Journal of Clinical Anesthesia最新文献

{"title":"Implementation of a goal directed perfusion strategy to reduce cardiac surgery associated kidney injury: A before and after study","authors":"Jules Loeb ,&nbsp;Geoffroy Hariri ,&nbsp;Vincenzo Montana ,&nbsp;Aude Carillion ,&nbsp;Axel Hirwe ,&nbsp;Pauline Dureau ,&nbsp;Nima Djavidi ,&nbsp;Aymeric Lancelot ,&nbsp;Pascal Leprince ,&nbsp;Guillaume Lebreton ,&nbsp;Adrien Bouglé","doi":"10.1016/j.jclinane.2025.111828","DOIUrl":"10.1016/j.jclinane.2025.111828","url":null,"abstract":"<div><h3>Purpose</h3><div>Cardiac surgery associated acute kidney injury (CSA-AKI) is a frequent and severe complication. Goal Directed Perfusion (GDP) during cardiopulmonary bypass (CPB) has been developed to reduce post-operative complications, in particular CSA-AKI. Hence, we aimed to assess the implementation of a GDP strategy during CPB on the incidence of CSA-AKI in a large, unselected cardiac surgery population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, before and after study, including all patients admitted to our surgical intensive care unit (ICU) following a cardiac surgery with CPB in the year prior to GDP implementation (No-GDP group), and in the year following its implementation (GDP group). Primary endpoint was the incidence of acute kidney injury (AKI) according to KDIGO classification in each group. Secondary endpoints were ICU mortality and length of stay, and the main post-operative complications after cardiac surgery. Risk factors of AKI were evaluated using a multivariable logistic regression model.</div></div><div><h3>Results</h3><div>Among 903 patients in our analysis, 314 (34 %) developed AKI. The incidence of AKI was lower after the implementation of GDP strategy (<em>n</em> = 111; 27.6 % vs <em>n</em> = 203; 40.5 %, <em>p</em> &lt; 0.001). In the multivariable analysis, GDP was an independent factor of AKI reduction (OR 0.37, 95 %CI [0.27–0.52], p &lt; 0.001). This benefit was significant regarding stage 1 AKI, but not stage 2 or 3 AKI. GDP was not associated with a change in post-operative ICU mortality, length of stay or any other post-operative complication.</div></div><div><h3>Conclusion</h3><div>GDP strategy implantation during CPB is associated with a reduction of postoperative AKI.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111828"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835198","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 anesthesia for quality of recovery score after surgery: A meta-analysis of randomized controlled trials","authors":"Di Wang M.D ,&nbsp;Zhi Liu M.D. ,&nbsp;Wenhui Zhang M.D. ,&nbsp;Siru Li M.D. ,&nbsp;Yutao Chen M.D. ,&nbsp;Xingguo Li M.D. ,&nbsp;Congjie Bi Ph.D.","doi":"10.1016/j.jclinane.2025.111823","DOIUrl":"10.1016/j.jclinane.2025.111823","url":null,"abstract":"<div><h3>Background</h3><div>This meta-analysis aimed to evaluate the impact of opioid-free anesthesia (OFA) on the postoperative subjective quality of recovery (QoR).</div></div><div><h3>Methods</h3><div>Our comprehensive literature search, spanning PubMed, Embase, Cochrane Library, and Google Scholar, targeted clinical trials that evaluated the effects of OFA versus opioid-based anesthesia (OBA) on postoperative QoR. The data were analyzed using Review Manager, STATA, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) profiler.</div></div><div><h3>Main results</h3><div>This meta-analysis included 13 randomized controlled trials (RCTs). OFA significantly improved the QoR-15 score (SMD 2.16; 95 % CI 0.13–4.20; I² = 98 %; 293 patients in 3 trials) and QoR-40 score (SMD 0.47; 95 % CI 0.18–0.77; I² = 82 %; 1464 patients in 236 trials). Furthermore, the incidence of nausea, vomiting, and hypotension was reduced, with no difference in the risk of bradycardia or time for extubation of the trachea.</div></div><div><h3>Conclusion</h3><div>This meta-analysis shows OFA improves early postoperative quality of recovery and reduces the occurrence of nausea, vomiting, and hypotension without increasing the risk of bradycardia or prolonging the time for extubation of the trachea.