Journal of Clinical Anesthesia最新文献

{"title":"Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) use in a pediatric population: A prospective, randomized controlled trial","authors":"Ellen Y. Wang MD ,&nbsp;Andrew J. Renuart MD ,&nbsp;Stephen G. Flynn MD ,&nbsp;Hanna Van Pelt BS ,&nbsp;Prabhakar Devavaram MBBS ,&nbsp;Linda A. Bulich MD ,&nbsp;Mary Lyn Stein MD ,&nbsp;Niroop R. Ravula MD, FRCA ,&nbsp;Rajvinder S. Dhamrait MD, MBA, FCARCSI, FRCA ,&nbsp;Kristin M. Kennedy MD ,&nbsp;Man Yee Suen MMedSc ,&nbsp;Christian Jackson MS ,&nbsp;Kush Gupta MD ,&nbsp;Alex Swanger MD ,&nbsp;Romy Yun MD ,&nbsp;Michael A. Evans MD, FAAP, FASA ,&nbsp;Vanessa A. Olbrecht MD ,&nbsp;Thomas J. Caruso MD, PhD","doi":"10.1016/j.jclinane.2025.112117","DOIUrl":"10.1016/j.jclinane.2025.112117","url":null,"abstract":"<div><h3>Background</h3><div>Maintenance of oxygenation during microdirect laryngoscopy and bronchoscopy (MDLB) is an anesthetic challenge for pediatric anesthesia providers. High flow nasal cannula (HFNC) as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a safe method to deliver humidified oxygen to pediatric patients; however, its role in pediatrics for preventing apneic desaturation while under anesthesia is unclear. This study evaluated THRIVE for pediatric patients undergoing airway procedures. The primary aim was to assess the frequency of patients who had at least one “relative desaturation” event, assessed as a 4 % drop from a patient's average baseline saturation using the measure of oxygen desaturation index (ODI). The secondary aims assessed frequencies of total relative desaturation events, absolute desaturations below 90 % and surgical interruptions due to airway conditions.</div></div><div><h3>Methods</h3><div>This was a prospective, randomized controlled trial conducted across three pediatric sites (Lucile Packard Children's Hospital [Stanford University, Palo Alto, CA], UC Davis Children's Hospital [University of California, Davis, CA], and Boston Children's Hospital [Harvard University, Boston, MA]). Participants between the ages of 2 months to 18 years underwent airway examinations or airway procedures under general anesthesia. Participants were randomized in a 1:1 ratio to THRIVE or standard of care (SOC).</div></div><div><h3>Results</h3><div>A total of 144 participants were included. ODI measurements of relative desaturation in the THRIVE group and SOC group showed no differences in number of the participants who ever desaturated (<em>p</em> = 0.18). There was a difference in total number of relative desaturation events, accounting for multiple events per participant (<em>p</em> = 0.04). There were no differences in surgical interruptions due to airway conditions.</div></div><div><h3>Conclusion</h3><div>THRIVE was not superior to SOC for reducing the number of patients who experienced desaturations or surgical interruptions, though it may have some benefit for reducing the total number of desaturation events in those who desaturate.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112117"},"PeriodicalIF":5.1,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880475","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}

{"title":"The PAPE block: Ultrasound-guided pericapsular anterior and posterior elbow nerve group block for motor-sparing analgesia","authors":"Qingyu Teng MM,&nbsp;Zhiqiang Qian MM,&nbsp;Sijia Yao MM,&nbsp;Qi Li MM,&nbsp;Tao Xu Ph.D, M.D","doi":"10.1016/j.jclinane.2025.112121","DOIUrl":"10.1016/j.jclinane.2025.112121","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112121"},"PeriodicalIF":5.1,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880473","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}

{"title":"Real-time visualization for post-pyloric feeding tube placement using a biologically transparent illumination device","authors":"Kazufumi Yaginuma M.D. ,&nbsp;Tatsuya Nagano M.D., Ph.D ,&nbsp;Akihiro Suzuki M.D., Ph.D ,&nbsp;Mamoru Takeuchi M.D., Ph.D","doi":"10.1016/j.jclinane.2025.112122","DOIUrl":"10.1016/j.jclinane.2025.112122","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112122"},"PeriodicalIF":5.1,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880474","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}

