Anesthesiology最新文献

{"title":"When Multimodal Analgesia Succeeds, Do Regional Blocks Still Have Value?","authors":"Kara M Barnett, Kelly Lebak","doi":"10.1097/ALN.0000000000006271","DOIUrl":"10.1097/ALN.0000000000006271","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"818-820"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918123","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":"Reassessing Local Anesthetic and Adjuvant Mixtures: Comment.","authors":"Matthias Thoma","doi":"10.1097/ALN.0000000000006249","DOIUrl":"10.1097/ALN.0000000000006249","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"1075-1076"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918094","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":"Superficial Cervical Plexus Block and Quality of Recovery after Thyroidectomy: A Randomized Clinical Trial.","authors":"Anita M Jegarl, Mitchell Martin, Nicholas R Cormier, Anthony Tanella, Dillon Schafer, Xiwen Zhao, Nadeera Dawlagala, Theo Yonn-Brown, Amanda Girod, Hung-Mo Lin, Adriana G Ramirez, Courtney E Gibson, Jennifer B Ogilvie, Jaime B Hyman","doi":"10.1097/ALN.0000000000006200","DOIUrl":"10.1097/ALN.0000000000006200","url":null,"abstract":"<p><strong>Background: </strong>Whether adding a bilateral superficial cervical plexus block to a thyroidectomy enhanced recovery pathway improves postoperative quality of recovery remains uncertain.</p><p><strong>Methods: </strong>In a single-center prospective, randomized, double-blind, placebo-controlled trial in adults undergoing thyroidectomy with general anesthesia, participants were randomized to bilateral superficial cervical plexus blocks with 0.25% bupivacaine or saline. All participants received multimodal analgesia with dexamethasone, acetaminophen, nonsteroidal anti-inflammatory drugs, and incisional local anesthetic. The primary outcome was quality of recovery, measured by the QoR-40 survey, on postoperative day 1. Secondary outcomes included the need for rescue opioid, total opioid consumption, nausea, vomiting, antiemetic administration, length of stay in the postanesthesia care unit (PACU), and opioid use on postoperative day 1.</p><p><strong>Results: </strong>A total of 160 participants were randomized to receive a superficial cervical plexus block with bupivacaine 0.25% (n = 78) or saline (n = 82). On postoperative day 1, mean QoR-40 scores were 174 (95% CI, 170 to 178) for bupivacaine and 173 (95% CI, 169 to 177) for saline. The adjusted mean difference between bupivacaine versus saline was 0.91 (95% CI, -3.57 to 5.40; P = 0.688). There were no significant between-group differences in the need for opioids in the PACU or on postoperative day 1, nausea, vomiting, or PACU length of stay. However, the total amount of opioid administered in the PACU was lower in the bupivacaine group (median [interquartile range], 0 [0 to 8]) compared with the saline group (2 [0 to 20]; Hodges-Lehmann location shift, 0 morphine milligram equivalents; 95% CI, -4 to 0; P = 0.017), and fewer participants in the bupivacaine group received rescue antiemetics (3 [3.8%] vs . 13 [16%]; difference, -12%; 95% CI, -22% to -1.8%; P = 0.011).</p><p><strong>Conclusions: </strong>Bilateral superficial cervical plexus blocks did not improve quality of recovery after thyroidectomy when added to a multimodal analgesic regimen including dexamethasone, acetaminophen, nonsteroidal anti-inflammatory drugs, and incisional local anesthetic but were associated with lower total PACU opioid consumption.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"918-926"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216003","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":"Holger K. Eltzschig, M.D., Ph.D., Recipient of the 2026 Award for Excellence in Research.","authors":"Alex S Evers","doi":"10.1097/ALN.0000000000006230","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006230","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"842-844"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944128","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":"Airway Management Risks in Pediatric Anesthesia: Comment.","authors":"Yasin Tire, Bedia Mine Hanedan, Bülent Hanedan, Abdullah Celep","doi":"10.1097/ALN.0000000000005988","DOIUrl":"10.1097/ALN.0000000000005988","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1056-1057"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508853","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":"Anesthesia Workstation Performance in Pediatric Ventilation: Part 1. Precision of Ventilation.","authors":"Johannes Spaeth, Malte Trost, Bernd Flamm, Christin Wenzel, Stefan Schumann","doi":"10.1097/ALN.0000000000006149","DOIUrl":"10.1097/ALN.0000000000006149","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilation of children sets the highest demands on the performance of anesthesia workstations. Different ventilator technologies are available, each representing unique pneumatic characteristics. The hypothesis of this study was that precision of delivered ventilation parameters depends on the ventilator type.</p><p><strong>Methods: </strong>Six modern anesthesia workstations (GE HealthCare Carestation 650; Mindray Bio-Medical Electronics Co. Ltd. Wato EX-65 Pro and A9; Dräger Medical Atlan A350 and Perseus A500; and Getinge Flow-c) were tested in physical models simulating the respiratory systems of a preterm baby, a neonate, an infant, and a toddler. Volume-controlled and pressure-controlled ventilation were investigated with and without airway leakage. Delivered tidal volume, peak inspiratory pressure, positive end-expiratory pressure, and inspiratory to expiratory ratio were compared to the set values. The data are presented descriptively; a difference greater than or equal to 10% between the delivered and set values was considered clinically relevant.