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111823"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739144","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":"Efficacy of erector spinae plane block for postoperative pain management: A meta-analysis and trial sequential analysis of randomized controlled trials","authors":"João Pedro Fernandes Gonçalves,&nbsp;Manuela Lopes Duran,&nbsp;Eduardo Silva Reis Barreto,&nbsp;César Romero Antunes Júnior,&nbsp;Luiz Gustavo Albuquerque,&nbsp;Liliane Elze Falcão Lins-Kusterer PhD,&nbsp;Liana Maria Torres de Araujo Azi MD, PhD,&nbsp;Durval Campos Kraychete MD, PhD","doi":"10.1016/j.jclinane.2025.111831","DOIUrl":"10.1016/j.jclinane.2025.111831","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain remains a major problem across a wide range of surgical procedures. The efficacy and clinical utility of the Erector Spinae Plane Block (ESPB) in reducing postoperative pain remains uncertain.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy and safety of the ESPB compared with placebo or sham block in perioperative pain management.</div></div><div><h3>Evidence review</h3><div>We searched PubMed, Embase, Web of Science, Scopus, and Cochrane CENTRAL for randomized controlled trials (RCTs) comparing ESPB to placebo or sham block in surgical patients. Primary outcomes included postoperative pain at 2 h, 6 h, 24 h, and 48 h, intraoperative and cumulative postoperative opioid consumption (24 h), and postoperative nausea and vomiting, pruritus, and block-related adverse events. Subgroup and sensitivity analyses, as well as meta-regressions, were performed to explore sources of heterogeneity. Trial sequential analysis (TSA) was used to assess the quantitative robustness of the available data. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024583633.</div></div><div><h3>Findings</h3><div>Forty-three RCTs were included, with 1361 patients randomized to the Erector Spinae Plane Block group. ESPB reduced postoperative pain at 2 h (MD −1.46;95 % CI −1.98 to −0.94;<em>p</em> &lt; 0.001;I² = 91 %), 6 h (MD −1.23;95 % CI −1.64 to −0.83;p &lt; 0.001;I² = 89 %), 24 h (MD −0.47;95 % CI −0.67 to −0.28;p &lt; 0.001;I² = 78 %), and 48 h (MD −0.24;95 % CI −0.39 to −0.09;<em>p</em> = 0.002;I² = 10 %). Also, intraoperative opioid consumption (MD -137.43 μg;95 % CI −208.73 to −66.13;<em>p</em> &lt; 0.001;I² = 100 %), 24 h cumulative opioid consumption (MD −25.62 mg;95 % CI −31.31 to −19.93;<em>p</em> &lt; 0.001;I² = 99 %), and incidence of postoperative nausea and vomiting (RR 0.56;95 % CI 0.44 to 0.72;p &lt; 0.001;I² = 16 %) were significantly lower in patients submitted to ESPB. No significant differences were found in postoperative pruritus (RR 0.62;95 % CI 0.35 to 1.10;<em>p</em> = 0.105;I² = 27 %). Notably, no block-related adverse events were reported in any study. Certainty of evidence was rated as low to moderate for most outcomes. TSA suggested that no further trials are needed to assess ESPB efficacy in the analyzed outcomes, except for postoperative pruritus.</div></div><div><h3>Conclusion</h3><div>ESPB is a safe and effective regional anesthesia technique that significantly reduces postoperative pain and opioid consumption across various surgical procedures.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111831"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790827","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":"Comparing the analgesic effect of regional nerve block technique in laparoscopic nephrectomy: A systematic review and network meta-analysis","authors":"Hao Liu MS ,&nbsp;Longfei Ding MS ,&nbsp;Yuewen He MD ,&nbsp;Zhengze Zhang MD ,&nbsp;Tong Wu MD ,&nbsp;Jiacheng Fu MS ,&nbsp;Yong Wang MD ,&nbsp;Wuhua Ma MD","doi":"10.1016/j.jclinane.2025.111829","DOIUrl":"10.1016/j.jclinane.2025.111829","url":null,"abstract":"<div><h3>Background</h3><div>Various regional nerve block techniques have been employed to manage acute pain following laparoscopic nephrectomy; however, the optimal technique remains unclear.