Journal of Clinical Anesthesia最新文献

{"title":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(26)00047-4","DOIUrl":"10.1016/S0952-8180(26)00047-4","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112169"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397757","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":"Queue management for the assignment of anesthesia clinician breaks to increase fractions completed before the end of surgical closure and during planned time windows","authors":"Franklin Dexter ,&nbsp;Sarah S. Titler ,&nbsp;Richard H. Epstein","doi":"10.1016/j.jclinane.2026.112136","DOIUrl":"10.1016/j.jclinane.2026.112136","url":null,"abstract":"<div><h3>Background</h3><div>At surgical suites with long workdays, anesthesia clinicians typically receive lunch breaks. We estimated the percentage relative impact of decision-making processes on 30-min breaks completed during cases' surgical periods and during two-hour windows (e.g., 11:00 AM to 1:00 PM).</div></div><div><h3>Methods</h3><div>Discrete-event simulations of breaks were performed using a retrospective cohort of a large teaching hospital's 15 years of actual dates (<em>N</em> = 5481 days), operating rooms (<em>N</em> = 53) in three surgical suites, surgical times (<em>N</em> = 460,354), and scheduled procedures (N = 30,212).</div></div><div><h3>Results</h3><div>Giving breaks preferentially to rooms with cases that had the least predicted time left until the end of surgery, provided the end of surgery was expected to be late enough to finish after the break, resulted in 16.5% fewer breaks versus giving preference to longest ongoing cases (<em>P</em> &lt; 0.0001). Pooled lists (i.e., using a single queue) with preferences for the longest ongoing cases resulted in overall 7.2% more complete breaks, with these substantive increases achieved for all three suites (all four P &lt; 0.0001). Using a pooled list and giving preference to the longest ongoing cases first achieved 28.4% more complete breaks than assigning each clinician to serve sequential near-adjacent rooms, and having those clinicians prioritize the cases with the least predicted time until the end of surgery (95% confidence interval 27.7–29.1%). Sensitivity analyses showed that results were insensitive to the specific time windows for breaks. Sensitivity analyses also showed the mechanism. If every case in every room daily was the same surgical procedure, then the strategy of prioritizing cases with the least predicted time left would be comparable to prioritizing cases that have been ongoing the longest. However, in the presence of high coefficients of variability in surgical times, following log-normal distributions, prioritizing cases with the least predicted time left resulted in more incomplete breaks.</div></div><div><h3>Conclusions</h3><div>For each clinician in a suite giving breaks, assign them to a first room to break. Then, while the first set of breaks is being completed, choose the next set of rooms for breaks with preference to cases having been ongoing the longest.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112136"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074538","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":"Beyond ASA-PS: Making frailty scores change the anesthetic prescription","authors":"Lukasz Szarpak ,&nbsp;Pawel Wieczorek ,&nbsp;Katarzyna Karczewska","doi":"10.1016/j.jclinane.2026.112152","DOIUrl":"10.1016/j.jclinane.2026.112152","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112152"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213383","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":"Melatonin or ramelteon for the prevention of postoperative delirium in elderly patients: A systematic review and meta-analysis of randomized clinical trials","authors":"João Mário Mira Furquim Borges MD ,&nbsp;Raphaela Gomes Mendes MD ,&nbsp;Rafaela Pereira Silva ,&nbsp;Henrique Baggio Pivetta ,&nbsp;Rafael Lopes Miranda ,&nbsp;Isabela Alles ,&nbsp;Tatiana Souza Nascimento MD","doi":"10.1016/j.jclinane.2026.112151","DOIUrl":"10.1016/j.jclinane.2026.112151","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative delirium (POD)—an acute, fluctuating disturbance in attention and awareness—is common among elderly surgical patients and is associated with morbidity, mortality, prolonged hospitalization, and increased costs. Melatonin has been investigated for POD prevention, but its perioperative effectiveness and safety remain uncertain. We conducted a systematic review and meta-analysis to assess whether perioperative melatonin or ramelteon reduces POD incidence in elderly surgical patients.