Anesthesiology最新文献

{"title":"Choice of anesthesia in microelectrode recording-guided deep brain stimulation surgery for Parkinson's disease (CHAMPION): A noninferiority randomized controlled trial.","authors":"Sining Xie, Lin Shi, Wei Xiong, Yifang Fan, Liang Chen, Xiangjiahui Li, Yuanyuan Tong, Anchao Yang, Fangang Meng, Anxin Wang, Jianguo Zhang, Ruquan Han","doi":"10.1097/ALN.0000000000006133","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006133","url":null,"abstract":"<p><strong>Background: </strong>Deep brain stimulation for Parkinson's disease is often performed under conscious sedation or general anesthesia. However, anesthetic agents may influence intraoperative microelectrode recording, and the optimal anesthesia method for microelectrode recording remains unclear. This study compared general anesthesia and conscious sedation in preserving microelectrode recording signal intensity during deep brain stimulation.</p><p><strong>Methods: </strong>In this prospective, noninferiority randomized controlled trial, patients with Parkinson's disease (UK Brain Bank criteria) undergoing elective bilateral surgery were randomized 1:1 to the conscious sedation or the general anesthesia group. During surgery, a desflurane anesthetic titrated against the quality of the electrophysiologic signal was applied in the general anesthesia group, whereas patients in the conscious sedation group received dexmedetomidine anesthesia. The primary outcome was the proportion of patients with high-quality microelectrode recording (normalized root mean square, nRMS >2.0), assessed postoperatively off-line. Secondary outcomes included operation and recording duration, 6-month clinical efficacy, and complication rates.</p><p><strong>Results: </strong>Of 188 randomized patients (94 general anesthesia, 93 conscious sedation), desflurane anesthesia was noninferior for high nRMS proportion (89.4% vs. 90.3%; difference, -0.96%; 95% CI, -9.62 to 7.70). The general anesthesia group had shorter operative time (difference, -9.07 minutes; 95% CI, -13.99 to -4.14; P<0.001). At 6 months, changes in Unified Parkinson's Disease Rating Scale score (difference, -2.50; 95% CI, -7.20 to 2.20; P=0.297), levodopa equivalent daily dose (difference, -58.4 mg; 95% CI, -133.56 to 16.75; P=0.128) and the complication rates (general anesthesia: 10.9% vs. conscious sedation: 8.9%; p=0.655) were comparable between the groups.</p><p><strong>Conclusion: </strong>General anesthesia is noninferior to conscious sedation for microelectrode-guided subthalamic nucleus deep brain stimulation, providing equivalent signal intensity and clinical outcomes while improving procedural efficiency, supporting its use as a valid clinical option.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervals For Oscillometric Arterial Pressure Monitoring During Noncardiac Surgery: the '2.5-Minute Versus 5-Minute' Randomized Clinical Trial.","authors":"Karim Kouz, Pawel Sierzputowski, Alparslan Turan, Moritz Flick, Dominik X Müller, Kristen K Thomsen, Mirja Wegge, Linda Krause, Alina Bergholz, Bernd Saugel","doi":"10.1097/ALN.0000000000006140","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006140","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend measuring arterial pressure at least every 5 minutes during surgery. However, it remains unknown whether shortening the measurement interval of intermittent oscillometric arterial pressure monitoring can help reduce intraoperative hypotension. This trial tested the primary hypothesis that oscillometric arterial pressure monitoring at 2.5-minute versus 5-minute intervals reduces intraoperative hypotension in noncardiac surgery patients under general anesthesia.</p><p><strong>Methods: </strong>In this single-center trial, 264 noncardiac surgery patients were randomized to oscillometric arterial pressure measurements with an upper-arm cuff at 2.5-minute or 5-minute intervals during surgery. The primary outcome was the amount of intraoperative hypotension quantified as the time-weighted average mean arterial pressure (MAP) <65 mmHg during surgery. Secondary outcomes included the administered time-weighted cumulative amount of norepinephrine indexed to body weight.