</div></div><div><h3>Methods</h3><div>This network meta-analysis (NMA) compares the analgesic efficacy of various regional nerve block techniques. We conducted a comprehensive search in PubMed, Embase, Web of Science (WOS), Cochrane, and Scopus databases from inception until October 10, 2024, for randomized controlled trials (RCTs) that compare the analgesic efficacy of regional nerve block techniques, including quadratus lumborum block (QLB), transversus abdominis plane block (TAPB), retrolaminar block (RLB), local infiltration anesthesia (LIA), erector spinae block (ESB), paravertebral block (PVB), and epidural analgesia) for post-laparoscopic nephrectomy pain management. The entire NMA analysis was conducted using R software and a Bayesian framework. The primary outcome of this NMA was the cumulative oral morphine equivalent (OME) consumption at 24 h postoperatively. Secondary outcomes included 6-h postoperative OME consumption, intraoperative OME consumption, time to first opioid use, incidence of rescue analgesic use, incidence of nausea and vomiting, and patient satisfaction.</div></div><div><h3>Results</h3><div>Our direct comparison results indicate that the interventions effectively reduced OME consumption at 24 h and 6 h postoperatively and intraoperatively, extended the time to first opioid use, improved patient satisfaction, and reduced the incidence of postoperative nausea and vomiting. The NMA results demonstrated that preoperative quadratus lumborum block (PreOp QLB; MD -31.23, 95 % CI -54.99 to −9.95; low-quality evidence) and preoperative erector spinae block (PreOp ESB; MD -44.44, 95 % CI -88.03 to −0.97; moderate-quality evidence) significantly reduced the 24-h postoperative OME consumption.</div></div><div><h3>Conclusions</h3><div>Analysis of existing evidence suggests that PreOp QLB demonstrates a superior advantage over other interventions, significantly reducing 24-h postoperative OME, 6-h postoperative OME, rescue analgesia usage, and the incidence of postoperative nausea and vomiting, as well as extending time to first opioid use. Other interventions, such as PreOp ESB, also show potential benefits. However, due to limitations in the current number of studies and sample sizes, future large-scale, high-quality studies are necessary to further support these findings.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111829"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790828","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":"In-hospital use of beta-blockers for critically ill patients with acute heart failure: Whether and when to initiate","authors":"Zeming Zhou MD ,&nbsp;Haixu Wang MD ,&nbsp;Wei Wang PhD ,&nbsp;Jingkuo Li BM ,&nbsp;Lubi Lei BM ,&nbsp;Lihua Zhang MD, PhD ,&nbsp;Haibo Zhang MD, PhD ,&nbsp;Jiamin Liu MD, PhD ,&nbsp;Xin Zheng MD, PhD","doi":"10.1016/j.jclinane.2025.111824","DOIUrl":"10.1016/j.jclinane.2025.111824","url":null,"abstract":"<div><h3>Background</h3><div>The use of beta-blockers during hospitalization for acute heart failure (AHF) remains controversial. This study aimed to investigate whether beta-blocker use is associated with a reduced risk of mortality in critically ill patients with AHF and to determine the optimal timing for initiating beta-blocker therapy.</div></div><div><h3>Methods</h3><div>Data from critically ill patients with AHF in the MIMIC-IV version 2.2 database were analyzed. Baseline characteristics, laboratory tests, comorbidities, vital signs, and medication usage at admission and during hospitalization were collected to perform inverse probability of treatment weighting (IPTW). IPTW-weighted logistic regression models were then used to examine the relationship between beta-blocker use and mortality.</div></div><div><h3>Results</h3><div>In the IPTW-weighted regression model, patients who newly started beta-blockers or continued their use had a lower risk of in-hospital mortality compared to those not treated with beta-blockers (odds ratio [OR]: 0.45; 95 % confidence interval [CI]: 0.34 to 0.61, and OR: 0.53; 95 % CI: 0.41 to 0.69, respectively). Conversely, those who had beta-blockers withdrawn showed a higher risk of in-hospital mortality (OR: 2.59; 95 % CI: 1.63 to 4.10). Among beta-blocker users, compared to patients treated before admission and who received their first dose within 48 h of admission, those who were not treated before admission but started after 48 h had a similar mortality risk (OR: 0.82; 95 % CI: 0.60 to 1.11; P = 0.202). However, patients previously treated with beta-blockers who initiated therapy after 48 h and those not treated before admission but started within 48 h had a lower risk of in-hospital mortality (OR: 0.44; 95 % CI: 0.30 to 0.64; P &lt; 0.001, and OR: 0.65; 95 % CI: 0.48 to 0.86; P = 0.003, respectively).