Anesthesiology最新文献

{"title":"Beyond Heparin: Redefining Anticoagulation Strategies during Cardiopulmonary Bypass.","authors":"Ravi V Joshi,Markus Velten","doi":"10.1097/aln.0000000000005701","DOIUrl":"https://doi.org/10.1097/aln.0000000000005701","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"23 1","pages":"808-809"},"PeriodicalIF":8.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017953","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 Clinician Performance in the Last 5 Years of the Merit-based Incentive Payment System.","authors":"Sunjay Letchuman,Diana C Mosquera,Lois A Connolly,Raj Letchuman,Matthew T Popovich,Jonathan S Gal","doi":"10.1097/aln.0000000000005613","DOIUrl":"https://doi.org/10.1097/aln.0000000000005613","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"84 1","pages":"1113-1116"},"PeriodicalIF":8.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017941","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 Second Randomized Trial to Suggest You Shouldn't Change Your Anesthetic in Infants to Avoid Neurotoxicity.","authors":"Andrew Davidson,Caleb Ing","doi":"10.1097/aln.0000000000005671","DOIUrl":"https://doi.org/10.1097/aln.0000000000005671","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"34 1","pages":"799-801"},"PeriodicalIF":8.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017954","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":"Minimal Protamine Dosing during Drug Shortages: Comment.","authors":"Michael Hardy,Dominique Lasne,Maximilien Gourdin,Thomas Lecompte,Isabelle Gouin-Thibault,Francois Mullier","doi":"10.1097/aln.0000000000005616","DOIUrl":"https://doi.org/10.1097/aln.0000000000005616","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"24 1","pages":"1128-1130"},"PeriodicalIF":8.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017942","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":"Tracheostomy Tube Pilot Balloon Spring as an Unrecognized Source of a Magnetic Resonance Imaging Metallic Artifact.","authors":"Edward H Tsai,Eric Nguyen,Ahmed Awad,Joseph R Ruiz","doi":"10.1097/aln.0000000000005654","DOIUrl":"https://doi.org/10.1097/aln.0000000000005654","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"56 1","pages":"1028-1029"},"PeriodicalIF":8.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017949","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":"Hippocampal Neural Dynamics and Postoperative Delirium-like Behavior in Aged Mice.","authors":"Shiqi Guo, Liuyue Yang, Weihua Ding, Tewodros Mulugeta Dagnew, Yuting Gao, Wei Wang, Pei Wang, Song Huang, Chongzhao Ran, Changning Wang, Le Shen, Qian Chen, Oluwaseun Akeju, Shiqian Shen","doi":"10.1097/ALN.0000000000005478","DOIUrl":"10.1097/ALN.0000000000005478","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common and serious clinical condition that occurs after anesthesia/surgery. While its clinical impact is well recognized, the underlying electrophysiologic mechanisms remain largely unknown, posing challenges for effective treatment. This study aims to investigate hippocampal neural dynamics before and after anesthesia/surgery in aged mice, which have a tendency to develop POD.</p><p><strong>Methods: </strong>This study included adult and aged mice with a POD model. POD-like behavior was assessed in N = 10 mice at baseline (the day before surgery), as well as at 9 h and 24 h after anesthesia/surgery. A behavioral battery, including the open field test, Y maze, buried food test, and novel object recognition, was used for assessment. In vivo chronic brain recordings were performed on awake, restrained mice using a high-density silicon probe during the same time intervals. To further investigate hippocampal neural dynamics, in vivo two-photon calcium imaging was also conducted. Additionally, aged mice were pretreated with indole-3-propionic acid (IPA), and its effects on POD-like behavior and neural activity were evaluated using electrophysiology and calcium imaging.</p><p><strong>Results: </strong>The first observation was that aged mice exhibited significant POD-like behavior, as measured by Z scores, compared to adult mice after anesthesia/surgery. Analysis revealed significant age-related differences in hippocampal neuronal activities. At 9 h after surgery, aged mice exhibited a marked increase in pyramidal cell activity and a reduction in interneuron activity compared to adult mice. These changes in neuronal dynamics were associated with the onset of POD-like symptoms in aged mice. By 24 h after surgery, both pyramidal cell and interneuron activity in aged mice had returned to presurgery levels, which coincided with an improvement in POD-like behavior. Additionally, IPA pretreatment modulated neuronal activity in aged mice, attenuating pyramidal cell hyperactivity and partially ameliorating interneuron dysfunction, changes associated with mitigated POD-like behavior.</p><p><strong>Conclusions: </strong>Alterations in hippocampal neural activity may significantly contribute to brain dysfunction and POD-like behavior. IPA pretreatment may modulate neural circuit imbalances in aged mice, potentially mitigating POD incidence.