</p><p><strong>Results: </strong>Of the 264 patients randomized (132 to each group), the primary outcome analysis included 132 patients in the 2.5-minute group and 131 in the 5-minute group. The median time-weighted average MAP <65 mmHg was 0.00 (0.00, 0.04) mmHg in patients assigned to the 2.5-minute group and 0.00 (0.00, 0.21) mmHg in patients assigned to the 5-minute group (estimated location shift -1.40x10-5 [95% CI: -6.64x10-5 to 2.93x10-6] mmHg; P=0.27). Seven patients (5.3%) in the 2.5-minute group had at least one 1-minute episode of a MAP <50 mmHg versus 13 patients (9.9%) in the 5-minute group (P=0.24). The median time-weighted cumulative amount of norepinephrine indexed to body weight patients were given during surgery was 0.05 (0.03, 0.08) µg kg-1 min-1 in the 2.5-minute group and 0.05 (0.02, 0.08) µg kg-1 min-1 in the 5-minute group (P=0.40).</p><p><strong>Conclusions: </strong>In our trial of patients having elective low-to-moderate risk surgery under general anesthesia, arterial pressure was tightly controlled with norepinephrine, and the amount of intraoperative hypotension was low - irrespective of the randomized arterial pressure measurement interval. Although oscillometric arterial pressure monitoring at 2.5-minute intervals - compared to 5-minute intervals - did not reduce the time-weighted average MAP <65 mmHg, we cannot exclude that monitoring at 2.5-minute intervals helps reduce profound hypotension.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical power and energy in invasively ventilated newborn infants.","authors":"Sofia De La Rubia, Barbara Loi, Laura Vivalda, Raffaele Dellacà, Marco Piastra, Giorgio Conti, Massimo Antonelli, Domenico L Grieco, Matteo Di Nardo, Daniele De Luca","doi":"10.1097/ALN.0000000000006128","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006128","url":null,"abstract":"<p><strong>Background: </strong>Mechanical power estimates the amount of energy delivered to ventilated lungs but there are no available data in neonates. We aim to provide a real-world description of power and investigate its relationship with clinical variables in neonates.</p><p><strong>Methods: </strong>Cross-sectional study enrolling neonates of any gestational age. Patients were classified as recovering from respiratory distress syndrome (RDS), affected by neonatal acute respiratory distress syndrome (ARDS), or with evolving broncho-pulmonary dysplasia (BPD). Simultaneously collected ventilation and oxygenation data as well as ultrasound-assessed lung aeration were used; power was calculated with four different equations.</p><p><strong>Results: </strong>100 (55 males) neonates (32 with RDS, 30 with neonatal ARDS, 10 with evolving BPD and 28 controls with no lung disease) were studied. Distributions of power and energy (i.e. power for a single breath) for the whole population were given (median power ranging between 0.28 [0.18, 0.39] and 0.39 [0.29, 0.54] J/min/Kg, median energy ranging between 7.1 [4.9, 9.1] and 9.5 [6.8, 12.3] mJ/Kg). Median power (difference varying between 0.21 and 0.9 J/min/Kg (p always <0.001), depending on the used equation) and energy (difference varying between 0.9 and 3 mJ/Kg (p always <0.001), depending on the used equation) were higher in neonates with respiratory failure than in controls. Components of power due to dynamic and static strain showed similar differences. Power correlated with oxygenation (adj-ρ between 0.18 (95%CI: 0.02; 0.34) and 0.22 (95%CI: 0.06; 0.38), p varying between 0.032 and 0.045) and lung aeration impairment (ρ between 0.25 (95%: 0.07;0.41) and 0.27 (95%CI: 0.08; 0.43), p varying between 0.009 and 0.013, depending on the used equation).</p><p><strong>Conclusions: </strong>Mechanical power, its components due to dynamic and static strain, and energy are higher in neonates with respiratory disorders than in controls. Mechanical power and its components are correlated with impairment of oxygenation and lung aeration.