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

{"title":"Reducing unnecessary preoperative testing in Day Surgery: a Choosing Wisely-based quality improvement study.","authors":"Loretta Tessitore, Giampiero Sciacca, Marika Aprea, Oriana De Crescenzo, Monica Mucciarone, Teresa Valerio, Andrea Di Pilla, Luigi Tritapepe","doi":"10.1186/s44158-026-00376-w","DOIUrl":"10.1186/s44158-026-00376-w","url":null,"abstract":"<p><p>Routine preoperative laboratory testing is widely performed despite strong evidence and international guidelines indicating limited value for healthy patients undergoing low-risk surgery. Overuse contributes to unnecessary costs, delays, and potential patient harm through false positives and cascades of care.Objective To evaluate the impact of a Choosing Wisely-based preoperative assessment model on testing rates, surgical delays, safety outcomes, and system efficiency in a Day Surgery setting.Design, setting, and participants This is a retrospective pre-post quality improvement study conducted at a tertiary academic hospital in Italy. Two cohorts of adult Day Surgery patients were compared: A pre-intervention group (June 2022-June 2023) and a post-intervention group following implementation of a redesigned preoperative pathway (July 2023-July 2024). Intervention It involves the implementation of a new preoperative model separating minor Day Surgery cases (ASA I-III) from intermediate/major surgery, eliminating routine testing unless clinically indicated after anesthesiologist evaluation. Main outcomes and measures These are proportion of patients receiving laboratory tests, ECG, or chest radiography, rate of surgery cancellations or delays, need for postoperative admission, time from anesthesiology visit to surgery, and estimated cost reduction. Results A total of 1059 patients formed the pre-intervention group and 1790 the post-intervention group. After implementation, testing decreased substantially: laboratory testing dropped to 2.6%, ECG to 6.7%, and chest radiography to 0.3%. No surgeries were cancelled due to insufficient work-up. No unplanned postoperative admissions occurred. Wait times were dramatically reduced from weeks to less than 7 days, eliminating previous structural bottleneck.Conclusions and relevance A Choosing Wisely aligned preoperative pathway safely reduced unnecessary testing, improved efficiency, shortened wait times, and lowered costs. This approach is scalable and may inform national policy and Value-Based Health Care strategies.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582871","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":"Ten tips for a safe approach in airway management.","authors":"Ida Di Giacinto, Massimiliano Sorbello, Stefano Falcetta, Clelia Esposito, Gerardo Cortese, Rita Cataldo, Paola Serio, Denise Battaglini","doi":"10.1186/s44158-026-00378-8","DOIUrl":"10.1186/s44158-026-00378-8","url":null,"abstract":"<p><p>Airway management remains a critical aspect of anesthesia, intensive care and emergency medicine, particularly when facing difficult airways. Traditional methods, such as endotracheal intubation via direct laryngoscopy, have evolved with the introduction of advanced tools designed to enhance oxygenation and facilitate airway control. This narrative review presents 10 essential tips for safe up-to-date airway management, emphasizing the importance of a patient-centered, oxygen-focused and strategic approach rather than a purely device-oriented one. By incorporating strategies for assessment, prediction and timely interventions and transition, healthcare professionals can improve patient outcomes and minimize complications during airway management.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522847","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":"How large language models will be regulated in academia.","authors":"Alessandro De Cassai, Burhan Dost, Giorgio Conti","doi":"10.1186/s44158-026-00381-z","DOIUrl":"10.1186/s44158-026-00381-z","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517344","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":"Ultrasound-guided transversus abdominis plane block in cesarean delivery: a randomized trial of ketamine versus neostigmine as bupivacaine adjuvants.","authors":"Ayman Mohamed Maaly, Hussien Mohamed Agameya, Mohamed Mohamed ElNakeeb, Steven Naser Abdul-Malak","doi":"10.1186/s44158-026-00371-1","DOIUrl":"10.1186/s44158-026-00371-1","url":null,"abstract":"<p><strong>Background: </strong>Cesarean delivery (CD) stands as one of the most prevalent surgical procedures for childbirth. Ensuring effective pain management during and after CD is paramount to safeguarding the well-being and comfort of the mother. The transversus abdominis plane (TAP) block is a widely used technique for postoperative pain control. To enhance the duration and quality of analgesia provided by TAP blocks, adjuvants such as ketamine and neostigmine have been investigated.