Journal of Clinical Anesthesia最新文献

{"title":"Response to letter to editor titled: Association between intraoperative blood pressure and postoperative delirium in cardiac surgery: A question yet to be resolved","authors":"Andrej Alfirevic MD FASE , Karan Shah MS , Andra E. Duncan MD MS","doi":"10.1016/j.jclinane.2024.111734","DOIUrl":"10.1016/j.jclinane.2024.111734","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111734"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894831","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":"Implementation of formal neuraxial ultrasound teaching in anesthesiology residency: Resident survey results","authors":"Alexander W.M. Hall M.D., M.Sc. , Reine Zbeidy M.D.","doi":"10.1016/j.jclinane.2024.111714","DOIUrl":"10.1016/j.jclinane.2024.111714","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111714"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813090","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 delirium under general anaesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomised controlled trials","authors":"Masafumi Suga ,&nbsp;Jun Yasuhara ,&nbsp;Atsuyuki Watanabe ,&nbsp;Hisato Takagi ,&nbsp;Toshiki Kuno ,&nbsp;Takeshi Nishimura ,&nbsp;Shinichi Ijuin ,&nbsp;Takuya Taira ,&nbsp;Akihiko Inoue ,&nbsp;Satoshi Ishihara ,&nbsp;Adrian Pakavakis ,&nbsp;Neil Glassford ,&nbsp;Yahya Shehabi","doi":"10.1016/j.jclinane.2024.111735","DOIUrl":"10.1016/j.jclinane.2024.111735","url":null,"abstract":"<div><h3>Background</h3><div>Remimazolam, an ultra-short-acting benzodiazepine, has similar clinical effects to propofol for sedation in general anaesthesia. However, it remains uncertain whether remimazolam could increase postoperative delirium (POD) compared with propofol.</div></div><div><h3>Objectives</h3><div>The purpose of our study was to compare the incidence of POD between remimazolam and propofol as sedative agents in general anaesthesia.</div></div><div><h3>Study design</h3><div>Systematic review and meta-analysis of randomised controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>PubMed, Embase, Cochrane Library, and Web of Science databases were searched for prospective RCTs published through September 16, 2024. RCTs reporting the incidence of POD and comparing remimazolam with propofol for general anaesthesia were included. Odds ratio (ORs) were calculated using a random-effects model. The primary outcome was the incidence of POD. The secondary outcomes included time to extubation, awakening time, and adverse events such as intraoperative hypotension.</div></div><div><h3>Results</h3><div>A total of six RCTs involving 1107 patients were included in this meta-analysis. For the primary outcome, the incidence of POD did not differ between the remimazolam and propofol groups (OR, 0.92; 95 % confidence interval [CI], 0.58–1.44). Regarding the secondary outcomes, remimazolam was associated with a lower incidence of intraoperative hypotension compared with propofol (OR, 0.31; 95 % CI, 0.21–0.46). There were no significant differences in other secondary outcomes. In the sensitivity analysis on three RCTs including only older patients (≥60 years old), there was no significant difference in the incidence of POD (OR, 1.00; 95 % CI, 0.52–1.93).</div></div><div><h3>Conclusion</h3><div>Perioperative remimazolam administration did not increase POD and reduced the risk of intraoperative hypotension compared to propofol. Further large-scale RCTs are warranted to explore the association of remimazolam and POD.</div><div>Systematic review protocol: PROSPERO CRD42024544122.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111735"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006294","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":"Supraglottic jet oxygenation and ventilation on hypoxemia risk: A trial sequential analysis","authors":"Chien-Ming Lin ,&nbsp;Ping-Hsin Liu ,&nbsp;Li-Chen Chang","doi":"10.1016/j.jclinane.2024.111712","DOIUrl":"10.1016/j.jclinane.2024.111712","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111712"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828874","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":"Establishing optimal methodology for studying chatbots in clinical decision making: A new frontier","authors":"Nada Ismaiel MD, MSc, FRCPC ,&nbsp;Brendan Carvalho MBBCh, FRCA ,&nbsp;Pervez Sultan MBChB, FRCA, MD (Res)","doi":"10.1016/j.jclinane.2024.111707","DOIUrl":"10.1016/j.jclinane.2024.111707","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111707"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854287","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":"Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study","authors":"Viviane Lauret MD ,&nbsp;Claude Guerin MD-PhD ,&nbsp;Sirine Boussena MD ,&nbsp;Mathilde De-Queiroz MD ,&nbsp;Lionel Bouvet MD-PhD ,&nbsp;Florent Baudin MD-PhD","doi":"10.1016/j.jclinane.2024.111710","DOIUrl":"10.1016/j.jclinane.2024.111710","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children.