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"625-640"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735578","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 and Genetic Factors Associated with Intraoperative Minimum Alveolar Concentration Ratio: A Single-center Retrospective Cohort and Genome-wide Association Study.","authors":"Nicholas J Douville, Elizabeth S Jewell, Xinyi Zhao, Douglas A Colquhoun, Emily Bertucci-Richter, Sebastian Zöllner, Ryan P Davis, Sathish S Kumar, George A Mashour","doi":"10.1097/ALN.0000000000005602","DOIUrl":"10.1097/ALN.0000000000005602","url":null,"abstract":"<p><strong>Background: </strong>Minimum alveolar concentration (MAC) is a standard dosing metric for general anesthesia. Although influences of MAC have been identified in controlled studies, the determinants of clinical delivery of MAC ratio are largely unknown. To address this knowledge gap, the authors performed this single-center retrospective study. The primary objective was to understand factors associated with MAC ratio, as indexed by the end-tidal volatile anesthetic concentration, for a given case. It was hypothesized that mean arterial pressure (MAP) was strongly associated with anesthetic delivery; a secondary objective was to perform a genome-wide association study to identify genetic variants associated with MAC ratio in clinical practice.</p><p><strong>Methods: </strong>The primary outcome was mean age-adjusted MAC ratio during the maintenance phase of anesthesia. The primary exposure variable was mean MAP during the same time window. The correlation between the outcome, exposure, and a variety of demographic, laboratory, procedural, and anesthetic covariates was assessed in adjusted multivariable linear regressions. Next, the authors performed two genome-wide association studies of clinically delivered MAC ratio.</p><p><strong>Results: </strong>Of the 30,125 cases included in the final dataset, mean ± SD age-adjusted MAC ratio was 1.066 ± 0.173, and mean MAP was 82 ± 10 mmHg. MAP was associated with MAC ratio in the overall model (β = 0.0028; 95% CI, 0.0024 to 0.0032; P < 0.0001). A variety of demographic ( e.g. , female sex: β = -0.0182; 95% CI, -0.0219 to -0.0144; P < 0.0001), laboratory, surgical, and anesthetic factors were also associated with anesthetic agent concentration. Eight variants located near six genes ( DPH6 , CPM , EEFSEC , SGSM1 , CDH9 , and DISC1 ) reached the lower suggestive threshold ( P < 1 × 10 -6 ) in one but not both models; none exceed the threshold for genome-wide significance ( P < 5 × 10 -8 ).</p><p><strong>Conclusions: </strong>The hypothesis was verified that MAP was associated with clinical delivery of MAC ratio. The authors also characterized practice patterns of inhalational anesthetic management and identified numerous covariates that need to be accounted for when modeling anesthetic requirements. Female patients received lower doses of anesthetic, despite evidence that they have a higher requirement. While genome-wide association studies failed to identify novel variants at the level of genome-wide significance ( P < 5 × 10 -8 ), multiple mechanistically plausible genes were suggested. Notably, the DISC1 gene has been shown to impact resting-state brain activations under general anesthesia with isoflurane and has been linked to abnormal sleep/wake patterns.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"541-558"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257177","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":"Impact of the U.S. Food and Drug Administration's Safety Communication on Gabapentinoid-Opioid Coprescription.","authors":"Periklis Giannakis, Alex Illescas, Lisa Reisinger, Haoyan Zhong, Crispiana Cozowicz, Lazaros Poultsides, Jiabin Liu, Jashvant Poeran, Stavros G Memtsoudis","doi":"10.1097/ALN.0000000000005564","DOIUrl":"10.1097/ALN.0000000000005564","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"775-778"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625294","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":"Psychological Effects of Explicit Recall under Sedation and after Surgery (PEERS): A Prospective Cohort Study on 2,500 Patients.","authors":"Jason Chui, Luis E Mendoza Vasquez, Courtney Fleming, Arjun Patel, Zahra Taboun, Madeline Green-Holland, LeeAnne Fochesato, Douglas Naudie, Homer Yang, John M Murkin","doi":"10.1097/ALN.0000000000005603","DOIUrl":"10.1097/ALN.0000000000005603","url":null,"abstract":"<p><strong>Background: </strong>Explicit recall occurring during sedation/regional anesthesia is common but has long been assumed to have no sequelae. A prospective cohort study was conducted to determine the incidence of explicit recall experience under sedation/regional anesthesia, as well as to assess the recall experiences that are associated with psychological consequences.