</p><p><strong>Results: </strong>Deviations of the delivered volume from the set tidal volume during volume-controlled ventilation ranged between -19.5 ± 0.6% and +35.1 ± 3.0% in the preterm baby model but decreased with increasing tidal volume. Positive end-expiratory pressure and peak inspiratory pressure during pressure-controlled ventilation did not differ relevantly from the set values in any device or lung model. Expiratory ratios varied widely in most devices, leading to relevant differences in tidal volume during pressure-controlled ventilation. With leakage, tidal volume was, on average, 7% lower during volume-controlled ventilation but 2% lower during pressure-controlled ventilation.</p><p><strong>Conclusions: </strong>Precision of ventilation with modern anesthesia workstations varies depending on the ventilator type, ventilation mode, and set parameters. Pressure-controlled ventilation is advantageous in the six workstations tested considering the good agreement between the applied and the set parameters and leakage compensation. The results imply precision superiority of pressure-controlled ventilation over volume-controlled ventilation in preterm babies and neonates, independent from the ventilator technology in use.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"942-953"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925688","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":"Unexpected Failure of Bronchial Blocker Placement Due to an Undiagnosed Tracheal Bronchus.","authors":"Xiangyi Kong, Yan Zhang, Longfei Wang, Penghui Wei","doi":"10.1097/ALN.0000000000006206","DOIUrl":"10.1097/ALN.0000000000006206","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1006-1007"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597997","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":"Flow- versus Pressure-controlled Ventilation: Comment.","authors":"Chih-Wen Wang, Cheng-Wei Lu","doi":"10.1097/ALN.0000000000006219","DOIUrl":"10.1097/ALN.0000000000006219","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1059-1060"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720985","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":"Nitric Oxide and Kidney Injury after Heart Surgery: Comment.","authors":"Nikolay O Kamenshchikov, Mark A Tyo, Igor V Kravchenko, Elena A Churilina, Maxim S Kozulin, Yuri K Podoksenov, Chong Lei","doi":"10.1097/ALN.0000000000006228","DOIUrl":"10.1097/ALN.0000000000006228","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1064-1065"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787392","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":"Cerebral Small-vessel Disease and Postoperative Delirium in Elderly Noncardiac Surgical Patients.","authors":"Dan Huang, Caiyang Chen, Yuxi Zhou, Qian Liu, Yingjie Chen, Zhiyong He, Xiaowei Sun, Manjia Liu, Ying Jiang, Yuxuan Lin, Nan Wang, Xiaoqiong Sun, Xia Jin, Yuting Yang, Yixu Zhao, Lijun Pan, Rui Zhang, Juan Wang, Zhisheng Lu, Shaohua Liu, Hailian Wang, Zhenhong Wang, Yan Zhou, Junyan Yao, Liqun Yang, Zengai Chen, Jun Zhang, Yingwei Wang, Weifeng Yu, Daniel I Sessler, Peiying Li","doi":"10.1097/ALN.0000000000006189","DOIUrl":"10.1097/ALN.0000000000006189","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium is common in elderly surgical patients and is associated with complications and prolonged hospitalization. Cerebral small-vessel disease, a leading cause of dementia, is highly prevalent in elderly surgical patients. However, the relationship between cerebral small-vessel disease and postoperative delirium remains unknown. The authors therefore tested the primary hypothesis that cerebral small-vessel disease is associated with postoperative delirium in elderly noncardiac surgical patients.</p><p><strong>Methods: </strong>The authors prospectively evaluated patients 65 to 85 yr old who had inpatient elective noncardiac surgery at five academic centers in China. Independent neuroradiologists, masked to clinical data, quantified preoperative magnetic resonance markers of cerebral small-vessel disease, including lacune, white matter hyperintensity, perivascular space, and cerebral microbleed, to estimate vascular abnormalities, which were converted into a cerebral small-vessel disease burden score. Postoperative delirium was assessed twice daily during the initial 3 postoperative days using the Confusion Assessment Method for Intensive Care Unit.</p><p><strong>Results: </strong>Between July 8, 2020, and Sep 30, 2024, the authors enrolled 804 patients, of whom 69 (9%) had postoperative delirium. The risk of postoperative delirium progressively increased with higher cerebral small-vessel disease burden scores, reaching 28% in the most severely affected patients. Preexisting high cerebral small-vessel disease burden was associated with an increased risk of postoperative delirium (adjusted odds ratio, 1.95; 95% CI, 1.15 to 3.31; P = 0.023). The attributable risk was estimated at 4.9% (95% CI, 3.4% to 6.4%), with an estimated attributable risk percentage of 44% (95% CI, 37% to 51%), indicating that nearly half of all postoperative delirium cases in this cohort were potentially attributable to preexisting high cerebral small-vessel disease burden. Lacunes were especially associated with an increased risk of postoperative delirium (adjusted odds ratio, 2.96; 95% CI, 1.71 to 5.10; P < 0.001), as were white matter hyperintensities (adjusted odds ratio, 3.32; 95% CI, 1.97 to 5.61; P < 0.001).</p><p><strong>Conclusions: </strong>Preexisting cerebral small-vessel disease burden measured by magnetic resonance imaging is associated with doubled odds of postoperative delirium in elderly noncardiac surgical patients. Cerebral small-vessel disease thus appears to be a novel risk factor for postoperative delirium risk.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"889-901"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161581","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}