</div></div><div><h3>Methods</h3><div>This meta-analysis included randomized controlled trials (RCTs) of elderly patients (&gt;60 years) undergoing surgery, comparing perioperative melatonin or ramelteon (a melatonin receptor agonist) with placebo or non-pharmacological interventions for the prevention and treatment of POD. Secondary outcomes included sedation, pain, and length of hospital stay. A comprehensive search was conducted across PubMed, Embase, and Cochrane databases. We utilized a random-effects model with 95% Confidence Intervals. Pooled-effect sizes were measured with Mean Difference (MD) or Standardized Mean Difference (SMD) for continuous outcomes and Risk Ratio (RR) for binary outcomes. Heterogeneity was assessed with I2 statistics. Statistical analyses were performed using R v4.5.0.</div></div><div><h3>Results</h3><div>Sixteen RCTs (<em>n</em> = 2115; 48.7% intervention) were included; 12 evaluated melatonin and 4 ramelteon. Overall, postoperative delirium occurred in 188/895 patients (21.0%) receiving melatonergic agents and 254/893 patients (28.4%) in control groups, corresponding to a significant reduction in POD (RR 0.72; 95% CI 0.56–0.92; <em>p</em> = 0.009). In melatonin-only trials, delirium incidence was 163/729 (22.4%) versus 230/732 (31.4%) in controls (RR 0.67; 95% CI 0.52–0.88; <em>p</em> = 0.004), whereas ramelteon showed no significant effect (25/166 [15.1%] vs 24/161 [14.9%]; RR 0.98; 95% CI 0.47–2.01; <em>p</em> = 0.948). Trials using melatonin doses ≥5 mg demonstrated a greater reduction in POD, with delirium occurring in 57/314 patients (18.2%) in the melatonin group compared with 113/308 patients (36.7%) in control groups (RR 0.52; 95% CI 0.40–0.68; <em>p</em> &lt; 0.001). No significant differences were found for pain, Ramsay Sedation Score, or length of stay. Heterogeneity was moderate to high for several analyses, and the certainty of evidence for POD was rated low.</div></div><div><h3>Conclusion</h3><div>Perioperative melatonin was associated with reduced POD in elderly surgical patients, with an apparent dose-response at ≥5 mg. Ramelteon did not demonstrate benefit in the available trials. Given heterogeneity and low certainty, findings—especially dose effects—should be interpreted cautiously.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112151"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213360","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":"Short- and immediate-term outcomes after sugammadex versus neostigmine in patients with severe chronic kidney disease: A retrospective cohort study","authors":"Kuo-Chuan Hung ,&nbsp;Li-Chen Chang ,&nbsp;Ping-Heng Tan ,&nbsp;Chih-Wei Hsu ,&nbsp;Yi-Chen Lai ,&nbsp;Jheng-Yan Wu ,&nbsp;I-Wen Chen","doi":"10.1016/j.jclinane.2026.112146","DOIUrl":"10.1016/j.jclinane.2026.112146","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between sugammadex use and postoperative complications in patients with severe chronic kidney disease (CKD) having elective gastrointestinal surgery.</div></div><div><h3>Design</h3><div>Retrospective cohort study using propensity score matching.</div></div><div><h3>Setting</h3><div>The TriNetX Research Network, a multi-institutional database primarily comprising U.S. healthcare organizations, with data from 2016 to 2024, reflecting the post-FDA-approved use of sugammadex.</div></div><div><h3>Interventions</h3><div>Patients received either sugammadex or neostigmine for reversal of rocuronium-based neuromuscular block.