Journal of Clinical Anesthesia最新文献

{"title":"Preoperative sleep disturbances: Therapeutic target or epiphenomenon of brain vulnerability?","authors":"Mattia Madeo , Stefano Fresilli , Andrea Bruni","doi":"10.1016/j.jclinane.2026.112132","DOIUrl":"10.1016/j.jclinane.2026.112132","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112132"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923705","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":"Potentially modifiable ventilatory factors contributing to outcome in patients with pulmonary and extrapulmonary ARDS — An individual patient data analysis","authors":"Galina Dorland ,&nbsp;Siebe G. Blok ,&nbsp;Pien Swart ,&nbsp;Fleur-Stefanie L.I.M. van der Ven ,&nbsp;M.W. Hollmann ,&nbsp;Luciano C. Azevedo ,&nbsp;Giacomo Bellani ,&nbsp;Michela Botta ,&nbsp;Elisa Estenssoro ,&nbsp;Eddy Fan ,&nbsp;Juliana Carvalho Ferreira ,&nbsp;John G. Laffey ,&nbsp;Ignacio Martin-Loeches ,&nbsp;Ana Motos ,&nbsp;Tai Pham ,&nbsp;Oscar Peñuelas ,&nbsp;Antonio Pesenti ,&nbsp;Luigi Pisani ,&nbsp;Ary Serpa Neto ,&nbsp;Marcus J. Schultz ,&nbsp;David M.P. van Meenen","doi":"10.1016/j.jclinane.2025.112120","DOIUrl":"10.1016/j.jclinane.2025.112120","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have identified potentially modifiable factors associated with mortality from acute respiratory stress syndrome (ARDS), however these studies did not differentiate between underlying causes of ARDS. As the etiology of ARDS may influence patient outcomes, we aimed to identify potentially modifiable factors associated with 60-day mortality from pulmonary and extrapulmonary ARDS.</div></div><div><h3>Methods</h3><div>Secondary pooled analysis of six observational studies studies on mechanical ventilation in patients with pulmonary and extrapulmonary ARDS. The primary endpoint was mortality at day 60 after inclusion. Exploratory outcomes included length of stay in hospital and ICU, duration of ventilation and ventilator-free days at day 28.</div></div><div><h3>Results</h3><div>Out of 7934 patients with pulmonary or extrapulmonary ARDS, 3402 (43%) did not survive. Potentially modifiable factors associated with 60-day mortality included high driving pressure (ΔP) and high respiratory rate (RR). There was an interaction between etiology of ARDS and ΔP on 60-day mortality, with ΔP showing a stronger association in pulmonary ARDS compared with extrapulmonary ARDS (<em>p</em> &lt; 0.001). In a sensitivity analysis excluding COVID-19 patients, RR was no longer associated with 60-day mortality, whereas ΔP remained associated. Tidal volume was not associated with 60-day mortality in either pulmonary or extrapulmonary ARDS. No interaction was found between ARDS etiology and RR or tidal volume on 60-day mortality.</div></div><div><h3>Conclusion</h3><div>High ΔP and high RR were associated with 60-day mortality in patients with pulmonary and extrapulmonary ARDS receiving mechanical ventilation, with ΔP showing a stronger association in pulmonary ARDS compared with extrapulmonary ARDS.</div></div><div><h3>Registration</h3><div>The pooled database was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (identifier <span><span>NCT05650957</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112120"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219797","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":"Reducing propofol waste during TIVA by pre-operative estimation of requirement: A single-center retrospective analysis","authors":"Florian Windler ,&nbsp;George Zhong ,&nbsp;Mark Coburn ,&nbsp;Xiabing Xu ,&nbsp;Florian Piekarski ,&nbsp;Philippe Kruse ,&nbsp;Birgit Bette ,&nbsp;Pascal Siegert","doi":"10.1016/j.jclinane.2026.112160","DOIUrl":"10.1016/j.jclinane.2026.112160","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether estimating propofol requirement before surgery using a target-controlled infusion (TCI) model-based algorithm could reduce waste whilst maintaining workflow.</div></div><div><h3>Design</h3><div>Retrospective cohort study with in silico TCI-TIVA simulations using the Eleveld model at fixed effect-site targets (Cet 2.5–4.0 μg.ml⁻¹) or a Cet corresponding to an estimated BIS of 45 (EC_BIS45). Monte-Carlo simulation examined uncertainty in surgical duration estimates.</div></div><div><h3>Setting</h3><div>University tertiary care provider.</div></div><div><h3>Patients</h3><div>229 adult patients undergoing general anesthesia with conventional propofol TIVA with manually adjusted infusion rate.</div></div><div><h3>Measurements</h3><div>Primary endpoint: predicted propofol amount for TCI and waste associated with three drawing-up strategies (50 ml vial only, 20 ml vial only, and vial combination based on estimated requirements). Secondary endpoint: relative number of syringe changes.</div></div><div><h3>Main results</h3><div>Propofol requirements predicted using Cet 3.0 and EC_BIS45 were similar to actual consumption. Algorithm-guided drawing-up produced significantly lower predicted waste than conventional TIVA practice (<em>p</em> &lt; 0.0001, CI = −61.0 to −27.0 mg/procedure for Cet 3.0; <em>p</em> = 0.001, CI = −60.0 to −26.7 mg/procedure for EC_BIS45), comparable to the 20 ml vial-only strategy but requiring fewer syringe changes. Waste remained significantly lower despite surgical duration estimation errors up to 20% for Cet 3.0 (<em>p</em> = 0.007) and 30% for EC_BIS45 (<em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Using the Eleveld TCI model to estimate pre-operative propofol requirements could significantly reduce waste and avoid excessive syringe changes, even when surgical duration is uncertain.