult patients undergoing non-ambulatory surgery between January 2016 and February 2023 at Montefiore Medical Center, a tertiary academic center in the Bronx, NY. The predetermined questionnaire items were defined as candidate predictors. Stepwise backwards elimination was used to identify independent predictors of mortality within 30 days of surgery. Model discrimination was assessed using area under the receiver operating characteristic curve [ROC-AUC] and was compared with ASA-PS, machine learning ASA [ML-ASA], Revised Cardiac Risk Index [RCRI], and Modified 5 Item Frailty Index [mFI-5] scores. Similarly, the model was evaluated in predicting non-home (adverse) discharge. Internal validation was performed using an independent cohort.</div></div><div><h3>Results</h3><div>In a developmental cohort of 59,099 patients, 891 (1.53 %) patients died within 30 days after surgery and 5013 (9.1 %) were adversely discharged. The final Anesthesia Risk Assessment Score [ARAS] model consisted of 6 independent predictors including history of stroke, seizure, heart failure/pacemaker or defibrillator implantation, liver failure, blood or bleeding disorder, and metabolic equivalents ≤4. The model showed superior predictive ability for 30-day postoperative mortality [AUC 0.82] compared to ASA-PS, ML-ASA, RCRI and mFI-5 [0.78, 0.79, 0.76, 0.72; p &lt; 0.001, respectively]. Similar performance was observed when predicting adverse discharge [AUC 0.76 vs 0.70, 0.74, 0.65, 0.73; p &lt; 0.001, respectively]. The results remained robust in the validation cohort (n = 13,137).</div></div><div><h3>Conclusion</h3><div>Six clinical questions that can be obtained directly from patients predict postoperative mortality and adverse discharge. The predictive accuracy is comparable to the ASA-PS, RCRI, and mFI-5 scores, with the advantage of being able to be used early in the preoperative evaluation triage process prior to clinician input.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111918"},"PeriodicalIF":5.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514347","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":"Perioperative implications of air pollution: Bridging environmental health and anesthesiology","authors":"Maressa Cumbermack BA ,&nbsp;Jamie Kim BA ,&nbsp;Robert S. White MD, MS ,&nbsp;John F. Pearson MD","doi":"10.1016/j.jclinane.2025.111911","DOIUrl":"10.1016/j.jclinane.2025.111911","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111911"},"PeriodicalIF":5.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480234","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":"Handoffs in regional anesthesia: An opportunity to improve perioperative patient safety","authors":"Rhea Gandhi BA ,&nbsp;Amit Pawa BSc (Hons), MB BS (Hons), FRCA, ESRA-DRA ,&nbsp;Alan J.R. Macfarlane BSc (Hons), MBChB (Hons), MRCP, FRCA, ESRA-DRA ,&nbsp;Edward R. Mariano MD, MAS, FASA, FASRA","doi":"10.1016/j.jclinane.2025.111913","DOIUrl":"10.1016/j.jclinane.2025.111913","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111913"},"PeriodicalIF":5.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471700","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":"Radiation-induced cognitive impairment and its implications for Anesthesia selection","authors":"Brian Wexler ,&nbsp;Quintin Norris ,&nbsp;Aasha I. Hoogland PhD ,&nbsp;Heather Jim PhD ,&nbsp;Jeffrey Huang MD","doi":"10.1016/j.jclinane.2025.111917","DOIUrl":"10.1016/j.jclinane.2025.111917","url":null,"abstract":"<div><div>Cancer remains a significant cause of death globally, highlighting the need for treatment strategies that are both effective and minimize side effects. Radiation therapy has become a foundational standard of cancer treatment and is included in a majority of treatment plans due to its innovative ability to pinpoint malignancies. Although radiation techniques are becoming increasingly more accurate, many approaches such as whole brain radiation therapy (WBRT) still maintain a risk for significant cognitive side effects, collectively referred to as radiation-induced cognitive impairment (RICI). This condition has underlying mechanisms including direct neural damage, blood brain barrier disruption, neurogenesis inhibition, neuroinflammation, and oxidative stress, all of which have been shown to lead to deficits in memory, learning, and executive function. Understanding that the pathogenesis of RICI is largely multifactorial is essential for developing neuroprotective strategies. Anesthesia considerations play a critical role in cancer patients undergoing radiation therapy and surgery, as anesthetic agents may influence the incidence of cognitive impairment. Preoperative screening, intraoperative management, and post operative consideration are crucial in minimizing these effects. This paper discusses modern radiation therapies on cognitive outcomes, the pathogenesis of RICI, and the importance of anesthesia intervention in reducing cognitive impairments in cancer patients receiving radiotherapy.