Anesthesia and analgesia最新文献

{"title":"Risk of Intraoperative Hypotension in ICI-Induced Versus Non-ICI-Associated Hypothyroidism: A Retrospective Study.","authors":"Fang Yan, Ge Qu, Yang Huang, Yan Rao, Hui Peng, Nianci Zhang, Weian Zeng, Chengtao Jiang, Haixia Guan, Wei Xing","doi":"10.1213/ANE.0000000000008342","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008342","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":"149147574","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":"An Assessment of Perceptions on Diversity and Cultural Humility Training in Anesthesiology Education: A Survey of the American Society of Anesthesiologists Membership.","authors":"Uchenna O Umeh, Oluwaseun Akinkuolie, Mia Zonies, Juliet Rowe, Pa Thor, David L Lee, Jashvant Poeran, Herodotos Ellinas, Katie J O'Conor, Edward R Mariano, Adam J Milam, Sylvia H Wilson","doi":"10.1213/ANE.0000000000008362","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008362","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":"149147024","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":"Beta Blockade in Septic Shock-Potential Focus for Future Studies.","authors":"Sebastian Rehberg, Duaa O Khair, Michel Slama, Tony Whitehouse","doi":"10.1213/ANE.0000000000008372","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008372","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":"149147028","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":"Age-Based Preoperative Transthoracic Echocardiography, Intraoperative Hypotension, and Postoperative Outcomes in Older Adults Undergoing Noncardiac Surgery: A Regression Discontinuity Analysis.","authors":"Takatomo Tesaki, Toshiyuki Nakanishi, Atsushi Ishikawa, Yuto Makino, Tatsuya Tsuji, Hiroya Hashimoto, Koichi Fujiwara, Kazuya Sobue","doi":"10.1213/ANE.0000000000008373","DOIUrl":"https://doi.org/10.1213/ANE.0000000000008373","url":null,"abstract":"<p><strong>Background: </strong>The clinical value of routine preoperative transthoracic echocardiography (TTE) in older adults remains controversial. Existing evidence is largely observational and vulnerable to confounding by indication, limiting causal interpretation of whether preoperative TTE improves intraoperative management and perioperative outcomes. We aimed to evaluate the local effect of routine age-based preoperative TTE using a quasi-experimental design.</p><p><strong>Methods: </strong>This single-center retrospective cohort study used a fuzzy regression discontinuity design based on an institutional policy of routine preoperative TTE in patients aged ≥75 years. Eligible patients were aged 60 to 89 years and underwent elective noncardiac surgery under general anesthesia from July 2017 to August 2024. To minimize confounding by indication, patients with guideline-based indications or other clinical conditions likely to prompt preoperative TTE independent of age were excluded. The primary outcome was intraoperative hypotension (IOH), defined as the duration of mean arterial pressure <65 mm Hg. Exploratory secondary outcomes included 30- and 90-day mortality, acute kidney injury (AKI), planned and unplanned intensive care unit (ICU) or cardiac care unit (CCU) admission, and postoperative length of hospital stay. Continuity of baseline characteristics and density of the running variable were assessed.</p><p><strong>Results: </strong>Among 7270 patients, the probability of undergoing preoperative TTE increased by 43.1 percentage points (95% confidence interval [CI], 33.3-52.9) at the 75-year-old cutoff, confirming a strong first-stage discontinuity. The estimated local effect of preoperative TTE on IOH was a 24.8-minute reduction (95% CI, -71.1 to 21.5). Sensitivity analyses using alternative bandwidths and covariate adjustment yielded similar findings. Point estimates for 30-day mortality (-2.1%; 95% CI, -6.0 to 1.8), 90-day mortality (-3.2%; 95% CI, -10.4 to 3.9), and AKI (-3.6%; 95% CI, -15.9 to 8.6) were below zero but imprecise. Point estimates were also below zero for unplanned ICU or CCU admission (-6.0 percentage points; 95% CI, -12.2 to 0.2) and postoperative length of hospital stay (-7.0 days; 95% CI, -14.6 to 0.5). Baseline characteristics and the density of the running variable (age) showed no clear discontinuity at the cutoff.</p><p><strong>Conclusions: </strong>Using a quasi-experimental design that reduces susceptibility to confounding by indication, we found no clear evidence that routine age-based preoperative TTE reduced IOH or improved postoperative outcomes near the threshold. The estimates were imprecise, and clinically meaningful benefit or harm could not be excluded. These findings suggest that age alone may be insufficient to justify routine preoperative TTE and support further evaluation of selective risk-based strategies.