Anesthesia & Analgesia最新文献

{"title":"Trends and Variations in Tracheal Intubation for Acute Respiration Failure in Critically Ill Patients in the United States.","authors":"Kunal Karamchandani,Alex Iancau,Eric B Rosero","doi":"10.1213/ane.0000000000008154","DOIUrl":"https://doi.org/10.1213/ane.0000000000008154","url":null,"abstract":"BACKGROUNDAcute respiratory failure (ARF) is a common indication for tracheal intubation in critically ill patients. This study sought to describe temporal trends and hospital variation in tracheal intubation among patients with ARF, identify factors associated with its use, and examine the relationship between tracheal intubation and hospital mortality.METHODSWe performed an observational cohort study of adult hospitalizations (2016-2019) for ARF using the National Inpatient Sample. We identified critically ill patients with ARF who required tracheal intubation and assessed outcomes, temporal trends in the incidence, and associated patient and hospital characteristics. Multivariable logistic regression was used to examine factors associated with the performance of tracheal intubation and to characterize the association between mortality and intubation status while controlling for type of respiratory failure, demographics, and patient comorbidities.RESULTSA total of 2017,349 admissions with a diagnosis of ARF were identified, representing 10,086,744 (95% confidence interval [CI], 9957,967-10,215,520) cases nationwide. Of those, 2153,460 (21.3%) required tracheal intubation. Intubated patients were more likely to be nonwhite men, have a higher comorbidity burden, be insured by Medicaid, and be hospitalized in large urban, teaching hospitals. Although ARF cases increased from 1872,519 in 2016 to 3194,075 in 2019, the proportion of patients undergoing tracheal intubation declined from 23.8% to 19.8% during the same period (P < .0001). Mortality rates were higher in intubated than in nonintubated patients (P < 001). Mortality remained stable in intubated patients (30.6% [95% CI, 30.2-31.1] in 2016, versus 31.0% [95% CI, 30.5-31.4] in 2019) but decreased in nonintubated patients during the same time period (8.1% [95% CI, 7.9-8.3] versus 6.6% [95% CI, 6.5-6.8]). 10.5% of the variability in intubation rates was attributable to the admitting hospital, and sepsis was the patient factor most strongly associated with tracheal intubation.CONCLUSIONSIn the National Inpatient Sample, tracheal intubation in critically ill patients with ARF has declined over time with no change in mortality. In the same period, mortality rates in nonintubated patients have fallen. Further work is needed to better understand factors affecting the decision to intubate for respiratory failure in critically ill patients.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552679","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 Propensity-Matched Cohort Study of Intravenous Versus Oral Iron Formulations for Management of Iron Deficiency Anemia in Pregnancy.","authors":"Una E Choi,Ryan C Nicholson,Katherine E Economy,Steven M Frank,Jean M Connors,David L Hepner","doi":"10.1213/ane.0000000000008229","DOIUrl":"https://doi.org/10.1213/ane.0000000000008229","url":null,"abstract":"BACKGROUNDAnemia in pregnancy detrimentally impacts maternal and fetal health. Previous research has demonstrated faster and more robust hemoglobin (Hb) increases with intravenous (IV) iron when compared to oral iron. We aimed to characterize additional clinical impacts of IV iron and, by exploring multiple iron formulations, this study seeks to provide a comprehensive analysis of the effects, safety, and patient response to both treatment options.METHODSA retrospective propensity-matched cohort analysis was performed using a large database (TriNetX Research Network) from January 2000 to November 2025. We identified pregnant patients aged ≥18 years with iron deficiency anemia (IDA) in the second trimester with ferritin <30 ng/mL and hemoglobin <11 g/dL, constructing two cohorts: (1) patients treated with IV iron and (2) patients treated with oral iron within 2 months of their anemia diagnosis. Propensity score matching was performed by age, demographics, overweight and obesity, type 2 diabetes, lipid disorders, hypertension, heart failure, chronic ischemic heart disease, hypothyroidism, chronic kidney disease, gastro-esophageal reflux disease, high-risk pregnancy, neoplasms, nicotine dependence, alcohol use disorder, other substance use disorder, and pretreatment Hb grouped by <6.5 g/dL, 6.5 to 7.9 g/dL, 8 to 9.9 g/dL, and 10 to 10.9 g/dL. Primary outcomes were blood transfusions, maternal mortality, preeclampsia, cesarean section (CS), and preterm labor. Secondary outcomes were an adverse outcome composite (gastritis,nausea/vomiting or anaphylactic shock), Hb, and ferritin in the 3 months after