Anesthesia and analgesia最新文献

{"title":"Heterogeneity in Uterotonic Administration During Cesarean Delivery: Results From a Survey of Society of Obstetric Anesthesia and Perinatology Centers of Excellence Institutions.","authors":"Snehi Shah, Natalie J Koons, Nisha Panigrahy, Lynn Squires, Jessica R Ansari, Brendan Carvalho, Kelly A Fedoruk","doi":"10.1213/ANE.0000000000008249","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008249","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"143 4","pages":"e68-e70"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975447","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":"Cardiac Surgery, Frailty, and Outcomes: Connecting the Dots.","authors":"","doi":"10.1213/ANE.0000000000008262","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008262","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":"143 4","pages":"683"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975517","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":"Impact of Obesity, Respiratory Symptoms, and Posture on Perioperative Respiratory Adverse Events and Lung Function in Children.","authors":"Britta S von Ungern-Sternberg, Aine Sommerfield, Walid Habre, Ferenc Petak","doi":"10.1213/ANE.0000000000007973","DOIUrl":"10.1213/ANE.0000000000007973","url":null,"abstract":"<p><strong>Background: </strong>Obesity is linked to altered lung function and increased perioperative respiratory adverse events (PRAEs). We examined the effects of obesity, respiratory symptoms, and posture on PRAEs, lung mechanics, and ventilation distribution in children undergoing general anesthesia.</p><p><strong>Methods: </strong>A total of 110 children (6-16 years) undergoing elective surgery were stratified into normal-weight and overweight/obese groups. Preoperative respiratory symptoms were documented. Respiratory mechanics and end-expiratory lung volume were assessed by forced oscillation technique (FOT) and multiple-breath nitrogen washout (MBW), respectively, in sitting and supine positions before anesthesia induction; FOT was repeated after induction. All PRAEs were recorded.</p><p><strong>Results: </strong>Severe PRAEs were uncommon (5/110, 4.5%, (95% confidence interval [CI], 1.5%-10.4%) laryngospasm; no bronchospasm). Minor PRAE occurred more frequently in obese children compared with normal-weight children (19/55, 34.5% (95% CI, 22.2%-48.6%) vs 9/55, 16.4% (95% CI, 7.9%-28.3%)), regardless of respiratory symptoms. Obesity was associated with increased peripheral airway resistance, most evident in the supine and anesthetized states. Respiratory symptoms primarily affected tissue mechanics, and additive impairments were observed when children were overweight/obese and had respiratory symptoms. MBW outcomes showed minimal group differences, though supine positioning consistently reduced functional residual capacity and increased lung clearance index. Anesthesia induction led to reduced resistance and improved elasticity, likely reflecting anesthesia-induced bronchodilation, but this effect was attenuated in obese children and those with respiratory symptoms.</p><p><strong>Conclusions: </strong>Obesity increased susceptibility to minor PRAE and elevated peripheral airway resistance, whereas respiratory symptoms impaired tissue mechanics. Postural change exerted a dominant influence on lung function. Anesthesia-induced bronchodilatation was blunted in obese children and those with respiratory symptoms, highlighting the need for targeted perioperative strategies.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"838-848"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257139","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":"Cardiopulmonary Bypass Effects on Minimum Alveolar Concentration and Other Bypass Terminology.","authors":"Hilary P Grocott","doi":"10.1213/ANE.0000000000008136","DOIUrl":"10.1213/ANE.0000000000008136","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e46-e47"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040674","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 Anaphylaxis Associated With Neuromuscular Blockade.","authors":"Luke Gainer, Srikiran Ramarapu","doi":"10.1213/ANE.0000000000008240","DOIUrl":"10.1213/ANE.0000000000008240","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e63-e65"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705155","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":"Nonalcoholic Anesthesia for Teetotalers: A Clinical and Ethical Imperative.","authors":"Saravana Babu, Shrinivas Vittal