Anesthesia and analgesia最新文献

{"title":"Right Ventricle-Pulmonary Artery Coupling and Major Morbidity and Operative Mortality After Cardiac Surgery.","authors":"Katherine W Sun, Yi-Ju Li, Hui Huang, Anne D Cherry, Daryl Kerr, Crosby M Culp, Fawaz Alenezi, Mihai V Podgoreanu, Brittany A Zwischenberger, Alina Nicoara","doi":"10.1213/ANE.0000000000007582","DOIUrl":"10.1213/ANE.0000000000007582","url":null,"abstract":"<p><strong>Background: </strong>The right ventricle-pulmonary artery (RV-PA) coupling ratio provides an assessment of RV function indexed to PA afterload. A low preoperative RV-PA ratio has been associated with increased mortality after transcatheter procedures. In patients undergoing cardiac surgery, we hypothesized that a lower preoperative RV-PA ratio is independently associated with a higher risk of major morbidity and operative mortality (MMOM).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult patients who underwent coronary artery bypass graft and/or valve surgery (aortic, mitral, and tricuspid). The RV-PA ratio was calculated using the ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP). The primary outcome was MMOM as defined by the Society of Thoracic Surgeons (STS). The Youden index was used to determine the optimal cutoff to classify into low versus high TAPSE/PASP ratio groups. Multivariable analysis was performed to test the association of TAPSE/PASP ratio with MMOM and other clinical outcomes with P- value <0.05 used for statistical significance.</p><p><strong>Results: </strong>One hundred and twenty-four (14.3%) of the 868 patients who met inclusion criteria had the primary outcome of MMOM. Patients in the low TAPSE/PASP group were more likely to have MMOM (90 (22.0%) vs 34 (7.4%); P < .001) as well as longer intensive care unit length of stay (ICU-LOS), hospital LOS (H-LOS), and mechanical ventilation time (MVT). By multivariable analysis, TAPSE/PASP ratio <0.52 mm/mm Hg was associated with a significant increase in the risk of MMOM (odds ratio [OR] 1.77, 95% confidence interval [CI], 1.10-2.83, P = .018). In the analyses of secondary outcomes, for every 0.1 mm/mm Hg increase in TAPSE/PASP ratio, there was a 4% reduction in ICU-LOS and MVT, and a 3% reduction in H-LOS.</p><p><strong>Conclusions: </strong>TAPSE/PASP ratio <0.52 mm/mm Hg was associated with a significant increase in the risk of MMOM. Low preoperative TAPSE/PASP ratio was also associated with longer ICU-LOS, H-LOS, and MVT, even when adjusting for STS risk score for MMOM and cardiopulmonary bypass time.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"793-800"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282015","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":"In Response.","authors":"A Steven Bradley, Brittany N Burton, Adam J Milam","doi":"10.1213/ANE.0000000000007674","DOIUrl":"10.1213/ANE.0000000000007674","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e60-e61"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688683","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":"In Response.","authors":"Brandon M Togioka, Shauna K Rakshe, Sandy H Fang, Daniel O Herzig","doi":"10.1213/ANE.0000000000007664","DOIUrl":"10.1213/ANE.0000000000007664","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e54-e55"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758897","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":"In Response.","authors":"Nikolas A Georgakis, Marcos F Vidal Melo, Michael P Kinsky, Daniel Arango","doi":"10.1213/ANE.0000000000007662","DOIUrl":"10.1213/ANE.0000000000007662","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e52-e53"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641575","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":"In Response.","authors":"Ronny Munoz-Acuna, Peter Cheng, William Rosenblatt","doi":"10.1213/ANE.0000000000007686","DOIUrl":"10.1213/ANE.0000000000007686","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e63-e64"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858802","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":"Preoperative Blood-Brain Barrier Integrity Influence on the Impact of Anesthesia and Surgery on Mice Brain.","authors":"Mengya Cao, Jie Chen, Gong Chen, Wen Ouyang, Jianbin Tong","doi":"10.1213/ANE.0000000000007330","DOIUrl":"10.1213/ANE.0000000000007330","url":null,"abstract":"<p><strong>Background: </strong>Brain homeostasis imbalance, characterized by cognitive dysfunction and delirium, frequently occurs in the elderly after surgery. Investigating why this complication only affects part of patients undergoing the same surgery, and anesthesia remains intriguing. This study tested the role of preoperative blood-brain barrier (BBB) integrity in the occurrence of postoperative brain homeostasis imbalance using mice with conditional BBB damage.</p><p><strong>Methods: </strong>Preoperative BBB breakdown was induced in End-SCL-Cre-ctnnb1 fl//fl (iCKO) mice by administering tamoxifen (intraperitoneal [i.p.]). This breakdown was assessed using Evans Blue (EB) leakage and immunoglobulin G (IgG) staining. Postoperative brain homeostasis imbalance was evaluated through the Novel Object Recognition test, the Barnes Maze, and neuroinflammation tests. Synapse loss was detected by colabeling synaptophysin and PSD-95, followed by Western blotting. The role of astrocytes in this pathogenesis was evaluated by comparing cognitive behaviors, hippocampal gene expression, and astrocytic phagocytosis of synaptophysin in iCKO mice with and without genetic inhibition of perioperative astrocyte activity.