Journal of Clinical Anesthesia最新文献

{"title":"Optimizing pediatric premedication for general anesthesia: A comprehensive Bayesian network meta-analysis","authors":"Gustavo R.M. Wegner ,&nbsp;Bruno F.M. Wegner ,&nbsp;Henrique S. Cumming ,&nbsp;Henrik G. de Oliveira ,&nbsp;Letícia R. Campos ,&nbsp;Luiz H.D. da Silva ,&nbsp;Carlos H.O. Ferreira ,&nbsp;Alesson M. Miranda ,&nbsp;André B. Donato ,&nbsp;Tatiana S. do Nascimento","doi":"10.1016/j.jclinane.2025.111903","DOIUrl":"10.1016/j.jclinane.2025.111903","url":null,"abstract":"<div><h3>Study objective</h3><div>To identify the most effective premedication strategies for improving mask acceptance, parental separation acceptance, and intravenous cannulation acceptance in pediatric patients undergoing general anesthesia.</div></div><div><h3>Design</h3><div>A systematic review and Bayesian network meta-analysis of randomized controlled trials.</div></div><div><h3>Setting</h3><div>Elective pediatric surgeries under general anesthesia.</div></div><div><h3>Patients</h3><div>Children aged 1–12 years, classified as American Society of Anesthesiologists (ASA) I–III, who received premedication with midazolam, dexmedetomidine, ketamine, or other relevant agents and combinations.</div></div><div><h3>Measurements</h3><div>Two main analyses were conducted using a Bayesian framework to generate comparative efficacy rankings. A primary analysis considered every unique combination of drug, dose, route, and timing as a distinct intervention. A secondary analysis grouped interventions solely by the pharmacological agent(s) used, regardless of dose, route, or timing. This dual approach allowed specific comparisons of route and dose while also providing a broader assessment of each drug or combination. Outcomes were satisfactory acceptance of mask application, parental separation, and intravenous cannulation. Meta-regression, sensitivity analyses, and assessment of risk of bias were also undertaken.</div></div><div><h3>Main results</h3><div>Sixty-nine trials encompassing 5794 pediatric patients were included. In the primary analysis, only mask acceptance could be evaluated. Combinations of dexmedetomidine, midazolam, and ketamine demonstrated the highest probabilities of satisfactory mask acceptance, with intranasal administration at shorter premedication intervals (15–30 min) showing greater efficacy. Clonidine, melatonin, and diazepam were comparatively less effective. In the secondary analysis, mask acceptance, intravenous cannulation acceptance, and parental separation acceptance yielded similar findings, with pharmacological combinations based on dexmedetomidine and midazolam ranking highest, while clonidine, melatonin, and diazepam remained less effective.</div></div><div><h3>Conclusions</h3><div>Dexmedetomidine-, midazolam-, and ketamine-based combinations offer superior preoperative cooperation in pediatric patients, as demonstrated by higher success rates of mask acceptance, intravenous cannulation acceptance, and parental separation acceptance. Routes, doses, and timing are critical factors influencing success.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111903"},"PeriodicalIF":5.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279130","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":"Application of deep learning-based facial pain recognition model for postoperative pain assessment","authors":"Ji-Tuo Zhang ,&nbsp;Xiao-Yi Hu ,&nbsp;Wen Duan ,&nbsp;Mu-Huo Ji (Ph.D) ,&nbsp;Jian-Jun Yang (Ph.D)","doi":"10.1016/j.jclinane.2025.111898","DOIUrl":"10.1016/j.jclinane.2025.111898","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain is a common and complex issue that affects patients' recovery and the quality of healthcare. Traditional pain assessment methods—primarily based on self-reporting and clinical observation—are often inadequate, particularly for patients with communication impairments. Deep learning technology offers new opportunities for automatic pain assessment. However, progress in this area is hindered by the limited availability of high-quality clinical datasets and a paucity of studies addressing real-world model deployment. This gap between laboratory research and clinical application requires further study.