Journal of Anesthesia最新文献

Purpose: Hypertensive surgical patients face heightened perioperative cardiovascular risk, and propofol often induces hypotension. This trial aimed to compare remimazolam and propofol for hemodynamic stability in hypertensive patients undergoing non-cardiac surgery, and explore underlying cardiac and vascular mechanisms via continuous monitoring.

Methods: This randomized single-blind trial enrolled 122 adults with controlled hypertension undergoing elective non-cardiac surgery, assigned to remimazolam-based or propofol-based total intravenous anesthesia. Primary outcomes were intraoperative hypotension episodes (mean arterial pressure < 65 mmHg or a > 20% decrease from baseline), norepinephrine bolus frequency and total dose. Hemodynamics were continuously tracked by Continuous Non-Invasive Arterial Pressure Monitor 500, with anesthesia depth maintained at a bispectral index of 40-60.

Results: Baseline characteristics were comparable. The remimazolam group had fewer hypotension episodes (remimazolam group vs. propofol group, median episodes [interquartile range, IQR], 2 [0-3] vs. 3 [1-5]; p = 0.003), fewer norepinephrine boluses (1 [0-3] vs. 3 [1-5]; p = 0.001), and lower total dose (8 µg [0-24] vs. 24 µg [8-40]; p < 0.001). Remimazolam showed non-significant trends toward smaller reductions in cardiac output (CO, - 8.10% vs. - 13.10%, p = 0.35) and systemic vascular resistance (SVR, - 10.83% vs. - 14.91%, p = 0.46). Extubation time and post-anesthesia care unit stay were similar.

Conclusion: For hypertensive patients, remimazolam provides superior hemodynamic stability over propofol, evidenced by fewer hypotensive episodes, reduced norepinephrine requirements, and attenuated perturbations in CO and SVR, without delaying recovery. It represents a valuable anesthetic alternative for this high-risk cohort.

Background: Chronic post-surgical pain (CPSP) is a prevalent complication following video-assisted thoracic surgery (VATS), significantly affecting long-term patient outcomes. This study aimed to evaluate the influence of uniport versus multiport VATS on the incidence of CPSP and postoperative recovery at six months.

Methods: Patients were stratified into uniport and multiport VATS groups, with propensity score matching (PSM). The primary endpoint was the incidence of CPSP at six months. The secondary endpoints comprise the short-term recovery outcomes within 30 days postoperatively, the quality of life at six months and group-based trajectory modeling to characterize pain trajectories over six months.

Results: After PSM, 222 patients (111 per group) were included in the final analysis. A significant difference in postoperative pain intensity {3(1.8-4) vs 4(3-5), P = 0.007} was observed on postoperative day 3 (POD3). However, no significant difference in CPSP incidence at six months was detected between the uniport and multiport VATS groups. Multivariate logistic regression analysis of the entire cohort identified a high pain score on POD3 as an independent risk factor for CPSP development. Pain trajectory analysis revealed three distinct postoperative pain patterns over the six-month period. Patients in the high pain trajectory required more remedial analgesia and were more likely to develop CPSP.

Conclusions: Uniport VATS was not associated with a lower incidence of CPSP compared to multiport VATS at six months postoperatively. A high pain score on POD3 emerged as a significant predictor of CPSP.

Purpose: Washout efficiency of volatile anesthetics may differ depending on anesthesia workstation structure, particularly the presence of a fresh gas decoupling valve (FGDV). However, this influence has not been systematically evaluated.

Methods: This in vitro study investigated sevoflurane washout in four anesthesia workstations: Fabius GS™ and KMA-1300Vi™ (with an FGDV), and Aespire™ and FLOW-i™ (without an FGDV). Three machines per model were tested. After equilibration at 2.0% sevoflurane, the vaporizer was turned off, and washout time to < 0.1% was measured at fresh gas flows (FGF) of 3-10 L/min. A mixed-effects ANOVA and linear regression analyses were performed.

Results: A total of 96 washout trials were carried out, including four workstation models, three devices, and eight FGF levels. Washout time decreased with increasing FGF in all models. Machines without an FGDV showed rapid washout at ≥ 6 L/min, while those with an FGDV exhibited gradual decline. ANOVA revealed significant effects of FGF (p < 0.001), the presence of an FGDV (p = 0.028), and their interaction (p < 0.01). Regression analyses showed robust inverse-proportional relationships in FGDV-equipped machines (adjusted R² > 0.9), whereas those without an FGDV  deviated from this model.

Conclusions: The presence of an FGDV significantly alters volatile anesthetic washout behavior. Workstations with an FGDV demonstrate more predictable but slower washout, while those without an FGDV allow faster clearance at higher FGF. These in vitro findings highlight that circuit architecture, including the presence of FGDV, affects washout dynamics. Further clinical studies are needed to determine implications for emergence and contamination control.

Purpose: To investigate the clinical characteristics of management strategies for, and outcomes in patients with preoperative venous thromboembolism (VTE) who underwent surgery in Japan.

