Journal of Anesthesia, Analgesia and Critical Care (Online)最新文献

{"title":"Histological evaluation of fascicular damage following repeated sciatic nerve transfixion: an anatomical study.","authors":"Rafael Boscolo-Berto, Alessandro De Cassai, Martina Contran, Veronica Macchi, Valentina Manzo, Raffaele De Caro, Burhan Dost, Serkan Tulgar, Annalisa Boscolo, Paolo Navalesi, Andrea Porzionato","doi":"10.1186/s44158-026-00383-x","DOIUrl":"10.1186/s44158-026-00383-x","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound guidance has improved the accuracy and safety of peripheral nerve blocks, yet intraneural and even intrafascicular needle placement remains possible. The true incidence of fascicular injury after direct nerve transfixion is uncertain due to limited histological data. This study aimed to determine the frequency of fascicular damage after needle transfixion of the sciatic nerve using a human anatomical model.</p><p><strong>Methods: </strong>A sciatic nerve segment was harvested from a fresh-frozen male cadaver without neurological disease. One hundred full-thickness transfixions were performed using a 22-gauge sharp needle, simulating accidental intraneural penetration. Each transfixion was replicated using a standardized technique. The nerve was fixed in formalin, sectioned every 5 mm, embedded in paraffin, and stained with hematoxylin and eosin for histological evaluation. The presence of fascicular injury or displacement was assessed microscopically. Descriptive statistics were used to summarize findings, and proportions with 95% confidence intervals were calculated using the Wald method.</p><p><strong>Results: </strong>All 100 needle trajectories were successfully identified histologically. Clear fascicular damage was observed in 30 of 100 transfixions, corresponding to an incidence of 30% (95% confidence interval, 21 to 39%). In four additional cases, the needle passed in close proximity to fascicles, causing their displacement without visible structural injury, yielding an incidence of 4% (95% confidence interval, 0.2 to 7.8%). In the remaining cases, the needle path did not involve any fascicles.</p><p><strong>Conclusions: </strong>One third of simulated sciatic nerve transfixions performed with a sharp needle resulted in direct fascicular injury, while a smaller proportion produced fascicular displacement without structural disruption. These findings suggest that fascicular penetration is more common than previously believed when sharp needles are used and highlight the potential for mechanical nerve injury during regional anesthesia procedures. The use of sharp needles for peripheral nerve blocks should be avoided, and further research should explore how needle design and tip geometry influence the likelihood of fascicular injury.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated use of natriuretic peptides and DASI for cardiac reserve evaluation in high-risk surgical patients: a narrative review.","authors":"Tarek Senussi Testa, Giuseppe Cuttone, Francesco Damiani, Giovanni Ippati, Christian Zanza, Giovanni Misseri, Luigi La Via","doi":"10.1186/s44158-025-00314-2","DOIUrl":"10.1186/s44158-025-00314-2","url":null,"abstract":"<p><strong>Background: </strong>The perioperative management of high-risk patients undergoing major noncardiac surgery remains a significant challenge in modern healthcare. Accurate preoperative risk stratification is crucial for optimizing patient outcomes and resource allocation. This narrative review explores the emerging approach of combining natriuretic peptide measurements with the Duke Activity Status Index (DASI) to evaluate cardiac reserve in high-risk surgical patients.</p><p><strong>Main body: </strong>We examine the individual roles of natriuretic peptides (primarily B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide) and the DASI in preoperative risk assessment, highlighting their strengths and limitations. The rationale for integrating these two measures is discussed, emphasizing their complementary nature in providing both objective biomarker data and patient-reported functional status. The review synthesizes current evidence supporting this combined approach, including recent studies demonstrating improved risk discrimination compared to traditional methods. We outline a methodology for implementing this integrated assessment, addressing the timing of measurements, interpretation of results, and integration with existing risk stratification tools. Furthermore, we provide guidance on the management of identified high-risk patients, including prehabilitation and optimization strategies. The natriuretic peptide/DASI approach is also positioned within the broader context of perioperative assessment to guide appropriate clinical implementation.</p><p><strong>Conclusion: </strong>The integration of natriuretic peptides and DASI represents a promising strategy for enhancing preoperative cardiac risk assessment in high-risk surgical patients. While further research is needed to refine and validate this approach, it offers a practical and potentially powerful tool for improving perioperative care and patient outcomes.