Journal of Clinical Anesthesia最新文献

{"title":"The framework of chronic pain management: Redefining the outcomes","authors":"Lisa Goudman Ph.D , Maarten Moens M.D. Ph. D","doi":"10.1016/j.jclinane.2025.111799","DOIUrl":"10.1016/j.jclinane.2025.111799","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111799"},"PeriodicalIF":5.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520436","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":"Comparison of regional anesthesia techniques for hypospadias surgery: A systematic review","authors":"Hiroki Nakamura MD ,&nbsp;Kensuke Shimada MD, MPH ,&nbsp;Masao Iwagami MD, PhD ,&nbsp;Tatsuhiko Masue MD, PhD ,&nbsp;Nanako Tamiya MD, MSc, PhD ,&nbsp;Ryota Inokuchi MD, PhD","doi":"10.1016/j.jclinane.2025.111792","DOIUrl":"10.1016/j.jclinane.2025.111792","url":null,"abstract":"<div><h3>Objectives</h3><div>Regional anesthesia is commonly used in hypospadias surgery; however, the optimal timing, drugs, and types of blocks remain controversial. Therefore, we conducted a systematic review to identify superior regional-anesthesia techniques for hypospadias surgery.</div></div><div><h3>Methods</h3><div>This systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42023431583). The following databases were utilized: MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar. We included randomized controlled trials (RCTs) published until June 3, 2023, which evaluated any regional anesthesia method for hypospadias surgery and investigated pain and complications.</div></div><div><h3>Results</h3><div>This review included 44 RCTs that compared: (i) types of regional anesthesia, (ii) timing of regional anesthesia (before and after surgery), (iii) drugs used, (iv) regional anesthesia with or without additional interventions, and (v) a composite comparison of the above comparisons. In studies comparing types of regional anesthesia, pudendal nerve block was found to be superior for hypospadias surgery compared to other types, including caudal and penile blocks. No advantage was observed in administering regional anesthesia post-surgery compared to pre- or both pre- and post-surgery. However, a meta-analysis was not feasible due to differing pain scales used across studies.</div></div><div><h3>Discussion</h3><div>The pudendal nerve block could provide better analgesia than other regional anesthesia methods in terms of pain scales and analgesia duration. Regional anesthesia administered before or both pre- and post-surgery may be more effective than that post-surgery based on pain scales and analgesia duration. A standardized pediatric pain scale is warranted to unify study results.</div><div><strong>PROSPERO ID:</strong> CRD42023431583.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111792"},"PeriodicalIF":5.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511902","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":"Comparison of surgical pleth index-guided analgesia versus conventional analgesia technique in general anesthesia surgeries: A systematic review and meta-analysis","authors":"Xi Xu ,&nbsp;Xue-Feng Zhang ,&nbsp;Zi-Hang Yu ,&nbsp;Jian Liu ,&nbsp;Liang Nie ,&nbsp;Jian-Li Song","doi":"10.1016/j.jclinane.2025.111800","DOIUrl":"10.1016/j.jclinane.2025.111800","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study is to investigate whether the use of surgical pleth index (SPI)-guided intraoperative analgesia can result in a reduction in opioid consumption, intraoperative circulatory fluctuations, and the incidence of postoperative adverse reactions when compared to conventional analgesia techniques.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from the inception of these databases to November 2024. The objective was to identify randomized controlled trials that compared the use of SPI-guided analgesia with conventional analgesia practices in adult patients who underwent general anesthesia. The primary outcome was the intraoperative consumption of opioids, while intraoperative circulatory fluctuations, postoperative opioid consumption, pain scores, and adverse events served as secondary outcomes. Standardized mean differences (SMDs), weighted mean differences (WMDs) or pooled risk ratios (RRs) along with the corresponding 95 % confidence intervals (CIs) were employed for analysis.</div></div><div><h3>Results</h3><div>Fourteen studies were included in our meta-analysis. The pooled results indicated no significant difference in intraoperative opioid consumption between the SPI-guided analgesia group and the control group (SMD = 0.16, 95 % CI: −0.15 to 0.47, <em>p</em> = 0.33). However, SPI-guided analgesia was found to reduce intraoperative propofol dosage (SMD = −0.31, 95 % CI: −0.54 to −0.08, <em>p</em> = 0.008), prevent intraoperative tachycardia (RR = 0.50, 95 % CI: 0.30 to 0.85, <em>p</em> = 0.011), and significantly shorten the eye-opening time (WMD = −1.89, 95 % CI: −2.47 to −1.31, <em>p</em> &lt; 0.001). No statistically significant differences were observed in extubation time, postoperative nausea and vomiting, pain scores, or postoperative opioid consumption.