Journal of Clinical Anesthesia最新文献

{"title":"From significance to feedback: Designing assessment with purpose and rigor","authors":"Getúlio Rodrigues de Oliveira Filho M.D., Ph.D","doi":"10.1016/j.jclinane.2025.111980","DOIUrl":"10.1016/j.jclinane.2025.111980","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111980"},"PeriodicalIF":5.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890453","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":"Incivility in the operating room: A French anesthesia survey","authors":"Julien Raft ,&nbsp;Anne-Sophie Lamotte ,&nbsp;Philippe Richebé ,&nbsp;Hervé Bouaziz","doi":"10.1016/j.jclinane.2025.111983","DOIUrl":"10.1016/j.jclinane.2025.111983","url":null,"abstract":"<div><h3>Background</h3><div>Incivilities in healthcare, especially in operating rooms, can cause emotional exhaustion, burnout, and reduced job satisfaction. Verbal and physical aggression, harassment, and sexual misconduct are common in surgical environments, negatively impacting healthcare workers and patient safety. This study assessed the prevalence of incivility in anesthesia teams in France and its impact.</div></div><div><h3>Methods</h3><div>A survey collecting demographic data and experiences of incivility was distributed to 4232 French Society of Anesthesia and Intensive Care (SFAR) members in 2022. The final sample (<em>n</em> = 873) showed a distribution of gender and professional roles broadly comparable to the overall SFAR membership. An adapted Maslach Burnout Inventory (MBI) was used to measure emotional exhaustion, depersonalization (interpreted here as loss of empathy), and personal accomplishment.</div></div><div><h3>Results</h3><div>Out of 989 responses, 873 were included (20,6 % of SFAR members), with the following gender distribution: 48 % male and 52 % female. A total of 83 % reported experiencing incivility, and over 60 % witnessed it regularly. The overall effect of incivility was low for emotional exhaustion and loss of empathy. Women reported significantly more verbal aggression, sexual harassment, and deviant behaviors. Emotional exhaustion was higher in women and nurse anesthetists, while anesthesiologists reported greater loss of personal accomplishment. No significant differences in depersonalization or loss of empathy were found.</div></div><div><h3>Conclusion</h3><div>Incivility is widespread in operating rooms toward anesthesia teams, with notable emotional impacts, especially on women and nurse anesthetists. Despite this, empathy for patients remains largely preserved. Addressing gender and hierarchical dynamics is essential for improve workplace culture and support staff well-being.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111983"},"PeriodicalIF":5.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892112","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":"Non-invasive intracranial pressure assessment in adult critically ill patients: A narrative review on current approaches and future perspectives","authors":"Cristian Deana ,&nbsp;Daniele Guerino Biasucci ,&nbsp;Raffaele Aspide ,&nbsp;Daniele Bagatto ,&nbsp;Sergio Brasil ,&nbsp;Domenico Brunetti Jr ,&nbsp;Thomas Saitta ,&nbsp;Mina Vapireva ,&nbsp;Christian Zanza ,&nbsp;Yaroslava Longhitano ,&nbsp;Elena Giovanna Bignami ,&nbsp;Luigi Vetrugno","doi":"10.1016/j.jclinane.2025.111977","DOIUrl":"10.1016/j.jclinane.2025.111977","url":null,"abstract":"<div><div>Intracranial hypertension (IH) is a life-threatening complication that may occur after acute brain injury. Early recognition of IH allows prompt interventions that improve outcomes. Even if invasive intracranial monitoring is considered the gold standard for the most severely injured patients, scarce availability of resources, the need for advanced skills, and potential for complications often limit its utilization. On the other hand, different non-invasive methods to evaluate acutely brain-injured patients for elevated intracranial pressure have been investigated. Clinical examination and neuroradiology represent the cornerstone of a patient's evaluation in the intensive care unit (ICU). However, multimodal neuromonitoring, employing widely used different tools, such as brain ultrasound, automated pupillometry, and skull micro-deformation recordings, increase the possibility for continuous or semi-continuous intracranial pressure monitoring.</div><div>Furthermore, artificial intelligence (AI) has been investigated to as a tool to predict elevated intracranial pressure, shedding light on new diagnostic and treatment horizons with the potential to improve patient outcomes.</div><div>This narrative review, based on a systematic literature search, summarizes the best available evidence on the use of non-invasive monitoring tools and methods for the assessment of intracranial pressure.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111977"},"PeriodicalIF":5.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890451","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":"Revisiting the hypoxemia–SSI relationship: Potential methodological influences","authors":"Guangdong Wang ,&nbsp;Tingting Liu ,&nbsp;Shuo Yu ,&nbsp;Lu Zhang","doi":"10.1016/j.jclinane.2025.111979","DOIUrl":"10.1016/j.jclinane.2025.111979","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111979"},"PeriodicalIF":5.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886937","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 “The role positioning of AI in clinical decision-making”","authors":"Junyang Ma ,&nbsp;Wenhao Bu ,&nbsp;Mengjiao Wan ,&nbsp;Liqin Deng ,&nbsp;Jing Cheng","doi":"10.1016/j.jclinane.2025.111975","DOIUrl":"10.1016/j.jclinane.2025.111975","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111975"},"PeriodicalIF":5.