</div></div><div><h3>Conclusion</h3><div>The use of beta-blockers during hospitalization for AHF is associated with a reduced risk of in-hospital mortality, and withdrawal was associated with an increased risk of mortality. Initiating beta-blockers within 48 h for beta-blocker-naïve patients and after 48 h for those previously treated with beta-blockers before admission may further decrease mortality risk.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111824"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785403","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":"Cortical, subcortical, brainstem and autonomic responses to nociception under total intravenous anesthesia","authors":"Sérgio Vide M.D., Ph.D ,&nbsp;Matthias Kreuzer Ph.D ,&nbsp;Ana Ferreira Ph.D ,&nbsp;Mafalda Couto Ph.D ,&nbsp;Mercè Agustí M.D. Ph.D ,&nbsp;Sebastian Jaramillo M.D ,&nbsp;Gerhard Schneider M.D., Ph.D ,&nbsp;Paul S. García M.D. Ph.D ,&nbsp;Fernando Abelha M.D., Ph.D ,&nbsp;Pedro Amorim M.D ,&nbsp;Iñaki Trocóniz Ph.D ,&nbsp;Merlin Larson M.D., Ph.D ,&nbsp;Pedro Gambús M.D. Ph.D","doi":"10.1016/j.jclinane.2025.111825","DOIUrl":"10.1016/j.jclinane.2025.111825","url":null,"abstract":"<div><h3>Background</h3><div>Physiological responses to nociception are complex and involve intricate associations between the central, peripheral, and autonomic nervous systems. To optimize intraoperative analgesic titration, several monitoring devices have been developed, each targeting specific physiologic variables. However, existing devices primarily focus on isolated components of the nociceptive response, such as autonomic or cortical activity, without integrating these perspectives comprehensively.</div><div>Our aim was to compare the performance of different nociception monitors in response to standardized tetanic stimulation and to investigate the correlation between these monitors' responses and varying concentrations of remifentanil.</div></div><div><h3>Methods</h3><div>In this study, we evaluated and compared the responses of the Nociception Level index (NOL), Analgesia Nociception Index (ANI), Pupillary Reflex Dilation (PRD) and both raw and processed electroencephalogram (EEG) under varying concentrations of propofol and remifentanil. Standardized tetanic stimuli were administered to patients under general anesthesia with target-controlled infusion of propofol and remifentanil. EEG, PRD, NOL, ANI, heart rate (HR), Bispectral index (BIS), and CONOX monitor indices (qCON and qNOX) were concomitantly recorded.</div></div><div><h3>Results</h3><div>ANI, BIS, HR, NOL, PRD, and qNOX significantly changed after noxious stimulation. In our dataset, PRD had the strongest correlation with varying remifentanil concentrations, while ANI, NOL, and qNOX did not show significant correlations with remifentanil concentrations. Following a noxious stimulus, the raw EEG in patients with low PRD exhibited a significant increase in power in the high EEG frequencies around 25 Hz and decreased power in frequencies corresponding to the alpha range (8–12 Hz) in the power spectral density.</div></div><div><h3>Conclusions</h3><div>PRD, HR, and BIS correlated with varying levels of remifentanil, with PRD exhibiting the strongest correlation. When CE remifentanil are low, noxious stimuli are more likely to dilate the pupil and be detected in the EEG. Considering the complexity of the nociceptive response, integrating multimodal neurophysiologic monitoring with pharmacological data may improve the anesthesiologist's ability to assess on the nociception-antinociception balance. However, further studies are needed to validate these findings and address the study's limitations.