Journal of Anesthesia最新文献

Purpose: Reports on postoperative delirium (POD), neutrophil-percentage-to-albumin ratio (NPAR), and systemic immune-inflammatory index (SII) are limited. We aimed to compare the accuracy of preoperative NPAR, SII, and neutrophil-to-lymphocyte ratio (NLR) in predicting POD in patients undergoing head and neck free-flap reconstruction.

Methods: This single-center, observational, retrospective study in Japan included 184 patients who underwent head and neck free-flap reconstruction. POD was diagnosed using the Intensive Care Delirium Screening Checklist. Multivariable logistic regression analyses were conducted to evaluate the association of preoperative NPAR, SII, and NLR with POD. Receiver operating characteristic (ROC) curves were used to compare the accuracy of each inflammatory marker in predicting POD.

Results: Seven patients were excluded, leaving 177 patients (52 females, 125 males). Of these, 38 (21.5%) were diagnosed with POD. Multivariable logistic regression showed that preoperative NPAR, SII, and NLR were significantly associated with POD in patients undergoing head and neck free-flap reconstruction surgery. The areas under the ROC curve of NPAR, SII, and NLR were 0.78 (95% confidence interval: 0.69-0.86), 0.72 (0.62-0.82), and 0.75 (0.66-0.84), respectively.

Conclusion: The Preoperative NPAR and SII were significantly correlated with POD in patients undergoing head and neck reconstruction, similar to NLR. Preoperative NPAR might serve as an established marker in predicting POD in patients undergoing head and neck free-flap reconstruction.

Spinal anesthesia is the technique of choice for cesarean delivery, offering rapid onset and reliable anesthesia, but conventional intrathecal doses of hyperbaric bupivacaine frequently cause significant hypotension and delayed recovery. Low-dose spinal anesthesia (LDSA), generally defined as ≤ 8 mg of hyperbaric bupivacaine, often combined with intrathecal opioids, has been investigated as a strategy to mitigate these effects. Current evidence indicates that LDSA can attenuate hemodynamic fluctuations and reduce intraoperative nausea without compromising neonatal outcomes; however, excessively low doses may increase the risk of incomplete block and conversion to general anesthesia. While LDSA may be advantageous in patients with cardiovascular compromise, routine dose reduction for all parturients is not supported by existing data. Thus, LDSA represents a context-specific alternative within modern obstetric anesthesia practice, with benefits and limitations that must be weighed against established prophylactic strategies for managing spinal-induced hypotension.

Purpose: Patients undergoing surgery are prone to postoperative hyponatremia, which can lead to delirium. However, the optimal sodium concentration for postoperative maintenance fluids in adult patients is still unclear. Therefore, this study examined the incidence of hyponatremia and delirium in postoperative patients.

Methods: This was a single-center, non-blinded, randomized trial. The inclusion criteria for this study were age 20 years or older and elective head and neck cancer or esophageal cancer surgery between April 2018 and June 2023. Patients were randomly assigned to one of three groups based on the sodium concentration in the intravenous fluids administered after surgery: the 140 mmol/L sodium (Na₁₄₀) group, the 77 mmol/L sodium (Na₇₇) group, and the 35 mmol/L sodium (Na₃₅) group.

Results: A total of 105 patients had complete data at the end of the study: Na₁₄₀ group (n = 35), Na₇₇ group (n = 32), and Na₃₅ group (n = 38). The incidence of postoperative hyponatremia was 22.9% (8/35) in the Na₁₄₀ group, significantly lower than in the Na₇₇ group [56.3% (18/32)] and the Na₃₅ group [60.5% (23/38)] (both p < 0.01). The incidence of postoperative delirium was 20.0% (7/35) in the Na₁₄₀ group, 31.3% (10/32) in the Na₇₇ group, and 23.7% (9/38) in the Na₃₅ group. No significant difference was observed among the groups (p = 0.56).

Conclusion: The use of postoperative fluids with a sodium concentration of 140 mmol/L significantly reduced the incidence of hyponatremia. There was no significant difference in the incidence of postoperative delirium.

Purpose: Laparoscopic surgery for colorectal cancer is performed globally. A 15-item quality of recovery (QoR-15) score is commonly used to evaluate postoperative recovery. However, women are particularly at risk for postoperative nausea and vomiting (PONV), anxiety and poorer overall recovery. Therefore, this study aims to evaluate the factors associated with changes in postoperative QoR-15 scores based on clinical features in women undergoing laparoscopic colorectal cancer surgery.