</div></div><div><h3>Methods</h3><div>The study constructed two distinct datasets to capture both clinical and laboratory scenarios. The Clinical Pain Dataset (CPD) includes 3411 facial pain images from 503 postoperative patients, while Simulated Pain Dataset (SPD) contains 1038 images from 51 volunteers. The two datasets were combined to form the Combined Dataset (CD). A pre-trained VGG16 model was used for training and validation. The model's performance on different datasets and pain levels was evaluated using area under the receiver operating characteristic curve (AUROC) and F1 scores.</div></div><div><h3>Results</h3><div>In the CPD and CD, the model demonstrated its highest performance in identifying severe pain, achieving AUROC values of 0.898 (95 %CI,0.877–0.917) and 0.867 (95 %CI,0.844–0.889), respectively. For overall evaluation, the highest AUROC values were observed in CPD-train (0.898 [95 % CI: 0.877–0.917]) and CD-train (0.917 [95 % CI: 0.883–0.948]) for severe pain classification. Building on these results, a facial pain recognition software was developed based on the model, offering a new option for clinical pain identification.</div></div><div><h3>Conclusions</h3><div>The findings indicate that deep learning models leveraging facial expression analysis hold significant potential to recognize varying degrees of pain in clinical settings, especially severe pain. In the future, they could help anesthesiologists monitor postoperative patients' pain levels in real-time, enhancing the quality of medical services.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111898"},"PeriodicalIF":5.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279858","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 the Letter “AI performance in blood gas analysis: Methodological and interpretative challenges”","authors":"Engin İhsan Turan ,&nbsp;Abdurrahman Engin Baydemir ,&nbsp;Anıl Berkay Balıtatlı ,&nbsp;Ayça Sultan Şahin","doi":"10.1016/j.jclinane.2025.111901","DOIUrl":"10.1016/j.jclinane.2025.111901","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111901"},"PeriodicalIF":5.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270669","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":"Preoperative low-dose dexmedetomidine reduces postoperative delirium in elderly patients with hip fracture under spinal anesthesia: A randomized, double blind, controlled clinical study","authors":"Pengcheng Geng ,&nbsp;Zixiang Shang ,&nbsp;Feng Cheng ,&nbsp;Yujie Zhang ,&nbsp;Xin Deng ,&nbsp;Xia Chen ,&nbsp;Li Zhan ,&nbsp;Lidong Zheng ,&nbsp;Xuesheng Liu","doi":"10.1016/j.jclinane.2025.111897","DOIUrl":"10.1016/j.jclinane.2025.111897","url":null,"abstract":"<div><h3>Study objective</h3><div>This study aims to evaluate the effects of preoperative low-dose dexmedetomidine administration for one night on the incidence of postoperative delirium in elderly patients with hip fracture.</div></div><div><h3>Design</h3><div>This was a randomized, double blind, placebo-controlled clinical trial.</div></div><div><h3>Setting</h3><div>Lu'an Hospital of Anhui Medical University, Anhui, China.</div></div><div><h3>Patients</h3><div>Patients aged ≥65 years with hip fracture (femoral neck, intertrochanteric, or subtrochanteric fracture) and scheduled for surgical repair(total hip arthroplasty, hemiarthroplasty, internal fixation with cannulated screw or intramedullary nail) under spinal anesthesia were eligible.</div></div><div><h3>Intervention</h3><div>Patients were randomized 1:1 to receive low-dose dexmedetomidine or placebo from 8:00 pm before surgery to 8:00 am the day of surgery.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of POD between postoperative days 1 and 7 or at hospital discharge. The secondary outcome measures included preoperative sleep quality, days of delirium, visual analog scale scores in quiet and active states on postoperative days 1–3, C-reactive protein level, number of analgesic pump presses, activities of daily living score at discharge and postoperative hospital stay. Perioperative adverse events were recorded.</div></div><div><h3>Main results</h3><div>Of the 248 patients randomized to the placebo (<em>n</em> = 124) or dexmedetomidine (n = 124) group, 233 participants (117 in the placebo group and 116 in the dexmedetomidine group) were included in the modified intention-to-treat analysis. The incidence of POD was lower in the dexmedetomidine group (10.3 %) than placebo group (22.2 %, <em>P</em> = 0.014). Compared to the placebo group, the dexmedetomidine group had higher preoperative Leeds Sleep Evaluation Questionnaire (LSEQ) scores (<em>P</em> &lt; 0.001), lower preoperative Insomnia Severity Index (ISI) scores (<em>P</em> &lt; 0.001), and lower postoperative C-reactive protein (CRP) levels (P &lt; 0.001). No differences in other secondary outcomes and perioperative adverse events were observed between the two groups.