</p><p><strong>Methods: </strong>A prospective, double-blind randomized controlled study was adopted. Eighty patients scheduled for elective CS were randomized into two equal groups after receiving spinal anesthesia. Group K received postoperative TAP block with plain bupivacaine and ketamine and Group N received TAP block with bupivacaine and neostigmine.</p><p><strong>Results: </strong>A significantly higher mean arterial blood pressure was observed at 18 h and 24 h in Group N compared to Group K. Comparing the postoperative visual analogue scale score, no significant differences were observed at 2 h, 4 h, and 6 h. At 12 h post-procedure, the mean VAS score was significantly higher for Group N compared to Group K. This trend continued at 18 and 24 h (p < 0.001).</p><p><strong>Conclusion: </strong>Both adjuvants effectively controlled postoperative pain, with stable intraoperative hemodynamics and high patient satisfaction levels. Ketamine demonstrated superior analgesic efficacy compared with neostigmine in cesarean delivery patients undergoing TAP blocks. An individualized treatment approach is needed to tailor the selection of adjuvants to optimize outcomes.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517299","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":"Efficacy and safety of Clevidipine for blood pressure control after carotid endarterectomy: a prospective cohort study.","authors":"Vives M, Kevin R, Riera R, Lloret B, Castanera-Duro A, Sosa C","doi":"10.1186/s44158-026-00377-9","DOIUrl":"10.1186/s44158-026-00377-9","url":null,"abstract":"<p><strong>Background: </strong>Strict postoperative blood pressure (BP) control within a narrow range is crucial after Carotid Endarterectomy (CEA) to minimize risks like stroke and hyperperfusion syndrome. Our institution targets a systolic BP (sBP) of 130-145 mmHg post-CEA. This study aimed to compare the efficacy of clevidipine versus standard intravenous antihypertensive treatment (labetalol ± urapidil) in maintaining this target range.</p><p><strong>Materials and methods: </strong>This single-center, prospective cohort study included consecutive patients (> 18 years) undergoing CEA at Hospital Universitari de Girona Dr J Trueta, Girona, Spain, between August 2018 and October 2021. Patients received either clevidipine or non-clevidipine treatment (labetalol ± urapidil) based on physician preference. The primary outcome was the Area Under the Curve for sBP outside the target range (AUC-sBP), normalized per hour (mmHg x min/h), during the first six postoperative hours. Data were analyzed using non-parametric tests and adjusted linear regression.</p><p><strong>Results: </strong>Data from 97 patients (44 clevidipine, 53 non-clevidipine [38 labetalol only, 15 labetalol + urapidil]) were analyzed. The clevidipine group had higher baseline sBP (144 ± 15 vs 140 ± 7 mmHg, SMD -0.34) and more comorbidities. Clevidipine use was associated with a significantly lower AUC-sBP compared to the non-clevidipine group (median [IQR]: 120 [92-150] vs 240 [240-300] mmHg x min/h, p < 0.00001). This association remained significant after adjusting for age, sex, and preoperative sBP (coef. -220 mmHg x min/h [95% CI -293 to -146], p = 0.0001). Mean cumulative clevidipine dose was 58 ± 86 mg over 14 ± 10 h. No significant differences were observed in secondary outcomes or pre-specified adverse events between groups.</p><p><strong>Conclusion: </strong>In this cohort, clevidipine treatment was associated with significantly better adherence to the target sBP range during the first six hours post-CEA compared to standard therapy with labetalol ± urapidil, without an observed increase in adverse effects.