Methods: Women who underwent laparoscopic colorectal cancer surgery in a randomized controlled trial (FDP-PONV trial) were included in this secondary analysis. Clinical variables were collected during the perioperative period in the original FDP-PONV trial. The explanatory factors were entered into a multiple linear mixed model for further selection.

Results: Overall, 852 female patients were included in this study. A linear mixed model was constructed over time with two clinically relevant factors. QoR-15 scores improved over time. Neoadjuvant chemotherapy was positively associated with changes in postoperative QoR-15 scores. Intraoperative hypertension was negatively associated with changes in postoperative QoR-15 scores.

Conclusion: Neoadjuvant chemotherapy and intraoperative hypertension were associated with changes in the quality of recovery following laparoscopic colorectal cancer surgery in women.

Purpose: To ensure safe, effective, and timely pediatric care, a standardized procedural sedation service was developed and implemented at a tertiary pediatric hospital.

Methods: Model development was guided by working group input, literature and policy review, site benchmarking, and an environmental scan. Sedation outcomes were evaluated using the Dartmouth Operative Conditions Scale (DOCS) and the Ramsay Sedation Score (RSS) in two groups of children aged > 1 year: dental outpatients and inpatients undergoing chest tube removal after cardiac surgery. The primary outcome was the proportion achieving optimal sedation (DOCS score - 2 to 2). Pre- and post-implementation outcomes were compared using Fisher's exact and Mann-Whitney U tests.

Results: The new interprofessional sedation model significantly improved sedation outcomes. In dental patients, the proportion with optimal DOCS scores increased from 32% (95% confidence interval, 16-52%) to 94% (79-99%) during local anesthetic injection [difference = 62% (43-81%), OR = 32 (6-163), P < 0.001] and from 18% (6-37%) to 94% (79-99%) at tooth extraction [difference = 76% (59-92%), OR = 69 (12-388), P < 0.001]. For chest tube removal, the proportion with optimal DOCS scores increased from 22% (5-38%) to 100% (92-100%) [difference = 78% (61-95%), OR = 144 (7.5-2793), P < 0.001], with a significant improvement in Ramsay sedation scores [median (10th-90th percentiles)] from 1 (1-2) to 4 (3-4) (P < 0.001).

Conclusion: Implementing a standardized, interprofessional sedation service that aligns with best-practice guidelines improved sedation quality and patient outcomes across pediatric outpatient and inpatient settings.

Emergence delirium (ED) is a frequent postoperative complication in children, marked by confusion, disorientation, and agitation following general anesthesia. Electroencephalogram (EEG)-guided anesthesia offers a promising approach to optimize anesthetic dosing, reduces sevoflurane exposure, and potentially lowers the incidence of ED. This systematic review and meta-analysis evaluates the impact of EEG-guided anesthesia on key outcomes in pediatric patients, including ED incidence, PACU stay duration, and PAED scores. This systematic review and meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD420251121848). A comprehensive search of PubMed, Embase, Scopus, and Cochrane Library was conducted up to July 2025. Only randomized controlled trials comparing EEG-guided anesthesia with standard care in pediatric patients undergoing sevoflurane-based general anesthesia were included. Primary outcomes were PAED scores and incidence of emergence delirium; secondary outcomes included sevoflurane exposure, PACU stay duration, extubation time, FLACC scores, and burst suppression. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated using GRADE. Statistical analysis was performed using a random effects model. Our analysis demonstrated that EEG-guided anesthesia significantly reduced PAED scores at 10 min post-extubation (MD: - 0.94; 95% CI - 1.59 to - 0.29; p = 0.004) and lowered the incidence of emergence delirium (PAED score > 10) by 60% (OR: 0.40; 95% CI 0.27-0.59; p < 0.00001), with no heterogeneity for the latter outcome. EEG guidance also shortened extubation time by over 3 min (MD: - 3.09; 95% CI - 3.87 to - 2.32; p < 0.00001, I² = 0%) and reduced maintenance end-tidal sevoflurane concentration (MD: - 0.46%; 95% CI - 0.84 to - 0.08; p = 0.02). While reductions in PACU stay (MD: - 7.01 min), induction EtSevo (MD: - 0.32%), burst suppression (OR: 0.54), and postoperative pain scores (MD: - 0.62) favored EEG-guided management, these did not reach statistical significance, often with substantial heterogeneity. EEG-guided anesthesia significantly reduces emergence delirium and PAED scores in children. It also lowers sevoflurane consumption and shortens recovery time. These findings support its routine use in pediatric anesthesia for improved outcomes.