Journal of Clinical Anesthesia最新文献

英文中文

Fixed 2-min time versus train of four–guided intubation following administration of rocuronium: Comment on study by Renew JR et al 罗库溴铵给药后固定2分钟时间与四导气管插管：Renew JR等研究的评论。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-29 DOI: 10.1016/j.jclinane.2025.112118

Habib Md Reazaul Karim (MD, DNB, IDCCM, FNIV) , Pradipta Bhakta (MD, MNAMS, FCAI, EDRA, EDIC, FNIV) , Mohan Mugawar (MD, FCAI, FRCA, EDIC)

引用次数: 0

Pupillometry and pre-operative cognitive function: A possible new tool in identifying a frail brain 瞳孔测量和术前认知功能：一种可能的识别脆弱大脑的新工具。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-29 DOI: 10.1016/j.jclinane.2025.112119

Paolo Zanatta , Andrea Rossi , Giorgio Fullin , Luigi Polesello , Alice Baruffol , Federico Linassi

引用次数: 0

Application of ultrasound-guided regional blocks in the perioperative period of hip arthroplasty: A systematic review and network meta-analysis 超声引导区域阻滞在髋关节置换术围手术期的应用：系统综述和网络荟萃分析

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-27 DOI: 10.1016/j.jclinane.2025.112110

Sisi Wang, Ziyi Wu, Yanhong Song, Xinyi Yang, Ping Zhao

Purpose

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).

Methods

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.

Results

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.

Conclusion

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.

目的：本贝叶斯网络荟萃分析（NMA）旨在比较不同超声引导区域阻滞在个体全髋关节置换术（THA）围手术期的疗效。方法在PubMed、Cochrane Library、Web of Science和Embase上进行广泛检索，截止到2024年12月9日。采用随机对照试验（RCTs）评价超声引导下腰丛阻滞（LPB）、腹股沟上髂筋膜阻滞（SIFIB）、囊周神经群阻滞（PENG）、股神经阻滞（FNB）、髂筋膜阻滞（FIB）、腰方肌阻滞（QLB）、竖立者脊柱平面阻滞（ESPB）、关节周注射（PAI）、生理盐水对照（control）术后镇痛及并发症。主要结果包括术后12和24小时内运动诱发疼痛（MEP）和静息疼痛（PAR）评分。次要结局包括术后吗啡当量消耗和恶心呕吐发生率。采用r4.4.2和Stata 18进行统计学分析。结果共纳入18项研究（2016-2024），1424名受试者。网络分析显示，对于主要结局，PAI、PENG和QLB组的MEP评分在术后12和24小时内显著降低。术后12 h和24 h的PAR评分无明显差异。在布比卡因亚组中，QLB组术后24 h内吗啡用量较低。与其他组相比，QLB组在住院期间吗啡用量最低。在术后恶心呕吐（PONV）方面，局部阻断组与安慰剂对照组相比有统计学上的显著差异。结论没有单一区域阻滞技术在所有术后结果中表现出优越性。超声引导QLB在减少吗啡消耗、减轻疼痛和降低PONV方面特别有效。PAI和PENG在减少术后疼痛和吗啡消耗方面也显示出疗效。未来需要进行大规模多中心随机对照试验来进一步验证这些发现。

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引用次数: 0

Randomized clinical trial between two sedation protocols during transcatheter aortic valve replacement procedures: Ketamine and Propofol versus Remifentanil and Dexmedetomidine 经导管主动脉瓣置换术中两种镇静方案的随机临床试验：氯胺酮和异丙酚与瑞芬太尼和右美托咪定

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-27 DOI: 10.1016/j.jclinane.2025.112116

Anna Castellari M.D , Matteo Lucchelli M.D , Mattia Gomarasca M.D , Valentina Salice M.D , Francesca Orsenigo M.D , Bedrana Moro Salihovic M.D , Federico Mondin M.D , Claudia Castiglioni M.D , Alessandro Calzolari M.D , Giovanni Mistraletti M.D

Objectives

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).

Design

Monocentric, prospective, randomized and controlled trial.

Setting

University hospital.

Participants

231 patients were enrolled in the trial.

198 patients were included in the final analysis.

Interventions

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.

Measurements and main results

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.

Conclusions

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.

