Anesthesia & Analgesia最新文献

{"title":"Association of Preoperative Frailty and Postoperative Outcomes in Older Adults Undergoing Major Cardiac Procedures: A Systematic Review and Meta-Analysis.","authors":"Vetri Thangavelu,Ojas Bhatia,Anushka Hasija,Nethmi Rajapakse,Ellene Yan,Aparna Saripella,Marina Englesakis,Frances Chung","doi":"10.1213/ane.0000000000007887","DOIUrl":"https://doi.org/10.1213/ane.0000000000007887","url":null,"abstract":"BACKGROUNDFrailty, characterized by reduced physiological resilience, is a pivotal risk factor in older adults undergoing major cardiac procedures. Although previous analyses have linked frailty to adverse surgical outcomes, knowledge gaps persist due to methodological inconsistency across frailty tools and limited synthesis of complications such as delirium, infection, and renal dysfunction. The objective of this systematic review and meta-analysis is to determine the prevalence of preoperative frailty in older adults undergoing major cardiac procedures, and assess its association with postoperative outcomes, including cardiac, respiratory, renal, infectious, stroke, and bleeding complications, postoperative delirium, hospital and intensive care unit (ICU) length of stay, nonhome discharge, hospital readmission, and both 30-day and 1-year mortality.METHODSA prespecified protocol was registered with PROSPERO (CRD#42024574916), following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, and Cochrane databases were searched for English-language studies of patients undergoing major cardiac procedures, including coronary artery bypass grafting (CABG), aortic or mitral valve replacement or repair, transcatheter aortic valve replacement (TAVR), or combined procedures. Validated frailty instruments (eg, Fried Frailty Phenotype, Clinical Frailty Scale) were required to determine preoperative frailty, along with reporting at least 1 postoperative outcome. Noncardiac surgeries, minor procedures, case reports, and reviews were excluded. Random-effects meta-analyses generated odds ratio (OR) or standardized mean difference (SMD) values with 95% confidence intervals (CI).RESULTSNineteen studies (n = 11,667; mean ± SD age 71.9 ± 8.1 years, 28% female) met inclusion criteria, spanning North America, Europe, Asia, and Oceania. The overall prevalence of preoperative frailty was 16.8%. Frailty was significantly associated with delirium (OR, 4.11; 95% confidence interval [CI], 2.00-8.45; P <.001), infection (OR, 3.72; 95% CI, 2.27-6.12; P <.001), renal complications (OR, 2.72; 95% CI, 2.05-3.60; P <.001), and extended hospital (SMD, 0.69 ; 95% CI, 0.35-1.02; P <.001) and ICU (SMD, 0.72; 95% CI, 0.51-0.94; P <.001) stays. Frailty increased the odds of 30-day (OR, 3.58; 95% CI, 2.16-5.93; P <.001) and 1-year (OR, 2.25; 95% CI, 1.56-3.25; P <.001) mortality.CONCLUSIONSFrailty affects nearly 1 in 5 older adults requiring major cardiac procedures. Frailty was significantly associated with adverse postoperative outcomes, including delirium, infections, renal complications, extended length of stay, and mortality. As frailty is potentially modifiable, targeted strategies-such as prehabilitation, nutritional optimization, and enhanced perioperative monitoring-may improve outcomes. Incorporating routine frailty screening into standard preoperative practice allows for earlier identification of high-risk patients, efficien","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823988","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":"Paradoxical Combinations of Bispectral Index and Burst Suppression Ratio.","authors":"Duygu Aydin,Max Ebensperger,Stefan Schwerin,Bernhard Graf,Gerhard Schneider,Matthias Kreuzer,Barbara Sinner","doi":"10.1213/ane.0000000000007877","DOIUrl":"https://doi.org/10.1213/ane.0000000000007877","url":null,"abstract":"BACKGROUNDThe relationship between the bispectral index (BIS) and the BIS monitor's burst suppression ratio (BSR) has been extensively researched, with the current consensus being that BIS is fully driven by the BSR for BSR ≥ 40%. For lower BSR, the BIS seems to be derived from an unknown combination of electroencephalogram (EEG) parameters. In general, the BIS and BSR are not linearly correlated. With limited knowledge about the indices and their interactions, BIS- and BSR-driven anesthesia navigation may lead to index combinations showing paradoxical information.METHODSUsing intraoperative recordings of BIS and BSR from 62 patients 80.9 ± 5.8 (mean ± standard deviation [SD]) years, we analyzed the distribution of BIS and BSR values as well as their relation to each other with a focus on paradoxical situations, ie, an adequate BIS of 40 to 60 together with BSR ≥ 5%. We quantified the incidence rate and duration of these situations as well as the distribution of these BSR events within the BIS = 40 to 60 range.RESULTSOnly 56.9 [44-74.2]% (median [Q1-Q3]) BIS values fell inside the 40 to 60 range despite titration to this range. We found a disproportionately high incidence of BIS 41 to 42. BSR showed an exponentially declining, continuous distribution. We could observe paradoxical BIS and BSR values lasting for considerable stretches of time that could exceed 2 minutes.CONCLUSIONSBIS values are not continuously scaled, with some index values occurring distinctly more often. Paradoxical values of BIS between 40 and 60 and BSR≥5% can occur, potentially confusing anesthesia care providers.