Pub Date : 2025-12-20DOI: 10.1016/j.jclinane.2025.112104
Paul Tauzi, Emilie Wargnier, Jeremy Klotz, Marie Dubillot, Sigismond Lasocki, Emmanuel Rineau
Introduction
Application of preoperative fasting rules appears insufficient despite the impact of excessive fasting on patient comfort and morbidity. Primary endpoint of the study was fasting durations before and after a multimodal awareness campaign about fasting rules.
Methods
This observational prospective study assessed liquid and solid fasting durations and their impact on recovery before and after a multimodal and multidisciplinary awareness campaign against excessive fasting. Fasting durations and data related to comfort and rehabilitation were collected at the admission to the operating room and on Day 1. Primary endpoint was the comparison of liquid and solid fasting times between the two groups. Secondary endpoints included quality of recovery.
Results
365 patients were included in the study in adult surgical departments, 185 during phase 1 from February to April 2023 and 179 during phase 2 from June to July 2023. Liquid fasting time were reduced in phase 2 with 7.5 [4.5–12.8] hours and 6.3 [3.7–11.3] hours in phase 1 and 2 (p < 0.001). Median solid fasting times were not reduced with 14.3 [12.3–17.0] hours in phase 1 versus 14.3 [12.4–16.5] in phase 2 (p = 0.66). Mean FQoR-15 recovery score was better in phase 2 compared to phase 1 (133 [CI 95 %: 129,6–136,1] vs 123 [CI 95 %: 119,3–125,8] respectively, p < 0.001).
Conclusions
After a multimodal awareness campaign, both median preoperative liquid fasting time and quality of recovery score were improved. However, the median solid fasting time was not reduced, calling for additional measures to further improve patient care.
尽管过度禁食对患者的舒适度和发病率有影响，但术前禁食规则的应用似乎不足。该研究的主要终点是禁食规则多模式意识运动前后的禁食持续时间。方法：本观察性前瞻性研究评估了液体和固体禁食持续时间，以及在多模式和多学科的反过度禁食意识运动前后对恢复的影响。在进入手术室和第1天收集禁食时间和与舒适和康复相关的数据。主要终点是两组之间液体和固体禁食时间的比较。次要终点包括恢复质量。结果共纳入成人外科365例患者，其中一期185例（2023年2月至4月），二期179例（2023年6月至7月）。第二阶段液体禁食时间缩短，第一阶段为7.5[4.5-12.8]小时，第二阶段为6.3[3.7-11.3]小时（p < 0.001）。中位固体禁食时间没有减少，第一阶段为14.3[12.3-17.0]小时，第二阶段为14.3[12.4-16.5]小时（p = 0.66）。2期患者的平均FQoR-15恢复评分优于1期患者（133 [CI 95%: 129,6 - 136,1] vs 123 [CI 95%: 119,3 - 125,8], p < 0.001）。结论多模式认知运动后，术前中位禁食时间和恢复评分质量均有提高。然而，中位固体禁食时间没有减少，需要采取额外措施进一步改善患者护理。
{"title":"Impact of a multimodal awareness campaign on preoperative fasting times and postoperative recovery: A prospective before-after study","authors":"Paul Tauzi, Emilie Wargnier, Jeremy Klotz, Marie Dubillot, Sigismond Lasocki, Emmanuel Rineau","doi":"10.1016/j.jclinane.2025.112104","DOIUrl":"10.1016/j.jclinane.2025.112104","url":null,"abstract":"<div><h3>Introduction</h3><div>Application of preoperative fasting rules appears insufficient despite the impact of excessive fasting on patient comfort and morbidity. Primary endpoint of the study was fasting durations before and after a multimodal awareness campaign about fasting rules.</div></div><div><h3>Methods</h3><div>This observational prospective study assessed liquid and solid fasting durations and their impact on recovery before and after a multimodal and multidisciplinary awareness campaign against excessive fasting. Fasting durations and data related to comfort and rehabilitation were collected at the admission to the operating room and on Day 1. Primary endpoint was the comparison of liquid and solid fasting times between the two groups. Secondary endpoints included quality of recovery.</div></div><div><h3>Results</h3><div>365 patients were included in the study in adult surgical departments, 185 during phase 1 from February to April 2023 and 179 during phase 2 from June to July 2023. Liquid fasting time were reduced in phase 2 with 7.5 [4.5–12.8] hours and 6.3 [3.7–11.3] hours in phase 1 and 2 (<em>p</em> < 0.001). Median solid fasting times were not reduced with 14.3 [12.3–17.0] hours in phase 1 versus 14.3 [12.4–16.5] in phase 2 (<em>p</em> = 0.66). Mean FQoR-15 recovery score was better in phase 2 compared to phase 1 (133 [CI 95 %: 129,6–136,1] vs 123 [CI 95 %: 119,3–125,8] respectively, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>After a multimodal awareness campaign, both median preoperative liquid fasting time and quality of recovery score were improved. However, the median solid fasting time was not reduced, calling for additional measures to further improve patient care.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112104"},"PeriodicalIF":5.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797912","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 : 2025-12-17DOI: 10.1016/j.jclinane.2025.112099
