Journal of Clinical Anesthesia最新文献

{"title":"Complete removal of nitrous oxide from the operating room.","authors":"Arash Motamed, Aren Nercisian, Bhavna Sharma","doi":"10.1016/j.jclinane.2025.111959","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111959","url":null,"abstract":"<p><strong>Study objective: </strong>To assess the use of nitrous oxide as an anesthetic gas in the operating room and assess the environmental impacts for the site-specific case mix.</p><p><strong>Design: </strong>The study focused on providing educational sessions to anesthesia staff at one academic medical center. The study assessed the usage of nitrous oxide E-cylinders and central supply in the operating room, which includes up to 46 anesthetizing locations, as part of the quality improvement initiative.</p><p><strong>Setting: </strong>Operating Room.</p><p><strong>Patients: </strong>No patient data or patients were included in the study.</p><p><strong>Interventions: </strong>Educational sessions, in the form of grand rounds and guest speakers, highlighted the environmental impact of anesthetic agents.</p><p><strong>Measurements: </strong>Operational data was used to quantify the usage of nitrous oxide. Emissions factors were used to calculate the avoided carbon dioxide equivalent emissions through discontinuation of nitrous oxide in 46 anesthetizing locations.</p><p><strong>Main results: </strong>Survey assessment of current usage and needs of nitrous oxide fostered staff engagement and promoted a collaborative approach to evaluating its discontinuation. Assessment showed that the availability of E-cylinders and central supply were not required in the anesthetizing locations and removal reduced emissions.</p><p><strong>Conclusions: </strong>Engaging anesthesia providers in discussion about the environmental impacts of anesthetic agents is critical in increasing awareness of healthcare's contribution to climate change. The study focused on nitrous oxide, surveying anesthesia providers to assess current usage patterns and anticipated future needs. The institution successfully eliminated E-cylinders and discontinued central supply of nitrous oxide from the sites. With targeted engagement and institutional support, complete removal of nitrous oxide from anesthesia practice is feasible and impactful.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111959"},"PeriodicalIF":5.1,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821506","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":"Validating sl-EEG in postoperative delirium: Biomarkers and subtype stratification","authors":"Yiming Wang","doi":"10.1016/j.jclinane.2025.111958","DOIUrl":"10.1016/j.jclinane.2025.111958","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111958"},"PeriodicalIF":5.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770971","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 paravertebral block with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after the Nuss procedure in children: A randomized clinical trial","authors":"Lei Wu,&nbsp;Si Wei Wei,&nbsp;Zheng Chen,&nbsp;Li Dan Jiang,&nbsp;Shuang Quan Qu,&nbsp;Zhen Du","doi":"10.1016/j.jclinane.2025.111953","DOIUrl":"10.1016/j.jclinane.2025.111953","url":null,"abstract":"<div><h3>Study objective</h3><div>Minimally invasive repair of pectus excavatum (Nuss procedure) is associated with significant postoperative pain and high-dose opioid consumption. Liposomal bupivacaine (LB), as an ultra-long-acting local anesthetic, has been extensively studied for perioperative analgesia. However, data regarding the effects of LB on postoperative pain in children undergoing the Nuss procedure remain limited. The aim of this study was to evaluate the ability of LB to reduce postoperative opioid use among children undergoing the Nuss procedure.</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients</h3><div>Children aged 6–18 years who were scheduled for elective Nuss procedures.</div></div><div><h3>Interventions</h3><div>Patients were randomly assigned to receive ultrasound-guided paravertebral block with either LB or non-liposomal bupivacaine (nLB) after anesthesia induction.</div></div><div><h3>Measurements</h3><div>The primary outcome was the consumption of morphine equivalent during the first 72 h after surgery. The secondary endpoints included the maximum Numerical Rating Scale (NRS) pain score within 72 h, incidence of moderate-to-severe pain within 72 h, incidence of rebound pain within 72 h, NRS sleep score at 3 days, incidence of postoperative nausea and vomiting, length of hospital stay after surgery, and time to first ambulation after the operation.