Journal of Clinical Anesthesia最新文献

{"title":"Tissue perfusion as the ultimate target of hemodynamic interventions in the perioperative period","authors":"Zbigniew Putowski ,&nbsp;Jan Bakker ,&nbsp;Eduardo Kattan ,&nbsp;Glenn Hernández ,&nbsp;Hafid Ait-Oufella ,&nbsp;Wojciech Szczeklik ,&nbsp;Philippe Guerci","doi":"10.1016/j.jclinane.2025.112009","DOIUrl":"10.1016/j.jclinane.2025.112009","url":null,"abstract":"<div><div>This point-of-view article examines the complex relationship between global hemodynamic parameters and tissue perfusion, emphasizing the limitations of using macrohemodynamic metrics as proxies for tissue-level oxygen delivery. Key topics of the paper include the physiological determinants of tissue perfusion, the influence of anesthesia on perfusion dynamics, and the role of hemodynamic interventions in optimizing perfusion. Furthermore, we explore the application of tissue perfusion monitoring in the perioperative setting, highlighting its potential to guide individualized therapies. By addressing these interconnected factors, we advocate for further research to evaluate whether adding perfusion-guided strategies to current protocols can enhance patient outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112009"},"PeriodicalIF":5.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091463","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":"Hypotension and postoperative mortality. Does it matter? Anything we can do?","authors":"Daniel I Sessler","doi":"10.1016/j.jclinane.2025.112008","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112008","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112008"},"PeriodicalIF":5.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086263","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 perioperative impact of frailty and cognitive impairment in older surgical patients: A multicentered longitudinal cohort study","authors":"Eric Cheuk BSc ,&nbsp;Ellene Yan HBSc ,&nbsp;Yasmin Alhamdah MSc ,&nbsp;Aparna Saripella MSc ,&nbsp;Sinead Campbell MB, BCh, BAO ,&nbsp;David He MD, PhD ,&nbsp;Leif Erik Lovblom PhD ,&nbsp;Jean Wong MD ,&nbsp;Frances Chung MD","doi":"10.1016/j.jclinane.2025.112015","DOIUrl":"10.1016/j.jclinane.2025.112015","url":null,"abstract":"<div><h3>Introduction</h3><div>Frailty and cognitive impairment (CI) are prevalent conditions that often co-exist in older patients and lead to worse perioperative outcomes. Despite this, these conditions are not routinely assessed preoperatively, and their impact and interactions during the perioperative period remain poorly understood. Using ultra-rapid screening tools, this study aimed to (1) compare the perioperative prevalence and trajectory of frailty between patients with and without CI and (2) investigate patient-reported outcome measures and clinical outcomes associated with preoperative frailty and CI.</div></div><div><h3>Methods</h3><div>This multicentered longitudinal cohort study assessed CI and frailty in 370 older non-cardiac surgical patients using ultra-rapid screening tools: the Ascertain Dementia Eight-item Questionnaire (AD8) (cutoff: ≥2) and 5-item FRAIL Questionnaire (prefrail: 1–2; frail: ≥3). The trajectories of frailty in CI versus no-CI patients were analyzed using a linear mixed-effects model. Univariable and multivariable logistic regressions were conducted to identify risk factors associated with preoperative frailty.</div></div><div><h3>Main results</h3><div>Up to 63% of older surgical patients experienced preoperative prefrailty (48%) or frailty (15%). Eighty-one percent of patients with preoperative CI were preoperatively prefrail (49%) or frail (32%). Patients with CI were more frail at all postoperative time points than no-CI patients. Patients classified as prefrail/frail preoperatively had longer length of stay, greater incidence of non-home discharge, and composite outcomes at 30 days than robust patients. Patients with combined prefrailty/frailty and CI experienced significantly worse 90-day composite outcomes than those with prefrailty/frailty alone. In the multivariable analysis, females (3-fold), orthopedic surgery (7-fold), significant preoperative functional disability (6-fold), and high risk of obstructive sleep apnea (5-fold) were significantly associated with preoperative frailty.