Lu Dong , Fang Wen , Lu-Mei Qin , Xiao-Yan Zhi , Run Li , Yi Liang , Wen Song , Qun Xia , Jian Wu , Li Qiu , Qiang-Lin Yi , Yang Zhao , Li Yan , Fang-Zhou Yang , Shang Shi , Lu Chen , Jie-Qiong Luo , Wen-Qi Zhang , Li Zeng , Kun Zhou , Xiao-Hua Zou
Study objective
To assess the relationship between frailty and major postoperative complications (POCs) in elderly patients undergoing elective surgery.
Design
A prospective cohort study.
Setting
Five hospitals in China.
Patients
A total of 1358 elderly patients (≥65 years) were included.
Exposure
Preoperative frailty.
Measurements
The primary outcome was major POCs. LASSO regression was used for selecting covariates. Multivariate logistic regression modeling were used to evaluate the associations between frailty and major POCs. Net Reclassification Index (NRI) and Integrated Discriminant Improvement Index (IDI) were calculated to further assess the additional predictive value of the frailty for major POCs beyond the identified risk factors. Further subgroup analyses were conducted to determine the robustness of the associations.
Main results
Logistic regression modeling revealed that frailty was associated with major POCs (adjusted odds ratio [aOR], 95 % confidence interval [CI]: 2.61, 1.47–4.62). Each 1-point increase in frailty was associated with a 35 % increase in the risk of major POCs (aOR, 95 % CI: 1.35, 1.10–1.66). Slow walking speed, low physical activity and frequent exhaustion were independently associated with major POCs. Their ORs (95 % CI): 2.34 (1.33–4.13), 1.98 (1.09–3.57), 2.26 (1.28–3.99). Adding frailty to baseline risk model improved the predictive value of major POCs (NRI: 0.5551, 0.3095–0.8006; IDI: 0.0144, 0.0003–0.0286). Subgroup analyses revealed the same trend between frailty and major POCs.
Conclusions
Frail elderly patients scheduled for elective surgery were at an increased risk of major POCs, especially those with slow walking speed, low levels of physical activity, and frequent feelings of exhaustion.
{"title":"Associations between preoperative frailty and major postoperative complications in older surgical patients","authors":"Lu Dong , Fang Wen , Lu-Mei Qin , Xiao-Yan Zhi , Run Li , Yi Liang , Wen Song , Qun Xia , Jian Wu , Li Qiu , Qiang-Lin Yi , Yang Zhao , Li Yan , Fang-Zhou Yang , Shang Shi , Lu Chen , Jie-Qiong Luo , Wen-Qi Zhang , Li Zeng , Kun Zhou , Xiao-Hua Zou","doi":"10.1016/j.jclinane.2025.112099","DOIUrl":"10.1016/j.jclinane.2025.112099","url":null,"abstract":"<div><h3>Study objective</h3><div>To assess the relationship between frailty and major postoperative complications (POCs) in elderly patients undergoing elective surgery.</div></div><div><h3>Design</h3><div>A prospective cohort study.</div></div><div><h3>Setting</h3><div>Five hospitals in China.</div></div><div><h3>Patients</h3><div>A total of 1358 elderly patients (≥65 years) were included.</div></div><div><h3>Exposure</h3><div>Preoperative frailty.</div></div><div><h3>Measurements</h3><div>The primary outcome was major POCs. LASSO regression was used for selecting covariates. Multivariate logistic regression modeling were used to evaluate the associations between frailty and major POCs. Net Reclassification Index (NRI) and Integrated Discriminant Improvement Index (IDI) were calculated to further assess the additional predictive value of the frailty for major POCs beyond the identified risk factors. Further subgroup analyses were conducted to determine the robustness of the associations.</div></div><div><h3>Main results</h3><div>Logistic regression modeling revealed that frailty was associated with major POCs (adjusted odds ratio [aOR], 95 % confidence interval [CI]: 2.61, 1.47–4.62). Each 1-point increase in frailty was associated with a 35 % increase in the risk of major POCs (aOR, 95 % CI: 1.35, 1.10–1.66). Slow walking speed, low physical activity and frequent exhaustion were independently associated with major POCs. Their ORs (95 % CI): 2.34 (1.33–4.13), 1.98 (1.09–3.57), 2.26 (1.28–3.99). Adding frailty to baseline risk model improved the predictive value of major POCs (NRI: 0.5551, 0.3095–0.8006; IDI: 0.0144, 0.0003–0.0286). Subgroup analyses revealed the same trend between frailty and major POCs.</div></div><div><h3>Conclusions</h3><div>Frail elderly patients scheduled for elective surgery were at an increased risk of major POCs, especially those with slow walking speed, low levels of physical activity, and frequent feelings of exhaustion.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112099"},"PeriodicalIF":5.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781241","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 : 2025-12-17DOI: 10.1016/j.jclinane.2025.112105
