Anesthesia & Analgesia最新文献

{"title":"A Novel Algorithm for Continuous Real-Time Cerebral Autoregulation Assessment Based on Mean Arterial Pressure and Cerebral Oxygen Saturation.","authors":"Antonio Albanese,Zhengmin Ma,Rogier V Immink,Hong Liu,Denise P Veelo,Alexander P J Vlaar,Bin Zhang,Gregory Fischer,Zhongping Jian,Feras Hatib,Paul Benni,Charles W Hogue","doi":"10.1213/ane.0000000000008179","DOIUrl":"https://doi.org/10.1213/ane.0000000000008179","url":null,"abstract":"BACKGROUNDContinuous and real-time assessment of cerebral autoregulation can be of important clinical value to individualize blood pressure targets in perioperative settings. There is a high interindividual variability of the lower (LLA) and upper (ULA) limits of cerebral blood flow autoregulation, and exposure to blood pressure values outside of these limits has been associated with complications. We have developed a novel algorithm for continuous real-time assessment of cerebral autoregulation based on analysis of the dynamic interactions of mean arterial pressure (MAP) and near-infrared spectroscopy cerebral oxygen saturation (Sto2) measurements. The algorithm generates an index, the cerebral autoregulation index (CAI), which characterizes the effectiveness of cerebral autoregulation on a 0 to 100 scale. The aim of this study is to validate the algorithm using data from animals and surgical patients.METHODSMAP, cerebral Sto2, and cerebral laser-Doppler blood flow (CBF) data were collected as part of an animal study on a piglet model of controlled hypotension. Additionally, simultaneous MAP, cerebral Sto2, and transcranial Doppler cerebral blood flow velocity (CBFV) data were collected on patients in a multicenter prospective observational study during surgery. Individual plots of CBF/CBFV versus MAP were constructed retrospectively for both the animal and human data, and ground truth labels of cerebral autoregulation status were obtained by identifying on these curves the LLA and ULA values. CAI values were generated by postprocessing MAP and cerebral Sto2 data through the algorithm. Receiver operating characteristic (ROC) analysis was then conducted to assess the capability of the algorithm to discriminate impaired autoregulation, where MAP is beyond the individual LLA/ULA limits, from intact autoregulation, where MAP is between LLA and ULA.RESULTSSeventy-one patients were enrolled in the human study, and the ROC analysis showed an area under the ROC curve (AUC) (95% confidence interval) of 0.92 (0.89-0.94), with a sensitivity and specificity of 0.82 (0.76-0.87) and 0.94 (0.92-0.96), respectively, at the CAI threshold of 45. In addition, 10 female piglets underwent a controlled hypotension protocol where MAP was lowered below the LLA. The ROC analysis showed an AUC of 0.99 (0.98-1.00), with a sensitivity and specificity of 0.95 (0.90-0.99) and 0.96 (0.94-0.98), respectively.CONCLUSIONSThe study demonstrates that the CAI algorithm, using MAP and processed Sto2 signals, is accurate in discriminating states of intact autoregulation from states of impaired autoregulation. This algorithm may allow for personalized cerebral autoregulation-oriented blood pressure management during surgery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148336120","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 Impact of the \"2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade\" on Quantitative Neuromuscular Monitoring Two Years Later.","authors":"J Ross Renew,Dustin D Linn,Ilana I Logvinov,Yaohua Ma,Sorin J Brull","doi":"10.1213/ane.0000000000008190","DOIUrl":"https://doi.org/10.1213/ane.0000000000008190","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148336121","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":"Anesthesia Care, Complications, and Airway Management for Patients With Spinal Muscular Atrophy: A Retrospective Chart Review From a Quaternary Children's Hospital.","authors":"Kathryn M Black,Steven J Staffa,Hanna van Pelt,Joseph P Cravero","doi":"10.1213/ane.0000000000008155","DOIUrl":"https://doi.org/10.1213/ane.0000000000008155","url":null,"abstract":"BACKGROUNDSpinal muscular atrophy (SMA) is a genetic disorder resulting in progressive muscle atrophy due to the degradation of motor neurons. There are limited data on anesthesia care for these patients, the incidence of anesthesia-related adverse events, and difficult intubations. The investigators aim to characterize patients with SMA who required anesthetics at a large quaternary pediatric hospital, describe the procedures being performed, report the incidence of severe anesthesia-related adverse events, and determine the incidence of difficult intubations. The investigators hypothesized that lumbar puncture for nusinersen administration would represent the most common procedure for which patients with SMA required anesthesia care.METHODSA retrospective chart review of anesthetics provided to SMA patients from June 1, 2012, to December 30, 2023. Data obtained included procedures performed, patient