Anesthesiology最新文献

{"title":"Anesthesia and the Periprocedural Management of Large Vessel Occlusion Stroke Treated with Mechanical Thrombectomy: A Narrative Review.","authors":"Russell Chabanne, Emmanuel Futier","doi":"10.1097/ALN.0000000000006250","DOIUrl":"10.1097/ALN.0000000000006250","url":null,"abstract":"<p><p>Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusion and has markedly improved functional outcomes. While procedural sedation was historically favored instead of general anesthesia due to safety concerns, current evidence does not support superior functional outcomes with procedural sedation compared with protocol-driven general anesthesia. General anesthesia is associated with higher reperfusion rates; however, strict hemodynamic control-particularly avoidance of hypotension-and ventilatory management are critical to preserving cerebral perfusion and improving outcomes. Ongoing trials are expected to clarify optimal anesthetic strategies in both anterior and posterior circulation strokes. In the meantime, the choice between general anesthesia and procedural sedation should consider patient-specific characteristics, procedural complexity, and institutional expertise. Future research should focus on better defining patient selection or stroke subtypes most likely to benefit from general anesthesia or procedural sedation, hemodynamic management, and neuroprotective strategies to maximize reperfusion, minimize complications, and improve recovery.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1265-1283"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975203","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":"Effectiveness of Selective Cyclooxygenase-2 Inhibitors for Postoperative Pain Management Using Multidimensional Pain Assessment: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Usman Kahloon, John B P Le, Sarah Tierney, Dean A Fergusson, Manoj M Lalu, Daniel I McIsaac, Alexis F Turgeon, Sanskruti Patel, Stephanie Musa, Michael Verret","doi":"10.1097/ALN.0000000000006216","DOIUrl":"10.1097/ALN.0000000000006216","url":null,"abstract":"<p><strong>Background: </strong>Although selective cyclooxygenase-2 (COX‑2) inhibitors are commonly used in perioperative pain management, it is uncertain whether these anti-inflammatory agents meaningfully improve postoperative recovery, including the impact of pain on daily functioning.</p><p><strong>Methods: </strong>This study systematically searched MEDLINE, Embase, and Cochrane CENTRAL for randomized controlled trials comparing systemic perioperative selective COX‑2 inhibitors with placebo, opioids, or usual care in adults. The primary outcome was postoperative acute pain, assessed using any validated multidimensional instrument evaluating pain‑related interference with daily living ( e.g. , Brief Pain Inventory; 0 to 10 scale, minimal clinically important difference = 1.0) within 1 month after surgery. Secondary outcomes included chronic pain, quality of recovery, and adverse events. Two reviewers independently performed study selection, data abstraction, risk of bias and certainty of evidence assessments. Clinical significance was assessed by estimating the difference between groups in the proportion of participants achieving the minimal important difference.</p><p><strong>Results: </strong>A total of 9,071 citations were screened, and 38 randomized controlled trials (5,424 participants) met eligibility criteria. Selective COX-2 inhibitors were associated with a reduction in acute pain‑related interference (Brief Pain Inventory mean difference [MD], -1.1; 95% CI, -1.4 to -0.8; n = 7; moderate certainty) and in chronic pain incidence (odds ratio, 0.44; 95% CI, 0.21 to 0.93; n = 5; low certainty), but no significant effect was found on chronic pain intensity (MD, -1.0; 95% CI, -2.7 to 0.7; n = 1; very low certainty). The modeled risk difference for achieving a clinically important analgesic effect showed a substantial benefit of COX-2 inhibitors for acute pain. Quality of recovery improved with the intervention (Quality of Recovery-9 [0 to 18 scale] MD, 0.84; 95% CI, 0.33 to 1.35; n = 7; low certainty). Intraoperative blood loss was lower (MD, -22 ml; 95% CI, -40 to -4; n = 3; low certainty), and no differences were observed in other adverse events ( i.e. , acute renal failure, gastrointestinal bleeding, impaired bone healing, myocardial infarction, stroke, and death).</p><p><strong>Conclusions: </strong>Perioperative selective COX‑2 inhibitors likely provide a clinically meaningful reduction in acute pain - related interference with daily function and may improve chronic pain and quality of recovery.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1174-1187"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904964","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":"Critical Closing and Perfusion Pressures in Sepsis: Reply.","authors":"Jing-Yi Wang, Bin Du","doi":"10.1097/ALN.0000000000006274","DOIUrl":"10.1097/ALN.0000000000006274","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1313-1314"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824222","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":"Genetic Prevalence of Malignant Hyperthermia Susceptibility-Associated Variants in a Nonmalignant Hyperthermia Referral Cohort.","authors":"Katharina Lichtenberger, Börge Bastian, Rami Abou Jamra, Henrik Rüffert","doi":"10.1097/ALN.0000000000006262","DOIUrl":"10.1097/ALN.0000000000006262","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1302-1304"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817151","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":"Adjusted Relationships between Mean Arterial Pressure, Cardiac Index, and Tissue Oxygenation during Off-pump Coronary Bypass.","authors":"Tao Wang, Zhao Zhang, Zhigang Guo, Ziyue Liu, Jiange Han, Lingzhong Meng","doi":"10.1097/ALN.0000000000006204","DOIUrl":"10.1097/ALN.0000000000006204","url":null,"abstract":"<p><strong>Background: </strong>Tissue oxygenation measured by near-infrared spectroscopy can guide hemodynamic management, yet the joint association of mean arterial pressure (MAP) and cardiac index with tissue oxygenation, and the conditional association of each at fixed levels of the other, remain incompletely defined.