Journal of Clinical Anesthesia最新文献

{"title":"Challenging current evidence: Peripheral perfusion index fails as a predictor of postinduction hypotension – Findings from a large diverse surgical population","authors":"Karam Azem M.D ,&nbsp;Roussana Aranbitski M.D ,&nbsp;Alexander Peres M.D ,&nbsp;Daniel Iluz-Freundlich M.D., B.Sc ,&nbsp;Vincent Gliesche M.D ,&nbsp;Olga Ciobanu-Caraus M.D ,&nbsp;Sharon Orbach-Zinger M.D ,&nbsp;Benjamin Zribi M.D ,&nbsp;Shai Fein M.D ,&nbsp;Philip Heesen B.Sc","doi":"10.1016/j.jclinane.2025.111969","DOIUrl":"10.1016/j.jclinane.2025.111969","url":null,"abstract":"<div><h3>Background</h3><div>Postinduction hypotension (PIH) is a common complication of general anesthesia with potential clinical consequences. A recent meta-analysis suggested that the peripheral perfusion index (PPI) has a high predictive value for PIH. However, this was limited by small sample sizes and significant heterogeneity. We aimed to evaluate the predictive performance of preinduction PPI for PIH in a large surgical cohort.</div></div><div><h3>Methods</h3><div>In this retrospective single-center study, we analyzed 6653 adult patients who had general anesthesia between May 2022 and May 2023. PIH was defined as mean arterial pressure &lt; 65 mmHg within 20 min after induction. We assessed the predictive performance of preinduction PPI for estimating PIH using the area under the receiver operating characteristic curve (AUC). A multivariable logistic regression was conducted to identify independent predictors of PIH.</div></div><div><h3>Results</h3><div>The overall incidence of PIH was 51.5 %. Preinduction PPI values were similar between patients who developed PIH and those who did not (1.22 [0.69–2.23] vs. 1.23 [0.75–2.13], <em>P</em> = 0.284). PPI demonstrated poor predictive performance for PIH (AUC 0.51, 95 % CI 0.49–0.52), with low sensitivity (31 %) and modest specificity (72 %) at the optimal cutoff (0.81). This poor discrimination persisted across all postinduction time intervals and patient subgroups. In contrast, independent predictors of PIH included preinduction mean arterial pressure, advanced age, higher ASA physical status, and emergency surgery.</div></div><div><h3>Conclusion</h3><div>Despite promising results from smaller studies, we found that preinduction PPI had no significant predictive value for PIH in a large, diverse surgical population. Anesthesiologists should focus on established risk factors rather than PPI when assessing PIH risk.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111969"},"PeriodicalIF":5.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842448","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 simple and effective technique for managing misplacement of left-sided visual double-lumen bronchial tube: Cervical tracheal traction method","authors":"Bing Li M.D.,&nbsp;Xinmin Liu M.D.,&nbsp;Jiaqiang Zhang M.D., Ph.D.,&nbsp;Wei Zhang M.D., Ph.D.","doi":"10.1016/j.jclinane.2025.111970","DOIUrl":"10.1016/j.jclinane.2025.111970","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111970"},"PeriodicalIF":5.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828279","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 \"The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery\".","authors":"Longsheng Zhang, Zitian Luo, Renzhe Lin","doi":"10.1016/j.jclinane.2025.111964","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111964","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111964"},"PeriodicalIF":5.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855384","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":"Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM)","authors":"Angela M. Mickle MS ,&nbsp;Bethany R. Tellor Pennington ,&nbsp;Arbi Ben Abdallah PhD ,&nbsp;Wei Wang PhD ,&nbsp;Nan Lin PhD ,&nbsp;Jordan Oberhaus BS ,&nbsp;Thaddeus P. Budelier MD ,&nbsp;Daniel Park BS ,&nbsp;Ben J. Palanca MD, PhD ,&nbsp;Troy S. Wildes MD ,&nbsp;Eva M. Schmitt PhD ,&nbsp;Sharon K. Inouye MD, MPH ,&nbsp;Michael S. Avidan MBBCh","doi":"10.1016/j.jclinane.2025.111963","DOIUrl":"10.1016/j.jclinane.2025.111963","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;The primary objective was to evaluate agreement between researchers' and family members' postoperative delirium assessment. The secondary objective was to assess the incidence of positive FAM-CAM after hospital discharge up to 30-days postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was a pre-specified sub-study of two multicenter randomized controlled trials that evaluated interventions to prevent postoperative delirium in older adults undergoing major elective surgery. In the hospital, delirium was ascertained using the Confusion Assessment Method (CAM) long-form or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), and structured chart review. Family members completed a Family Confusion Assessment Method (FAM-CAM) concurrent with researchers' assessments in the afternoons on postoperative days 1–3. At the time of hospital discharge, a booklet of FAM-CAM surveys was provided to complete daily until postoperative day 30. Agreement between researcher-rated CAM/CAM-ICU and family-rated FAM-CAM was analyzed using Generalized Linear Mixed Model with repeated measures, and Bland-Altman analysis. Inter-rater reliability for each instrument was modeled using intraclass correlation coefficient (ICC). Overall agreement beyond chance between researcher's assessment and the FAM-CAM was evaluated using repeated measure Cohen's Kappa and sensitivity, specificity, and positive