Journal of Anesthesia最新文献

Purpose: Time-resolved spectroscopy (TRS) has recently become clinically available and offers superior measurement accuracy over conventional spatially resolved spectroscopy (SRS). This study evaluated the feasibility of transitioning from the SRS-based INVOS 5100C to the TRS-based tNIRS-1 by comparing cerebral oxygen saturation measurements taken during pediatric cardiac surgery.

Methods: We retrospectively analyzed data from 149 children (< 6 years) who had undergone cardiac surgery. We compared simultaneously measured cerebral tissue oxygen saturation (StO₂) (tNIRS-1) and regional cerebral oxygen saturation (rSO₂) (INVOS 5100C) after anesthesia induction. Both values were assessed against reference cerebral oxygen saturation (REF CX). Clinical decisions based on StO₂ and rSO₂ were also compared to current reference thresholds.

Results: The Wilcoxon matched-pairs signed-rank test showed significantly lower StO₂ than rSO₂ (54.8 [48.9-61.0] vs. 69 [61-75], p < 0.0001); this observation was consistent across all age groups and cyanotic statuses. Bland-Altman analysis confirmed non-interchangeability (mean bias: - 13.1; limits: - 31.7 to 5.5). Compared with REF CX, rSO₂ more closely reflected true cerebral oxygenation (mean bias: - 5.7; limits: - 22.5 to 11.2) than StO₂ (mean bias: - 19.3; limits: - 36.5 to - 2.1). Most patients were classified as normal by rSO₂ but borderline by StO₂.

Conclusion: A transition from INVOS 5100C to tNIRS-1 is not currently feasible due to clinically significant discrepancies. Therefore, it may be appropriate to either select the device based on the specific measurement objectives or use both devices in a complementary manner.

Purpose: Postpartum depression (PPD) is a major health issue affecting maternal and neonatal well-being. Labor pain is a significant psychophysiological stressor, and its association with PPD is not completely understood. This study investigated the relationship between the effectiveness of labor epidural analgesia (LEA), measured as percentage improvement in pain (PIP), and the risk of PPD at six weeks postpartum.

Methods: In this prospective observational cohort study, 156 women were enrolled. Participants self-selected whether to receive LEA. Pain intensity was assessed using the Numerical Rating Scale, and PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) on postpartum day 3 and at six weeks postpartum.

Results: A moderate positive correlation was observed between LEA satisfaction and PIP (r_s = 0.389, P < 0.001). A small but significant negative correlation was found between LEA satisfaction and EPDS scores (r_s =  - 0.268, P = 0.007). However, PIP was not significantly associated with the risk of PPD. PPD prevalence did not significantly differ between the LEA group (7.9%) and the non-LEA group (12.7%) (P = 0.491).

Conclusion: While the use of LEA provided effective pain relief, it was not associated with the risk of PPD. Maternal perception of pain relief may have greater psychological relevance than the objective degree of pain reduction. Comprehensive psychosocial and medical care remains essential.

Purpose: Effective postoperative analgesia management is critical for optimizing recovery and patient satisfaction following lumbar discectomy. Erector Spinae Plane Block (ESPB) is an established regional anesthesia technique with proven efficacy, while the novel Quadro-Iliac Plane Block (QIPB) has shown promise as an alternative approach. This study compares the analgesic efficacy, opioid-sparing potential, and safety of ESPB and QIPB in single-level lumbar discectomies.

Method: This multicenter, prospective, randomized, double-blind study included 60 patients aged 18-65 years undergoing single-level lumbar discectomy. Patients were randomized into ESPB (n = 30) and QIPB (n = 30) groups. Both blocks were performed at the end of surgery, before the extubation under ultrasound guidance using 40 ml (0.25%) bupivacaine bilaterally. The primary outcome was postoperative pain assessed by the Numeric Rating Scale (NRS) at 12 h. Secondary outcomes included tramadol consumption, rescue analgesia requirements, hemodynamic parameters, and adverse events.

Results: The primary outcome, 12-h NRS scores, did not differ significantly between groups (p > 0.05), indicating similar analgesic efficacy. Secondary outcomes-including total tramadol consumption (54.00 ± 49.03 mg for ESPB vs. 44.67 ± 44.16 mg for QIPB, p = 0.476), need for rescue analgesia, and incidence of nausea and vomiting-were also comparable. No motor block was observed in either group.

