Journal of Clinical Anesthesia最新文献

{"title":"Anesthesia-induced electroencephalogram oscillations and perioperative outcomes in older adults undergoing cardiac surgery","authors":"Isaac G. Freedman ,&nbsp;Gonzalo Boncompte ,&nbsp;Jason Z. Qu ,&nbsp;Zain Q. Khawaja ,&nbsp;Isabella Turco ,&nbsp;Ariel Mueller ,&nbsp;Kwame Wiredu ,&nbsp;Tina B. McKay ,&nbsp;M. Brandon Westover ,&nbsp;Juan C. Pedemonte ,&nbsp;Oluwaseun Akeju","doi":"10.1016/j.jclinane.2025.111770","DOIUrl":"10.1016/j.jclinane.2025.111770","url":null,"abstract":"<div><h3>Background</h3><div>Electroencephalogram oscillations during general anesthesia may change as a function of cognitive and physical health. This study aimed to characterize associations between anesthesia-induced oscillations and postoperative outcomes in cardiac surgery patients over 60 years.</div></div><div><h3>Methods</h3><div>This was a prespecified secondary data analysis from the Minimizing Intensive Care Unit Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) study. Participants were admitted from home for elective cardiac surgery with cardiopulmonary bypass. The primary outcome was postoperative delirium obtained using the Confusion Assessment Method. Secondary outcomes were non-home discharge and 30-day readmission. The exposure of interest was alpha power measured during the maintenance phase of isoflurane-general anesthesia. Confounding cognitive and physical health variables were collected.</div></div><div><h3>Results</h3><div>Of 394 participants in the MINDDS study, 302 had analyzable electroencephalograms. The incidence of postoperative delirium was 11.1 %. Odds of postoperative delirium decreased by 14 % for every decibel increase in alpha power (OR 0.86, 95 % CI: 0.78 to 0.95; <em>P</em> = 0.004). This finding was not significant in adjusted analysis (OR_adj 0.92, 95 % CI: 0.81 to 1.03; <em>P</em> = 0.154). Non-home discharge setting findings were not associated with alpha power. The odds of 30-day readmission decreased by 20 % for every decibel increase in alpha power (OR_adj 0.80, 95 % CI: 0.71 to 0.91; <em>P</em> &lt; 0.001). Findings were conserved in exploratory and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>In this study anesthesia-induced oscillations were associated with postoperative outcomes; however, these were not independently associated with delirium or discharge disposition after considering preoperative cognitive and physical health. These oscillations were robustly associated with 30-day readmission however, which may help anesthesiologists identify high-risk patients, offering benefits beyond the operating room.</div><div><strong>Clinical trial registration:</strong> Registration Number: <span><span>NCT02856594</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111770"},"PeriodicalIF":5.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350065","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 letter regarding manuscript “Aspirin is associated with improved outcomes in patients with sepsis-induced myocardial injury: An analysis of the MIMIC-IV database”","authors":"Yiming Dong ,&nbsp;Shujian Wei","doi":"10.1016/j.jclinane.2025.111769","DOIUrl":"10.1016/j.jclinane.2025.111769","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111769"},"PeriodicalIF":5.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093866","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":"New postoperative atrial fibrillation after in OR extubation after cardiac surgery – A response to a letter to the editor","authors":"Ragini G. Gupta,&nbsp;Jennie Y. Ngai","doi":"10.1016/j.jclinane.2024.111716","DOIUrl":"10.1016/j.jclinane.2024.111716","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111716"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872259","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":"Optimizing neuromuscular block monitoring and reversal: A large-scale quality improvement initiative in a diverse healthcare setting","authors":"Pavel Goriacko ,&nbsp;Jerry Chao ,&nbsp;Philipp Fassbender ,&nbsp;Maíra I. Rudolph ,&nbsp;Paul Beechner ,&nbsp;Harshal Shukla ,&nbsp;Vicken Yaghdjian ,&nbsp;Curtis Choice ,&nbsp;Frank Aroh ,&nbsp;Mark Sinnett ,&nbsp;Ibraheem M. Karaye ,&nbsp;Matthias Eikermann","doi":"10.1016/j.jclinane.2024.111709","DOIUrl":"10.1016/j.jclinane.2024.111709","url":null,"abstract":"<div><h3>Background</h3><div>Residual neuromuscular block (NMB) after anesthesia poses significant risk to patients, which can be reduced by adhering to evidence-based practices for the dosing, monitoring, and reversal of NMB. Incorporation of best practices into routine clinical care remains uneven across providers and institutions, prompting the need for effective implementation strategies.</div></div><div><h3>Methods</h3><div>An interdisciplinary quality improvement initiative aimed to optimize NMB reversal practices across a large multi-campus urban medical center. Using the Institute for Healthcare Improvement (IHI) framework, interventions were designed to increase Train-of-Four (TOF) monitoring and promote evidence-based and cost-effective use of the NMB reversal agents. Process and outcome measures were tracked through Plan-Do-Study-Act (PDSA) cycles. Qualitative interviews provided insights into clinician perspectives.