treatment. Subgroup analysis of IV iron users (excluding iron sucrose) versus oral iron users was performed.RESULTSThere were 1693 postmatch patients per cohort. IV iron was associated with lower risk for preterm labor (7.7% vs 10.04%, risk ratio [RR] 0.77 [0.62-0.96]) and CS (18.67% vs 22.15%, RR 0.84 [0.74-0.96]) and higher posttreatment Hb (10.6 vs 9.7, adj. P = .0001) and ferritin (138 vs 39, adj. P = .0001). There was no difference in other outcome measures. There were 914 postmatch patients per cohort in the subgroup analysis. IV iron (excluding iron sucrose) was again associated with decreased risk of preterm labor (5.25% vs 9.30%, RR 0.57 [0.40-0.80]), higher Hb (10.7 vs 9.8, adj. P = .0001) and ferritin (175 vs 42, adj. P = .0001). All other outcomes were not significant.CONCLUSIONSThis study evaluates the differential effects of IV compared with oral iron formulations in a large cohort of matched pregnant patients. Compared to oral iron, IV iron may be preferable for increasing Hb, resolving IDA, and reducing maternal complications.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552681","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":"Repurposing the Transcranial Doppler Probe for Precordial Detection of Venous Air Embolism in Craniosynostosis Surgery: A Novel Rescue Technique.","authors":"Deep Sengupta,Subodh Raju","doi":"10.1213/ane.0000000000008183","DOIUrl":"https://doi.org/10.1213/ane.0000000000008183","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462323","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 Nonlinear Association Between Preoperative Hemoglobin and Intraoperative Oxygen Desaturation in High-Altitude Surgical Patients: A Retrospective Observational Study.","authors":"Qi Yan,Yuanbin Xu,Yimei Guo,Ronghui Li,Dawa Puzhen,Yiting Mao,Laba Ciren,Yi Feng","doi":"10.1213/ane.0000000000008115","DOIUrl":"https://doi.org/10.1213/ane.0000000000008115","url":null,"abstract":"BACKGROUNDHigh hemoglobin concentration is a compensatory adaptation to high-altitude hypoxia that theoretically increases oxygen-carrying capacity. However, the associated rise in blood viscosity may compromise microcirculatory flow and contribute to intrapulmonary shunting during anesthesia. This study investigates sex-specific associations between preoperative hemoglobin concentrations and intraoperative oxygen desaturation events in surgical patients residing at high altitude.METHODSIn this retrospective study, we analyzed data from 8010 high-altitude residents undergoing general anesthesia for noncardiothoracic surgery at People's Hospital of Xizang Autonomous Region between January 2020 and October 2024. The dataset comprised preoperative baseline characteristics, information related to surgery and anesthesia. The primary outcome was intraoperative oxygen desaturation, defined as a peripheral oxygen saturation (Spo2 <90% lasting for ≥1 minute) measured by pulse oximetry in patients receiving mechanical ventilation during general anesthesia. Patients were stratified by sex: male (n = 3622) and female (n = 4388). Nonlinear associations were analyzed using multivariable-adjusted restricted cubic splines, and piecewise logistic regression was used to identify hemoglobin thresholds.RESULTSNonlinear associations between preoperative hemoglobin concentrations and intraoperative oxygen desaturation were observed in both sexes. For males, piecewise regression identified a statistical inflection point at 20.6 g/dL (adjusted odds ratio [adjOR] per 1 g/dL increase, 1.50; 95% confidence interval [CI], 1.18-1.92; P = .001). For females, the threshold was notably lower at 14.9 g/dL, above which the risk significantly increased (adjOR per 1 g/dL increase, 1.33; 95% CI, 1.13-1.58; P < .001). However, for males, a clinically significant risk increase was observed starting at 18.0 g/dL (adjOR per 1 g/dL increase, 1.23; 95% CI, 1.05-1.45; P = .012). Sensitivity analyses validated these findings across different definitions of desaturation and imputation methods.CONCLUSIONSIn high-altitude surgical patients receiving mechanical ventilation during general anesthesia, we identified sex-specific hemoglobin thresholds associated with intraoperative oxygen desaturation. While statistical inflection points occur at higher levels, particularly in males, our data suggest that clinical caution is advised when hemoglobin exceeds 18.0 g/dL in males and 14.9 g/dL in females. These findings underscore the rheological risks of higher hemoglobin concentrations and support the adoption of sex-stratified preoperative assessment protocols to optimize perioperative oxygen delivery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462325","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":"Beyond Hemoglobin: The Clinical Imperative for Managing Nonanemic Iron Deficiency in Perioperative Care-A