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823889","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":"Posttraumatic Stress Disorder: A Milligram of Prevention for a Life-Long Problem?","authors":"Ryan O Parker,Joshua W Sappenfield","doi":"10.1213/ane.0000000000007890","DOIUrl":"https://doi.org/10.1213/ane.0000000000007890","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823891","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, Human Cadaveric Airway Model for Preclinical Testing of Medical Devices and Interventions: The Dynamic Airway Patency Model.","authors":"Jacob Provencio,Connor J Evans,Jennifer A Achay,R Lyle Hood,Robert A De Lorenzo,Steven Venticinque","doi":"10.1213/ane.0000000000007884","DOIUrl":"https://doi.org/10.1213/ane.0000000000007884","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801338","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":"Association of Perioperative Dexamethasone With Postoperative Complications After Primary Total Joint Arthroplasty: An Instrumental Variable Analysis.","authors":"Ian A Jones,Kevin C Liu,Matthew A Lim,Sagar Telang,Julian Wier,Nathanael D Heckmann","doi":"10.1213/ane.0000000000007856","DOIUrl":"https://doi.org/10.1213/ane.0000000000007856","url":null,"abstract":"BACKGROUNDRetrospective studies suggest that dexamethasone may provide benefits that extend beyond its antiemetic properties, including a reduction in postoperative complications. However, results from randomized controlled trials have not consistently shown there to be a reduction in composite major adverse events. This discrepancy may be due to confounding factors, measurement error, or simultaneity bias among retrospective investigations. This study used instrumental variable analysis (IVA) to help address potential sources of bias and better estimate treatment effects in patients undergoing total joint arthroplasty (TJA).METHODSPatients who underwent primary elective TJA between 2016 and 2021 were identified using diagnosis and procedural codes. Bivariate regression, multivariable regression, and IVA were conducted. The primary end point was a 90-day composite (any versus none) of major postoperative medical complications. Secondary outcomes were infection, readmission, and death. Two distinct instruments-the frequency of dexamethasone use by surgeon and by hospital-were used to evaluate the robustness of our IVA. Patient demographics, hospital factors, and comorbidities were reported using descriptive statistics. Instrumental variable covariates were selected using the least absolute shrinkage and selection operator with 3 regularization parameter strategies.RESULTS1525,844 TJAs performed between 2015 and 2021 were identified (976,996 knees [total knee arthroplasty {TKA}]; 548,848 hips [total hip arthroplasty {THA}]). Major postoperative medical complications were observed in 31,299 (3.43%) dexamethasone-exposed patients compared to 31,266 (4.87%) unexposed patients. Surgeon-based IVA yielded results comparable to the multivariable and bivariate analysis (local average treatment effect [LATE]: TKA: -1.20% [95% confidence interval [CI], -1.33% to -1.08%]; THA: -1.14% [95% CI, -1.30% to -0.99%]). Hospital-based IVA produced similar findings (LATE: TKA: -1.23% [95% CI, -1.38% to -1.09%]; THA: -1.18% [95% CI, -1.35% to -1.00%]). Both instruments demonstrated high F-statistics and significant Hausman tests. Secondary outcomes mirrored these results, except for mortality, which did not meet endogeneity criteria across analyses.CONCLUSIONSThe findings of this study support that dexamethasone exposure is associated with a reduction in composite major postoperative complications after TJA. The observed moderate treatment effect, in conjunction with a low baseline incidence of adverse events, may explain the inconsistent outcomes reported in previous randomized trials. Future prospective studies should incorporate composite end points and target high-risk patient populations or procedural subgroups.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"370 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765395","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":"Detecting Inconsistencies and Fraud in Research Data: Time for Authors to Share the Data Underlying Their Summary Statistics as a Matter of Course.","authors":"Nicholas J L Brown,John B Carlisle","doi":"10.1213/ane.0000000000007889","DOIUrl":"https://doi.org/10.1213/ane.0000000000007889","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765476","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":"Pooled Efficacy and Exploration of Effect Modifiers of Exercise Prehabilitation: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials.","authors":"Lana Ramic,Karina Branje,Mariam Al-Bayati,Gurlavine D Kidd,Nathaniel Neilipovitz,Brian Hutton,Dianna M Wolfe,Dean Fergusson,Julio F Fiore,Chelsia Gillis,Emily Hladkowicz,Daniel I McIsaac, ","doi":"10.1213/ane.0000000000007882","DOIUrl":"https://doi.org/10.1213/ane.0000000000007882","url":null,"abstract":"BACKGROUNDLow certainty evidence supports exercise prehabilitation's efficacy in reducing complications and length of stay in specific populations. Identification of procedural, participant, and program characteristics associated with greater prehabilitation efficacy is required to optimize effective application of prehabilitation programs. Our objectives were to (1) estimate the pooled efficacy of all approaches to exercise prehabilitation across all procedures, participants, and programs in reducing postoperative complications and length of stay, and (2) identify program, participant, and procedural characteristics associated with greater efficacy of exercise prehabilitation.METHODSA peer-reviewed search strategy was applied to Ovid Medline, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane CENTRAL Register of Controlled Trials (inception to March 1, 2022, and updated on October 25, 2023, and April 10, 2024). Randomized controlled trials addressing a population of adults (≥18 years) undergoing major elective surgery where participants were allocated to an exercise prehabilitation intervention were included. A multistage review of 6675 citations and 1220 full texts was completed independently in duplicate using DistillerSR. Data were pooled using random effects pairwise meta-analyses and meta-regression. Certainty of evidence and credibility of effect modifiers were evaluated. Critical outcomes were postoperative length of stay and the incidence of postoperative complications. Effect modifiers and hypotheses were identified a priori and published in the study's registered protocol (CRD42023487683).RESULTSAcross 99 included trials (n = 8222), pooled data suggested that exercise prehabilitation likely reduces complication rates (odds ratio [OR] = 0.54; 95% confidence interval [CI], 0.44-0.67; P < .01; I2 = 45%; moderate certainty) and length of stay (mean difference = -0.90 days; 95% CI, -1.23 to -0.58; P < .01; I2 = 78%; low certainty). Inspiratory muscle training was the only significant effect modifier for greater efficacy of exercise prehabilitation in reducing both complications (OR = 0.65; 95% CI, 0.44-0.97; low certainty) and length of stay (MD = -1.04; 95% CI, -1.75 to -0.32; low certainty). No other prespecified procedural, participant, or program factors were consistent or credible effect modifiers.CONCLUSIONSExercise prehabilitation may reduce complications and LoS; however, well-reported multicenter trials synthesized using individual participant data are required to identify procedural, participant, and program factors associated with optimal exercise prehabilitation efficacy.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765393","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":"Effect of Goal-Directed Intraoperative Blood Pressure Management on Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial.","authors":"Ziyu Huang,Yunqi Zhu,Jing Yuan,Bo Wang,Hong Zhao,Yi Feng","doi":"10.1213/ane.0000000000007869","DOIUrl":"https://doi.org/10.1213/ane.0000000000007869","url":null,"abstract":"BACKGROUNDPostoperative delirium is a frequent and serious complication in older patients after surgery, particularly following hip fracture repair surgery, with an incidence of 10% to 55%. This study investigated whether goal-directed intraoperative blood pressure management could reduce the incidence of postoperative delirium in older patients undergoing hip fracture repair surgery.METHODSIn this single-center randomized controlled trial, 188 older patients (over 65 years) scheduled for elective hip fracture repair surgeries under spinal anesthesia were randomized to either goal-directed arterial blood pressure (ABP) group or control group. The goal-directed ABP group maintained systolic blood pressure (SBP) >80% preoperative values with continuous infusion of norepinephrine, while the control group aimed to keep SBP ≥90 mm Hg using intermittent administration of phenylephrine or ephedrine. The primary outcome was the incidence of postoperative delirium, assessed twice daily using the Confusion Assessment Method (CAM) until hospital discharge. Incidence of postoperative intensive care unit (ICU) admittance was also compared between groups. Quality of life was followed-up via telephone 3 months after surgery using the 3-level version of EuroQol Five Dimensional Questionnaire (EQ-5D-3L).RESULTSAccumulative time spent under 80% preoperative systolic blood pressure (SBP) values was significantly shorter in goal-directed ABP group than in control group (0 [0-8] vs 12 [0-38] minutes; P < 0.001). Incidence of postoperative delirium was 26.6% (25/94) in the goal-directed ABP group and in 36.2% (34/94) in the control group, with an absolute risk reduction (ARR) of 9.6% (95% confidence interval [CI], -3.6 to 22.8), relative risk of 0.735 (95% CI, 0.478-1.130), P = .162. There was no difference in the incidence of postoperative ICU admittance or quality of life at 3 months follow-up.CONCLUSIONSGoal-directed intraoperative blood pressure management did not significantly reduce postoperative delirium in older patients undergoing hip fracture repair surgery under spinal anesthesia.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765397","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 an Optimal Femoral Central Venous Catheter Length Using Computerized Tomography Estimation.","authors":"Dhupal Patel,Yagazie Z Udeaja,Teikchoon See,Andrew J Johnston","doi":"10.1213/ane.0000000000007837","DOIUrl":"https://doi.org/10.1213/ane.0000000000007837","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"22 Suppl 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752628","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":"Intrathecal hydromorphone and Post-Cesarean Delivery Analgesia.","authors":"","doi":"10.1213/ane.0000000000007881","DOIUrl":"https://doi.org/10.1213/ane.0000000000007881","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"370 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759998","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}