Anesthesia and analgesia最新文献

{"title":"Citrate Burden: The Missing Variable in Whole Blood Versus Component Therapy Comparisons.","authors":"Min Uk Jang, Kenichi A Tanaka, Kenneth E Stewart, Amir L Butt","doi":"10.1213/ANE.0000000000008243","DOIUrl":"10.1213/ANE.0000000000008243","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e72-e73"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705100","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":"Effects of Ketamine and Esketamine on Postoperative Delirium After General Anesthesia: A Meta-Analysis and Meta-Regression Analysis.","authors":"Shuying Li, Wenqin Zhou, Ping Li, Yajiao Hu","doi":"10.1213/ANE.0000000000008380","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008380","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a frequent and serious complication, particularly in older adults undergoing major surgery. Pharmacologic prevention remains limited. This study aimed to evaluate whether perioperative ketamine or esketamine reduces POD incidence and to explore optimal administration strategies.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to January 2025 for randomized controlled trials (RCTs) comparing perioperative ketamine or esketamine with placebo or standard care. The primary outcome was POD incidence (risk ratio [RR]). Subgroup, meta‑regression, and trial sequential analysis (TSA) were performed. Sensitivity analyses addressed active comparators and unit‑of‑analysis issues.</p><p><strong>Results: </strong>Twenty-five RCTs (3344 patients) were included (ketamine: 9; esketamine: 16). Both agents reduced POD risk versus control (ketamine: RR 0.69, 95% CI, 0.49-0.98, P = .04; esketamine: RR 0.58, 95% CI, 0.36-0.95, P = .03). Benefit was more evident with high-dose regimens (single bolus: ketamine >0.5 mg/kg or esketamine >0.25 mg/kg; cumulative dose: ketamine >1.0 mg/kg or esketamine >0.5 mg/kg), bolus-plus-infusion, and in major surgery. The effect was observed when POD was assessed 2 to 7 days postoperatively, but not within 24 hours. TSA indicated that current evidence remains inconclusive due to insufficient information size. Dizziness risk increased (RR 1.45, 95% CI, 1.14-1.84, P = .002), while postoperative depressive symptoms decreased (RR 0.78, 95% CI, 0.63-0.96, P = .02; based on 2 studies, 493 patients).</p><p><strong>Conclusions: </strong>Perioperative ketamine and esketamine show a potential signal for POD reduction, particularly with optimized dosing in high‑risk patients. However, the evidence is currently inconclusive, and increased dizziness risk precludes routine recommendation. Large, multicenter RCTs are urgently needed.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206371","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":"Health Equity and Belonging: A Career Framework for Healthcare Diversity, Equity, and Inclusion in Anesthesiology.","authors":"Stephen R Estime, Leziga T Obiyo, Matthew C Wixson","doi":"10.1213/ANE.0000000000008370","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008370","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206428","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 Cardio-obstetric Epidemiology of Heart Valve Surgery During Pregnancy and Delivery Hospitalizations: A US National Analysis.","authors":"Grettel J Zamora-Berridi, Diana Barragan-Bradford, Ruben Oganesyan, Omar Hyder","doi":"10.1213/ANE.0000000000008368","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008368","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206458","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":"Intraoperative Hemodynamic and Resuscitation Practice Variation for Left Ventricular Assist Device Implantation: A Multicenter Observational Analysis.","authors":"Allison M Janda, Jonathan J Herrera, Michael J Pienta, Graciela B Mentz, Sachin Kheterpal, Tessa M Watt, Francis D Pagani, Donald S Likosky, Robert B Schonberger, Kamrouz Ghadimi, Michael R Mathis","doi":"10.1213/ANE.0000000000008367","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008367","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190649","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":"Exploratory Optimization of Focused Ultrasound Parameters for Selective Peripheral Nerve Fiber Inhibition.","authors":"Namrata Sangwan, Lidia Mergelian, Michael Klukinov, Morteza Mohammadjavadi, Riya Navani, Cholawat Pacharinsak, Kim Butts Pauly, David C Yeomans, Thomas A Anderson","doi":"10.1213/ANE.0000000000008386","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008386","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190589","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":"Trending Agreement: Bland-Altman Is All You Need.","authors":"Johannes Enevoldsen, Alexander Hapfelmeier, Lasse Vormfenne, Andreas Magnussen, Aleksander L Falsig, Peter Juhl-Olsen, Bernd Saugel, Simon T Vistisen","doi":"10.1213/ANE.0000000000008389","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008389","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190597","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":"Halothane Withdrawal From Clinical Practice: Strategic Implications Informed by a Scoping Review.","authors":"Simon Ponthus, Amina Omari, Natacha Pfeiffle, Camille Valera, M Dylan Bould, Adrian W Gelb, Lionel Dumont","doi":"10.1213/ANE.0000000000008334","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008334","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179008","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":"Effect of Sevoflurane, Propofol, and Remifentanil on Hemodynamic Response to Pneumoperitoneum and Laparoscopic Surgery: A Randomized Controlled Trial.","authors":"Martin Luginbühl, Olivier M Schmid, Paul A Schmidt, Livia S Schmalz, Thomas W Schnider","doi":"10.1213/ANE.0000000000008352","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008352","url":null,"abstract":"<p><strong>Background: </strong>Although the interaction of sevoflurane, propofol, and opioids has been investigated regarding motor response to laryngoscopy, their hemodynamic impact during surgical stimulation remains unexplored. We therefore assessed the effect of sevoflurane, propofol, and remifentanil on the hemodynamic response to pneumoperitoneum and laparoscopic surgery.