</div></div><div><h3>Conclusion</h3><div>In patients aged ≥65 years undergoing elective hip fracture surgery under spinal anesthesia, continuous overnight administration of low-dose dexmedetomidine improved sleep quality on the night before surgery and reduced the incidence of POD.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111897"},"PeriodicalIF":5.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270668","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":"Reversal of rocuronium-induced neuromuscular blockade by sugammadex in patients undergoing kidney transplantation: Pharmacokinetics, efficacy, and safety analyses","authors":"Yiyang Tang ,&nbsp;Yi Feng ,&nbsp;Bin Jia ,&nbsp;Wenfei Long ,&nbsp;Qiuyuan Chen ,&nbsp;Shijie Gu ,&nbsp;Gaofeng Zhao ,&nbsp;Bo Xu","doi":"10.1016/j.jclinane.2025.111900","DOIUrl":"10.1016/j.jclinane.2025.111900","url":null,"abstract":"<div><h3>Background</h3><div>The pharmacokinetics of sugammadex were significantly different between severe renal failure patients and healthy subjects. The objective of our study is to investigate the pharmacokinetics of sugammadex in patients with end-stage renal disease undergoing kidney transplantation.</div></div><div><h3>Methods</h3><div>Seventeen ASA class III renal failure patients undergoing kidney transplantation and 17 ASA I-II healthy controls were included. Sugammadex 2 mg·kg⁻¹ was administered at reappearance of the second twitch of the train-of-four for reversal of rocuronium-induced neuromuscular blockade. Plasma concentration of sugammadex was measured at regular time points and pharmacokinetics determined using non-compartmental analysis.</div></div><div><h3>Results</h3><div>Pharmacokinetic data of sugammadex were obtained from 30 patients. The geometric mean of elimination half-life of sugammadex was 10 h in renal failure and 2 h in controls (P &lt; 0.001). The geometric mean of plasma clearance of sugammadex was significantly different between the two groups (15.2 ml·min⁻¹ in renal patients vs 82.5 ml·min⁻¹ in controls, P&lt;0.001). The recovery of train-of-four-ratio ≥ 0.9 was similar between the two groups. No sugammadex-related serious adverse events were considered.</div></div><div><h3>Conclusion</h3><div>The significant differences in the pharmacokinetics of sugammadex between the patients undergoing kidney transplantation and healthy controls were observed. In patients with end-stage renal disease, sugammadex 2 mg·kg⁻¹ provided a safety profile similar to healthy controls. Sugammadex is safe and effective for patients undergoing kidney transplantation, although the clearance of sugammadex is slower in this patient population.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111900"},"PeriodicalIF":5.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262642","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":"Effects of intranasal dexmedetomidine premedication on hemodynamics, oxygenation and bleeding in patients undergoing total knee arthroplasty under spinal anesthesia - a secondary analysis of a prospective, double-blinded, randomized controlled trial (TKADEX)","authors":"Suvi-Maria Tiainen ,&nbsp;Atte Koskinen ,&nbsp;Sanna Mäkelä ,&nbsp;Ruut Laitio ,&nbsp;Eliisa Löyttyniemi ,&nbsp;Keijo Mäkelä ,&nbsp;Carl-Olof Pirttikangas ,&nbsp;Teijo I. Saari ,&nbsp;Panu Uusalo","doi":"10.1016/j.jclinane.2025.111899","DOIUrl":"10.1016/j.jclinane.2025.111899","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine is a sedative adjunct with sympatholytic properties. Despite many beneficial effects, hemodynamic effects limit its use.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of the data from TKADEX study. This single-center, double-blind, two-arm study compared intranasal dexmedetomidine premedication (1 μg kg-1) with intranasal saline in 101 planned subjects undergoing total knee arthroplasty (TKA). We analyzed the perioperative hemodynamics, oxygenation, amount of intraoperative bleeding and perioperative change in hemoglobin and thrombocytes.