Anesthesiology最新文献

{"title":"Highly Individualized Management in Esophagectomy: Comment.","authors":"Javier Ripollés-Melchor, Ángel V Espinosa, M Ignacio Monge-García","doi":"10.1097/ALN.0000000000006258","DOIUrl":"10.1097/ALN.0000000000006258","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1305-1306"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817130","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":"Bleeding after Heart Transplantation: Comment.","authors":"Kenichi A Tanaka, Matthew T Kelly, Min U Jang","doi":"10.1097/ALN.0000000000006302","DOIUrl":"10.1097/ALN.0000000000006302","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1330-1331"},"PeriodicalIF":9.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900062","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":"Operating Room Air Filtration-Sterilization and Surgical Infections: The ORACLE Randomized Trial in 110,538 Surgeries.","authors":"Daniel I Sessler, Edward J Mascha, Elyad Ekrami, Mauro Bravo, Catalina Dussan, Federico Almonacid-Cardenas, Yanyan Han, Alparslan Turan","doi":"10.1097/ALN.0000000000006424","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006424","url":null,"abstract":"<p><strong>Background: </strong>Surgical infections are the most common nosocomial infections and cause substantial morbidity and mortality. Operating rooms are relatively clean, but far from sterile. An unknown fraction of infections result from wound contamination by air-borne bacteria. We therefore tested the hypothesis that supplemental air purification reduces wound infections and related complications.</p><p><strong>Methods: </strong>Operating rooms, our clusters, were each randomized in each 4-week blocks to either active or identical-looking sham supplemental air sterilization. All investigators, clinicians, and patients were fully blinded to treatment. No other aspect of anesthetic or surgical management was proscribed. Intent-to-treat analysis was restricted to adults who had surgery lasting at least an hour without evidence of pre-existing wound infections. We tested the primary hypothesis that supplemental active purification reduces a collapsed (one or more) composite of surgical wound infections, infection-related complications, or death within 30 days after inpatient surgery. Secondarily, we tested the hypothesis that supplemental air purification reduces the same composite after combined inpatient and outpatient surgeries.</p><p><strong>Results: </strong>A total of 110,538 combined inpatients and outpatients were enrolled across 68 operating rooms, with 107,334 qualifying for analysis. At the third interim analysis, the futility boundary on the composite outcome was crossed for inpatients and for all patients. Enrollment thus stopped with 58,938 randomized inpatients. The primary composite outcome occurred in 8.1% (n=2,389) of inpatients randomized to active purification versus 8.2% (n=2,405) with sham purification: odds ratio 0.98 (95%CI: 0.92 to 1.05), P=0.609. Across all patients, the secondary composite outcome occurred in 5.5% (n=2,959 / 53,730) of active purification cases versus 5.6% (n=2,981 / 53,604) sham cases: odds ratio 0.98 (95% CI: 0.93 to 1.05), P=0.669). Treatment effect did not vary over the weeks in the randomized periods.</p><p><strong>Conclusion: </strong>Supplemental active purification did not reduce surgical wound infections or mortality in surgical patients. Infection-control efforts might better focus on limiting direct wound contamination.Trial registration:A priori registration at ClinicTrials.gov: NCT04610294.Funding: Supported by a grant from ActivePure (Bristol, VA) to the Cleveland Clinic. The funder approved the original protocol which was written by the lead author. The funder was not involved in data acquisition, analysis, or manuscript preparation. A draft of the manuscript was provided to the funder as a courtesy.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223236","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":"Transversus Abdominis Plane Blocks in Surgery: Reply.","authors":"Alparslan Turan, Wael Ali Sakr Esa, Daniel I Sessler","doi":"10.1097/ALN.0000000000006342","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006342","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191049","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":"Transversus Abdominis Plane Blocks in Surgery: Comment.","authors":"Suwen Hu, Zina Zhu, Yun Dong","doi":"10.1097/ALN.0000000000006341","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006341","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190995","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":"Dynamic Arterial Elastance: Physiologic Basis, Current Clinical Evidence, and Future Directions.","authors":"Jorge Iván Alvarado-Sánchez, Andres Felipe Yepes-Velasco, Manuel Ignacio Monge-García, Michael R Pinsky","doi":"10.1097/ALN.0000000000006352","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006352","url":null,"abstract":"<p><p>Restoring arterial pressure in hypotensive shock is a primary resuscitation goal, yet