Journal of Clinical Anesthesia最新文献

{"title":"Ferric carboxymaltose with or without phosphate substitution in iron deficiency or iron deficiency anemia before elective surgery – The DeFICIT trial","authors":"Alexander Kaserer M.D ,&nbsp;Julia Braun Ph.D ,&nbsp;Alexander Mair M.D ,&nbsp;Samira Akbas M.D ,&nbsp;Julian Rössler M.D ,&nbsp;Heike A. Bischoff-Ferrari (Prof) ,&nbsp;Matthias Turina (Prof) ,&nbsp;Pierre-Alain Clavien (Prof) ,&nbsp;Isabelle Opitz (Prof) ,&nbsp;Andreas Hülsmeier D.Sc ,&nbsp;Gergely Karsai D.Sc ,&nbsp;Greta Gasciauskaite M.D ,&nbsp;Gabriela H. Spahn M.D ,&nbsp;Martin Schläpfer (Prof) ,&nbsp;Donat R. Spahn (Prof)","doi":"10.1016/j.jclinane.2024.111727","DOIUrl":"10.1016/j.jclinane.2024.111727","url":null,"abstract":"<div><h3>Background</h3><div>Iron deficiency anemia in the perioperative setting is treated predominantly with intravenous iron formulation, of which ferric carboxymaltose may induce hypophosphatemia by modulating fibroblast growth factor 23.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, randomized, double-blind trial, we consented 92 adult patients scheduled for elective major abdominal or thoracic surgery. These patients either had isolated iron deficiency (plasma ferritin &lt;100 ng/mL or transferrin saturation &lt; 20 %) or iron deficiency anemia (hemoglobin (Hb) 100–130 g/L with plasma ferritin &lt;100 ng/mL or transferrin saturation &lt; 20 %). Preoperatively, participants received a single preoperative intravenous dose of ferric carboxymaltose and were then randomly assigned to receive either phosphate or placebo, administered orally three times a day for 30 days corresponding to an 18 mmol dose of daily phosphate supplementation in the intervention group. The primary endpoint was the minimum serum phosphate concentration during follow-up visits. The key secondary efficacy endpoint was mean perioperative hemoglobin concentration of postoperative days 0, 2 and 4, assessing the non-inferiority of additional phosphate supplementation.</div></div><div><h3>Results</h3><div>We randomly consented 46 patients in each group (mean ± SD age 56 ± 17 years, 57 % female). Minimal phosphate concentration was 0.49 ± 0.21 mmol/L in the treatment group and 0.42 ± 0.17 mmol/L in the placebo group (<em>p</em> = 0.12, two-sided <em>p</em>-value). Average mean hemoglobin was 110 ± 16 g/L in the treatment and 113 ± 13 g/L in the placebo group (<em>p</em> = 0.023, one-sided p-value for non-inferiority). Hypophosphatemia occurred in 32 patients (70 %) of the treatment group and in 39 patients (85 %) of the placebo group (odds ratio 0.15, 95 % CI from 0.02 to 0.77, <em>p</em> = 0.014). Secondary outcomes, such as rescue medication use, core muscle strength and MOCA test scores, did not differ between groups.</div></div><div><h3>Conclusion</h3><div>Co-administration of oral phosphate supplementation to ferric carboxymaltose cannot prevent hypophosphatemia. However, hypophosphatemia occurs in fewer patients. Phosphate co-administration did not impede the treatment of iron deficiency anemia with ferric carboxymaltose.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111727"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822271","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":"Response of Letter to the Editor Regarding “The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial”","authors":"Yaxin Wang ,&nbsp;Xu Jin","doi":"10.1016/j.jclinane.2024.111731","DOIUrl":"10.1016/j.jclinane.2024.111731","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111731"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894829","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":"Associations of intraoperative end–tidal CO2 levels with postoperative outcome–secondary analysis of a worldwide observational study","authors":"Prashant Nasa ,&nbsp;David M.P. van Meenen ,&nbsp;Frederique Paulus ,&nbsp;Marcelo Gama de Abreu ,&nbsp;Sebastiaan M. Bossers ,&nbsp;Patrick Schober ,&nbsp;Marcus J. Schultz ,&nbsp;Ary Serpa Neto ,&nbsp;Sabrine N.T. Hemmes ,&nbsp;for the LAS VEGAS-investigators ,&nbsp;PROVE Network ,&nbsp;ESAIC CTN","doi":"10.1016/j.jclinane.2024.111728","DOIUrl":"10.1016/j.jclinane.2024.111728","url":null,"abstract":"<div><h3>Background</h3><div>Patients receiving intraoperative ventilation during general anesthesia often have low end–tidal CO₂ (etCO₂). We examined the association of intraoperative etCO₂ levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently–sized international, prospective study named ‘Local ASsessment of Ventilatory management during General Anesthesia for Surgery’ (LAS VEGAS).