Anesthesiology最新文献

{"title":"Continuous Erector Spinae Plane Blocks to Treat Pain Following Percutaneous Nephrolithotomy: A Randomized, Triple-Masked, Placebo-Controlled Clinical Trial.","authors":"John J Finneran, Seth K Bechis, Roger L Sur, Manoj Monga, Kenneth S Miller, Brenton Alexander, Baharin Abdullah, Michael C Donohue, Adam Schaar, Brian M Ilfeld","doi":"10.1097/ALN.0000000000006129","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006129","url":null,"abstract":"<p><strong>Background: </strong>Single-injection erector spinae plane blocks (ESPB) provide analgesia following percutaneous nephrolithotomy (PCNL) but are limited in their duration. A continuous ESPB involving local anesthetic administered via a perineural catheter may extend analgesia duration. We hypothesized that adding a continuous ESPB to a single-injection ESPB following outpatient PCNL would decrease pain severity and/or opioid consumption over the first 2 postoperative days (dual primary outcomes).</p><p><strong>Methods: </strong>Preoperatively, adults undergoing PCNL had an ultrasound-guided perineural catheter inserted at the 8th transverse process following saline injection. Bupivacaine 0.25% with epinephrine (20 mL) was manually injected via the catheter for all participants who were subsequently randomly allocated to one of two postoperative treatments: ACTIVE with bupivacaine 0.25% or PLACEBO with normal saline. An automatic intermittent bolus of 21 mL was delivered every 4 hours using a portable infusion pump for approximately 57 h.</p><p><strong>Results: </strong>During the first 2 postoperative days, the median [interquartile range] average daily pain intensity as measured with the numeric rating scale for ACTIVE (n=25) was 3.5 [2.0, 4.5] compared with 3.0 [1.3, 4.5] for PLACEBO (n=25; estimated difference 0.25, 95% CI -1.0 to 1.5; p=0.538). Cumulative oxycodone consumption during this same period was 10 [0, 25] mg for ACTIVE versus 15 [0, 30] mg for PLACEBO (estimated difference 0, 95% CI -15 to 5; p=0.358). During this period, the maximum daily pain for ACTIVE was 7.0 [4.3, 8.0] compared with 6.5 [5.5, 8.0] for PLACEBO (p=0.754). Sleep disturbances the second night were 0 [0, 1] for both groups (p=0.423). During the day after surgery, pain's interference with physical and emotional functioning was 10 [0, 33] for ACTIVE and 8 [23, 48] for PLACEBO as measured with the Brief Pain Inventory (p=0.587).</p><p><strong>Conclusions: </strong>This investigation failed to identify benefits of adding a continuous ESPB to a single-injection ESPB following PCNL.</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":"147809762","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":"Rewarding Productivity, Hoping for Creativity.","authors":"Larry F Chu, Christopher L Wu, Mitchell H Tsai","doi":"10.1097/ALN.0000000000005954","DOIUrl":"10.1097/ALN.0000000000005954","url":null,"abstract":"<p><p>Academic anesthesiology has increasingly used grant dollars, citation impact factor, and publication numbers to measure faculty productivity. While they were originally designed as proxies for quality, they now risk becoming the mission driving the specialty. Academic anesthesiology departments are facing increasing faculty burnout, leaving departments bottom-heavy and lacking creativity, mentorship, and leadership. This has consequences for anesthesiology and patient care. Self-determination theory helps explain this pattern by showing how controlling metrics erode autonomy, competence, and relatedness, the core drivers of motivation. To protect the vitality of the specialty, departments must realign their missions with values that metrics cannot easily capture: teaching, mentorship, integrity, and community engagement. Diversified portfolios and balanced scorecards demonstrate feasible ways to support these values within financial constraints. Aligning systems with principles rather than proxies will allow departments to cultivate innovation and restore medicine's moral foundation. Metrics may guide us, but they must never define us.