Anesthesia & Analgesia最新文献

{"title":"Looking at History, Planning for the Future: \"An Unexpected Emergency\".","authors":"Guillermo Lema","doi":"10.1213/ane.0000000000007636","DOIUrl":"https://doi.org/10.1213/ane.0000000000007636","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603789","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":"Age-Dependent Entropic Features During Propofol Anesthesia in Developing Brain.","authors":"Yue Zhang,Zhen-Hu Liang,Xin Wang,Ning Zhang,Hui-Ting Zhu,Dong-Xin Wang,Xiang-Yang Guo,Xiao-Li Li,Lin-Lin Song","doi":"10.1213/ane.0000000000007608","DOIUrl":"https://doi.org/10.1213/ane.0000000000007608","url":null,"abstract":"BACKGROUNDPrecise monitoring of anesthetic depth in children receiving propofol anesthesia is crucial. Commercial depth of anesthesia monitoring devices do not account for age-related changes in brain states and provide misleading information regarding the actual depth in young children. Entropy analysis, a typical complexity methodology, has been demonstrated to be a simple and robust tool for monitoring consciousness levels during anesthesia in adults. The validity of entropic measures for depth of anesthesia monitoring in children receiving general anesthesia remains largely unexplored. The age-related entropic feature dynamics during propofol anesthesia are still not clear.METHODSWe prospectively studied frontal electroencephalogram (EEG) recordings from subjects aged 1 to 18 years receiving propofol anesthesia. We calculated spectral power, permutation entropy (PeEn), sample entropy (SampEn), beta ratio, and bispectral index (BIS) from EEG segments obtained during wakefulness, maintenance, and recovery. PeEn quantifies the randomness of a time series and SampEn quantifies its unpredictability. Both measures convey complexity information on local connectivity within neural circuits for an EEG signal. The accuracy of these EEG measures to distinguish between propofol-induced unresponsiveness and clinical recovery was assessed. The changes in entropic feature dynamics with age during propofol anesthesia were investigated.RESULTSSeventy-seven subjects were included for analysis. Propofol induced a significant decrease in frontal PeEn (from a median [interquartile range] of 0.75 [0.71-0.78] during wakefulness to 0.61 [0.57-0.63] during maintenance, P < .001), which returned to wakefulness levels during recovery (0.75 [0.71-0.79]), contrasting with BIS, which remained lower. A significant increase in SampEn was noted from wakefulness to maintenance (0.04 [0.04-0.06] vs 0.25 [0.20-0.28], P < .001). PeEn provided excellent performance for distinguishing between unresponsiveness and clinical recovery at an optimal classification threshold of 0.67 with the accuracy of 96.6%. The distinguishing capability of PeEn appeared superior in toddlers compared to BIS (accuracy: 94.7% vs 88.9%). SampEn also exhibited good distinguishing accuracy of 81.1% at an optimal threshold of 0.18. Frontal PeEn and SampEn, indicating information amount of intracortical neural circuits connectivity, decreased with age during propofol maintenance (P = .017 and .026, respectively). The adolescents exhibited significantly lower frontal power, PeEn, and SampEn values during propofol administration.CONCLUSIONSThe frontal PeEn served as an excellent indicator for distinguishing propofol-induced unresponsiveness from recovery in children. Frontal complexity, represented by PeEn and SampEn, decreased with age during propofol maintenance, which was hypothesized to reflect sequential neurophysiological development in frontal cortex, particularly its maturation during adolescence.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603797","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":"Ambulatory Surgery During Intravenous Fluid Shortage-A Potential Cost Saving and Sustainable Strategy for the Future?","authors":"Abigail F Schirmer,Nina Sharifi,Olga C Nin,Laurie K Davies,Joseph R AbuRahma,Lauren C Berkow","doi":"10.1213/ane.0000000000007630","DOIUrl":"https://doi.org/10.1213/ane.0000000000007630","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603796","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":"Erector Spinae Plane Block in Multimodal Analgesia After Lumbar Spinal Fusion Surgery: A Blinded Randomized Placebo-Controlled Trial.","authors":"Ilse H van de Wijgert,Maaike G E Fenten,Akkie Rood,Regina L M van Boekel,Miranda L van Hooff,Kris C P Vissers","doi":"10.1213/ane.0000000000007611","DOIUrl":"https://doi.org/10.1213/ane.0000000000007611","url":null,"abstract":"BACKGROUNDPostoperative pain after lumbar spine surgery is often severe, necessitating multimodal analgesic regimens that include opioids. Locoregional anesthesia, such as the Erector Spinae Plane Block (ESPB), may be effective in reducing postoperative pain and opioid use. This study evaluated the effect of bilateral ESPB on early postoperative pain and opioid use after lumbar spinal fusion surgery.METHODSA single-center, randomized, blinded, placebo-controlled trial included 76 patients undergoing elective lumbar spinal fusion. Participants received either bilateral ESPB with ropivacaine or placebo (normal saline) after surgery. The primary outcome was pain intensity 1-hour postanesthesia, measured using the Numeric Rating Scale (NRS). Secondary outcomes included opioid consumption in the first 12 hours, time to first opioid use, quality of recovery, and pain intensity and opioid use at 30 days. Statistical significance was set at P < .05.RESULTSThe mean NRS 1-hour postanesthesia did not differ significantly between the ropivacaine and placebo group (3.8 ± 3 vs 4. 