Wesley L. Allen , Kiran S. Merchant , Archer K. Martin, Shaun E. Gruenbaum, Benjamin F. Gruenbaum
Acute intracranial injuries including subarachnoid hemorrhage, traumatic brain injury, stroke, and seizures often trigger cardiovascular and pulmonary complications through the neurocardiac axis. This bidirectional connection between the brain and the heart is mediated by sympathetic overactivity, catecholamine excess, autonomic imbalance, and systemic inflammation. This narrative review synthesizes current evidence published between 1968 and 2025, identified through a comprehensive literature search. Representative studies were selected to provide an integrative overview of neurocardiac complications in acute neurologic injury, focusing on underlying mechanisms, clinical manifestations, diagnostic challenges, and management strategies. We describe the mechanisms underlying neurogenic stunned myocardium and Takotsubo syndrome, highlighting regional vulnerability based on autonomic innervation. Electrocardiographic features, cardiac biomarkers, and echocardiographic findings are discussed in the context of early recognition and risk stratification. We further examine diagnostic challenges, the importance of distinguishing neurologic from primary cardiac pathology, and therapeutic approaches including autonomic modulation and cardiopulmonary protective strategies. Understanding the unique pathogenesis of these syndromes can help guide individualized treatment strategies and anesthetic management to improve outcomes in patients with acute neurologic injury. By consolidating multidisciplinary insights, this review aims to enhance recognition and management of neurocardiac complications in this population.
{"title":"The neurocardiac axis in acute intracranial stress","authors":"Wesley L. Allen , Kiran S. Merchant , Archer K. Martin, Shaun E. Gruenbaum, Benjamin F. Gruenbaum","doi":"10.1016/j.jclinane.2025.112105","DOIUrl":"10.1016/j.jclinane.2025.112105","url":null,"abstract":"<div><div>Acute intracranial injuries including subarachnoid hemorrhage, traumatic brain injury, stroke, and seizures often trigger cardiovascular and pulmonary complications through the neurocardiac axis. This bidirectional connection between the brain and the heart is mediated by sympathetic overactivity, catecholamine excess, autonomic imbalance, and systemic inflammation. This narrative review synthesizes current evidence published between 1968 and 2025, identified through a comprehensive literature search. Representative studies were selected to provide an integrative overview of neurocardiac complications in acute neurologic injury, focusing on underlying mechanisms, clinical manifestations, diagnostic challenges, and management strategies. We describe the mechanisms underlying neurogenic stunned myocardium and Takotsubo syndrome, highlighting regional vulnerability based on autonomic innervation. Electrocardiographic features, cardiac biomarkers, and echocardiographic findings are discussed in the context of early recognition and risk stratification. We further examine diagnostic challenges, the importance of distinguishing neurologic from primary cardiac pathology, and therapeutic approaches including autonomic modulation and cardiopulmonary protective strategies. Understanding the unique pathogenesis of these syndromes can help guide individualized treatment strategies and anesthetic management to improve outcomes in patients with acute neurologic injury. By consolidating multidisciplinary insights, this review aims to enhance recognition and management of neurocardiac complications in this population.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112105"},"PeriodicalIF":5.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781166","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 : 2025-12-16DOI: 10.1016/j.jclinane.2025.112097
Daniel D. King , Rhea Temmermand , Jennifer E. Greenwood
Background
Cannabis use is increasingly common, yet its effects on postoperative pain and opioid requirements remain unclear. While cannabinoids are used in chronic pain, their role in acute perioperative recovery is less defined.
