Anesthesiology最新文献

{"title":"Transitional Pain Service for Preventing Chronic Postsurgical Pain: A Scoping Review of Published Literature and Considerations for Research and Practice.","authors":"Harsha Shanthanna, Maram Khaled","doi":"10.1097/ALN.0000000000005606","DOIUrl":"10.1097/ALN.0000000000005606","url":null,"abstract":"<p><p>Since its introduction, the transitional pain service, a multicomponent perioperative program, has been considered to hold the promise of reducing the risk of chronic postsurgical pain unlike single-modality interventions. This scoping review on the use of transitional pain service or transitional pain service-like programs observed limited and low-quality evidence in the form of fifteen studies (seven retrospective chart reviews, five cohort studies, and only one randomized controlled trial), with only six studies assessing any postoperative pain outcomes and only one assessing postsurgical pain as a secondary outcome. A majority of studies focused on postoperative opioid use, observing important reductions. Along with a comprehensive review of transitional pain service, this study discusses its inherent appeal for reducing chronic postsurgical pain; essential components based on its theoretical foundations and the need to distinguish it from other multimodal perioperative strategies; challenges and limitations; and lastly the need for effectiveness research through pragmatic trials. Despite continuing to be an important outcome, the overall prescription opioid use rate has decreased due to practice and regulatory oversight. Hence, the incentive to convince stakeholders and develop a transitional pain service program based on opioid reduction may not be a viable long-term strategy.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1382-1398"},"PeriodicalIF":9.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939658","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":"Transfusion of Amustaline/Glutathione Pathogen-reduced Red Blood Cells in Cardiac Surgery: A Randomized Phase 3 Clinical Trial.","authors":"Michael E Sekela, Edward L Snyder, Ian J Welsby, Yoshiya Toyoda, Mohamed Alsammak, Neel R Sodha, Thomas M Beaver, J Peter R Pelletier, James D Gorham, John S McNeil, Roman M Sniecinski, Ronald G Pearl, Gregory A Nuttall, Ravi Sarode, T Brett Reece, Richard J Benjamin","doi":"10.1097/ALN.0000000000005716","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005716","url":null,"abstract":"<p><strong>Background: </strong>Transfusion has a persistent low risk of transfusion-transmitted infection and transfusion-associated graft-versus-host disease that may be addressed using pathogen reduction. The Red Cell Pathogen Inactivation (ReCePI) trial tested whether amustaline/glutathione pathogen-reduced red cells are noninferior to conventional transfusions for support of acute surgical blood loss.</p><p><strong>Methods: </strong>A phase 3, double-blinded, noninferiority trial randomized cardiac or thoracic-aorta surgery patients with increased risk of red cell transfusion to receive pathogen-reduced or conventional red cells during and for 7 days postsurgery. The primary endpoint was the proportion of patients with acute kidney injury (AKI), which is defined as an increase from baseline of greater than or equal to 0.3 mg/dl serum creatinine within 48 h of surgery. Noninferiority was claimed if the upper bound 95% CI of the treatment difference was less than half (50%) of the observed conventional arm incidence. Adverse events and treatment-emergent red cell antibodies were assessed for 28 and 75 days, respectively.</p><p><strong>Results: </strong>A total of 581 subjects were randomized, and 321 (55%) were transfused with study red cells. Transfused subjects in both arms had similar baseline demographics, medical histories, hemoglobin levels, and surgical procedures. Hemoglobin day 3 nadir levels (8.6 g/dl [7.8 to 9.2] in the pathogen-reduced arm; 8.4 g/dl [7.8 to 9.3] in the conventional arm; P = 0.52) were comparable. Incidence of AKI by 48 h was 46 of 157 (29.3%) in the pathogen-reduced arm and 45 of 161 (28.0%) in the conventional arm (treatment difference, 0.7%; 95% CI, -8.9 to 10.4%; noninferiority margin, 14.0%; P = 0.001 for noninferiority). AKI within 7 days by Kidney Disease Improving Global Outcomes staging criteria was not different (59 of 159 [37.1%] in the pathogen-reduced arm; 55 of 162 [34.0%] in the conventional arm; P = 0.53), but stage III was more common in the pathogen-reduced arm (pathogen-reduced arm, 15 of 159 [9.4%]; conventional arm, 7 of 162 [4.3%]; P = 0.075). Of 159 pathogen-reduced red cell recipients, 5 (3.1%) developed specific, low-titer antibodies without evidence of hemolysis.