目的比较经导管主动脉瓣置换术（TAVR）中两种不同镇静方案的疗效和安全性；氯胺酮和异丙酚（KETOFOL）与瑞芬太尼和右美托咪定（REMIDEX）。设计：单中心、前瞻性、随机对照试验。SettingUniversity医院。231名患者参加了这项试验。198例患者纳入最终分析。干预：根据随机分配的两种可能的药物组合（酮fol vs REMIDEX）中的一种，入组患者接受了程序性镇静治疗。在手术过程中记录干预次数和临床参数。记录手术后不良事件的发生率。测量和主要结果：remidex组呼吸性酸中毒的原始发生率有较高的趋势（67.7% vs 54.3%）。多因素logistic回归分析证实了相关性，REMIDEX组发生呼吸性酸中毒的风险增加（OR 1.844%, 95% CI 1.014-3.427）。REMIDEX组患者诱导时间明显延长。REMIDEX组需要更多的药理学调整，术中躁动发生率更高，去饱和发作次数更多。其他术中或术后安全指标均无差异。结论两种方案均显示心血管不良事件和术后并发症（如POD和POCD）的发生率较低且相当。酮fol方案似乎提供了更大的镇静稳定性，似乎对呼吸不良事件的发生率更有保护作用。

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引用次数: 0

Beyond oxygen delivery: Do stroke volume maximization and preoperative cardiac index maintenance truly improve clinical-relevant perfusion in major abdominal surgery? 除供氧外：最大卒中容量和术前心脏指数维持真的能改善腹部大手术的临床相关灌注吗？

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-27 DOI: 10.1016/j.jclinane.2025.112113

Jinyan Guo , Ke Chen , Xue Han , Weifeng Yao

引用次数: 0

The fascial plane blocks in the upper arm surgery and trauma: A narrative review 上臂手术与创伤中的筋膜面阻滞：叙述性回顾。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-27 DOI: 10.1016/j.jclinane.2025.112115

Francesco Marrone , Lorenza Sbucafratta , Pierfrancesco Fusco

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.

筋膜平面阻滞作为一种有效且安全的止痛方法正变得越来越受欢迎。虽然它们在胸部和腹部手术中的应用是众所周知的，但它们在上臂手术和创伤中的应用是强调的。这篇综述探讨了近10年来关于使用筋膜平面阻滞来缓解上肢手术或创伤后疼痛的研究。研究包括随机对照试验、观察性研究和病例报告。他们研究了颈椎和胸高段竖脊肌平面（ESP）阻滞、锁骨筋膜平面（CFP）阻滞、上后锯肌肋间平面（SPSIP）阻滞和关节周围入路（如肩关节囊周阻滞）等技术。高胸段ESP阻滞可缓解疼痛，且常伴有持续导管输注。研究表明，有一种趋势是将筋膜阻滞相互结合或与周围神经阻滞相结合，以覆盖更多的区域，减少阿片类药物的使用。即使结果很有希望，文献中也没有多少随机试验，因此数据仍然大多是低质量的。潜在并发症的风险，如局麻全身毒性（LAST）或意外传播到重要解剖区域，虽然没有报道，但存在。这项研究显示了筋膜平面阻滞在上肢手术中的变化，并建议进行更多高质量的研究，以找出最佳使用时间、安全性和效果。

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引用次数: 0

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 评论：“最大卒中容量与维持术前静息心脏指数对腹大手术患者氧输送、耗氧量和微循环组织灌注的影响：一项随机定制的探索试验”-回复

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-26 DOI: 10.1016/j.jclinane.2025.112114

Moritz Flick , Bernd Saugel

引用次数: 0

Corrigendum to "Unmasking the silent threat: Navigating the myocardial injury in oncological surgery" [Journal of Clinical Anesthesia 108 (2026) 112063]. “揭露无声的威胁：在肿瘤手术中导航心肌损伤”的更正[临床麻醉杂志108(2026)112063]。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-25 DOI: 10.1016/j.jclinane.2025.112111

Zhen-Zhen Xu, Dong-Liang Mu

引用次数: 0

Protection of the nasotracheal tube tip with a red rubber catheter in adults undergoing nasotracheal intubation: A randomized controlled trial 用红色橡胶导管保护鼻气管插管成人鼻气管管尖端：一项随机对照试验。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-24 DOI: 10.1016/j.jclinane.2025.112109

Neil S. Bailard MD , David W. Mercier MD , Christina A. Riccio MD , Catherine N. Vu MD , Peter W. Hsu MD , Rebekka Reinhardt MD , Paul A. Nakonezny PhD , Carin A. Hagberg MD

Background

Nasotracheal intubation (NTI) is often required for oropharyngeal surgery to maximize surgical access, but epistaxis is a common complication. NTI using a nasotracheal tube (NTT) telescoped into a red rubber urinary catheter (RRC) to guide the NTT and protect the nasal mucosa has been described for adults and studied in children but has not been systematically evaluated in adults.

