{"title":"Association of Risk of Suspected Ocular Injury With Forced-Air Upper Body Heating During General Anesthesia.","authors":"Mitra Khany,Kara Liebich,Isabel Podolski,Béla-Simon Paschold,Theresa Tenge,Satya Krishna Ramachandran","doi":"10.1213/ane.0000000000007654","DOIUrl":"https://doi.org/10.1213/ane.0000000000007654","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756150","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}
Yanjie Dong,Yi Yang,Weichao Guo,Shuangwen Wang,Hui Yang,Qian Li
{"title":"Comparison of Phonomyography Prototype With Train-of-Four Watch SX for Neuromuscular Monitoring: A Prospective Observational Study.","authors":"Yanjie Dong,Yi Yang,Weichao Guo,Shuangwen Wang,Hui Yang,Qian Li","doi":"10.1213/ane.0000000000007648","DOIUrl":"https://doi.org/10.1213/ane.0000000000007648","url":null,"abstract":"BACKGROUNDQuantitative neuromuscular monitoring has been advocated to deal with residual neuromuscular block. Phonomyography (PMG) is a technology that captures the acoustic signals yielded by muscle contraction, which is easy to use, anti-interference, and has multiple alternative monitoring sites. Our previous study has developed a PMG prototype for neuromuscular monitoring, and its feasibility was preliminarily verified, but further study on its clinical reliability with different neuromuscular blocking agents (NMBs) is needed.METHODSThis single-center, prospective, observational study compared the effect of a PMG prototype and TOF-Watch SX on neuromuscular monitoring of the ipsilateral adductor pollicis muscle with the use of non-depolarizing and depolarizing NMBs among 102 surgical patients. Patients were divided into 3 groups by NMBs, namely Group C (cisatricurium), Group V (vecuronium), and Group S (succinylcholine). The PMG prototype and TOF-Watch SX were placed at ipsilateral hand of each individual and measured data from NMBs administration to a stable train-of-four ratio (TOFr) ≥ 0.9 or T value ≥ 0.9 were compared.RESULTSEighty patients were included in the data analysis. For non-depolarizing NMBs, the PMG prototype recorded a longer onset time compared to TOF-Watch SX (median [interquartile range, IQR], 210 [180-240] seconds vs 150 [135-180] seconds, P < .001, mean bias 48 [40-55]; mean ± [standard deviation, SD], 197 ± 48 seconds vs 159 ± 36 seconds, P < .001, mean bias 38 [28-48]; for Group C and Group V, respectively) and a shorter full recovery time (4014 ± 511 seconds vs 5072 ± 713 seconds, P < .001, mean bias -1058 [-1215 to -901], 3352 ± 791 seconds vs 4931 ± 902 seconds, P < .001, mean bias -1084 [-1237 to -931], for Group C and Group V, respectively). For depolarizing NMBs, the results were similar (94 ± 26 seconds vs 80 ± 25 seconds, P < .001, mean bias 15 [10-19] for onset time; 447 ± 126 seconds vs 689 ± 223 seconds, P < .001, mean bias -242 [-294 to -191] for full recovery time).CONCLUSIONSWhen non-depolarizing NMBs were administered, the PMG prototype measured a significantly longer onset and a shorter recovery time compared with TOF-Watch SX. The same trend was also found when depolarizing NMBs were administered. The PMG prototype is clinical feasible and stable but not interchangeable with TOF-Watch SX.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"342 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756121","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}
Daniel J McCoy,Logan M Olson,Neil B Sandson,Catherine Marcucci
{"title":"Suzetrigine-Induced Metabolism of Factor Xa Inhibitors May Increase Risk of Thrombosis in Perioperative and Pain Patients.","authors":"Daniel J McCoy,Logan M Olson,Neil B Sandson,Catherine Marcucci","doi":"10.1213/ane.0000000000007721","DOIUrl":"https://doi.org/10.1213/ane.0000000000007721","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"132 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737361","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}
Dhanesh D Binda,Maxwell B Baker,Marissa Tuler,Erin Dienes,Xuan A He,Ala Nozari
{"title":"The Academic Impediment: Why Are Women Chairs in Anesthesiology Still Underrepresented in the United States?","authors":"Dhanesh D Binda,Maxwell B Baker,Marissa Tuler,Erin Dienes,Xuan A He,Ala Nozari","doi":"10.1213/ane.0000000000007651","DOIUrl":"https://doi.org/10.1213/ane.0000000000007651","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693496","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}
Lisa Reisinger,Crispiana Cozowicz,Haoyan Zhong,Alex Illescas,Periklis Giannakis,Stavros G Memtsoudis,Jashvant Poeran,Jiabin Liu
