Anesthesiology最新文献

{"title":"Hoping to Help: The Promises and Pitfalls of Global Health Volunteering.","authors":"Kathryn E McGoldrick","doi":"10.1097/ALN.0000000000005543","DOIUrl":"10.1097/ALN.0000000000005543","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"796-798"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582875","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":"Perioperative Management of Preeclampsia: Comment.","authors":"Lorena Basso, Hector J Lacassie, Mauricio Vasco, José Rojas-Suarez","doi":"10.1097/ALN.0000000000005598","DOIUrl":"10.1097/ALN.0000000000005598","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 3","pages":"788-789"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820409","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":"Perioperative Management of Preeclampsia: Reply.","authors":"Alicia T Dennis, Annie Xin, Michaela K Farber","doi":"10.1097/ALN.0000000000005599","DOIUrl":"10.1097/ALN.0000000000005599","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 3","pages":"790-793"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820410","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":"A Pharmacist-partnered Opioid-tapering Service before Total Hip or Knee Arthroplasty: Qualitative Analysis of Patient Counseling Sessions.","authors":"Sophie A Young, Chi Tran, Claire E Ashton-James, Asad E Patanwala, Jennifer Stevens, Justine M Naylor, Furkan Genel, Sam Adie, Bernadette Brady, Kate Luckie, Geraldine Hassett, Gilbert Whitton, Joseph Descallar, Frances Page, Mary Keehan, Cheng Fai Hui, Shaniya Ogul, Anders G Jansson, Amy Archer, Andrew Sefton, Mitchell Fung, Thomas Byrnes, Geoffrey Murphy, Erica Morgan, Emily Mayze, Clare Eastment, Shania Liu, Jonathan Penm","doi":"10.1097/ALN.0000000000005594","DOIUrl":"10.1097/ALN.0000000000005594","url":null,"abstract":"<p><strong>Background: </strong>Currently, no literature on patients' experiences with opioid tapering before elective surgery has been published. Recent evidence indicates that tapering opioids before total hip or knee arthroplasty improves postsurgical outcomes. This study qualitatively analyzed consultation sessions of patients receiving a pharmacist-partnered opioid-tapering service before total hip or knee replacement surgery to understand their experiences and attitudes.</p><p><strong>Methods: </strong>A qualitative analysis of pharmacist counseling sessions within a randomized controlled trial was conducted. Participants were those recruited from seven hospitals between December 2021 and September 2022 who were assigned to the pharmacist-partnered opioid-tapering intervention arm of a randomized controlled trial. Consultations of participants with the pharmacist were audio-recorded and transcribed verbatim. Consultation data underwent inductive thematic analysis.</p><p><strong>Results: </strong>Consultations were available for 20 participants, with a total of 48 audio-recorded consultations. Among these participants, four major themes including motivations to taper, knowledge and beliefs, psychosocial context, and attitudes toward tapering opioids were identified. Of the 20 participants, 70% tapered their opioids 50% or greater, with awareness of the surgery date appearing to be a key external motivating factor to taper opioids, regardless of the dose of opioids. Another notable theme was the motivation to improve fitness for participation in social activities, allowing participants to interact more with their kids and grandkids. Additionally, participant's psychosocial context revealed that factors such as stress affected their ability to taper. Pharmacists played a foundational role in shaping patients' attitudes and optimization of pain management strategies. Attitudes were identified as \"optimistic,\" \"hesitant,\" and \"resistant,\" with patients displaying an optimistic attitude being more likely to taper.</p><p><strong>Conclusions: </strong>Exploring the experiences of patients with osteoarthritis in a pharmacist-led opioid-tapering service before elective surgery revealed that external motivations, such as knowledge of a surgery date, play a crucial role in successful opioid tapering. Patients were more likely to taper if they knew their surgery date. Attitudes toward opioid tapering were identified as a modifiable factor. Tailoring tapering plans and patient education to individual patient contexts may enhance tapering outcomes.