</div></div><div><h3>Results</h3><div>Compared to baseline measurements, mean arterial pressure (MAP) decreased in the dexmedetomidine group 36.3 (1.7) mmHg (95 % CI 32.9–39.7; <em>p</em> &lt; 0.001) and in the placebo group 26.5 (1.7) mmHg (95 % CI 23.2–29.7; <em>p</em> &lt; 0.001), and heart rate (HR) in the dexmedetomidine group 11.6 (1.3) bpm (95 % CI 9.1–14.1; <em>p</em> &lt; 0.001) and in the placebo group 9.7 (1.2) bpm (95 % CI 7.3–12.2; p &lt; 0.001) after induction of spinal anesthesia. Patients in the dexmedetomidine group had lower intraoperative MAP (maximal difference − 8.5 (2.5) mmHg; 95 % CI -13.5 - -3.5; <em>p</em> &lt; 0.001) and HR (maximal difference − 6.1 (2.2) bpm; 95 % CI -10.5 - -1.7; <em>p</em> = 0.007) compared to the placebo group. There was higher incidence of intraoperative hypertension in the placebo group (<em>p</em> = 0.03). There was no difference in oxygenation, in the incidence of intraoperative bradycardia, tachycardia or hypotension, in the amount of intraoperative bleeding or in the change in perioperative blood count between the groups.</div></div><div><h3>Conclusions</h3><div>Intranasal dexmedetomidine appears to be hemodynamically well tolerated premedication for patients undergoing TKA under spinal anesthesia. It appears to lower the incidence of intraoperative hypertension without effects on intraoperative bleeding.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111899"},"PeriodicalIF":5.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255341","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":"Hemidiaphragmatic paralysis after ultrasound-guided brachial plexus blocks for shoulder surgery: A systematic review and meta-analysis of randomized clinical trials","authors":"P. Oliver-Fornies PhD ,&nbsp;C. Aragon-Benedi PhD ,&nbsp;R. Gomez Gomez PhD ,&nbsp;Cristina Anton Rodriguez ,&nbsp;Blanca San-Jose-Montano ,&nbsp;Ece Yamak Altinpulluk ,&nbsp;M. Fajardo Perez","doi":"10.1016/j.jclinane.2025.111874","DOIUrl":"10.1016/j.jclinane.2025.111874","url":null,"abstract":"<div><h3>Study objective</h3><div>This review aimed to explore whether diaphragm-sparing regional techniques are more effective at preventing hemidiaphragm paralysis than conventional interscalene brachial plexus blockade (ISB) following shoulder surgery.</div></div><div><h3>Design</h3><div>Systematic review of randomized clinical trials (RCTs) including meta-analyses, meta-regression, trial sequential analyses (TSA) and GRADE methodology.</div></div><div><h3>Setting</h3><div>Online databases (Cochrane Library; MEDLINE; EMBASE; Scopus; Web of Science; and international trial registries) were searched for RCTs up to December 2022.</div></div><div><h3>Patients</h3><div>Adult patients undergoing shoulder surgery following ultrasound-guided brachial plexus blockade, where incidence of hemidiaphragmatic paralysis was reported.</div></div><div><h3>Interventions</h3><div>Diaphragm-sparing techniques following ultrasound-guided brachial plexus blockade were included: modifications of ISB (low-volume, extrafascial, and lower concentration); superior trunk block; supraclavicular brachial plexus block, infraclavicular brachial plexus block; costoclavicular brachial plexus block; and anterior and posterior approaches to the suprascapular nerve block.</div></div><div><h3>Measurements</h3><div>The primary endpoint was the incidence of complete hemidiaphragmatic paralysis. Secondary endpoints included postoperative analgesia and safety-related outcomes.</div></div><div><h3>Main results</h3><div>Twenty-eight RCTs involving 1737 subjects were identified. Of these, 22 were eligible for meta-analysis. Six regional techniques were analysed. The low-volume technique significantly reduced the incidence of hemidiaphragmatic paralysis as compared with the conventional ISB (risk ratio 0.62; 95 % CI 0.42 to 0.91; <em>p</em> = 0.02; absolute risk difference − 0.30 [95 % CI -0.39 to −0.20]; I² = 80 %) at short-term follow-up. TSA confirmed the results of this meta-analysis but did not reach the required sample size by 19.5 %, indicating that the result was not definitive.</div><div>The combined infraclavicular-suprascapular blocks, the extrafascial technique, the lower concentration technique, and the supraclavicular block reduced the incidence of hemidiaphragmatic paralysis by 97 %, 64 %, 57 % and 46 %, respectively. For the superior trunk block, TSA did not reach statistical significance.</div></div><div><h3>Conclusions</h3><div>There is conclusive evidence that the extrafascial technique (high-level); lower concentration technique (moderate-level); and the supraclavicular blockade (low-level) are less detrimental to hemidiaphragmatic paralysis than the conventional ISB. However, the results for other comparisons were not definitive.</div><div>Systematic review protocol: PROSPERO CRD42022335056.