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134752","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":"Discordance Between Analgesia Nociception Index and Nociception Level Index Reflects Autonomic Imbalance Rather Than Monitor Unreliability.","authors":"Ming-Hui Hung","doi":"10.1213/ANE.0000000000008112","DOIUrl":"10.1213/ANE.0000000000008112","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e40-e41"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013176","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":"Cost Analysis of Ultrasound-Guided Regional Anesthesia for Upper Extremity Surgery in a Public Hospital in Guatemala.","authors":"Timothy S Ghan, Jakob E Gamboa, César Augusto Ramírez Ochoa, Juan Efraín Nájera Franke, Colby G Simmons","doi":"10.1213/ANE.0000000000008059","DOIUrl":"10.1213/ANE.0000000000008059","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"923-925"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249000","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":"Efficiency of Alveolar Ventilation During High-Frequency Modes in Piglets: Effects of Airway and Tissue Heterogeneity.","authors":"Péter Makra, Gergely H Fodor, Roberta Südy, Álmos Schranc, Gergely Albu, Walid Habre, Ferenc Peták","doi":"10.1213/ANE.0000000000008029","DOIUrl":"10.1213/ANE.0000000000008029","url":null,"abstract":"<p><strong>Background: </strong>Oscillatory high-frequency ventilation modalities, including high-frequency oscillatory, percussive, and jet ventilation, are commonly used during anesthesia and critical care to improve oxygenation or facilitate airway surgery. These techniques rely on rapid, small-amplitude pressure oscillations to sustain gas exchange while minimizing baro- or volutrauma. However, how effectively such oscillations transmit through the conducting airways to the alveoli in mechanically heterogeneous lungs remains poorly understood, particularly under perioperative conditions associated with atelectasis, airway narrowing, or altered chest wall mechanics.</p><p><strong>Methods: </strong>We combined in vivo measurements in anesthetized, mechanically ventilated piglets with computational simulations to quantify pressure transmission and ventilation heterogeneity across controlled variations in airway and tissue mechanical properties. Airway opening, tracheal, and alveolar capsule pressures (n = 16) were recorded with miniature pressure transducers during multifrequency (0.5-20.75 Hz) oscillations at positive end-expiratory pressures (PEEP) of 5 and 10 cmH 2 O. The experimental data informed a simulation model comprising heterogeneous airway and tissue compartments to identify determinants of alveolar ventilation during oscillatory modes.</p><p><strong>Results: </strong>The in vivo measurements revealed that the endotracheal tube accounted for most of the total flow resistance and inertance, whereas the chest wall contributed approximately two-thirds of tissue damping and elastance. Only 29% (95% confidence interval [CI], 22%-36%) to 43% (95% CI, 32%-54%) of tracheal oscillatory pressure reached the alveoli, showing strong frequency-dependent attenuation that was not significantly influenced by PEEP. Simulation results validated against measured pressure transfer functions indicated that airway heterogeneity dominated regional disparities in pressure and tidal volume, causing up to 250% differences in local volumes at high net resistance. Tissue heterogeneity exerted smaller (<100%) but distinct effects on pressure-volume relationships.</p><p><strong>Conclusions: </strong>Airway heterogeneity, common in perioperative atelectasis, bronchospasm, and acute lung injury, profoundly limits the efficiency of oscillatory ventilation. Understanding how airway and tissue properties modulate oscillatory pressure transmission provides a mechanistic basis for tailoring high-frequency ventilation to individual patients. These insights may inform more rational ventilation strategies to optimize gas exchange while minimizing regional overdistension and collapse.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"907-916"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508914","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":"Bronchial Cuff Pressure in Robot-Assisted Thoracic Surgery versus Video-Assisted Thoracic Surgery: A Prospective Observational Study.","authors":"Yuko Yamada, Kumiko Tanabe, Arisa Tanaka, Takuma Ishihara, Koyo Shirahashi, Yoshinori Kamiya","doi":"10.1213/ANE.0000000000008070","DOIUrl":"10.1213/ANE.0000000000008070","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"933-936"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855802","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":"Propofol or Sevoflurane for Maintenance of Pediatric Anesthesia: An Outcome-Focused Perspective.","authors":"Lance S Patak, Michael Puglia, Elizabeth E Hansen, Jennifer L Chiem, Diane W Gordon","doi":"10.1213/ANE.0000000000008122","DOIUrl":"10.1213/ANE.0000000000008122","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"773-780"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142167","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":"Provider-Level Distribution and Persistence of Lactated Ringer's Solution and Normal Saline Use in US Medicaid, 2018-2024.","authors":"Javier Ripollés-Melchor, Ángel V Espinosa, María J Colomina, Rachel Budithi","doi":"10.1213/ANE.0000000000008214","DOIUrl":"10.1213/ANE.0000000000008214","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"e54-e56"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705091","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}