Journal of Clinical Anesthesia最新文献

{"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}

{"title":"Ultrasound-guided trapezius plane block: a novel interfacial block technique","authors":"Chen-Guang Li ,&nbsp;Ming-Yi Huang ,&nbsp;Kun Fan","doi":"10.1016/j.jclinane.2025.111999","DOIUrl":"10.1016/j.jclinane.2025.111999","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 111999"},"PeriodicalIF":5.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004818","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":"Letter to the editor family-assisted detection of postoperative delirium: Opportunities for perioperative practice","authors":"Olga Horn","doi":"10.1016/j.jclinane.2025.111996","DOIUrl":"10.1016/j.jclinane.2025.111996","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 111996"},"PeriodicalIF":5.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996976","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":"Differences in incidence of post-induction hypotension depending on the time of day: a post-hoc propensity score matched analysis","authors":"Johan T.M. Tol MD ,&nbsp;Arjen J.G. Meewisse MD ,&nbsp;Sijm H. Noteboom MSc ,&nbsp;Ward H. van der Ven MD ,&nbsp;Vincent C. Kurucz MD ,&nbsp;Lotte E. Terwindt MD ,&nbsp;Eline Kho PhD ,&nbsp;Björn van der Ster PhD ,&nbsp;Alexander P.J. Vlaar MD PhD ,&nbsp;Dirk J. Stenvers MD PhD ,&nbsp;Jeroen Hermanides MD PhD ,&nbsp;Mark L. van Zuylen MD PhD ,&nbsp;Denise P. Veelo MD PhD ,&nbsp;Jimmy Schenk PhD","doi":"10.1016/j.jclinane.2025.111984","DOIUrl":"10.1016/j.jclinane.2025.111984","url":null,"abstract":"<div><h3>Background</h3><div>Many physiological processes show a diurnal rhythm, including sympathetic and parasympathetic tone, adrenal hormone secretion and blood pressure. Since these physiological rhythms may affect the sensitivity to anaesthesia, we hypothesised that the time of day when anaesthesia induction occurs may affect the incidence of post-induction hypotension.</div></div><div><h3>Methods</h3><div>This was a post-hoc propensity score matched analysis of prospectively collected blood pressure data of 760 elective non-cardiac surgery patients receiving general anaesthesia. The primary endpoint was the incidence of post-induction hypotension, defined as mean arterial pressure &lt; 65 mmHg for at least one minute. Secondary endpoints were a &gt; 30 % decrease in mean arterial pressure, and baroreflex sensitivity.</div></div><div><h3>Results</h3><div>In the analysis of 237 propensity score matched pairs, post-induction hypotension was more frequent if anaesthesia induction occurred in the morning (08:00 AM - 12:00 PM) (odds ratio (OR) 1.48, 95 % confidence interval (CI): 1.00–2.20, <em>p</em> = 0.049). Secondary analyses of the matched cohort showed that a &gt; 30 % decrease in mean arterial pressure was likewise more frequent in the morning than the afternoon (12:00 PM – 17:00 PM) (OR 1.45, 95 % CI: 1.00–2.11, <em>p</em> = 0.0499), but no differences in instantaneous baroreflex sensitivity were observed.</div></div><div><h3>Conclusions</h3><div>Post-induction hypotension was more frequent in the morning compared to the afternoon. While this finding is in line with the presumed physiological mechanisms, it may be affected by unmeasured confounding. These findings should be replicated in larger, preferably randomised, studies to confirm whether a causal relationship between the time of day of anaesthesia induction and post-induction hypotension exists.</div><div><strong>Clinical registration number</strong></div><div>This study was registered in the Dutch Medical Research in Humans (OMON) register on 18 June 2019 (ID: NL7810). The study was approved by the Medical Ethics Committee of the Amsterdam UMC, location AMC, Netherlands in December 2018 (NL 6748.018.18; 2018).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 111984"},"PeriodicalIF":5.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933169","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":"Postoperative oxygen saturation and surgical-site infection after major non-cardiac surgery: A retrospective analysis.","authors":"Eva Rivas, Jacqueline Palermo, Busra Tok Cekmecelioglu, Yufei Li, Dongsheng Yang, Amit K Saha, Barak Cohen, Ashish K Khanna, Daniel I Sessler","doi":"10.1016/j.jclinane.2025.111947","DOIUrl":"10.1016/j.jclinane.2025.111947","url":null,"abstract":"<p><strong>Objective and background: </strong>Tissue hypoxia impairs wound healing, oxidative killing by neutrophils, and production of superoxide radicals, thus potentially increasing susceptibility to bacterial infections. We tested the primary hypothesis that postoperative hypoxemia, defined as the area under curve (AUC) for oxygen saturation below 90 %, is associated with increased incidence of a 30-day composite of surgical site infections, wound complications, sepsis, and in-hospital mortality in patients recovering from noncardiac surgery.