increases in cardiac output after fluid administration do not consistently produce meaningful increases in arterial pressure. This dissociation highlights the importance of understanding pressure-flow interactions during hemodynamic interventions. Dynamic arterial elastance (EaDyn) is a functional hemodynamic index proposed to characterize these interactions. Rather than reflecting static vascular resistance, EaDyn is hypothesized to describe the dynamic relationship between cardiac output and arterial load within the framework of ventriculo-arterial coupling. Clinically, EaDyn has been investigated as a predictor of the arterial pressure response to fluid administration in preload-responsive patients and as a marker of pressure stability during vasopressor reduction. However, current clinical evidence remains limited, heterogeneous, and derived largely from selected populations. This review summarizes the physiologic basis of EaDyn, critically appraises the available clinical evidence, and highlights current limitations and priorities for future research.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191065","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":"Transversus Abdominis Plane Blocks in Surgery: Comment.","authors":"Ratan K Banik, Jacob Hutchins, James Flaherty, Steven P Cohen","doi":"10.1097/ALN.0000000000006340","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006340","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191036","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":"Association of Nerve Block with Myocardial Injury: Reply.","authors":"Jinyu Wu, Yuelun Zhang, Hongye Zhang","doi":"10.1097/ALN.0000000000006364","DOIUrl":"https://doi.org/10.1097/ALN.0000000000006364","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191083","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":"Hypotension Prediction Index versus Mean Arterial Pressure Alarm for Preventing Intraoperative Hypotension in Elective Noncardiac Surgery: A Randomized Controlled Trial.","authors":"Anna A Florax, Marijn P Mulder, Roland P van Ieperen, Libera Fresiello, Dirk W Donker, Jan-Willem Potters","doi":"10.1097/ALN.0000000000006338","DOIUrl":"10.1097/ALN.0000000000006338","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypotension is common during surgery and has been retrospectively associated with acute kidney injury, myocardial injury, and increased mortality. The Hypotension Prediction Index was developed to support proactive blood pressure management but shows a strong correlation with mean arterial pressure. Observational data suggest that a mean arterial pressure alarm set at 72 mmHg may perform similarly to the default Hypotension Prediction Index alarm (greater than 85). The authors hypothesized that a 72 mmHg mean arterial pressure alarm is noninferior to the Hypotension Prediction Index in preventing intraoperative hypotension.</p><p><strong>Methods: </strong>In this single-center, blinded, randomized controlled trial, adults undergoing moderate- or high-risk elective noncardiac surgery with continuous arterial pressure monitoring were assigned to either a mean arterial pressure alarm (less than 72 mmHg) or a Hypotension Prediction Index alarm (greater than 85). The primary outcome was the area under the threshold for mean arterial pressure less than 65 mmHg. Secondary outcomes included the incidence and severity of hypo- and hypertension, duration of active alarms, incidence of acute kidney and myocardial injury, 30-day mortality, hospital length of stay, and cumulative dosages of vasoactive medication and fluids.</p><p><strong>Results: </strong>A total of 143 participants were included in the final analysis. The median [IQR] area under the hypotension threshold was 3.75 [0.00 to 22.62] mmHg ⋅ min in the mean arterial pressure group and 4.00 [0.00 to 19.00] mmHg ⋅ min in the Hypotension Prediction Index group. After log-transformation, the mean difference was 0.03 (95% CI, -0.24 to 0.29), with the lower bound remaining above the predefined noninferiority margin (-0.4). No differences were observed in secondary hemodynamic metrics, alarm characteristics, patient outcomes, or administered medications and fluids.</p><p><strong>Conclusion: </strong>A mean arterial pressure alarm of 72 mmHg is noninferior to the Hypotension Prediction Index greater than 85 in preventing intraoperative hypotension. Given its simplicity and broad availability, a mean arterial pressure alarm of 72 mmHg represents a pragmatic and cost-effective alternative for proactive blood pressure management.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787389","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":"3 of 5 Green Lights and Cleared for Landing","authors":"Alexander S. Doyal,Jonathan P. Wanderer,Holly B. Ende","doi":"10.1097/aln.0000000000006380","DOIUrl":"https://doi.org/10.1097/aln.0000000000006380","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"34 1","pages":"A16-A16"},"PeriodicalIF":8.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208764","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}