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488957","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":"Behavioral nudges and targeted education as sustainability strategies to reduce hazardous waste generation in intensive care and perioperative settings: a prospective interventional study.","authors":"Giulia Roveri, Martina Vacondio, Ruth Martintoni, Kai Riemer, Matthias Bock, Simon Rauch","doi":"10.1186/s44158-026-00368-w","DOIUrl":"10.1186/s44158-026-00368-w","url":null,"abstract":"<p><strong>Background: </strong>Intensive care units (ICUs) and operating rooms (ORs) are resource-intensive hospital areas and major contributors to healthcare waste. Proper segregation of hazardous and residual waste reduces carbon-intensive disposal and supports sustainability, yet practices depend heavily on staff behavior and knowledge.</p><p><strong>Methods: </strong>We conducted a prospective three-phase interventional study in the ICU and ORs of Merano Hospital, Italy (September 2023-May 2025). Baseline hazardous waste generation and staff knowledge/barriers were assessed (phase 1). Subsequently, low-cost behavioral nudges (enhanced bin visibility, labeling, placement-phase 2) and targeted online education on waste segregation (phase 3) were introduced in sequence. The primary outcome was the reduction in hazardous waste, normalized to ICU patient-days and surgical procedures; secondary outcomes included changes in perceived barriers and knowledge.</p><p><strong>Results: </strong>Hazardous waste generation declined across all phases in both ICUs and ORs. In the ICU, waste decreased from 3.31 (± 1.07) to 2.97 (± 1.40) kg/patient-day after behavioral nudges (- 10.3%, p = 0.31) and further to 1.97 (± 1.33) after education, representing a 40.6% reduction versus baseline (p < 0.001). In ORs, waste fell from 5.84 (± 1.40) to 4.38 (± 2.58) kg/procedure post-nudges (- 25.0%, p = 0.027) and to 3.84 (± 1.46) post-education, corresponding to a 34.4% reduction (p < 0.001). Structured questionnaires identified limited bin availability and unclear sorting rules as key barriers; behavioral nudges addressed structural obstacles, while education improved knowledge and confidence.</p><p><strong>Conclusions: </strong>Integrating low-cost behavioral nudges with targeted education effectively reduces hazardous waste in ICU and perioperative settings. Environmental changes improve waste practices, while education enhances staff knowledge, awareness, and confidence, emphasizing that infrastructure alone is insufficient without supportive training.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482695","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":"Spread of injectate during the transversalis fascia plane block: a preliminary anatomical investigation.","authors":"Bahadir Ciftci, Serkan Tulgar, Aybegüm Fazlioglu, Bora Bilal, Selcuk Alver, Izzet Alatli, Ali Osman Korkmaz, Bayram Ufuk Sakul, Alessandro De Cassai, Ali Ahiskalioglu","doi":"10.1186/s44158-026-00375-x","DOIUrl":"10.1186/s44158-026-00375-x","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482676","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":"Can algorithms come to the rescue of a failing heart? Machine learning, artificial intelligence, and decision-making in cardiogenic shock.","authors":"Alice Bottussi, Patrick M Wieruszewski, Elena Giovanna Bignami, Justyna Swol, Kevin G Buda, Wisit Cheungpasitporn, Omar Elmadhoun, Jacopo D'Andria Ursoleo","doi":"10.1186/s44158-026-00373-z","DOIUrl":"10.1186/s44158-026-00373-z","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12980856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438232","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":"Implementation and learning curve in AI-assisted fluid management during abdominal oncologic surgery: a retrospective observational study.","authors":"Gilda Pasta, Luciano Frassanito, Maria Maciariello, Carmine Iermano, Rosanna Accardo, Andrea Belli, Pasquale Sansone, Francesco Coppolino, Vincenzo Pota, Francesco Vassalli, Arturo Cuomo","doi":"10.1186/s44158-026-00354-2","DOIUrl":"10.1186/s44158-026-00354-2","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative fluid management during major abdominal oncologic surgery is complex and highly operator-dependent. Assisted Fluid Management (AFM) is an artificial intelligence-based decision support system designed to guide fluid challenges based on real-time Stroke Volume (SV) analysis. However, limited data are available on how AFM is adopted in routine clinical practice and how clinician interaction with the system evolves over time.