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864514","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 short duration smoking cessation on post-operative complications: A systematic review and meta-analysis","authors":"Evan Tang MD ,&nbsp;Ray Martinez Rodriguez BScN BSc ,&nbsp;Ananya Srivastava MD ,&nbsp;Roshan Malhan MD ,&nbsp;Isabelle Laksono MD ,&nbsp;Ellene Yan ,&nbsp;Marina Englesakis MLIS ,&nbsp;Jean Wong MD ,&nbsp;Frances Chung MD","doi":"10.1016/j.jclinane.2025.111967","DOIUrl":"10.1016/j.jclinane.2025.111967","url":null,"abstract":"<div><h3>Background</h3><div>Use of tobacco poses significant health risks, particularly in surgical patients, where smoking is a well-established risk factor for postoperative complications. Patients are often seen in the pre-assessment clinic 2–4 weeks prior to surgery, presenting a window of opportunity to intervene. The objective of our systematic review and meta-analysis is to explore the impact of short-term smoking cessation on postoperative outcomes, focusing on the critical 2–4-week period preceding surgery.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews.</div></div><div><h3>Patients</h3><div>Adults undergoing surgical procedures with a defined smoking cessation pre-operative smoking cessation interval.</div></div><div><h3>Measurement</h3><div>Post-operative complications including pulmonary complications, surgical site infection, wound complication, bleeding, mortality, and composite complications.</div></div><div><h3>Results</h3><div>Fifty-five studies were included in the systematic review and meta-analysis. Pulmonary complications were more prevalent in former smokers compared to non-smokers, even after cessation. Progressively longer smoking cessation periods showed improved outcomes. Compared to active smokers, preoperative cessation reduced pulmonary complications by 27 % at ≥2 weeks (RR 0.73, 95 % CI 0.60–0.89), 29 % at ≥4 weeks (RR 0.71, 95 % CI 0.61–0.82), and 37 % at ≥8 weeks (RR 0.63, 95 % CI 0.41–0.95). With ≥4 weeks of cessation, there was a 33 % lower risk of wound complications (RR 0.67, 95 % CI 0.47–0.94), 31 % lower risk of composite complications (RR 0.69, 95 %CI 0.63–0.76), and 14 % lower risk of mortality (RR 0.86, 95 % CI 0.77–0.97). Short term cessation did not seem to have a significant impact on surgical site infections or bleeding.</div></div><div><h3>Conclusions</h3><div>Short term cessation of at least 2–4 weeks demonstrates benefits in reducing post-operative complications.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111967"},"PeriodicalIF":5.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864515","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 external oblique intercostal plane block versus subcostal transversus abdominis plane block for postoperative analgesia in living liver donors: A prospective randomized trial","authors":"Taylan Sahin ,&nbsp;Ali Sait Kavakli ,&nbsp;Eryigit Eren ,&nbsp;Alaaddin Aydin ,&nbsp;Nese Kutluturk Sahin ,&nbsp;Mehmet Tokac ,&nbsp;Ayhan Dinckan","doi":"10.1016/j.jclinane.2025.111971","DOIUrl":"10.1016/j.jclinane.2025.111971","url":null,"abstract":"<div><h3>Introduction</h3><div>Pain relief provided by the transversus abdominis plane (TAP) block in individuals who have undergone living liver donation during the postoperative period has been demonstrated in previous studies. The external oblique intercostal plane (EOI) block is a recently introduced technique designed to provide analgesia for the anterolateral region of the upper abdominal wall.</div><div>This study aims to evaluate and compare the efficacy of the external oblique intercostal plane (EOI) block and the subcostal TAP block in individuals who have undergone living liver donation.</div></div><div><h3>Methods</h3><div>Patients were randomly assigned to one of two groups: EOI block group and subcostal TAP block group. In both groups, bilateral blocks were performed using a total of 40 ml of 0.25 % bupivacaine at the end of surgery and prior to extubation. Postoperatively, all patients were connected to an intravenous patient-controlled analgesia (PCA) device containing morphine. The primary outcome of the study was intravenous morphine consumption during the first 24 h postoperatively.</div></div><div><h3>Results</h3><div>The median [interquartile range] morphine consumption at 24 h postoperatively was similar between EOI block and subcostal TAP block groups (23.5 [19.5 to 27.5] vs 26 [<span><span>[24]</span></span>, <span><span>[25]</span></span>, <span><span>[26]</span></span>, <span><span>[27]</span></span>, <span><span>[28]</span></span>], respectively). There were no significant differences in terms of numerical rating scale (NRS) scores at rest and during movement at 2, 6, 12 and 24 h. No block-related complications were observed in any patients.</div></div><div><h3>Conclusion</h3><div>The results of the study showed that there were no statistically significant differences in 24-h morphine consumption or pain scores at rest and during movement between the subcostal TAP and EOI block groups in living liver donors undergoing right hepatectomy. Either technique may be preferred depending on the clinician's experience and institutional practice.</div><div>Trial registration.