2 ± 2.6, P = .56). The median 12-hour opioid consumption was 11.3mg [2.5-21.5] vs 12.5 mg [5.1-22.4], median time to first opioid use 64 [22-171.5] vs 41 [21.3-89.5] minutes, and mean quality of recovery on day 1: 90. 7 ± 36 vs 102. 8 ± 20.5 and day 3: 108. 3 ± 21.2 vs 112. 5 ± 22.7, for the ropivacaine and placebo group, respectively. At 30 days, the mean NRS was 3. 4 ± 2.4 vs 3. 6 ± 2.5. Opioid use at 30 days occurred in 12 patients (16.2%) of the ropivacaine and in 15 (20.3%) of the placebo group.CONCLUSIONSBilateral ESPB with ropivacaine did not reduce early postoperative pain or opioid use in patients undergoing lumbar spinal fusion. Its overall benefits in a multimodal analgesic regimen appear limited and application of bilateral ESPB in all patients undergoing lumbar spine surgery is not recommended.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547853","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 Single Child With a Single Ventricle.","authors":"Rohan Magoon","doi":"10.1213/ane.0000000000007524","DOIUrl":"https://doi.org/10.1213/ane.0000000000007524","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547848","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":"Awake Bronchoscopic Intubation: A Survey of Practicing Members of the American Society of Anesthesiologists.","authors":"Richard M Pino,Edward A Bittner,Mack A Thomas","doi":"10.1213/ane.0000000000007615","DOIUrl":"https://doi.org/10.1213/ane.0000000000007615","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547849","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":"Continuous and Noninvasive Total Blood Hemoglobin Measurement Using Near-Infrared Reflectance Spectrometry.","authors":"Stefan F van Wonderen,Andres Aguirre,Paul Benni,Rokus E C van den Dool,Juan Pedro Macias Pingarron,Gumersindo Javier Solares,Feras Hatib,Denise P Veelo,Alexander P J Vlaar,Zhongping Jian","doi":"10.1213/ane.0000000000007618","DOIUrl":"https://doi.org/10.1213/ane.0000000000007618","url":null,"abstract":"BACKGROUNDContinuous measurement of total hemoglobin (tHb) can be of great clinical value during surgery, visualizing tHb trends and guiding blood transfusion practices. Devices such as those pulse oximetry-based have been available and studied over the past decade with varying results on their accuracy. We recently developed a first-of-its-kind near-infrared reflectance spectroscopy (NIRS) based algorithm to measure tHb continuously and noninvasively. This study was conducted to evaluate the performance of the NIRS based tHb algorithm using a cerebral oximetry sensor.METHODSWe performed a post hoc retrospective analysis of data collected during cardiac surgery from 3 clinical sites. Both NIRS data and blood gas tHb data were collected. Then the NIRS data was postprocessed through the NIRS based tHb algorithm to generate continuous measurement of tHb. Comparison between the 2 tHb measurements was assessed using the Bland-Altman analysis, mean absolute error (MAE), root mean square error (RMSE), 4-quadrant concordance, and error-grid analysis.RESULTSOne hundred and eighty-nine (189) patients were included in the analysis. The bias (or mean difference) and precision (or 1 standard deviation of the difference) (95% confidence interval) are 0.08 (0.02-0.19) g/dL and 1.01 (0.93-1.09) g/dL, respectively. The limits of agreement were -1.90 and 2.06 g/dL. The MAE is 0.79 (0.69-0.91) g/dL, the RMSE is 1.12 (0.94-1.30 g/dL), and the concordance is 86.1 (79.8-92.1) %. The error-grid analysis demonstrated that the majority (84%) of the measurements are in the green zone and 0% in the red zone.CONCLUSIONSThe exploratory study shows that the NIRS based tHb provided an accurate measurement of tHb in cardiac surgery patients. Further research may be needed to evaluate its accuracy and implementation in other clinical settings.