Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

{"title":"Blood pressure management during cardiac surgery: a survey of Canadian cardiac anesthesiologists, perfusionists, and cardiac surgeons.","authors":"Karen Zhao, Renée Fournier, Kevin Kennedy, Hilary P Grocott, Emilie Belley-Côté, Matthew Cameron, Richard P Whitlock, C Scott Brudney, Allison M Janda, Eric Jacobsohn, C David Mazer, François Lamontagne, Christie Smith, Gordon Guyatt, Jessica Spence","doi":"10.1007/s12630-025-02971-x","DOIUrl":"10.1007/s12630-025-02971-x","url":null,"abstract":"<p><strong>Purpose: </strong>Clinicians presume a relationship between the management of blood pressure during cardiac surgery and postoperative morbidity and mortality. With limited evidence to inform practice, we surveyed Canadian cardiac anesthesiologists, perfusionists, and cardiac surgeons. We sought to solicit information to inform a trial evaluating the blood pressure management approach on outcomes after cardiac surgery.</p><p><strong>Methods: </strong>We iteratively developed a survey assessing the lowest and highest blood pressures respondents would target, the narrowest feasible blood pressure range to achieve, the range of blood pressure observed in clinical practice, and factors influencing targeted blood pressure before, during, and after cardiopulmonary bypass (CPB). We contacted leads from every Canadian hospital providing cardiac surgery to distribute the survey via a computerized link. We used a modified Dillman approach to optimize response rate. Responses were analyzed descriptively.</p><p><strong>Results: </strong>Of 819 clinicians surveyed, 532 (65%) responded. Respondents' lowest pooled mean arterial pressure (MAP) target, presented as mean (standard deviation [SD]), was 59 (6) mm Hg before CPB, 55 (7) mm Hg during CPB, and 60 (5) mm Hg after CPB. Respondents' highest pooled MAP target, presented as mean (SD), was 92 (10) mm Hg before CPB, 84 (7) mm Hg during CPB, and 75 (6) mm Hg after CPB. The narrowest feasible MAP range, presented as mean (SD), all respondents believed could be achieved was 19 (7) mm Hg before CPB, 16 (7) mm Hg during CPB, and 20 (7) mm Hg after CPB.</p><p><strong>Conclusions: </strong>The responses to our survey support the clinical acceptability of a trial examining blood pressure target thresholds at the extreme ends of the range recommended by existing guidelines and the feasibility of maintaining blood pressure within a narrow target range.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"895-903"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of perioperative changes in serum primary metabolites in patients after major surgery under general anesthesia: an exploratory secondary analysis of the TAPIR trial.","authors":"Nadine Krieg, Philipp Baumbach, Iuliana-Andreea Ceanga, Anne Standke, Markus H Gräler, Ralf A Claus, Julia Y Nicklas, Martin S Winkler, Bernd Saugel, Sina M Coldewey","doi":"10.1007/s12630-025-02984-6","DOIUrl":"10.1007/s12630-025-02984-6","url":null,"abstract":"<p><strong>Purpose: </strong>Major surgery under general anesthesia substantially alters physiologic homeostasis. Nevertheless, the intricate effects on the metabolome are poorly studied. Metabolic fingerprints may allow the identification of patients at risk for unfavourable outcomes.</p><p><strong>Methods: </strong>We conducted a secondary, exploratory, targeted metabolomic analysis of 177 high-risk patients undergoing major abdominal surgery under general anesthesia enrolled in the Targeting preoperatively Assessed Personal cardiac Index in major abdominal suRgery patients (TAPIR) randomized controlled trial. We analyzed primary serum metabolites using liquid chromatography coupled with triple quadrupole mass spectrometry before surgery (on preoperative day 0) and on postoperative day 3 (POD3). Our primary aim was to investigate postoperative alterations in primary serum metabolites. Secondary objectives included analyses in different subgroups, including patients with postoperative complications (composite of complication, delirium, acute kidney injury, and infection) up to day 30. We applied regression analyses and calculated false discovery rate-adjusted P values to address multiplicity.