Anesthesia and analgesia最新文献

{"title":"Impact, Not Impact \"Factor\": Strategies to Maintain Anesthesia & Analgesia As the World's Most Cited Anesthesia Journal in the New Online Format.","authors":"Jaideep J Pandit","doi":"10.1213/ANE.0000000000008311","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008311","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147496","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":"Common Laryngoscopy Errors Among Novice Pediatric Anesthesia Trainees Intubating Neonates and Infants.","authors":"Samuel Y Kim, Mary Lyn Stein, Raymond S Park, James M Peyton, Pete G Kovatsis, Stephen G Flynn","doi":"10.1213/ANE.0000000000008258","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008258","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147599","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":"When Exposure Precedes Randomization: Rethinking Interpretation of Transfusion Threshold Trials.","authors":"Kevin M Trentino, Michael F Leahy, Shannon L Farmer","doi":"10.1213/ANE.0000000000008325","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008325","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147236","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":"Artificial Intelligence-Driven Clinical Decision Support for Postoperative Delirium Prevention: A Pragmatic Randomized Controlled Trial.","authors":"Danielle Scharp, Kerry Meyers, Girish Nadkarni, Alex Federman, Catherine Sarkisian, Matthew A Levin, Spencer Perry, Pooja Gownivaripally, Natalia N Egorova, Yuxia Ouyang, Susana Vacas, Ira Hofer","doi":"10.1213/ANE.0000000000008318","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008318","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium affects up to 50% of older adults with cognitive impairment, yet preoperative identification of at-risk patients remains limited. Artificial intelligence methods, such as natural language processing, can extract cognitive impairment signals from electronic health records and enable targeted clinical decision support interventions to promote adherence to perioperative best practices and reduce postoperative delirium. We aimed to evaluate the effectiveness of an artificial intelligence-driven non-interruptive clinical decision support intervention in reducing postoperative delirium by promoting adherence to best practices among anesthesia teams caring for surgical patients with cognitive impairment.</p><p><strong>Methods: </strong>We conducted a pragmatic randomized controlled trial embedded within routine clinical care at The Mount Sinai Hospital in New York City from June 20, 2023, to August 31, 2024, including patients with preoperative cognitive impairment identified immediately before surgery using a validated natural language processing algorithm, Mini-Mental State Examination scores, or diagnostic codes. Patients were randomized to an artificial intelligence-driven non-interruptive clinical decision support intervention within the electronic health record to promote adherence to best practices among anesthesia teams or routine perioperative care. The primary outcome was postoperative delirium, assessed with the 4 A's Test within seven days postoperatively. Secondary outcomes were adherence to 12 perioperative best practices. We used chi-square tests for primary and secondary outcome analyses.</p><p><strong>Results: </strong>Overall, 7294 patients were identified as having cognitive impairment immediately before surgery and were randomized to the intervention (n = 3624) or control (n = 3670) group. In total, 1255/7294 (17.2%) patients had documented postoperative delirium assessments, of whom 426/1255 (34%) developed this condition. Between intervention and control groups, there were no statistically significant differences in POD incidence (225/641, 35.1% vs 201/614, 32.7%, P = .37) or best practice adherence (all P > .05).</p><p><strong>Conclusions: </strong>In this pragmatic randomized controlled trial, less than 20% of the sample had documented delirium assessments due to variability in routine POD screening practices, limiting our ability to conclude that artificial intelligence-driven clinical decision support was not effective in preventing postoperative delirium. However, based on our secondary outcome analyses, the intervention did not significantly change best practice adherence. Further work is needed to determine the best way to use these tools effectively.