</p><p><strong>Results: </strong>Tamoxifen treatment (30 mg/kg/d) induced BBB breakdown of iCKO mice in a time-dependent manner (analysis of variance [ANOVA] for time, P = .0006), but not in their littermate control mice (nCKO, P > .999). A 3-day tamoxifen treatment induced slight BBB breakdown (EB leakage: 95% confidence interval [CI], 13.9-204.8, P = .013; IgG level: 95% CI, 12.6-51.4: P = .001), but did not cause significant cognitive impairment in the Novel Object Recognition test in iCKO mice (95% CI, -7.99 to 6.12; P > .999). Anesthesia and surgery-induced significant cognitive impairment (all P < .0001 for the Novel Object Recognition test, Barnes Maze test), neuroinflammation, and synaptic loss in iCKO mice with 3-day tamoxifen treatment, but not in nCKO mice with the same treatment. Inhibiting astrocyte activity alleviated the impact of anesthesia and surgery on cognitive function (all P < .0001 for the Novel Object Recognition test, Barnes Maze test), gene expression, and synapse pruning in iCKO mice with 3-day tamoxifen treatment.</p><p><strong>Conclusions: </strong>Preoperative BBB integrity influences the impact of anesthesia and surgery on the brain, with astrocytes modulating this effect. These findings partly explain the heterogeneity in the occurrence of postoperative brain homeostasis imbalance.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"896-907"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845637","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":"For the Love of Clove.","authors":"Thomas R Vetter","doi":"10.1213/ANE.0000000000007235","DOIUrl":"10.1213/ANE.0000000000007235","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"931-932"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942753","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":"Fibrinogen Dose Variability in Cardiac Surgery Patients Who Required Cryoprecipitate Replacement.","authors":"Félix R Montes, Laura Peña-Blanco, Andrea Barragán-Méndez, Angélica M Patiño, Hugo Mantilla-Gutiérrez, German Franco-Gruntorad","doi":"10.1213/ANE.0000000000007412","DOIUrl":"10.1213/ANE.0000000000007412","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"908-910"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121829","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":"Intubation Setting and Mortality in Trauma Patients Undergoing Hemorrhage Control Surgery: A Propensity Score-Matched Analysis.","authors":"Tomer Talmy, Irina Radomislensky, Isaac Brzezinski Sinai, Ruth Shaylor, Eldad Katorza, Sami Gendler","doi":"10.1213/ANE.0000000000007542","DOIUrl":"10.1213/ANE.0000000000007542","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation is essential for airway management in trauma patients but may cause hemodynamic instability and delay critical resuscitation measures. Recent studies have suggested that emergency department (ED) intubation may be linked with higher mortality compared to operating room (OR) intubation in trauma patients. However, it remains unclear if these findings apply to broader trauma populations, including both civilian and military patients. This study uses a nationwide trauma registry to test the hypothesis that ED intubation is associated with higher in-hospital mortality among major trauma patients, compared to OR intubation.</p><p><strong>Methods: </strong>Registry-based analysis of the Israeli National Trauma Registry evaluating major trauma (Injury Severity Score [ISS] ≥16) patients requiring hemorrhage control surgery between 2016 and 2023. ED intubation was the main exposure variable with in-hospital mortality serving as the primary outcome. Multivariable logistic regression and propensity score matching were applied to adjust for confounders, including injury severity, ED vital signs, penetrating injury, and blood product administration.</p><p><strong>Results: </strong>The study included 975 patients, 470 (48.2%) of whom were intubated in the ED. ED-intubated patients had significantly higher ISS and higher proportion of profound shock compared to those intubated in the OR. In-hospital mortality was more common among patients intubated in the ED (22.6%) as compared with those intubated in the OR (8.5%). In the unadjusted logistic regression, ED intubation was associated with higher odds of in-hospital mortality (OR: 3.13, 95% confidence interval [CI], 2.15-4.62). However, after adjusting for several potential confounders, the association became nonsignificant and was persistent across sensitivity subgroup analyses. Propensity score matching resulted in 1:1 matching of 271 patients in each group, balancing characteristics such as ISS, profound shock, Glasgow Coma Scale, and penetrating injury. After matching, the mortality rate was similar between groups (12.5% for ED intubation vs 12.2% for OR intubation). In the matched cohort, logistic regression demonstrated no significant association between ED intubation and in-hospital mortality (OR: 0.97, 95% CI, 0.58-1.61). ED intubation was associated with a greater than 2-fold increase in odds of ICU admission in adjusted and propensity score-matched analyses.</p><p><strong>Conclusions: </strong>ED intubation was not significantly associated with increased in-hospital mortality after controlling for injury severity and shock. These findings suggest that while ED intubation may be more frequent in severely injured patients, its independent impact on mortality in patients undergoing emergent surgery remains unclear, warranting further prospective investigation.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"836-846"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075541","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":"In Response.","authors":"Jing-Yang Liou, Chien-Kun Ting","doi":"10.1213/ANE.0000000000007670","DOIUrl":"10.1213/ANE.0000000000007670","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e58-e59"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783273","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}