</div></div><div><h3>Conclusions</h3><div>Patients with preoperative CI were significantly more frail at all perioperative time points than those without. While preoperative prefrailty/frailty was associated with significantly worse 30-day outcomes, only patients with combined prefrailty/frailty and CI experienced worse long-term outcomes at 90 days.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112015"},"PeriodicalIF":5.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086235","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":"Impact of perioperative selenium supplementation on perioperative hemodynamics in patients undergoing cardiac surgery: a post hoc analysis of the Sustain CSX trial","authors":"Ghaith Mohsen ,&nbsp;Daniel Catena ,&nbsp;Zheng-Yii Lee ,&nbsp;Quirin Notz ,&nbsp;Xuran Jiang ,&nbsp;Markus Velten ,&nbsp;Benjamin O'Brien ,&nbsp;Maren Kleine-Brueggeney ,&nbsp;Sascha Ott ,&nbsp;Daren K. Heyland ,&nbsp;Georg Daniel Duerr ,&nbsp;Patrick Meybohm ,&nbsp;Christian Stoppe","doi":"10.1016/j.jclinane.2025.112011","DOIUrl":"10.1016/j.jclinane.2025.112011","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112011"},"PeriodicalIF":5.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond discrepancy: Integrating artificial intelligence and digital phenotyping for a New Paradigm in postoperative delirium detection","authors":"Ping Deng,&nbsp;Qi Zhang,&nbsp;Shiqi Diao","doi":"10.1016/j.jclinane.2025.112005","DOIUrl":"10.1016/j.jclinane.2025.112005","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112005"},"PeriodicalIF":5.1,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046141","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":"Myocardial injury and short- and long-term outcomes after oncological surgery: A large-scale retrospective cohort study","authors":"Shaoyong Wu ,&nbsp;Xiong Song ,&nbsp;Yi Li ,&nbsp;Jingxiu Huang ,&nbsp;Xiao Ke ,&nbsp;Chenyang Feng ,&nbsp;Wei Xing ,&nbsp;Fei Cao ,&nbsp;Weian Zeng","doi":"10.1016/j.jclinane.2025.112002","DOIUrl":"10.1016/j.jclinane.2025.112002","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial injury after noncardiac surgery (MINS) significantly contributes to perioperative mortality, yet its incidence and prognostic value in patients undergoing oncological surgery remain inadequately characterized.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we analyzed 6277 adults (mean age 58.9 years; 60.0 % male) undergoing intermediate-to-high-risk oncological surgeries between September 2013 and September 2022 with postoperative high-sensitivity troponin I (hsTnI) measurements. Dose-response relationships between peak hsTnI and the outcomes of 30-day mortality and 30-day major adverse cardiovascular events (MACE) were modeled using multivariable Cox regression with restricted cubic splines. MINS was defined as an ischemic hsTnI elevation &gt;26 ng/L. Long-term (365-day) mortality was analyzed using both 30-day landmark analysis and flexible parametric survival model (FPSM) to account for potential time-varying effects.</div></div><div><h3>Results</h3><div>Each standard deviation increase in log-transformed hsTnI was associated with a twofold higher risk of 30-day mortality (adjusted hazard ratio [aHR] 2.33, 95 % CI: 1.94–2.80; <em>P</em> &lt; 0.001) and a nearly fourfold higher risk of 30-day MACE (aHR 3.91, 95 % CI: 3.47–4.42; <em>P</em> &lt; 0.001). After excluding 22 patients with nonischemic troponin elevations, MINS occurred in 19.1 % of patients, with 98.7 % being asymptomatic. MINS independently predicted 30-day mortality (aHR 7.10, 95 % CI: 4.21–11.97; <em>P</em> &lt; 0.001) and accounted for 53.8 % of the population-attributable risk. Adding MINS modestly improved the C-index for 30-day mortality prediction (0.831 vs. 0.797; ΔC-index, 0.034; <em>P</em> = 0.090) but significantly improved risk reclassification (net reclassification improvement, 31.51 %) and discrimination (integrated discrimination improvement, 0.037). Landmark analysis showed an 8.1-fold increased risk within 30 days and a sustained 1.8-fold risk from day 31 to 365. FPSM confirmed a sustained excess mortality hazard throughout the year.</div></div><div><h3>Conclusions</h3><div>MINS is common, largely asymptomatic, and strongly associated with both early and late mortality after oncological surgery. Routine troponin monitoring may help identify high-risk patients for intervention.