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147863","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":"Tracking the Publication Fate of Rejected Manuscripts: A Hybrid Automated-Manual Approach.","authors":"Valluvan Rangasamy, Daniel Mount, Thomas R Vetter","doi":"10.1213/ANE.0000000000008347","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008347","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147847","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":"Borja Barrachina, Cristina Vinuesa, Ibai Iriarte, Ania Albinarrate","doi":"10.1213/ANE.0000000000008305","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008305","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134767","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 a Multidisciplinary Institution-Wide Enhanced Surgical Recovery Framework on Perioperative Opioid Use: A Retrospective Cohort Study of 49,394 Patients.","authors":"Alison A Whalen, Stacy A Brethauer, Kimberly Halm, Kristin I Brower, Valerie Pervo, Mahmoud Abdel-Rasoul, Tejen Shah, Ahmad Shabsigh, Michelle L Humeidan","doi":"10.1213/ANE.0000000000008097","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008097","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Enhanced surgical recovery (ESR) programs aim to support opioid-sparing care through patient education and multimodal analgesia (MMA) with pharmacologic and regional anesthesia approaches. Few studies have evaluated longitudinal, institution-wide ESR implementation across multiple surgical specialties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We completed a retrospective cohort analysis of patients with eligible surgical procedures 2 years prior to ESR implementation (base) and after implementation (ESR) for ambulatory and inpatient surgeries at a large academic medical center, covering a 10-year span. Patients were grouped by discharge disposition (same day discharge, postoperative day [POD]. 1discharge, and POD ≥ 2 discharge) and by individual protocol. We examined the association between ESR adoption and use of MMA, opioid consumption, and patient-reported pain scores. Oral morphine equivalency (OME) was compared for periprocedural (inpatient OME per day) and post-discharge (total outpatient OME prescribed within 30 days) phases of care. Utilization of multimodal analgesia (MMA use), including specific procedural (regional blocks with local anesthesia or intrathecal morphine) and pharmacologic contributors (administration of at least two periprocedural non-opiate pain medication adjuncts), was also examined, in addition to maximum pain score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 49,394 patients (14,607 Base; 34,787 post-ESR), ESR implementation was associated with meaningful reductions in opioid use for all discharge dispositions, with the most significant decreases observed among patients having surgery associated with longer postoperative stays (median [IQR], POD ≥ 2 discharge: Inpatient OME per day: Base 50.5 [27.3-83.7], ESR 36.3 [20.0-60.5], P &lt; .0001; total outpatient OME: Base 300.0 [150.0-600.0], ESR 150.0 [90.0-225.0], P &lt; .0001)). Utilization of non-opioid analgesics and regional analgesia varied by discharge disposition but was consistently observed to increase for ESR patients, with largest gains shown in the POD ≥ 2 discharge group (MMA use: same day discharge, base 50.1%, ESR 61.5%, P &lt; .0001; POD 1 discharge, base 77.4%, ESR 89.1%, P &lt; .0001; POD ≥2 discharge, base 70.6%, ESR 89.0%, P &lt; .0001). Segmented regression analyses identified downward trends in opiate use beginning during the planning phase of ESR with additional decreases temporally aligned with protocol initiation. The models showed significantly increased MMA in all discharge groups since the start of ESR. Maximum pain scores before and after ESR implementation remained stable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;System-wide implementation of an ESR framework was associated with lower perioperative opioid use without compromising pain control. Variation in MMA approach across individual protocols and discharge disposition groups highlights the value of multidisciplinary ESR programs in promoting effective and standardized, yet also customized,","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134827","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 Deep Versus Moderate Neuromuscular Block on Chronic Postsurgical Pain After Lumbar Spine Surgery: A Randomized Clinical Trial.","authors":"Xinghe Wang, Jing Xia, Dong Huang, Jie Guo, Yan Wu, Tianyu Yin, Yuqi Zhang, Keqin Wang, Ziqian Zhang, Yumei Li, Jia Sun, Su Liu","doi":"10.1213/ANE.0000000000008324","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008324","url":null,"abstract":"<p><strong>Background: </strong>Chronic postsurgical pain (CPSP) is a debilitating complication following posterior lumbar surgery, often exacerbated by retraction-induced paraspinal muscle injury. While deep neuromuscular blockade (DNMB) optimizes surgical conditions, its ability to mitigate this mechanical injury and prevent pain chronification remains unproven. This trial investigated the effect of DNMB on the incidence of CPSP and its underlying biological mechanisms.</p><p><strong>Methods: </strong>Participants scheduled for posterior lumbar interbody fusion were randomized to either the DNMB group or the moderate neuromuscular blockade (MNMB) group. The primary outcome was CPSP incidence at 3 months. Secondary outcomes included the incidence of CPSP at 6 months, postoperative opioid consumption, acute muscle injury biomarkers (creatine kinase [CK], myoglobin [MYO], and lactate dehydrogenase [LDH]), and radiographic assessment of cross-sectional area (CSA) and fat infiltration (FI) of paraspinal muscles.