</div></div><div><h3>Patients</h3><div>Adult patients with severe CKD who had gastrointestinal surgery. Of the 13,693 patients receiving sugammadex and 5714 receiving neostigmine, one-to-one propensity score matching yielded 5690 patients in each group for analysis.</div></div><div><h3>Measurements</h3><div>The primary outcome was composite pulmonary complications (CPCs) within 30 days, whereas secondary outcomes included acute respiratory failure (ARF), intensive care unit (ICU) admission, all-cause mortality, and major adverse cardiovascular events (MACEs). All outcomes were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes and assessed at the 7-, 30-, and 90-day follow-up intervals.</div></div><div><h3>Results</h3><div>At the 30-day follow-up, no significant differences were observed between the groups for CPCs (2.1% vs. 2.1%; hazard ratio [HR]: 1.00, 95% confidence interval [CI]: 0.78–1.29, <em>p</em> = 0.983), ARF (1.8% vs. 1.8%; HR:1.00, 95% CI 0.76–1.32, <em>p</em> = 0.984), or MACEs (3.1% vs. 3.1%; HR:0.98, 95%CI 0.80–1.21, <em>p</em> = 0.849). ICU admission was numerically higher in the sugammadex group (4.9% vs. 4.0%; HR 1.23, 95% CI 1.04–1.47, <em>p</em> = 0.019), but did not reach statistical significance after Bonferroni correction (adjusted significance threshold of <em>p</em> &lt; 0.01). At the 7-day and 90-day follow-ups, no outcome reached statistical significance after Bonferroni correction at either time point.</div></div><div><h3>Conclusions</h3><div>Sugammadex was not associated with a significantly increased risk of pulmonary, cardiovascular, or mortality outcomes compared with neostigmine in patients with severe CKD having elective gastrointestinal surgery. Given the potential residual confounding by unmeasured factors such as surgical complexity, randomized controlled trials are needed to confirm these findings.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112146"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131918","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":"Improving definitions and innovations for identification and prevention of postoperative opioid-induced respiratory depression (OIRD): Proceedings of the International Consensus Conference","authors":"Richard D. Urman ,&nbsp;Andreas H. Taenzer ,&nbsp;Albert Dahan ,&nbsp;Alparslan Turan ,&nbsp;Basem B. Abdelmalak ,&nbsp;Bernd Saugel ,&nbsp;Bhargavi Gali ,&nbsp;Robert H. Dworkin ,&nbsp;Faisal N. Masud ,&nbsp;Frances Chung ,&nbsp;Ken B. Johnson ,&nbsp;Piyush Mathur ,&nbsp;Michael Wong ,&nbsp;Rutger van der Schrier ,&nbsp;Sabry Ayad ,&nbsp;Toby N. Weingarten ,&nbsp;Tong Joo Gan (TJ) ,&nbsp;Ashish K. Khanna","doi":"10.1016/j.jclinane.2026.112133","DOIUrl":"10.1016/j.jclinane.2026.112133","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112133"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023980","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":"Intravenous dexmedetomidine and its effects on remifentanil-induced hyperalgesia and opioid consumption: A systematic review and meta-analysis of randomized controlled trials","authors":"Narinder P. Singh MD ,&nbsp;Naveed T. Siddiqui MD ,&nbsp;James Khan FRCPC ,&nbsp;Jeetinder K. Makkar MD ,&nbsp;Preet M. Singh MD ,&nbsp;Cristian Arzola MD","doi":"10.1016/j.jclinane.2026.112138","DOIUrl":"10.1016/j.jclinane.2026.112138","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the efficacy of dexmedetomidine in reducing remifentanil-induced hyperalgesia (RIH) and its potential implications for acute opioid tolerance (AOT) in the adult surgical population.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>Perioperative setting.</div></div><div><h3>Patients</h3><div>Thirteen randomized controlled trials (RCTs) including 803 patients.</div></div><div><h3>Interventions</h3><div>Intravenous dexmedetomidine.</div></div><div><h3>Measurements</h3><div>A comprehensive systematic search of PubMed, Embase, and Scopus was performed from their inception through September 2024 to identify RCTs assessing the effectiveness of dexmedetomidine in preventing RIH or AOT in the adult surgical population. Outcomes included time to first rescue analgesia, hyperalgesia incidence, opioid consumption, pain scores, and dexmedetomidine-related adverse events.