</p><p><strong>Results: </strong>Of the 37 metabolites analyzed, 20 were different on POD3 after comparison with before surgery (lower: 4-hydroxyproline, alanine, asparagine, citrulline, cystine, dimethylglycine, glutamine, glutamic acid, glycine, guanosine, histidine, niacinamide, serine, uric acid, and xanthine; higher: isoleucine, leucine, methionine, methionine sulfoxide, pyruvic acid; adjusted P values < 0.05). We found no statistically significant preoperative differences between patients with and without postoperative complications (all adjusted P values ≥ 0.05). Postoperatively, patients with (vs without) delirium within thirty days after surgery (n = 13/177) showed lower levels of alanine, asparagine, citrulline, cystine, glutamine, glutamic acid, serine, threonine, and tyrosine after adjusting for preoperative metabolite levels.</p><p><strong>Conclusion: </strong>Major abdominal surgery under general anesthesia was associated with complex changes in primary metabolites. We identified alterations in certain metabolites that were associated with postoperative delirium. Future research may establish metabolic patterns allowing the identification of patients at risk for unfavourable postoperative outcomes.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"954-965"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New evidence amid old assumptions for thromboembolic risk after total knee arthroplasty: a twist in the story.","authors":"Derek Dillane, Colleen Harnett","doi":"10.1007/s12630-025-02958-8","DOIUrl":"10.1007/s12630-025-02958-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"871-876"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ donation after death determination by circulatory criteria: family members' experiences with withdrawal of life-sustaining measures in Canadian intensive care units.","authors":"Aimee J Sarti, Stephanie Sutherland, Maureen Meade, Matthew J Weiss, Sonny Dhanani, Ken M Lotherington, Angele Landriault, Brandi Vanderspank-Wright, Sabira Valiani, Sean Keenan, Andreas H Kramer, Stephen Beed, Joanne Brennan, Pierre Cardinal, Michaël Chassé, Peter Nickerson, Sam D Shemie","doi":"10.1007/s12630-025-02978-4","DOIUrl":"10.1007/s12630-025-02978-4","url":null,"abstract":"<p><strong>Purpose: </strong>Donation after death determination by circulatory criteria (DCC) is an option currently available for imminently dying patients who do not meet neurologic criteria for death. When organ donation is not successful following withdrawal of life-sustaining measures (WLSM), family members may experience additional feelings of loss and bereavement. In this study, we sought to explore the lived experiences of family members who consented to donation after DCC, including families whose loved ones proceeded to donation and those for whom donation was not possible.</p><p><strong>Methods: </strong>We conducted a qualitative study using semi-structured interviews with family members whose loved ones agreed to donation after DCC and underwent WLSM in Canadian intensive care units. We recruited participants from all Canadian provinces with an organ donation organization (n = 10) and analyzed themes using a modified grounded theory approach.</p><p><strong>Results: </strong>Interviews with 79 family members of 78 potential donors with DCC revealed nine main themes as important in the context of WLSM in DCC: 1) early and repetitive communication, 2) predicting time of death (after WLSM), 3) invitation to witness WLSM, 4) family agency in donation after DCC (e.g., wishing they had been able to take some action and/or exert more control), 5) environment, 6) support, 7) honouring donor/meaning making, 8) guilt, and 9) triple loss (i.e., death, unsuccessful donation, and loss for recipients).</p><p><strong>Conclusion: </strong>In this qualitative study, we identified a range of experiences among family members in the context of WLSM in DCC. Among those, we found family involvement in the WLSM and the DCC process to be very important. Family member perspectives on organ donation are essential to guide practices that can support consistent, high-quality family-centred care in this context.