Anesthesia & Analgesia最新文献

{"title":"Perioperative Interventions in Autism Spectrum Disorder: A Systematic Review of Randomized Trials.","authors":"Brenda Larissa da Rocha Forte,Rafaela Noronha de Carvalho Vasconcelos,Marcelo de Almeida Pinheiro,Eduardo Vidal Vasconcelos,Samantha Ottoni Adolphsson Zidan","doi":"10.1213/ane.0000000000008232","DOIUrl":"https://doi.org/10.1213/ane.0000000000008232","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148441000","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":"Early Adoption of Suzetrigine After FDA Approval: Inpatient and Outpatient Practice Patterns.","authors":"Matthew M Colontonio,Tugba Yavuz Kivanc,Benjamin F Gruenbaum,Fiorela Martinez,Sareidenn Ancayan,Ilana I Logvinov,Christine Hunt","doi":"10.1213/ane.0000000000008223","DOIUrl":"https://doi.org/10.1213/ane.0000000000008223","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"152 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432661","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":"Clinical Effectiveness of Acute Normovolemic Hemodilution in Cardiac Surgery: A Systematic Review and Meta-analysis.","authors":"Mahmoud Elfiki,Abdalla Elfeky,Mustafa Shafeeq Ali,Amr Ibrahim,Mariem Zayed,Amira Fahmy El-Nemr,Ahmed Elshahat,Abdelrahman Ali Hendawy,Ahmed Sobhy,Ahmed Elmorsy Mohamed,Mohamed Elnady","doi":"10.1213/ane.0000000000008221","DOIUrl":"https://doi.org/10.1213/ane.0000000000008221","url":null,"abstract":"BACKGROUNDAcute normovolemic hemodilution (ANH) is endorsed by contemporary patient blood management guidelines as a cost-effective strategy for reducing allogeneic transfusion in cardiac surgery. However, evidence remains inconsistent due to protocol variability and limited statistical power in earlier trials. This systematic review and meta-analysis seek to evaluate the clinical effectiveness of ANH in adult patients undergoing cardiac surgery.METHODSA comprehensive search of four databases was performed up to October 2025 to identify randomized controlled trials (RCTs) and matched cohort studies comparing ANH with standard intraoperative care. The primary outcome of interest was the incidence of allogeneic red blood cell (RBC) transfusion. Data were pooled using DerSimonian-Laird random-effects models, expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).RESULTSNineteen studies (15 RCTs, four cohorts) involving 9418 patients were included. ANH significantly reduced the incidence of allogeneic RBC transfusion compared with control (27.6% vs 31.5%; RR = 0.85, 95% CI [0.75-0.96], P = .01). The transfusion reduction was more evident in crystalloid-based protocols (RR = 0.72, 95% CI [0.54-0.96], P = .026) and on-pump surgeries (RR = 0.86, 95% CI [0.76-0.97], P = .01). Matched cohort analyses also confirmed the benefit (RR = 0.87, 95% CI [0.81-0.94], P = .001), whereas RCT-only analysis showed a nonsignificant difference (RR = 0.81, 95% CI [0.64-1.02], P = .07). No significant differences were found in hematocrit, hemoglobin, fresh frozen plasma transfusion, renal dysfunction, myocardial infarction, stroke, or mortality.CONCLUSIONANH significantly reduces the need for allogeneic transfusions while maintaining a favorable safety profile for patients undergoing cardiac surgery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432659","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":"Clinical Performance of Supraglottic Devices in Patients Undergoing Cancer Surgery: A Retrospective Study.","authors":"Eduardo Nunez-Rodriguez,Nicolas A Cortes-Mejia,Tarikul Islam,Jinwen Cao,Gang Zheng,Spencer Kee,Carin A Hagberg,Juan P Cata","doi":"10.1213/ane.0000000000008210","DOIUrl":"https://doi.org/10.1213/ane.0000000000008210","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"365 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432662","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 Next Frontier in Anesthesia Safety-From Standards to Implementation: APSF Ellison C. Pierce Lecture 2025 and WCA Harold Griffith Lecture 2026.","authors":"Jonathan Matías Chejfec-Ciociano,Paul Barach,Adrian W Gelb","doi":"10.1213/ane.0000000000008195","DOIUrl":"https://doi.org/10.1213/ane.0000000000008195","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432660","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":"Feasibility of Application of Artificial Intelligence in Neuroanesthesia and Neurocritical Care in Low- and Middle-Income Countries.","authors":"Indu Kapoor,Hemanshu Prabhakar,Charu Mahajan,Mani Kalaivani, ","doi":"10.1213/ane.0000000000008213","DOIUrl":"https://doi.org/10.1213/ane.0000000000008213","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432663","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":"Multimodal Machine Learning Model Predicting Postoperative Delirium Based on Heart Rate Variability: A Prospective Observational Study.","authors":"Yuling Tang,Yuanhui Liu,Jiayi Tang,Yu Wang,Qing Zhong,Pengfei