</p><p><strong>Methods: </strong>The authors analyzed intraoperative 1-Hz signals from patients undergoing off-pump coronary artery bypass surgery. Synchronized MAP, cardiac index, cerebral tissue oxygenation saturation (SctO 2 ), and forearm tissue oxygenation saturation (SftO 2 ) were modeled using generalized additive models. Two-dimensional smoothing over MAP-cardiac index estimated surfaces and two-dimensional slices characterized conditional relationships. Covariates were prespecified. Bootstrap quantified uncertainty and 95% CI. The authors emphasized estimation and visualization.</p><p><strong>Results: </strong>Analytic cohorts included 1,864 patients for left SctO 2 , 1,863 for right SctO 2 , and 1,860 for SftO 2 , each with more than 20 million eligible observations. Adjusted surfaces characterized mean tissue oxygenation across combinations of MAP and cardiac index. Two-dimensional slices showed that SctO 2 depended on both MAP and cardiac index. The MAP-SctO 2 relationship showed a substantial reduction in slope over a MAP range of 70 to 100 mmHg, mimicking cerebral pressure autoregulation. SctO 2 increased as cardiac index rose, reached its highest level at approximately 4.2 l · min -1 · m -2 , and then plateaued or slightly decreased at higher cardiac index. SftO 2 was sensitive to cardiac index, not MAP; it increased most steeply at cardiac index 2.8 l · min -1 · m -2 or less, showed a reduced slope over the cardiac index range of 2.8 to 4.2 l · min -1 · m -2 , and continued to increase at higher cardiac index. These patterns were more prominent in younger patients, females, and those with a baseline blood pressure less than 140/90 mmHg.</p><p><strong>Conclusions: </strong>During off-pump coronary artery bypass surgery, cerebral oxygenation was sensitive to both pressure and flow, whereas forearm oxygenation primarily tracked flow. Reductions in slope across specific pressure and flow ranges may reflect physiologic regulation but should not be interpreted as evidence for treatment targets or practice-changing interventions.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1145-1159"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249020","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 Prospective Evaluation of Routine Extubation Criteria in Children with Upper Respiratory Symptoms Undergoing Elective Surgery.","authors":"T Wesley Templeton, L Daniela Smith, Tim Mosher, Amit K Saha, Ashley S Hodges, Susan R Vishneski, Shelly H Pecorella, Lan Chi B Tran, Dudley E Hammon, Timothy E Smith, Douglas G Ririe, Martina G Downard, Lisa K Lee, Phillip J McPherson, Christopher S McLaughlin, Cameron J Sutton, J David Bradshaw, Phillip R Tennant, Leah B Templeton","doi":"10.1097/ALN.0000000000006197","DOIUrl":"10.1097/ALN.0000000000006197","url":null,"abstract":"<p><strong>Background: </strong>A previous study has shown that tidal volume greater than 5 ml/kg, conjugate gaze, facial grimace, purposeful movement, and eye opening are predictive of emergence and extubation readiness in children anesthetized primarily with inhalational agents. The hypothesis was that having any three of the aforementioned Big Five criteria will be similarly predictive of extubation success even if upper respiratory symptoms are present.</p><p><strong>Methods: </strong>After verbal consent, 756 patients 7 yr of age or younger were extubated awake. A parental questionnaire was performed preoperatively to assess upper respiratory symptoms and risk factors for respiratory adverse events. Based on this questionnaire, patients were assigned to either the non-upper respiratory infection symptom cohort or the upper respiratory infection symptom cohort. The presence or absence of the Big Five and other routine extubation criteria were recorded at extubation. Patients were included in the primary analysis only if they achieved three or more of the Big Five at the time of extubation. Awake extubations were graded as successful, intervention required, or major intervention required, according to a standard rubric. Intervention required and major intervention required were combined as a single outcome for the primary analysis. The positive predictive value of successful extubation was compared between the two cohorts using an equivalence analysis. The clinical equivalence margin was set at less than 5%.</p><p><strong>Results: </strong>The positive predictive value of successful extubation with three or more of the Big Five criteria in the non-upper respiratory infection symptom cohort was 94.7% (95% CI, 92.5 to 97.0%) and 93.9% (95% CI, 91.5 to 96.3%) in the upper respiratory infection symptom cohort. The effect size (95% CI) was 0.8% (95% CI, -2.6 to 4.2%). This was below the clinical equivalence margin of 5%.</p><p><strong>Conclusions: </strong>The presence of three or more of the Big Five criteria appears to be equivalently predictive of successful awake extubation in patients with upper respiratory symptoms when compared to patients with no upper respiratory symptoms.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1097-1106"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196962","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":"Fragility Index of Spinal Cord Stimulation Trials: Comment.","authors":"Anthony M-H Ho, David Clinkard, Tracy Cupido, Scott Duggan, Christopher Haley, Gregory Klar, Glenio B Mizubuti","doi":"10.1097/ALN.0000000000006277","DOIUrl":"10.1097/ALN.0000000000006277","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1317-1318"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824204","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":"Ancient Mitochondrial Genetic Variant: Reply.","authors":"Richard J Levy, Phil G Morgan","doi":"10.1097/ALN.0000000000006264","DOIUrl":"10.1097/ALN.0000000000006264","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1309-1310"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817199","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":"Critical Closing and Perfusion Pressures in Sepsis: Comment.","authors":"Xinyue Wang, Xinyi Xu, Yan Li","doi":"10.1097/ALN.0000000000006273","DOIUrl":"10.1097/ALN.0000000000006273","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1312-1313"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824179","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 Hypoperfusion Stroke.","authors":"Lingzhong Meng","doi":"10.1097/ALN.0000000000006142","DOIUrl":"10.1097/ALN.0000000000006142","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1242-1264"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668183","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}