</div></div><div><h3>Results</h3><div>The study encompassed 35,198 surgical cases utilizing NMB agents. The interventions led to a sustained increase in TOF monitoring from 42 % to 83 %. Significant increases were also observed in TOF ratio documentation and utilization of sugammadex. Postoperative respiratory complication rates decreased by 41 % (RR 0.59, 95 % CI 0.32–0.96) over the course of the initiative. The most pronounced increases in TOF monitoring were associated with financial incentives for the achievement of department-wide target monitoring rate.</div></div><div><h3>Conclusion</h3><div>This initiative demonstrates successful large-scale integration of quantitative TOF monitoring and evidence based NMB management across a diverse medical center, while highlighting important barriers in implementation. These findings contribute to the broader discussion on translating evidence into practice, offering insights for improving patient care and safety through tailored implementation strategies.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111709"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822272","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":"Proposing Bromo-epi-androsterone (BEA) for perioperative neurocognitive disorders with Interleukin-6 as a druggable target","authors":"Coad Thomas Dow ,&nbsp;Zade Kidess","doi":"10.1016/j.jclinane.2024.111736","DOIUrl":"10.1016/j.jclinane.2024.111736","url":null,"abstract":"<div><div>Cognitive impairment following surgery is a significant complication, affecting multiple neurocognitive domains. The term “perioperative neurocognitive disorders” (PND) is recommended to encompass this entity. Individuals who develop PND are typically older and have increases in serum and brain pro-inflammatory cytokines notwithstanding the type of surgery undergone. Surgical trauma induces production of small biomolecules, damage-associated molecular patterns (DAMP), particularly the DAMP known as high molecular group box 1 protein (HMGB1). Mechanistically, peripheral surgical trauma promotes pro-inflammatory cytokines that stimulate central nervous system (CNS) inflammation by disrupting the blood-brain barrier (BBB) causing functional neuronal disruption that leads to PND. PND is strongly linked to elevations in serum and CNS pro-inflammatory cytokines interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα); these cytokines cause further release of HMGB1 creating a positive feedback loop that amplifies the inflammatory response. The cytokine IL-6 is necessary and sufficient for PND. Dehydroepiandrosterone (DHEA) is a principal component of the steroid metabolome and is involved in immune homeostasis. DHEA has been shown to suppress expression of several pro-inflammatory cytokines by regulation of the NF-kB pathway. Bromo-epi-androsterone (BEA) is a potent synthetic analog of DHEA; unlike DHEA, it is non-androgenic, non-anabolic and is an effective modulator of immune dysregulation. In a randomized, placebo-controlled clinical trial, BEA effected significant and sustained decreases in IL-1β, TNFα and IL-6. This article presents BEA as a potential candidate for clinical trials targeting PND and further suggests the use of BEA in elective total hip arthroplasty as a well-documented surgical entity relevant to the management of PND.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111736"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921924","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":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(25)00012-1","DOIUrl":"10.1016/S0952-8180(25)00012-1","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111752"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160687","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":"Key points for analyzing ferric carboxymaltose with or without phosphate substitution in iron deficiency or iron deficiency anemia before elective surgery","authors":"Xin Li ,&nbsp;Xue Xiao ,&nbsp;Tianjiao Liu","doi":"10.1016/j.jclinane.2025.111768","DOIUrl":"10.1016/j.jclinane.2025.111768","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111768"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080238","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":"Intraoperative FiO2 and risk of impaired postoperative oxygenation in lung resection: A propensity score-weighted analysis","authors":"Alex Choi ,&nbsp;Hao Deng ,&nbsp;Mitchell Fuller ,&nbsp;Jamie L. Sparling ,&nbsp;Min Zhu ,&nbsp;Brooks Udelsman ,&nbsp;Gyorgy Frendl ,&nbsp;Marcos F. Vidal Melo ,&nbsp;Alexander Nagrebetsky","doi":"10.1016/j.jclinane.2024.111739","DOIUrl":"10.1016/j.jclinane.2024.111739","url":null,"abstract":"<div><h3>Study objective</h3><div>To assess whether, in a lung resection cohort with a low probability of confounding by indication, higher FiO₂ is associated with an increased risk of impaired postoperative oxygenation – a clinical manifestation of lung injury/dysfunction.</div></div><div><h3>Design</h3><div>Pre-specified registry-based retrospective cohort study.</div></div><div><h3>Setting</h3><div>Two large academic hospitals in the United States.</div></div><div><h3>Patients</h3><div>2936 lung resection patients with an overall good intraoperative oxygenation (median intraoperative SpO₂ ≥ 95 %).</div></div><div><h3>Measurements</h3><div>We compared patients with a higher (≥0.8) and lower (&lt;0.8) median intraoperative FiO₂ after propensity score-weighting for 75 perioperative variables based on a causal inference framework. The primary outcome of impaired oxygenation was defined as at least one of the following within seven postoperative days: (1) SpO₂ &lt; 92 %; (2) imputed PaO₂/FiO₂ &lt; 300 mmHg [(1) or (2) at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or &gt; 50 % oxygen or high-flow oxygen).