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112160"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258245","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":"From healthy volunteers to laboring patients: Interpreting novice gastric ultrasound accuracy","authors":"Amrit Jalf ,&nbsp;Catherine Cha ,&nbsp;Judi Turner ,&nbsp;Brittany N. Burton MD MHS","doi":"10.1016/j.jclinane.2026.112158","DOIUrl":"10.1016/j.jclinane.2026.112158","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112158"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776310","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":"Endothelial glycocalyx in perioperative medicine current understanding and future direction","authors":"Ehab Farag ,&nbsp;Youssef Esa ,&nbsp;Nour El Hage Chehade ,&nbsp;Vanessa Bou Sleiman ,&nbsp;John Seif","doi":"10.1016/j.jclinane.2026.112154","DOIUrl":"10.1016/j.jclinane.2026.112154","url":null,"abstract":"<div><div>The endothelial glycocalyx (EG) is a dynamic, gel-like layer that lines the luminal surface of blood vessels, playing a crucial role in vascular biology. Previously considered a passive barrier, it is now recognized as a key regulator of vascular tone, permeability, inflammation, and coagulation. Composed mainly of proteoglycans, glycoproteins, and glycosaminoglycans, the EG serves as a semipermeable interface between blood and the endothelium, maintaining microvascular flow and modulating nitric oxide (NO) production while protecting against oxidative and inflammatory damage.</div><div>This review highlights the physiological functions of the EG and its significance in perioperative medicine. It regulates shear-dependent NO release, ensuring adequate vasodilation and tissue perfusion, while its negative charge reduces friction and clot formation. Damage to this layer can lead to vascular dysfunction, particularly in surgical and critical care patients.</div><div>The review examines the mechanisms of glycocalyx injury in various conditions. Hyperglycemia and diabetes accelerate degradation through reactive oxygen species and enzymes like heparanase. In sepsis, inflammatory mediators disrupt glycocalyx, leading to capillary leak syndrome. Ischemia-reperfusion injury causes rapid shedding of glycocalyx components, impairing vasodilation.</div><div>Potential therapeutic strategies for preserving glycocalyx integrity include albumin, fresh frozen plasma, and sphingosine-1-phosphate, which stabilize endothelial junctions. Maintaining normovolemia during surgery is crucial, as both excessive fluid and hypovolemia can accelerate glycocalyx breakdown. Overall, the endothelial glycocalyx should be considered in perioperative care as it may influence patient outcome. We outline future avenues for research and clinical intervention.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112154"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213357","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":"Desflurane versus propofol for ambulatory surgery: A systematic review and meta-analysis","authors":"Wei Hu ,&nbsp;Jing Zhuang ,&nbsp;Xin Liu ,&nbsp;Peng Zhang","doi":"10.1016/j.jclinane.2026.112140","DOIUrl":"10.1016/j.jclinane.2026.112140","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the efficacy, side effects and recovery profile of two commonly used anesthetic agents, desflurane versus propofol, for maintaining general anesthesia in ambulatory surgery.</div></div><div><h3>Methods</h3><div>Studies compared propofol with desflurane in adult patients undergoing ambulatory surgery were included. The generalized pivotal method was used to estimate the median and variance of the ratios of means and standard deviations of recovery times, and these ratios were then pooled in a DerSimonian-Laird random-effects meta-analysis with Knapp-Hartung adjustment.</div></div><div><h3>Results</h3><div>Twenty-two studies with a total of 1504 adult participants were included in this review. Compared with propofol, desflurane significantly reduced early recovery times, with reductions of at least 9.1% in mean time and 4.2% in standard deviation (variability) (both based on the lower limit of the 99%CI), all significant after Benjamini-Hochberg (BH) correction. In contrast, no significant differences were observed for most intermediate and late recovery metrics. Desflurane increased the risk of in-hospital PONV (RR: 2.15, 95%CI: 1.12 to 4.11), and postoperative antiemetic rescue (RR: 2.59, 95%CI: 1.35 to 4.95), all significant after BH correction. The subgroup analysis indicated that adding N₂O to desflurane was associated with an increased incidence of in-hospital PONV compared with propofol plus N₂O.</div></div><div><h3>Conclusions</h3><div>In ambulatory surgery, desflurane demonstrated faster early recovery, higher incidence of in-hospital PONV and antiemetic rescue, compared with propofol. The reductions in mean time and variability for early recovery with desflurane could potentially contribute to improved operating room efficiency and lower labor costs. Future studies are needed to confirm these findings.