Anesthesia and analgesia最新文献

{"title":"Investigation of Prolonged Mechanical Ventilation Mediating the Association Between Mechanical Power and Mortality After Cardiac Surgery.","authors":"Milo Engoren, Michael R Mathis, Nicholas J Douville","doi":"10.1213/ANE.0000000000007945","DOIUrl":"10.1213/ANE.0000000000007945","url":null,"abstract":"<p><strong>Background: </strong>Studies in both intensive care unit (ICU) and noncardiac intraoperative patients have shown that higher pulmonary mechanical power is associated with increased mortality. We sought to estimate whether intraoperative mechanical power is associated with operative mortality, and secondarily with late mortality, in cardiac surgery patients and if these associations are mediated via prolonged mechanical ventilation.</p><p><strong>Methods: </strong>In this restrospective, single-center, cohort study of adult, cardiac surgery patients, we calculated mechanical power based on tidal volume, peak inspiratory pressure, positive end-expiratory pressure, and respiratory rate. After transforming mechanical power using fractional polynomials, we used logistic regression models to estimate the associations between mechanical power, prolonged mechanical ventilation, and the primary outcome of operative mortality, with prolonged mechanical ventilation as the mediator between mechanical power and mortality. Similar separate regressions were done for the secondary outcome of late mortality, which excluded patients with operative mortality.</p><p><strong>Results: </strong>Mean ± standard deviation (SD) of mechanical power for the 5907 patients was 7.9 ± 2.6 J/min. One hundred thirty-six (2.3%) patients were operative mortalities, and a total of 598 (10%) patients were dead at a median (interquartile range) follow-up of 792 (161-1496) days. Late mortality in patients who survived the perioperative period was 462 of 5771 (8.0%) patients. Operative mortality doubled from 1.9% to 3.8% between the first (mechanical power <6.13 J/min) and last (>9.23 J/min) mechanical power quartiles. Late mortality in patients who survived the perioperative period increased from 7.7% to 9.7% between the first (mechanical power <6.13 J/min) and last (mechanical power >9.23 J/min) quartiles. After adjustment for confounders, mechanical power was associated with operative mortality odds ratio (OR) = 1.102 (per J/min) (95% confidence interval [CI], 1.030-1.179], P = .005. Mechanical power via the square, MP 2 , and cubic, MP 3 , terms of the transformations was associated with prolonged mechanical ventilation (OR = 1.015 [95% CI, 1.008-1.021], P < .001 for MP 2 and OR = 0.99961 [95% CI, 0.99930-0.99991], P = .012 for MP 3 ). These correspond to a combined OR = 0.746 (95% CI, 0.622-0.891), 1.431 (1.108-1.857), and 3.033 (1.109-8.222) for mechanical power = 6, 10, and 14 J/min, respectively, compared to a patient with the mean mechanical power = 7.9 J/min. By mediation analysis, all of mechanical power's association with operative mortality was mediated via its association with prolonged mechanical ventilation.</p><p><strong>Conclusion: </strong>We found that higher levels of mechanical power were associated with intraoperative and late mortality, and this association was mediated by prolonged mechanical ventilation. Further study is needed to understand how mech","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1074-1083"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206568","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":"Decreasing Resident Stressors: It Is All in the Family.","authors":"Grant A Neely, Rebekah K Guillow, Edward C Nemergut","doi":"10.1213/ANE.0000000000008094","DOIUrl":"10.1213/ANE.0000000000008094","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"966-968"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013169","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":"How to Innovate as an Anesthesiologist: Guidance From the American Society of Anesthesiologists Committee on Innovation.","authors":"Neil E Rens, Nathan J Smischney, Jiapeng Huang, Haobo Ma, Roya Saffary, Smitha Arekapudi, Ronald G Pearl","doi":"10.1213/ANE.0000000000008075","DOIUrl":"10.1213/ANE.0000000000008075","url":null,"abstract":"<p><p>While the field of anesthesiology has a storied history of innovation, especially related to patient safety, contemporary anesthesiologists face growing barriers to innovation from complex regulatory requirements and financial constraints. The Biodesign framework offers a systematic approach to medical technology development that can be applied to the perioperative space to address these challenges. This process begins with identification and screening of high-value clinical needs, followed by generation and evaluation of potential solutions, and culminates in strategy development, business planning, and fundraising. Each stage is designed to guide clinicians from early observation through translation into viable technologies. By adopting this structured method, anesthesiologists are well-positioned to transform clinical insights into scalable solutions, ensuring the specialty continues to advance patient safety and care in the face of evolving clinical demands.