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111825"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823562","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 sodium-glucose transporter 2 inhibition on cardiac surgery-associated acute kidney injury: An open-label randomized pilot study","authors":"Lars I.P. Snel ,&nbsp;Maartina J.P. Oosterom-Eijmael ,&nbsp;Elena Rampanelli ,&nbsp;Yugeesh R. Lankadeva ,&nbsp;Mark P. Plummer ,&nbsp;Benedikt Preckel ,&nbsp;Jeroen Hermanides ,&nbsp;Daniel H. van Raalte ,&nbsp;Abraham H. Hulst","doi":"10.1016/j.jclinane.2025.111811","DOIUrl":"10.1016/j.jclinane.2025.111811","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose transporter-2 (SGLT2) inhibitors reduced the incidence of acute kidney injury in large cardiovascular outcome trials in patients with chronic heart and kidney failure. Acute kidney injury is a common complication following cardiac surgery. We hypothesized that perioperative SGLT2 inhibition could reduce kidney injury after cardiac surgery, measured with the biomarker neutrophil gelatinase-associated (NGAL).</div></div><div><h3>Methods</h3><div>In this open-label phase IV, randomized, parallel-group, pilot study, adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomized to receive either an SGLT2 inhibitor, empagliflozin (10 mg; oral) once daily, from three days before surgery until postoperative day two, or standard-of-care. The primary outcome was the between-group difference of serum NGAL on the second postoperative day. Moreover, other biomarkers for acute kidney injury were measured, including serum kidney injury molecule-1 (KIM-1), hypoxia-inducible factor-1 alpha (HIF-1α), and urine NGAL/Creatinine and KIM-1/Creatinine ratios. Additional outcomes included acute kidney injury incidence within the first seven days following cardiac surgery according to Kidney Disease: Improving Global Outcomes criteria and metabolic parameters, including ketone body concentrations and glycemic control.</div></div><div><h3>Results</h3><div>Between March 2022 and April 2023, 55 patients were included (sex: 73 % male, age: 66 ± 10 years, BMI: 28 ± 4 kg/m², empagliflozin <em>n</em> = 25, control <em>n</em> = 30) in the intention-to-treat analysis. There were no significant between-group differences in serum and urine NGAL or KIM-1. However, empagliflozin significantly reduced the incidence of acute kidney injury (20 % vs 66.7 %; absolute difference 46.7 %, 95 % CI, −69.7 – -23.6; <em>P</em> &lt; .001). A significant increase in serum HIF-1α after surgery was solely observed in the control group. We observed no between-group differences in the incidence of (euglycemic) ketoacidosis or hypoglycemic events.</div></div><div><h3>Conclusions</h3><div>In this pilot study, perioperative SGLT2 inhibition was not associated with lower NGAL levels. We observed that SGLT2 inhibition reduced the incidence of acute kidney injury in this small study population. As the results of this pilot study are hypotheses-generating, further validation is needed in a large-scale, double-blind, placebo-controlled, randomized trial, which is currently ongoing.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111811"},"PeriodicalIF":5.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715709","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":"Effect of esketamine on postoperative depression in women with breast cancer and preoperative depressive symptoms: The EASE randomized trial","authors":"Qingfeng Wei MD ,&nbsp;Mengmeng Li MD ,&nbsp;Qiuling Du MD ,&nbsp;Huiwen Zhang MD ,&nbsp;Yongjie Liang MD ,&nbsp;Cen Cheng MD ,&nbsp;Bin Mei MD, PhD ,&nbsp;Xiaowei Yang MD, PhD ,&nbsp;Yinguang Fan PHD ,&nbsp;Jiajia Zhu MD, PhD ,&nbsp;Jingjie Zhang MD, PhD ,&nbsp;Yongqiang Yu MD, PhD ,&nbsp;Qiying Shen MD, PhD ,&nbsp;Xuesheng Liu MD, PhD ,&nbsp;Daniel I. Sessler MD","doi":"10.1016/j.jclinane.2025.111821","DOIUrl":"10.1016/j.jclinane.2025.111821","url":null,"abstract":"<div><h3>Study objective</h3><div>To determine whether intraoperative low-dose esketamine ameliorates depression in women having breast cancer surgery.</div></div><div><h3>Design</h3><div>A prospective single-center double blind randomized placebo-controlled trial.</div></div><div><h3>Setting</h3><div>Perioperative period, operating room, post anesthesia care unit and hospital ward.</div></div><div><h3>Patients</h3><div>108 women 18–65 years old who were scheduled for elective breast cancer surgery. All had preoperative depressive symptoms as defined by Montgomery-Åsberg depression scores ≥12 (range, 0–60; higher scores indicate more severe depression).</div></div><div><h3>Interventions</h3><div>Eligible participants were randomized to esketamine 0.25 mg/kg or saline placebo. Blinded trial drugs were given intravenously over the initial 40 min of anesthesia.