Anesthesiology最新文献

{"title":"Peripartum Cardiac Arrest during Anesthetic Care: Comment.","authors":"Yao Yu, Peng Liu","doi":"10.1097/ALN.0000000000006252","DOIUrl":"10.1097/ALN.0000000000006252","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1079-1080"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787526","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":"Pain during Cesarean Delivery: Comment.","authors":"Carlo Pancaro, Arvind Palanisamy","doi":"10.1097/ALN.0000000000006241","DOIUrl":"10.1097/ALN.0000000000006241","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1068"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787479","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":"Clinical Performance in Critical Care Simulation under Sleep Deprivation: Effects of Power Napping in the Recovery Napping Protocol for Anesthesiologist Performance (R-NAP) Randomized Controlled Trial.","authors":"Laura Schmidt, Florian Genty, Thomas Delaire, Berenice Valero, Isaline Rey, Leslie Galan, Sacha Mairet-Mabboux, Marion Douplat, Sophie Schlatter, Thomas Rimmele, Stephanie Mazza, Marc Lilot","doi":"10.1097/ALN.0000000000006135","DOIUrl":"10.1097/ALN.0000000000006135","url":null,"abstract":"<p><strong>Background: </strong>Sleep deprivation is common among anesthesia residents and impairs both technical and nontechnical skills such as leadership. Napping is recommended in fatigue management across healthcare and other safety-sensitive sectors, yet its effectiveness for healthcare providers remains underexplored. This study evaluated whether a 30-min nap opportunity improved simulated crisis performance after a 24-h shift.</p><p><strong>Methods: </strong>Residents were tested twice: once rested and once using a 24-h shift to induce partial sleep deprivation. Between sessions, they were trained in fatigue management. In the sleep-deprived condition, they were randomized to a nap opportunity or a control condition. Actigraphy objectively assessed sleep and nap duration. The primary endpoint was overall simulated clinical performance (0 to 200; combined technical and nontechnical scores). Secondary endpoints were technical and nontechnical subscales. Group effects were primarily tested using intention-to-treat regression models adjusted for rested performance, previous sleep, and critical care experience.</p><p><strong>Results: </strong>Thirty-five residents were enrolled (nap opportunity, n = 19; control, n = 16). In the primary analysis sample (n = 27), clinical performance was 14.8 points higher after the nap opportunity compared with controls (95% CI, 2.8 to 26.9; P = 0.018), corresponding to a 7.4% improvement. Technical skills did not differ significantly between groups, although more sleep was associated with better technical performance. Nontechnical skills were higher in the nap opportunity condition (+11.0 points; 95% CI, 2.2 to 19.8; P = 0.016), including significant effects of leadership and resource utilization. Exploratory analyses suggested associations between longer nap duration and multiple performance domains, strongest for technical skills ( P = 0.010).</p><p><strong>Conclusions: </strong>Napping appears to enhance clinical performance, while the nap opportunity, nap duration, and previous sleep deprivation each influenced technical and nontechnical performance in distinct ways. These findings support integrating napping and recovery into medical education and scheduling.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1008-1021"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832409","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":"Higher versus Routine Intraoperative Blood Pressure Targets in Noncardiac Surgery: A Systematic Review and Meta-analysis with Trial Sequential Analysis of Randomized Trials.","authors":"Katie Chiou, Sovann Vikram, Kiana Rowshan, Smeet Shah, Dolly Modha, Edgard Engelman, David Guthrie, Anil Tiwari, Joseph Rinehart, Alexandre Joosten, Bernd Saugel, Sean Coeckelenbergh","doi":"10.1097/ALN.0000000000006190","DOIUrl":"10.1097/ALN.0000000000006190","url":null,"abstract":"<p><strong>Background: </strong>Observational studies consistently link intraoperative hypotension to adverse postoperative outcomes, leading guidelines to recommend maintaining mean arterial pressure 60 to 65 mmHg or greater during noncardiac surgery. Whether targeting higher intraoperative blood pressure values improves clinical outcomes remains uncertain.