Anesthesia & Analgesia最新文献

{"title":"Refusals to Provide Anesthesia for Abortion Care: Reconsidering Conscientious Objection Claims Among Anesthesiologists.","authors":"Jacob M Nieb,Katie Watson,Alyssa Burgart","doi":"10.1213/ane.0000000000008057","DOIUrl":"https://doi.org/10.1213/ane.0000000000008057","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome Differences Between General and Neuraxial Anesthesia for Hip Fracture by Frailty and Age in the Elderly: A Retrospective Cohort Study.","authors":"Periklis Giannakis,Mariana Restrepo,Alexander B Stone,Sophia T Zhuang,Junying Wang,Crispiana Cozowicz,Alex Illescas,Juliet E Rowe,Lisa Reisinger,Lazaros Poultsides,Jiabin Liu,Jashvant Poeran,Stavros G Memtsoudis","doi":"10.1213/ane.0000000000008062","DOIUrl":"https://doi.org/10.1213/ane.0000000000008062","url":null,"abstract":"BACKGROUNDFrailty and age are major outcome drivers in hip fracture surgery, but their interaction has not been considered in neuraxial versus general anesthesia comparisons. Using the Hospital Frailty Risk Score (HFRS), we examined this interaction.METHODSIn this retrospective cohort study (2016-2023, Premier Healthcare Database), adults undergoing hip fracture surgery with neuraxial or general anesthesia were included and stratified by age quantiles (≤71, 72-86, ≥87 years) and HFRS (low, intermediate/high). The primary outcome was an in-hospital composite of mortality and major system complications. Intensive care unit (ICU) admission and high opioid use or prolonged length of stay (LOS) ≥75th percentile were also assessed. We used mixed-effects models and reported odds ratios (OR) and 95% confidence intervals (CIs).RESULTSAmong 623,122 patients, neuraxial (versus general) anesthesia was associated with lower odds of the composite outcome in patients ≥87 years with intermediate/high frailty (OR, 0.88 and 95% CI, 0.83-0.94; P < .001). Overall, neuraxial anesthesia was linked to higher odds of respiratory complications (OR, 1.06 and 95% CI, 1.01-1.10; P = .03), driven by patients ≤71 years with intermediate/high frailty, and lower odds of renal failure (OR, 0.87 and 95% CI, 0.83-0.92; P < .001), primarily among those ≥72 years with intermediate/high frailty. Neuraxial anesthesia was also associated with higher cardiac complication odds (OR, 1.07 and 95% CI, 1.02-1.12; P = .008), particularly in patients aged 72 to 86 years with intermediate/high frailty. Mortality odds were lower overall (OR, 0.83 and 95% CI, 0.74-0.93; P = .003), driven by patients ≥87 years with intermediate/high frailty. Neuraxial anesthesia was associated with higher odds of prolonged LOS in patients aged 72 to 86 years with low frailty (OR, 1.16 and 95% CI, 1.04-1.31; P = .035), but lower odds in those ≥87 years with intermediate/high frailty (OR, 0.92 and 95% CI, 0.87-0.97; P = .012). It was associated with lower odds of high opioid use overall and within each subgroup. ICU admission odds were higher in patients ≤71 years with intermediate/high frailty (OR, 1.16 and 95% CI, 1.05-1.29; P = .019) but lower in those ≥87 years with intermediate/high frailty (OR, 0.82 and 95% CI, 0.75-0.90; P < .001). Neuraxial anesthesia was linked to higher odds of discharge home (OR, 1.08 and 95% CI, 1.04-1.12; P < .001), except among ≥87-year-old intermediate/high frailty patients, where odds were lower (OR, 0.90 and 95% CI, 0.81-0.99; P = .041).CONCLUSIONSNeuraxial versus general anesthesia showed modest overall benefits after hip fracture, varying by age-frailty subgroup, supporting frailty-guided anesthetic decisions clinically.Level of evidence: III. Retrospective cohort study.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Dexamethasone in Periprosthetic Joint Infection Surgery: Diabetes-Stratified Results From a Propensity Score-Matched Retrospective Cohort Study.","authors":"Ian A Jones,Julian Wier,Avinash Iyer,McKenzie W Culler,Jay R Lieberman,Nathanael D Heckmann","doi":"10.1213/ane.0000000000008049","DOIUrl":"https://doi.org/10.1213/ane.0000000000008049","url":null,"abstract":"BACKGROUNDDexamethasone is used in primary total joint arthroplasty (TJA) to reduce postoperative nausea and vomiting, and there is emerging evidence that it also ameliorates adverse events more broadly. Despite a lack of supporting data, a vocal minority has continued to question the appropriateness of dexamethasone in cases where the hyperglycemic burden and/or risk of infection are increased. This study sought to assess the benefits and potential harms of dexamethasone in a cohort of patients undergoing revision TJA for