</div></div><div><h3>Methods</h3><div>Patients at high risk of PPCs were categorized as ‘low etCO₂’ or ‘normal to high etCO₂’ patients, using a cut–off of 35 mmHg. The primary endpoint was a composite of previously defined PPCs; the individual PPCs served as secondary endpoints. The need for unplanned oxygen was defined as mild PPCs and severe PPCs included pneumonia, respiratory failure, acute respiratory distress syndrome, barotrauma, and new invasive ventilation. We performed propensity score matching and LOESS regression to evaluate the relationship between the lowest etCO₂ and PPCs.</div></div><div><h3>Results</h3><div>The analysis included 1843 (74 %) ‘low etCO₂’ patients and 648 (26 %) ‘normal to high etCO₂’ patients. There was no difference in the occurrence of PPCs between ‘low etCO₂’ and ‘normal to high etCO₂’ patients (20 % vs. 19 %; RR 1.00 [95 %–confidence interval 0.94 to 1.06]; <em>P</em> = 0.84). The proportion of severe PPCs among total occurring PPCs, were higher in ‘low etCO₂’ patients compared to ‘normal to high etCO₂’ patients (35 % vs. 18 %; RR 1.16 [1.08 to 1.25]; <em>P</em> &lt; 0.001). Propensity score matching did not change these findings. LOESS plot showed an inverse relationship of intraoperative etCO₂ levels with the occurrence of PPCs.</div></div><div><h3>Conclusions</h3><div>In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between ‘low etCO₂’ patients and ‘normal to high etCO₂’ patients, but severe PPCs occurred more often in ‘low etCO₂’, with an inverse dose–dependent relationship between intraoperative etCO₂ levels and PPCs.</div></div><div><h3>Funding</h3><div>This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anesthesiology and Intensive Care (ESAIC) and the Amsterdam University Medical Centers, location ‘AMC’.</div></div><div><h3>Registration</h3><div>LAS VEGAS was registered at <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> (<span><span>NCT01601223</span><svg><path></path></svg></span>), first posted on May 17, 2012.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111728"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869391","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":"Response to letter to editor titled: Association between intraoperative blood pressure and postoperative delirium in cardiac surgery: A question yet to be resolved","authors":"Andrej Alfirevic MD FASE ,&nbsp;Karan Shah MS ,&nbsp;Andra E. Duncan MD MS","doi":"10.1016/j.jclinane.2024.111734","DOIUrl":"10.1016/j.jclinane.2024.111734","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111734"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894831","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":"Implementation of formal neuraxial ultrasound teaching in anesthesiology residency: Resident survey results","authors":"Alexander W.M. Hall M.D., M.Sc. ,&nbsp;Reine Zbeidy M.D.","doi":"10.1016/j.jclinane.2024.111714","DOIUrl":"10.1016/j.jclinane.2024.111714","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111714"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813090","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":"Postoperative delirium under general anaesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomised controlled trials","authors":"Masafumi Suga ,&nbsp;Jun Yasuhara ,&nbsp;Atsuyuki Watanabe ,&nbsp;Hisato Takagi ,&nbsp;Toshiki Kuno ,&nbsp;Takeshi Nishimura ,&nbsp;Shinichi Ijuin ,&nbsp;Takuya Taira ,&nbsp;Akihiko Inoue ,&nbsp;Satoshi Ishihara ,&nbsp;Adrian Pakavakis ,&nbsp;Neil Glassford ,&nbsp;Yahya Shehabi","doi":"10.1016/j.jclinane.2024.111735","DOIUrl":"10.1016/j.jclinane.2024.111735","url":null,"abstract":"<div><h3>Background</h3><div>Remimazolam, an ultra-short-acting benzodiazepine, has similar clinical effects to propofol for sedation in general anaesthesia. However, it remains uncertain whether remimazolam could increase postoperative delirium (POD) compared with propofol.</div></div><div><h3>Objectives</h3><div>The purpose of our study was to compare the incidence of POD between remimazolam and propofol as sedative agents in general anaesthesia.</div></div><div><h3>Study design</h3><div>Systematic review and meta-analysis of randomised controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>PubMed, Embase, Cochrane Library, and Web of Science databases were searched for prospective RCTs published through September 16, 2024. RCTs reporting the incidence of POD and comparing remimazolam with propofol for general anaesthesia were included. Odds ratio (ORs) were calculated using a random-effects model. The primary outcome was the incidence of POD. The secondary outcomes included time to extubation, awakening time, and adverse events such as intraoperative hypotension.