Journal of Clinical Anesthesia最新文献

{"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}

{"title":"Automated intraoperative safety event reporting: A pilot study on cardiovascular events","authors":"Michael Salomon MD,&nbsp;Qainat Shah MD,&nbsp;Katie Basch DO,&nbsp;Alexandra Pearce MD,&nbsp;George Istafanos DO,&nbsp;Nour El Hage Chehade MD,&nbsp;Avneep Aggarwal MD,&nbsp;Jacek Cywinski MD,&nbsp;Reem Khatib MD,&nbsp;Piyush Mathur MD","doi":"10.1016/j.jclinane.2025.111912","DOIUrl":"10.1016/j.jclinane.2025.111912","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111912"},"PeriodicalIF":5.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366480","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":"Safety and efficacy of high frequency jet ventilation: A systematic and narrative review","authors":"Jasmin Spaar ,&nbsp;Peter Biro ,&nbsp;Michael Sander ,&nbsp;Volker Gross ,&nbsp;Michael Scholtes ,&nbsp;Keywan Sohrabi","doi":"10.1016/j.jclinane.2025.111906","DOIUrl":"10.1016/j.jclinane.2025.111906","url":null,"abstract":"<div><h3>Background</h3><div>High-Frequency Jet Ventilation (HFJV) is a specific modality of mechanical ventilation employed in certain operative and critical care settings. Despite its technical advantages, particularly in procedures requiring minimal organ motion, HFJV remains underutilised in routine clinical practice, largely due to limited high-quality evidence and the absence of formal national guidelines.</div></div><div><h3>Objective</h3><div>This systematic review aims to critically appraise the current evidence regarding the safety and efficacy of HFJV in adult and paediatric patients. The analysis covers both operating room and intensive care unit settings, and compares HFJV with conventional ventilation strategies.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in accordance with PRISMA guidelines. We included 41 studies published after 1997, which were appraised using the Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence and Cochrane risk-of-bias tools (RoB 2 and ROBINS-I).</div></div><div><h3>Results</h3><div>Most studies demonstrated favourable physiological and procedural outcomes with HFJV in intraoperative settings, The benefits were most notable during airway surgeries, tissue ablation procedures, and atrial fibrillation ablation.. In contrast, results in neonatal intensive care were heterogeneous, with some studies reporting improved gas exchange, while others indicated higher complication or mortality rates. Common limitations included small sample sizes, methodological heterogeneity, and risk of selection and publication bias. Volatile anaesthetic delivery was universally unfeasible, and HFJV performance was reduced in obese or COPD patients.</div></div><div><h3>Conclusions</h3><div>This review underscores the need for further research to optimise HFJV application and to better understand its long-term clinical impacts. The insights gained provide valuable guidance for future clinical use.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111906"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366393","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 response to: Association of intraoperative end-tidal CO2 levels with postoperative outcomes – The importance of considering cardiac output in complication risk","authors":"Prashant Nasa ,&nbsp;Sabrine N.T. Hemmes ,&nbsp;Marcus J. Schultz ,&nbsp;for the LAS VEGAS investigators","doi":"10.1016/j.jclinane.2025.111908","DOIUrl":"10.1016/j.jclinane.2025.111908","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111908"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364764","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":"Is there still a need for cadaveric studies on the superficial parasternal intercostal plane block?","authors":"Burhan Dost MD ,&nbsp;Alessandro De Cassai MD","doi":"10.1016/j.jclinane.2025.111910","DOIUrl":"10.1016/j.jclinane.2025.111910","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111910"},"PeriodicalIF":5.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320896","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 on midazolam dosing and metoclopramide use in a trial on postoperative bowel recovery","authors":"Mustafa Büyükcavlak MD","doi":"10.1016/j.jclinane.2025.111907","DOIUrl":"10.1016/j.jclinane.2025.111907","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111907"},"PeriodicalIF":5.