Methods
A systematic search of PubMed, CINAHL, and Embase identified studies published within the past ten years that examined preoperative cannabis use and its relationship with postoperative pain and opioid consumption. Forty-two studies met the inclusion criteria. Data were extracted and summarized using a narrative synthesis methodology.
Results
Exposure definitions, surgical specialties, and outcome metrics were heterogeneous, limiting cross-study comparability; therefore, effects were reported in their native form without pooling. Of the 42 included studies, 14 (33.3 %) found that cannabis users reported higher postoperative pain, 10 (23.8 %) reported no difference, 2 (4.8 %) suggested reduced pain, and 16 (38.1 %) did not report pain outcomes. Regarding opioids, 18 studies (42.9 %) indicated greater postoperative requirements, 17 (40.5 %) found no difference, 3 (7.1 %) suggested reduced use, and 4 (9.5 %) did not report opioid outcomes. Specialty-specific patterns emerged: mixed cohorts (90 %) and spine populations (55 %) more frequently reported increased opioid use, whereas arthroplasty studies more often reported no difference (62 %). Limited, low-certainty evidence suggested that resuming cannabis after discharge was associated with lower persistent opioid use.
Conclusions
Preoperative cannabis exposure is associated with increased postoperative pain and opioid requirements in some, but not all, surgical contexts. Outcomes vary by specialty, and residual confounding and nonstandardized exposure measurement constrain inference, underscoring the need for standardized exposure definitions, prospective designs, and individualized perioperative pain strategies.
{"title":"Preoperative cannabinoid exposure and postoperative pain: A narrative review","authors":"Daniel D. King , Rhea Temmermand , Jennifer E. Greenwood","doi":"10.1016/j.jclinane.2025.112097","DOIUrl":"10.1016/j.jclinane.2025.112097","url":null,"abstract":"<div><h3>Background</h3><div>Cannabis use is increasingly common, yet its effects on postoperative pain and opioid requirements remain unclear. While cannabinoids are used in chronic pain, their role in acute perioperative recovery is less defined.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, CINAHL, and Embase identified studies published within the past ten years that examined preoperative cannabis use and its relationship with postoperative pain and opioid consumption. Forty-two studies met the inclusion criteria. Data were extracted and summarized using a narrative synthesis methodology.</div></div><div><h3>Results</h3><div>Exposure definitions, surgical specialties, and outcome metrics were heterogeneous, limiting cross-study comparability; therefore, effects were reported in their native form without pooling. Of the 42 included studies, 14 (33.3 %) found that cannabis users reported higher postoperative pain, 10 (23.8 %) reported no difference, 2 (4.8 %) suggested reduced pain, and 16 (38.1 %) did not report pain outcomes. Regarding opioids, 18 studies (42.9 %) indicated greater postoperative requirements, 17 (40.5 %) found no difference, 3 (7.1 %) suggested reduced use, and 4 (9.5 %) did not report opioid outcomes. Specialty-specific patterns emerged: mixed cohorts (90 %) and spine populations (55 %) more frequently reported increased opioid use, whereas arthroplasty studies more often reported no difference (62 %). Limited, low-certainty evidence suggested that resuming cannabis after discharge was associated with lower persistent opioid use.</div></div><div><h3>Conclusions</h3><div>Preoperative cannabis exposure is associated with increased postoperative pain and opioid requirements in some, but not all, surgical contexts. Outcomes vary by specialty, and residual confounding and nonstandardized exposure measurement constrain inference, underscoring the need for standardized exposure definitions, prospective designs, and individualized perioperative pain strategies.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112097"},"PeriodicalIF":5.1,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774788","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 : 2025-12-15DOI: 10.1016/j.jclinane.2025.112101
Anne B. Alnor , Rasmus B. Lynggaard , Lina E. Pedersen , Jonas Storgaard , Martin S. Laursen , Pernille J. Vinholt
{"title":"Extracting intraoperative blood loss from unstructured clinical narratives","authors":"Anne B. Alnor , Rasmus B. Lynggaard , Lina E. Pedersen , Jonas Storgaard , Martin S. Laursen , Pernille J. Vinholt","doi":"10.1016/j.jclinane.2025.112101","DOIUrl":"10.1016/j.jclinane.2025.112101","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112101"},"PeriodicalIF":5.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768240","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 : 2025-12-15DOI: 10.1016/j.jclinane.2025.112103
Michael Kolland , Selina Sartori , Christoph Klivinyi , Michael Schörghuber , Jakob Pannold , Igor Knez , Alexander H. Kirsch , Nikolaus Schreiber
Background
Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG), associated with adverse short- and long-term outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce occurrence of AKI in several populations, yet their perioperative effects in patients undergoing CABG are unknown.