</p><p><strong>Results: </strong>Of 180 patients randomized, 178 were included in the modified intention-to-treat analysis. At 3 months, the incidence of CPSP was significantly lower in the DNMB group (17/89 [19.1%]) compared with the MNMB group (31/89 [34.8%]) (risk ratio [RR], 0.6; 95% confidence interval [CI], 0.3-0.9; P = .018). There was no significant difference in the incidence of CPSP at 6 months (13/89 [14.6%] vs 17/89 [19.1%]; RR, 0.8; 95% CI, 0.4-1.5; P = .423). Furthermore, the DNMB group demonstrated lower postoperative pain scores, reduced opioid consumption, and higher surgeons' satisfaction scores (P < .05, P < .001, P < .001, respectively). This group also exhibited lower early postoperative serum concentrations of CK, MYO, and LDH (all P < .001 on postoperative day 1), alongside better preservation of CSA and less progression of FI on 6-month magnetic resonance imaging (MRI; all P < .001).</p><p><strong>Conclusions: </strong>Compared to MNMB, DNMB significantly reduced the 3-month incidence of CPSP and decreased opioid consumption in patients undergoing spinal surgery. These clinical benefits were associated with reduced acute muscle injury, as reflected by lower early injury biomarkers and better preservation of long-term paraspinal muscle structure.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134775","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 Risk Prediction Tools for Morbidity: An Evidence-Based Perspective.","authors":"Claire Dunstan, Alesha Wale, Hannah Shaw","doi":"10.1213/ANE.0000000000008323","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008323","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147282","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":"Perioperative Anemia Development and Recovery in Adult Surgical Patients: An Observational Cohort Study.","authors":"Denis Snegovskikh, Juan J Morales Behaine, German J Medina-Rincon, Ethan H Crispell, Andrew C Hanson, Kellie A Robbins, Matthew A Warner","doi":"10.1213/ANE.0000000000008365","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008365","url":null,"abstract":"<p><strong>Background: </strong>Anemia affects more than two billion people worldwide and is common among surgical patients. Despite growing recognition of the risks associated with preoperative anemia, we have limited understanding of the epidemiology of anemia development and recovery.</p><p><strong>Methods: </strong>This is an observational cohort study of adults undergoing surgery at a large tertiary care medical center from August 2012 to July 2023. Hemoglobin concentrations were obtained preoperatively, during postoperative hospitalization, and through 12 months after surgery. Anemia was defined primarily using World Health Organization criteria (hemoglobin <12 g/dL in women, <13 g/dL in men) and secondarily with a gender-neutral threshold of <13 g/dL. Descriptive analyses summarize preoperative anemia prevalence, postoperative anemia prevalence and incidence, and post-hospitalization anemia recovery across demographic, clinical, and surgical features.</p><p><strong>Results: </strong>281,217 patients undergoing 423,066 procedures (51.9% among women) were included. Among those with available preoperative hemoglobin assessments (n = 308,959), 28.9% had anemia, with similar prevalence in men (29.5%) and women (28.4%) using World Health Organization (WHO) definitions, but with prevalence increasing to 51.0% in women when using the gender-neutral anemia definition. Preoperative anemia was most common in Black patients (44.0%) and in those ≥75 years (39.6%). Surgical subspecialties showed wide variation in preoperative anemia prevalence, ranging from 18.6% in spine surgery to 45.8% in vascular surgery. Among previously nonanemic patients admitted to the hospital postoperatively, 76.9% developed new postoperative anemia, with the highest incidence in cardiac surgery (97.5%). Women experienced more severe postoperative anemia than men. Overall, 81.1% of patients were anemic at hospital discharge. Recovery was gradual and incomplete: among those discharged with mild, moderate, or severe anemia, 28.5%, 51.9%, and 66.3%, respectively, remained anemic at 12 months. Among patients who were nonanemic preoperatively but developed new postoperative anemia, 29.3% remained anemic at 12 months.</p><p><strong>Conclusions: </strong>Preoperative and postoperative anemia are highly prevalent, and anemia frequently persists for months after hospitalization. Older adults, women, and Black patients bear a disproportionate burden. Despite this, anemia evaluations and treatments remain underutilized. These findings highlight substantial opportunities for patient blood management (PBM) programs to improve perioperative anemia detection, optimization, and post-discharge management.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147432","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}