Li,Xiaoxia Duan","doi":"10.1213/ane.0000000000008199","DOIUrl":"https://doi.org/10.1213/ane.0000000000008199","url":null,"abstract":"BACKGROUNDPostoperative delirium is a common and serious complication after general anesthesia; its accurate prediction remains a substantial challenge in perioperative medicine. Existing models primarily rely on clinical variables and may have limited predictive accuracy. This study aimed to evaluate the added value of heart rate variability parameters in predicting postoperative delirium and construct an interpretable multimodal predictive model.METHODSIn this prospective observational study, 1418 patients undergoing general anesthesia were included. Seventy-three features, including electrocardiogram abnormalities and heart rate variability time-, frequency-, and nonlinear-domain indicators, were extracted from electrocardiogram data. Postoperative delirium was assessed using the Chinese version of the 3-Minute Diagnostic Interview for Delirium within 3 days postoperatively. Feature selection was conducted by combining least absolute shrinkage and selection operator (LASSO) regression, the Boruta algorithm, and random forests, and 10 machine learning models were developed. Model performance was evaluated through receiver operating characteristic curves and decision curve analysis, with interpretability assessed via Shapley additive explanations. Clinical prediction tools were derived from key features. We used an external validation set to further evaluate the generalization ability of the models.RESULTSPostoperative delirium occurred in 255 (18%) patients. Seventeen key predictors were identified in total. The combined clinical-electrocardiogram-heart rate variability model demonstrated the highest predictive performance (area under the curve = 0.728), outperforming clinical-only (area under the curve = 0.673) and electrocardiogram-only models (area under the curve = 0.679). Logistic regression showed the highest discrimination. In the external validation set, the model maintained robust performance with an area under the curve value of 0.836. Shapley additive explanations highlighted seven core predictors: atrial or ventricular arrhythmia, operative time, ST-segment abnormalities, age, American Society of Anesthesiologists classification, heart rate variability entropy, and overall electrocardiogram abnormalities. A nomogram and online platform enabled personalized risk assessment.CONCLUSIONSOur results indicate that integrating heart rate variability with clinical and electrocardiogram features significantly enhances the personalized predictive efficacy of postoperative delirium.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432849","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":"Manual versus Automatic Perioperative QTc Interval Assessment: A Prospective Observational Investigation.","authors":"Vijay K Ramaiah,Evan D Kharasch","doi":"10.1213/ane.0000000000008226","DOIUrl":"https://doi.org/10.1213/ane.0000000000008226","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415999","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":"Brain Sex Steroid-Mediated Intergenerational Sex-Specific Neurocognitive Effects of Paternal Sevoflurane Exposure in Rats.","authors":"Ling-Sha Ju,Zeeshan A Khan,Nikolaus Gravenstein,Barry Setlow,Anatoly E Martynyuk","doi":"10.1213/ane.0000000000008197","DOIUrl":"https://doi.org/10.1213/ane.0000000000008197","url":null,"abstract":"BACKGROUNDThe biological basis for the male-biased prevalence of many neurodevelopmental disorders remains poorly understood. We found that preconception exposure of male rats to sevoflurane induces persistent dysregulation of stress and inflammatory signaling, while their offspring, almost exclusively males, develop neurobehavioral abnormalities. These effects in both generations are prevented by paternal pretreatment with either the Na+/K+/2Cl- cotransporter inhibitor bumetanide or the glucocorticoid receptor antagonist RU486. Using offspring from the same treatment groups, we tested the hypothesis that dysregulation of male-specific, sex hormone-dependent brain masculinization processes during the perinatal critical period contributes to the observed male-biased abnormalities.METHODSSprague-Dawley F0 males were exposed to 2.1% sevoflurane for 3 hours on postnatal days (P) 56, 58, and 60. Subsets received bumetanide or RU486 30 minutes before each exposure. On P90, F0 males were mated to generate F1 offspring. On P0-P1, F1 males of sevoflurane-exposed sires received the androgen receptor (AR) antagonist flutamide, the estradiol (E2) synthesis inhibitor formestane, the estrogen receptor α (ERα) antagonist 1,3-Bis(4-hydroxyphenyl)-4-methyl-5-[4-(2-piperidinylethoxy)phenol]-1H-pyrazole dihydrochloride (MPP), or the estrogen receptor β (ERβ) antagonist 4-[2-Phenyl-5,7-bis(trifluoromethyl)pyrazolo[1,5-a]pyrimidin-3-yl]phenol (PHTPP) (n = 18/group). Sex steroid