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Performance in Critical Care Simulation Under Sleep Deprivation: Effects of Power Napping in the R-NAP Randomized Controlled Trial.","authors":"Laura Schmidt, Florian Genty, Thomas Delaire, Berenice Valero, Isaline Rey, Leslie Galan, Sacha Mairet-Mabboux, Marion Douplat, Sophie Schlatter, Thomas Rimmele, Stephanie Mazza, Marc Lilot","doi":"10.1097/ALN.0000000000006135","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006135","url":null,"abstract":"<p><strong>Background: </strong>Sleep deprivation is common among anesthesia residents and impairs both technical and non-technical skills such as leadership. Napping is recommended in fatigue management across healthcare and other safety-sensitive sectors, yet its effectiveness for healthcare providers remains underexplored. This study evaluated whether a 30-min nap opportunity improved simulated crisis performance after a 24-h shift.</p><p><strong>Methods: </strong>Residents were tested twice: once rested and once using a 24-h shift to induce partial sleep deprivation. Between sessions, they were trained in fatigue management. In the sleep-deprived condition, they were randomized to a nap opportunity or a control condition. Actigraphy objectively assessed sleep and nap duration. The primary endpoint was overall simulated clinical performance (0-200; combined technical and non-technical scores). Secondary endpoints were technical and non-technical subscales. Group effects were primarily tested using intention-to-treat regression models adjusted for rested performance, prior sleep, and critical care experience.</p><p><strong>Results: </strong>Thirty-five residents were enrolled (nap opportunity n = 19, control n = 16). In the primary analysis sample (n = 27), clinical performance was 14.8 points higher following the nap opportunity compared with controls (95% confidence interval: 2.8-26.9; p =.018), corresponding to a 7.4% improvement. Technical skills did not differ significantly between groups, although more sleep was associated with better technical performance. Non-technical skills were higher in the nap opportunity condition (+11.0 points; 95% confidence interval: 2.2-19.8; p =.016), including significant effects of leadership and resource utilization. Exploratory analyses suggested associations between longer nap duration and multiple performance domains, strongest for technical skills (p =.010).</p><p><strong>Conclusions: </strong>Napping appears to enhance clinical performance, while the nap opportunity, nap duration, and prior sleep deprivation each influenced technical and non-technical performance in distinct ways. These findings support integrating napping and recovery into medical education and scheduling.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short- and Long-Term Efficacy and Safety of Levosimendan in VA-ECMO Weaning: The WEANILEVO Randomized Double-Blind Multicenter Trial.","authors":"Pierre-Grégoire Guinot, Vivien Berthoud, Agnes Soudry Faure, Osama Abou-Arab, Paul Michel Mertes, Marc-Olivier Fischer, Mouhamed Moussa, Omar Ellouze, Maxime Nguyen, Belaid Bouhemad","doi":"10.1097/ALN.0000000000006143","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006143","url":null,"abstract":"<p><strong>Background: </strong>Liberation from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remains challenging. To date, we have limited evidence from observational studies supporting pharmacological interventions to facilitate successful VA-ECMO weaning. The present study aimed to evaluate the efficacy and safety of a single dose of levosimendan in patients supported by VA-ECMO who met predefined criteria for weaning.</p><p><strong>Methods: </strong>The WEANILEVO study was a multicenter, double-blind, randomized, parallel-group, placebo-controlled trial. Eighty patients from five French centers who met VA-ECMO weaning criteria were randomly assigned 1:1 to receive either levosimendan (0.2 μg/kg/min) or placebo for 24 hours. The primary endpoint was VA-ECMO weaning failure, defined as absence of weaning within 48 hours, recourse to another circulatory assistance device, or death within 7 days of weaning.</p><p><strong>Results: </strong>Due to halted funding, the planned number of patients could not be recruited. The final modified intention-to-treat analysis included 80 patients (40 in the levosimendan group and 40 in the control group). VA-ECMO weaning failure occurred in 25% of patients in both the levosimendan and placebo groups (OR=1.00 [95%CI: 0.36-2.75], p=1.00). Acute kidney injury at day 30 was significantly more frequent in the levosimendan group (62.5% vs. 38.5%; OR=2.67 [95%CI: 1.08-6.62], p=0.03). Patients receiving levosimendan required more vasopressor support (47.5% vs. 28.2%, p=0.07) and had longer ICU stays (12 [7-24] vs. 6 [4-13] days, p=0.02). Mortality rates at 30 days (18.0% vs. 33.3%, p=0.07) and 1 year (31.6% vs. 51.4%, p=0.08) did not significantly differ between groups.