</div></div><div><h3>Main results</h3><div>Among the 2936 included patients, 2171 (73.8 %) received median intraoperative FiO₂ ≥ 0.8. Impaired postoperative oxygenation occurred in 1627 (74.9 %) and 422 (55.2 %) patients in the higher and lower FiO₂ groups, respectively. In a propensity score-weighted analysis, higher intraoperative FiO₂ was associated with an 84 % increase in the likelihood of impaired postoperative oxygenation (OR 1.84; 95 % CI 1.60 to 2.12; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Despite plausible harm from hyperoxia, high intraoperative FiO₂ is extremely common during lung resection. Nearly three-quarters of lung resection patients with acceptable oxygenation received median intraoperative FiO₂ ≥ 0.8. Such higher FiO₂ was associated with an increased risk of impaired postoperative oxygenation – a clinically relevant manifestation of lung injury or dysfunction. This observation supports the administration of a lower (&lt; 0.8) intraoperative FiO₂ and its further assessment in clinical trials.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111739"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927303","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-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial","authors":"Tatsuya Kunigo M.D ,&nbsp;Yusuke Yoshikawa M.D., Ph.D ,&nbsp;Shunichi Niki M.D ,&nbsp;Masahiro Ohtani M.D ,&nbsp;Mami Muraki M.D ,&nbsp;Asako Nitta M.D ,&nbsp;Yuki Ohsaki Ph.D ,&nbsp;Kanna Nagaishi M.D., Ph.D ,&nbsp;Michiaki Yamakage M.D., Ph.D","doi":"10.1016/j.jclinane.2024.111740","DOIUrl":"10.1016/j.jclinane.2024.111740","url":null,"abstract":"<div><h3>Study objective</h3><div>We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees.</div></div><div><h3>Design</h3><div>A cadaveric observational study and a clinical randomized controlled trial.</div></div><div><h3>Setting</h3><div>Sapporo Medical University Hospital.</div></div><div><h3>Patients</h3><div>A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers.</div></div><div><h3>Interventions</h3><div>Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group).</div></div><div><h3>Measurements</h3><div>The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases.</div></div><div><h3>Main results</h3><div>Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87–158] vs 46 s [34–54] s, <em>p</em> &lt; 0.001 and 197 [156–328] vs 341 [303–488] s, <em>p</em> = 0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263–467] s vs 391 [354–533] s, <em>p</em> = 0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5 %], <em>p</em> = 0.019).</div></div><div><h3>Conclusions</h3><div>Our novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111740"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927304","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":"Mitochondrial oxygenation monitoring and acute kidney injury risk in cardiac surgery: A prospective cohort study","authors":"Calvin J. de Wijs M.D. ,&nbsp;Lucia W.J.M. Streng M.D. ,&nbsp;Robert Jan Stolker M.D., Ph.D. ,&nbsp;Maarten ter Horst M.D., Ph.D. ,&nbsp;Ewout J. Hoorn M.D., Ph.D. ,&nbsp;Edris A.F. Mahtab M.D., Ph.D. ,&nbsp;Egbert G. Mik M.D., Ph.D. ,&nbsp;Floor A. Harms M.D., Ph.D.","doi":"10.1016/j.jclinane.2024.111715","DOIUrl":"10.1016/j.jclinane.2024.111715","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery and is associated with increased morbidity and mortality. Recent guidelines emphasize the need for new monitoring methods to facilitate targeted CSA-AKI prevention and treatment strategies. In vivo real-time measurement of mitochondrial oxygen tension (mitoPO₂), could potentially fulfil this role during cardiac surgery, as suggested in our previous pilot study.</div></div><div><h3>Methods</h3><div>In this prospective observational study, we investigated 75 cardiac surgery patients with an increased preoperative CSA-AKI risk. The primary aim of this study was to assess whether patients who developed CSA-AKI experienced prolonged periods of mitoPO₂ &lt; 20 mmHg during surgery. mitoPO₂ was measured intraoperatively, and CSA-AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Four additional mitoPO₂ thresholds (&lt;25, &lt;30, &lt;35, and &lt; 40 mmHg) were analyzed, including the predictive capacity of all thresholds for CSA-AKI.</div></div><div><h3>Results</h3><div>This study found that patients who developed CSA-AKI had a significantly longer intraoperative time with mitoPO₂ &lt;20 mmHg and &lt;25, &lt;30, &lt;35, and &lt;40 mmHg. Subsequently, we tested all thresholds for their association with the risk of CSA-AKI, with the &lt;25 mmHg threshold demonstrating the highest significant odds ratio. Every minute spent below &lt;25 mmHg increased the risk of CSA-AKI by 0.7 % (<em>P</em> = 0.021).</div></div><div><h3>Conclusions</h3><div>This study highlighted the association between mitoPO₂ and the onset of CSA-AKI. Extended durations below the mitoPO₂ threshold of 25 mmHg significantly correlate with an elevated CSA-AKI risk. Using mitoPO₂ as a monitoring tool shows promise in potentially predicting and possibly preventing CSA-AKI when used as a treatment trigger in cardiac surgery patients.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111715"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807340","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}