</p><p><strong>Methods: </strong>The authors conducted a Preferred Reporting Items for Systematic Reviews and Meta-analyses-guided search on PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Embase from inception to April 2026. Randomized trials comparing higher intraoperative blood pressure targets, either as fixed absolute thresholds or personalized to preoperative baseline, versus routine blood pressure management in adults undergoing elective noncardiac surgery with general anesthesia were included. Outcomes included in-hospital or 30-day mortality, postoperative delirium, acute kidney injury (AKI), 30-day major cardiovascular events, acute myocardial injury, stroke, length of stay, and intraoperative hypotension.</p><p><strong>Results: </strong>Fifteen trials (15,603 patients) were included. Higher targets did not reduce AKI (risk ratio [RR], 0.95; 95% CI, 0.85 to 1.06; P = 0.36; I 2 = 16%) or acute myocardial injury (RR, 1.02; 95% CI, 0.94 to 1.12; P = 0.59; I 2 = 0%) compared with routine targets, with firm evidence from trial sequential analysis. Higher targets were associated with a significant reduction in postoperative delirium (RR, 0.73; 95% CI, 0.54 to 0.98; P = 0.04; I 2 = 26%), although trial sequential analysis indicated the cumulative evidence remained insufficient to draw firm conclusions. No significant effect was observed on in-hospital or 30-day mortality (RR, 1.00; 95% CI, 0.75 to 1.34; P = 1.00; I 2 = 0%); evidence on 30-day major cardiovascular events, stroke, and length of stay was similarly insufficient to draw firm conclusions.</p><p><strong>Conclusion: </strong>In adults undergoing elective noncardiac surgery, targeting higher intraoperative blood pressure values does not improve major postoperative outcomes compared with routine management. A potential reduction in postoperative delirium warrants confirmation in adequately powered trials.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"872-888"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161624","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":"Flow- versus Pressure-controlled Ventilation: Comment.","authors":"Zhang Liu, Weiqin Huang","doi":"10.1097/ALN.0000000000006227","DOIUrl":"10.1097/ALN.0000000000006227","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1061-1062"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720043","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":"Doctrinal Shift in Jehovah's Witness Governing Body Policy on Autologous Blood Storage and Transfusion.","authors":"Russell K McAllister","doi":"10.1097/ALN.0000000000006236","DOIUrl":"10.1097/ALN.0000000000006236","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"1055-1056"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918063","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":"Anesthesia Workstation Performance in Pediatric Ventilation: Part 2. Characteristics during Pressure Support Ventilation and Oxygen Rise Times.","authors":"Johannes Spaeth, Malte Trost, Bernd Flamm, Christin Wenzel, Stefan Schumann","doi":"10.1097/ALN.0000000000006150","DOIUrl":"10.1097/ALN.0000000000006150","url":null,"abstract":"<p><strong>Background: </strong>Modern anesthesia workstations include various ventilator technologies, but the effects on pediatric ventilation are unclear. The hypothesis of this study was that performance during pressure support ventilation and times to increase oxygen concentrations depend on the type of anesthesia workstation.</p><p><strong>Methods: </strong>Six modern anesthesia workstations (GE HealthCare Carestation 650; Mindray Bio-Medical Electronics Co. Ltd. Wato EX-65 Pro and A9; Dräger Medical Atlan A350 and Perseus A500; and Getinge Flow-c) were evaluated in respiratory models of a preterm baby, a neonate, an infant, and a toddler. Trigger response rates, trigger delay, and time to reach 50% of peak inspiratory pressure during pressure support ventilation were compared. Furthermore, the times required to increase oxygen concentration from 21 to 90% during pressure-controlled ventilation at fresh gas flows of 1, 3, and 10 l · min -1 were assessed in a compartment of the lung models with the volume corresponding to the respective model's functional residual capacity.