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renin-dependent association between oxidative stress and organ dysfunction in acute hypoxemic respiratory failure.","authors":"Davide Eleuteri, Salvatore Lucio Cutuli, Massimo Antonelli, Luca Montini","doi":"10.1186/s44158-026-00392-w","DOIUrl":"10.1186/s44158-026-00392-w","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-lung ventilation in minimally invasive cardiac surgery: challenges, techniques and complications.","authors":"Andrea Montisci, Giulia Maj, Luigi La Via, Massimiliano Sorbello, Giuseppe Cuttone, Elisabetta Roberti, Serena Ambrosi, Tarek Senussi Testa, Nicolò Antonino Patroniti, Federico Pappalardo","doi":"10.1186/s44158-026-00387-7","DOIUrl":"10.1186/s44158-026-00387-7","url":null,"abstract":"<p><p>This review highlights the pathophysiology and anesthesiologic management of pulmonary complications in minimally invasive cardiac surgery, emphasizing challenges of one-lung ventilation and cardiopulmonary bypass, to improve postoperative respiratory outcomes.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13234966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of ICU mortality in septic patients in a resource-limited African setting: a prospective multicenter cohort study in Lubumbashi, DRC.","authors":"Michel Muteya Manika, Rivain Fefe Iteke, Berthe Nsimire Barhayiga, Florence Mutomb Mujing'a, Eric Ilunga Kasamba, Serge Kapend Matanda, Christian Ngama Kakisingi, Ildéphose Mwanza Teta, Yves Banza Mukalayi, Jackson Rashidi Djuma, Deogracias Umba Mulewa, Nathan Kusthid Nguz'a, Sandra Zalambo Saggboze, Alain-Willy Kabey A Kabey, Pitchou Mukaz Mbey, Aristophane Koffi Tanon, Hippolyte Nani-Tuma Situakibanza, Liévin Kalala Kapend'a","doi":"10.1186/s44158-026-00384-w","DOIUrl":"10.1186/s44158-026-00384-w","url":null,"abstract":"<p><strong>Background: </strong>Sepsis remains a leading cause of intensive care unit (ICU) mortality globally, with the highest burden observed in low- and middle-income countries where diagnostic capacity, timely referral, and access to organ support are limited. However, commonly used prognostic tools rely on laboratory and monitoring resources that are often unavailable in such settings. This study aimed to identify independent predictors of ICU mortality among adults with sepsis in Lubumbashi, Democratic Republic of the Congo, and to develop a context-adapted prognostic score suitable for resource-constrained environments.</p><p><strong>Methods: </strong>We conducted a prospective multicentre cohort study across three ICUs between January 2021 and April 2023. Adults meeting Sepsis-3 criteria were consecutively enrolled. Clinical status, basic laboratory parameters, therapeutic timing, and socioeconomic characteristics were recorded within 24 h of ICU admission. Independent predictors of 28-day mortality were identified using multivariable logistic regression. A simplified point-based prognostic model (SPARS-Basique) was constructed and evaluated for discrimination (AUROC) and calibration, with internal validation using bootstrap resampling (1,000 iterations). The outcome of interest was 28-day ICU mortality.</p><p><strong>Results: </strong>Seven variables were independently associated with ICU mortality: delayed ICU admission > 5 days, low socioeconomic status, absence of health insurance, GCS ≤ 10, SpO₂ < 90%, serum creatinine ≥ 3 mg/dL, and blood glucose ≥ 8 mmol/L. Age ≥ 60 years and shock index ≥ 0.9 showed clinically relevant but non-significant trends after adjustment and were therefore not retained in the final SPARS-Basique score. The final 0-9-point SPARS-Basique model demonstrated strong discrimination, with an AUROC of 0.88 (95% CI 0.82-0.93) and an optimism-corrected AUROC of approximately 0.87 after bootstrap internal validation, suggesting limited overfitting. Calibration was good. Observed ICU mortality increased progressively across risk groups: 21.4% in the low-risk group (0-2 points), 64.3% in the moderate-risk group (3-5 points), and 91.2% in the high-risk group (6-9 points).</p><p><strong>Conclusions: </strong>Sepsis mortality in Lubumbashi ICUs remains high and is influenced by both biological severity and structural barriers to timely care. The SPARS-Basique score demonstrated good internal performance for early risk stratification of ICU mortality in this cohort. However, as this was an exploratory derivation study in a modest sample, external validation in larger, independent cohorts is required before broader clinical application can be considered.