Journal of Anesthesia最新文献

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.

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.

We previously reported that administering local anesthetic into the space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess (SEDIC) at the 10th intercostal space via the re-modified thoracoabdominal nerves block through the perichondrial approach (RM-TAPA) effectively anesthetizes the lower abdomen (T9-T12). However, the analgesic area obtained by RM-TAPA was distinct from prior reports of M-TAPA, which achieved broader analgesic effects from T4 to L1. The aim of this study was to verify the range of analgesic effects when local anesthetics are administered into the SEDIC at the 9th intercostal space, which was estimated to be close to the needle tip of the M-TAPA, in ten healthy volunteers. Each volunteer received 20 mL of 0.2% ropivacaine into the SEDIC at the 9th intercostal space, and sensory blockade was assessed 1 h post-injection using a pinprick test. RM-TAPA performed at the 9th intercostal space provided adequate analgesia from T6 to T10. The analgesic effect on the lateral cutaneous branches was more pronounced on the right side than on the left. These findings imply that optimizing needle position and injection site in RM-TAPA, tailored to specific surgical needs, represents a refinement in perioperative pain management strategies.

Purpose: Intraoperative monitoring can be used to prevent postoperative urinary dysfunction due to surgical manipulation. However, preoperative neurological dysfunction and young age make monitoring challenging. Therefore, in this study, we evaluated the efficacy of combining two monitoring methods, the bulbocavernosus reflex (BCR) and motor-evoked potential from the external anal sphincter (EAS-MEP) in assessing urinary function in the same pediatric patients during untethering surgery.

Methods: We retrospectively identified pediatric patients (aged < 6 years) who underwent BCR and EAS-MEP monitoring during untethering surgery between October 2013 and March 2022. Anesthesia was maintained using propofol or sevoflurane/opioid without neuromuscular blockade.

Results: We identified 18 pediatric patients who underwent BCR and EAS-MEP monitoring during untethering surgery. Our results showed that the baseline success rates were 78%, 61%, and 89% for BCR, EAS-MEP, and the concomitant use of BCR and EAS-MEP, respectively. Furthermore, of the 18 pediatric patients, the two patients with new urinary dysfunction required postoperative urinary catheterization, and the three patients with worsened preoperative urinary dysfunction showed an increased frequency of catheterization. The accuracy of the BCR and EAS-MEP monitoring for the same patients was 93% and 91%, respectively.

Conclusion: The accuracy of BCR and EAS-MEP monitoring is similar in pediatric untethering surgery, and the concomitant use of BCR and EAS-MEP improves continuous intraoperative monitoring compared with using only one method.

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.

Access to epidural analgesia remains limited, particularly for high-risk underserved US women. Our scoping review aims to identify barriers experienced by US underserved and rural pregnant women in gaining access to epidurals and to review the scope of current interventions that exist to address these concerns. The Arksey and O'Malley York methodology was used as guidance for this review and consists of five steps: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. The Joanna Briggs Institute (JBI) recommendations were also used for the extraction, analysis, and presentation of results in this scoping review. 10 studies were retained for analysis. Of the various SDOH identified, those related to social and community context had the highest rates, and among the SDOH, race was the most prevalent. Barriers encountered by US underserved and rural maternal populations in accessing epidural analgesia fell at the individual level (n = 27), followed by organizational (n = 25), interpersonal (n = 18), social/political (n = 17), and community levels (n = 10). Major themes in future directions were identified through qualitative thematic analysis to address gaps in access and utilization of epidural analgesia in underserved US women. SDOH and systemic barriers play a role in hindering access to and utilization of epidural analgesia. Efforts to improve access to epidural analgesia through multifaceted, culturally responsive, and systemic interventions are required to address informational gaps and structural challenges.

Purpose: Helicopter Emergency Medical Services (HEMS) provide rapid prehospital care for patients with severe trauma and acute medical conditions. Airway management (including tracheal intubation, placement of supraglottic airway [SGA] device, cricothyrotomy, and bag-valve-mask [BVM] ventilation) and respiratory management (including mechanical ventilation and thoracostomy) are critical strategies used in prehospital settings. Although data on airway or respiratory management in patients who were treated by HEMS teams that are staffed by physicians in Japan are limited, this study aimed to describe the proportion and clinical characteristics of such patients using a nationwide registry.

Methods: We conducted a nationwide cohort study with a retrospective design, analyzing data from the Japanese Society for Aeromedical Services Registry between April 2020 and March 2023. Patients who underwent prehospital airway or respiratory management were included in this study. Data regarding age, sex, diagnosis, cardiac arrest, type of telecommunication, and airway or respiratory management were also collected. Descriptive statistics were used for analyses.

Results: Among 54,140 patients treated by HEMS, 7477 (13.8%) underwent airway or respiratory management. The median age of the patients was 69 years, and 67.8% were male. The most frequent age group was 60-79 years (42.7%), and trauma was the most common diagnosis (35.4%). The most common management was orotracheal intubation (8.7%), followed by BVM ventilation (2.3%), mechanical ventilation (1.9%), thoracostomy (performed either via needle or chest tube) (1.0%), and SGA device placement (0.2%).

Conclusion: This nationwide study revealed that airway or respiratory management was required in 13.8% of HEMS patients in Japan, particularly among older adults and those with trauma.