Journal of Clinical Anesthesia最新文献

{"title":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(26)00164-9","DOIUrl":"10.1016/S0952-8180(26)00164-9","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112286"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651183","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":"Pharmacology, clinical applications, and future perspectives of Ciprofol: A narrative review","authors":"Xiaobo Yang","doi":"10.1016/j.jclinane.2026.112275","DOIUrl":"10.1016/j.jclinane.2026.112275","url":null,"abstract":"<div><h3>Background</h3><div>Ciprofol comes from a structural modification of the propofol molecule. Approved in China for non-intubated procedures, the induction and maintenance of general anesthesia, and sedation in the intensive care unit, it is now transiting from studies into clinical practice. This review focuses on its pharmacological basis, comparative clinical profile, and the potential to shape the future of anesthesia and sedation.</div></div><div><h3>Main body</h3><div>Ciprofol acts on γ-aminobutyric acid type A receptors. It has a predictable linear pharmacokinetic and pharmacodynamic relationship and well-characterized metabolic pathways. Compared to propofol, ciprofol demonstrates superior tolerability, causing significantly less injection pain, better hemodynamic stability, and a low potential for clinically relevant drug interactions. Ciprofol is likely to be a non-inferior alternative to propofol for achieving successful anesthesia and sedation that may translate into clinical benefits for various specialized patient groups. Beyond its hypnotic effects, ciprofol may possess additional therapeutic potentials.</div></div><div><h3>Conclusion</h3><div>Ciprofol is transitioning from a novel structural analogue of propofol to a clinically relevant intravenous anesthetic and sedative agent with potential advantages. Future research should prioritize the clinical validation of promising preclinical and early clinical findings. These efforts will help define ciprofol's role in patient-centered anesthesia and sedation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112275"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497603","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":"Interpreting driving pressure and mechanical power during one-lung ventilation","authors":"Lukasz Szarpak,&nbsp;Jacek Smereka","doi":"10.1016/j.jclinane.2026.112276","DOIUrl":"10.1016/j.jclinane.2026.112276","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112276"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535836","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":"Dynamic changes in oxygen-hemoglobin affinity during liver transplantation","authors":"Marco Ronzani,&nbsp;Nikolai Staier,&nbsp;Simon Woyke,&nbsp;Christopher Rugg,&nbsp;Rupert Oberhuber,&nbsp;Simon Mathis,&nbsp;Thomas Haller,&nbsp;Christoph Frisch,&nbsp;Norbert Mair,&nbsp;Herbert Oberacher,&nbsp;Stefan Schneeberger,&nbsp;Lukas Gasteiger","doi":"10.1016/j.jclinane.2026.112269","DOIUrl":"10.1016/j.jclinane.2026.112269","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112269"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352145","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":"Opioid-free anaesthesia with paravertebral block in breast surgery: interpreting recovery outcomes","authors":"Jiayu Liu,&nbsp;Xiaojin Yu","doi":"10.1016/j.jclinane.2026.112272","DOIUrl":"10.1016/j.jclinane.2026.112272","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112272"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471023","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":"Minimum effective volume of the pericapsular nerve group (PENG) block in association with a standardized obturator nerve block for analgesia in hip osteoarthritis: An up-and-down study","authors":"Pedro Hilton de Andrade Filho M.D, Ph.D,&nbsp;Rayane da Silva Souza Barbosa M.D,&nbsp;Guilherme Pompei Tafner M.D,&nbsp;Guilherme Anitele Silva M.D,&nbsp;Maria Fernanda de Paula Ferreira,&nbsp;Henrique Melo de Campos Gurgel M.D, pH.D,&nbsp;Philip W.H. Peng M.D,&nbsp;Hazem Adel Ashmawi M.D, pH.D","doi":"10.1016/j.jclinane.2026.112267","DOIUrl":"10.1016/j.jclinane.2026.112267","url":null,"abstract":"<div><h3>Background</h3><div>The pericapsular nerve group (PENG) block has emerged as an effective regional anesthesia technique for managing hip pain, offering substantial analgesia while preserving motor function. However, the minimum effective volume (MEV) required to achieve consistent analgesia in patients with hip osteoarthritis (HOA) has not yet been established. This study aimed to determine the MEV₅₀ of the PENG block necessary to produce clinically meaningful pain relief and to assess the relationship between injectate distribution and analgesic efficacy.</div></div><div><h3>Methods</h3><div>This prospective, single-center, up-and-down sequential study included 26 patients with chronic HOA pain. Under ultrasound and fluoroscopic guidance, variable volumes of a local anesthetic mixture were injected for PENG block determined by Dixon's up and down method. The primary outcome was analgesic success, defined as a ≥ 50% reduction in pain during hip flexion 30 min after injection. Secondary outcomes included pain with movement, quadriceps strength, functional performance (Timed Up and Go test), and fluoroscopic injectate spread.</div></div><div><h3>Results</h3><div>The MEV₅₀ was estimated at 1.53 mL, when combined with a 1 mL obturator nerve injection. Quadriceps strength and mobility were preserved in all patients. Fluoroscopy showed spread between anterior inferior iliac spine and iliopubic eminence and to inferomedial acetabulum in 100% and 58% of cases but the spread did not correlate with analgesic outcome. No adverse events were observed.</div></div><div><h3>Conclusion</h3><div>Low-volume PENG block provides effective and motor-sparing analgesia for HOA, supporting its potential for neurolytic applications in chronic pain management.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112267"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316871","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":"Residents are the answer: A financial analysis of the value of anesthesiology residents to academic health systems","authors":"G. Colton Gardner BS,&nbsp;Adam Mastrantonio BS,&nbsp;Christian S. Guay MD,&nbsp;Alastair E. Moody MD","doi":"10.1016/j.jclinane.2026.112265","DOIUrl":"10.1016/j.jclinane.2026.112265","url":null,"abstract":"<div><ul><li><span>•</span><span><div>Resident physicians provide substantial economic value across multiple hospital services.