Anesthesia & Analgesia最新文献

{"title":"Uncomfortable Transitions in Payment Models for Chronic Low Back Pain: Navigating Medicare's Mandatory Payment Reforms in Anesthesiology and Chronic Pain Management.","authors":"Isaac Y Hung,Navid Alem,Zeev N Kain","doi":"10.1213/ane.0000000000008067","DOIUrl":"https://doi.org/10.1213/ane.0000000000008067","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731419","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":"Sustainable Anesthesia: A Scoping Review of Carbon Reduction Strategies.","authors":"Angelika Moser,Sascha Hammer,Alexander König,Helmar Bornemann-Cimenti,Lioba Heuschneider,Kordula Lang-Illevich","doi":"10.1213/ane.0000000000008046","DOIUrl":"https://doi.org/10.1213/ane.0000000000008046","url":null,"abstract":"Anesthesia contributes substantially to healthcare-related greenhouse gas (GHG) emissions especially by inhalational agents such as desflurane, sevoflurane, nitrous oxide, relying on single-use equipment and having high energy demand equipment. Over the past decade, increased awareness of these impacts has led to growing research into sustainable anesthesia, exploring interventions such as low-emission techniques, equipment reuse, waste reduction, and workflow optimization. A scoping review was conducted according to PRISMA and PRESS guidelines. The databases Embase and MEDLINE were searched for studies (2010-2025) reporting on interventions to reduce anesthesia-related carbon footprint equivalents (CO2e). Eligible studies were prospective or retrospective in human patients and reported results in CO2e. Two reviewers independently screened and extracted data. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Of 3309 records identified, 33 studies met the inclusion criteria and were included in the synthesis. Five studies were rated as low quality. The included studies, conducted across ten countries, evaluated diverse sustainability interventions including nitrous oxide restriction, reduction or elimination of desflurane, promotion of total intravenous or regional anesthesia, optimization of fresh gas flows, equipment reuse, waste reduction, telemedicine, and departmental educational programs. Reported outcomes showed CO2e reductions ranging from 50% to over 90%, with some interventions achieving absolute savings of several tonnes CO2e per year. Our analysis shows that various strategies, including low-emission techniques, equipment reuse, waste reduction, and telemedicine, can significantly lower anesthesia-related CO2e without compromising patient safety. The greatest impact comes from combining behavioral, technical, and organizational measures, highlighting the need for a coordinated, system-wide approach.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147726036","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":"Society for Ambulatory Anesthesia Position Statement on Risk Assessment and Prophylaxis for Prevention of Venous Thromboembolism After Ambulatory Surgery: A Simplified Approach.","authors":"Niraja Rajan,John George,Kathy Walsh,Dawn Schell,Girish P Joshi","doi":"10.1213/ane.0000000000008044","DOIUrl":"https://doi.org/10.1213/ane.0000000000008044","url":null,"abstract":"Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT), pulmonary embolism (PE), and post-thrombotic syndrome (PTS), affects up to 900,000 people in the United States each year and as many as 60,000 to 100,000 of these patients may die. More than half of the VTE events occurring after hospital discharge are directly linked to a recent hospitalization or surgery. Sudden death is the first symptom in 25% of those who experience a PE, so prevention of VTE is of paramount importance. Several professional organizations have published perioperative guidelines for VTE prevention and accreditation organizations have incorporated VTE risk assessment and prophylaxis in their standards. Ambulatory anesthesiologists, by being part of multidisciplinary teams to establish enhanced recovery pathways at their outpatient facilities, play a pivotal role in identifying patients at risk for developing VTE, customizing risk assessment tools, and establishing thromboprophylaxis protocols for patients at their centers. In addition, anesthesiologists can play a key role in patient education, which is an important component of VTE prevention. With increased migration of complex procedures and patients to the outpatient setting, VTE risk in the high-risk groups of patients approaches inpatient levels. This position statement from the Society for Ambulatory Anesthesia (SAMBA) is tailored toward ambulatory surgery centers and summarizes and synthesizes existing VTE risk assessment and prophylaxis tools into an easy-to-use algorithm.