Anesthesiology最新文献

{"title":"Unlocking Prognostic Potential in the Postarrest Electroencephalogram.","authors":"Peter J Schuller, Jamie W Sleigh, Matthew B Allen","doi":"10.1097/ALN.0000000000005407","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005407","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"777-778"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802368","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 Long Silence of Catastrophe.","authors":"Nathaniel J Brown","doi":"10.1097/ALN.0000000000005325","DOIUrl":"10.1097/ALN.0000000000005325","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"949"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584392","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":"Anesthesiology.","authors":"","doi":"10.1097/ALN.0000000000005481","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005481","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"A3-A8"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802345","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":"Chevalier Jackson: Shining a Light on Physiologic and Societal Obstructions.","authors":"","doi":"10.1097/ALN.0000000000005448","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005448","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"873"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802348","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":"Nobility in Small Things: A Surgeon's Path.","authors":"Kathryn E McGoldrick","doi":"10.1097/ALN.0000000000005349","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005349","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"972-973"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802358","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":"Comparative Methods to Predict Redosing of Bupivacaine and Ropivacaine in Truncal Catheters.","authors":"Brittani Bungart, Lana Joudeh, Eric S Schwenk, Christopher Chiang, Michael R Fettiplace","doi":"10.1097/ALN.0000000000005406","DOIUrl":"10.1097/ALN.0000000000005406","url":null,"abstract":"<p><strong>Background: </strong>Despite the frequent use of ropivacaine and bupivacaine, there is limited guidance on redosing of these medications after an initial bolus. Intermittent redosing is a clinical practice in the setting of nerve catheters, often utilizing large doses. Comparatively, theoretical elimination rates are available from pharmacokinetic studies, providing estimates on total body content of these drugs. The authors hypothesized that published redosing of bupivacaine and ropivacaine in clinical literature comported with safe elimination of the drugs based on pharmacokinetic studies.</p><p><strong>Methods: </strong>Clinical redosing of bupivacaine and ropivacaine were identified from previously published articles that used intermittent bolus dosing into the transversus abdominis plane and paravertebral space. The dosing data were fit to an exponential curve using least squares regression and 1/Y 2 weighting with the equation: Y = Y M - (Y M - Y 0 ) * e -k * x , where YM is the maximal dose (175 mg for bupivacaine, 210 mg for ropivacaine), Y0 is the dose at time zero, k is the elimination constant, and x is time. Both minimal ( i.e. , slowest) and average pharmacokinetic elimination constants for ropivacaine and bupivacaine were identified in the published literature. Clinical redosing was compared with pharmacokinetic elimination.</p><p><strong>Results: </strong>The maximal pharmacokinetic half-lives of bupivacaine and ropivacaine were 603 min (range, 154 to 2,970 min; N = 49) and 528 min (range, 204 to 3,276 min; N = 39), respectively. Clinically reported redosing of bupivacaine fit to an exponential curve with k bupi(clinical) = 0.077 h -1 , representing the 53.5th percentile of extracted pharmacokinetic minimal elimination constants. Clinically reported redosing of ropivacaine fit to a curve with k ropi(clinical) = 0.083 h -1 consistent with the 52nd percentile of minimal pharmacokinetic elimination constants.</p><p><strong>Conclusions: </strong>Clinically reported redosing of bupivacaine and ropivacaine in the published literature reflect the slowest pharmacokinetic elimination based on human studies. The combined data without evidence of toxicity permit the authors to make practical recommendations about safe redosing of these agents.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"885-895"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188097","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":"Cytokine Hemoadsorption versus Standard Care in Cardiac Surgery Using the Oxiris Membrane: The OXICARD Single-center Randomized Trial.","authors":"Osama Abou-Arab, Pierre Huette, Azrat Ibrahima, Christophe Beyls, Guillaume Bayart, Mathieu Guilbart, Adrien Coupez, Youssef Bennis, Aurélie Navarre, Gaelle Lenglet, Roman Béal, Gilles Touati, Thierry Caus, Stéphane Bar, Estelle Josse, Maxime Nguyen, Hervé Dupont, Brigitte Gubler, Saïd Kamel, Momar Diouf, Yazine Mahjoub","doi":"10.1097/ALN.0000000000005376","DOIUrl":"10.1097/ALN.0000000000005376","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery can lead to dysregulation with a proinflammatory state, resulting in adverse outcomes. Hemadsorption using the AN-69 membrane (Oxiris membrane, Baxter, USA) has the properties to chelate inflammatory cytokines. The authors hypothesized that in patients at high risk of inflammation, the use of the Oxiris membrane could decrease inflammation, preserve endothelial function, and improve postoperative outcomes.</p><p><strong>Methods: </strong>The authors conducted a randomized single-center study at Amiens University Hospital (Amiens, France). The study population consisted of adult patients admitted for scheduled cardiac surgery with an expected cardiopulmonary bypass (CPB) time greater than 90 min. The patients were allocated to either the standard group or the Oxiris group. The intervention consisted of using the Oxiris membrane on a Prismaflex device (Baxter, USA) at a blood flow rate of 450 ml/min during CPB. The primary outcome was the assessment of microcirculation on day 1 after surgery by measuring sublingual microcirculation using the microvascular flow index. Microvascular flow index reflects the microcirculation flow type and is graded from 0 to 3 as follows: 0, no flow; 1, intermittent flow; 2, sluggish flow; 3, continuous flow. The secondary outcome was a composite adverse outcome within 30 days after surgery. Cytokines and endothelial biomarkers were measured in all patients at different time points. An intention-to-treat analysis was performed.</p><p><strong>Results: </strong>From October 2019 to November 2022, the study included 70 patients. Two patients were excluded from the Oxiris group: one patient did not undergo surgery, and one procedure was performed under deep hypothermia. The microvascular flow index did not differ between groups on day 1 from baseline: difference (95% CI) Oxiris minus standard at -0.17 (-0.44 to 0.10); P = 0.2. The occurrence of a composite adverse outcome did not significantly differ between groups (14 [42%] for the Oxiris group vs. 12 [35%] for the standard group; P = 0.7). The overall variation in cytokines and angiopoietins did not significantly differ between groups.</p><p><strong>Conclusions: </strong>In patients scheduled for a cardiac surgery with prolonged CPB, the authors could not demonstrate the benefit on microcirculation and major cardiovascular events.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"874-884"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021883","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":"Prediction of Hypotension: Comment.","authors":"Simon J Davies, Zhongping Jian, Monty Mythen, Feras Hatib","doi":"10.1097/ALN.0000000000005423","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005423","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"970-971"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802359","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":"Reviewing DNR Guidelines at a Time of Transition: Reply.","authors":"Matthew B Allen","doi":"10.1097/ALN.0000000000005341","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005341","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"955-956"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802362","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":"Discordance between Chest Radiography and Lung Ultrasound in the Evaluation of Intraoperative Hypoxemia.","authors":"Yuriy S Bronshteyn, Diana Hsu, Ashley Vincent, Sophia Dunworth","doi":"10.1097/ALN.0000000000005378","DOIUrl":"10.1097/ALN.0000000000005378","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"916-917"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584390","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}