Pub Date : 2026-01-01Epub Date: 2025-11-26DOI: 10.1016/j.jclinane.2025.112079
Terry J. Biel MD MBA , Cristina L. Wood MD MS , Rachel M. Kacmar MD
{"title":"Response to the Comment on “From ‘how busy we are’ to ‘how we are busy’: Pragmatic, minute-by-minute analysis of obstetric anesthesia activity, service capacity, and utilization”","authors":"Terry J. Biel MD MBA , Cristina L. Wood MD MS , Rachel M. Kacmar MD","doi":"10.1016/j.jclinane.2025.112079","DOIUrl":"10.1016/j.jclinane.2025.112079","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112079"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-25DOI: 10.1016/j.jclinane.2025.112036
Maximiliano Cardozo-Panoff , Robert Blasco-Mariño , Marcos De Miguel , Míriam Basagaña-Farrés , Alfons Biarnes
Background
Cocaine use is a global concern, particularly in Europe, where it ranks as the second most commonly abused drug after cannabis. This systematic review examines perioperative outcomes in patients with positive cocaine urine tests scheduled for elective surgery.
Methods
We searched MEDLINE, Embase, Web of Science, Scopus, GlobalETD, and ClinicalTrials.gov. The study quality was assessed using the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The systematic review protocol was registered with PROSPERO.
Results
Three studies were analysed (n = 707 patients) (one retrospective cohort and two prospective cohort). No significant differences in haemodynamic event incidence were observed between positive and negative CUT groups. Two studies reported a higher use of vasopressors, and one study reported an increased use of antihypertensive administration in patients with a positive urine test for cocaine. No arrhythmias were reported. Mortality was assessed in two studies, neither of which reported any events. Two studies reported longer surgical durations in patients with a negative urine test for cocaine, without an associated increase in haemodynamic instability.
Conclusions
Asymptomatic patients with a positive cocaine urine test undergoing elective surgery have not been shown to have higher perioperative complication rates than controls. The limited number of studies and methodological shortcomings of the available evidence—such as retrospective design, small samples and potential biases—preclude definitive conclusions. Further prospective studies are needed to clarify perioperative risk and guide clinical decision-making.
可卡因的使用是一个全球关注的问题，特别是在欧洲，它是仅次于大麻的第二大滥用药物。本系统综述探讨了可卡因尿检阳性患者择期手术的围手术期预后。方法检索MEDLINE、Embase、Web of Science、Scopus、GlobalETD和ClinicalTrials.gov。研究质量采用纽卡斯尔-渥太华量表进行评估。根据系统评价和荟萃分析指南的首选报告项目综合数据。系统评价方案已在PROSPERO注册。结果共分析了3项研究（n = 707例）（1项回顾性队列研究和2项前瞻性队列研究）。CUT阳性组和阴性组的血流动力学事件发生率无显著差异。两项研究报告了更高的血管加压药物的使用，一项研究报告了可卡因尿检阳性患者抗高血压药物的使用增加。无心律失常报告。两项研究评估了死亡率，但均未报告任何事件。两项研究报告，尿检可卡因阴性的患者手术时间更长，但血流动力学不稳定性没有相应的增加。结论有症状的可卡因尿检阳性的择期手术患者围手术期并发症发生率不高于对照组。有限的研究数量和现有证据的方法学缺陷——如回顾性设计、小样本和潜在的偏倚——妨碍了明确的结论。需要进一步的前瞻性研究来明确围手术期风险，指导临床决策。
{"title":"Perioperative outcomes in patients with positive cocaine urine tests undergoing elective surgery: A systematic review","authors":"Maximiliano Cardozo-Panoff , Robert Blasco-Mariño , Marcos De Miguel , Míriam Basagaña-Farrés , Alfons Biarnes","doi":"10.1016/j.jclinane.2025.112036","DOIUrl":"10.1016/j.jclinane.2025.112036","url":null,"abstract":"<div><h3>Background</h3><div>Cocaine use is a global concern, particularly in Europe, where it ranks as the second most commonly abused drug after cannabis. This systematic review examines perioperative outcomes in patients with positive cocaine urine tests scheduled for elective surgery.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, Web of Science, Scopus, GlobalETD, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>. The study quality was assessed using the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The systematic review protocol was registered with PROSPERO.</div></div><div><h3>Results</h3><div>Three studies were analysed (<em>n</em> = 707 patients) (one retrospective cohort and two prospective cohort). No significant differences in haemodynamic event incidence were observed between positive and negative CUT groups. Two studies reported a higher use of vasopressors, and one study reported an increased use of antihypertensive administration in patients with a positive urine test for cocaine. No arrhythmias were reported. Mortality was assessed in two studies, neither of which reported any events. Two studies reported longer surgical durations in patients with a negative urine test for cocaine, without an associated increase in haemodynamic instability.</div></div><div><h3>Conclusions</h3><div>Asymptomatic patients with a positive cocaine urine test undergoing elective surgery have not been shown to have higher perioperative complication rates than controls. The limited number of studies and methodological shortcomings of the available evidence—such as retrospective design, small samples and potential biases—preclude definitive conclusions. Further prospective studies are needed to clarify perioperative risk and guide clinical decision-making.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112036"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Various adjuvants can be added to local anesthetics (LAs) to prolong the duration of regional anesthesia. This network meta-analysis (NMA) aimed to compare the relative efficacy of commonly used adjuvants in transversus abdominis plane (TAP) blocks following cesarean delivery (CD).
