Journal of Clinical Anesthesia最新文献

{"title":"Sodium bicarbonate alkalinization of local anesthetics for peripheral nerve blocks: A systematic review","authors":"Noy Norman Kambuaya M.D.,&nbsp;Iwan Fuadi M.D., Ph.D.,&nbsp;Dedi Fitri Yadi M.D.","doi":"10.1016/j.jclinane.2026.112268","DOIUrl":"10.1016/j.jclinane.2026.112268","url":null,"abstract":"<div><h3>Background</h3><div>Alkalinization of local anesthetic solutions is intended to increase the non-ionized fraction of the local anesthetic, but its clinical benefit in onset time, duration, or block quality in peripheral nerve blocks remains uncertain.</div></div><div><h3>Methods</h3><div>PubMed and Embase were searched to October 2025 with no date restrictions. Eligible studies were comparative clinical studies evaluating sodium bicarbonate alkalinization versus non-alkalinised solutions for single-shot peripheral nerve blocks, reporting onset time, duration, or block quality. Risk of bias was assessed using design-appropriate tools and a structured narrative synthesis was performed.</div></div><div><h3>Results</h3><div>A total of 422 records were identified; after deduplication, screening, and eligibility assessment, 18 studies were included. Thirteen of 16 studies providing group-comparable onset data found faster onset in at least one outcome after alkalinization, with more consistent findings for motor than sensory onset. Effects on block duration were heterogeneous and block quality findings were inconsistent. Risk of bias was predominantly some concerns; incomplete final pH reporting in several studies limited intervention fidelity.</div></div><div><h3>Conclusions</h3><div>This review shows that alkalinization may accelerate onset time in peripheral nerve blocks, particularly with lidocaine (lignocaine) and most consistently for motor onset, but the effect is variable, agent-specific, and supported by evidence of low-to-moderate certainty. The available evidence supports a selective rather than universal approach to alkalinization.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD420251248335).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112268"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-lung ventilation in pediatric patients: A clinically focused narrative review","authors":"L. Daniela Smith M.D,&nbsp;T. Wesley Templeton M.D,&nbsp;Ankita Prakash B.S,&nbsp;Leah B. Templeton M.D,&nbsp;Shelly H. Pecorella M.D,&nbsp;Martina G. Downard M.D","doi":"10.1016/j.jclinane.2026.112273","DOIUrl":"10.1016/j.jclinane.2026.112273","url":null,"abstract":"<div><div>Successful institution and management of one-lung ventilation in pediatric patients requires knowledge of the unique airway anatomy and respiratory physiology of these patients, options for lung isolation, and awareness of common intra-procedure complications. Pediatric patients are more vulnerable to changes in ventilation as compared to adults due to anatomic and physiologic differences in their respiratory systems. There are several methods for lung isolation available to the clinician, the selection of which depends on a variety of factors including size and age of the patient, pathology involved, and the needs of the surgeon. Each method comes with its own potential pitfalls, which the clinician must be aware of in order to anticipate and manage common complications. Ventilation strategies during one-lung ventilation may also differ based on the aforementioned factors. To date, there is little credible evidence to support a clear benefit of one ventilation strategy over another, so choice can be made on an individual patient basis. The approach to resumption of two-lung ventilation and extubation are also important steps in the perioperative management of these patients.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112273"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497521","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":"General vs. non-general anesthesia for transcatheter aortic valve replacement: A real-world target trial emulation study","authors":"Mahmoud S. Mohamed MD,&nbsp;Osama Abu-Shawer MD MS,&nbsp;Mohamed H.E. Makhlouf MD,&nbsp;Ahmed Sherif Taher MD,&nbsp;Osamah Badwan MD,&nbsp;Mada Helou MD,&nbsp;Jibran Ikram MD","doi":"10.1016/j.jclinane.2026.112270","DOIUrl":"10.1016/j.jclinane.2026.112270","url":null,"abstract":"<div><h3>Background</h3><div>The optimal anesthetic strategy for transcatheter aortic valve replacement (TAVR) remains debated, with limited real-world data on long-term outcomes and healthcare utilization.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including adults undergoing TAVR between January 2015 and December 2024. Patients were categorized by anesthetic strategy: general anesthesia (GA) or non-general anesthesia (NGA; regional anesthesia or sedation). A target trial emulation framework with 1:1 propensity score matching was used to balance baseline characteristics. Outcomes at 30, 90, and 365 days included all-cause mortality, major cardiovascular, renal, and respiratory complications, and all-cause hospital readmission.