Methods: We categorized patients with preoperative VTE into the following three groups: pulmonary embolism (PE), proximal deep vein thrombosis (DVT), and distal DVT. We investigated baseline characteristics, including risk factors; perioperative treatment and prophylaxis, including anticoagulation; and postoperative outcomes, including postoperative VTE recurrence, bleeding, and death.

Results: We divided 13,025 patients into PE (n = 2425, 19%), proximal DVT (n = 1792, 14%), and distal DVT groups (n = 8808, 68%). The PE group had the highest incidence of malignancy; the proximal DVT group had the highest incidence of leg fractures; and the distal DVT group had the lowest incidence of physical immobility. Furthermore, the PE group most frequently received preoperative anticoagulation therapy after VTE diagnosis, whereas the proximal DVT group most frequently received an inferior vena cava filter for intraoperative management. Death within 30 postoperative days was most common in the PE group. In addition, recurrent PE was most frequent in the PE group, whereas major bleeding events were least frequent in distal DVT group.

Conclusions: This study, based on nationwide anesthesiologic database, provides contemporary practice patterns and clinical outcomes in patients with preoperative VTE who underwent surgery in Japan. These findings may provide valuable information for healthcare providers involved in surgery.

Purpose: Induction of anesthesia in patients with unstable hemodynamics presents a major challenge for anesthesiologists; however, evidence to guide optimal practice remains limited. Although recent studies recommend etomidate and ketamine for tracheal intubation, etomidate may cause adverse effects such as adrenal insufficiency. Therefore, this systematic review evaluated the relationship between commonly used induction agents other than etomidate-including ketamine and midazolam-and the incidence of post-induction hypotension.

Methods: We systematically searched the PubMed and Cochrane Library databases from inception through March 16, 2025. Eligible studies included randomized controlled trials and observational studies involving critically ill adults undergoing emergency tracheal intubation. We compared induction agents including ketamine, fentanyl, midazolam, remimazolam, propofol, thiopental, and placebo or saline. The primary outcome was post-induction hypotension.

Results: A total of 1,063 articles were identified during the initial screening, and nine met the inclusion criteria. Owing to marked heterogeneity in study design and drug comparisons, meta-analysis was not feasible. Reported incidence of post-induction hypotension varied widely (6-84%), reflecting differences in patient case mix, drug regimens, and definitions of hypotension. Definitions of hypotension and observation periods also differed across studies.

Conclusion: This review found limited evidence on the hemodynamic effects of anesthetic agents other than etomidate during tracheal intubation in critically ill patients. Standardized definitions and high-quality research are needed to better characterize post-induction hypotension and determine the safest anesthetic combinations.

In Japan, Ministry of Health, Labour and Welfare statistics show a significant decline in blood donors from 1985 to 2023, especially among young people and high school students, while donations among those aged 50 - 69 increased substantially. The decline has been attributed in part to reduced promotional activities. According to the material in the Japanese Red Cross Society, the production and supply volume of red blood cells (RBCs) and platelet concentrates (PCs) remained stable from 2006 to 2023, whereas the supply of fresh frozen plasma (FFP) has decreased. The 2003 Act on Securing a Stable Supply of Safe Blood Products requires medical physicians to ensure appropriate use of blood products. In cases of massive hemorrhage, however, appropriate use for life-saving transfusion is required. The new 2025 Guideline for the Management of Critical Bleeding introduced recommendations on cryoprecipitate and fibrinogen use, and added guidance on tranexamic acid, calcium supplementation, and sodium bicarbonate. To reduce transfusion in routine clinical practice, autologous transfusion should also be considered. In 2024, the Blood Donation Promotion Committee emphasized the importance of research to develop new products.

Purpose: No definite recommendations exist for anesthetic and obstetric management of pregnant patients with intracranial neurovascular disorders during delivery. This case series describes the management of pregnant patients with intracranial vascular abnormalities during delivery.

Methods: Information was gathered from institutional databases to include pregnant patients evaluated by neurology or neurosurgery at a single institution between January 2000 and August 2025 for any central nervous system vascular abnormality. Patients were included if evaluation by neurology or neurosurgery occurred either before, during pregnancy, or up to six months post-partum.

Results: The study cohort consisted of 26 patients having 31 deliveries. The most common lesions were cavernous malformation (n = 8) and cerebral arteriovenous malformation (n = 8). The remainder had aneurysm (n = 4), dural arteriovenous fistula (n = 2), moyamoya disease (n = 2), venous angioma (n = 1), and carotid dissection (n = 1). Twenty-one deliveries were vaginal and 10 were cesarean delivery (CD). The presence of a neurovascular abnormality was an indication for induction of labor in three individuals and for CD in four deliveries. Neuraxial labor analgesia was used in 14 of the 21 patients who had vaginal delivery. Parturients who underwent CD had spinal anesthesia (n = 8), preexisting labor epidural anesthesia (n = 1), and general anesthesia (n = 1). There were no complications attributed to neuraxial anesthesia.

Conclusions: The presence of central nervous system vascular abnormalities in pregnant patients is rare but poses unique challenges to obstetric and anesthetic management. Neuraxial anesthesia and analgesia can be offered to women with central nervous system vascular abnormalities without abnormal neurologic symptoms.