</p><p><strong>Results: </strong>Trigger response rates were above 90%, with few exceptions. Trigger delays ranged between 73 ± 6 and 145 ± 0 ms. Times to reach 50% peak pressure ranged between 161 ± 1 and 312 ± 1 ms, with decreasing variability in the larger patient models. Oxygen rise time varied between 94 ± 3 and 615 ± 60 s at the lowest fresh gas flow and decreased with increasing fresh gas flow to 3 l · min -1 and less so with further increasing fresh gas flow to 10 l · min -1 . Activation of oxygen flush did not generally increase oxygen concentration but caused relevant airway pressure increases in some devices.</p><p><strong>Conclusions: </strong>Modern anesthesia workstations show an overall good performance during pressure support ventilation of children. During pressure-controlled ventilation, a moderate increase of fresh gas flow accelerated the rise in oxygen concentration, depending on the device. Oxygen flush brings no advantage in this regard but may put the patient at risk of high airway pressure.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"954-965"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925817","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":"Measures of Quality of Recovery and Discharge-readiness Tools in the Pediatric Postanesthesia Care Unit.","authors":"Issada Jindawatthana, Cameron Graydon, Paul Lee-Archer, Tania Ramos, Suzette Sheppard, Andrew Davidson","doi":"10.1097/ALN.0000000000006193","DOIUrl":"10.1097/ALN.0000000000006193","url":null,"abstract":"<p><p>The postanesthesia care unit is a critical phase of recovery, yet routine assessment often focuses on discharge readiness rather than the child's recovery experience. This study reviewed measures used in pediatric postanesthesia care unit pathways to assess discharge readiness and early recovery quality and synthesized how they capture domains that matter to children, families, and clinicians. This is a structured literature review with narrative synthesis and identified eight tools used in children: Steward score, Modified Aldrete Score, physiologic criteria-based score, White and Song fast-track score, Criteria for Fast-Tracking Children, Pediatric Post-Anesthetic Discharge Scoring System, Pediatric Readiness for Discharge Instrument, and Discerning Post Anesthesia Readiness for Transition. These tools varied by intended phase and destination, with consistent coverage of consciousness, oxygenation, and hemodynamics but variable assessment of the airway, pain, nausea and vomiting, bleeding, and function. A postanesthesia care unit-specific pediatric quality-of-recovery measure remains a key research and quality improvement gap.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1031-1041"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597919","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":"A Mechanical Strategy for Preventing Perioperative Pulmonary Aspiration.","authors":"Kevin R Olsen, Anastasia Jones, Alfonso Pepe","doi":"10.1097/ALN.0000000000006198","DOIUrl":"10.1097/ALN.0000000000006198","url":null,"abstract":"<p><p>Pulmonary aspiration of gastric contents is a rare but serious complication of impaired consciousness, such as during the induction of anesthesia, and is associated with significant morbidity and mortality. Despite numerous standard interventions, there is limited evidence that these strategies reliably prevent aspiration. Alginates are naturally derived polysaccharides that form a buoyant gel \"raft\" barrier in the stomach and have been used safely for decades to prevent acid reflux worldwide. However, according to the scientific literature, alginates have not been employed to potentially prevent pulmonary aspiration of gastric contents during induction of anesthesia and represent a promising new prophylactic option, serving as an ingestible physical barrier to esophageal reflux of stomach contents. With established safety and efficacy in the treatment of gastroesophageal reflux disease, alginates may offer an immediate, nonsystemic, inert, and safe reflux barrier to limit the risk of aspiration by physically inhibiting the regurgitation of gastric contents.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"831-835"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705095","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":"Reassessing Local Anesthetic and Adjuvant Mixtures: Comment.","authors":"Daniel Brosius, Alexandra Hart, Veena Graff, Taras Grosh","doi":"10.1097/ALN.0000000000006248","DOIUrl":"10.1097/ALN.0000000000006248","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"145 4","pages":"1072-1073"},"PeriodicalIF":9.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918066","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}