and negative predicted values. Post-discharge FAM-CAM data were summarized descriptively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 817 patients had 1349 concurrent delirium assessments. Postoperative delirium incidence by researchers' assessment was 18.8 % and detection of delirium symptoms by FAM-CAM was 22.4 %. Analysis comparing delirium assessments showed there is an observed agreement beyond chance of 79.7 % with a kappa of 0.33 between the assessments by Generalized Linear Mixed Modeling with repeated measures, treating patients and raters as random effects, with FAM-CAM being more likely to report a positive delirium outcome. Assessment by features showed similar results. Both methods had an excellent degree of internal validity (CAM/CAM-ICU intraclass correlation =0.938, FAM-CAM intraclass correlation = 0.985). Repeated measures Cohen's kappa indicated good overall agreement (kappa = 0.72 [95 % confidence interval, 0.63 to 0.81]). Of the 330 booklets, 133 (40.3 %) were returned. A total of 18 patients exhibited symptoms indicative of delirium based on the FAM-CAM assessment between hospital discharge and 30 days postoperatively. Out of these, 9 (50 %) had also been diagnosed with postoperative delirium during their hospitalization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study demonstrated that family member completed FAM-CAM had acceptable agreement with researchers' delirium assessments. Postoperative delirium symptoms were detected more frequently by family-administered FAM-CAM compared to delirium incidenc","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111963"},"PeriodicalIF":5.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828276","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":"Removal of EpCAM-positive tumor cells during intraoperative blood salvage– A pivotal multicenter clinical study (REMOVE)","authors":"Patrick Meybohm MD ,&nbsp;Suma Choorapoikayil PhD ,&nbsp;Sebastian Zinn MD ,&nbsp;Simone Lindau MD ,&nbsp;Markus Heiss MD ,&nbsp;Jerome Defosse MD ,&nbsp;Eva Wittenmeier MD ,&nbsp;Marion Ferner MD ,&nbsp;Maximillian Kriegmair MD ,&nbsp;Niklas Westhoff MD ,&nbsp;Sebastian Hottenrott MD ,&nbsp;Tobias Haas MD ,&nbsp;Peter Kranke MD ,&nbsp;Tom-Philipp Zucker MD ,&nbsp;Andreas Schnitzbauer MD ,&nbsp;Luis Kluth MD ,&nbsp;Frank Wappler MD ,&nbsp;Nina Walossek MD ,&nbsp;Michael Schuster MD ,&nbsp;Anna Lotz ,&nbsp;Kai Zacharowski MD, PhD","doi":"10.1016/j.jclinane.2025.111972","DOIUrl":"10.1016/j.jclinane.2025.111972","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative blood salvage can reduce the need for allogeneic blood transfusions, minimizing immunological risks and infection by reusing the patient's own blood. However, in cancer surgery, a key concern limiting its use is the potential reintroduction of viable cancer cells. Additional risks, such as infection and coagulopathy, have also contributed to its limited adoption. Irradiation of salvaged blood remains an option; however, it is time-intensive and may have detrimental effects on blood cells. These challenges highlight the need for improved technologies to enable safe application in oncological procedures. One such promising tool is CATUVAB®, which removes epithelial cell adhesion molecule (EpCAM)-positive tumor cells from salvaged blood.</div></div><div><h3>Methods</h3><div>In this multicenter, clinical validation study, patients undergoing major surgery for bladder cancer, gastric carcinoma, ovarian carcinoma, pancreatic carcinoma, colon/rectal carcinoma, non-small cell lung cancer, or peritoneal carcinomatosis were included. The primary objective of the study was to elucidate the efficacy of CATUVAB® in depleting intraoperatively salvaged blood of EpCAM-positive tumor cells. Secondary objectives included the determination of residual Catumaxomab antibody amount and cytokine levels in the final erythrocyte concentrate (EC).</div></div><div><h3>Results</h3><div>203 patients were assessed for eligibility, and 80 were included in the safety analysis, of whom 61 had EpCAM-positive tumor cells in intraoperative blood. The primary efficacy analysis demonstrated a 100 % (95 % CI (95.8 %–100 %)) rate of sufficient depletion of EpCAM-positive tumor cells (<em>p</em> &lt; 0.0001). In 117 out of 131 EC samples (89 %) the catumaxomab concentration was below the limit of quantification. Additionally, cytokines IL-6 and IL-8, typically due to surgical trauma, were significantly reduced (30- to 38-fold) in ECs compared to intraoperative blood.</div></div><div><h3>Conclusion</h3><div>The study demonstrates the efficacy, safety and feasibility of CATUVAB® for the re-infusion of autologous EC processed by a cell salvage device during high-blood-loss cancer surgeries. These promising results have the potential to re-define the intraoperative blood salvage protocols in cancer surgeries.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111972"},"PeriodicalIF":5.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828277","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":"Overlooked clinical realities in ChatGPT vs. DeepSeek comparative studies: Barriers to translating dynamic decision support to practice","authors":"Jiwei Wu ,&nbsp;Zheying Huang","doi":"10.1016/j.jclinane.2025.111961","DOIUrl":"10.1016/j.jclinane.2025.111961","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111961"},"PeriodicalIF":5.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809662","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":"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}