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111874"},"PeriodicalIF":5.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240494","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: Beyond occurrence: Exploring the quality and impact of intraoperative anesthesia handover","authors":"Xiao-Ling Zhang ,&nbsp;Dong-Xin Wang","doi":"10.1016/j.jclinane.2025.111894","DOIUrl":"10.1016/j.jclinane.2025.111894","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111894"},"PeriodicalIF":5.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221789","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 \"Does spinal chloroprocaine pharmacokinetic profile actually translate into a clinical advantage in terms of clinical outcomes when compared to low-dose spinal bupivacaine? A systematic review and meta-analysis\" [Journal of Clinical Anesthesia 2019;52: 99-104].","authors":"Andrea Saporito, Marcello Ceppi, Andreas Perren, Davide La Regina, Stefano Cafarotti, Alain Borgeat, José Aguirre, Marc Van De Velde, An Teunkens","doi":"10.1016/j.jclinane.2025.111889","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111889","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111889"},"PeriodicalIF":5.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248162","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":"Understanding preoperative concerns and attitudes towards prehabilitation in older surgical populations: A survey study","authors":"Melanie Li ,&nbsp;Ellene Yan ,&nbsp;Aparna Saripella ,&nbsp;Yasmin Alhamdah ,&nbsp;Majid Nabipoor ,&nbsp;Shabbir M.H. Alibhai ,&nbsp;Jean Wong ,&nbsp;Frances Chung","doi":"10.1016/j.jclinane.2025.111895","DOIUrl":"10.1016/j.jclinane.2025.111895","url":null,"abstract":"<div><h3>Study objectives</h3><div>To identify common preoperative concerns in older surgical populations and explore their attitudes towards prehabilitation, functional, and cognitive assessments.</div></div><div><h3>Design</h3><div>Multicenter cross-sectional study.</div></div><div><h3>Setting</h3><div>Preoperative questionnaire examining preoperative concerns and attitudes towards prehabilitation, functional, and cognitive assessments.</div></div><div><h3>Patients</h3><div>236 non-cardiac surgical patients ≥65 years old.</div></div><div><h3>Measurements</h3><div>Concerns across five domains—surgery, anesthesia, functional status, cognitive status, and financial burden—were measured on a five-point Likert scale, ranging from ‘not concerned at all’ to ‘very concerned.’ Attitudes towards prehabilitation and preoperative assessments were assessed on a five-point scale from ‘strongly disagree’ to ‘strongly agree.’ Exploratory factor analysis identified concerns, and confirmatory factor analysis validated them. Reliability was assessed with Cronbach's alpha, and model fit was evaluated using the root mean square error of approximation, comparative fit index, and related indices.</div></div><div><h3>Results</h3><div>Surgical concerns were highest (2.5 ± 1.2), particularly regarding postoperative pain, surgical failure, and complications. Concerns about anesthesia (2.0 ± 1.3) and functional status (1.9 ± 1.3) followed, with lower concerns about cognitive status (1.5 ± 1.1) and financial burden (1.4 ± 0.9). Attitudes towards prehabilitation were generally positive. Most participants were open to functional assessments and training programs, though only 37 % were willing to undergo memory assessment. Factor analysis revealed a five-factor structure of preoperative concerns: basic activities of daily living, instrumental activities of daily living, surgical/anesthesia concerns, cognitive/financial concerns, and discharge concerns. Confirmatory factor analysis supported this structure with adequate model fit.</div></div><div><h3>Conclusions</h3><div>This study highlights common preoperative concerns among older adults, particularly regarding surgery, anesthesia, and functional status, with greater concern reported by those with functional dependence. While attitudes towards prehabilitation were generally positive, there was low willingness to undergo preoperative memory testing. Future research should refine prehabilitation programs to optimize effectiveness, accessibility, and adherence in older adults and further evaluate their impact on surgical outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"105 ","pages":"Article 111895"},"PeriodicalIF":5.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221788","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}