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547847","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 Medicine, Perioperative Surgical Home, and Enhanced Recovery After Surgery: Distinct Constructs or Different Names for the Same Journey.","authors":"Vijaya Gottumukkala,Girish P Joshi,Zeev N Kain","doi":"10.1213/ane.0000000000007561","DOIUrl":"https://doi.org/10.1213/ane.0000000000007561","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547850","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":"Continuous Vital Sign Monitoring at the Surgical Ward for Improved Outcomes After Major Noncardiac Surgery: A Randomized Clinical Trial.","authors":"Jesper Mølgaard,Katja K Grønbæk,Søren S Rasmussen,Jonas P Eiberg,Lars N Jørgensen,Michael P Achiam,Malene Rohrsted,Upender M Singh,Tuyet-Hoa Hoang,Marlene Søgaard,Christian S Meyhoff,Eske K Aasvang","doi":"10.1213/ane.0000000000007606","DOIUrl":"https://doi.org/10.1213/ane.0000000000007606","url":null,"abstract":"BACKGROUNDComplications occur in a third of patients after major noncardiac surgery and are often preceded by vital sign deviations undetected by current vital sign monitoring practice, despite major advances in surgical and perioperative care. Continuous wireless vital sign monitoring with real-time alerts may allow for a reduction of vital sign abnormalities and complications.METHODSAdult patients undergoing major noncardiac surgery were included and randomized to either standard of care (manual intermittent vital sign monitoring) vs standard of care plus continuous wireless vital sign monitoring with real-time vital sign alerts to staff smartphones at the general postoperative ward. The primary outcome was cumulative duration of severe vital sign deviations, including desaturation, tachy- and bradycardia, tachy- and bradypnea, hypo- and hypertension. Secondary outcomes included adverse events within 30 days. Patients and outcome assessors were blinded to the randomization.RESULTSFour hundred patients were randomized, with 200 in the intervention and 200 in the control group, respectively. Median [interquartile range (IQR)] duration of severely deviating vital signs was 60 [25-136] vs 76 [28-192] min/d in the intervention versus control group, respectively (P = .19). Duration of Spo2 <88% had a mean reduction of 47 minutes per day (95% confidence interval [CI], 18-80, P = .02). Adverse events occurred in 42.5% vs 31.5% of patients within 30 days (P = .02), and serious adverse events in 34.5% vs 29.5% (P = .39).CONCLUSIONSContinuous vital sign monitoring with real-time staff alerts did not significantly reduce cumulative severe vital sign deviations in this setup. Significant reductions in desaturations and adverse events were found, giving evidence to future studies in the use of continuous vital sign monitoring to improve patient outcomes.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533297","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":"Alterations in Functional Connectivity and Network Topology During Remimazolam-Induced Unresponsiveness.","authors":"Xin Wen,Sijie Li,Jing Wang,Liang Bi,Yi Sun,Xuyang Wang,Yiri Du,Zhenhu Liang,Changwei Wei","doi":"10.1213/ane.0000000000007614","DOIUrl":"https://doi.org/10.1213/ane.0000000000007614","url":null,"abstract":"BACKGROUNDRemimazolam, an ultrashort-acting intravenous benzodiazepine, is a safe and effective sedative agent. Previous studies have established a strong correlation between cortical network alterations and general anesthesia. However, the effects of remimazolam on the cortical network remain unclear.METHODSTwenty-two patients were administered intravenous remimazolam. Recordings were obtained using a 32-channel electroencephalography across the baseline, anesthesia, and recovery states. Brain oscillatory activity during remimazolam anesthesia was assessed through spectral power analysis. Functional connectivity was assessed using the weighted and directed phase lag indices, with the former used to construct weighted brain networks. Network characteristics were analyzed using nodal metrics (nodal clustering coefficient and efficiency) and global metrics (average clustering coefficient, average path length, modularity, and small-worldness). In addition, hub nodes were identified using the largest betweenness centrality to investigate the network's hub structure across different states.RESULTSRemimazolam induced significant anteriorization of alpha power and markedly decreased alpha functional connectivity in both prefrontal-frontal and anterior-posterior regions (P < .019). Remimazolam significantly affected the alpha-band functional brain network, characterized by reduced nodal clustering (P < .001) and efficiency (P < .001), but increased global clustering (P < .001), average path length (P = .022), and modularity (P < .001). The small-world property-a network structure balancing high clustering with short path lengths-was preserved under remimazolam anesthesia (slightly increased, P = .028). After remimazolam anesthesia, the hub structure of the brain was reconfigured and characterized by hub node redistribution from the posterior to anterior regions.CONCLUSIONSRemimazolam induced reorganization of functional brain networks from highly connected, highly integrated complex networks to sparsely connected, locally modular cortical networks. These findings strengthen the notion that consciousness relies on networks capable of efficient information transmission that critically depends on the balance between global functional integration and segregation.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521219","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}