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1026-1033"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147961927","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":"In Response.","authors":"Amanda M Kleiman, Susan M Walters, John S McNeil, Miklos D Kertai, Michael A Mazzeffi","doi":"10.1213/ANE.0000000000008278","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008278","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"143 5","pages":"e79-e80"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227048","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":"Evaluation of Artificial Intelligence versus Human-Authored Anesthesia Patient Education Materials: A Multi-Institution Survey Study.","authors":"Catherine Wu, Daniel Qian, Jeffrey Huang, Robert B Maniker, Yuxia Ouyang, Natalia Egorova, Garrett W Burnett","doi":"10.1213/ANE.0000000000008102","DOIUrl":"10.1213/ANE.0000000000008102","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1158-1161"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809385","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":"Dexmedetomidine Preemptive Analgesia on Intra- and Postoperative Pain in Noncardiac Surgery: A Randomized, Double-Blind, Controlled Study.","authors":"Xiaohua Wang, Haosheng Chang, Wenwei Qi, Hongmei Wang, Yi Huang, Zhiwei Wu, Qian Wang, Wei Jiang, Tianlong Wang","doi":"10.1213/ANE.0000000000008078","DOIUrl":"10.1213/ANE.0000000000008078","url":null,"abstract":"<p><strong>Background: </strong>Inadequate pain management affects over half of the 230 million major surgeries performed annually. Preemptive analgesia aims to prevent peripheral and central sensitization. Dexmedetomidine (DEX) offers non-opioid analgesia and opioid-sparing effects. This study evaluated the efficacy of preemptive DEX using the nociception index (NOX) for objective intraoperative monitoring and assessed its impact on perioperative outcomes.</p><p><strong>Methods: </strong>In this single-center, double-blind, randomized controlled trial, 220 eligible patients were assigned to receive either intravenous DEX (1.5 µg·kg -1 ·h -1 ) (DEX group) or placebo (normal saline) (PO group) from 15 minutes before anesthesia induction until 15 minutes post-induction. The co-primary outcomes were the intraoperative NOX compliance rate (mean NOX ≤60 during nociceptive stimulation) and the incidence of moderate-to-severe postoperative pain (pNRS > 3) at 0, 24, 48 hours, and 7 days. Secondary outcomes included hemodynamic parameters, postoperative nausea and vomiting (mPONV), dizziness, analgesic consumption, and safety events.</p><p><strong>Results: </strong>The DEX group demonstrated a significantly higher NOX compliance rate compared to the placebo group (98/108, 90.7% vs 14/112, 12.5%; P < .001). The incidence of NRS>3 was significantly lower in the DEX group at all postoperative time points (3/108, 2.8% vs 29/112, 25.9% at 0 hour; 6/108, 5.6% vs 33/112, 29.5% at 24 hours; 1/108, 0.9% vs 19/112, 17% at 48 hours; 0/108, 0% vs 6/112, 5.4% at 7 d; P = .000). DEX also reduced rescue opioid consumption ( z = -2.428, P = .004), decreased mPONV ( z = -4.901, P = .001), and improved hemodynamic stability. Safety profiles were favorable in DEX group.</p><p><strong>Conclusion: </strong>Preemptive analgesia with DEX significantly improves both intraoperative nociceptive control as objectively measured by the NOX and postoperative pain control. It validates the role in optimizing perioperative analgesia and enhancing recovery.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1106-1115"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052022","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":"In Response.","authors":"Phuong-Lan Thi Nguyen","doi":"10.1213/ANE.0000000000008244","DOIUrl":"10.1213/ANE.0000000000008244","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e73-e74"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918210","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 Commitment to Trust and Integrity in Science: Implications for Pain and Anesthesiology Research.","authors":"Tonya M Palermo, Didier Bouhassira, Karen D Davis, Hugh C Hemmings, Robert W Hurley, Joel Katz, Jaideep J Pandit, Theodore J Price, Michael E Schatman, Stephan K W Schwarz, Dennis C Turk, Marc Van de Velde, Matthew D Wiles, Tony L Yaksh, David Yarnitsky","doi":"10.1213/ANE.0000000000007632","DOIUrl":"10.1213/ANE.0000000000007632","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"946-952"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129911","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":"Pain: A Pantoum-A Numb Place.","authors":"Bright O Etumuse","doi":"10.1213/ANE.0000000000008060","DOIUrl":"10.1213/ANE.0000000000008060","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1168"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248978","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":"Trust Under Scrutiny: The Changing Face of Scientific Integrity.","authors":"","doi":"10.1213/ANE.0000000000008358","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008358","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"143 5","pages":"939"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227054","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}