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111917"},"PeriodicalIF":5.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480235","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":"Development of an artificial intelligence-assisted system for tracheal intubation using a video laryngoscope in infants and neonates","authors":"Hiroki Nakamura MD ,&nbsp;Kouki Fukuda MD ,&nbsp;Takahiko Asano MD ,&nbsp;Tatsuhiko Masue MD, PhD","doi":"10.1016/j.jclinane.2025.111914","DOIUrl":"10.1016/j.jclinane.2025.111914","url":null,"abstract":"<div><h3>Background</h3><div>The larynx of infants and neonates is occasionally challenging to identify using video laryngoscope. This study aimed to develop an artificial intelligence (AI)-assisted model that can identify the larynx, including the opening vocal cord and the arytenoid portion, on images obtained using a video laryngoscope.</div></div><div><h3>Methods</h3><div>First, 1197 images were extracted by the author from the 653 videos for train and validation data. An AI-assisted model for identifying the larynx was developed using YOLOv8n. Then, 399 images were selected from the additional 63 videos for the test data at every 150 frames.</div></div><div><h3>Results</h3><div>The sensitivity, specificity, and area under the curve of the AI-assisted model for identifying the larynx were 0.74, 0.99, and 0.91, respectively. The AI model correctly identified the opening vocal cord and arytenoid portion in cases without obstacles. Esophageal misidentification of the larynx and undetected cases of the larynx caused by obstacles were observed.</div></div><div><h3>Conclusions</h3><div>The AI-assisted model effectively identified the larynx, including the opening vocal cord and the arytenoid portion, during video laryngoscopy and potentially can enhance the safety of tracheal intubation of infants and neonates. However, esophageal misidentification remains critical. Further studies are needed to refine the model and ensure its reliability in clinical practice.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111914"},"PeriodicalIF":5.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480233","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 effects of maximizing stroke volume versus maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and microcirculatory tissue perfusion in patients having major abdominal surgery: The exploratory randomized CUSTOM trial","authors":"Moritz Flick ,&nbsp;Luisa Briesenick-Weskamm ,&nbsp;Pawel Sierzputowski ,&nbsp;Marie-Christin Süykers ,&nbsp;Parisa Moll-Khosrawi ,&nbsp;Linda Krause ,&nbsp;Alina Bergholz ,&nbsp;Kristen K. Thomsen ,&nbsp;Alexandre Joosten ,&nbsp;Karim Kouz ,&nbsp;Bernd Saugel","doi":"10.1016/j.jclinane.2025.111905","DOIUrl":"10.1016/j.jclinane.2025.111905","url":null,"abstract":"<div><h3>Background</h3><div>Mechanistic effects of intraoperative blood flow-guided hemodynamic therapy remain poorly understood. Therefore, we aimed to determine the effects of a) maximizing stroke volume and b) maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and sublingual and abdominal microcirculatory tissue perfusion in major abdominal surgery patients.</div></div><div><h3>Methods</h3><div>We randomized 76 patients to maximizing stroke volume, maintaining preoperative resting cardiac index, or routine care during and for the first 6 h after surgery. We measured oxygen delivery index, oxygen consumption index, sublingual microvascular flow index, and urethral perfusion index.</div></div><div><h3>Results</h3><div>At the end of surgery and 6 h after surgery, the median (25th percentile, 75th percentile) oxygen delivery index was higher in patients assigned to stroke volume maximization (460 (404, 556) ml/min/m² and 503 (466, 595) ml/min/m²) or to preoperative cardiac index maintenance (507 (460, 664) ml/min/m² and 516 (403, 604) ml/min/m²) than in patients assigned to routine care (403 (338, 517) ml/min/m² and 390 (351, 510) ml/min/m²). There were no important differences in oxygen consumption index and sublingual microvascular flow index among the three groups. The intraoperative average urethral perfusion index was slightly higher in patients assigned to stroke volume maximization or to preoperative cardiac index maintenance than in patients assigned to routine care.</div></div><div><h3>Conclusion</h3><div>In our trial, both maximizing stroke volume and maintaining preoperative resting cardiac index resulted in higher intraoperative and postoperative oxygen delivery index than routine care in major abdominal surgery patients. Large clinical trials are required to determine whether achieving higher perioperative oxygen delivery index translates into better outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111905"},"PeriodicalIF":5.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480232","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}