Conclusion: Although QIPB did not demonstrate superiority over ESPB, it was found to be not inferior in analgesic effect and safety outcomes. These findings suggest that QIPB may be a reliable alternative to ESPB in lumbar discectomy procedures.

Generative artificial intelligence (AI) is rapidly transforming perioperative medicine, particularly anesthesiology, by enabling novel applications, such as real-time data synthesis, individualized risk prediction, and automated documentation. These capabilities enhance clinical decision-making, patient communication, and workflow efficiency in the operating room. In education, generative AI offers immersive simulations and tailored learning experiences that improve both technical skills and professional judgment. However, overreliance without critical appraisal may compromise patient safety and humanistic care. This paper introduces a novel professionalism framework for anesthesiology in the AI era, comprising three pillars: critical AI literacy, human-centered care, and digital accountability. The model supports resident training, certification, and lifelong learning by integrating AI competencies with ethical awareness and reflective practice. By encouraging anesthesiologists to critically engage with AI tools, the framework ensures safe, effective, and compassionate perioperative care.

Key interventions for anesthesia patients include administering drugs, infusing fluids and blood, and providing artificial ventilation. As general anesthetics are always administered to patients undergoing general anesthesia, anesthetists need to be familiar with the fundamentals and the latest issues of general anesthesia/anesthetics. The Journal of Anesthesia symposium 2025 aimed to discuss fundamental topics and environmental issues related to general anesthesia and anesthetics. In this symposium, we had following topics: (1) patient outcomes of general anesthesia observed outside the operating room after the surgery, (2) updated information on the benefits and limitations of intravenous and inhalational anesthesia, (3) the environmental impact and recommended actions, and (4) potential reasons for not selecting intravenous anesthesia despite its apparent benefits for anesthetized patients.

Purpose: Postoperative delirium (POD) is a frequent complication after surgery, especially in elderly patients undergoing head and neck cancer surgery with free flap reconstruction. This study aimed to assess the associations between intraoperative hypotension (IOH), its duration, and occurrence of POD.

Methods: This retrospective study included 239 patients aged 65 years or older who underwent head and neck cancer surgery with free flap reconstruction. IOH was defined at seven mean arterial pressure (MAP) thresholds, ranging from 55 to 85 mmHg, in 5 mmHg increments. The duration of each IOH was compared between patients with or without POD before and after initiation of microsurgery. Multivariate analysis was conducted to assess the independent association of each IOH duration with the risk of POD.

Results: POD occurred in 43 (18.0%) of the 239 patients. Before the initiation of microsurgery, the cumulative duration of hypotension below MAP thresholds of < 70 to 80 mmHg was significantly longer in patients with POD. After the initiation of microsurgery, the cumulative duration of hypotension below MAP thresholds of < 55 to 85 mmHg was also significantly longer in patients with POD. In multivariate analysis, the cumulative duration of hypotension below MAP thresholds of 70, 75, and 80 mmHg before and after the initiation of microsurgery was independently associated with POD (p < 0.05 at each threshold).

Conclusion: Prolonged IOH, particularly below MAP thresholds of 70, 75, and 80 mmHg, was significantly associated with POD in elderly patients undergoing head and neck cancer surgery with free flap reconstruction.

Retraction Watch indicates that half of the worst 10 cases of research misconduct were by Japanese researchers. This is exemplified in an article entitled 'Tide of Lies' published in the Journal "Science". This article is a no holds barred view of some of the science in Japan and is an essential step on the road to prevention. However, as 3 Japanese anesthesiologists are listed in the worst 10, many Japanese academic societies point the finger at the Japanese Society of Anesthesiologists (JSA). The society cannot ignore this. Prevention of research misconduct/fraud has therefore been considered. Whilst there are no measures that can completely prevent research misconduct, there are steps that can reduce its likelihood. At the researcher level, mandatory ethics training. At the department and laboratory level, central data management, regular research progress/debriefing meetings. At the academic society level, Research Misconduct Monitoring Committees should be set up to facilitate anonymous reporting. Regaining research reputation and passion in Japan is critical to moving our specialty forward. This must be done with renewed vigor for the prevention of research misconduct.