characteristics, perioperative care, anesthesia technique, and outcomes.RESULTSIn total, 1804 procedures were performed for 175 patients with SMA. The majority of procedures (1423/1804, 78.9%) were for lumbar puncture for nusinersen administration; 234 of 1804 (13.0%) received general anesthesia with endotracheal tube placement; 22 of 1804 total cases (1.2%) or 22 of 234 (9.4%) of those with endotracheal tube placement met the definition of difficult intubation. There were no statistically significant associations between difficult intubation and SMA type, age, and presence of halo headframe (all P > .05). There were six severe anesthesia-related adverse events (0.33%). Of 1423 total procedures for lumbar punctures for nusinersen administration, 1254 of 1423 (88.1%) were performed with a natural airway (nasal canula, facemask, or home continuous positive airway pressure [CPAP] or biphasic positive airway pressure [BiPAP]) or pre-existing tracheostomy.CONCLUSIONSLumbar puncture for nusinersen administration made up the vast majority of procedures for which patients with SMA presented for anesthesia care. The incidence of difficult intubation was 9.4%, and the incidence of anesthesia-related severe adverse events was 0.33%. These results indicate the need to focus research on the perioperative and airway-related risks for this evolving and medically complex population.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148336119","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":"Computer Simulation Approach to Assessing Anesthetic Gas Leak Exposure to Theater Staff.","authors":"Fred Mendonça,Kenneth F Barker,Pawan Ghildiyal,Andrew Heather,Michael Ralph,Steven Chawk","doi":"10.1213/ane.0000000000008178","DOIUrl":"https://doi.org/10.1213/ane.0000000000008178","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148336123","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":"Associations Between Pulmonary Artery Catheter Use and Outcomes After Cardiac Surgery: An Entropy-Balanced Cohort Study.","authors":"Luke A Perry,Sashritha Peiris,Noah Greifer,Alexandra Karamesinis,Lisa Q Rong,Mario Gaudino,Julian A Smith,Andrew Silvers,Jayme Bennetts,Reny Segal,Marco Larobina,Rinaldo Bellomo,Lachlan F Miles","doi":"10.1213/ane.0000000000008198","DOIUrl":"https://doi.org/10.1213/ane.0000000000008198","url":null,"abstract":"BACKGROUNDPulmonary artery catheters are used widely in cardiac surgery despite conflicting associations with patient outcomes. We evaluated the associations between pulmonary artery catheter use and clinical outcomes following cardiac surgery using a large cohort of patients treated at a US academic center.METHODSWe performed a retrospective entropy-balanced cohort study of consecutive adults undergoing cardiac surgery from a single tertiary center in Boston, Massachusetts, from 2008 to 2022. We used entropy balancing to achieve exact covariate balance on prespecified baseline characteristics and then estimated the average treatment effect of pulmonary artery catheter use on clinical and mechanistic outcomes. The primary outcome was mortality measured 90 days after surgery. Secondary outcomes were acute kidney injury, hospital and intensive care unit (ICU) length of stay, time in postoperative organ dysfunction measured at 7 days, prolonged inotrope use (>4 hours), significant peak vasopressor requirement (>0.1 μg/kg/min in norepinephrine equivalents), net fluid balance at 24 hours, number of fluid boluses administered, volume of allogeneic red blood cells transfused, and total duration of mechanical ventilation.RESULTSWe included 10,044 patients, of whom 5850 (58.2%) were managed with a pulmonary artery catheter. Pulmonary artery catheter use was not associated with 90-day mortality (risk ratio [RR], 0.966; 95% confidence interval [CI], 0.719-1.30; P =.816) nor in-hospital mortality (RR, 0.921; 95% CI, 0.632-1.34; P =.670). There was no between-group difference in hospital length of stay (median difference [MD], 0.050 days; 95% CI, 0.0477-0.148; P =.269), but patients managed with a pulmonary artery catheter had greater ICU length of stay (MD = 13.1 hours; 95% CI, 9.74-16.4; P <.001). Pulmonary artery catheters were also associated with increased incidence of acute kidney injury (RR, 1.12; 95% CI, 1.07-1.17; P <.001). Patients who received a pulmonary artery catheter were more likely to have prolonged inotrope requirements (RR, 4.13; 95% CI, 3.42-4.98; P <.001), significant vasopressor requirements (RR, 1.37; 95% CI, 1.28-1.46; P <.001), higher positive fluid balances (MD, 566 mL; 95% CI, 453-678; P <.001), higher volumes of allogeneic RBCs transfused (MD, 226 mL; 95% CI, 183-269; P <.001), higher time in postoperative organ dysfunction (MD, 3.96 hours; 95% CI, 3.01-4.90; P <.001), and longer durations of mechanical ventilation (MD, 11.3 hours; 95% CI, 7.33-15.2; P <.001).CONCLUSIONSIn a large entropy-balanced cohort study of adults undergoing cardiac surgery, pulmonary artery catheter use was not associated with mortality, but was linked with a higher treatment intensity and longer ICU stay.