periprosthetic joint infection (PJI). We hypothesize that perioperative dexamethasone exposure is associated with fewer postoperative complications, regardless of diabetes status.METHODSAn all-payer, US hospital-based dataset was queried. Patients ≥18 years with a diagnosis of hip or knee PJI between 2015 and 2023 were identified using billing and procedural codes, and verified using hospital charges for antibiotics and spacers. The primary outcome was composite complications. Secondary outcomes (wound and infectious complications, as well as mortality) were evaluated to probe for potential safety signals.RESULTSIn total, 61,527 patients were identified. A total of 30,644 nondiabetic patients and 14,996 diabetic patients were 1:1 matched based on dexamethasone exposure, with good balance. Dexamethasone-treated patients had fewer aggregate complications in both cohorts (nondiabetic: adjusted odds ratio [aOR], 0.934 and 95% confidence interval [CI], 0.760-0.978; diabetic: aOR, 0.814 and 95% CI, 0.746-0.889). Dexamethasone was also associated with fewer wound complications (nondiabetic: aOR, 0.891 and 95% CI, 0.823-0.964; diabetic: aOR, 0.879 and 95% CI, 0.787-0.981) and infectious complications (nondiabetic: aOR, 0.891 and 95% CI, 0.823-0.964; diabetic: aOR, 0.827 and 95% CI, 0.754-0.908) . Only diabetic patients saw a statistically significant decrease in mortality (aOR, 0.692 and 95% CI, 0.532-0.901).CONCLUSIONSAs with any retrospective study, findings should be interpreted cautiously due to the possibility of residual confounding. Nevertheless, dexamethasone appears to be safe to use in patients undergoing first-stage revision for TJA for PJA regardless of diabetic status. Further, findings suggest that dexamethasone is associated with lower odds of aggregate complications, and contrary to conventional wisdom, these benefits may be even greater among diabetics.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Federated Learning in Anesthesiology: A Privacy-Preserving Approach to Collaborative Predictive Modeling.","authors":"Victor F A Almeida,Manoela Dantas,Glaudir Donato,Avneep Aggarwal","doi":"10.1213/ane.0000000000008069","DOIUrl":"https://doi.org/10.1213/ane.0000000000008069","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Size Does Not Fit All: A Call for More Personalized Perioperative Metrics.","authors":"Angela M Bader","doi":"10.1213/ane.0000000000008092","DOIUrl":"https://doi.org/10.1213/ane.0000000000008092","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Multidisciplinary Algorithm on Early Complications After Hip Fracture Surgery: A Retrospective Time-Series Study.","authors":"Michele Carella,Florian Beck,Ambre Tanke,Vincent L Bonhomme","doi":"10.1213/ane.0000000000008055","DOIUrl":"https://doi.org/10.1213/ane.0000000000008055","url":null,"abstract":"BACKGROUNDHip fracture carries high morbidity in elderly patients. While most efforts focus on single perioperative measures, we assessed whether a coordinated multidisciplinary algorithm could reduce early postoperative complications (EPOCs) within 7 days. The Advise, Surgery, Analgesia, Pharmacology (ASAP) bundle comprises four components: orthogeriatric consultation (Advise), surgery within 12 hours (Surgery), supra-inguinal fascia iliaca block (SFIB; Analgesia), and chronic therapy adjustment (Pharmacology).METHODSIn this retrospective, single-center interrupted time-series cohort study (January 2017-December 2022), we compared hip fracture patients admitted pre-ASAP (January 1, 2017-December 31, 2019) versus post-ASAP (January 1, 2020-December 31, 2022). Following ethics approval, we conducted interrupted time-series analysis of 7-day EPOC rates, stratified by Clavien-Dindo grades: all complications (1-4) and major complications (2-4). Kaplan-Meier and Cox proportional hazards models evaluated cumulative incidence and hazard ratios (HRs).RESULTSAmong 845 patients (480 pre-ASAP, 365 post-ASAP), all EPOCs declined immediately after ASAP implementation (P = .032) with a sustained negative trend over time (P = .008), and major EPOCs also decreased immediately (P < .001) with a flatter subsequent trend (P = .20). Kaplan-Meier curves confirmed a lower cumulative incidence of both all and major complications post-ASAP (log-rank P < .001). ASAP reduced the hazard for all EPOCs (HR, 0.58; 95% confidence interval [CI], 0.49-0.68) and major EPOCs (HR, 0.60; 95% CI, 0.49-0.73). Early surgery and SFIB each independently predicted fewer all EPOCs, whereas only early surgery predicted fewer major EPOCs.CONCLUSIONSImplementation of the ASAP bundle significantly lowered EPOCs after hip fracture surgery. Early surgery and SFIB were especially impactful, supporting broader adoption of multimodal perioperative strategies in elderly patients.