Methods
A comprehensive literature search was performed in PubMed, Embase, CENTRAL, web of science, and Wanfang data. Eligible studies were randomized controlled trials comparing the effects of adding an adjuvant to LA versus LA alone or versus another adjuvant in a single-shot TAP block after CD. The primary outcome was time to first analgesia request. Bayesian random-effects NMAs were performed using the LA alone group as the comparator.
Results
Thirty-nine studies involving five adjuvants were included. None of the studies administered intrathecal morphine. Compared to LA alone, time to first analgesic request was significantly prolonged with clonidine (6.9 h, 95 % CrI 4.5–9.4 h), dexamethasone (5.8 h, 95 % CrI 4.2–7.4 h), dexmedetomidine (4.1 h, 95 % CrI 2.7–5.5 h) and magnesium sulfate (3.2 h, 95 % CrI 0.9–5.7 h). Clonidine ranked first, followed by dexamethasone, dexmedetomidine, and magnesium. However, in the outlier analysis and the subgroup analysis of women receiving basic analgesics, dexamethasone ranked first, while magnesium was ineffective. Overall, adjuvants had minimal clinical impact on postoperative opioid consumption or pain scores. Notably, high heterogeneity was observed, and the quality of evidence was rated as low or very low.
Conclusions
With the high heterogeneity and the low or very low quality of the evidence, clonidine, dexamethasone, and dexmedetomidine may prolong analgesia after CD without intrathecal morphine when used as adjuvants in TAP blocks. Furthermore, dexamethasone and dexmedetomidine appear preferable when basic analgesics are administered. Nevertheless, these results should be interpreted with caution.
{"title":"Adjuvants in transversus abdominis plane blocks to prolong analgesia duration following cesarean delivery: A systematic review and network meta-analysis","authors":"Li-Zhong Wang, Jia-Yue Huang, Xiang-Yang Chang, Feng Xia","doi":"10.1016/j.jclinane.2025.112067","DOIUrl":"10.1016/j.jclinane.2025.112067","url":null,"abstract":"<div><h3>Background</h3><div>Various adjuvants can be added to local anesthetics (LAs) to prolong the duration of regional anesthesia. This network meta-analysis (NMA) aimed to compare the relative efficacy of commonly used adjuvants in transversus abdominis plane (TAP) blocks following cesarean delivery (CD).</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed in PubMed, Embase, CENTRAL, web of science, and Wanfang data. Eligible studies were randomized controlled trials comparing the effects of adding an adjuvant to LA versus LA alone or versus another adjuvant in a single-shot TAP block after CD. The primary outcome was time to first analgesia request. Bayesian random-effects NMAs were performed using the LA alone group as the comparator.</div></div><div><h3>Results</h3><div>Thirty-nine studies involving five adjuvants were included. None of the studies administered intrathecal morphine. Compared to LA alone, time to first analgesic request was significantly prolonged with clonidine (6.9 h, 95 % CrI 4.5–9.4 h), dexamethasone (5.8 h, 95 % CrI 4.2–7.4 h), dexmedetomidine (4.1 h, 95 % CrI 2.7–5.5 h) and magnesium sulfate (3.2 h, 95 % CrI 0.9–5.7 h). Clonidine ranked first, followed by dexamethasone, dexmedetomidine, and magnesium. However, in the outlier analysis and the subgroup analysis of women receiving basic analgesics, dexamethasone ranked first, while magnesium was ineffective. Overall, adjuvants had minimal clinical impact on postoperative opioid consumption or pain scores. Notably, high heterogeneity was observed, and the quality of evidence was rated as low or very low.</div></div><div><h3>Conclusions</h3><div>With the high heterogeneity and the low or very low quality of the evidence, clonidine, dexamethasone, and dexmedetomidine may prolong analgesia after CD without intrathecal morphine when used as adjuvants in TAP blocks. Furthermore, dexamethasone and dexmedetomidine appear preferable when basic analgesics are administered. Nevertheless, these results should be interpreted with caution.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112067"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-08-13DOI: 10.1016/j.jclinane.2025.111964
Longsheng Zhang , Zitian Luo , Renzhe Lin
{"title":"Comment on “The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery”","authors":"Longsheng Zhang , Zitian Luo , Renzhe Lin","doi":"10.1016/j.jclinane.2025.111964","DOIUrl":"10.1016/j.jclinane.2025.111964","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 111964"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-01-08DOI: 10.1016/j.jclinane.2025.111741
Adam Marcus , Ivan Oransky , Alessandro De Cassai
{"title":"Please don't cite this editorial","authors":"Adam Marcus , Ivan Oransky , Alessandro De Cassai","doi":"10.1016/j.jclinane.2025.111741","DOIUrl":"10.1016/j.jclinane.2025.111741","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 111741"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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