Gadhinglajkar","doi":"10.1213/ANE.0000000000008212","DOIUrl":"10.1213/ANE.0000000000008212","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e52-e54"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705179","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":"Time-Varying Associations Between Selected Clinical Indicators And In-Hospital Mortality During The Early Period Of Critical Care.","authors":"Maxwell Roth, Brian Healy, Crystal M North, Kenneth Shelton, Lorenzo Berra, Julia Collins, Henry Paik, Patricia Brunker, Robert Makar, Walter Sunny Dzik","doi":"10.1213/ANE.0000000000007990","DOIUrl":"10.1213/ANE.0000000000007990","url":null,"abstract":"<p><strong>Background: </strong>Many patients in intensive care units (ICUs) are clinically unstable during the first several days of ICU care. The goal of this study was to describe how the association between selected clinical variables and in-hospital mortality varied across short, sequential time periods during the early phase of ICU care.</p><p><strong>Methods: </strong>Retrospective analysis of 19,439 ICU encounters among 17,769 patients, aged 18 to 102, who were treated in three ICUs at a single academic medical center during the years 2018 to 2023. Each encounter was segmented into brief intervals of care defined by time between complete blood count results. We analyzed 144,157 time intervals representing the early period of care up to the first 20 consecutive time intervals. For each time interval, we performed multivariable logistic regression to estimate the odds ratios of association between nine selected clinical variables and in-hospital death. Variables included patient demographics, laboratory results, and treatment modalities previously found to be associated with ICU survival in published studies. Both current and previous exposure to life-support treatments (mechanical ventilation, pressors, or dialysis) and interactions among life-support treatments were also investigated as variables.</p><p><strong>Results: </strong>The mean duration of the analyzed time intervals of care was 512 ±215 minutes (median 574, IQR 326-720 minutes). One third of in-hospital mortality among ICU patients occurred during the first 20 time intervals of care. The odds ratios for death for age, sex, platelet count, hemoglobin, and transfusion ranged from 1.01 to 1.35 with small variations across periods of care, whereas the odds ratios for ventilator use, dialysis, pressors, and bilirubin varied more widely from 1.43 to 4.75.</p><p><strong>Conclusion: </strong>The strength of association between selected clinical variables and in-hospital mortality varied with time during early periods of ICU care.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"822-828"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206621","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":"Impaired Cognitive Domains in Surgical Patients: A Systematic Review and Meta-Analysis.","authors":"Subin Park, Ellene Yan, Ray Martinez-Rodriguez, Bijal Desai, Jonathan Chung, Aparna Saripella, Marina Englesakis, Keera N Fishman, Frances Chung","doi":"10.1213/ANE.0000000000007948","DOIUrl":"10.1213/ANE.0000000000007948","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is a highly prevalent but frequently overlooked issue among surgical patients preoperatively. This systematic review and meta-analysis aimed to (1) determine the perioperative prevalence of impaired cognitive domains in surgical patients, (2) explore perioperative changes in the different domains, and (3) examine postoperative outcomes associated with preoperatively impaired cognitive domains.</p><p><strong>Methods: </strong>Five electronic databases were searched from inception to March 19, 2024. Inclusion criteria were (1) surgical patients ≥18 years of age; (2) preoperative cognitive assessments using a neuropsychological battery; (3) reported the prevalence of impairment in specific cognitive domains or changes perioperatively; and (4) sample size of ≥100 surgical patients. The exclusion criteria included studies involving neurological surgery; cross-sectional, case-control, and case series studies; non-English articles; and studies with overlapping data.