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"De Senectute\" in the perioperative and critical care continuum-advancing personalized care for the geriatric patient at the intersection of frailty, aging, and multimorbidity.","authors":"Jacopo D'Andria Ursoleo, Elena Giovanna Bignami","doi":"10.1186/s44158-026-00390-y","DOIUrl":"10.1186/s44158-026-00390-y","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes, knowledge, practices, and perceived barriers on sustainability actions among Italian anesthesiologists-intensivists: a nationwide survey.","authors":"Raffaele Mandarano, Savino Spadaro, Danila Azzolina, Rita Commissari, Vincenzo Lionetti, Roberta Monzani, Stefano Romagnoli, Massimiliano Sorbello, Alessia Violini, Elena Bignami, Gilda Cinnella","doi":"10.1186/s44158-026-00379-7","DOIUrl":"10.1186/s44158-026-00379-7","url":null,"abstract":"<p><strong>Background: </strong>Healthcare systems contribute approximately 4.6% of global carbon emissions, with anesthesia and intensive care representing major sources of environmental impact. Although awareness of sustainable practices is increasing, real-world implementation in these fields remains limited. This study aimed to describe knowledge, attitudes, practices, and perceived barriers toward sustainability among Italian anesthesiologists-intensivists.</p><p><strong>Methods: </strong>A cross-sectional, web-based survey was conducted among members of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) between June and July 2025. The questionnaire assessed demographics, clinical practices, environmental behaviors, and perceived barriers to sustainability. Descriptive statistics and an unsupervised clustering approach (Factor Analysis of Mixed Data followed by hierarchical clustering) were applied to identify distinct respondent profiles.</p><p><strong>Results: </strong>A total of 459 responses were analyzed. Overall, 83.4% rated environmental sustainability as \"very important,\" and 95.6% supported the adoption of renewable energy in hospitals. Despite this, 93.1% reported routine use of single-use devices, and only 7.4% worked in departments with a designated sustainability officer. Cluster analysis identified two main groups: the Experienced Generation (older, senior specialists) and the Green Generation (younger, early-career clinicians). While both valued sustainability, the Green Generation more frequently implemented eco-friendly practices, including the use of total intravenous anesthesia (71.2% vs. 57.5%), regional anesthesia (74.1% vs. 64.0%), and reusable/recyclable devices (> 80% vs. < 20%). The most frequently reported barriers to sustainability application were lack of training (76.3%), resistance to change (66.4%), and absence of guidelines (54.7%).</p><p><strong>Conclusions: </strong>Italian anesthesiologists-intensivists demonstrate strong environmental awareness but variable implementation of sustainable practices. Strengthening formal education, institutional leadership, and guideline dissemination is essential to promote widespread adoption of sustainable anesthesia and intensive care practices.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SurgiGuide: enhancing perioperative patient education with a rule-based digital agent in elective colorectal surgery.","authors":"Valentina Bellini, Lorenzo Viani, Luigino Jalale Darhour, Paolo Del Rio, Elena Bignami","doi":"10.1186/s44158-026-00386-8","DOIUrl":"10.1186/s44158-026-00386-8","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of spinal anesthesia-induced hypotension during cesarean delivery: a narrative review.","authors":"Mina Adolf Helmy, Kerlous Adolf Helmy, Wael Mahmoud El Darandly, Haitham Hassan Awad, Fatma Morsy, Reham Amin Kaddah, Mohamed Ahmed Shamma, Lydia Magdy Milad","doi":"10.1186/s44158-026-00382-y","DOIUrl":"10.1186/s44158-026-00382-y","url":null,"abstract":"<p><p>Spinal anesthesia-induced hypotension remains a major challenge in obstetric anesthesia, with significant maternal and fetal consequences despite prophylactic measures. Reliable prediction tools are essential to stratify risk and optimize management. This review narratively discusses evidence on clinical, hemodynamic, Doppler-derived, and pulse oximetry-based predictors of spinal anesthesia-induced hypotension in cesarean delivery. Clinical factors such as body mass index, maternal age, baseline blood pressure, and spinal anesthetic dose demonstrate variable predictive value. Hemodynamic markers, including heart rate variability and shock index, show promise but require further validation. Advanced monitoring techniques, such as stroke volume variation, subaortic velocity time integral, and femoral artery Doppler indices, exhibit high accuracy, while venous diameter-based measures (inferior vena cava, internal jugular vein, subclavian vein-axillary vein) yield inconsistent results. Pulse oximetry-derived indices, particularly the perfusion index, demonstrate moderate to good predictive ability across systematic reviews. Composite risk models integrating multiple parameters may enhance precision compared to single predictors. Overall, while several modalities show potential, translation into routine practice requires simplification, validation in larger cohorts, and integration into standard monitoring systems.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment heterogeneity in intravenous lidocaine analgesia: implications for pain phenotype-guided therapy.","authors":"Ming-Hui Hung, Shu-Yueh Cheng","doi":"10.1186/s44158-026-00385-9","DOIUrl":"10.1186/s44158-026-00385-9","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}