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"975-985"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of health care providers involved in organ donation or transplantation on cardiac donation after death by circulatory criteria: a qualitative study.","authors":"Kimia Honarmand, Ian Ball, Maureen O Meade, Aimee Sarti, Danielle LeBlanc, John Basmaji, Emilie P Belley-Côté, Michaël Chassé, Frédérick D'Aragon, Gordon Guyatt, Bram Rochwerg, Sam D Shemie, Robert Sibbald, Marat Slessarev, Mathew J Weiss, Jeanna Parsons Leigh","doi":"10.1007/s12630-025-02979-3","DOIUrl":"10.1007/s12630-025-02979-3","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiac donation after death determination by circulatory criteria (DCC) can be performed using either 1) direct procurement and perfusion of ex situ organs or 2) normothermic regional perfusion (NRP). Nevertheless, there are concerns regarding the acceptability and ethics of these procedures, particularly NRP in which the blood supply to the brain is surgically interrupted and circulation in the thorax and abdomen is restored prior to heart retrieval. We aimed to understand the perspectives on cardiac donation following DCC of Canadian clinicians who are involved in donation and transplantation.</p><p><strong>Methods: </strong>We performed a qualitative descriptive study of 75 clinicians to better understand the perspectives of physicians on cardiac DCC. We purposively sampled clinicians who care for organ donors (N = 51) and those who care for transplant recipients (N = 24) in Canada. We performed thematic analysis to generate themes describing participants' perspectives about cardiac DCC and its implementation in Canada.</p><p><strong>Results: </strong>We found that the broad support and interest to implement cardiac DCC among the cohort of clinicians interviewed was tempered by their anticipation that other clinicians, donor families, and the public would be less supportive. Donor clinicians were particularly concerned about potential erosion in public trust in the organ donation system as a whole. Participants identified opportunities to address anticipated challenges, including strategies for education and communication around cardiac DCC, staged/gradual introduction of cardiac DCC, and the option for stakeholders (clinicians, donor families, potential transplant recipients) to opt out of participation in cardiac DCC.</p><p><strong>Conclusions: </strong>In this qualitative study of clinicians involved in organ donation or transplantation across Canada, we found broad support for cardiac DCC. Nevertheless, we observed several challenges with the implementation of cardiac DCC, particularly concerns of nonsupport by other stakeholders. Participants also identified opportunities to address anticipated barriers.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"986-999"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine and acute kidney injury in patients with sepsis: a retrospective cohort study.","authors":"Papawadee Chaengsuthiworawat, Tharin Thampongsa, Thanyalak Thamjamrassri, Chawika Pisitsak","doi":"10.1007/s12630-025-02977-5","DOIUrl":"10.1007/s12630-025-02977-5","url":null,"abstract":"<p><strong>Purpose: </strong>Acute kidney injury (AKI) is a common complication of sepsis. AKI is associated with increased morbidity and mortality. Studies show that dexmedetomidine has a protective effect against AKI. We sought to evaluate the association between dexmedetomidine administration and AKI in patients with sepsis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 331 adult patients with sepsis. We divided patients into two groups: patients who received an infusion of dexmedetomidine of ≥ 0.2 µg·kg^-1·hr^-1 for > 6 hr within 72 hr of sepsis diagnosis (the dexmedetomidine group; N = 73) and patients who did not receive a dexmedetomidine infusion (the nondexmedetomidine group; N = 258). The primary outcome was the incidence of AKI within seven days, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We analyzed our results using multivariable logistic regression models including 1) the entire cohort (331 patients) or 2) a 1:1 propensity-score-matched cohort (73 patients per group).