</div><div><span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> identifier: <span><span>NCT05890079</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111971"},"PeriodicalIF":5.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864512","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 “overlooked clinical realities in ChatGPT vs. DeepSeek comparative studies: Barriers to translating dynamic decision support to practice”","authors":"Junyang Ma ,&nbsp;Wenhao Bu ,&nbsp;Mengjiao Wan ,&nbsp;Liqin Deng ,&nbsp;Jing Cheng","doi":"10.1016/j.jclinane.2025.111974","DOIUrl":"10.1016/j.jclinane.2025.111974","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111974"},"PeriodicalIF":5.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864513","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":"Efficacy of thoracic paravertebral block with liposomal bupivacaine for postoperative analgesia in patients undergoing liver resection: A randomized controlled trial","authors":"Jiangling Wang ,&nbsp;Daoying Zhou ,&nbsp;Sunyuan Xu ,&nbsp;Zewu Ding ,&nbsp;Man Fang ,&nbsp;Ping Chen ,&nbsp;Pingbo Xu","doi":"10.1016/j.jclinane.2025.111968","DOIUrl":"10.1016/j.jclinane.2025.111968","url":null,"abstract":"<div><h3>Background</h3><div>Patients often suffer from moderate to severe acute postoperative pain after liver resection, and the use of liposomal bupivacaine (LB) for pain management is widespread. However, no studies have demonstrated the effect of postoperative analgesia with LB administered via a thoracic paravertebral block (TPVB). The aim of this study was to evaluate the effects of TPVB-administered LB and standard bupivacaine (SB) on opioid sparing and postoperative recovery following liver resection</div></div><div><h3>Methods</h3><div>In this randomized, prospective, single-blind study, 96 patients were randomly (1:1) assigned to two groups. The primary outcome was cumulative opioid consumption over the first 72 h. the secondary outcomes were the time to first opioid use after surgery, plasma bupivacaine concentration, quality of recovery 40 (QoR-40) score area under the curve (AUC) from 24 to 72 h, pain visual analog scale (VAS) score AUC from 6 h to 3 months, postoperative plasma inflammatory factor levels, and sleep quality at 3 months after surgery</div></div><div><h3>Results</h3><div>Ninety-three patients (age (SD), 59.8 (10.5) years; 74 males, 79.6 %) were included in the final analysis. The cumulative opioid consumption was lower in the LB group 63.0 (IQR: 10.5, 90.0) than in the SB group of patients receiving the (72.0 (IQR: 27.0, 135.0) mg oral morphine equivalent (<em>p</em> = 0.041). Compared to those in the SB group, the time to first opioid use was longer, and the plasma bupivacaine and TNF-α levels were greater postoperatively in the LB group. There was no difference in other outcomes between the two groups, and there were no adverse events in this study</div></div><div><h3>Conclusion</h3><div>TPVB-administered LB reduced total opioid consumption postoperatively in patients undergoing hepatectomy in the first 72 h.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111968"},"PeriodicalIF":5.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828278","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":"A novel comprehensive model of indicators reflecting the relative spatial position of the anterior cervical structures for predicting difficult laryngoscopy in patients with cervical spondylosis","authors":"Tianhao Zhang ,&nbsp;Yujie Wang ,&nbsp;Binlong Li,&nbsp;Rui Zhang,&nbsp;Wenxuan Liu,&nbsp;Bin Wei,&nbsp;Mao Xu","doi":"10.1016/j.jclinane.2025.111966","DOIUrl":"10.1016/j.jclinane.2025.111966","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of difficult airway (DA) is critical, as failure to identify DA may lead to life-threatening complications. This study aimed to develop a multiparameter predictive model for DA using a novel ultrasound reference line (XU-line).</div></div><div><h3>Methods</h3><div>In this prospective, observational, single-blinded study, patients scheduled for elective cervical spondylosis surgery at Peking University Third Hospital underwent preoperative airway evaluation via physical indices and ultrasonography. Distances from the XU-line to six anatomical landmarks (hyoid bone, cricoid cartilage, epiglottis, vocal cords, thyroid isthmus, and suprasternal notch) were measured both in supine and sniffing positions. Participants were stratified into “easy laryngoscopy” and “difficult laryngoscopy” groups based on Cormack–Lehane (C-L) grades. Multivariate logistic regression identified independent predictors of difficult laryngoscopy.</div></div><div><h3>Results</h3><div>There were significant differences in the thirteen clinical factors between the two groups. Sex, modified Mallampati test, skin-to-epiglottis distance (neutral position), XU-line-to-vocal-cords distance (sniffing position), and spatial distances from XU-line to cricoid cartilage were found to be independent risk factors for difficult laryngoscopy. A combined model incorporating these five factors demonstrated superior predictive performance (sensitivity: 82.0 %; specificity: 61 %) compared to individual clinical predictors or traditional clinical models.</div></div><div><h3>Conclusion</h3><div>The spatial relationship between cervical airway structures and the XU-line may serve as a novel predictive index in a comprehensive DA assessment model.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111966"},"PeriodicalIF":5.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842447","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}