Journal of Anesthesia最新文献

Purpose: Intentional placement of an epidural catheter toward the operative side can produce a predominantly ipsilateral effect, which may benefit patients undergoing unilateral knee surgery. In this study, we retrospectively evaluated the success rate and efficacy of intentional ipsilateral epidural catheter placement in patients undergoing anterior cruciate ligament reconstruction (ACLR).

Methods: With IRB approval, we retrospectively analyzed existing clinical data that had been routinely collected from patients who underwent ACLR and received intentional ipsilateral epidural catheter placement combined with spinal anesthesia between January 2021 and December 2023. All epidural catheters were advanced toward the operative side and used for continuous infusion for 3 days. Catheter tip position was evaluated by X-ray on postoperative day (POD) 1. Pain scores on the Numerical Rating Scale (NRS), analgesic requirements, distribution of sensory blockade, motor function, and complications through POD4 were evaluated.

Results: Of 307 patients undergoing ACLR, 297 patients were included in the analysis. Catheters were inserted between the T11/12 and L1/2 intervertebral spaces. X-rays revealed that the epidural catheter tip was located on the operated side in 274 patients (92.3%). An ipsilateral-dominant sensory block covering lumbar segments was observed in more than 90% of patients throughout 3 PODs. Median NRS scores during mobilization remained below 3 with epidural infusion, and 263 patients (88.6%) could perform active straight leg raise on the operative side on POD1.

Conclusion: Intentional ipsilateral epidural catheter placement demonstrated a high success rate, provided motor-sparing and satisfactory analgesia in patients undergoing ACLR.

Purpose: The purpose of this study was to investigate the association between body mass index (BMI) and changes in pain scores among elderly patients with chronic pain. The pain disability assessment scale (PDAS) and the pain catastrophizing scale (PCS) were employed as assessment tools.

Methods: A single-center, retrospective cohort study was conducted at a university hospital multidisciplinary pain center from 2017 to 2020, involving 180 patients aged ≥ 65 years with noncancer pain persisting for at least 3 months. Patients were classified into three groups according to BMI: low (BMI < 18.5), standard (18.5 ≤ BMI < 25), and high (BMI ≥ 25). Initial, 3-month, and 6-month PDAS and PCS scores were collected and analyzed using mixed-effects models.

Results: No significant differences were observed in PDAS scores across BMI groups. However, PCS scores were significantly higher in the low BMI group. Furthermore, no significant differences were detected in PDAS and PCS scores based on the interaction between BMI group and time point (month).

Conclusion: Among elderly patients with chronic pain, the low BMI group exhibited a significantly higher PCS score, while PDAS scores did not vary based on the BMI group. No differences were detected in treatment-related changes over time across BMI groups.

Purpose: Desflurane and sevoflurane are widely used for general anesthesia; however, it remains uncertain if sevoflurane might be preferable for patients with chronic respiratory inflammatory diseases. This study compared postoperative outcomes of desflurane and sevoflurane following gastrointestinal cancer surgery in patients with chronic obstructive pulmonary disease (COPD) or asthma.

Methods: We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database (April 2011-March 2022), identifying patients with COPD or asthma who underwent gastrointestinal cancer surgery. The primary outcome was postoperative pulmonary complications, including pneumonia, respiratory failure, mechanical ventilation > 24 h, and unplanned reintubation within 7 days after surgery. Secondary outcomes were in-hospital mortality and postoperative stay. We conducted propensity score overlap weighting and instrumental variable analyses adjusted for confounders.

Results: We identified 24,243 COPD and 16,199 asthma patients. Propensity score overlap weighting showed no significant association between desflurane and increased postoperative pulmonary complications in COPD [adjusted risk difference (aRD) - 0.57%; 99% confidence interval (CI), - 1.8% to 0.60%] or asthma (aRD, - 0.62%; 99% CI, - 1.8% to 0.59%). In-hospital mortality did not differ significantly between groups in COPD (aRD, - 0.24%; 99% CI, - 0.76% to 0.29%) or asthma (aRD, 0.07%; 99% CI, - 0.45% to 0.59%). The postoperative stay also showed no significant association between the desflurane and sevoflurane groups.

Conclusions: Desflurane-based anesthesia was not associated with increased postoperative pulmonary complications and mortality compared to sevoflurane in patients with chronic respiratory diseases undergoing gastrointestinal cancer surgery. However, further studies using reliable diagnostic criteria to assess COPD or asthma are warranted.

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.