Methods
We conducted a retrospective study at the Department of Cardiac Surgery, Medical University of Graz (2020–2024) to evaluate the impact of preoperative SGLT2i use on cardiac surgery–associated AKI in adults undergoing urgent or emergent isolated coronary artery bypass grafting in patients with an indication for SGLT2i therapy (type 2 diabetes mellitus, heart failure with reduced ejection fraction, or chronic kidney disease). Patients with preoperative dialysis, sepsis, reoperation, mechanical circulatory support or missing laboratory data were excluded. Exposure was defined as SGLT2i use within two weeks before surgery, and the primary outcome was cardiac surgery-associated AKI (CSA-AKI) according to KDIGO criteria. Secondary outcomes included kidney replacement therapy, ICU length of stay, 30-day mortality and postoperative diabetic ketoacidosis. Causal effects were estimated using entropy balancing. Results were reported as weighted risk differences, risk ratios, and adjusted mean differences, with time-to-event outcomes analyzed via weighted Cox models and Kaplan–Meier estimates.
Results
Among 484 patients, 135 were on SGLT2i. CSA-AKI occurred in 23.0 % of SGLT2i users vs. 28.1 % of non-users (risk ratio of 0.63 [95 % CI 0.44–0.91; p = 0.014]). The association was pronounced in patients with heart failure with reduced ejection fraction and those with high EuroSCORE II. No differences were observed in other secondary endpoints and no cases of postoperative diabetic ketoacidosis occurred.
Conclusion
Preoperative SGLT2i use was associated with a significantly lower risk of CSA-AKI in patients undergoing urgent or emergent CABG. These findings need to be confirmed in prospective multicenter trials but underline the favorable safety profile of this medication.
背景：急性肾损伤（AKI）是冠状动脉旁路移植术（CABG）后常见的并发症，与不良的短期和长期预后相关。钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）已被证明可以减少几个人群AKI的发生，但其在CABG患者的围手术期效果尚不清楚。方法：我们在格拉茨医科大学心脏外科（2020-2024）进行了一项回顾性研究，以评估术前使用SGLT2i对有SGLT2i治疗指征（2型糖尿病、心力衰竭伴射血分数降低或慢性肾病）的成人紧急或紧急孤立冠状动脉旁路移植术中心脏手术相关AKI的影响。排除术前透析、败血症、再手术、机械循环支持或缺少实验室数据的患者。暴露被定义为术前两周内使用SGLT2i，根据KDIGO标准，主要结局是心脏手术相关AKI （CSA-AKI）。次要结局包括肾脏替代治疗、ICU住院时间、30天死亡率和术后糖尿病酮症酸中毒。利用熵平衡估计因果效应。结果报告为加权风险差异、风险比和调整后的平均差异，并通过加权Cox模型和Kaplan-Meier估计分析事件发生时间。结果：484例患者中，有135例接受SGLT2i治疗。SGLT2i使用者中CSA-AKI发生率为23.0%，非使用者中为28.1%（风险比为0.63 [95% CI 0.44-0.91; p = 0.014]）。在射血分数降低的心力衰竭患者和EuroSCORE II高的患者中，这种关联明显。其他次要终点无差异，术后无糖尿病酮症酸中毒病例发生。结论：术前使用SGLT2i与急诊或紧急冠脉搭桥患者CSA-AKI风险显著降低相关。这些发现需要在前瞻性多中心试验中得到证实，但强调了该药物的良好安全性。
{"title":"Preoperative SGLT2i therapy and acute kidney injury in patients undergoing emergency and urgent coronary artery bypass grafting - A causal inference framework","authors":"Michael Kolland , Selina Sartori , Christoph Klivinyi , Michael Schörghuber , Jakob Pannold , Igor Knez , Alexander H. Kirsch , Nikolaus Schreiber","doi":"10.1016/j.jclinane.2025.112103","DOIUrl":"10.1016/j.jclinane.2025.112103","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG), associated with adverse short- and long-term outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce occurrence of AKI in several populations, yet their perioperative effects in patients undergoing CABG are unknown.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study at the Department of Cardiac Surgery, Medical University of Graz (2020–2024) to evaluate the impact of preoperative SGLT2i use on cardiac surgery–associated AKI in adults undergoing urgent or emergent isolated coronary artery bypass grafting in patients with an indication for SGLT2i therapy (type 2 diabetes mellitus, heart failure with reduced ejection fraction, or chronic kidney disease). Patients with preoperative dialysis, sepsis, reoperation, mechanical circulatory support or missing laboratory data were excluded. Exposure was defined as SGLT2i use within two weeks before surgery, and the primary outcome was cardiac surgery-associated AKI (CSA-AKI) according to KDIGO criteria. Secondary outcomes included kidney replacement therapy, ICU length of stay, 30-day mortality and postoperative diabetic ketoacidosis. Causal effects were estimated using entropy balancing. Results were reported as weighted risk differences, risk ratios, and adjusted mean differences, with time-to-event outcomes analyzed via weighted Cox models and Kaplan–Meier estimates.