</div></div><div><h3>Design</h3><div>Prospective observational clinical pilot-study.</div></div><div><h3>Setting</h3><div>University Children's Hospital of Lyon, France.</div></div><div><h3>Patients</h3><div>Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.</div></div><div><h3>Intervention</h3><div>After the beginning of Guedel's stage 3 of anesthesia, several settings were applied for 60 s in the following systematic order: spontaneous breathing when applying a facemask (SB-Mask), then PEEP 4 cmH₂O, PSV 4 cmH2O above PEEP 4 cmH₂O, and PSV 4 to 7 cmH₂O above PEEP 4 cmH₂O, at the anesthesiologist's discretion.</div></div><div><h3>Measurements</h3><div>Children were monitored using Electrical Impedance Tomography (EIT; Pulmovista 500, Dräger, France). Tidal volume (TV), dorsal fraction of the ventilation, and end-expiratory lung impedance (EELI) were assessed with the ventilator and EIT.</div></div><div><h3>Main results</h3><div>Twenty-two patients were included (20 analyzed), their median [IQR] age was 21 [14–36] months. TV did not significantly differ between the settings. The increase in EELI was greater with PSV (+0.60 [0.48–0.91] arbitrary units) than with PEEP 4 cmH₂O alone (+0.39 [0.20–0.06] arbitrary units, <em>p</em> = 0.005), and did not change with increased level of PSV (+0.66 [0.40–1.22] arbitrary units). The dorsal fraction of lung ventilation decreased using PSV, from 56 % [45–63] with SB-mask to 53 % [43–56] with PSV 4cmH₂O (<em>p</em> = 0.002) and 47 % [40–55] with PSV 7cmH₂O (<em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111710"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854290","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":"Association between intraoperative blood pressure and postoperative delirium in cardiac surgery: A question yet to be resolved","authors":"Jing Wang MD,&nbsp;Han Zhang MD,&nbsp;Tianlong Wang MD,&nbsp;Bingyang Ji MD, PhD","doi":"10.1016/j.jclinane.2024.111717","DOIUrl":"10.1016/j.jclinane.2024.111717","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111717"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818396","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 regarding “Recovery quality of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery: A randomized trial”","authors":"Jianjun Yang MD,&nbsp;Xiaocou Wang MD,&nbsp;Pinguo Fu MD","doi":"10.1016/j.jclinane.2024.111738","DOIUrl":"10.1016/j.jclinane.2024.111738","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111738"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894794","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":"Frailty as an independent risk factor for prolonged postoperative length of stay: A retrospective analysis of 2015–2019 ACS NSQIP data","authors":"Jane Y. Xu MPH ,&nbsp;Hannah E. Madden BS ,&nbsp;Pablo Martínez-Camblor PhD ,&nbsp;Stacie G. Deiner MD","doi":"10.1016/j.jclinane.2024.111730","DOIUrl":"10.1016/j.jclinane.2024.111730","url":null,"abstract":"<div><h3>Background</h3><div>Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure.</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data. Frailty, measured by the modified 5-item frailty index (mFI-5), was categorized as non-frail (mFI-5 &lt; 2) or frail (mFI-5 ≥ 2). We modeled LOS, adjusting for demographic variables, comorbidities, and surgical factors, and conducted a subgroup analysis based on emergency surgery status and surgical procedure type.