</div></div><div><h3>Conclusions</h3><div>Compared to the conventional analgesia group, SPI-guided analgesia does not reduce intraoperative opioid consumption in adult patients undergoing general anesthesia.</div><div>Trial registration: The protocol for this meta-analysis has been registered in PROSPERO (CRD42024611690).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111800"},"PeriodicalIF":5.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520437","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":"Flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation – A randomized controlled trial","authors":"Julia Abram MD ,&nbsp;Patrick Spraider PhD ,&nbsp;Judith Martini MD ,&nbsp;Corinna Velik-Salchner MD ,&nbsp;Hannes Dejaco MD ,&nbsp;Florian Augustin MD ,&nbsp;Gabriel Putzer MD ,&nbsp;Tobias Hell PhD ,&nbsp;Tom Barnes PhD ,&nbsp;Dietmar Enk MD","doi":"10.1016/j.jclinane.2025.111785","DOIUrl":"10.1016/j.jclinane.2025.111785","url":null,"abstract":"<div><h3>Study objective</h3><div>Comparison of flow-controlled ventilation (FCV) to standard of pressure-controlled ventilation (PCV) in thoracic surgery procedures requiring one-lung ventilation.</div></div><div><h3>Design</h3><div>Prospective, non-blinded, randomized, controlled trial.</div></div><div><h3>Setting</h3><div>Operating theater at a university hospital, Austria.</div></div><div><h3>Patients</h3><div>Patients scheduled for elective, thoracic surgery.</div></div><div><h3>Interventions</h3><div>Participants received ventilation randomly either with FCV or PCV per-protocol for the duration of anesthesia.</div></div><div><h3>Measurements</h3><div>The primary endpoint was oxygenation assessed by paO₂ / FiO₂ ratio 30 min after the start of OLV. Secondary endpoints included the required minute volume for CO₂ removal, applied mechanical power and incidence of postoperative pulmonary complications.</div></div><div><h3>Main results</h3><div>A total of 46 patients were enrolled and 43 included in the primary analysis. The primary endpoint paO₂ / FiO₂ ratio was significantly higher in the FCV group (<em>n</em> = 21) compared to the control group (PCV <em>n</em> = 22) (187 vs 136 mmHg, MD 39 (95 % CI 1 to 75); <em>p</em> = 0.047). The required respiratory minute volume to obtain comparable mild hypercapnia during OLV was significantly lower in FCV (3.0 vs 4.5 l/min, MD -1.3 (95 % CI -1.9 to −0.8); <em>p</em> &lt; 0.001). The applied mechanical power was also significantly lower (3.5 versus 7.6 J/min, MD -3.8 (95 % CI -5.3 to −2.7); p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In this single-center randomized controlled trial, flow-controlled ventilation improved gas exchange parameters in terms of oxygenation and carbon dioxide removal during one-lung ventilation in patients undergoing thoracic surgery and reduced the mechanical impact of artificial ventilation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111785"},"PeriodicalIF":5.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510440","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":"Decision-making profiles of anesthetists in selecting neuromuscular blocking agents for general anesthesia: A survey study","authors":"Chloe Zanoni Msc ,&nbsp;Mathieu Servant PhD ,&nbsp;Guillaume Besch MD, PhD ,&nbsp;Francis Berthier MD ,&nbsp;Emmanuel Samain MD, PhD ,&nbsp;Sebastien Pili-Floury MD, PhD ,&nbsp;Djamila Bennabi MD, PhD ,&nbsp;David Ferreira MD, PhD","doi":"10.1016/j.jclinane.2025.111790","DOIUrl":"10.1016/j.jclinane.2025.111790","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111790"},"PeriodicalIF":5.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474936","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":"Pain medication tapering in chronic pain patients: a concept analysis","authors":"Elke Wuyts ,&nbsp;Frenn Bultinck ,&nbsp;Lisa Goudman ,&nbsp;Dries Ceulemans ,&nbsp;Cleo Lina Crunelle ,&nbsp;Dominique Van de Velde ,&nbsp;Hubert Van Puyenbroeck ,&nbsp;Maarten Moens","doi":"10.1016/j.jclinane.2025.111784","DOIUrl":"10.1016/j.jclinane.2025.111784","url":null,"abstract":"<div><h3>Study objective</h3><div>When risks and side effects of pain medication use outweigh its benefits, pain medication tapering (PMT) should be considered. PMT gained prominence in the treatment plan for patients with chronic pain (CP) and consist of heterogeneous components. This study aims to clarify the concept of PMT by conceptualizing essential components for use in CP patients.</div></div><div><h3>Design</h3><div>Concept analysis based on the eight-step method of Walker and Avant.</div></div><div><h3>Data sources</h3><div>A comprehensive literature search up to July 2023 was performed in six databases: MEDLINE (via PubMed), Web of Science, Embase, Scopus, PsychINFO and the Cochrane database.</div></div><div><h3>Patients</h3><div>CP patients on long-term pain medication therapy to whom PMT is beneficial.</div></div><div><h3>Interventions</h3><div>Attributes, illustrative cases, antecedents, consequences and empirical referents were developed. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used for transparency and reproducibility of the search, and to increase readability and clarity.