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112140"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074535","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":"Response to: No simple answer: Choosing regional analgesia for hip fracture pain","authors":"Haiming Liao,&nbsp;Zhen Wan,&nbsp;Jingjing Su,&nbsp;Dong Han,&nbsp;Wentao Lin,&nbsp;Muzhao Yu,&nbsp;Ge Sun,&nbsp;Fuhu Song,&nbsp;Jun Zhou M.D.","doi":"10.1016/j.jclinane.2026.112145","DOIUrl":"10.1016/j.jclinane.2026.112145","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112145"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170497","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":"A framework for success: Compassionate interventions to support healthcare colleagues when concerns arise","authors":"Michael G. Fitzsimons M.D. ,&nbsp;Daniel Saddawi-Konefka M.D., M.B.A. ,&nbsp;John Herman M.D. ,&nbsp;Sarah Arnholz J.D. ,&nbsp;Andy Gottlieb CNP ,&nbsp;Keith H. Baker M.D., Ph.D.","doi":"10.1016/j.jclinane.2026.112139","DOIUrl":"10.1016/j.jclinane.2026.112139","url":null,"abstract":"<div><div>Physicians suffer from the same medical, emotional, and psychiatric illnesses that those in non-medical careers do. These conditions may impair their performance, which could prove detrimental to the patients whose lives we are responsible for, especially in the specialty of anesthesiology. Yet, many physicians are reluctant to address their colleagues when performance appears impaired. In 2003, we implemented a substance use disorder (SUD) prevention program. Over the subsequent 20 years, the program evolved to include the critical component of professional intervention. Central to these interventions are prompt action, recognition of uncertainty, and a strong commitment to professionalism. The process emphasizes privacy, fairness, and dignity, with consistent application across all cases. Although our system arose from an effort to reduce substance use disorders, we believe that the process can be applied to other specialties even when drug testing is not involved.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112139"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074537","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":"Evaluation of induction practices for general anesthesia in patients with obesity: A French nationwide online survey","authors":"Tanguy Barthélémy ,&nbsp;Marc Garnier ,&nbsp;Audrey De Jong ,&nbsp;Thomas Godet ,&nbsp;Emmanuel Futier ,&nbsp;Pierre Borrel ,&nbsp;Laurent Renard Triché ,&nbsp;Mathilde Lapeyre ,&nbsp;Benjamin Andanson ,&nbsp;Matthieu Jabaudon","doi":"10.1016/j.jclinane.2026.112147","DOIUrl":"10.1016/j.jclinane.2026.112147","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a growing public health issue associated with increased peri-induction risk during general anesthesia, particularly airway-related complications. Substantial variability in national and international guidelines may contribute to heterogeneous clinical practice. This study aimed to describe anesthetic induction practices in patients with obesity in France and to explore the influence of body mass index and obesity-related comorbidities on the decision for or against rapid sequence induction.</div></div><div><h3>Methods</h3><div>This nationwide declarative survey used an anonymous online questionnaire distributed to French anesthesiologists between May and December 2024. Using standardized theoretical clinical scenarios, induction strategies were classified as rapid sequence induction or conventional induction, as reported by participants. Data were analyzed descriptively, with group comparisons performed using Pearson's chi-square test.</div></div><div><h3>Results</h3><div>Of the 665 responses collected, 652 were analyzed, revealing wide variability in practices. For a body mass index of 43 kg/m², 57% of participants would not perform rapid sequence induction. Among respondents, 33% regarded a body mass index threshold of ≥40 kg/m² as appropriate for initiating rapid sequence induction, whereas 24% did not define any specific threshold. Rapid sequence induction was primarily selected for patients with daily gastroesophageal reflux disease, gastroesophageal reflux disease associated with a hiatal hernia, or a history of bariatric surgery. Anesthesiologist experience was associated with differences in the choice of induction sequence (<em>p</em> = 0.003). Considerable heterogeneity remained in the calculation of neuromuscular blocking agent doses: 28% of practitioners used total body weight for non-depolarizing agents. Apneic oxygenation remained underused, with 32% of respondents reporting that they never used it.</div></div><div><h3>Conclusions</h3><div>This nationwide survey highlights substantial variability in anesthetic induction practices for patients with obesity, reflecting the absence of consensus. These findings underscore the need for further evidence to inform future recommendations and optimize anesthetic management in this high-risk population.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112147"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170498","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":"Beyond technical mastery: The inner work of leadership in medicine","authors":"T. Baima MD, BME ,&nbsp;M.M. Luedi MD, PhD ,&nbsp;C.S. Romero MD, PhD, MStat","doi":"10.1016/j.jclinane.2026.112142","DOIUrl":"10.1016/j.jclinane.2026.112142","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112142"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105597","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}