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112002"},"PeriodicalIF":5.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027137","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":"Full stomach and gastric ultrasound: Debunking some myths.","authors":"José A Sastre, Miguel Á Fernández-Vaquero","doi":"10.1016/j.jclinane.2025.111998","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111998","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111998"},"PeriodicalIF":5.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040298","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":"Author's reply “Implementation of a goal directed perfusion strategy to reduce cardiac surgery associated kidney injury: A before and after study”","authors":"Jules Loeb MD ,&nbsp;Guillaume Lebreton MD, PhD ,&nbsp;Adrien Bouglé MD, PhD ,&nbsp;Geoffroy Hariri MD, PhD","doi":"10.1016/j.jclinane.2025.112004","DOIUrl":"10.1016/j.jclinane.2025.112004","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112004"},"PeriodicalIF":5.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027138","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":"Ultrasound-guided bilateral serratus plane block versus thoracic paravertebral block following minimally invasive pectus excavatum repair in children: A randomized controlled non-inferiority study.","authors":"Yi He MD, PhD ,&nbsp;Mingzhe Xu MD ,&nbsp;Zhi Li MD ,&nbsp;Jiaqi Yu ,&nbsp;Qian Li MD, PhD ,&nbsp;Yunxia Zuo MD, PhD ,&nbsp;Yi Kang MD ,&nbsp;Bin Du MD","doi":"10.1016/j.jclinane.2025.112003","DOIUrl":"10.1016/j.jclinane.2025.112003","url":null,"abstract":"<div><h3>Study objective</h3><div>This study evaluated whether ultrasound-guided serratus anterior plane block (SAPB) provided non-inferior analgesic effects for minimally invasive pectus excavatum repair surgery compared with thoracic paravertebral block (TPVB).</div></div><div><h3>Design</h3><div>A noninferiority randomized trial.</div></div><div><h3>Setting</h3><div>West China Hospital of Sichuan University.</div></div><div><h3>Patients</h3><div>Seventy-four children aged 7–16 years who underwent minimally invasive pectus excavatum repair surgery were enrolled.</div></div><div><h3>Intervention</h3><div>Patients were randomly assigned to receive bilateral SAPB (<em>n</em> = 37) or TPVB (n = 37) after induction of anesthesia (0.5 mL kg⁻¹ 0.25 % of ropivacaine per side)<strong>.</strong></div></div><div><h3>Measurements</h3><div>Pain scores assessed via numerical rating scale (NRS) postoperatively; opioid consumption, block-related complications; and plasma ropivacaine concentrations were measured.</div></div><div><h3>Main results</h3><div>Median (IQR) pain scores for SAPB were 1 (1.0–2.0) and 1 (0.5–2.0) for those with TVPB 24 h postoperatively (effect size = 0.027; 95 % confidence interval, −0.42 to 0.47, <em>P</em> = 0.905), meeting the non-inferiority criterion with a pre-specified margin of 0.5. The TPVB group exhibited a greater incidence of hypotension (29.7 % vs. 8.1 %, <em>p</em> = 0.018). The ropivacaine concentrations were lower in the SAPB group at all measured time points (SAPB: 0.44 (0.21), 0.56 (0.23), and 0.66 (0.29) μg mL⁻¹ vs. TPVB: 1.18 (0.39), 1.17 (0.30), and 1.13 (0.26) μg mL⁻¹ at 10, 30, and 60 min post-injection, respectively).</div></div><div><h3>Conclusion</h3><div>Compared with TPVB, SAPB provides non-inferior analgesia for children undergoing minimally invasive pectus excavatum repair surgery. Moreover, SAPB is associated with less intraoperative hemodynamic instability and lower plasma concentrations, suggesting it is a safe and valid alternative.</div></div><div><h3>Trial registration</h3><div>Chinese Clinical Trial Registry, identifier: ChiCTR 2,200,056,596.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112003"},"PeriodicalIF":5.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010774","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":"Challenges in applying the family CAM: Agreement, caregiver factors, and post-discharge validity.","authors":"Guangdong Wang, Tingting Liu, Shuo Yu, Lu Zhang","doi":"10.1016/j.jclinane.2025.111997","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111997","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111997"},"PeriodicalIF":5.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029805","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}