</div></div><div><h3>Main results</h3><div>Dexmedetomidine significantly prolonged the time to first rescue analgesia (mean difference [MD] 46.08 min, 95% CI 30.52 to 61.65, <em>p</em> &lt; 0.00001) and reduced opioid consumption in the postoperative anesthesia care unit (PACU) and at 24 h postoperatively. Pain scores in PACU and up to 24 h were significantly lower with dexmedetomidine. Dexmedetomidine also exhibited a moderate protective effect against primary hyperalgesia but was associated with a greater incidence of intraoperative bradycardia.</div></div><div><h3>Conclusions</h3><div>Dexmedetomidine may mitigate RIH and, indirectly, aspects of AOT as suggested through surrogate outcomes such as opioid consumption and pain scores. However, significant heterogeneity limits certainty. While dexmedetomidine appears promising as an adjunct to remifentanil, careful monitoring for bradycardia is warranted. Further research should define optimal dosing strategies and clarify its role in preventing AOT.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112138"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074536","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 preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study","authors":"Chao Chen ,&nbsp;Shengfeng Yang ,&nbsp;Yewei Shi ,&nbsp;Zhenyan Zhu ,&nbsp;Xinglong Xiong ,&nbsp;Ling Huang ,&nbsp;Jun Lu ,&nbsp;Guangling Tang ,&nbsp;Xianzhou Gu ,&nbsp;Guangdi Zhang ,&nbsp;Yu Wan ,&nbsp;Ruixue Zhai ,&nbsp;Sijie Tang ,&nbsp;Yuanyu Feng ,&nbsp;Yusu Wang ,&nbsp;Jielei Pan ,&nbsp;Jing Shi","doi":"10.1016/j.jclinane.2026.112123","DOIUrl":"10.1016/j.jclinane.2026.112123","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative neurocognitive disorders (PND) significantly affect recovery in older adult surgical patients. However, whether untreated preoperative sleep disturbance (SD) independently contributes to postoperative cognitive dysfunction (POCD) remains unclear.</div></div><div><h3>Methods</h3><div>This multicenter prospective cohort study involving 535 patients aged ≥60 years undergoing major non-cardiac surgery (≥2 h) was conducted between June 30, 2024 and May 31, 2025. Patients were stratified by Pittsburgh Sleep Quality Index (PSQI): SD (PSQI&gt;7, <em>n</em> = 288) or non-SD (PSQI≤7, <em>n</em> = 247). The primary outcome was POCD assessed on postoperative days 7, 30, 90, and 180. Secondary outcomes included postoperative delirium (days 1–3), 15-item quality of recovery (QoR-15) scores, and insomnia severity (days 30, 90, and 180). Generalized estimating equations identified independent predictors of POCD.</div></div><div><h3>Results</h3><div>Compared with non-SD patients, SD patients showed significantly increased POCD risk on postoperative day 7 (41.7 % vs. 27.1 %; RR = 1.44, 95 %CI 1.16–1.79; <em>P</em> &lt; 0.001), day 30 (36.1 % vs. 18.2 %; RR = 1.73, 95 %CI 1.33–2.25; <em>P</em> &lt; 0.001), day 90 (25.7 % vs. 13.0 %; RR = 1.66, 95 %CI 1.22–2.25; <em>P</em> &lt; 0.001), and day 180 (19.4 % vs. 8.9 %; RR = 1.75, 95 %CI 1.21–2.52; <em>P</em> &lt; 0.001). Preoperative SD was associated with increased delirium risk (29.9 % vs. 18.6 %; RR = 1.43, <em>P</em> = 0.006), poorer QoR-15 scores (difference = 8, <em>P</em> &lt; 0.001), and persistent insomnia (34.7 % vs. 13.8 % at day 180, <em>P</em> &lt; 0.001). PSQI≥10 optimally predicted POCD risk (sensitivity 71.8 %, specificity 69.4 %).</div></div><div><h3>Conclusions</h3><div>Untreated preoperative SD independently predicts both early delirium and POCD after major non-cardiac surgery. A PSQI≥10 effectively identifies high-risk older adult patients, emphasizing preoperative sleep optimization as a potential strategy to mitigate postoperative cognitive impairment.