</p><p><strong>Methods: </strong>We conducted a retrospective observational study based on a prospectively maintained institutional database at a high-volume tertiary referral center. Adult patients undergoing major abdominal oncologic surgery with intraoperative AFM monitoring were included. Two consecutive time periods following AFM implementation were compared. Analyses were performed at the fluid-challenge level and focused on patterns of fluid challenge initiation (clinician-initiated vs AFM-suggested), hemodynamic effectiveness (SV response), and bolus characteristics, as markers of system adoption and learning curve. Postoperative clinical outcomes were not assessed.</p><p><strong>Results: </strong>Fifty-nine patients were included, accounting for 404 fluid challenges. Over time, clinician-initiated boluses significantly decreased and AFM-suggested fluid challenges increased (p < 0.001). This shift was associated with higher overall effectiveness of fluid challenges and greater SV responses, particularly for AFM-suggested boluses, which showed a significant improvement in effectiveness and ΔSV over time (p < 0.05).</p><p><strong>Conclusions: </strong>Progressive integration of AFM into routine anesthetic practice was associated with measurable changes in clinician behavior and improved physiological effectiveness of intraoperative fluid challenges over time, consistent with a learning curve effect. These findings support the role of AI-based decision support systems in promoting more consistent and physiologically targeted fluid management and provide a foundation for future prospective studies evaluating their impact on clinical outcomes.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438148","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":"Anesthetic strategies for manual removal of retained placenta: an observational cohort study at a university referral center.","authors":"Mohamad Yousef, Daniel Shatalin, Tehila Avitan, Yaacov Gozal, Yair Binyamin, Alexander Ronenson, Alexander Ioscovich","doi":"10.1186/s44158-026-00374-y","DOIUrl":"10.1186/s44158-026-00374-y","url":null,"abstract":"<p><strong>Background: </strong>Retained placenta is a significant cause of postpartum hemorrhage (PPH) and maternal morbidity. Despite its clinical importance, limited data exists on the safety and effectiveness of different anesthetic techniques for manual removal of placenta (MROP). This study aimed to assess anesthesia-related outcomes and complications in a large tertiary care center with 20,000 to 22,000 annual deliveries.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on women who underwent MROP in the operating room between January 2018 and September 2024. Institutional Review Board approval was obtained prior to data collection. Patient demographics, risk factors, anesthetic techniques, and clinical outcomes were collected and analyzed.</p><p><strong>Results: </strong>During the study period, there were 130,338 vaginal deliveries at our institution. Among 1,366 women (1.05%) undergoing MROP, 860 required placental revision and 506 underwent manual placental removal. Vacuum-assisted delivery was performed in 99 cases (22%). Neuraxial anesthesia was the predominant modality (81.9%), with spinal anesthesia most frequently used (73.7%) and 25.7% subsequently converted to epidural anesthesia. General anesthesia (GA) (16.6%) and sedation (1.5%) were less commonly employed. Women receiving GA had significantly higher risks of blood transfusion (RR 6.0 for RBC, RR 19.5 for FFP, p < 0.0001), longer hospitalization (4.1 ± 2.3 vs. 3.5 ± 3.4 days, p < 0.002), and increased need for ICU/PACU monitoring (RR 20.9, p < 0.0001). Difficult intubation occurred in three cases, with one reported case of aspiration. No hysterectomies were required.</p><p><strong>Conclusions: </strong>Neuraxial anesthesia was the preferred method for MROP, demonstrating a low failure rate. In contrast, GA was associated with increased morbidity, including higher transfusion requirements, prolonged hospitalization, and greater need for intensive monitoring. The occurrence of airway complications in GA cases underscores the importance of optimizing anesthetic management. Minimizing the use of GA, when feasible, may contribute to improved patient outcomes in MROP procedures.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438215","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}