</div></div><div><h3>Results</h3><div>After matching, 3586 patients (1793 per group) were included. All-cause mortality did not differ between GA and NGA at 30, 90, or 365 days. Rates of stroke, myocardial infarction, acute kidney injury, atrial fibrillation, major vascular complications, and respiratory failure were also similar across follow-up intervals. At 365 days, heart failure was nominally higher in the GA group compared with NGA (HR 1.44, 95% CI 1.05–1.99; <em>p</em> = 0.023). NGA was associated with lower all-cause hospital readmission within 30 days post-procedure, with no differences at later follow-up.</div></div><div><h3>Conclusions</h3><div>In this large real-world analysis, anesthetic strategy during TAVR was not associated with differences in mortality or most major complications through one year. Although heart failure events at 365 days were nominally higher with GA, overall outcomes were largely comparable. NGA was associated with reduced early hospital readmission.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112270"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535863","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":"On the cover - M. Skarin et al.","authors":"","doi":"10.1016/S0952-8180(26)00162-5","DOIUrl":"10.1016/S0952-8180(26)00162-5","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112284"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651181","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 anyone paying attention?","authors":"Joshua A Bloomstone, Bruce P Kingsley","doi":"10.1016/j.jclinane.2026.112263","DOIUrl":"https://doi.org/10.1016/j.jclinane.2026.112263","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112263"},"PeriodicalIF":6.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316924","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":"Early hypoxemia detection with minimal FiO₂: Putting routine hyperoxygenation in anesthesia practice to the test","authors":"Anna Shalman Merkin M.D. ,&nbsp;Michael Shalman M.D.","doi":"10.1016/j.jclinane.2026.112241","DOIUrl":"10.1016/j.jclinane.2026.112241","url":null,"abstract":"<div><h3>Background</h3><div>High inspired oxygen fractions (FiO₂) are routinely administered during mechanical ventilation in anesthesia in order to prevent hypoxemia. However, liberal oxygen use often exceeds physiological requirements, increasing the risk of oxygen toxicity and absorption atelectasis. Moreover, by sustaining normal-appearing oxygen saturation, high FiO₂ may obscure the presence of pulmonary congestion, edema, acute respiratory distress syndrome (ARDS), inadvertent endobronchial intubation, pneumothorax, and other conditions associated with impaired gas exchange. This approach may postpone the detection and treatment of underlying pathology caused by ventilation-perfusion (V/Q) mismatch or pure pulmonary shunt.</div></div><div><h3>Content</h3><div>This narrative review revisits the core principles of Nunn's isoshunt diagrams as a physiological framework for understanding the relationships among shunt fraction, arterial oxygenation (PaO₂), and inspired oxygen fraction (FiO₂). It examines these diagrams' mathematical foundation, historical evolution, and subsequent refinements, emphasizing their diagnostic utility, particularly at lower FiO₂ levels. By integrating classical physiology with contemporary monitoring and clinical evidence we support a paradigm change away from regular hyperoxygenation toward an accurate, patient specific FiO₂ titration.</div></div><div><h3>Conclusions</h3><div>Maintaining the FiO₂ low, usually around 0.3, not only reduces the damage caused by hyperoxia but also reveals mild abnormalities in gas exchange that are concealed under high FiO₂ settings. By detecting abnormal gas exchange early, this personalized, physiologically informed approach to oxygen therapy in anesthesia challenges conventional approach and supports a more sophisticated, evidence-based practice, ultimately improving patient safety.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"Article 112241"},"PeriodicalIF":5.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015692","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":"Analgesic efficacy and safety of erector spinae plane block after sternotomy and minimally invasive cardiac surgery: A systematic review and Meta-analysis of randomized trials","authors":"Diana Perez-Moreno MD, MSc, FIPP, CIPS ,&nbsp;Mauricio Forero MD, FIPP ,&nbsp;María Fernanda Contreras MD ,&nbsp;Javier Andres Mora-Arteaga MD, MBA, MSc","doi":"10.1016/j.jclinane.2026.112240","DOIUrl":"10.1016/j.jclinane.2026.112240","url":null,"abstract":"<div><h3>Background</h3><div>The erector spinae plane block (ESPB) is increasingly used for analgesia in cardiac surgery, but its effectiveness across surgical approaches remains uncertain. We aimed to evaluate the analgesic efficacy, recovery effects, and safety of ESPB in adult cardiac surgery, with analyses stratified by surgical approach (median sternotomy versus minimally invasive cardiac surgery [MICS]).</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, CENTRAL, and Scopus (January 2016–June 2025) for randomized controlled trials (RCTs) comparing ultrasound-guided ESPB with standard systemic analgesia in adults undergoing cardiac surgery. This PRISMA-compliant review (PROSPERO: CRD42024570340) used random-effects meta-analyses with Hartung–Knapp adjustment. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. The primary outcome was postoperative pain within 24 h. Secondary outcomes included opioid consumption, time to extubation, ICU and hospital length of stay, and complications.