Anesthesia & Analgesia最新文献

{"title":"Gene Therapy in the Setting of Chronic Pain Medicine.","authors":"Amit Beniwal,Sahil Amin,Edgar J Remotti,Parker A Woolley,Fangyu Chen,Trent Emerick","doi":"10.1213/ane.0000000000007774","DOIUrl":"https://doi.org/10.1213/ane.0000000000007774","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203703","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":"Assessment of Gastric Content Using Gastric Ultrasound in Patients on Glucagon-Like Peptide-1 Receptor Agonists Before Anesthesia.","authors":"Sher-Lu Pai,Sindhuja R Nimma,W Brian Beam,Beth A VanderWielen,Hari K Kalagara,Layne M Bettini,Soojie Yu,Emily E Sharpe,Monica W Harbell, ","doi":"10.1213/ane.0000000000007764","DOIUrl":"https://doi.org/10.1213/ane.0000000000007764","url":null,"abstract":"BACKGROUNDThe use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has significantly increased in recent years. GLP-1 RAs delay gastric emptying, resulting in early satiety and weight loss. This may increase the risk of pulmonary aspiration of residual gastric contents (RGC) during anesthesia delivery. Evidence is urgently needed to guide perioperative anesthesia management for patients taking GLP-1 RAs. This study evaluated preoperative factors that may be associated with high RGC.METHODSAdult patients who were taking GLP-1 RAs and scheduled to receive anesthesia at 3 hospitals between June 30, 2023, and August 15, 2024, were evaluated via preoperative point-of-care gastric ultrasonography (GUS). The primary outcome was high RGC, defined by the presence of solids food or >1.5 mL/kg of clear liquids on GUS, and its association with preoperative factors (eg, existing medical conditions, indication and route of taking GLP-1 RAs, length of taking GLP-1 RAs, days of withholding GLP-1 RAs before surgery, and preoperative fasting periods). Data are presented as median (interquartile range [IQR]).RESULTSAmong the 316 patients (60.9 years [52.1-68.9] of age; 167 [52.8%] females) included in the study, 113 (35.8%) had high RGC. A higher percentage (5.3%; 6/113) of patients in the high RGC group had an opioid prescription for pain management within 3 months of the GUS assessment compared to the low RGC group (1.0%; 2/203; P = .027). No statistical difference was found between the groups in other existing medical conditions, indication and route of taking GLP-1 RAs, and length of taking GLP-1 RAs. Of the 294 patients taking weekly injections, there were 187 (63.6%) with low RGC and 107 (36.4%) with high RGC. Patients with low RGC withheld their GLP-1 RAs for 8 days [5-10], while patients with high RGC withheld for 6 days [3-9] (P = .003). Receiver operating characteristic (ROC) analysis found ≤7.5 days of withholding the medication as cutoff for increased prevalence of high RGC in patients taking GLP-1 RA injections. Patients with low RGC fasted from solid food for 20.0 hours [14.8-40.8], and patients with high RGC fasted from solid food for 15.0 hours [12.8-19.0] (P < .001). ROC found ≤21.3 hours of fasting from solid food as the cutoff for increased prevalence of high RGC.CONCLUSIONSGLP-1 RA usage may delay gastric emptying. In preoperatively fasting adults, ≤7.5 days of withholding injections and ≤21.3 hours of fasting from solid food are associated with high RGC.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203700","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":"The Renin-Angiotensin-Aldosterone System in Cardiac Surgery and Angiotensin II Therapy for Vasoplegia.","authors":"Alexander Zarbock,Jean-Louis Vincent,Daniel De Backer,Rinaldo Bellomo,Matthieu Legrand,Ashish K Khanna,Marlies Ostermann,Katarzyna Kotfis,Annoni Filippo,Patrick M Wieruszewski,Marc Leone,Massimo Girardis,Ricardo Ferrer,Yuki Kotani,Peter Pickkers,Gennaro De Pascale,Pierre Tissieres,Giovanni Landoni","doi":"10.1213/ane.0000000000007779","DOIUrl":"https://doi.org/10.1213/ane.0000000000007779","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203673","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":"Transforming Anesthesia Practice With Qualitative Research.","authors":"Jennifer M Weller,Tanisha Jowsey,Rebecca D Minehart,Thomas R