</p><p><strong>Results: </strong>Acute kidney injury was diagnosed in 190/331 (57.4%) patients. The incidence of AKI was not different between the dexmedetomidine group and the nondexmedetomidine group in both the entire cohort (54.8% vs 58.1%; P = 0.61) and the propensity-matched cohort (54.7% vs 63.0%; P = 0.31). Additionally, there were no significant differences between groups in the incidence of renal replacement therapy (10.9% vs 13.6%; P = 0.61) and 30-day mortality (32.8% vs 24.6%; P = 0.27). We observed a statistically significant interaction between patient age > 65 yr and reduced odds of developing AKI in patients who received dexmedetomidine (adjusted odds ratio, 0.25; 95% confidence interval, 0.07 to 0.90; P = 0.03).</p><p><strong>Conclusions: </strong>While there was no association between dexmedetomidine administration and AKI in our overall cohort of patients with sepsis, we observed reduced odds of developing AKI in older patients (aged > 65 yr) who received dexmedetomidine. Further research is needed to confirm that dexmedetomidine has a protective effect against AKI in this patient population.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"966-974"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory total knee arthroplasty in a patient with cold agglutinin disease.","authors":"Shikha Bansal","doi":"10.1007/s12630-025-02961-z","DOIUrl":"10.1007/s12630-025-02961-z","url":null,"abstract":"<p><strong>Purpose: </strong>Cold agglutinin disease (CAD) is a rare autoimmune disease caused by high titres of cold-reacting autoantibodies that cause red blood cell agglutination and subsequent hemolysis at low temperatures. Trauma, surgery, and infection/inflammation exacerbate CAD. The present report describes the successful perioperative management of a patient with CAD who underwent outpatient total knee arthroplasty (TKA).</p><p><strong>Clinical features: </strong>A 70-yr-old female was diagnosed with CAD in 2016 with symptoms of pain and pallor in her fingertips, numbness and bluish discoloration of her tongue, and shortness of breath. She was treated with folic acid, rituximab, and bendamustine. After remaining symptom-free for 4 yrs and following consultation with hematology, she was scheduled to undergo TKA. She received a spinal anesthetic with chloroprocaine, intravenous sedation, antiemetic prophylaxis, and an adductor canal catheter for continuous perineural analgesia. Warming measures, including a warm (20 °C) operating room, warm intravenous fluids, warm irrigating fluids, warm surgical prepping solution, forced-air warming blankets, and avoidance of a thigh tourniquet, helped prevent hypothermia in the patient. The patient's perioperative course was uneventful, and she was discharged on the same day. She was followed up via a patient monitoring mobile application and advised to monitor herself for signs of CAD relapse. She had no concerns up to three months after surgery.</p><p><strong>Conclusion: </strong>The perioperative management of patients with CAD is challenging, and multidisciplinary collaboration and coordination between the anesthesiologist, surgeon, hematologist, and nurses, as well as adequate intraoperative precautions and postoperative instructions and monitoring, are essential to ensuring safe surgery and optimal patient outcomes.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1015-1020"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilical analgesic concentrations after labour analgesia with programmed intermittent epidural bolus: a prospective observational study.","authors":"Arisa Ijuin, Masaki Sato, Nagayoshi Umehara, Shoichiro Amari, Jumpei Saito, Mayuko Abe, Wataru Matsunaga, Yoko Yamashita, Yasuyuki Suzuki, Kenichi Masui","doi":"10.1007/s12630-025-02975-7","DOIUrl":"10.1007/s12630-025-02975-7","url":null,"abstract":"<p><strong>Purpose: </strong>The umbilical analgesic concentrations after using programmed intermittent epidural bolus (PIEB) and patient-controlled epidural analgesia (PCEA) without continuous infusion are unknown. We aimed to characterize umbilical ropivacaine and fentanyl concentrations and examine their influence on neonatal conditions at delivery.</p><p><strong>Methods: </strong>We prospectively studied 50 parturients with singleton pregnancies who received combined spinal-epidural analgesia using PIEB (7 mL every 45 min) and PCEA (7 mL per bolus; lockout interval: 15 min) with 0.08% ropivacaine and 2 μg·mL^-1 fentanyl, with clinician-administered boluses as necessary. We evaluated the umbilical venous analgesic concentrations and neonatal characteristics.