</p><p><strong>Conclusions: </strong>Levosimendan administration did not reduce VA-ECMO weaning failure in patients who already met weaning criteria; however, a clinically important benefit or harm cannot be ruled out. The observed higher incidence of acute kidney injury and longer ICU stays in the levosimendan group are hypothesis-generating and require confirmation in larger, adequately powered trials.REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04158674.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Effect of weight-based versus absolute norepinephrine dosing on mortality risk in obese patients with septic shock: an observational, multicohort, retrospective study\".","authors":"Pedro D Wendel-Garcia, Sebastian Morales, Sascha David, Miguel Ibarra-Estrada, Christian Jung, Reto A Schuepbach, Ricardo Castro, Jaime Retamal, Antonio Messina, Giovanni Camen, Christian Bode, Luis I Cortínez, Nicolás Severino, Philipp Karl Buehler, Niklas Rodemund, Greta Emilia Kiavialaitis, Edda Tschernko, Gustavo A Ospina-Tascón, Jan Bakker, Glenn Hernández, Eduardo Kattan","doi":"10.1097/ALN.0000000000006134","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006134","url":null,"abstract":"<p><strong>Background: </strong>Norepinephrine dose is used as an indicator of severity and a decision-making tool in septic shock management, influencing the initiation of adjuvant therapies, life support limitation and mortality estimation. However, weight-based dosing may impact its accuracy, particularly given the rising global incidence of obesity. Our objective was to assess how body mass index (BMI) influences the relationship between norepinephrine dosing strategy (absolute vs. weight-based) and observed mortality in patients with septic shock.</p><p><strong>Methods: </strong>Retrospective analysis of six open-access datasets encompassing more than 300 intensive care units (ICU) in four countries. The relationship with ICU mortality of both absolute and weight-based norepinephrine dosing was analyzed in the same set of septic shock patients using non-parametric generalized additive models, adjusted by disease severity.</p><p><strong>Results: </strong>Among 386,792 critically ill patients screened, 10,246 septic shock patients were identified. Patients had a SOFA score of 7 [5, 10], required a norepinephrine dose of 0.1 [0.05, 0.2] μg/kg/min (7 [3.4, 15.8] μg/min) and presented lactate levels of 3.0 [2.3, 4.8] mmol/l at diagnosis. 2,858 (28%) patients had a BMI above 30 kg/m 2. SOFA-adjusted estimated mortality using weight-based norepinephrine dosing was significantly affected by BMI, with a mean difference in predicted mortality of 14.5% (95% CI 13.7 to 15.3%, pAnalysis of Deviance<0.001) between obese and non-obese patients. At higher norepinephrine doses (>0.3 µg/kg/min), weight-based dosing led to a progressive mortality underestimation with increasing BMI, reaching mortality divergences of up to 26% at doses of 1 µg/kg/min between patients with BMIs of 20 and 50 kg/m 2. In contrast, mortality estimation by absolute norepinephrine dosing was not affected by BMI (mean difference in predicted mortality between obese and non-obese 0.3% [95% CI, -0.1 to 0.6%], pAnalysis of Deviance=0.715).</p><p><strong>Conclusion: </strong>Weight-based norepinephrine dosing may underestimate ICU mortality in obese patients with septic shock, especially at higher doses, distorting risk stratification and potentially influencing clinical decision making. Absolute dosing offers a simpler, consistent approach across BMI categories and dose ranges.