Vetter","doi":"10.1213/ane.0000000000007762","DOIUrl":"https://doi.org/10.1213/ane.0000000000007762","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203701","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":"Combined Pecto-intercostal Fascial Plane and Rectus Sheath Blocks Versus Local Infiltration for Pain Management Following Pediatric Cardiac Surgery: A Randomized Clinical Trial.","authors":"Lisa M Einhorn,Evan D Kharasch,Janice Lim,Matthew Fuller,Jennifer L Turi,Edmund H Jooste,Benjamin Y Andrew,Warwick A Ames","doi":"10.1213/ane.0000000000007754","DOIUrl":"https://doi.org/10.1213/ane.0000000000007754","url":null,"abstract":"BACKGROUNDPrevious studies have shown that regional anesthesia (RA) use versus placebo control is associated with less postsurgical opioid requirements and improved pain scores. This trial compared a novel combination of bilateral pecto-intercostal fascial plane and unilateral rectus sheath blocks to an active comparator of surgeon-administered local anesthetic wound infiltration in children undergoing septal defect repair. The study tested the hypothesis that RA use would result in less opioid use and lower pain intensity compared to wound infiltration.METHODSThis double-blind, randomized, parallel group, single-center trial included children (<18 years) undergoing primary atrial septal defect (ASD) or ventricular septal defect (VSD) repair. Participants were randomized to RA consisting of ultrasound-guided pecto-intercostal fascial plane and rectus sheath blocks or no-block, consisting of local anesthetic wound infiltration. Both groups received 1.5 mL/kg of ropivacaine 0.2% for the intervention. The primary outcome was opioid use (oral morphine milligram equivalents [MME]/kg) 0-12 hours after surgery. Secondary outcomes were opioid use at additional time points, pain (0-10 scale) between 0 and 48 hours (area under the curve [AUC]), and hospital length of stay (LOS).RESULTSData analysis included 42 children (24 RA, 18 infiltration), age 3.3 ± 2.7 years (mean ± standard deviation [SD]; median, 3; range, 4 months-10 years). Opioid use (MME/kg mean ± SD) 0-12 hours after surgery was 0.44 ± 0.19 in the RA group compared to 0.83 ± 0.39 in the infiltration group (mean difference -0.39; 95% confidence interval [CI], -0.59 to -0.18; P = .001). Total postoperative opioid use from 0 to 48 hours after surgery was 0.95 ± 0.40 in the RA group compared to 1.57 ± 0.75 in the infiltration group (mean difference -0.64; 95% CI, -1.02 to -0.22, P = .004). Pain intensity AUC (0-48 hours) was 45.0 ± 26.8 in the RA group compared to 94.5 ± 55.7 in the infiltration group (mean difference -49.5 [-78.9 to -20.1]; P = .002). Opioid use between 12 and 48 hours and hospital LOS was not different between groups.CONCLUSIONSThis single-center study showed that the combined pecto-intercostal fascial plane and rectus sheath blocks were opioid-sparing and provided superior pain control compared to contemporary practice of local anesthetic infiltration in children following septal defect repair. This investigation strengthens the evidence to support RA use to improve postoperative pain in this population.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203885","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":"The Association Between Surgeon-Anesthesiologist Dyad Familiarity and Operative Mortality: A Retrospective Study at a Large Academic Cardiac Surgery Program.","authors":"Sameer Lakha,Sharon G Huang,Cindy Wang,Eric Rome,Natalia Egorova,Yuxia Ouyang,Matthew A Levin,Samuel DeMaria","doi":"10.1213/ane.0000000000007759","DOIUrl":"https://doi.org/10.1213/ane.0000000000007759","url":null,"abstract":"BACKGROUNDEffective teamwork is essential in high-stakes environments such as cardiac surgery, where complex procedures require coordinated efforts, particularly between surgeons and anesthesiologists. While team dynamics have been shown to affect surgical outcomes, the impact of surgeon-anesthesiologist familiarity on operative mortality in cardiac surgery remains underexplored. We aimed to assess whether increased familiarity within this dyad was associated with reduced operative mortality and improved