</div></div><div><h3>Results</h3><div>A total of six RCTs involving 1107 patients were included in this meta-analysis. For the primary outcome, the incidence of POD did not differ between the remimazolam and propofol groups (OR, 0.92; 95 % confidence interval [CI], 0.58–1.44). Regarding the secondary outcomes, remimazolam was associated with a lower incidence of intraoperative hypotension compared with propofol (OR, 0.31; 95 % CI, 0.21–0.46). There were no significant differences in other secondary outcomes. In the sensitivity analysis on three RCTs including only older patients (≥60 years old), there was no significant difference in the incidence of POD (OR, 1.00; 95 % CI, 0.52–1.93).</div></div><div><h3>Conclusion</h3><div>Perioperative remimazolam administration did not increase POD and reduced the risk of intraoperative hypotension compared to propofol. Further large-scale RCTs are warranted to explore the association of remimazolam and POD.</div><div>Systematic review protocol: PROSPERO CRD42024544122.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111735"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006294","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":"Supraglottic jet oxygenation and ventilation on hypoxemia risk: A trial sequential analysis","authors":"Chien-Ming Lin ,&nbsp;Ping-Hsin Liu ,&nbsp;Li-Chen Chang","doi":"10.1016/j.jclinane.2024.111712","DOIUrl":"10.1016/j.jclinane.2024.111712","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111712"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828874","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":"Establishing optimal methodology for studying chatbots in clinical decision making: A new frontier","authors":"Nada Ismaiel MD, MSc, FRCPC ,&nbsp;Brendan Carvalho MBBCh, FRCA ,&nbsp;Pervez Sultan MBChB, FRCA, MD (Res)","doi":"10.1016/j.jclinane.2024.111707","DOIUrl":"10.1016/j.jclinane.2024.111707","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111707"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854287","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":"Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study","authors":"Viviane Lauret MD ,&nbsp;Claude Guerin MD-PhD ,&nbsp;Sirine Boussena MD ,&nbsp;Mathilde De-Queiroz MD ,&nbsp;Lionel Bouvet MD-PhD ,&nbsp;Florent Baudin MD-PhD","doi":"10.1016/j.jclinane.2024.111710","DOIUrl":"10.1016/j.jclinane.2024.111710","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children.</div></div><div><h3>Design</h3><div>Prospective observational clinical pilot-study.</div></div><div><h3>Setting</h3><div>University Children's Hospital of Lyon, France.</div></div><div><h3>Patients</h3><div>Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.</div></div><div><h3>Intervention</h3><div>After the beginning of Guedel's stage 3 of anesthesia, several settings were applied for 60 s in the following systematic order: spontaneous breathing when applying a facemask (SB-Mask), then PEEP 4 cmH₂O, PSV 4 cmH2O above PEEP 4 cmH₂O, and PSV 4 to 7 cmH₂O above PEEP 4 cmH₂O, at the anesthesiologist's discretion.</div></div><div><h3>Measurements</h3><div>Children were monitored using Electrical Impedance Tomography (EIT; Pulmovista 500, Dräger, France). Tidal volume (TV), dorsal fraction of the ventilation, and end-expiratory lung impedance (EELI) were assessed with the ventilator and EIT.</div></div><div><h3>Main results</h3><div>Twenty-two patients were included (20 analyzed), their median [IQR] age was 21 [14–36] months. TV did not significantly differ between the settings. The increase in EELI was greater with PSV (+0.60 [0.48–0.91] arbitrary units) than with PEEP 4 cmH₂O alone (+0.39 [0.20–0.06] arbitrary units, <em>p</em> = 0.005), and did not change with increased level of PSV (+0.66 [0.40–1.22] arbitrary units). The dorsal fraction of lung ventilation decreased using PSV, from 56 % [45–63] with SB-mask to 53 % [43–56] with PSV 4cmH₂O (<em>p</em> = 0.002) and 47 % [40–55] with PSV 7cmH₂O (<em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111710"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854290","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":"Association between intraoperative blood pressure and postoperative delirium in cardiac surgery: A question yet to be resolved","authors":"Jing Wang MD,&nbsp;Han Zhang MD,&nbsp;Tianlong Wang MD,&nbsp;Bingyang Ji MD, PhD","doi":"10.1016/j.jclinane.2024.111717","DOIUrl":"10.1016/j.jclinane.2024.111717","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111717"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818396","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}