</p><p><strong>Results: </strong>In total, of the 12,082 articles identified from 5 databases, 21 studies (5725 patients, 11 non-cardiac surgery studies, and 10 cardiac surgery studies) were included. Among the 6 cognitive domains assessed preoperatively, the pooled prevalence of impairment was highest in executive function (18%; 95% CI, 13%-24%), visuospatial function (16%; 95% CI, 6%-26%), and attention/working memory/processing speed (14%; 95% CI, 9%-18%). Perceptual-motor control (13%; 95% CI, 9%-36%), language (13%; 95% CI, 8%-17%), and learning/memory (12%; 95% CI, 8%-16%) had lower pooled prevalence. The cognitive domains that were assessed postoperatively showed a high prevalence of impairment at 1 week, with 35% (95% CI, 4%-66%) in attention/working memory/processing speed, 34% (95% CI, 16%-51%) in executive function, and 28% (95% CI, 16%-40%) in learning/memory. The pooled prevalence subsequently decreased within 3 months to 16% (95% CI, 3%-35%) in attention/working memory/processing speed, 15% (95% CI, 6%-24%) in executive function, and 12% (95% CI, -2% to 25%) in learning/memory.</p><p><strong>Conclusions: </strong>The prevalence of preoperatively impaired cognitive domains was the highest in executive function, followed by visuospatial function and attention/working memory/processing speed. Identifying commonly impaired cognitive domains may help optimize cognitive assessments in the perioperative setting. Further research is needed to clarify the clinical utility of assessing specific cognitive domains in surgical populations to improve postoperative outcomes and reduce cognitive deterioration.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"781-793"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211979","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":"HSK21542 for Postoperative Analgesia in Gynecological Surgery: A Pooled Post-Hoc Analysis of Two Phase III Randomized Controlled Trials.","authors":"Shui Yu, Lijing Zou, Siwei Dong, Jianing Wu, Xin Huang, Yinbo Zhong, Haiying Wang, Yuanyuan Yao, Min Yan","doi":"10.1213/ANE.0000000000008004","DOIUrl":"10.1213/ANE.0000000000008004","url":null,"abstract":"<p><strong>Background: </strong>Effective postoperative pain management in gynecological surgery is challenging because of complex visceral-somatic pain interactions and the adverse effects of conventional analgesics. HSK21542, a novel peripherally restricted kappa-opioid receptor (KOR) agonist that selectively targets visceral pain pathways enriched with KORs, may provide adequate analgesia without systemic adverse events.</p><p><strong>Methods: </strong>We conducted a pooled post-hoc analysis of data from two phase III, multicenter, triple-blinded, randomized controlled trials (Study 301, HSK21542 vs placebo; Study 303, HSK21542 vs tramadol vs placebo). Eligible patients undergoing elective gynecological surgery were included. The primary outcome was the summed pain-intensity difference over 12 and 24 hours (SPID 12h and SPID 24h ). Secondary outcomes were pain-relief quality (proportion of patients relieved from severe pain with a pain numerical rating score ≤ 3 between 0 and 24 hours) and rescue-analgesic requirements (number of doses and time to first rescue analgesic). Adverse events were also assessed.</p><p><strong>Results: </strong>A total of 370 patients were analyzed: 150 received HSK21542, 139 received a placebo, and 81 received tramadol. After inverse probability of treatment weighting (IPTW) adjustment, baseline characteristics were well-balanced across treatment groups (all standardized mean differences [SMD] <0.1; see Table 1 for 95% CIs). HSK21542 produced greater reductions in pain intensity over 12 and 24 hours than placebo (least-squares mean differences -8.1 and -16.3 for SPID 12h and SPID 24h , respectively. Both P < .001) and no statistically significant difference was observed between HSK21542 and tramadol ( P > .05). Significantly more patients in the HSK21542 group were relieved from severe pain at 0 to 12 hours (92.7% vs 82.7%, P < .001) and required fewer rescue doses at 0 to 12 hours (0.00 [IQR 0.00-1.00] vs 1.00 [IQR 0.00-2.00], P < .001) and 0 to 24 hours (0.00 [IQR 0.00-1.00] vs 1.00 [IQR 0.00-2.00], P < .001) than those in the placebo group, whereas no significant differences with tramadol both in 0 to 12 and 0 to 24 hours. HSK21542 was also associated with significantly lower incidences of nausea (24.7% vs 66.7%) and vomiting (21.3% vs 60.5%) than tramadol. Only one case of dizziness occurred in the tramadol group.</p><p><strong>Conclusions: </strong>HSK21542 could provide adequate postoperative analgesia with few adverse events in patients undergoing gynecological surgery.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"869-876"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508928","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":"We Met.","authors":"Zhaohui Su","doi":"10.1213/ANE.0000000000007941","DOIUrl":"10.1213/ANE.0000000000007941","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"937"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965105","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}