{"title":"Fixed 2-min time versus train of four–guided intubation following administration of rocuronium: Comment on study by Renew JR et al","authors":"Habib Md Reazaul Karim (MD, DNB, IDCCM, FNIV) ,&nbsp;Pradipta Bhakta (MD, MNAMS, FCAI, EDRA, EDIC, FNIV) ,&nbsp;Mohan Mugawar (MD, FCAI, FRCA, EDIC)","doi":"10.1016/j.jclinane.2025.112118","DOIUrl":"10.1016/j.jclinane.2025.112118","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112118"},"PeriodicalIF":5.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145863126","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}

{"title":"Pupillometry and pre-operative cognitive function: A possible new tool in identifying a frail brain","authors":"Paolo Zanatta ,&nbsp;Andrea Rossi ,&nbsp;Giorgio Fullin ,&nbsp;Luigi Polesello ,&nbsp;Alice Baruffol ,&nbsp;Federico Linassi","doi":"10.1016/j.jclinane.2025.112119","DOIUrl":"10.1016/j.jclinane.2025.112119","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112119"},"PeriodicalIF":5.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145863120","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}

{"title":"Application of ultrasound-guided regional blocks in the perioperative period of hip arthroplasty: A systematic review and network meta-analysis","authors":"Sisi Wang,&nbsp;Ziyi Wu,&nbsp;Yanhong Song,&nbsp;Xinyi Yang,&nbsp;Ping Zhao","doi":"10.1016/j.jclinane.2025.112110","DOIUrl":"10.1016/j.jclinane.2025.112110","url":null,"abstract":"<div><h3>Purpose</h3><div>This Bayesian network meta-analysis (NMA) aimed to compare the perioperative efficacy of various ultrasound-guided regional blocks in individuals on total hip arthroplasty (THA).</div></div><div><h3>Methods</h3><div>An extensive search was implemented across PubMed, Cochrane Library, Web of Science, and Embase up to December 9, 2024. Randomized controlled trials (RCTs) were selected to appraise postoperative analgesia and complications following ultrasound-guided lumbar plexus block (LPB), suprainguinal fascia iliaca block (SIFIB), pericapsular nerve group block (PENG), femoral nerve block (FNB), fascia iliaca block (FIB), quadratus lumborum block (QLB), erector spinae plane block (ESPB), periarticular injection (PAI), and saline control (CONTROL). Primary outcomes encompassed scores of movement-evoked pain (MEP) and pain at rest (PAR) within 12 and 24 h postoperatively.Secondary outcomes encompassed postoperative morphine equivalent consumption and the incidence of nausea and vomiting. Statistical analyses were carried out utilizing R 4.4.2 and Stata 18.</div></div><div><h3>Results</h3><div>Eighteen studies (2016–2024) involving 1424 participants were included. Network analysis revealed that, for the primary outcome, The MEP scores in the PAI, PENG, and QLB groups were significantly lower within 12 and 24 h postoperatively.No significant differences were discovered in PAR scores within 12 h or 24 h postoperatively. Within the bupivacaine subgroup, the QLB group had lower consumption of morphine within 24 h postoperatively. Compared to others, the QLB group had the lowest consumption of morphine during the hospital stay.In terms of postoperative nausea and vomiting (PONV), regional blockade had a statistically substantial difference against the placebo control cohort.</div></div><div><h3>Conclusion</h3><div>No single regional block technique demonstrated superiority across all postoperative outcomes. Ultrasound-guided QLB was particularly effective in reducing morphine consumption, alleviating pain, and decreasing PONV. PAI and PENG also demonstrated efficacy in reducing postoperative pain and consumption of morphine. Future large-scale multi-center RCTs are necessary to further validate these findings.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112110"},"PeriodicalIF":5.1,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837094","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}