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304734","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":"Routine Preoperative Cognitive Assessment to Improve Brain Health in Older Surgical Patients: Insights From an Anesthesia Patient Safety Foundation Survey.","authors":"Valluvan Rangasamy,Lena Scotto,Steven Greenberg,Jeffrey Huang","doi":"10.1213/ane.0000000000008181","DOIUrl":"https://doi.org/10.1213/ane.0000000000008181","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304733","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":"Comparing Approaches to Estimation of Anesthesia Agent and Gas Consumption: A Single-Center Retrospective Analysis.","authors":"Armaan Patel,Yuan Yuan,Graciela Mentz,Nirav Shah,Jeffery Feldman,Douglas A Colquhoun","doi":"10.1213/ane.0000000000008182","DOIUrl":"https://doi.org/10.1213/ane.0000000000008182","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304736","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":"Emergency Jet Oxygenation Via a Narrow-Bore Cannula: A Computational Modelling Investigation.","authors":"Marianna Laviola,James Dinsmore,David Lacquiere,Christian Niklas,Andrew Heard,Jonathan G Hardman","doi":"10.1213/ane.0000000000008194","DOIUrl":"https://doi.org/10.1213/ane.0000000000008194","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304737","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":"Live Interactive Music Therapy Across the Perioperative Continuum: A Scoping Review.","authors":"Kerry Devlin,Jamie C Shegogue,Christian DeGroot,Divya Manikandan,Lori-Ann M Edwards,Katie L Lobner,Kyurim Kang,Sapna R Kudchadkar","doi":"10.1213/ane.0000000000008130","DOIUrl":"https://doi.org/10.1213/ane.0000000000008130","url":null,"abstract":"Music therapy is a nonpharmacologic, patient-centered intervention increasingly used in perioperative settings to improve the surgical experience for patients and their families. Despite growing evidence, music therapy's integration into anesthesia care remains variable, highlighting a need to synthesize the current landscape of music therapy in this clinical context. This scoping review aimed to map the primary characteristics and impacts of live interactive music therapy delivered by a certified music therapist across the perioperative continuum and identify gaps in the literature to guide future research and practice in perioperative settings. Following PRISMA-ScR guidance, database searches were conducted October 2024 to June 2025 using key medical subject headings (MeSH) terms. Inclusion criteria specified (1) live or recorded music therapy delivered by a certified music therapist and (2) intervention timing within 24 hours pre- to 72 hours post-operation. The initial search yielded 2095 articles. After abstract screening, 1049 remained and underwent full-text review. 25 articles met criteria and were included in data extraction. The 25 articles included 1821 patients aged 9-months- to 94-years-old across diverse surgical specialties. Music therapy was delivered preoperatively (n = 17), intraoperatively (n = 8), and postoperatively (n = 15), with inclusion of flexible and protocolized approaches. Pediatric music therapy was more frequently delivered preoperatively, emphasizing play-based, active engagement. Adult music therapy was more evenly distributed across perioperative timepoints, emphasizing introspective, emotion-focused approaches. Selected outcome measures reflected these differences, with pediatric effects captured through behavioral observation (e.g, modified-Yale Perioperative Anxiety Scale [m-YPAS]), whereas adult outcomes relied more heavily on self-reporting (eg, visual analog scale [VAS]). Postoperatively, pediatric and adult music therapy approaches were more aligned across age groups given both used relaxation-based approaches. Perioperative music therapy is a feasible, low-risk adjunct that may complement existing pharmacologic strategies to support anxiety, mood, and pain with minimal interruption to patient care for teams with access to this resource. Limitations including small sample sizes, expectancy effects, inconsistent music therapy intervention reporting, and lack of therapist-contact controls prompt cautious interpretation. Future research should explore intraoperative delivery logistics, dose-response relationships, integration of multimodal outcomes, and anesthesia team perspectives to guide practical integration of music therapy into the anesthesia armamentarium.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148286843","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":"Refusals to Provide Anesthesia for Abortion Care: Reconsidering Conscientious Objection Claims Among Anesthesiologists.","authors":"Jacob M Nieb,Katie Watson,Alyssa Burgart","doi":"10.1213/ane.0000000000008057","DOIUrl":"https://doi.org/10.1213/ane.0000000000008057","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754930","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}