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112123"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903816","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 high-intensity work on the physical and mental health of anesthesiologists and intervention strategies","authors":"Wenjie Cheng","doi":"10.1016/j.jclinane.2026.112153","DOIUrl":"10.1016/j.jclinane.2026.112153","url":null,"abstract":"<div><div>With the ongoing transformation of the healthcare landscape, anesthesiologists are experiencing increasing occupational stress, which profoundly affects their physical and mental health. A high-intensity work environment adversely affects the physiological health of anesthesiologists, leading to issues such as cardiovascular diseases and sleep disorders. Furthermore, it also leads to an increased risk of mental health problems such as anxiety, depression, and burnout. This article aims to review the current state of research in this field and analyze the characteristics of anesthesiologists' work environments and the sources of stress they bring. It also explores the specific mechanisms by which high-intensity work negatively impacts physical and mental health, while considering the moderating effects of individual and work environment factors. Based on existing research, this article proposes targeted intervention strategies to improve anesthesiologists' physical and mental health. Finally, the limitations of the current research are summarized. Future research directions are proposed to provide references for further exploration in related fields.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112153"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213373","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":"From fast track to enhanced recovery after Cardiac surgery: 15 years of experience with the Leipzig concept in a specialized post-anesthesia care unit","authors":"Waseem Zakhary ,&nbsp;Anna Flo Forner ,&nbsp;David Holzhey ,&nbsp;Michael A. Borger ,&nbsp;Wolfgang Otto ,&nbsp;Massimiliano Meineri ,&nbsp;Joerg Karl Ender","doi":"10.1016/j.jclinane.2026.112137","DOIUrl":"10.1016/j.jclinane.2026.112137","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Cardiac Surgery (ERACS) has become the standard of care for selected patients. This study evaluated the evolution of the Leipzig concept in a specialized postanaesthesia care unit (PACU) over 15 years, with a focus on temporal trends and clinical outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on patients admitted to PACU after cardiac surgery at the Heart Center Leipzig between November 2005 and December 2020. Postoperative outcomes, including postprocedural complications, hospital length of stay, delirium, and mortality, were recorded. The outcomes were analyzed via multivariable models, and the adjusted results are reported.</div></div><div><h3>Results</h3><div>Among 56,371 cardiac surgery patients, 42% (<em>n</em> = 23,724) were admitted to the PACU and managed according to the ERACS protocol. After excluding incomplete datasets, 20,773 patients were analyzed. Utilization increased from 19% in 2006 to 60% in 2020. Despite a rising proportion of moderate- and high-complexity surgeries, in-hospital mortality has remained stable. Improved adherence to the ERACS components, including the integration of a delirium prevention bundle, was associated with significant reductions in postoperative delirium (<em>p</em> = 0.02) and in-hospital mortality (<em>p</em> = 0.007). Patients treated with sufentanil exhibited significantly lower in-hospital mortality than did those receiving remifentanil (<em>p</em> = 0.005). Subgroup analyses revealed higher in-hospital mortality in patients with EuroSCORE II ≥6%, complex procedures, and age ≥ 75 years (<em>p</em> &lt; 0.001, <em>p</em> = 0.04, and p &lt; 0.001, respectively).</div></div><div><h3>Conclusions</h3><div>This study presents the largest collection of consecutive ERACS patients ever collected and demonstrates the safety and efficacy of ERACS management with a specialized PACU, highlighting the benefits of continuous protocol optimization.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112137"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124986","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}