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147726062","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":"Sex-Specific Effects of Intravenous Anesthetics on the Hemoglobin-Oxygen Dissociation Curve: A Pilot In Vitro Study.","authors":"Marco Ronzani,Norbert Mair,Simon Woyke,Christoph Frisch,Katharina Marcher,Thomas Haller,Mathias Ströhle,Christopher Rugg","doi":"10.1213/ane.0000000000008066","DOIUrl":"https://doi.org/10.1213/ane.0000000000008066","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147726035","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":"Influence of the Glutamatergic MS-LH Circuit Activation on Emergence From Sevoflurane Anesthesia in Mice.","authors":"Jiayi Wu,Xinyi Dai,Hong Wu,Shaojie Gao,Daiqiang Liu,Pei Zhang,Bo Tian,Wei Mei","doi":"10.1213/ane.0000000000008038","DOIUrl":"https://doi.org/10.1213/ane.0000000000008038","url":null,"abstract":"BACKGROUNDGlutamatergic neurons in the medial septum (MS) are identified to promote emergence from sevoflurane general anesthesia (GA), with the potential downstream neural circuit remaining to be explored.METHODSRabies virus (RV)-mediated monosynaptic retrograde tracing and anterograde tracing were first used to identify the projection from glutamatergic MS neurons (MSGlu) to glutamatergic neurons in the lateral hypothalamus (LH, LHGlu). In vivo fiber photometry, optogenetic bidirectionally manipulations, electroencephalogram/electromyogram (EEG/EMG), and behavioral tests were further employed to investigate the role of the circuit from MSGlu neurons to the LH (MSGlu-LH circuit) in regulating states of consciousness under two different states of sevoflurane GA: continuous, steady-state general anesthesia (CSSGA) and burst-suppression (BS) oscillations.RESULTSThe retrogradely labeled upstream neurons of LHGlu neurons were extensively detected in the MS, and most RV-infected neurons in the MS were co-labeled by Vesicular glutamate transporter 2 (Vglut2, mean ± standard error of the mean [SEM], 86.3% ± 1.5%, n = 4 mice). And the MSGlu-LHGlu circuit constitutes the highest proportion among the three downstream LH neuronal populations (presynaptic boutons co-localized ratio: glutamatergic, 77.0% ± 2.2%; γ-aminobutyric acid-ergic, 59.6% ± 0.9%; orexinergic, 28.5% ± 2.0%; n = 4 mice). The calcium activity of the MSGlu-LH circuit was inhibited concurrently as the process of loss of consciousness during 2.4% sevoflurane induction. Optogenetic activation of the MSGlu-LH circuit promoted behavioral arousal and increased β power of EEG (stimulation vs pre-stimulation, 16.8% ± 2.3% vs 9.7% ± 1.7%, P =.0065; n = 8 mice) during CSSGA. In contrast, during CSSGA, optogenetic inhibition of the MSGlu-LH projection deepened cortical inhibition, characterized by increased δ power and decreased power of β and γ (inhibition vs pre-inhibition, δ: 62.4% ± 4.5% vs 55.3% ± 4.2%, P =.0404; β: 6.7% ± 0.8% vs 9.4% ± 1.3%, P =.0069; γ: 3.3% ± 0.6% vs 4.8% ± 0.8%, P =.0076; n = 8 mice). Optogenetic bidirectionally manipulations of the MSGlu-LH circuit induced similar effects during BS: activation of this projection resulted in cortical activation with decreased burst-suppression ratio (BSR; median [25%-75% percentiles], stim vs pre, 59.0% [43.8%-64.5%] vs 77.5% [74.0%-84.3%], P =.0121; n = 8 mice), while inhibition of this projection led to cortical inhibition with increased BSR (inhib vs pre, 76.1% ± 7.0% vs 64.5% ± 8.4%, P =.0382; n = 8 mice).CONCLUSIONSThis study reveals that activation of the glutamatergic MS-LH circuit promotes emergence from sevoflurane GA.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147726037","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 of Preoperative Cognitive Dysfunction to Common Intraoperative Electroencephalographic Parameters and Cerebral Hypoxia During Cardiac Surgery.","authors":"Alkananda Behera,Rushil Vladimir Ramachandran,Zaid Hussain,Riku Johannes Ihalainen,Hibiki Orui,Jordan Peck,Ajay Ananthakrishnan,Priyam Mathur,Jochen D Muehlschlegel,Jean F Pittet,Amit Bardia,Robert B Schonberger,Kestutis Kveraga,Balachundhar Subramaniam","doi":"10.1213/ane.0000000000007724","DOIUrl":"https://doi.org/10.1213/ane.0000000000007724","url":null,"abstract":"BACKGROUNDOlder cardiac surgery patients have a higher prevalence of cognitive dysfunction and elevated risk of perioperative neurocognitive disorders (PND), both independently related to adverse postoperative outcomes. Neuromonitoring using electroencephalogram (EEG) and cerebral oximetry (CO) may predict PND. However, preoperative factors influencing intraoperative neurophysiological characteristics are not well understood. We conducted a study in a cardiac