Anesthesia and analgesia最新文献

{"title":"Microcirculation Under the Magnifying Glass: When the Analysis Does Go Wrong.","authors":"Arnaldo Dubin","doi":"10.1213/ANE.0000000000007728","DOIUrl":"10.1213/ANE.0000000000007728","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e83-e85"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939270","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":"Lee A Goeddel, Ciprian M Crainiceanu, Nauder Faraday","doi":"10.1213/ANE.0000000000007720","DOIUrl":"10.1213/ANE.0000000000007720","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e81-e82"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758898","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":"Thinking of Obstructive Sleep Apnea in the Causal Pathway: Cause or Mediator?","authors":"Brad Luo, Amir L Butt, Kenichi A Tanaka, Kenneth E Stewart","doi":"10.1213/ANE.0000000000007369","DOIUrl":"10.1213/ANE.0000000000007369","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e73"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370234","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":"Influence of Repeated Exposure to Neonatal Isoflurane on Sleep Architecture and Neuronal Delta and Theta Oscillations in Adolescent Rats.","authors":"Arthur J Armijo, Brier Fine-Raquet, Nemanja Useinovic, Francesca M Manzella, Vesna Jevtovic-Todorovic, Slobodan M Todorovic","doi":"10.1213/ANE.0000000000007462","DOIUrl":"10.1213/ANE.0000000000007462","url":null,"abstract":"<p><strong>Background: </strong>Normal sleep architecture is important for brain development, and we previously demonstrated that a single exposure to isoflurane during the neonatal period did not induce changes in the sleep architecture and only minimally altered neuronal beta oscillations in adolescent rats. Here, we hypothesized that a more clinically relevant scenario of repeated shorter exposures to isoflurane during brain development may have more profound effects on sleep and wake behavior and associated delta and theta oscillations, respectively.</p><p><strong>Methods: </strong>Male and female rat pups were exposed to sham anesthesia (30% oxygen) or repeated isoflurane delivery for 2 hours each on 3 consecutive days (total exposure of 6 hours). The rat pups were divided into 2 cohorts. In cohort 1, we evaluated the neurotoxic effects of exposure postanesthesia. In cohort 2, electroencephalogram electrodes were implanted into the rat cortex between postnatal days 21-23, and sleep architecture was classified as wake, nonrapid eye movement (NREM), and rapid-eye movement (REM) sleep. Electroencephalogram power spectra were also measured in adolescent rats over a 72-hour period.</p><p><strong>Results: </strong>Isoflurane exposure (n = 11) increased neuroapoptosis to 27. 7 ± 6.5 per mm -2 when compared to the sham group (9. 6 ± 3.0 per mm -2 , n = 12, P < .001) and disrupted sleep architecture in adolescent rats. Specifically, there was an increase in the total sleep time (light + dark period) from 89. 9 ± 14.2 minutes in sham group (n = 9) to 111. 2 ± 32.2 minutes in the experimental group (n = 11, P < .05). Furthermore, there were fewer transitions during the dark period from 157. 1 ± 43.3 in sham group (n = 9) to 110. 6 ± 52.5 in the experimental group (n = 11, P < .05). The absolute power of delta oscillations was significantly decreased during the light period of NREM from an average 2217 ± 2016 μV 2 in the sham group (n = 8) to 791 ± 659 μV 2 in the experimental group (n = 11, P < .05). Further, theta oscillations in the wake stage were significantly decreased in the light period from 1579 ± 885 μV 2 in sham group (n = 8) to 690 ± 413 μV 2 in the experimental group (n = 11, P < .05) and light + dark period from 1390 ± 808 μV 2 in sham group (n = 8) to 691 ± 421 μV 2 in the experimental group (n = 11, P < .05).</p><p><strong>Conclusions: </strong>Exposing neonatal rats to isoflurane repeatedly causes significant neurotoxicity, and alters delta and theta thalamocortical oscillations, as well as sleep architecture in adolescence. This contrasts with a single continuous exposure to isoflurane, in which we previously reported no significant effects on sleep-wake architecture and only minimal effect on beta oscillations despite similar acute neurotoxicity.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1010-1019"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571508","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":"Alexandre Joosten, Sean Coeckelenbergh, Tristan Grogan, Moritz Flick, Jacques Duranteau","doi":"10.1213/ANE.0000000000007729","DOIUrl":"10.1213/ANE.0000000000007729","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e85-e86"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939211","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":"The Case for the Role of Primary Care in Patient Blood Management.","authors":"Pradeep H Jayasuriya, Anusha Philips, Hafiza B Misran","doi":"10.1213/ANE.0000000000006912","DOIUrl":"10.1213/ANE.0000000000006912","url":null,"abstract":"<p><p>Patient blood management (PBM) is a patient-centered evidence-based strategy designed to preserve a patient's own blood and improve health outcomes. The effectiveness of PBM programs is now well-established globally within tertiary and secondary sectors, with demonstrable outcome benefits and cost savings. However, the role of primary care and the general practitioner in PBM is poorly understood. Yet the essential attributes of primary care, including access, continuity, coordination, and comprehensiveness, align well with PBM principles, enabling general practitioners to provide personalized holistic management of anemia for the community. The skill set of general practitioners in integrating and continuing care through the transition period after hospitalization is especially important. General practitioners are well-suited to the roles of health promotion and prevention, and have the potential to deliver substantial population health benefits. Given the public health imperative of this condition, it is vital that policy-makers appropriately support the role of general practitioners with financing, education, and resources for PBM in primary care.