{"title":"Randomized clinical trial between two sedation protocols during transcatheter aortic valve replacement procedures: Ketamine and Propofol versus Remifentanil and Dexmedetomidine","authors":"Anna Castellari M.D ,&nbsp;Matteo Lucchelli M.D ,&nbsp;Mattia Gomarasca M.D ,&nbsp;Valentina Salice M.D ,&nbsp;Francesca Orsenigo M.D ,&nbsp;Bedrana Moro Salihovic M.D ,&nbsp;Federico Mondin M.D ,&nbsp;Claudia Castiglioni M.D ,&nbsp;Alessandro Calzolari M.D ,&nbsp;Giovanni Mistraletti M.D","doi":"10.1016/j.jclinane.2025.112116","DOIUrl":"10.1016/j.jclinane.2025.112116","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare efficacy and safety of two different sedation protocols during Transcatheter Aortic Valve Replacement (TAVR); Ketamine and Propofol (KETOFOL) versus Remifentanil and Dexmedetomidine (REMIDEX).</div></div><div><h3>Design</h3><div>Monocentric, prospective, randomized and controlled trial.</div></div><div><h3>Setting</h3><div>University hospital.</div></div><div><h3>Participants</h3><div>231 patients were enrolled in the trial.</div><div>198 patients were included in the final analysis.</div></div><div><h3>Interventions</h3><div>Patients enrolled underwent procedural sedation according to one of the two possible drug combinations, KETOFOL vs REMIDEX, assigned through randomization. During the procedure intervention times and clinical parameters were recorded. After the procedure incidence of postoperative adverse events were recorded.</div></div><div><h3>Measurements and main results</h3><div>REMIDEX group showed a higher trend in the raw incidence of respiratory acidosis (67.7 % vs 54.3 %). The correlation was confirmed in the multivariate logistic regression analysis, with an increased risk of developing respiratory acidosis in the REMIDEX group (OR 1.864 %, 95 % CI 1.014–3.427). Patients in the REMIDEX group showed significantly longer induction times. REMIDEX group required a greater number of pharmacological adjustments, had a higher incidence of intraoperative agitation, and more episodes of desaturation. No other differences were observed in any of the other intraoperative or postoperative safety indicators.</div></div><div><h3>Conclusions</h3><div>Both protocols showed a low and comparable incidence of cardiovascular adverse events and postoperative complications such as POD and POCD. KETOFOL protocol appears to offer greater sedative stability and seems to be more protective regarding the incidence of respiratory adverse events.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112116"},"PeriodicalIF":5.1,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837096","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}

{"title":"Beyond oxygen delivery: Do stroke volume maximization and preoperative cardiac index maintenance truly improve clinical-relevant perfusion in major abdominal surgery?","authors":"Jinyan Guo ,&nbsp;Ke Chen ,&nbsp;Xue Han ,&nbsp;Weifeng Yao","doi":"10.1016/j.jclinane.2025.112113","DOIUrl":"10.1016/j.jclinane.2025.112113","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112113"},"PeriodicalIF":5.1,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837093","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}

{"title":"The fascial plane blocks in the upper arm surgery and trauma: A narrative review","authors":"Francesco Marrone ,&nbsp;Lorenza Sbucafratta ,&nbsp;Pierfrancesco Fusco","doi":"10.1016/j.jclinane.2025.112115","DOIUrl":"10.1016/j.jclinane.2025.112115","url":null,"abstract":"<div><div>Fascial plane blocks are becoming popular as useful and safe methods to provide pain relief. While their use in thoracic and abdominal surgery is well known, their application in upper arm surgery and trauma is underscored. This review explores research from the last 10 years focusing the use of fascial plane blocks to relieve pain after surgery or trauma in the upper limb. Studies include randomized controlled trials, observational studies, and case reports. They look at techniques like the cervical and high-thoracic erector spinae plane (ESP) block, the clavipectoral fascia plane (CFP) block, the superior posterior serratus intercostal plane (SPSIP) block, and periarticular approaches like the pericapsular (PENG) shoulder block. The high-thoracic ESP block provided pain relief and was often given with a continuous catheter infusion. The research shows that there is a tendency toward combining fascial blocks with each other or with peripheral nerve blocks to cover more area and cut down on the use of opioids. Even if the results are promising, there aren't many randomized trials in the literature, thus data are still mostly low-quality level. Risk of potential complications, such as local anesthetic systemic toxicity (LAST) or unintentional dissemination to important anatomical areas, exists although not reported. This study shows how fascial plane blocks in upper limb surgery are changing and recommends for more high-quality research to find out when they are best used, how safe they are, and how well they may work.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112115"},"PeriodicalIF":5.1,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850418","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}

{"title":"Comments on “The effects of maximizing stroke volume versus maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and microcirculatory tissue perfusion in patients having major abdominal surgery: The exploratory randomized CUSTOM trial” – Reply","authors":"Moritz Flick ,&nbsp;Bernd Saugel","doi":"10.1016/j.jclinane.2025.112114","DOIUrl":"10.1016/j.jclinane.2025.112114","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112114"},"PeriodicalIF":5.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837095","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}