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320895","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":"Sitting position, face-to-face rapid sequence intubation with the Airtraq™ video laryngoscope for cancer patients with higher aspiration risk","authors":"Edward Hsu Tsai MD,&nbsp;Huang Huang MD,&nbsp;Emily Lai MD,&nbsp;Mi Wang MD,&nbsp;Joseph Ruiz MD","doi":"10.1016/j.jclinane.2025.111909","DOIUrl":"10.1016/j.jclinane.2025.111909","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111909"},"PeriodicalIF":5.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320894","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":"Incidence of delirium post cardiac surgery: Discrepancy between clinical observation, DOS scores, and single‑lead EEG","authors":"Sophie Adelaars ,&nbsp;Mariska E. te Pas ,&nbsp;Steffy W.M. Jansen ,&nbsp;Carolien M.J. van der Linden ,&nbsp;Erwin Oosterbos ,&nbsp;Daan van de Kerkhof ,&nbsp;Marc P. Buise ,&nbsp;R. Arthur Bouwman","doi":"10.1016/j.jclinane.2025.111896","DOIUrl":"10.1016/j.jclinane.2025.111896","url":null,"abstract":"<div><h3>Rational</h3><div>Postoperative delirium (POD) is a common complication after cardiac surgery, associated with increased morbidity, mortality, prolonged hospitalization, and cognitive decline. Early and accurate diagnosis is crucial, but current methods like the Delirium Observation Screening (DOS) scale rely on subjective assessments. Single‑lead EEG (sl-EEG), particularly the DeltaScan Brainstate Monitor, offers a more objective approach. This study compares the incidence of delirium detected by clinical observation, DOS scores, and single‑lead EEG scores in patients undergoing aortic valve replacement (AVR) surgery.</div></div><div><h3>Methods</h3><div>This prospective cohort study included 50 patients aged 65 or older scheduled for AVR surgery. Delirium was assessed preoperatively and on postoperative days 1, 3, and 7 using clinical observation, DOS, and single‑lead EEG. Incidence rates were calculated, and the McNemar's Chi-squared test was used to assess differences between methods.</div></div><div><h3>Results</h3><div>Delirium incidence varied widely by method: 32 % by clinical assessment, 28 % by DOS, and 76 % by single‑lead EEG. Clinical assessment and DOS had an 80 % concordance, while single‑lead EEG detected significantly more cases (<em>p</em> &lt; 0.001). Incidence declined across all methods over seven postoperative days.</div></div><div><h3>Conclusion</h3><div>Our findings reveal significant discrepancies in POD detection rates by diagnostic methods. The high sensitivity of sl-EEG suggests a risk of false positives, while clinical assessment and DOS may risk underdiagnosis, especially in hypoactive delirium. An integrated diagnostic approach combining multiple methods may improve accuracy and capture the full spectrum of delirium symptoms. Future studies should refine these tools and explore advanced technologies to develop reliable, easily deployable diagnostics for clinical practice.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111896"},"PeriodicalIF":5.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322279","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 protocol based on thoracic paravertebral block enhances postoperative recovery after breast cancer surgery: A two-center, prospective, randomized, controlled trial","authors":"Panpan Tong ,&nbsp;Ying Guo ,&nbsp;Yun Wang ,&nbsp;Yuerou Feng ,&nbsp;Xiong Song ,&nbsp;Guanli Luo ,&nbsp;Weiyi Qin ,&nbsp;Xiaofan Lu ,&nbsp;Liquan Zheng ,&nbsp;Haidong Wang ,&nbsp;Yali Lu ,&nbsp;Renchun Lai","doi":"10.1016/j.jclinane.2025.111904","DOIUrl":"10.1016/j.jclinane.2025.111904","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate whether the implementation of an opioid-free anaesthesia (OFA) protocol based on thoracic paravertebral block (TPVB) could improve early postoperative recovery quality in patients undergoing breast cancer surgery. We hypothesized that opioid-free anaesthesia with TPVB would improve the 15-item quality of recovery (QoR-15) at 24 h relative to conventional anaesthesia protocol.</div></div><div><h3>Design</h3><div>A prospective, randomized and controlled trial.</div></div><div><h3>Setting</h3><div>Sun Yat-Sen University Cancer Center and Gansu Provincial Cancer Hospital.</div></div><div><h3>Patients</h3><div>Based on a minimal clinically important difference (MCID) of 6.0 and an assumed standard deviation (SD) of 16 for postoperative QoR-15 score, a total of 252 patients undergoing breast cancer surgery were enrolled.