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"680-690"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233013","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":"Association of Intraoperative Hypotension with Postoperative Nausea and Vomiting in Laparoscopic Gastrointestinal Surgery: A Secondary Analysis of a Randomized Trial.","authors":"Zijia Li, Yingyin Zhao, Jiankun Shi, Chujun Liang, Shimin Zhang, Jiayi Zheng, Nassirou Bizo Mailoga, Yang Zhao","doi":"10.1097/ALN.0000000000005585","DOIUrl":"10.1097/ALN.0000000000005585","url":null,"abstract":"<p><strong>Background: </strong>Few studies have examined the association between intraoperative hypotension and postoperative nausea and vomiting (PONV), and no definitive conclusions have been established. This study investigated the association between intraoperative hypotension and PONV in patients undergoing laparoscopic gastrointestinal surgery.</p><p><strong>Methods: </strong>This secondary analysis of a randomized trial included adult patients at high risk for PONV undergoing laparoscopic gastrointestinal surgery. Intraoperative hypotension was quantified as a time-weighted average mean arterial pressure (TWA-MAP) less than 65 mmHg. Primary and secondary outcomes were PONV within 0 to 24 h and 25 to 120 h after surgery, respectively. The authors assessed the association between intraoperative hypotension and outcomes using restricted cubic splines and multiple logistic regression models, adjusting for potential confounders. Sensitivity analyses were conducted using various mean arterial pressure thresholds (70, 60, 55 mmHg) and metrics (area under the curve [AUC], duration) with similar models.</p><p><strong>Results: </strong>In total, 1,093 patients were included (median age, 56 yr; 1,054 [96.4%] women). The medians [interquartile ranges] of TWA-MAP less than 65 mmHg, AUC, and duration of mean arterial pressure less than 65 mmHg were 0.03 [0.00, 0.14] mmHg, 6.33 [0.17, 30.17] mmHg · min, and 1.83 [0.17, 7.00] min, respectively. The overall incidence of PONV within 0 to 24 h and 25 to 120 h after surgery was 40.4% and 42.9%, respectively. No exposure-response relationship was found between TWA-MAP less than 65 mmHg and either the primary or secondary outcome. Compared with the first tertile of TWA-MAP less than 65 mmHg, patients in the second and third tertiles did not have a higher risk of primary outcome (adjusted odds ratio, 0.92 [95% CI, 0.67 to 1.24; P = 0.569] and 0.95 [95% CI, 0.70 to 1.30; P = 0.755], respectively) or secondary outcome (adjusted odds ratio, 1.05 [95% CI, 0.77 to 1.42; P = 0.772] and 0.86 [95% CI, 0.63 to 1.18; P = 0.360], respectively). Intraoperative hypotension was not associated with PONV in any sensitivity analyses.</p><p><strong>Conclusions: </strong>Intraoperative hypotension was not associated with PONV in patients at high risk of PONV who underwent laparoscopic gastrointestinal surgery.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 3","pages":"582-592"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820408","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":"\"Bioblasts\" in the Crosshairs-Again.","authors":"Misha Perouansky, Philip G Morgan","doi":"10.1097/ALN.0000000000005587","DOIUrl":"10.1097/ALN.0000000000005587","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 3","pages":"499-500"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12346152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Plasma Fibroblast Growth Factor 23 and In-hospital Acute Kidney Injury after Cardiac Surgery.","authors":"Sreekanth R Cheruku, Javier A Neyra, Hamza Mohammad, Johnny Trinh, Georgina Hernandez, Paul A Nakonezny, Michael E Jessen, Orson W Moe, Amanda A Fox","doi":"10.1097/ALN.0000000000005605","DOIUrl":"10.1097/ALN.0000000000005605","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) occurs in 20 to 30% of cardiac surgery patients and is most often classified as mild. A previous study reported that intact fibroblast growth factor 23 (iFGF23) and C-terminal fibroblast growth factor 23 (cFGF23) measured after cardiopulmonary bypass (CPB) were associated with severe AKI after cardiac surgery but did not analyze the association between iFGF23 and all-stage AKI. The primary aim of the study was to determine whether FGF23 biomarker measurements 6 h after CPB were associated with all-stage AKI after cardiac surgery.