</div></span></li><li><span>•</span><span><div>Replacing resident coverage requires markedly higher staffing expenditures.</div></span></li><li><span>•</span><span><div>Cost estimates are highly sensitive to resident work hours and compensation assumptions.</div></span></li><li><span>•</span><span><div>Residents remain the most cost-efficient staffing model across clinical service lines.</div></span></li></ul></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112265"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316902","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":"NRFit connectors: Implementation after the engineering solution","authors":"John O'Keeffe","doi":"10.1016/j.jclinane.2026.112271","DOIUrl":"10.1016/j.jclinane.2026.112271","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112271"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375886","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":"AI-assisted interpretation of arterial blood gases using a hybrid Stewart and standard base excess model","authors":"Furkan Tontu,&nbsp;Dicle Birtane,&nbsp;Emral Canan,&nbsp;Esra Tontu,&nbsp;Hilal Akca,&nbsp;Cansu Kilinc Berktas,&nbsp;Gokhan Sertcakacilar,&nbsp;Zafer Cukurova","doi":"10.1016/j.jclinane.2026.112266","DOIUrl":"10.1016/j.jclinane.2026.112266","url":null,"abstract":"<div><h3>Background</h3><div>Arterial blood gas (ABG) interpretation is essential in critical care, but conventional approaches may not fully characterize complex acid–base disturbances at the bedside. The Partitioned Standard Base Excess (SBE) model provides a structured framework for decomposing metabolic acid–base components, but its routine use requires repeated calculations. Large language models may support structured reporting and visualization when combined with predefined physiologic rules and supplied clinical context.</div></div><div><h3>Methods</h3><div>This retrospective, single-center study evaluated the clinical concordance of a ChatGPT-based arterial blood gas interpretation framework using the Partitioned SBE model. A cohort of 1234 ICU patients was stratified according to primary admission diagnosis. The model received ABG values, selected laboratory parameters, and the primary ICU admission diagnosis as predefined input variables, calculated BECl, BEAlb, BELac, and BEOther using explicit equations, generated graphical visualizations, and produced structured clinical comments and management suggestions. Two independent anesthesiologists reviewed the model outputs for clinical concordance.</div></div><div><h3>Results</h3><div>The model correctly reproduced all predefined partitioned SBE calculations and reference-range classifications for ABG and electrolyte parameters. Clinical comments and management suggestions were rated concordant in 93.1% of cases (95% CI: 91.6–94.4). Concordance rates exceeded 96% in renal, metabolic, and sepsis subgroups, whereas lower concordance was observed in hematologic and malignancy subgroups. The graphical decomposition of acid–base components provided a visual representation of mixed metabolic disturbances.</div></div><div><h3>Conclusions</h3><div>A formula-guided ChatGPT-based framework using the Partitioned SBE model generated interpretable ABG reports, graphical visualizations, and contextual clinical comments with high concordance to expert assessment. These findings support its potential role as an adjunctive educational and reporting tool, although prospective validation, external testing, and outcome-based studies are required before clinical implementation.</div></div><div><h3>Visual abstract</h3><div>A graphical summary of the model's stepwise interpretation process is provided separately as the <em>Visual Abstract Figure</em>.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112266"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345507","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":"Sodium bicarbonate alkalinization of local anesthetics for peripheral nerve blocks: A systematic review","authors":"Noy Norman Kambuaya M.D.,&nbsp;Iwan Fuadi M.D., Ph.D.,&nbsp;Dedi Fitri Yadi M.D.","doi":"10.1016/j.jclinane.2026.112268","DOIUrl":"10.1016/j.jclinane.2026.112268","url":null,"abstract":"<div><h3>Background</h3><div>Alkalinization of local anesthetic solutions is intended to increase the non-ionized fraction of the local anesthetic, but its clinical benefit in onset time, duration, or block quality in peripheral nerve blocks remains uncertain.</div></div><div><h3>Methods</h3><div>PubMed and Embase were searched to October 2025 with no date restrictions. Eligible studies were comparative clinical studies evaluating sodium bicarbonate alkalinization versus non-alkalinised solutions for single-shot peripheral nerve blocks, reporting onset time, duration, or block quality. Risk of bias was assessed using design-appropriate tools and a structured narrative synthesis was performed.</div></div><div><h3>Results</h3><div>A total of 422 records were identified; after deduplication, screening, and eligibility assessment, 18 studies were included. Thirteen of 16 studies providing group-comparable onset data found faster onset in at least one outcome after alkalinization, with more consistent findings for motor than sensory onset. Effects on block duration were heterogeneous and block quality findings were inconsistent. Risk of bias was predominantly some concerns; incomplete final pH reporting in several studies limited intervention fidelity.</div></div><div><h3>Conclusions</h3><div>This review shows that alkalinization may accelerate onset time in peripheral nerve blocks, particularly with lidocaine (lignocaine) and most consistently for motor onset, but the effect is variable, agent-specific, and supported by evidence of low-to-moderate certainty. The available evidence supports a selective rather than universal approach to alkalinization.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD420251248335).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112268"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361130","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}