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1060-1062"},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269534","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":"Rural America Nears a Cliff: Federal Funding Cuts Threaten Health Systems and Anesthesia Care.","authors":"Charley Yan, Naileshni S Singh, Chinar D Sanghvi, Scott G Pritzlaff","doi":"10.1097/ALN.0000000000005934","DOIUrl":"10.1097/ALN.0000000000005934","url":null,"abstract":"<p><p>Rural hospitals operate on thin margins, sustained largely by federal funding through Medicaid and bolstered by the Affordable Care Act premium subsidies. As these supports erode due to recent federal legislative changes through the One Big, Beautiful Bill Act and a failure of the U.S. Congress to renew Affordable Care Act monies, millions will lose affordable insurance. For anesthesiologists, these changes will translate into closed healthcare systems, cancelled cases, less coverage for medication-assisted treatment used in opioid use disorder, and shrinking surgical capacity. These changes will be disproportionately felt in rural America, where residents already faced disparities in health care. Protecting coverage and rural hospital funding is not just a matter of equity; it is central to maintaining safe, timely anesthesia care for millions of Americans.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1057-1059"},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430376","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":"Gabapentin for Postsurgical Pain: Comment.","authors":"Evan G Pivalizza","doi":"10.1097/ALN.0000000000005961","DOIUrl":"10.1097/ALN.0000000000005961","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1260-1261"},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466879","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":"Intranasal Naloxone Reversal of Opioid-induced Respiratory Depression in Opioid-naive Individuals and Self-reported Daily Opioid Users.","authors":"Maarten A van Lemmen, Jeffry Florian, Zhihua Li, Monique van Velzen, Erik Olofsen, Albert Dahan, Marieke Niesters, Elise Sarton, Rutger van der Schrier","doi":"10.1097/ALN.0000000000005931","DOIUrl":"10.1097/ALN.0000000000005931","url":null,"abstract":"<p><strong>Background: </strong>Since current opioid overdose deaths occur mainly from potent synthetic opioids with high affinity for the opioid receptor, such as fentanyl and carfentanil, it is important to determine the efficacy of naloxone, particularly the intranasal formulation, in reversing opioid-induced respiratory depression. This study evaluated effectiveness of 4 mg intranasal naloxone (Narcan; Adapt Pharma Inc., USA) in reversing moderate respiratory depression induced by fentanyl and sufentanil in opioid-naive individuals and self-reported daily opioid users. Sufentanil was compared to fentanyl because of its higher affinity for the opioid receptor.</p><p><strong>Methods: </strong>In this prospective, crossover trial, 12 opioid-naive individuals and 18 daily opioid users (morphine milligram equivalent, 291; range, 60 to 2,250 mg/day) received continuous fentanyl or sufentanil infusions, titrated to achieve 30 to 40% reduction in minute ventilation ( ). Participants were administered Narcan during steady-state respiratory depression. Primary endpoints included time to reversal of diminished and elevated end-tidal carbon dioxide concentration (pCO 2 ).</p><p><strong>Results: </strong>Narcan restored within 2 to 4 min across all participants but showed delayed reversal of end-tidal pCO 2 (11 to 17 min), with pCO 2 recovery during sufentanil exposure in just 8 opioid-naive individuals and 10 daily opioid users. Hysteresis analysis showed for reversal onset/offset times (blood-effect-site equilibration half-lifes) of 0 to 1 min and for end-tidal pCO 2 2 to 11 min. Because of withdrawal symptoms, 7 of 18 daily opioid users participated once in the study. Study limitations included continuous opioid infusions that do not occur in real-world overdose settings.</p><p><strong>Conclusions: </strong>A single Narcan dose reversed moderate fentanyl- and sufentanil-induced respiratory depression, although effectiveness varied by endpoint and opioid receptor affinity. Rapid recovery suggests clinical utility of intranasal naloxone, but delayed and sometimes incomplete recovery of end-tidal pCO 2 , particularly during exposure to the high-affinity opioid sufentanil, indicates reversal inefficacy and persistence of respiratory instability. Further studies are needed to address optimal naloxone doses and alternative formulations to address high-dose potent opioid threats.