{"title":"Trends in Comorbidities and Complications Among Octogenarians and Nonagenarians Undergoing Primary Total Joint Arthroplasty in the United States.","authors":"Lisa Reisinger,Crispiana Cozowicz,Haoyan Zhong,Alex Illescas,Periklis Giannakis,Stavros G Memtsoudis,Jashvant Poeran,Jiabin Liu","doi":"10.1213/ane.0000000000007631","DOIUrl":"https://doi.org/10.1213/ane.0000000000007631","url":null,"abstract":"BACKGROUNDWith an aging population and gaining popularity of total knee and hip arthroplasty (TKA, THA), patients aged 80+ are likely to increase. These patients present unique challenges regarding perioperative risks. Large population data characterizing this group is lacking. The aim of this study was to offer an overview of trends in practices and outcomes among octogenarians and nonagenarians.METHODSWe utilized the Premier Healthcare database to identify patients undergoing TKA and THA from 2006 to 2022. Patients 80 to 88 years and 89+ years old were compared to those aged 65 to 70, the typical age group for TKA/THA recipients. We evaluated trends of practice pattern, patient demographics, and comorbidity burden. Multivariable models were applied to compare major complications.RESULTSNeuraxial anesthesia was used more frequently among older patients undergoing TKA. Mean length of stay for both TKA and THA continuously decreased over time. Interestingly, octogenarian and nonagenarian TKA recipients had fewer comorbidities than 65- to 70-year-olds, while the reverse was observed among THA recipients. Multivariable analysis showed that among patients with similar comorbidity burden, octogenarian and nonagenarian patients had higher odds [95% CI] of major complications (TKA: OR 2.2 [2.0-2.4] and 2.7 [2.0-3.7] in 2006, OR 1.8 [1.6-2.1] and 2.0 [1.5-2.8] in 2022, respectively; for THA: OR 2.5 [2.1-3.0] and 3.7 [2.7-5.1] in 2006, OR 2.1 [1.8-2.4] and 2.7 [2.1-2.4] in 2022, respectively).CONCLUSIONSAlthough THA/TKA patients appear to be in good health relative to 65- to 70-year-olds, age remains a significant risk factor for increased morbidity.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"278 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693364","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 Disparities and the Imperative for Continued Equity-Focused Research.","authors":"Robert S White,Jamie Kim,Maressa Cumbermack","doi":"10.1213/ane.0000000000007673","DOIUrl":"https://doi.org/10.1213/ane.0000000000007673","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684144","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":"High-Flow Nasal Oxygen versus Mechanical Ventilation Through a Laryngeal Mask During General Anesthesia Without Muscle Paralysis: A Randomized Clinical Trial.","authors":"Luciano Frassanito,Domenico Luca Grieco,Francesco Vassalli,Alessandra Piersanti,Marco Scorzoni,Francesca Ciano,Bruno Antonio Zanfini,Stefano Catarci,Ursula Catena,Giovanni Scambia,Massimo Antonelli,Gaetano Draisci","doi":"10.1213/ane.0000000000007620","DOIUrl":"https://doi.org/10.1213/ane.0000000000007620","url":null,"abstract":"BACKGROUNDApneic oxygenation with high-flow nasal oxygen is a novel intraoperative respiratory support strategy for patients undergoing general anesthesia, but data about its clinical effects are scarce. We conducted a randomized trial to assess whether high-flow nasal oxygen is noninferior to mechanical ventilation through a laryngeal mask in terms of success rate of intraoperative respiratory support among patients undergoing a 30-minute general anesthesia session.METHODSSingle-center, randomized, noninferiority trial conducted in Italy between May 2022 and June 2023 and involving American Society of Anesthesiologists class I and II patients undergoing general anesthesia for operative hysteroscopy. Participants were randomized to receive laryngeal mask ventilation (volume-controlled ventilation to obtain end-tidal carbon dioxide between 35 and 45 mm Hg, inhaled oxygen fraction to achieve peripheral oxygen saturation greater than 95%) or high-flow nasal oxygen (70 L per minute, inhaled oxygen fraction of 100%) for intraoperative respiratory support. Patients received general anesthesia with propofol target-controlled infusion without neuromuscular blockade. Primary outcome was intraoperative respiratory support success rate, which was defined as peripheral oxygen saturation greater than 94% and transcutaneous carbon dioxide lower than 65 mm Hg with no need for rescue airway interventions for the entire procedure. Secondary outcomes included the rate of airway-related complications (including need for bag-mask or laryngeal mask ventilation, or tracheal intubation), postoperative respiratory