</div></div><div><h3>Results</h3><div>Among 484 patients, 135 were on SGLT2i. CSA-AKI occurred in 23.0 % of SGLT2i users vs. 28.1 % of non-users (risk ratio of 0.63 [95 % CI 0.44–0.91; <em>p</em> = 0.014]). The association was pronounced in patients with heart failure with reduced ejection fraction and those with high EuroSCORE II. No differences were observed in other secondary endpoints and no cases of postoperative diabetic ketoacidosis occurred.</div></div><div><h3>Conclusion</h3><div>Preoperative SGLT2i use was associated with a significantly lower risk of CSA-AKI in patients undergoing urgent or emergent CABG. These findings need to be confirmed in prospective multicenter trials but underline the favorable safety profile of this medication.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112103"},"PeriodicalIF":5.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768267","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 : 2025-12-15DOI: 10.1016/j.jclinane.2025.112095
Aubrey Samost-Williams, Alparslan Turan, Victoria Tang
{"title":"Beyond the operating room: Holistic support for frail surgical patients.","authors":"Aubrey Samost-Williams, Alparslan Turan, Victoria Tang","doi":"10.1016/j.jclinane.2025.112095","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112095","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112095"},"PeriodicalIF":5.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762742","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}
Coagulopathy is a key determinant of maternal prognosis in case of postpartum hemorrhage. We sought to assess the impact of implementing a thromboelastometry-based coagulopathy management protocol on fibrinogen concentrate use and transfusion strategies.
Design
Retrospective study.
Setting
Tertiary care obstetric unit, university hospital, Lyon, France.
Patients
Adult women with postpartum hemorrhage (≥500 mL blood loss within 24 h postpartum) at a gestational age ≥ 22 weeks.
Interventions
Three distinct periods were analyzed: Period 1 (2016–2018, no viscoelastic test available), Period 2 (2019–2020, thromboelastometry available in our maternity unit) and Period 3 (2021–2023, implementation of a thromboelastometry-based coagulopathy management protocol).
Measurements
The primary endpoint was the proportion of patients receiving fibrinogen concentrate in each period. Secondary endpoints were the proportions of patients transfused with blood products within the first 24 h in each period. Adjusted odds ratios (aOR) for each outcome were estimated using bidirectional stepwise regression in a final model that included 12 preselected confounders.
Main results
A total of 3899 patients were analyzed. Period 3 and Period 2 were independently associated with significantly lower odds of fibrinogen concentrate administration compared to Period 1. The aOR was 0.19 (95 %CI: 0.14 to 0.28) for Period 3 and 0.70 (95 %CI: 0.50 to 0.98) for Period 2. Period 3 was also independently associated with significantly lower odds of transfusion of red blood cells (aOR = 0.25 [95 %CI: 0.19 to 0.33]), fresh frozen plasma (aOR = 0.17 [95 %CI: 0.09 to 0.33]) and platelet concentrates (aOR = 0.23 [95 %CI: 0.08 to 0.62]) compared to Period 1. The frequency of massive postpartum hemorrhage (≥2500 mL) did not change significantly across the three periods.