</p><p><strong>Methods: </strong>The American Society of Anesthesiologists (ASA) physical status I or II patients scheduled for elective laparoscopic surgery were randomly assigned to one of six groups with different combinations of sevoflurane-remifentanil, propofol-remifentanil, or sevoflurane-propofol-remifentanil, respectively. The Ce50 BARPP (pneumoperitoneum) for sevoflurane and propofol in combination with remifentanil was determined with the up-and-down method, and the interaction of the three drugs on mean arterial pressure (MAP) response was described with a linear-additive model. During surgery remifentanil was titrated to keep the MAP <100 mm Hg at fixed concentrations of sevoflurane (1 vol%), propofol (3 µg mL-1), or sevoflurane (0.5 vol%) plus propofol (1.5 µg mL-1). The relationship between remifentanil and MAP during surgery was described with a linear mixed-effects model.</p><p><strong>Results: </strong>Data of 155 patients were analyzed. At remifentanil 5 ng mL-1 the Ce50 BARPP (95% CI) of sevoflurane was 1.56 (1.18-1.95) vol%, and of propofol 4.82 (4.29-5.36) µg mL-1. At remifentanil 3 ng/ml plus either propofol 1.8 µg mL-1 or sevoflurane 0.6 vol%, the values were 2.2 (2.0-2.4) vol% and 5.9 (5.7-6.0) µg mL-1. The drug interaction model revealed a propofol scaling factor (scaleSP) of 0.31 (0.19-0.44), representing the potency of propofol relative to sevoflurane, and a remifentanil constant kremi of 2.03 (0.82-3.24), representing the hypnotic-sparing effect of remifentanil. The median (interquartile range) of remifentanil during surgery was 6.4 (5.8-7.7), 4.9 (3.6-6.7), and 5.0 (3.7-6.0) ng mL-1 in groups SR, PR, and SPR, respectively. The MAP did not correlate with the remifentanil concentrations, demonstrating evidence for the drug titration paradox.</p><p><strong>Conclusions: </strong>The relative potency of sevoflurane to propofol in reducing the MAP response to pneumoperitoneum is similar to that for tolerance of laryngoscopy but differs from that for hypnotic endpoints. The effect of remifentanil on reducing the MAP response is similar whether it is combined with sevoflurane or propofol. Because titration to a dynamic clinical end point decouples the traditional relationship between drug input and clinical outcome, titration data cannot be used to validate pharmacodynamic models.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179002","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 HIV on Perioperative Organ Injury and Surgical Outcomes in 41 Million Surgical Patients: A Retrospective Cohort Study.","authors":"Serena Dasani, Sai Keerthi Annam, Sicheng Wang, Felix Kork, Simon Betancourt-Escobar, Holger K Eltzschig, Yafen Liang","doi":"10.1213/ANE.0000000000008377","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008377","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;While antiretroviral therapy has improved surgical safety for people living with HIV, comprehensive data on perioperative organ injury and its impact on patient safety remain limited. This study aimed to compare the incidence of perioperative organ injury, in-hospital mortality, hospital length of stay, and hospitalization costs between people living with HIV and HIV-negative individuals undergoing surgery in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study used data from the National Inpatient Sample (NIS) from 2016 to 2021. The population-based sample included adult patients (age &gt;18 years) identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Of 41,622,004 eligible surgical admissions, 2,088,307 (5.0%) were people living with HIV and 39,533,697 were HIV-negative. Primary outcomes were perioperative organ injury incidence and associated mortality; secondary outcomes included hospital length of stay and total hospital charges. Adjusted models accounted for baseline characteristics and surgical complexity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 41,622,004 surgical admissions, people living with HIV were found to be older and carried a significantly higher comorbidity burden, with a Charlson Comorbidity Index of 8 compared to 1 in the HIV-negative group. Perioperative organ injury occurred in 1,348,363 of 2,088,307 people living with HIV (64.6%) compared with 7,867,547 of 39,533,697 HIV-negative patients (19.9%). Acute myocardial infarction (33.5%) and acute kidney injury (22.0%) were the most common injuries among people living with HIV. In-hospital mortality occurred in 66,935 of 2,088,307 people living with HIV (3.2%) compared with 872,170 of 39,533,697 HIV-negative patients (2.2%). Hospital length of stay and hospital charges were also significantly higher. Adjusted analyses demonstrated that HIV status was independently associated with higher in-hospital mortality (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.54-1.78), longer hospital length of stay (β = 2.73 days; 95% CI, 2.56-2.90), a decreased likelihood of home discharge (hazard ratio [HR], 0.73; 95% CI, 0.72-0.73), and increased hospitalization costs (β = $18,423; 95% CI, 16,712-20,134). Sensitivity analyses demonstrated that elevated perioperative risk persisted among patients with asymptomatic HIV infection, although the greatest risk was observed among patients with symptomatic HIV disease/AIDS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;People living with HIV incur a significantly higher risk of perioperative organ injury and worse surgical outcomes despite advances in antiretroviral therapy. HIV status was independently associated with adverse perioperative outcomes in adjusted models, supporting its inclusion as a risk stratification variable in surgical planning. Future research should incorporate immunologic markers, such as CD4 count and viral load,","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178975","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}