patient outcomes.METHODSWe conducted a retrospective, single-center cohort study using data from a large academic medical center, covering cases from July 2011 to January 2024. Surgeon-anesthesiologist dyads were defined by unique pairings who worked together in each case. Familiarity was measured by the frequency of collaboration over the previous 365 days and divided into quintiles. The primary outcome was operative mortality, defined as death before discharge or within 30 days post-procedure. Secondary outcomes included operative length, hospital and intensive care length of stay, reoperation, readmission, and reported organ system complications. A logistic mixed-effects model adjusted for patient demographics, comorbidities, and procedure type, was used to examine associations.RESULTSWe identified 481 unique surgeon-anesthesiologist pairs from 16,811 cases. Higher dyad familiarity was associated with significantly lower operative mortality when analyzing the entire cohort (P < .001). Patients cared for by higher-familiarity dyads also had reduced rates of several adverse outcomes, although deep sternal wound infection showed no association with dyad familiarity. After adjusting for confounders, the odds of operative mortality were significantly higher for the lowest-familiarity dyads compared to the highest-familiarity dyads (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.29-2.81, P = .001).CONCLUSIONSIncreased surgeon-anesthesiologist familiarity was associated with lower operative mortality and improved outcomes in cardiac surgery, highlighting the importance of consistent team collaboration. Multi-center studies are warranted to validate these findings and explore familiarity's effects across diverse clinical settings.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203667","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":"Subjective Sleep Quality Audit in the Surgical Intensive Care Unit.","authors":"Sara Ai Lin Ang,Sherwyn Koh,Zachary Chu,Jun Xiang Tan,Ashton Yin,Yie Hui Lau","doi":"10.1213/ane.0000000000007562","DOIUrl":"https://doi.org/10.1213/ane.0000000000007562","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203670","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":"Neuraxial Compared With General Anesthesia on Postoperative Outcomes After Hip Arthroplasty for Geriatric Hip Fracture: Results From a National Database.","authors":"Fanqiang Meng,Yuqing Wang,Liusong Shen,Junzhi Sheng,Huizhong Long,Hu Chen,Xiaoxiao Li,Dongxing Xie,Xiang Ding","doi":"10.1213/ane.0000000000007758","DOIUrl":"https://doi.org/10.1213/ane.0000000000007758","url":null,"abstract":"BACKGROUNDAnesthesia choice affects hip fracture surgery outcomes. However, limited evidence exists regarding the impact of neuraxial anesthesia (NA) versus general anesthesia (GA) on postoperative outcomes, specifically in hip arthroplasty for fracture. The purpose of this study was to compare 30-day readmission, in-hospital complications, hospitalization charges, and length of stay between the elderly who received NA and GA during this procedure.METHODSThe Hospital Quality Monitoring System was analyzed for patients undergoing hip arthroplasty for geriatric hip fracture (≥60 years of age) between 2013 and 2019. After adjusting for potential confounders with propensity score matching, logistic regression and linear regression analyses were conducted to compare NA with GA in terms of 30-day readmission rates and causes, in-hospital complications (including in-hospital mortality, pulmonary embolism, deep vein thrombosis, wound infection, and blood transfusion), hospitalization charges, and length of stay.RESULTSOf the 90,745 patients undergoing hip arthroplasty for geriatric hip fracture during the study period (40,551 [44.7%] for NA, 50,194 [55.3%] for GA), a total of 62,022 patients (31,011 propensity score-matched pairs) were included after study exclusions and propensity score matching. NA was significantly associated with a lower incidence of 30-day readmission (4.60% vs 4.97%, odds ratio [OR] = 0.92, 95% confidence interval [CI], 0.86-0.99, P =.032) and fewer genitourinary system complaints (0.18% vs 0.26%, OR = 