Perspective.","authors":"Manuel Muñoz,Ioav Cabantchik,Rodolfo D Cançado,Caroline Evans,Domenico Girelli,Vernon Louw,Patrick Meybohm,Sherri Ozawa,Joshua Ozawa-Morriello,Dorine W Swinkels,Donat R Spahn,Aryeh Shander","doi":"10.1213/ane.0000000000008217","DOIUrl":"https://doi.org/10.1213/ane.0000000000008217","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462285","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":"Predicting Fluid Responsiveness in Mechanically Ventilated Adults: An Umbrella Review of Diagnostic Accuracy Meta-Analyses.","authors":"Massimo Meco,Enrico Giustiniano,Fulvio Nisi,Pierluigi Zulli,Emiliano Agosteo","doi":"10.1213/ane.0000000000008215","DOIUrl":"https://doi.org/10.1213/ane.0000000000008215","url":null,"abstract":"BACKGROUNDDynamic indices and maneuvers are widely used to predict fluid responsiveness in mechanically ventilated patients, yet their relative performance remains uncertain.METHODSWe conducted an umbrella review of diagnostic accuracy meta-analyses published up to August 2025. Eligible reviews evaluated pulse pressure variation (PPV), stroke volume variation (SVV), passive leg raising (PLR), end-expiratory occlusion test (EEOT), tidal volume challenge (TVC), pleth variability index (PVI), or respiratory variation in inferior vena cava diameter (ΔIVC) in mechanically ventilated adults. Redundancy across reviews was assessed using the Corrected Covered Area (CCA), with pairwise overlap explored using Jaccard coefficients. The primary umbrella-level comparative metric was pooled area under the receiver operating characteristic curve (AUC) as reported by the included meta-analyses. Pooled sensitivity, specificity, and hierarchical ROC information were extracted when available. Secondary analyses included cumulative meta-analysis, subgroup and meta-regression analyses, prediction intervals, and assessment of small-study effects/publication bias.RESULTSSeven meta-analyses were included, synthesizing 123 primary diagnostic studies and 10,300 patients. Global CCA was approximately 5.5% to 5.6%, consistent with borderline slight-to-moderate overlap across the included meta-analyses. TVC showed the highest comparative diagnostic performance (AUC 0.96, 95% CI, 0.94-0.97), followed by EEOT (AUC 0.95, 95% CI, 0.92-0.96). Passive leg raising (PLR) achieved good accuracy (AUC 0.91, 95% CI, 0.88-0.93), whereas pulse pressure variation (PPV) and stroke volume variation (SVV) showed only moderate performance (AUC 0.87-0.88). Pleth variability index (PVI) and inferior vena cava variation (ΔIVC) were the least reliable (AUC 0.82-0.83). Subgroup and moderator analyses indicated that tidal volume was the main effect modifier: TVC and EEOT remained comparatively robust.CONCLUSIONSAmong dynamic predictors of fluid responsiveness, TVC and EEOT appear to be the most accurate and robust indices. PLR retains intermediate utility, PPV and SVV show moderate reliability, whereas PVI and ΔIVC should not be used in isolation.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462286","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":"Residual Gastric Contents in Glucagon-Like Peptide-1 Receptor Agonist Users: The Potential Confounding Role of Diabetes-Related Gastric Dysmotility.","authors":"Suolang Dajie,Zhuoma Yangzong,Wen Yang","doi":"10.1213/ane.0000000000008151","DOIUrl":"https://doi.org/10.1213/ane.0000000000008151","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":"e27-e28"},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365255","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 Novel Method To Reduce Aspiration Risk In Anesthesia And Critical Care Settings Using Alginate Gel Formulation.","authors":"Anastasia Jones,Pepe Alfonso,Kevin Olsen","doi":"10.1213/ane.0000000000008142","DOIUrl":"https://doi.org/10.1213/ane.0000000000008142","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"161 1","pages":"e25-e27"},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365256","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":"Beyond the BASICs: Understanding Why Demographics Affect Examination First-Pass Rates for ABA Basic Examination and What Can Be Done.","authors":"Stephanie Cardenas,Andrew B Steiner","doi":"10.1213/ane.0000000000008138","DOIUrl":"https://doi.org/10.1213/ane.0000000000008138","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"136 1","pages":"e23-e25"},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365304","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":"Epidural Blood Patches: In Search of the Optimal Volume.","authors":"","doi":"10.1213/ane.0000000000008185","DOIUrl":"https://doi.org/10.1213/ane.0000000000008185","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"62 1","pages":"235"},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365257","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}