Conclusions
Implementing a thromboelastometry-guided protocol was associated with significantly reduced use of fibrinogen concentrate, red blood cells, fresh frozen plasma, and platelet concentrates, without increasing the risk of progression to massive hemorrhage. Further assessments of maternal outcomes and cost-effectiveness are required.
{"title":"Impact of implementing a thromboelastometry-guided transfusion strategy on fibrinogen supplementation and transfusion in women with postpartum hemorrhage","authors":"Anne Zheng , Valérie Chamouard , Christophe Nougier , François-Pierrick Desgranges , Charles-Hervé Vacheron , Lionel Bouvet","doi":"10.1016/j.jclinane.2025.112102","DOIUrl":"10.1016/j.jclinane.2025.112102","url":null,"abstract":"<div><h3>Study objective</h3><div>Coagulopathy is a key determinant of maternal prognosis in case of postpartum hemorrhage. We sought to assess the impact of implementing a thromboelastometry-based coagulopathy management protocol on fibrinogen concentrate use and transfusion strategies.</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Setting</h3><div>Tertiary care obstetric unit, university hospital, Lyon, France.</div></div><div><h3>Patients</h3><div>Adult women with postpartum hemorrhage (≥500 mL blood loss within 24 h postpartum) at a gestational age ≥ 22 weeks.</div></div><div><h3>Interventions</h3><div>Three distinct periods were analyzed: Period 1 (2016–2018, no viscoelastic test available), Period 2 (2019–2020, thromboelastometry available in our maternity unit) and Period 3 (2021–2023, implementation of a thromboelastometry-based coagulopathy management protocol).</div></div><div><h3>Measurements</h3><div>The primary endpoint was the proportion of patients receiving fibrinogen concentrate in each period. Secondary endpoints were the proportions of patients transfused with blood products within the first 24 h in each period. Adjusted odds ratios (aOR) for each outcome were estimated using bidirectional stepwise regression in a final model that included 12 preselected confounders.</div></div><div><h3>Main results</h3><div>A total of 3899 patients were analyzed. Period 3 and Period 2 were independently associated with significantly lower odds of fibrinogen concentrate administration compared to Period 1. The aOR was 0.19 (95 %CI: 0.14 to 0.28) for Period 3 and 0.70 (95 %CI: 0.50 to 0.98) for Period 2. Period 3 was also independently associated with significantly lower odds of transfusion of red blood cells (aOR = 0.25 [95 %CI: 0.19 to 0.33]), fresh frozen plasma (aOR = 0.17 [95 %CI: 0.09 to 0.33]) and platelet concentrates (aOR = 0.23 [95 %CI: 0.08 to 0.62]) compared to Period 1. The frequency of massive postpartum hemorrhage (≥2500 mL) did not change significantly across the three periods.</div></div><div><h3>Conclusions</h3><div>Implementing a thromboelastometry-guided protocol was associated with significantly reduced use of fibrinogen concentrate, red blood cells, fresh frozen plasma, and platelet concentrates, without increasing the risk of progression to massive hemorrhage. Further assessments of maternal outcomes and cost-effectiveness are required.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112102"},"PeriodicalIF":5.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748518","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}
The objective of this systematic review and meta-analysis is to evaluate the clinical utility of preoperative screening for obstructive sleep apnea (OSA) and determine the impact of targeted interventions on reducing postoperative adverse outcomes in surgical patients identified as high risk of OSA (HR-OSA).
Methods
A comprehensive literature search was conducted across multiple databases for studies evaluating the utilization of validated OSA screening tools and OSA interventions within the surgical setting. Primary outcomes included postoperative adverse respiratory and cardiac events, delirium, length of stay (LOS), intensive care unit (ICU) admissions, 30-day readmissions, and mortality. Interventions included continuous positive airway pressure (CPAP) or auto-titration positive airway pressure (APAP) use, sleep consultation, OSA safety protocols, wrist bands, and patient education. Certain studies used a combination of these interventions for HR-OSA patients.