</div></div><div><h3>Interventions</h3><div>Patients were allocated to either opioid-based anaesthesia (OA) group or OFA group.</div></div><div><h3>Measurements</h3><div>The primary outcome was QoR-15 score at 24 h postoperatively. Secondary outcomes included QoR-15 score at 48 h, numerical rating scale (NRS) pain scores at rest and during activity at PACU, 6, 12, 24, and 48 h postoperatively, postoperative analgesic rescue, the occurrence of adverse effects such as nausea and vomiting, the time to first urination and the length of hospital stay.</div></div><div><h3>Main results</h3><div>At 24 h postoperatively, means and standard errors (SE) of QoR-15 score were 139.12 (0.72) in the OFA group significantly higher than those in the OA group 132.48 (0.84) [difference of 6.6, 95 % Confidence Interval (CI), 4.87–8.40, <em>P</em> &lt; 0.001]. The QoR-15 score of OFA [145.31 (0.67)] at 48 h is also higher than that of OA [142.18 (0.88)]. The resting NRS score at 6 h and the active NRS score within 12 h after surgery in the OFA group were significantly lower than those in the OA group (<em>P</em> &lt; 0.001). Fewer patients suffered from postoperative nausea and retching in the OFA group (P &lt; 0.001). There were no statistical differences in the time to first urination and length of stay between OFA and OA groups (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>OFA based on TPVB improved the postoperative quality of recovery in patients undergoing breast cancer surgery.</div></div><div><h3>Trial registration</h3><div><span><span>http://www.chictr.org.cn</span><svg><path></path></svg></span>, Identifier: ChiCTR2300072501, principal investigator: Renchun Lai, date of registration: 2023-06-15.</div></div><div><h3>Clinical trial registration</h3><div>ChiCTR2300072501.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111904"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298064","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 prospective, observational study of non-invasive venous waveform analysis (NIVA) for the detection of acute low volume blood loss in humans","authors":"Bret D. Alvis MD ,&nbsp;Dawson Wervey BS ,&nbsp;Romy Pein BS ,&nbsp;Eric Wise MD ,&nbsp;Jenna Sobey MD ,&nbsp;Annmarie Mede MD ,&nbsp;Lexie Vaughn MD ,&nbsp;Marisa Case RN ,&nbsp;Meghan Breed MD ,&nbsp;Jain Priyanka BS ,&nbsp;Philip Leisy MD ,&nbsp;Colleen Brophy MD ,&nbsp;Kyle Hocking PhD","doi":"10.1016/j.jclinane.2025.111902","DOIUrl":"10.1016/j.jclinane.2025.111902","url":null,"abstract":"<div><h3>Background</h3><div>Accurate non-invasive monitoring for the diagnosis of hemorrhage is an unmet need in acute care settings. Non-Invasive Venous waveform Analysis (NIVA) has demonstrated significant sensitivity in detecting acute hemorrhage with 8–10 % blood volume loss. To determine whether NIVA can accurately and non-invasively detect lower volumes of blood loss, we performed a prospective observational study using a digital blood volume monitor at an American Red Cross (ARC) donation center to assess NIVA's performance at lower blood volume loss.</div></div><div><h3>Methods</h3><div>Venous waveforms were successfully captured in 33 ARC-approved patients. Waveforms were recorded for the duration of whole blood donation and then transformed from the time domain to the frequency domain. The ratiometric power contribution of the cardiac frequencies was used to calculate a representative volume status value, the IntraVAscular Number (IVAN).</div></div><div><h3>Results</h3><div>A significant decrease in the IVAN output was observed after just 200 mL (3–4 % blood volume) of whole blood donation (<em>p</em> &lt; 0.05). The ROC curve demonstrated an Area Under the Curve (AUC) of 0.65 for the ability of delta IVAN to detect 200 mL of blood loss. The Receiver Operating Characteristic (ROC) curve demonstrated an AUC of 0.91 for the ability of delta IVAN to detect 500 mL of blood loss.</div></div><div><h3>Conclusion</h3><div>There remains a large unmet need for accurate and timely detection of acute hemorrhage. This study supports the potential application of NIVA in the detection of acute low-volume human blood loss. NIVA is a novel technology that uses previously undetectable low-amplitude venous signals of the cardiac pulse, which may prove useful for more accurate and early detection of acute hemorrhage.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111902"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298065","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}