</p><p><strong>Methods: </strong>This prospective observational study included 173 patients undergoing nonemergent coronary artery bypass graft (CABG) and/or valve surgery on CPB. The primary study outcome was all-stage postoperative in-hospital AKI defined using the Kidney Disease: Improving Global Outcomes serum creatinine criteria through postoperative day 7, or earlier if the hospital stay was less than 7 days. Plasma iFGF23 and cFGF23 were measured 6 h after the end of CPB.</p><p><strong>Results: </strong>A total of 32 patients developed in-hospital postoperative AKI (18.5%) by the seventh postoperative day. The incidence of AKI was 18.5% in CABG patients, 14.3% in valve surgery patients, and 41.2% in combined CABG valve patients. A two-fold increase in cFGF23 was associated with 1.57 greater predicted odds of developing in-hospital postoperative AKI (odds ratio [OR], 1.57; 95% CI, 1.26 to 1.96; P < 0.0001). This association remained significant after adjusting for clinical covariates (OR, 1.40; 95% CI, 1.10 to 1.77; P = 0.006) and after adjusting for preoperative Cleveland Clinic score (OR, 1.54; 95% CI, 1.22 to 1.95; P = 0.0003). A two-fold increase in iFGF23 was associated with 1.59 greater predicted odds of developing in-hospital postoperative AKI (OR, 1.59; 95% CI, 1.08 to 2.35; P = 0.018).</p><p><strong>Conclusions: </strong>Early postoperative measurements of cFGF23 and iFGF23 are associated with all-stage AKI after cardiac surgery. The utility of these biomarkers for risk classification in cardiac surgery patients remains to be determined.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"593-603"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Near-infrared spectroscopy (NIRS) and skin tone in children: A prospective cohort study.","authors":"Joseph R Starnes, Wendi Welch, Christopher Henderson, Stephen Hudson, Briana McVean, Scott Risney, George T Nicholson, Thomas P Doyle, Dana Janssen, Bevan P Londergan, David A Parra, James C Slaughter, Muktar H Aliyu, John A Graves, Jonathan H Soslow","doi":"10.1097/ALN.0000000000005738","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005738","url":null,"abstract":"<p><strong>Background: </strong>Retrospective studies suggest that pulse oximetry overestimates saturation in children from races that may be associated with darker skin tone. Near-infrared spectroscopy (NIRS) relies on similar optical technology, but less is known about the effect of skin tone on NIRS. We aimed to quantify the effect of skin tone on NIRS performance.</p><p><strong>Methods: </strong>Consecutive patients under 21 years undergoing cardiac catheterization were enrolled (N=110). Skin tone was measured using spectrophotometry. Regional oxygen saturation was recorded from a Medtronic INVOS 5100C NIRS device placed on the forehead and was compared to the mixed venous saturation. Multivariable linear regressions were used to determine the effect of skin tone measured by individual typology angle (ITA).</p><p><strong>Results: </strong>Mean bias was larger for patients with darker skin in ITA categories 5-6 at -12.8% compared to ITA 3-4 at -2.5% with a difference of 10.3% (95%CI[4.4, 16.3], p<0.001) and ITA 1-2 at 0.3% with a difference of 13.1% (95%CI[7.5, 18.7], p<0.001). ITA was associated with NIRS bias in multivariable regression analysis (coefficient 0.173, p<0.001).</p><p><strong>Conclusions: </strong>Darker skin tone is associated with worse NIRS performance and lower NIRS values compared to mixed venous saturation for the INVOS 5100C system. This may lead to differences in care and contribute to inequities in outcomes. Better validation guidelines are needed to ensure equity in performance across varying skin tones.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939611","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":"The GABAergic Parafacial Zone: Integrating Consciousness and Respiratory Control in Sevoflurane Anesthesia.","authors":"Linlin Luo, Zaixun Qin, Mei Chen, Yuanli Pi, Ying Wang, Zongcheng Jiang, Zhimin Deng, Jia Li, Xuejiao Dou, Junli Jiang, Haiying Wang, Shouyang Yu, Tian Yu, Tianyuan Luo","doi":"10.1097/ALN.0000000000005735","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005735","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia induces both unconsciousness and respiratory depression, but whether these effects share a common neural substrate remains unclear. The parafacial zone (PZ), a GABAergic sleep-promoting region, has been proposed to modulate respiration. This study investigates whether PZ GABAergic neurons function as a common neural node coordinating anesthetic-induced unconsciousness and respiratory suppression.