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole Blood and Components in Trauma Resuscitation: The Whole Truth.","authors":"Aryeh Shander,Shannon L Farmer,Dieter G Weber,Michael F Leahy","doi":"10.1213/ane.0000000000008071","DOIUrl":"https://doi.org/10.1213/ane.0000000000008071","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Respiratory Outcomes in Stroke Patients With General Anesthesia Versus Nongeneral Anesthesia.","authors":"Blaze T Borowski,Andrew R Owens,Emma Parenteau,Megan K Schultz,Jeffrey Hu,Brian G Wilhelmi","doi":"10.1213/ane.0000000000008088","DOIUrl":"https://doi.org/10.1213/ane.0000000000008088","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"153 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic Effect of a Thromboxane A2 Receptor Agonist on Multiple Pain Models in Mice.","authors":"Atsushi Fujiwara,Takeshi Ueno,Shinji Matsumura,Seiji Ito,Toshiaki Minami","doi":"10.1213/ane.0000000000008045","DOIUrl":"https://doi.org/10.1213/ane.0000000000008045","url":null,"abstract":"BACKGROUNDThromboxane A2 (TXA2), a metabolite of arachidonic acid, is well known for its role in vasoconstriction and platelet aggregation via activation of thromboxane prostanoid receptors (TPR). Although other prostanoid receptors have established roles in pain modulation, the contribution of TXA2-TPR signaling to nociceptive processing remains unclear. This study evaluated the analgesic effects of a TPR agonist in mouse models of pain.METHODSFour-week-old male ddY mice, an outbred mouse strain, received intrathecal (i.t.) administration of (Z)-7-((1S,2R,3R,4R)-3-((R,E)-3-hydroxy-4-(4-iodophenoxy)but-1-en-1-yl)-7-oxabicyclo[2.2.1]heptan-2-yl)hept-5-enoic acid (I-BOP), a TPR agonist, in four pain models (n = 6-10 per group): hot plate test, formalin test, prostaglandin E2 (PGE2)-induced allodynia, and L5 spinal nerve transection (L5-SNT). Behavioral tests evaluated pain responses as the primary outcome. The mRNA expression levels of cyclooxygenase (COX)-1, COX-2, TXA2 synthase (TXAS), and TPR were analyzed by reverse transcription-polymerase chain reaction and compared between ipsilateral and contralateral L4-L6 spinal dorsal horns. TPR localization in the spinal dorsal horn was determined by immunohistochemistry. Data were analyzed using appropriate parametric or nonparametric tests based on the results of normality assessment. Comparisons between groups were performed using Student t test, the Mann-Whitney U test, 1-way analysis of variance (ANOVA) with Dunnett post hoc test, 2-way ANOVA with Bonferroni post hoc test, or Friedman test followed by Wilcoxon signed-rank tests with Bonferroni correction as appropriate. All behavioral assessments were conducted in a blinded manner.RESULTSIn the PGE2-induced allodynia model, coadministration of I-BOP dose dependently reduced the allodynia score compared with PGE2 alone. When the response to PGE2 alone was defined as 100%, the allodynia scores were reduced to 20% (95% confidence interval [CI], -7 to 47; P = .0012) at 1 ng and 10% (95% CI, -11 to 31; P < .001) at 10 ng I-BOP. In the L5-SNT neuropathic pain model, i.t. I-BOP produced a dose-dependent elevation of mechanical withdrawal thresholds, with significant main effects of dose (P < .001) and time (P < .001) and a significant dose × time interaction (P = .0012). In the formalin test, I-BOP selectively reduced nociceptive behavior during the second phase (I-BOP 140 ± 6.2 seconds; saline 623 ± 18.1 seconds, expressed as mean ± standard error of the mean [SEM]; P = .008), without affecting the first phase. The ipsilateral spinal dorsal horn of L5-SNT mice showed increased TPR mRNA expression. Immunohistochemistry revealed TPR localization in both the substantia gelatinosa and deep laminae of the spinal dorsal horn.CONCLUSIONSThese findings suggest that a TPR agonist exerts analgesic effects by acting on TPR expressed in the spinal cord, highlighting the potential role of TPR signaling in pain modulation.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nipping Fraud in the Bud? Challenges for Detecting and Managing Issues of Research Integrity Before Publication.","authors":"Michael F Haney,Jenny Kent,Kush M Kale,Tim Dare,Jaideep J Pandit","doi":"10.1213/ane.0000000000008065","DOIUrl":"https://doi.org/10.1213/ane.0000000000008065","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}