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1160-1172"},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123511","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":"Diversity, Equity, and Inclusion: Scoping Review: Reply.","authors":"Cody R Sain, Angela M Bader, Morana Lasic","doi":"10.1097/ALN.0000000000006041","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006041","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809769","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":"Geographic Variability in American Society of Anesthesiologists Physical Status Scoring: Insights from a United States-Japan Database Comparison and the MILESTONE-2 Trial.","authors":"Makishi Maeda, Yusuke Yoshikawa, Michiaki Yamakage","doi":"10.1097/ALN.0000000000006058","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006058","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809789","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":"Norepinephrine in Major Abdominal Surgery: Comment.","authors":"Ahmed Hasanin, Maha Mostafa, Rana M Zaki, Mohamed Abdulatif","doi":"10.1097/ALN.0000000000006036","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006036","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809865","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":"Surgical Urgency and Perioperative Mortality: A National Analysis Using Procedure-specific Classification.","authors":"Omar Hyder, Timothy M Pawlik","doi":"10.1097/ALN.0000000000005948","DOIUrl":"10.1097/ALN.0000000000005948","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1243-1246"},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430367","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":"Association of Peripheral Nerve Block with Postoperative Myocardial Injury in High-risk Cardiac Older Adults Undergoing Hip Fracture Surgery: A Two-center Retrospective Cohort Study.","authors":"Hongye Zhang, Jinyu Wu, Dongmei Ni, Yanxia Sun, Yi Ren, Yongsheng Miao, Na Jia, Yuelun Zhang, Zongyang Qu, Dong-Xin Wang, Zhen Hua","doi":"10.1097/ALN.0000000000005921","DOIUrl":"10.1097/ALN.0000000000005921","url":null,"abstract":"<p><strong>Background: </strong>Myocardial injury after hip fracture surgery is common and associated with increased mortality. Acute pain is an important risk factor, but whether peripheral nerve block (PNB) could reduce postoperative myocardial injury remains unclear. This study aimed to evaluate the association between single-injection PNB, administered as an adjunct to general or neuraxial anesthesia, and postoperative myocardial injury in high-risk cardiac older adults undergoing hip fracture surgery.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients 65 yr or older who underwent hip fracture surgery during general or neuraxial anesthesia between 2012 and 2023 were included. Based on medical records, patients who received a single-injection PNB as an adjunct were assigned to the PNB group; those who did not were assigned to the non-PNB group. The primary outcome was postoperative myocardial injury, defined as any postoperative cardiac troponin measurement exceeding the 99th percentile upper reference limit during the index hospitalization. Confounding effects were adjusted using inverse probability of treatment weighting based on 27 baseline and intraoperative variables. A weighted logistic regression model was used to estimate odds ratio for PNB versus non-PNB groups. Missing data (24.3% of cases) were imputed using multiple imputation.</p><p><strong>Results: </strong>Data from 1,467 patients were included in the final analysis. Postoperative myocardial injury occurred in 12.0% (96 of 798) of patients in the PNB group and 21.5% (144 of 669) in the non-PNB group. The weighted logistic regression analysis showed that single-injection PNB was associated with a significantly lower odds of postoperative myocardial injury (adjusted odds ratio, 0.60; 95% CI, 0.44 to 0.82; P = 0.002).</p><p><strong>Conclusions: </strong>Single-injection PNB as an adjunct to general or neuraxial anesthesia was associated with a reduced risk of postoperative myocardial injury in high-risk cardiac older adults undergoing hip fracture surgery, possibly through mitigating the link between pain and myocardial injury. Further prospective trials are needed to validate these findings.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1094-1104"},"PeriodicalIF":9.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888147","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}