</p><p><strong>Methods: </strong>We included adult inpatients who had major noncardiac surgery and continuous postoperative oximetry for 48 h or until discharge. Our primary outcome was a composite including the components of 30-day superficial, deep or organ-space surgical site infections, sepsis, pneumonia, and/or in-hospital mortality. We primarily assessed the average relative effect of hypoxemia (AUC SpO₂ < 90 %) across the six components using a multivariate generalized estimating equation model to account for within-patient correlations among the components.</p><p><strong>Results: </strong>Among 1355 patients (mean age 55 years, 61 % female), the median continuous postoperative monitoring time was 42 h and the overall AUC SpO₂ < 90 % was 75 [4, 417] min*%, with a median time under a saturation below 90 % of 38 [2.4, 187] min. 85 (6.3 %) patients experienced at least one component of the primary outcome composite. Patients experiencing at least one component had AUC <90 % of 253 [40, 617] and those without had 69 [3, 402] min*%. Adjusting for confounding, there was no association found between postoperative AUC SpO₂ < 90 % and the primary composite outcome, with an average relative effect odds ratio of 1.00 (95 %CI, 0.99, 1.01) for an increase of 30 min*% beyond the threshold, P = 0.61. There were also no significant saturation-related differences in any of the composite components. Sensitivity analyses found similar results.</p><p><strong>Conclusion: </strong>Postoperative hypoxemia was not significantly associated with a composite of surgical site infections and in-hospital mortality. Hypoxemia during recovery from major surgery does not appear to enhance infection or mortality risk.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"111947"},"PeriodicalIF":5.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804231","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":"Associations of preoperative sleep disturbance with intraoperative and postoperative adverse outcomes among Chinese surgical patients: evidence from the China surgery and anesthesia cohort (CSAC).","authors":"Wenwen Chen, Yao Yang, Huazhen Yang, Di Yang, Yuanyuan Qu, Lei Yang, Huolin Zeng, Qian Li, Huan Song","doi":"10.1016/j.jclinane.2025.111956","DOIUrl":"10.1016/j.jclinane.2025.111956","url":null,"abstract":"<p><strong>Background: </strong>Despite of the established association between sleep disturbance and impaired health, these association among the Chinese surgical patients are lacking.</p><p><strong>Method: </strong>This study utilized data from the China Surgery and Anesthesia Cohort (CSAC) which included patients aged 40-65 years who underwent surgery at four medical centers between July 15, 2020 and November 24, 2023. Preoperative sleep quality one month before surgery was assessed using Pittsburgh Sleep Quality Index(PSQI), and sleep patterns were identified through k-means clustering. We ascertained two intraoperative, nine within-hospital, and eight after-discharge adverse outcomes. Logistic regression models were used to examine the interested associations. We additionally used mediation analyses to evaluate the mediating role of postoperative neuropsychological traits on the studied associations.</p><p><strong>Results: </strong>The mean age of 14,129 included participants was 52.3 years with a predominance of females (58.8 %). Preoperative sleep disturbance was associated with two within-hospital (odds ratios[ORs] = 1.19-1.52) and all eight after-discharge adverse outcomes, with the most pronounced ORs observed for postoperative moderate-to-severe sleep disturbance(ORs = 3.88-18.64 at 1 month, 3.44-13.31 at 6 months, and 3.98-15.58 at 12 months), and depression(1.88-3.30 at 1 month, 2.20-3.96 at 6 months, and 2.44-5.60 at 12 months), compared with no sleep disturbance group. Analyses of preoperative sleep patterns indicated that compared to the 'least affected' group, patients featured by the 'multiple sleep problems with daytime dysfunction' obtained the highest estimates for the majority of studied adversities. Mediation analyses identified moderate-to-severe sleep disturbance and depression after surgery were significant mediators of longer-term adverse outcomes.</p><p><strong>Conclusions: </strong>Preoperative sleep disturbance was significantly associated with multiple adverse outcomes. These findings underscore the importance of assessing and managing sleep quality to improve overall prognosis.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"111956"},"PeriodicalIF":5.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812095","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}