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating Endothelial Signature: A Biomarker of Delirium Risk and Severity in Postoperative Patients.","authors":"Rosa Dolores Prieto-Utrera, Adrián García-Concejo, Esther Gómez-Sánchez, Miguel Bardají-Carrillo, Rosa Cobo-Zubia, Irina Rebollo-Mato, Marina Pérez-Mazzali, Jessica Matesanz-Isabel, Álvaro Tamayo-Velasco, María Sherezade Tovar-Doncel, Peter Adamove, María Fernández-Arranz, Rosario Calaveras, José Ignacio Alonso-Fernández, Iciar Martínez-Almeida, Eva López-Santín, Hugo Gonzalo-Benito, Rocío López-Herrero, Rafael Badenes, Federico Bilotta, Roberto Hornero, David Bernardo, Mario Lorenzo-López, Eduardo Tamayo, Rodrigo Poves-Álvarez","doi":"10.1097/ALN.0000000000006137","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006137","url":null,"abstract":"<p><strong>Justification: </strong>Delirium is a frequent complication in critically ill and septic patients and has been linked to endothelial dysfunction, microvascular injury and blood-brain barrier disruption. Circulating endothelial cells may reflect endothelial phenotypic alterations beyond soluble markers. We investigated the association between endothelial subsets and postoperative sepsis-related delirium in ICU patients.</p><p><strong>Objective: </strong>To investigate the role of circulating endothelial subsets in the development of delirium in post-surgical sepsis patients and their relationship with hypoperfusion and clinical outcomes, to identify potential prognostic biomarkers and mechanistic insights.</p><p><strong>Methods: </strong>In this prospective cohort study, 214 postoperative ICU patients were enrolled at the time of surgery or sepsis diagnosis and classified as non-septic ICU (n=77), sepsis (n=61) or septic shock (n=76) according to Sepsis-3 criteria. Blood samples were obtained within 24 hours of critical illness onset. Circulating endothelial subsets were characterized using high-dimensional flow cytometry with unsupervised clustering. Delirium was assessed daily using the CAM-ICU. Cox regression, ROC analysis and causal mediation models were applied to evaluate associations with 28-day delirium and organ-dysfunction related clinical events occurring after sampling.</p><p><strong>Results: </strong>Among 13 endothelial subpopulations identified, CD32b⁺ subset were independently associated with 28-day delirium (HR 2.41, 95% CI 1.32-4.40; p=0.004). CD32b⁺ subset demonstrated discriminative performance for delirium (AUC 0.79, 95% CI 0.60-0.98), which improved after adjustment for age and sex (AUC 0.89, 95% CI 0.82-0.98). Models based solely on organ-dysfunction related clinical events showed lower performance (AUC 0.69, 95% CI 0.52-0.86). Mediation analysis indicated that approximately 20% of the total effect was mediated through organ-dysfunction related events, suggesting partial mediation, while the remaining 80% may involve alternative endothelial and microvascular mechanisms not captured by conventional measures.</p><p><strong>Conclusions: </strong>Elevated CD32b⁺ subset are associated with postoperative delirium and organ-dysfunction related clinical events in critically ill patients, supporting an association between endothelial phenotypic alterations and vulnerability to brain dysfunction.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Respiratory Mechanics and Gas Exchange after Lung Transplantation: Associations with Severe Primary Graft Dysfunction.","authors":"Vittorio Scaravilli, Jacopo Fumagalli, Valentina Cattaneo, Francesca Balestreri, Andrea Bolchini, Marco Bosone, Anna Vitalini, Sebastiano Maria Colombo, Letizia Corinna Morlacchi, Margherita Brivio, Lorenzo Rosso, Alberto Zanella, Mario Nosotti, Francesco Blasi, Giacomo Grasselli","doi":"10.1097/ALN.0000000000006138","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006138","url":null,"abstract":"<p><strong>Background: </strong>Primary Graft Dysfunction (PGD) is a major cause of early morbidity and mortality following lung transplantation (LUTX), with limited early predictive markers. This study aimed to determine whether early post-operative bedside respiratory pathophysiology can predict severe PGD at 72 hours.</p><p><strong>Methods: </strong>In this prospective, single-center study, adult LUTX recipients underwent a decremental PEEP trial (14, 10, 6 cmH₂O) within 12 hours post-reperfusion. Gas exchange (venous admixture [Qs/Qt], alveolar dead space [VdALV/Vt]), partitioned respiratory mechanics (respiratory system, chest-wall, lung compliances-CplRS, CplCW, CplLUNG), and regional ventilation/perfusion (V̇/Q̇) and collapse/overdistension (via electrical impedance tomography) were assessed. Severe PGD was defined as PaO₂/FiO₂ <200 mmHg at 72 hours with bilateral infiltrates.