</div></div><div><h3>Main results</h3><div>Out of 4,162 articles, 110 articles were included. Six attributes were identified: medication use and decrease, support, patient preparation/education, personalization, controlling and monitoring throughout and following tapering, and alternative treatments for pain relief. Three cases were developed, illustrating PMT programs containing all, some or none of the attributes. Antecedents such as suitability for tapering, convinced patient, experienced multidisciplinary team and well-established patient-physician relationship were identified, and consequences were described according to the International Classification of Functioning, Disability and Health, with results predominantly found in the body functions and structures category.</div></div><div><h3>Conclusion</h3><div>Conceptualization of PMT for patients with CNCP creates a common ground for improving current knowledge about PMT programs and can serve as a starting point for development of future research into PMT interventions.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111784"},"PeriodicalIF":5.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464812","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":"Assessing the accuracy of ChatGPT in interpreting blood gas analysis results ChatGPT-4 in blood gas analysis","authors":"Engin İhsan Turan ,&nbsp;Abdurrahman Engin Baydemir ,&nbsp;Anıl Berkay Balıtatlı ,&nbsp;Ayça Sultan Şahin","doi":"10.1016/j.jclinane.2025.111787","DOIUrl":"10.1016/j.jclinane.2025.111787","url":null,"abstract":"<div><h3>Background</h3><div>Arterial blood gas (ABG) analysis is a critical component of patient management in intensive care units (ICUs), operating rooms, and general wards, providing essential information on acid-base balance, oxygenation, and metabolic status. Interpretation requires a high level of expertise, potentially leading to variability in accuracy. This study explores the feasibility and accuracy of ChatGPT-4, an AI-based model, in interpreting ABG results compared to experienced anesthesiologists.</div></div><div><h3>Methods</h3><div>This prospective observational study, approved by the institutional ethics board, included 400 ABG samples from ICU patients, anonymized and assessed by ChatGPT-4. The model analyzed parameters including acid-base status, oxygenation, hemoglobin levels, and metabolic markers, and provided both diagnostic and treatment recommendations. Two anesthesiologists, trained in ABG interpretation, independently evaluated the model's predictions to determine accuracy in potential diagnoses and treatment.</div></div><div><h3>Results</h3><div>ChatGPT-4 achieved high accuracy across most ABG parameters, with 100 % accuracy for pH, oxygenation, sodium, and chloride. Hemoglobin accuracy was 92.5 %, while bilirubin interpretation showed limitations at 72.5 %. In several cases, the model recommended unnecessary bicarbonate treatment, suggesting an area for improvement in clinical judgment for acid-base balance management. The model's overall performance was statistically significant across most parameters (<em>p</em> &lt; 0.05).</div></div><div><h3>Discussion</h3><div>ChatGPT-4 demonstrated potential as a supplementary tool for ABG interpretation in high-demand clinical settings, supporting rapid, reliable decision-making. However, the model's limitations in interpreting complex metabolic markers highlight the need for clinician oversight. Future refinements should focus on enhancing AI training for nuanced metabolic interpretation, particularly for markers like bilirubin, to ensure safe and effective application across diverse clinical contexts.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111787"},"PeriodicalIF":5.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454002","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":"Editorial: The global need for standardized education in airway management.","authors":"Gregor Massoth, Maria Wittmann","doi":"10.1016/j.jclinane.2025.111781","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111781","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111781"},"PeriodicalIF":5.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476636","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":"The expanding role of critical care anesthesiologists outside the ICU.","authors":"Siddharth Dave, Brigid Flynn, Kunal Karamchandani","doi":"10.1016/j.jclinane.2025.111779","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.111779","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111779"},"PeriodicalIF":5.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472533","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 closer look at a decade of industry payments to anesthesiologists","authors":"Caitlin Sebastian BS ,&nbsp;Catherine Cha MD ,&nbsp;Brittany N. Burton MD, MHS, MAS","doi":"10.1016/j.jclinane.2025.111775","DOIUrl":"10.1016/j.jclinane.2025.111775","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111775"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445705","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}