</p><p><strong>Results: </strong>The median [interquartile range (IQR)] hourly ropivacaine and fentanyl doses were 13 [11-15] mg·hr^-1 and 39 [30-50] µg·hr^-1, respectively. The ropivacaine and fentanyl concentrations were 77 [56-98] ng·mL^-1 and 0.125 [0.125-0.20] ng·mL^-1 at delivery, respectively. The umbilical analgesic concentrations were correlated with the labour duration and total dose. In parturients given clinician-administered boluses within 1 hr before delivery, the ropivacaine and fentanyl concentrations were similar to those without (81 [54-104] vs 77 [54-96] ng·mL^-1 and 0.20 [0.125-0.20] vs 0.125 [0.05-0.20] ng·mL^-1, respectively). The umbilical arterial pH was > 7.2 and the Apgar score at 5 min was ≥ 8 for all neonates. No neonates exhibited systemic local anesthetic toxicity. Respiratory support was required for 14 neonates.</p><p><strong>Conclusions: </strong>Umbilical analgesic concentrations at delivery were low after labour analgesia using a regimen of PIEB with PCEA for up to 19 hr. An intermittent bolus dosing regimen may contribute to a decrease in umbilical analgesic concentrations.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"934-944"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features and airway management experience in an infant with Arboleda-Tham syndrome.","authors":"Kumi Kataoka, Igor Luginbuehl","doi":"10.1007/s12630-025-02966-8","DOIUrl":"10.1007/s12630-025-02966-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1028-1029"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between general anesthesia combined with peripheral nerve blocks versus neuraxial anesthesia without nerve blocks for high-risk isolated distal deep venous thrombosis in patients undergoing knee arthroplasty: a historical cohort study.","authors":"Nanbo Luo, Li Luo, Lei Yang, Zhi Li, Qingmin Yu, Wenling Jian, Wei Sun, Pac-Soo Chen, Qian Chen, Daqing Ma, Qingsheng Xue, Yan Luo, Buwei Yu, Hao Wang, Zhiheng Liu","doi":"10.1007/s12630-025-02957-9","DOIUrl":"10.1007/s12630-025-02957-9","url":null,"abstract":"<p><strong>Purpose: </strong>General anesthesia combined with peripheral nerve blocks has become a common anesthesia regimen for knee replacement surgery. Its association with high-risk isolated distal deep venous thrombosis (IDDVT) remains uncertain.</p><p><strong>Methods: </strong>In this cohort study, we obtained consecutive data from the electronic inpatient records of Shenzhen Second People's Hospital, including adults who underwent knee arthroplasty from 1 September 2019 to 31 August 2021. The primary outcome was the incidence of high-risk IDDVT. We compared the outcomes in patients who received general anesthesia combined with nerve blocks with those in patients who received neuraxial anesthesia without nerve blocks, using a multivariable regression model with inverse probability weighting according to the propensity score.</p><p><strong>Results: </strong>Of the 848 patients who underwent knee arthroplasty, 330 were excluded because they lacked thrombus testing or had received other types of anesthesia. Of the remaining 518 patients, 267/518 (52%) received general anesthesia combined with nerve blocks and 251/518 (48%) received neuraxial anesthesia with no nerve blocks. A total of 99 patients developed high-risk IDDVT. In the primary multivariable analysis with inverse probability weighting according to the propensity score, general anesthesia combined with nerve blocks was associated with a significantly reduced high-risk IDDVT compared with neuraxial anesthesia without nerve blocks (odds ratio, 0.50; 95% confidence interval, 0.31 to 0.81; P = 0.005). The results of multiple sensitivity analyses were similar between the two cohorts. E-value analysis suggested robustness to unmeasured confounding.</p><p><strong>Conclusions: </strong>Compared with neuraxial anesthesia without peripheral nerve blocks, general anesthesia combined with peripheral nerve blocks in patients undergoing knee arthroplasty was associated with a reduced incidence of high-risk IDDVT in our retrospective study. A large multicentre prospective clinical trial is needed to validate our findings.</p><p><strong>Study registration: </strong>ChiCTR.org.cn ( ChiCTR2200057006 ), first submitted 25 February 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"882-894"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}