</div></div><div><h3>Measurements</h3><div>Our primary outcome was the fraction of patients who had at least a 50 % reduction in the Montgomery-Åsberg depression score within 3 postoperative days. Secondary outcomes included the fraction of patients with depression remission defined as Montgomery-Åsberg scores ≤10, the numeric value of the Montgomery-Åsberg depression scores, postoperative severe pain, and anxiety as determined by the Generalized Anxiety Disorder 7-item score. Adverse events were monitored for 72 postoperative hours.</div></div><div><h3>Main results</h3><div>54 women each were randomized to esketamine and saline, and 104 were available for our intent-to-treat analysis. The mean age was 50 years. Esketamine non-significantly doubled the fraction of patients who had a 50 % reduction in their depressions scores: 27 % vs 13 %, odds ratio 2.4, [95 % CI 0.9 to 6.6], <em>P</em> = 0.087. Montgomery-Åsberg depression scores were nearly a factor-of-two and significantly lower (better) on postoperative days 1 to 5 in patients given esketamine. Montgomery-Åsberg scores decreased significantly more from baseline in patients randomized to esketamine: mean difference − 2.5 [95 % CI -4.5 to −0.6], <em>P</em> = 0.010. Esketamine treatment had no significant effect on other secondary outcomes or on adverse events.</div></div><div><h3>Conclusions</h3><div>Intraoperative administration of 0.25 mg/kg esketamine did not significantly improve the fraction of depressed women having breast cancer patients who had a 50 % reduction in their depression scores at 3 days postoperatively. However, the observed factor-of-two treatment effect was clinically meaningful and esketamine significantly reduced short-term postoperative depression scores without provoking complications. Robust trials are warranted.</div><div><strong>Registration Trial registry:</strong> <span><span>http://www.chictr.org.cn/;</span><svg><path></path></svg></span> Identifier: ChiCTR2300071062.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111821"},"PeriodicalIF":5.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705384","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 \"Comparisons in analgesic effects between ultrasound-guided erector spinae plane block and surgical intercostal nerve block after video-assisted thoracoscopic surgery: A randomized controlled trial\" [Journal Title volume (year) Start page-End page/Article Number] [95 (2024) / 111448].","authors":"Chun-Sung Sung, Tzu-Jung Wei, Jung-Jyh Hung, Fu-Wei Su, Shih-I Ho, Mong-Wei Lin, Kuang-Cheng Chan, Chun-Yu Wu","doi":"10.1016/j.jclinane.2025.111820","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111820","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111820"},"PeriodicalIF":5.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719447","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":"Hyperkalemia in liver transplantation","authors":"William Chang MD ,&nbsp;Ming-Ray Xu MD ,&nbsp;Alexander George MD ,&nbsp;Meredith Kingeter MD ,&nbsp;Christopher Patrick Henson DO ,&nbsp;Kelly Mishra MD ,&nbsp;Martin Montenovo MD ,&nbsp;Michael Rizzari MD ,&nbsp;Kara Siegrist MD","doi":"10.1016/j.jclinane.2025.111822","DOIUrl":"10.1016/j.jclinane.2025.111822","url":null,"abstract":"<div><div>Hyperkalemia commonly occurs in patients undergoing liver transplantation. The intraoperative course of liver transplant often involves hemodynamic and metabolic derangements leading up to liver reperfusion. Potassium levels can rise to dangerous levels immediately after reperfusion. The consequences of intraoperative hyperkalemia include risk of malignant arrhythmias and cardiac arrest. This review explores the numerous causes of hyperkalemia, including contributing surgical and anesthetic factors. The authors also discuss various treatment options and surgical techniques to manage perioperative hyperkalemia. It is important for anesthesiologists to understand the implications and management of hyperkalemia to optimize patients and reduce the risk of an intraoperative cardiac arrest.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111822"},"PeriodicalIF":5.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696627","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}