</div></div><div><h3>Main results</h3><div>Among 1,254,809 patients, 29.0 % were frail. A higher proportion of frail patients were Black (10 % vs. 5.5 %), Hispanic (6.1 % vs. 3.8 %), of ASA class IV/V (23.3 % vs. 9.1 %), malnourished (2.7 % vs. 1.9 %), and underwent vascular surgery (16.5 % vs. 8.3 %). They experienced longer median LOS across all surgical procedures, except bariatric surgery. Unadjusted analysis revealed that mFI-5 scores of 4 and 5 were associated with increased median LOS by 3.5 days (95 % CI 3.36–3.64) and 4.64 days (95 % CI 3.96–5.32), respectively, compared to mFI-5 scores of 0. In adjusted analysis, frailty remained a significant risk factor for increased median LOS, with an mFI-5 score of 5 associated with a 3-day longer increase (95 % CI 2.79–3.22) compared to an mFI-5 score of 0. Subgroup analysis showed that each one-point increase in mFI-5 score had the strongest association with increased median LOS in emergency surgery (0.5 days, 95 % CI 0.48–0.52) and lower extremity bypass surgery (0.53 days, 95 % CI 0.47–0.59).</div></div><div><h3>Conclusions</h3><div>Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111730"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872258","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":"Reduction of postoperative pain and opioid consumption by VVZ-149, first-in-class analgesic molecule: A confirmatory phase 3 trial of laparoscopic colectomy","authors":"Ho-Jin Lee M.D., Ph.D. ,&nbsp;Ji-Yeon Sim M.D., Ph.D. ,&nbsp;Inkyung Song Ph.D. ,&nbsp;Srdjan S. Nedeljkovic M.D. ,&nbsp;Duk Kyung Kim M.D., Ph.D. ,&nbsp;Ah-Young Oh M.D., Ph.D. ,&nbsp;Seung Zhoo Yoon M.D., Ph.D. ,&nbsp;Young-Jin Moon M.D., Ph.D. ,&nbsp;Mi-Hye Park M.D., Ph.D. ,&nbsp;Insun Park M.D., Ph.D. ,&nbsp;Jina Kim M.S. ,&nbsp;Sang Rim Lee M.S. ,&nbsp;Sunyoung Cho Ph.D. ,&nbsp;Jae-Hyon Bahk M.D., Ph.D.","doi":"10.1016/j.jclinane.2024.111729","DOIUrl":"10.1016/j.jclinane.2024.111729","url":null,"abstract":"<div><h3>Study objective</h3><div>VVZ-149 is a small molecule that inhibits the glycine transporter type 2 and the serotonin receptor 5-hydroxytryptamine 2 A. In this Phase 3 study, we investigated the efficacy and safety of VVZ-149 as a single-use injectable analgesic for treating moderate to severe postoperative pain after laparoscopic colectomy.</div></div><div><h3>Design</h3><div>Randomized, parallel group, double-blind, Phase 3 clinical trial (Trial no. <span><span>NCT05764525</span><svg><path></path></svg></span>).</div></div><div><h3>Setting</h3><div>5 tertiary referral centers in South Korea.</div></div><div><h3>Patients</h3><div>284 patients undergoing laparoscopic colectomy.</div></div><div><h3>Interventions</h3><div>A continuous 10-h intravenous infusion of VVZ-149 (<em>n</em> = 141) or placebo (<em>n</em> = 143) administered after emergence from anesthesia.</div></div><div><h3>Measurements</h3><div>Pain intensity was assessed using a numeric rating scale (NRS) from the start of infusion for 48 h. The primary efficacy measure was the Sum of Pain Intensity Difference (SPID) for the first 12 h after the start of drug infusion. Other efficacy measures included SPID at other time points, opioid consumption via on-demand patient-controlled analgesia (PCA) and rescue medication, and proportion of patients who did not require rescue opioids for 48 h post-dose.</div></div><div><h3>Main results</h3><div>Pain relief as measured by SPID was significantly improved by 35 % in the VVZ-149 group compared to the placebo group at 6 h (<em>p</em> = 0.0193) and 12 h (<em>p</em> = 0.0047) after the start of infusion. Significantly lower pain intensity scores were observed between 4–10 h in the VVZ-149 group compared to the placebo group (<em>p</em> = 0.0007), reaching mild pain (mean NRS &lt;4) at 8 h. VVZ-149 alleviated pain during the first 12 h post-dose with 30.8 % less opioid consumption and 60.2 % fewer PCA requests when compared with placebo. A higher proportion of patients receiving VVZ-149 were rescue opioid-free during 2–6 h (<em>p</em> = 0.0026) and 6–12 h (<em>p</em> = 0.0024) compared with the placebo group. VVZ-149 administration in post-colectomy patients was generally safe and well tolerated.</div></div><div><h3>Conclusions</h3><div>When compared to placebo, VVZ-149 infusion demonstrated a significant reduction of pain within the first 12 h after surgery with a substantial decrease in opioid use. VVZ-149 rapidly lowers the pain intensity starting at as early as 4 h post-dose, allowing subjects to experience mild pain levels from 8 h through 48 h. Therefore, the analgesic effect of VVZ-149 was shown to effectively relieve pain and reduce opioid use for treating moderate to severe pain in the early postoperative care setting.</div><div><strong>Registration number</strong>: Trial Number <span><span>NCT05764525</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111729"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869393","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}