surgery cohort to better understand the relationship of preoperative cognitive dysfunction to intraoperative burst suppression (BS), spectral edge frequency (SEF), cerebral hypoxia/desaturation, and dual cerebral events involving both BS and cerebral desaturation to potentially link preoperative cognitive dysfunction to intraoperative neuromonitoring variables associated with PND.METHODSThis is a secondary analysis of a triple-blinded, ongoing, multi-center randomized trial assessing the efficacy of postoperative intravenous acetaminophen to reduce postoperative delirium (POD) in older cardiac surgery patients. We studied 110 patients ≥60 years who underwent CABG and/or valve surgery under general (inhalational) anesthesia at a single academic center. Preoperative cognitive status was assessed using the Montreal Cognitive Assessment (MoCA) and classified as normal (MoCA score≥26) or impaired (MoCA <26). Intraoperative frontal electroencephalogram data were recorded using the EEG monitor (SedLine, Masimo Inc). BS was detected using a recursive variance estimation algorithm, quantifying burst suppression duration (BSD). SEFs were derived through multi-taper spectral analysis. Intraoperative cerebral oxygenation was measured via cerebral oximetry (O3, Masimo), identifying cerebral desaturations (CO values <60%). Univariate analyses assessed associations between preoperative cognitive dysfunction and BSD, SEF, cerebral desaturation, and dual cerebral events of BS and cerebral desaturation. Multivariable regression analyses for these variables controlled for demographics and intraoperative confounders.RESULTSBaseline characteristics were comparable between the groups. There was no statistically significant correlation between preoperative cognition and BSD in cognitively impaired individuals (Cohen's d = 0.33; P = .09; remaining insignificant on adjustment, P = .8). Adjusted analyses showed those with abnormal MoCA scores had an average of 1.4 Hz lower SEF values (95% confidence interval [CI], 0.07-2.6; P = .03). Cognitively impaired patients demonstrated no significant increase in time spent in cerebral desaturations (55.4 [12.4-119] vs 46.3 [19.2-81.9] minutes; P = .6). No disparities were observed between the groups regarding concurrent and nonconcurrent abnormal EEG and CO values.CONCLUSIONSPreoperative cognitive dysfunction was associated with significantly lower SEFs, indicating increased isoflurane sensitivity without affecting BS or correlating with CO. SEF shows potential as a marker for","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"111 1","pages":"964-974"},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680325","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":"Intraoperative Hypotension in Children Undergoing Noncardiac Surgery: An Exploratory Single-Center Analysis of Incidence, Associated Risk Factors, and Outcomes.","authors":"Carine Foz,Steven J Staffa,Virginia E Tangel,James DiNardo,Jurgen C de Graaff,Viviane G Nasr","doi":"10.1213/ane.0000000000008043","DOIUrl":"https://doi.org/10.1213/ane.0000000000008043","url":null,"abstract":"BACKGROUNDIntraoperative hypotension (IOH) in pediatric patients is associated with multiple adverse outcomes. This study aims to delineate the incidence of IOH, the risk factors associated with its occurrence, and the association of IOH with outcomes in pediatric patients undergoing noncardiac procedures.METHODSData from 6748 pediatric patients undergoing noncardiac surgical procedures between January 2015 and August 2022 at a single center were extracted from the American College of Surgery National Surgical Quality Improvement Program pediatric database. Blood pressure data yielded the incidence of IOH, defined as a decrease in systolic blood pressure to below -2 standard deviations for the age- and sex-specific preparation and surgical phase reference values as established by de Graaff et al, for a minimum duration of 5 minutes. This threshold was chosen based on its clinical relevance and its ability to capture significant hypotensive events that may impact patient outcomes. Exploratory multivariable analysis was performed to identify independent risk factors for IOH and associated outcomes, including cardiac arrest, mortality, length of stay, and postoperative ventilation.RESULTSThe institution-specific incidence of IOH was 7.8% (529/6748, 95% CI, 7.2%-8.5%)). The majority of patients with IOH, 58.4% (309/529), had only one 5-minute epoch below the threshold. Preoperative factors including respiratory disease (aOR 1.5 [95% CI, 1.1-2.05]; P = .01), ASA ≥ 3 (aOR 1.9 [95% CI, 1.29-2.82]; P = .001), previous CPR (aOR 8.7 [95% CI, 1.09-69.2]; P = .041), malignancy (aOR 2.4 [95% CI, 1.24-4.62]; P = .009), age 2 to 5 years (aOR 4 [95% CI, 1.18-13.5]; P = .026), age 6 to 8 years (aOR 4.86 [95% CI, 1.36-17.3]; P = .015), age 9 to 11 years (aOR 6.46 [95% CI, 1.68-24.7]; P = .007), and age ≥ 12 years (aOR 7.49 [95% CI, 1.92-29.3]; P = .004) were found to be associated with IOH. Also, patients with IOH had higher rates of postoperative ventilation (aOR 2.25 [95% CI, 1.07-4.73]; P < .001).DISCUSSIONAlthough brief intervals of IOH among children undergoing noncardiac procedures can occur, recognizing risk factors for IOH can identify high-risk patients preoperatively. This enables the tailoring of perioperative care with preventive measures and management strategies such as adjusting anesthetic agents, fluid management, and intraoperative monitoring, to mitigate the occurrence and impact of IOH, thereby optimizing postoperative outcomes.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680329","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":"Microconvex In-plane Subclavian Puncture: A Safer Approach?","authors":"","doi":"10.1213/ane.0000000000008032","DOIUrl":"https://doi.org/10.1213/ane.0000000000008032","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"223 1","pages":"856"},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680327","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":"General vs. Neuraxial for Hip Fractures: Left to Interpretation.","authors":"","doi":"10.1213/ane.0000000000008031","DOIUrl":"https://doi.org/10.1213/ane.0000000000008031","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"52 1","pages":"847"},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680326","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":"A Retrospective Cohort Assessment of Labor Epidural Catheter Replacement With Programmed Intermittent Epidural Bolus and Continuous Epidural Infusion.","authors":"Brendan E Morgan,Allana Munro,Ronald B George","doi":"10.1213/ane.0000000000007788","DOIUrl":"https://doi.org/10.1213/ane.0000000000007788","url":null,"abstract":"BACKGROUNDLabor epidural analgesia (LEA) catheter failure and replacement is a common problem in obstetrical anesthesia. The relationship between LEA catheter replacement and labor analgesia maintenance regimen is not well defined. The primary study objective was to investigate whether maintenance with programmed intermittent epidural boluses (PIEB) is associated with fewer epidural catheter replacements than continuous epidural infusions (CEI). A secondary study objective was to investigate whether initiation of LEA by the combined spinal epidural (CSE) technique was associated with fewer catheter replacements than the common epidural (EPID) technique.METHODSA combined pre-post and historical cohort study was conducted with data retrieved between July 1, 2013, and December 31, 2019, to compare patients who received labor LEA initiated by either EPID or CSE (cohort study) and maintained with either PIEB or CEI (pre-post comparison), each in combination with patient-controlled epidural analgesia. The a priori primary outcome was catheter replacement. Secondary outcomes consisted of time until catheter replacement, incidence of catheter top-ups, incidence of catheter withdrawal, a collapsed composite index of catheter intervention, and time until catheter top-up. Data were analyzed using confounder-adjusted logistic regression and Cox proportional hazards regression, and primary factors were assessed for 2-way interactions.RESULTSA total of 11,277 EPIDs and 4082 CSEs were included. A total of 13,177 were maintained with PIEB and 2182 with CEI. When considering the primary outcome, EPID was associated with a 1.28× increase in the odds of replacement of the LEA catheter compared to CSE (95% confidence interval [CI], 1.01-1.65; P = .049). However, CEI was not significantly related to the primary outcome of LEA catheter replacement (odds ratio [OR] = 1.19; 95% CI, 0.90-1.56; P = .21). Among secondary outcomes, CEI was associated with a 1.34× increase in the odds of at least 1 catheter top-up (95% CI, 1.17-1.55; P < .001), a 1.34× increase in the odds of catheter intervention (95% CI, 1.10-1.64; P = .004), and had a greater hazard ratio (HR) for shorter time until catheter top-up (HR = 1.29; 95% CI, 1.14-1.46; P < .001) compared to PIEB.CONCLUSIONSLEA catheter replacement was more common with EPID than CSE, but not markedly different between CEI and PIEB. Clinician interventions to optimize analgesia were more common with CEI than with PIEB.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"128 1","pages":"947-953"},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680324","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}