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"975-983"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370780","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":"A Retrospective Study of Ultramassive Transfusion in Trauma Patients: Is There a Value After Which Additional Transfusions Are Futile?","authors":"Frank R Major, Trevor A Pickering, Kristen Stefanescu, Mandeep Singh, Damon H Clark, Kenji Inaba, Jeffry T Nahmias, Erika L Tay-Lasso, Claudia Alvarez, Joy L Chen, Farzin Ahmed, Olga Y Kaslow, Jeffrey L Tong, Jianzhou Xiao, Elizabeth Hall, Rania Elkhateb, Youssef Bahgat, Danielle Tatum, John T Simpson, Siddharth Singh, Norma J Klein, Richard L Applegate, Catherine M Kuza","doi":"10.1213/ANE.0000000000007569","DOIUrl":"10.1213/ANE.0000000000007569","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is a leading cause of preventable mortality in trauma. During times of blood shortages, it may be prudent to consider a transfusion threshold during massive transfusion after which additional transfusions are futile due to nonsurvivability. The main objective of this study is to examine outcomes associated with ultramassive transfusion (UMT; defined as ≥20 units of red blood cells [RBC] within 24 hours) and determine if there is a threshold beyond which additional transfusion efforts should cease.</p><p><strong>Methods: </strong>We performed a retrospective (2016-2022) analysis of adult trauma patients (≥ 18 years old) who underwent surgery and received blood products within 24 hours of admission at 7 US Level I trauma centers. We compared patients who received UMT and patients who received <20 units RBC and evaluated the effects of various amounts of blood products on mortality, length of stay (LOS), mechanical ventilation (MV), and complications. Segmented logistic regression analysis was performed to determine if there is a \"plateau\" effect of increasing RBC units on mortality.</p><p><strong>Results: </strong>Of 3248 patients included, 2913 (89.7%) received <20 RBC units within 24 hours, and 333 (10.3%) received ≥20 RBC units within 24 hours. Patients receiving UMT had increased 24-hour mortality (risk ratio [RR] 6.00, 95% confidence interval [CI], 4.79-7.52, P < .001) and index hospitalization mortality (RR 3.99 [3.34-4.75], P < .001). These patients also more often developed complications (RR 1.67 [1.44-1.94], P < .001) and multiple organ failure (RR 2.78 [2.20-3.52], P < .001). Compared to those receiving 20 to 29 RBC units, those receiving 30 to 44 RBC units had statistically similar associated risk of death (RR 1.32 [0.93-1.87], P = .12); however, those receiving ≥45 RBC units had an increased associated risk of death (RR 1.59, [1.12-2.25], P = .009), and additional transfusion beyond this point did not improve the probability of survival.</p><p><strong>Conclusions: </strong>In this study, patients who received UMT had higher mortality and worse outcomes than those who received fewer units. However, this study did not identify a threshold beyond which all patients died and therefore cannot justify implementing a limit on the number of RBC units transfused based on these data alone.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1126-1136"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186267","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":"Comparative Effectiveness of Analgesia for Early Pain Management After Pediatric Tonsillectomy: A Systematic Review and Network Meta-Analysis.","authors":"Xialin Deng, Shishun Zhao, Wenlai Guo, Xiao Wan, Di You","doi":"10.1213/ANE.0000000000007352","DOIUrl":"10.1213/ANE.0000000000007352","url":null,"abstract":"<p><strong>Background: </strong>Timely and effective analgesia after tonsillectomy in children is crucial, but there is currently no consensus on the optimal analgesics. This analysis aimed to identify the most effective for this surgery.</p><p><strong>Methods: </strong>We conducted a systematic review and network meta-analysis (random-effects model) of randomized controlled trials comparing analgesics for pediatric tonsillectomy. We searched relevant studies in PubMed, Embase, Cochrane Library, and Web of Science databases from database inception until June 30, 2023. Children (≤18 years old) who underwent tonsillectomy with or without adenoidectomy were eligible for inclusion. Primary outcomes encompassed pain score and postoperative complications; secondary outcomes included postoperative supplementary analgesia, functional evaluation, and sedation score.