Journal of Clinical Anesthesia最新文献

{"title":"Ultrasound-guided trapezius plane block: a novel interfacial block technique","authors":"Chen-Guang Li , Ming-Yi Huang , 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}

{"title":"Individualized hemodynamic goals in major surgery: Is preoperative baseline the optimal target?","authors":"Kunpeng Yang, Wenjuan Sun, Bao Wang","doi":"10.1016/j.jclinane.2025.111962","DOIUrl":"10.1016/j.jclinane.2025.111962","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"111962"},"PeriodicalIF":5.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816826","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-hour music intervention to improve the quality of recovery in female patients undergoing elective surgery after general anesthesia: A single-center randomized clinical study.","authors":"Yuwen Zhang, Diksha Basnet, Yanhong Zhao, Mengyun Wei, Runsheng Xu, Fan Wu, Jiehui Liu, Yi Wang, Jianhui Liu","doi":"10.1016/j.jclinane.2025.111955","DOIUrl":"10.1016/j.jclinane.2025.111955","url":null,"abstract":"<p><strong>Study objective: </strong>This study determined whether a one-hour music intervention while patients were in the post-anesthesia care unit (PACU) could improve postoperative recovery for female patients.</p><p><strong>Design: </strong>Single-center, prospective, randomized controlled trial.</p><p><strong>Setting: </strong>Tertiary university hospital in China.</p><p><strong>Patients: </strong>194 females aged 18-65 years scheduled for laparoscopic gynecological surgical procedures under general anesthesia.</p><p><strong>Interventions: </strong>Patients were randomly assigned to receive therapist-selected music through earphones or wore earphones without listening to music.</p><p><strong>Measurements: </strong>The primary outcome was State-Trait Anxiety Inventory (STAI; STAI-S and STAI-T subscales) scores. Secondary outcomes included post-operative quality recovery scale (PQRS) scores and other scales assessing pain and sleep quality, as well as serum glucose, lactate, and stress hormones levels, including adrenocorticotropic hormone (ACTH), cortical hormone releasing hormone (CRH), cortisol, and aldosterone.</p><p><strong>Main results: </strong>Results from 188 patients were analyzed. Participants in both music and control groups had decreased STAI-S scores on the first and second postoperative days. The music group had a greater reduction in STAI-S scores than the control group (P < 0.001). The music group also had reduced agitation, pain intensity, and reliance on analgesics, as well as improved sleep quality compared to the control group. The control group had higher ACTH levels (P = 0.03) and cortisol levels (P = 0.003) than the music group. CRH, aldosterone, blood glucose, and lactate concentrations did not significantly differ between groups.</p><p><strong>Conclusions: </strong>Music intervention in PACU for female patients undergoing elective laparoscopic gynecological surgery under general anesthesia helped alleviate postoperative anxiety and enhanced the quality of postoperative recovery.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"111955"},"PeriodicalIF":5.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804217","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(25)00252-1","DOIUrl":"10.1016/S0952-8180(25)00252-1","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111991"},"PeriodicalIF":5.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996246","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":"Selection of the most suitable eye model for sub-tenon anesthesia.","authors":"Murat Sırrı Akosman","doi":"10.1016/j.jclinane.2025.111965","DOIUrl":"10.1016/j.jclinane.2025.111965","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"111965"},"PeriodicalIF":5.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816827","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 intravenous lidocaine on propofol-based sedation in adult patients during gastrointestinal endoscopic procedures: an updated systematic review and meta-analysis.","authors":"Pasquale Rinaldi, Andrea Galderisi, Elena Maria Lamacchia, Marta Di Folco, Alessandro Strumia, Fedra Lavorante, Alessia Mattei, Lorenzo Schiavoni, Giuseppe Pascarella, Rita Cataldo, Massimiliano Carassiti, Felice Eugenio Agrò, Maria Luisa Garo","doi":"10.1016/j.jclinane.2025.111960","DOIUrl":"10.1016/j.jclinane.2025.111960","url":null,"abstract":"<p><strong>Introduction: </strong>Sedation during endoscopic gastrointestinal procedures is now a routine practise that can improve patient outcomes. Propofol is one of the most commonly used intravenous anaesthetics. However, despite its popularity, it has been associated with various side effects, particularly haemodynamic and respiratory complications, especially in frail patient populations. Intravenous (IV) lidocaine, used as an adjuvant, has already demonstrated its efficacy in improving certain outcomes during sedation with propofol. However, the emergence of further studies requires an update to enhance the quality of existing data and refine this anaesthetic practise. The aim of this systematic review and meta-analysis is to evaluate the efficacy of intravenous lidocaine in reducing propofol consumption, decreasing episodes of desaturation and involuntary movements during the procedure, improving awakening time, relieving post-procedure pain, and increasing endoscopist satisfaction during propofol sedation in gastrointestinal endoscopic procedures (PROSPERO registration: CRD420250651511).</p><p><strong>Methods: </strong>We included randomised controlled trials conducted in adult patients undergoing propofol sedation with IV lidocaine administered as an adjunct during gastrointestinal endoscopic procedures. A comprehensive systematic search was conducted in PubMed/MEDLINE, Scopus and Web of Science from January to February 2025 without language or time restrictions. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2).</p><p><strong>Results: </strong>Seventeen randomised controlled trials (1698 patients) were selected based on full text and included in the study. Lower propofol consumption was observed with intravenous lidocaine compared with the control group (SMD: -1.36, 95 % CI: -1.67 to -1.05; p < 0.001), with consistent results in all subgroups. Awakening time was significantly shorter in the IV lidocaine group (SMD = -0.92 [95 % CI: -1.18 to -0.66]; p < 0.001), while no significant difference was observed in full recovery time. Lidocaine administration was associated with a 59 % reduction in desaturation events, 36 % reduction in hypotension events and a 57 % reduction in involuntary movements. Continuous infusion after bolus administration was required to achieve these effects. Infusion rates of 2 mg/kg/h and 4 mg/kg/h were equally effective.</p><p><strong>Conclusion: </strong>Intravenous lidocaine is a safe and effective adjunct to propofol sedation in gastrointestinal endoscopy, reducing anaesthetic requirements and sedation-related complications. Routine use of lidocaine may increase the safety of the procedure, especially in high-risk populations and complex procedures.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"111960"},"PeriodicalIF":5.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816825","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}