</p><p><strong>Conclusions: </strong>The incidence of AKI in recipients of pathogen-reduced red cells was noninferior to conventional red cell transfusion. Treatment-emergent antibodies were uncommon and not clinically significant.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 5","pages":"1196-1210"},"PeriodicalIF":9.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285320","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":"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 yr 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 or longer. 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>This study analyzed 13 yr 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 (hazard ratio [95% CI], 2.55 [1.31 to 4.97]) and dementia (1.53 [1.13 to 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":"2025-10-16","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}

{"title":"Intraoperative Electroencephalogram Alpha Power Associated with Mortality: Reply.","authors":"Rory V Mather,Ryan D Nipp,Gustavo Balanza,Tom A D Stone,Rodrigo Gutierrez,Praachi Raje,Masaya Higuchi,Ran Liu,Laura A Santa Cruz Mercado,Edward A Bittner,Hiroko Kunitake,Patrick L Purdon","doi":"10.1097/aln.0000000000005676","DOIUrl":"https://doi.org/10.1097/aln.0000000000005676","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"37 1","pages":"1425-1427"},"PeriodicalIF":8.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283957","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":"Hemodynamic Management with Hypotension Prediction Index in Surgery: Reply.","authors":"Javier Ripollés-Melchor,Manuel I Monge-García,César Aldecoa,Begoña Quintana-Villamandos,Ángel V Espinosa,Alfredo Abad-Gurumeta","doi":"10.1097/aln.0000000000005700","DOIUrl":"https://doi.org/10.1097/aln.0000000000005700","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"1 1","pages":"1433-1435"},"PeriodicalIF":8.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283960","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":"Encouraging Low Fresh Gas Flow with Sevoflurane via Real-time Decision Support: A Randomized Controlled Evaluation of an Electronic Health Record Reminder Alert.","authors":"Daniel Gessner,Natasha Harrison,Dipro Chakraborty,Poonam Ahir,Praveen Kalra,Rachel Outterson","doi":"10.1097/aln.0000000000005663","DOIUrl":"https://doi.org/10.1097/aln.0000000000005663","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"73 1","pages":"1407-1410"},"PeriodicalIF":8.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283963","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":"Aging Brain-Heart-Immune Axis and Postoperative Delirium: A Prospective Observational Study of Preoperative Heart Rate Variability Using At-home Wearable Devices.","authors":"Kenneth C Roberts,Sloan A Soyster Heinz,Sarah Peskoe,Nathaniel E Brooke,Morgan A Rosser,Hayden C Kenny,Hannah Mekaru,Vincent Chen,Emmalee Metzler,Jeffrey Browndyke,Heather E Whitson,J P Ginsberg,Leah C Acker","doi":"10.1097/aln.0000000000005674","DOIUrl":"https://doi.org/10.1097/aln.0000000000005674","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"8 1","pages":"1403-1406"},"PeriodicalIF":8.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283964","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":"Hemodynamic Management with Hypotension Prediction Index in Surgery: Comment.","authors":"Yusuke Yoshikawa,Michiaki Yamakage","doi":"10.1097/aln.0000000000005698","DOIUrl":"https://doi.org/10.1097/aln.0000000000005698","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"8 1","pages":"1430-1431"},"PeriodicalIF":8.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283953","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":"Hemodynamic Management with Hypotension Prediction Index in Surgery: Comment.","authors":"Gumersindo Solares","doi":"10.1097/aln.0000000000005699","DOIUrl":"https://doi.org/10.1097/aln.0000000000005699","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"1 1","pages":"1432-1433"},"PeriodicalIF":8.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283955","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":"Hemodynamic Management with Hypotension Prediction Index in Surgery: Comment.","authors":"Ana Pérez Carbonell,Simon J Davies","doi":"10.1097/aln.0000000000005697","DOIUrl":"https://doi.org/10.1097/aln.0000000000005697","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"10 1","pages":"1429-1430"},"PeriodicalIF":8.8,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283958","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}