</div></div><div><h3>Main results</h3><div>A total of 109 subjects were included in the intention-to-treat analysis. Within 72 h after surgery, the morphine equivalent consumption in the LB group was reduced by about 23 % compared with the nLB group (median difference: 23.1 mg; <em>P</em> = 0.023). The incidence of rebound pain was significantly lower in the LB group than in the nLB group (13.0 % [7/54] vs. 29.1 % [16/55], relative risk 0.46; 95 % CI: 0.20 0.96; <em>P</em> = 0.039). Subjective sleep quality was better in the LB group than in the nLB group on the second and third nights after surgery (median difference: −1 point; <em>P</em> = 0.005 and <em>P</em> = 0.016). The incidence of adverse events was similar in both groups, and no patients experienced severe adverse events during the study period.</div></div><div><h3>Conclusions</h3><div>Paravertebral bock with LB reduces opioid use (a ∼ 23 % reduction) and the incidence of rebound pain in children after the Nuss procedure compared to nLB group.</div></div><div><h3>Trial registration</h3><div><span><span>www.chictr.org.cn</span><svg><path></path></svg></span> (Registration number ChiCTR2400085350, Registration date June 5, 2024).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111953"},"PeriodicalIF":5.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770969","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":"Comment on “Prevalence of postoperative neurocognitive disorders in older non-cardiac surgical patients: A systematic review and meta-analysis”","authors":"Juan P. Cata MD ,&nbsp;Eduardo Nunez-Rodriguez MD","doi":"10.1016/j.jclinane.2025.111954","DOIUrl":"10.1016/j.jclinane.2025.111954","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111954"},"PeriodicalIF":5.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770970","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":"Evaluation of the information content of individual items' scores in the anesthesiologist supervision instrument using Cochran's Q tests and McNemar's tests to provide specific feedback to ratees in addition to reliable evaluation of clinical performance","authors":"Franklin Dexter MD PhD FASA ,&nbsp;Bradley J. Hindman MD ,&nbsp;Kokila N. Thenuwara MD, MBBS, MME, MHCDS","doi":"10.1016/j.jclinane.2025.111946","DOIUrl":"10.1016/j.jclinane.2025.111946","url":null,"abstract":"<div><h3>Background</h3><div>Annual professional practice evaluations (i.e., peer review) are mandatory for anesthesiologists in many practice settings. The de Oliveira Filho clinical anesthesia supervision instrument is a valid and psychometrically reliable tool suitable for these high-stakes assessments. We studied item-specific feedback to anesthesiologists to increase their scores.</div></div><div><h3>Methods</h3><div>The retrospective cohort study used all 11 academic years for which the studied department used the supervision instrument, July 2013 through June 2024. There were 55,195 evaluations of 715 combinations of anesthesiologist and year by 242 rating trainees (e.g., anesthesia residents), each evaluation with 9-items scored 4=always, 3=frequently, 2=rarely, or 1=never.</div></div><div><h3>Results</h3><div>The 9-item supervision instrument had Cronbach alpha 0.96 and functioned as a binary (4 vs ≤3) multivariate array. Consequently, the 87% (47,859/55,195) of evaluations with all 9 items 4=always, or all 9 items ≤3, provided information about the quality of performance of the anesthesiologists, but no potentially useful item-specific information for feedback to anesthesiologists. Cochran Q tests were performed for each of the 715 combinations of anesthesiologist and year using the remaining 7336 evaluations. There were 17% (124/715) of the combinations of anesthesiologist and year with adjusted <em>P</em> &lt; 0.05, showing one or more of the items' scores differed significantly from the other items' scores. The 17% of combinations represented 6.0% (3311/55,195) of evaluations. For each of those 124 combinations of anesthesiologist and year, 36 McNemar tests were performed, comparing the 1st item to the 2nd, …, 8th item to 9th. Among those pairwise comparisons that were statistically significant, the directions of odds ratios were examined. The items about teaching quality accounted for 19% and 26% of the odds ratios &lt;1 (i.e., low scores), respectively, while the other seven items each accounted for ≤5%.</div></div><div><h3>Conclusions</h3><div>Earlier it was known that anesthesiologists' annual professional practice evaluations can be provided along with education regarding good teaching attributes associated with high quality intraoperative supervision and greater supervision scores. Our results show that also providing analyses of individual item scores could benefit, at most, &lt;20% of the faculty anesthesiologists.