0.70, 95% CI, 0.50-0.97, P =.035) for readmission compared with GA. The incidence of in-hospital mortality (0.41% vs 0.64%, OR = 0.64, 95% CI, 0.52-0.81, P <.001), deep vein thrombosis (1.84% vs 2.57%, OR = 0.71, 95% CI, 0.64-0.79, P <.001), and pulmonary embolism (0.22% vs 0.38%, OR = 0.58, 95% CI, 0.43-0.79, P <.001) was also lower for NA compared with GA. Moreover, patients with NA had decreased charges (49,851.8 Chinese Yuan [CNY] vs 54,754.8 CNY, P <.001) relative to GA. The length of stay did not differ significantly between NA and GA (13.7 days vs 13.8 days, P =.217).CONCLUSIONSIn geriatric patients undergoing hip arthroplasty for hip fracture, NA is associated with lower rates of 30-day readmission, fewer readmission caused by genitourinary system complaints, reduced complications, and decreased hospitalization charges compared to GA.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153431","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":"Retrospective Analysis of the Association of Preoperative Sex Hormone Therapy With the Development of Postoperative Acute Kidney Injury.","authors":"Shreya Khandelwal,Ravi Jasti,Abhishek Prasad,Pattrapun Wongsripuemtet,Matthew Fuller,André J Savadjian,Karthik Raghunathan,Tetsu Ohnuma,Rebecca Schroeder,Thomas M Price,Vijay Krishnamoorthy,Jamie R Privratsky","doi":"10.1213/ane.0000000000007727","DOIUrl":"https://doi.org/10.1213/ane.0000000000007727","url":null,"abstract":"BACKGROUNDPostoperative acute kidney injury (AKI) worsens surgical outcomes. Previous studies have observed an age- and sex-dependent effect on postoperative AKI rates. The objective of our study was to determine whether preoperative exposure to male or female sex hormone therapies modified AKI risk after both noncardiac and cardiac surgery. We hypothesized that women older than 55 years on estrogen/progesterone replacement therapy and men on antiandrogen therapy would have lower odds of postoperative AKI compared to counterparts not receiving sex hormone therapies.METHODSWe conducted a retrospective cohort study, using data from Duke University Medical Center from 2013 to 2023. The study included women older than 55 years and men older than 18 years undergoing surgery. Exclusions included patients with missing creatinine values, patients with chronic kidney disease stage 5 (CKD5), transplant cases, and minor cases. The primary exposure was preoperative utilization of exogenous sex hormones, and the primary outcome was the development of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Multivariable logistic regression was used to examine the association of preoperative sex hormones with postoperative AKI.RESULTSThere were 82,557 patients in the cohort, with 68,471 undergoing noncardiac surgery and 14,086 undergoing cardiac surgery. Among men undergoing noncardiac surgery, exposure to antiandrogens was associated with lower odds of postoperative AKI (0.83, 95% confidence interval [CI], 0.72-0.96, P < .01). Among women undergoing noncardiac surgery, preoperative exposure to vaginal estrogen was associated with lower odds of postoperative AKI (adjusted odds ratio [OR], 0.61, 95% CI, 0.47-0.79, P < .001). Neither male nor female sex hormone exposures were associated with AKI risk after cardiac surgery.CONCLUSIONSPreoperative antiandrogen therapy in men and vaginal estrogen therapy in women older than 55 years were associated with reduced odds of postoperative AKI after noncardiac surgery. Our findings provide correlative evidence that sex hormones might modify postoperative AKI outcomes, while revealing complexity in drug and patient selection.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127214","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":"Monitoring the Influence of Low CVP Versus Stroke Volume-Guided Fluid Therapy on Sublingual and Intestinal Microcirculatory Perfusion.","authors":"Zühre Uz,Iris M Jongerius,Denise P Veelo,Bülent Ergin,Thomas M van Gulik,Can Ince, ","doi":"10.1213/ane.0000000000007734","DOIUrl":"https://doi.org/10.1213/ane.0000000000007734","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127216","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}