concentrations and hippocampal mRNA expression of enzymes and receptors involved in brain masculinization were measured in P0 F1 males from control sires (F1M_C), sevoflurane-exposed sires (F1M_S), or sires pretreated with bumetanide (F1M_BS) or RU486 (F1M_RS) (n = 6-8/group). Behavioral and stress-responsivity outcomes were assessed in adulthood.RESULTSCompared with F1M_C, P0 F1M_S exhibited increased hippocampal testosterone (mean ± standard error of the mean [SEM]: 1.979 ± 0.527 vs 0.524 ± 0.122 ng/mg; P = .008) and E2 levels (10.997 ± 3.756 vs 2.793 ± 0.719 ng/mg; P = .027). Hippocampal mRNA expression of the testosterone-synthesizing enzyme 17β-hydroxysteroid dehydrogenase (1.629 ± 0.135 vs 1.000 ± 0.066; P = .001) and the E2-synthesizing enzyme aromatase (1.617 ± 0.093 vs 1.000 ± 0.070; P = .001) was also increased. In contrast, serum testosterone levels and hippocampal Ar, Erα, and Erβ mRNA expression were unchanged. F1M_BS and F1M_RS did not differ from F1M_C in any of these measures. Perinatal flutamide treatment reduced stress and neuroinflammatory markers and improved sociability, anxiety-like behavior, sensorimotor gating, and spatial memory in adulthood. Formestane normalized inflammatory and behavioral abnormalities; MPP improved sociability and spatial memory; and PHTPP improved spatial memory only.CONCLUSIONSThese findings suggest that male-specific neurodevelopmental abnormalities following paternal preconception sevoflurane exposure arise from stress- and inflammation-program","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416003","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":"Prehospital Pain Management in Trauma Treated by Helicopter Emergency Medical Services: Association of Patient and Physician Sex.","authors":"Benedick Satari,Julian Klug,Janine Uhr,Roland Albrecht,Alexander Fuchs,Urs Pietsch","doi":"10.1213/ane.0000000000008164","DOIUrl":"https://doi.org/10.1213/ane.0000000000008164","url":null,"abstract":"BACKGROUNDPain in trauma patients is frequent and associated with adverse physiological and psychological outcomes. Despite the recognized importance of early and effective analgesia, prehospital pain management remains insufficient in a substantial proportion of cases. Emerging evidence suggests sex-related differences in analgesic treatment, with both patient and physician sex potentially influencing therapy. This study investigates whether specific physician-patient sex pairings, alongside clinical and operational factors, are associated with the efficacy of prehospital pain management and explores how these factors interrelate to contribute to inadequate analgesia.METHODSWe conducted an observational cohort study of trauma patients treated by a Swiss physician-staffed Helicopter Emergency Medical Service between September 7, 2020, and July 24, 2025. We included patients with a Glasgow Coma Scale (GCS) ≥13, a National Advisory Committee for Aeronautics (NACA) Score <VI, on-scene pain of ≥3 on a patient-reported numeric rating scale (NRS), and a second pain assessment at hospital arrival. Patient and physician demographics, injury characteristics, and pain management were extracted. The primary outcome was sufficient pain management at hospital arrival, defined as NRS ≤3 at hospital arrival. Analgesic administration was evaluated for associations with insufficient pain control (NRS >3), persistent untreated pain, and pain reduction.RESULTSOf the 43,024 prehospital missions analyzed, 5168 met the inclusion criteria. The cohort was predominantly male (3097/5168; 59.9%); the median age was 47 [29-62] years. Extremity trauma was most common (3514/5168; 68%). In 32.2% (1663/5168; 95% confidence interval [CI], 30.9-33.3) of cases, analgesia was insufficient. While male physicians achieved greater NRS reduction (Coef. 0.20; 95% CI, 0.12-0.28), male patients reported less pain relief (Coef. -0.13; 95% CI, -0.21 to -0.05). Higher initial NRS scores (odds ratio [OR] = 1.45; 95% CI, 1.39-1.51) and omission of analgesics (OR = 5.70; 95% CI, 4.54-7.15) were associated with insufficient analgesia. The use of a combination of opioid and ketamine was associated with improved analgesia (OR = 0.69; 95% CI, 0.58-0.83). The greatest pain reduction was observed with ketamine or combination therapy. The median ΔNRS was 5 (interquartile range [IQR] 3-6) for ketamine and 5 (IQR 4-6) for combination therapy.CONCLUSIONSIn this large cohort, we found sex-related differences in patient-reported analgesia: male patients were more likely than female patients to report insufficient analgesia. Treatment by male physicians was associated with better patient-reported analgesia. Ketamine and its combination with opioids were associated with greater patient-reported NRS reduction compared to opioid monotherapy in a prehospital setting.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416005","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}