</p><p><strong>Results: </strong>In total 82 randomized controlled trials involving 6110 patients were included, forming the primary network that comprised comparative data for 16 different interventions (including placebo) across 6 types of analgesics. The integrated analysis revealed that nonsteroidal anti-inflammatory drugs except ketoprofen had no significant effects in relieving postoperative pain (mean difference [MD], -2.96; 95% confidence interval [CI], -5.59 to -0.32; P = .10). Local anesthetic infiltration (bupivacaine: MD, -2.76; 95% CI, -3.88 to -1.64, P = .01; ropivacaine: MD, -2.49; 95% CI, -4.25 to -0.73, P = .02; lidocaine: MD, -1.86; 95% CI,-3.52 to -0.2, P = .02; levobupivacaine: MD, -1.06; 95% CI, -2.00 to -0.12, P = .01), analgesics (morphine: MD, -2.07; 95% CI, -3.14 to -1.00; P = .02), and glucocorticoids (dexamethasone: MD, -0.45; 95% CI, -0.73 to -0.16; P = .01) were effective in relieving pain after pediatric tonsillectomy. In reducing incidence of postoperative complications, dexamethasone was superior to bupivacaine (relative risk [RR], 0.60; 95% CI, 0.43-0.83; P = .02). Regarding the number of patients needing rescue analgesic, levobupivacaine was superior to lidocaine (RR, 0.51; 95% CI, 0.32-0.81; P = .01). In rescue analgesia requirement, morphine outperformed lidocaine (RR, 0.44; 95% CI, 0.25-0.75; P = .01) and ropivacaine (RR, 0.54; 95% CI, 0.32-0.91; P = .01) in efficacy but not different from bupivacaine ( P = .10) and levobupivacaine ( P = .12).</p><p><strong>Conclusions: </strong>Based on these results, we would recommend local bupivacaine infiltration or local levobupivacaine infiltration for older children and dexamethasone injection for younger children for early analgesia after tonsillectomy. However, clinicians should choose the optimal analgesic based on the individual child's condition and clinical situation.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1037-1051"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869292","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":"Design and Staged Implementation of a Multidisciplinary Preoperative Anemia Clinic at a Tertiary Care Medical Center.","authors":"Ethan H Crispell, Claire E Cassianni, Jennifer M Burt, Jessica A Gonzalez, Jamie L Petsch, Andrew C Hanson, Kellie A Robbins, Ronald S Go, Juan A Crestanello, Adam K Jacob, Daryl J Kor, Matthew A Warner","doi":"10.1213/ANE.0000000000007435","DOIUrl":"10.1213/ANE.0000000000007435","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anemia is common and associated with adverse outcomes in surgical patients. There is limited information to guide the design and implementation of preoperative anemia clinics (PAC), which represents a critical barrier to entry for many practices.</p><p><strong>Methods: </strong>This is a descriptive observational study highlighting the design and implementation of a multidisciplinary PAC, including key steps in planning, stakeholder engagement, organizational structure, identification of target populations, establishing anemia treatments, information technology and electronic health record integration, provider training, and data infrastructure. Demographic and clinical characteristics, laboratory results, and anemia treatments for individuals evaluated in the PAC from November 4, 2019 through September 15, 2023 are enumerated. Patient-reported outcomes (PROs) assessing changes in anemia symptoms and well-being after surgery are evaluated for 2 subsets of patients (one before PAC implementation [pre-PAC], another after PAC implementation [post-PAC]), without formal statistical comparison given limited sample sizes.</p><p><strong>Results: </strong>The PAC was initiated as a multidisciplinary effort under support from a Mayo Clinic Practice Transformation Award in 2019, including broad representation from anesthesiology, surgery, and medical practices, along with institutional project management support (eg, project manager, information technologists, systems engineers). While initially limited to cardiac surgery patients, the PAC underwent planned incremental expansion to include other surgical services. Over the study period, 1188 PAC consultations across 1159 unique patients met eligibility criteria, with a median age of 66 (57-73) years and 58.1% women. The most common etiology of anemia was iron deficiency (69.1%) followed by anemia related to cancer (17.3%). Anemia-directed therapies were recommended in 1038 (87.4%) encounters, with 730 (70.3%) of those receiving recommended treatment preoperatively. Seven hundred nine (97.1%) treatments included intravenous iron and 146 (20.0%) included erythropoiesis-stimulating agents. Fifteen pre-PAC and 38 post-PAC implementation patients completed PROs. PAC implementation was accompanied by earlier resolution of anemia symptoms and less pronounced declines in postoperative well-being scores.</p><p><strong>Conclusions: </strong>This report highlights the key steps for successful PAC implementation. Treatment is possible for most patients and may be accompanied by improvements in patient-important outcomes.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"964-974"},"PeriodicalIF":3.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522487","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":"The Current State of Pediatric Cardiac Anesthesiology Staffing in the United States.","authors":"Joseph Huffman, Todd Glenski, Christian Taylor, Nathaniel Lata","doi":"10.1213/ANE.0000000000007647","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007647","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243621","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}