</div></div><div><h3>Results</h3><div>Nineteen RCTs (<em>N</em> = 1344; 673 received ESPB) were included. In the median sternotomy subgroup (<em>n</em> = 1092), ESPB was associated with modest improvements in 24-h pain (0–10 VAS/NRS; mean difference [MD] −0.65, 95% CI − 1.14 to −0.16), intraoperative and 24-h opioid consumption (MD − 80.8 and − 45.8 mg OME), time to extubation (MD −1.28 h), and ICU stay (MD −13.1 h). However, heterogeneity was substantial (I² &gt; 85% for most outcomes), and wide prediction intervals crossed the null, suggesting that effects may vary substantially across clinical settings.</div><div>In the MICS subgroup (4 RCTs, <em>n</em> = 252), no clear statistically significant or clinically meaningful benefits were detected for most outcomes in pain, opioid use, or recovery outcomes.</div></div><div><h3>Conclusion</h3><div>Low- to very-low-certainty evidence suggests that ESPB is associated with modest improvements in early pain and recovery after median sternotomy; however, very high heterogeneity and wide prediction intervals indicate that effects may vary substantially between centers. In contrast, no clear benefit was demonstrated within ERAS-optimized MICS pathways, and findings in this subgroup remain preliminary.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"Article 112240"},"PeriodicalIF":5.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054877","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":"Reworking the maximum surgical blood ordering schedule 50 years later","authors":"Roya Saffary,&nbsp;Steven M. Frank,&nbsp;Nadia B. Hensley","doi":"10.1016/j.jclinane.2026.112224","DOIUrl":"10.1016/j.jclinane.2026.112224","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"Article 112224"},"PeriodicalIF":5.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838736","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":"Association between total fluid volume and postoperative morbidity after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy","authors":"Rania Mhenni ,&nbsp;Louis Boutin ,&nbsp;Arthur Moreau ,&nbsp;Maxime Coutrot ,&nbsp;Thais Walter ,&nbsp;Alois Ordi ,&nbsp;Chiheb Ben Maaouia ,&nbsp;Adrien Gillibert ,&nbsp;Elodie Gaultier ,&nbsp;Sophie Labayle-Pabet ,&nbsp;Delphine Cheron-Leroy ,&nbsp;Samia Boughezala ,&nbsp;Carole Chahine ,&nbsp;Anouare Friaa ,&nbsp;Amal Bellout ,&nbsp;Eric Roland ,&nbsp;Emmanuel Basto ,&nbsp;Marie Christine Becq ,&nbsp;Mathilde Ponsin ,&nbsp;Mihai Ott ,&nbsp;Benjamin Deniau","doi":"10.1016/j.jclinane.2026.112243","DOIUrl":"10.1016/j.jclinane.2026.112243","url":null,"abstract":"<div><h3>Background</h3><div>While intraoperative fluid management has been explored in various clinical settings, the impact of perioperative fluid administration on outcomes in patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS with HIPEC) remains under investigated. We aimed to assess the association between perioperative fluid balance in patients undergoing CRS with HIPEC and 28-day outcomes, and to describe postoperative complications<strong>.</strong></div></div><div><h3>Methods</h3><div>This retrospective, single-center, observational case-control study included patients undergoing CRS with HIPEC between January 2019 and June 2024. The primary outcome was the Comprehensive Complication Index (CCI) at day 28. Secondary outcomes included a detailed description of postoperative complications. Multivariable analysis was performed to identify independent prognostic factors.</div></div><div><h3>Results</h3><div>A total of 132 patients were included. The median CCI at day 28 was 21 (IQR 0–31). Crystalloids were the most frequent administered fluids during surgery (132 patients, 100%), whereas colloids were used in 16 patients (12%). The median intraoperative fluid rate was 13.6 (IQR 11.0–17.7) mL/kg/h. Median intraoperative fluid administration was 18.4 mL/kg/h (IQR 14.7–32.1) in the first CCI tertile and 33.3 mL/kg/h (23.5–51.7) in the third CCI tertile (<em>p</em> &lt; 0.001). Median total day-0 fluid administration was 110.9 mL/kg (84.1–157.1) in the first CCI tertile and 175.7 mL/kg (133.3–251.9) in the CCI third tertile (<em>p</em> &lt; 0.001). Seventy-five patients (57%) experienced at least one complication. Higher total fluid volume administered on the day (intra and postoperative) of surgery was significantly associated with increased morbidity (OR 1.12 [95% CI 1.06–1.19], p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>In patients undergoing CRS with HIPEC, total fluid balance on the day of surgery—including intraoperative and immediate postoperative fluids—was associated with postoperative morbidity at day 28. These findings highlight the importance of careful fluid management beyond the intraoperative period and support the need for prospective studies focusing on fluid balance in these patients to refine perioperative strategies and improve patient outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"Article 112243"},"PeriodicalIF":5.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054845","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":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(26)00128-5","DOIUrl":"10.1016/S0952-8180(26)00128-5","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"112 ","pages":"Article 112250"},"PeriodicalIF":5.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148178722","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}