</p><p><strong>Results: </strong>Eight (17%) out of 47 enrolled patients developed PGD. Compared to non-PGD patients, those with PGD exhibited significantly lower CplLUNG (58 vs. 80 mL/cmH₂O, p = 0.021) and CplRS (37 vs. 44 mL/cmH₂O, p = 0.038), elevated Qs/Qt (21% vs. 5%, p < 0.001), higher VdALV/Vt (15% vs. 12%, p = 0.010), and greater lung collapse (p = 0.015). Non-PGD patients had more regions with high V̇/Q̇ (p = 0.036). In PGD, increasing PEEP reduced Qs/Qt (difference -6.1%; 95%CI, -9.1, -3.1; p=0.001) and collapse (difference -19.0%; 95%CI -27.7, -10.3; p=0.002) without altering mechanics. In non-PGD, higher PEEP induced hyperinflation (difference 16.2%; 95%CI 13.6, 18.8; p<0.001), reducing CplRS (difference -2.9 mL/cmH2O; 95%CI -4.8, -1.0; p=0.008), CplCW (difference -25.3 mL/cmH2O; 95%CI -41.9, -8.7; p=0.024), and increasing VdPHYS/Vt (difference 2.9 % 95%CI 1.2, 4.6; p = 0.010,). Qs/Qt showed the highest discriminative performance (AUC 0.92, 95%CI 0.88, 0.96) in predicting PGD development.</p><p><strong>Conclusion: </strong>Severe PGD is associated with early increases in venous admixture, reduced lung compliance, increased dead space, and patterns of collapse. These findings provide the rationale for studies exploring early pathophysiology-guided ventilatory management after LUTX.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity, Equity, and Inclusion: Scoping Review: Comment.","authors":"Courtney J Burns, Valeria Gamarra","doi":"10.1097/ALN.0000000000006040","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006040","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating three routes of tranexamic acid administration in total hip and knee arthroplasty: A nationwide database analysis in Taiwan.","authors":"Ling-I Hsu, Jen-Wei Chen, Hao-Wei Hsu, Sheng-Mou Hou","doi":"10.1097/ALN.0000000000006114","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006114","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) reduces perioperative blood loss, but comparative effectiveness and safety across administration routes remain uncertain. We evaluated topical, intravenous [IV], and oral TXA in unilateral total hip and knee arthroplasty.</p><p><strong>Methods: </strong>Using Taiwan's national health insurance database (2012-2021), we identified patients undergoing unilateral arthroplasty and evaluated perioperative TXA use, red blood cell transfusion, and adverse events within 60 days after discharge. Conditional logistic regression and six propensity-score-matched comparisons were conducted: topical vs none, IV vs none, oral vs none, topical vs IV, topical+ 1.0g IV vs topical alone, and IV+ 1.0g topical vs IV alone.</p><p><strong>Results: </strong>Compared with no TXA, all routes were associated with lower transfusion risk (topical: RR 0.45, 95%CI 0.41-0.48, p <0.001; IV: RR 0.80, 95%CI 0.79-0.84, p <0.001; oral: RR 0.82, 95%CI0.73-0.92, p=0.007). Topical and IV TXA were associated with similar risk (RR 1.09, 95%CI:0.96-1.24, p>0.999), and the combined use was not associated with a different risk compared with either route alone. Topical TXA was associated with the greatest reduction in predicted transfusion risk at low dose (- 3,087 per 10,000 [-2,886, -3,276], 0→3.0g). Overall, TXA use was not associated with increased venous thromboembolism (VTE), infections, or wound complications. A higher VTE incidence was observed with topical TXA in patients with prior vascular disease without pharmacological prophylaxis, but this was not significant after adjustment for confounders. TXA was not associated with renal injury overall, but high-dose IV (>3.0 g) or oral (>8.0 g) TXA increased predicted risk (~10%) in patients with preexisting renal disease.</p><p><strong>Conclusion: </strong>TXA use was associated with substantial transfusion reduction without an overall increase in adverse events. No administration route or combination proved superior. Caution is warranted with higher-dose IV or oral TXA in patients with renal disease, and the association between topical TXA and VTE in high-risk patients merits further investigation.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}