Results
Fifty-four studies (324,935 patients) were included. The odds of adverse postoperative respiratory complications (OR 3.59, 95 % CI: 1.73–7.43) and cardiac complications (OR 2.82, 95 % CI: 1.62–4.92) events were significantly higher, and hospital LOS was significantly longer (mean difference: 0.79 days, 95 % CI: 0.42–1.15) for HR-OSA patients than those at low risk of OSA (LR-OSA). The odds of delirium, ICU admission, and 30-day readmission were not significantly increased for HR-OSA patients. In contrast, for HR-OSA patients who received post-screening interventions such as safety protocols, education and other targeted interventions, no significant differences in respiratory complications (OR 0.86, 95 % CI: 0.56–1.31), delirium (OR 0.69, 95 % CI: 0.12–4.06), escalation of care (OR 0.86, 95 % CI: 0.62–1.18), or composite adverse events (OR 0.81, 95 % CI: 0.61–1.08) were found compared to OSA patients who received no intervention.
Conclusions
Our findings confirm HR-OSA as a risk factor for postoperative adverse events. Preoperative screening for OSA and subsequent targeted perioperative interventions and management strategies may contribute to a reduction in postoperative adverse outcomes. The current evidence regarding the efficacy of targeted interventions is limited by significant heterogeneity and sparsity of high-quality data and should be interpreted as exploratory.
{"title":"The clinical effectiveness of preoperative screening and post-screening interventions for obstructive sleep apnea: A systematic review and meta-analysis","authors":"Rushil Parikh HBSc , Linor Berezin MD , Aparna Saripella MSc , Ellene Yan HBSc , Bianca Pivetta MD , Khashayar Poorzargar MSc , Emmanuel Olaonipekun BSc , Marina Englesakis MLIS , Majid Nabipoor PhD , Frances Chung MD","doi":"10.1016/j.jclinane.2025.112084","DOIUrl":"10.1016/j.jclinane.2025.112084","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this systematic review and meta-analysis is to evaluate the clinical utility of preoperative screening for obstructive sleep apnea (OSA) and determine the impact of targeted interventions on reducing postoperative adverse outcomes in surgical patients identified as high risk of OSA (HR-OSA).</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across multiple databases for studies evaluating the utilization of validated OSA screening tools and OSA interventions within the surgical setting. Primary outcomes included postoperative adverse respiratory and cardiac events, delirium, length of stay (LOS), intensive care unit (ICU) admissions, 30-day readmissions, and mortality. Interventions included continuous positive airway pressure (CPAP) or auto-titration positive airway pressure (APAP) use, sleep consultation, OSA safety protocols, wrist bands, and patient education. Certain studies used a combination of these interventions for HR-OSA patients.</div></div><div><h3>Results</h3><div>Fifty-four studies (324,935 patients) were included. The odds of adverse postoperative respiratory complications (OR 3.59, 95 % CI: 1.73–7.43) and cardiac complications (OR 2.82, 95 % CI: 1.62–4.92) events were significantly higher, and hospital LOS was significantly longer (mean difference: 0.79 days, 95 % CI: 0.42–1.15) for HR-OSA patients than those at low risk of OSA (LR-OSA). The odds of delirium, ICU admission, and 30-day readmission were not significantly increased for HR-OSA patients. In contrast, for HR-OSA patients who received post-screening interventions such as safety protocols, education and other targeted interventions, no significant differences in respiratory complications (OR 0.86, 95 % CI: 0.56–1.31), delirium (OR 0.69, 95 % CI: 0.12–4.06), escalation of care (OR 0.86, 95 % CI: 0.62–1.18), or composite adverse events (OR 0.81, 95 % CI: 0.61–1.08) were found compared to OSA patients who received no intervention.</div></div><div><h3>Conclusions</h3><div>Our findings confirm HR-OSA as a risk factor for postoperative adverse events. Preoperative screening for OSA and subsequent targeted perioperative interventions and management strategies may contribute to a reduction in postoperative adverse outcomes. The current evidence regarding the efficacy of targeted interventions is limited by significant heterogeneity and sparsity of high-quality data and should be interpreted as exploratory.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112084"},"PeriodicalIF":5.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742761","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 : 2025-12-11DOI: 10.1016/S0952-8180(25)00347-2
{"title":"On the Cover - Mogianos et al","authors":"","doi":"10.1016/S0952-8180(25)00347-2","DOIUrl":"10.1016/S0952-8180(25)00347-2","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112086"},"PeriodicalIF":5.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732971","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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