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111946"},"PeriodicalIF":5.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739022","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":"Superficial vs. deep serratus anterior plane block for analgesia in patients undergoing single-port video-assisted thoracoscopic surgery: A randomized prospective trial","authors":"Gaige Meng,&nbsp;Wen Chen,&nbsp;Dewen Shi,&nbsp;Bin Mei,&nbsp;Xuesheng Liu","doi":"10.1016/j.jclinane.2025.111950","DOIUrl":"10.1016/j.jclinane.2025.111950","url":null,"abstract":"<div><h3>Study objective</h3><div>Postoperative pain following thoracic surgery is often severe, and serratus anterior plane block (SAPB) is widely used for perioperative analgesia in such patients. Local anesthetics injected on the surface of the serratus anterior muscle are called superficial SAPB (SSAPB), while those injected on the deep surface are called deep SAPB (DSAPB). We observed the differences in analgesic effects of two variants of SAPB (superficial and deep) on patients receiving single-port video-assisted thoracoscopic surgery (VATS).</div></div><div><h3>Design</h3><div>A randomized prospective trial.</div></div><div><h3>Setting</h3><div>Single university teaching hospital.</div></div><div><h3>Patients</h3><div>Eighty patients who underwent single-port VATS under general anesthesia.</div></div><div><h3>Interventions</h3><div>Eighty patients who received single-port VATS were randomly assigned to Group S (patients who received SSAPB) and Group D (patients who received DSAPB).</div></div><div><h3>Measurements</h3><div>The primary outcome was opioid consumption within 24 h after surgery. Secondary outcomes were pain scores at rest and on coughing before surgery, immediately after surgery, 6, 12, and 24 h after surgery.</div></div><div><h3>Main results</h3><div>Within 24 h after surgery, the total opioid consumption of patients in Group S was lower than that of patients in Group D (<em>P</em> = 0.001). The pain scores of patients in Group S were lower than those in Group D at rest or coughing 6 h after surgery (<em>P</em> = 0.000, <em>P</em> = 0.000). The pain score on coughing in Group S was lower than that in Group D at 12 h after surgery (<em>P</em> = 0.000), and there was no difference in postoperative pain scores between the two groups at other time points.</div></div><div><h3>Conclusion</h3><div>For patients undergoing single-port VATS lobectomy, SSAPB was associated with reduced opioid consumption and lower pain scores compared to DSAPB.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111950"},"PeriodicalIF":5.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739021","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":"HRAD ± and the future of perioperative emotional assessment in children","authors":"Pouria Farahani ,&nbsp;Ali Hosseini","doi":"10.1016/j.jclinane.2025.111949","DOIUrl":"10.1016/j.jclinane.2025.111949","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111949"},"PeriodicalIF":5.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749163","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, “Association between intravenous 5 % albumin administration and acute kidney injury after partial nephrectomy. A retrospective study”.","authors":"Zhe Peng ,&nbsp;Long Zhang ,&nbsp;Lili Jiang","doi":"10.1016/j.jclinane.2025.111944","DOIUrl":"10.1016/j.jclinane.2025.111944","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111944"},"PeriodicalIF":5.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721945","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":"Response to “Overdiagnosis of catheter-related thrombosis: When intensive screening detects clinically irrelevant findings”","authors":"Sebastian Gibb,&nbsp;Sebastian Engelhardt,&nbsp;Falk von Dincklage,&nbsp;Sven-Olaf Kuhn","doi":"10.1016/j.jclinane.2025.111941","DOIUrl":"10.1016/j.jclinane.2025.111941","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111941"},"PeriodicalIF":5.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702914","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":"Clinical relevance of opioid-free anesthesia on quality of recovery: Methodological considerations","authors":"Wei-Hung Chen ,&nbsp;Wan-Jung Cheng ,&nbsp;Ming Yew","doi":"10.1016/j.jclinane.2025.111948","DOIUrl":"10.1016/j.jclinane.2025.111948","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111948"},"PeriodicalIF":5.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703033","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}