</p><p><strong>Methods: </strong>A total of 95 male mice (10-12 weeks) were used. Chemogenetic and optogenetic methods targeted PZ GABAergic neurons to assess anesthetic efficacy and respiratory changes. Immunostaining evaluated neuronal activation, and awake-state stimulation tested for anesthesia-like effects.</p><p><strong>Results: </strong>Chemogenetic activation of PZ GABAergic neurons enhanced anesthetic sensitivity, shifting the sevoflurane dose-response curve leftward (ED50: 0.662%, 95% CI: 0.624-0.699% vs. 1.569%, 95% CI: 1.502-1.637%) and lowering the concentration required for loss of righting reflex (0.735 ± 0.027% vs. 1.601 ± 0.048%, P < 0.0001, n = 10). Induction was faster (48 ± 4 s vs. 112 ± 3 s, P < 0.0001, n = 8) and emergence delayed (435 ± 12 s vs. 89 ± 12 s, P < 0.0001, n = 8). EEG showed increased delta and decreased theta power. Respiratory rate declined significantly (183 ± 24 bpm vs. 471 ± 3 bpm, P < 0.0001, n = 8). During anesthesia, brief optogenetic activation of PZ GABAergic neurons immediately elevated burst suppression ratio (69.5 ± 5.1% vs. 32.5 ± 7.7%, P < 0.0001, n = 9) and reduced respiratory rate (38 ± 13 bpm vs. 120 ± 21 bpm, P = 0.0016, n = 7), indicating concurrent modulation of cortical and respiratory function. Chemogenetic inhibition weakened anesthetic potency. Increased c-Fos expression in PZ GABAergic neurons during sevoflurane anesthesia confirmed their recruitment. In awake mice, optogenetic activation alone induced a low-arousal state with several features of anesthesia, including hypoactivity, analgesia, respiratory depression, and cortical suppression without abolishing righting reflex.</p><p><strong>Conclusions: </strong>The GABAergic PZ is a shared critical node regulating both respiration and consciousness during sevoflurane anesthesia; its activation suppresses both, helping explain anesthesia-related respiratory depression.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939672","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":"Cognitive decline and dementia in chronic widespread pain: A longitudinal population-based study.","authors":"Xue Jiang, Elin Johansson, Jo Nijs, Xueqiang Wang","doi":"10.1097/ALN.0000000000005731","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005731","url":null,"abstract":"<p><strong>Background: </strong>Despite preliminary research suggesting an impact of chronic pain on cognition, the direct effects of chronic widespread pain (CWP) on cognition and its underlying mechanisms remain unclear. This study aims to investigate the effects of CWP on dementia and cognitive performance and explore its potential neurobiological mechanisms.</p><p><strong>Methods: </strong>This was a population-based cohort study utilizing data from the UK Biobank, which enrolled 500,000 individuals aged 37 to 73 years from 2006 to 2010, with brain imaging scans initiated in 2014. CWP was defined based on participants' self-reported pain all over the body lasting for ≥3 months. The incidence of dementia and mild cognitive impairment was identified through inpatient records. Cognitive performances were assessed using eight tests: fluid intelligence, numeric memory, trail making (A and B), symbol digit substitution, paired associate learning, matrix pattern completion, and pairs matching. Systemic inflammatory markers were extracted from baseline blood samples. Data analysis was conducted from April 2024 to August 2024.</p><p><strong>Results: </strong>We analyzed 13 years of follow-up data from 188,594 participants to assess the relationship between CWP and cognitive outcomes, while exploring the mediating effects of brain structure and systemic inflammation. Individuals with CWP have an elevated risk of mild cognitive impairment (HR [95%CI]: 2.55[1.31 - 4.97]) and dementia (1.53 [1.13 - 2.0]). No evidence of a causal association was found between CWP and dementia (β = 1.50, PAdjusted = 0.076). Additionally, brain structural volumes (thalamus, insular cortex, prefrontal cortex, amygdala, precentral gyrus, and postcentral gyrus) and systemic inflammatory markers (lymphocytes, platelets, neutrophils, and leukocytes) may mediate the relationship between CWP and cognitive performance, as imprecision in timing of mediator assessment should lead to cautious interpretation.</p><p><strong>Conclusions: </strong>CWP is significantly associated with an elevated risk of cognitive impairment and dementia, mediated by alterations in brain structure and systemic inflammation.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939661","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}