</p><p><strong>Methods: </strong>The study prospectively recruited 2,500 adults who underwent elective total hip or knee arthroplasty under sedation/regional anesthesia from September 2021 to March 2024 at University Hospital in London, Ontario, Canada. The primary exposure was recall experience, assessed using the modified Brice questionnaire. The co-primary outcomes included probable depression (defined as a Patient Health Questionnaire score of 8 or higher) and suspected posttraumatic stress disorder (PTSD) symptoms (defined as a Post-traumatic Stress Disorder Checklist for Civilians score of 13 or higher) at 6 weeks postoperatively. The association between specific recall experiences and the co-primary outcomes was evaluated by multivariable regression analysis. Additionally, the incidence and mental health burden related to the psychological effects of surgery in the entire cohort were assessed.</p><p><strong>Results: </strong>A total of 2,138 patients were included in the final analysis. Explicit recall was reported by 475 participants (22.2%) but was not associated with the co-primary outcomes. Regarding surgery's overall impact, 61 participants (5%) developed new probable depression, 105 participants (5%) reported suspected PTSD, and 95 patients (4.4%) developed new suicidal ideation postoperatively. The authors estimated that 1 in 18 patients required new psychiatric consultation.</p><p><strong>Conclusions: </strong>Explicit recall per se during sedation/regional anesthesia did not increase the odds of developing psychiatric illness. Surgery itself carries significant risks of triggering depression and PTSD that are severe enough to reach levels associated with suicidal ideation, requiring immediate mental care. This study reveals a significant, yet underappreciated, mental healthcare burden.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"570-581"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257180","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":"Analgesic Benefits of Motor-sparing Fascial Plane Blocks in Comparison to Periarticular Local Infiltration Analgesia for Total Hip Arthroplasty: A Network Meta-analysis.","authors":"Nasir Hussain, Richard Brull, Alex T Freedenberg, Chris Vannabouathong, Ryan S D'Souza, Steven Havlik, Peyton Beachy, Antonius Gunawan, Tristan E Weaver, Daniel I McIsaac, Colin J L McCartney, Faraj W Abdallah","doi":"10.1097/ALN.0000000000005607","DOIUrl":"10.1097/ALN.0000000000005607","url":null,"abstract":"<p><strong>Background: </strong>Periarticular local infiltration analgesia has become an important mainstay of multimodal analgesia after elective total hip arthroplasty (THA). However, the role of novel motor-sparing fascial plane blocks-with or without periarticular local infiltration analgesia-has not been fully elucidated for patients undergoing THA. The authors conducted a network meta-analysis evaluating the relative analgesic effectiveness of motor-sparing fascial plane blocks (quadratus lumborum, erector spinae, and pericapsular nerve group blocks) and periarticular local infiltration analgesia for adult patients undergoing THA.</p><p><strong>Methods: </strong>Randomized trials examining single-injection quadratus lumborum, erector spinae, or pericapsular nerve group blocks, or periarticular local infiltration analgesia, for THA were sought. The primary outcome was area under the curve (AUC) rest pain scores during the period from 0 to 24 h. Secondary outcomes included rest pain scores at 0, 6, 12, and 24 h; postoperative function at 6, 12, and 24 h; analgesic consumption at 0 to 24 h; incidence of opioid-related side effects; and incidence of block-related complications. Network meta-analysis was performed using a frequentist approach.</p><p><strong>Results: </strong>A total of 44 trials (3,579 patients) evaluating the quadratus lumborum block, erector spinae block, pericapsular nerve group block, or periarticular local infiltration analgesia for THA were considered. Network meta-analysis was used to derive the probability of each intervention being the most effective as compared to the others (P score). For AUC 0 to 24 h rest pain, periarticular local infiltration analgesia was the most effective intervention, as demonstrated by a P score of 89%. For postoperative analgesic consumption, the quadratus lumborum block was the most effective intervention, with a P score of 88%. This was followed by the pericapsular nerve group block (74%), the erector spinae block (38%), and periarticular local infiltration analgesia (42%).</p><p><strong>Conclusions: </strong>Periarticular local infiltration analgesia alone provides the most consistent improvements in postoperative rest pain, analgesic consumption, and functional recovery after THA. The addition of a quadratus lumborum block or pericapsular nerve group block to periarticular local infiltration may further improve analgesic outcomes.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"604-624"},"PeriodicalIF":9.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257176","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}