symptoms, and postoperative dyspnea.RESULTSAll 180 patients who were randomized completed the trial (90 patients in each group). Median [interquartile range] anesthesia duration was 25 [20-36] minutes in high-flow group and 32 minutes [27-44] in the laryngeal mask group. Intraoperative respiratory support was successful in 89 patients (99%) in both groups (absolute difference 0, unilateral 95% confidence interval, 3%, noninferiority P < .001). Incidence of postoperative respiratory symptoms was significantly lower in high-flow versus laryngeal mask group (2% vs 19%, P < .001), while airway-related complications and postoperative dyspnea were not different. Intraoperative transcutaneous carbon dioxide was significantly higher in high-flow group, with 43% of patients showing values greater than 55 mm Hg.CONCLUSIONSHigh-flow nasal oxygen is noninferior to laryngeal mask ventilation for intraoperative respiratory support during 30-minute general anesthesia without muscle paralysis. The risk of hypercarbia warrants careful patient selection and monitoring.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"110 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678105","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}
Raffaella L Fantin,Francois Uys,Thomas Schuetz,Margot Flint,Carl J Lombard,Mushi J Matjila,Ayesha Osman,Justiaan L Swanevelder,Robert A Dyer,Clemens M Ortner
{"title":"Prevalence of Point-of-Care Ultrasound Abnormalities and Raised Serum NT-proBNP in Early-Onset Preeclampsia.","authors":"Raffaella L Fantin,Francois Uys,Thomas Schuetz,Margot Flint,Carl J Lombard,Mushi J Matjila,Ayesha Osman,Justiaan L Swanevelder,Robert A Dyer,Clemens M Ortner","doi":"10.1213/ane.0000000000007650","DOIUrl":"https://doi.org/10.1213/ane.0000000000007650","url":null,"abstract":"BACKGROUNDPreeclampsia is a multisystem disorder associated with adverse maternal and fetal outcomes. A previous study in patients with late-onset preeclampsia (LOPE), showed an association between pulmonary interstitial syndrome (PIS), detected by lung ultrasound, and elevated left ventricular end-diastolic pressure (LVEDP), measured by transthoracic echocardiography (TTE). In early onset preeclampsia (EOPE); however, the cardiopulmonary status remains poorly characterized.METHODSThis prospective observational cohort study enrolled women with EOPE with severe features. Point of care ultrasound (POCUS) assessments included lung ultrasound, TTE, and sonographic assessment of the optic nerve sheath diameter (ONSD). PIS was defined as the presence of bilateral B-lines on lung ultrasound. An ONSD >5.8 mm was considered compatible with raised intracranial pressure. Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and albumin levels were measured. The primary aim was to assess the association between PIS and elevated LVEDP in EOPE. Secondary aims included assessing the prevalence of POCUS abnormalities in EOPE and their association with serum NT-proBNP and albumin levels, and comparing the results with historical data from patients with LOPE.RESULTSSixty-4 patients completed the study. There was no association between PIS and elevated LVEDP (P = .53). PIS, diastolic dysfunction, systolic dysfunction, and elevated LVEDP were observed in 23% (95% CI, 14.4-35.4%), 52% (95% CI, 39.3-63.8%), 30% (95% CI, 19.9-42.5%), and 35% (95% CI, 24.2-47.6%) of women, respectively. Increased ONSD was noted in 2 women (3%). Median (IQR) NT-proBNP levels were significantly elevated (278 [119-678] ng/L) and associated with PIS (P = .015) and elevated LVEDP (P = .003). Using a threshold for NT-proBNP of 125 ng/L, the sensitivity and specificity for predicting PIS were 93.3% and 34%, and for increased LVEDP, 90.5% and 40%, respectively. Receiver operating characteristic analysis showed limited diagnostic value of NT-proBNP for PIS (AUC = 0.78) and for elevated LVEDP (AUC = 0.68). No association was found between serum albumin and PIS, systolic dysfunction, or elevated LVEDP. The prevalence of systolic dysfunction was significantly higher (P < .01) and raised ONSD lower (P < .01) than in historical controls with LOPE.CONCLUSIONSLung ultrasound and TTE showed a high prevalence of PIS, systolic dysfunction, and raised LVEDP in women diagnosed with EOPE. PIS was not associated with elevated LVEDP. NT-proBNP level was significantly associated with PIS and elevated LVEDP, however clinical predictive value was limited. Women with EOPE had a higher prevalence of systolic dysfunction than those with LOPE.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678103","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}