Methods

This was a two-center, single-blinded, randomized controlled trial. 112 adults (mean age 57.1 ± 16.3 years, 61.6 % male) undergoing surgery requiring NTI were randomized 1: 1 to intubation with a thermosoftened, lubricated NTT, either alone or telescoped into an RRC to shield the beveled NTT tip. The primary outcome was incidence of epistaxis assessed at 5 min post-intubation by a blinded observer. Secondary outcomes included the severity of epistaxis, time to intubation, the rate of complications during nasotracheal intubation, and the degree of postoperative pain in PACU.

Results

Use of an RRC significantly reduced the likelihood of epistaxis (39.3 % vs. 62.5 %, Odds Ratio (OR) = 0.380, p = 0.0140; 95 % CI: 0.174 to 0.831, p = 0.0153; FDR = 0.0255) and the severity of epistaxis (OR for lower severity = 4.145; 95 % CI: 1.923 to 8.934, p = 0.0003; FDR = 0.0013), but was associated with a longer time to intubation (Least squares adjusted means 104.2 (SE = 6.87) seconds vs. 74.30 (SE = 6.86) seconds, p = 0.0005; FDR = 0.0015, d = 0.70). No difference was found in postoperative pain or in the rate of procedural complications.

Conclusions

Use of the RRC significantly reduced the likelihood and severity of epistaxis following nasal intubation, at the cost of longer time to intubation.

背景：鼻气管插管（NTI）通常需要口咽手术，以最大化手术通路，但鼻出血是一个常见的并发症。使用鼻气管管（NTT）插入红色橡胶导尿管（RRC）来引导鼻气管管（NTT）并保护鼻黏膜的NTI已被描述并在儿童中进行了研究，但尚未对成人进行系统评估。方法：双中心、单盲、随机对照试验。112名接受手术需要NTI的成年人（平均年龄57.1±16.3岁，61.6%为男性）被随机分为1:1组，分别使用热软化、润滑的NTT插管，或单独插管，或将其伸缩到RRC中以保护倾斜的NTT尖端。主要结局是在插管后5分钟由盲法观察者评估鼻衄的发生率。次要结局包括鼻出血严重程度、插管时间、鼻气管插管并发症发生率和PACU术后疼痛程度。结果：RRC的使用显著降低了鼻出血的可能性(39.3% vs. 62.5%，优势比(OR) = 0.380, p = 0.0140；95% CI: 0.174 ~ 0.831, p = 0.0153；FDR = 0.0255)和鼻出血严重程度（较低严重程度OR = 4.145; 95% CI: 1.923 ~ 8.934, p = 0.0003; FDR = 0.0013），但与插管时间较长相关(调整后最小二乘均值为104.2 （SE = 6.87）秒vs. 74.30 （SE = 6.86）秒，p = 0.0005；FDR = 0.0015, d = 0.70)。术后疼痛和手术并发症发生率无差异。结论：使用RRC显著降低鼻插管后鼻出血的可能性和严重程度，但代价是插管时间更长。

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引用次数: 0

Comparison between infraspinatus-Teres minor (ITM) Interfascial block and superior trunk block in shoulder arthroscopy: A randomized non-inferiority trial 肩关节镜下小粗圆肌（ITM）筋膜间阻滞和上干阻滞的比较：一项随机非效性试验。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2025-12-24 DOI: 10.1016/j.jclinane.2025.112106

Yu He M.D , Wei Zhao M.D. , Zhenyu Ze M.D. , Yan Zhao M.D. , Manyun Bao M.D. , Ming Yan M.D

Study objective

To evaluate whether there are differences in postoperative pain scores and the incidence of hemidiaphragmatic paralysis (HDP) between ultrasound-guided superior trunk block (STB) and infraspinatus teres minor fascial plane block (ITM).

Design

Prospective, randomized controlled non-inferiority trial.

Setting

A tertiary hospital.

Patients

A total of 100 patients aged 18 to 65 years scheduled for elective arthroscopic surgery were enrolled.

Interventions

Following sterile skin preparation, patients in the STB group received 15 mL of 0.375 % ropivacaine, while those in the ITM group received 25 mL of 0.375 % ropivacaine.

Measurements

The primary outcome was the highest resting pain score during the first 24 h postoperatively. Secondary outcomes included resting pain scores at six predefined time points (1, 3, 6, 9, 12,and 24 h), the incidence and severity of hemidiaphragmatic paralysis (HDP), block performance time, sensory block onset time, duration of analgesia, postoperative rescue analgesic consumption, grip strength, patient satisfaction scores, 24-h Quality of Recovery-15 (QoR-15) assessments, and Overall Benefit of Analgesia Scores (OBAS).

Main results

Within 24 h postoperation, the highest pain score was 3 [2.0–4.0] in the STB group and 3 [2.8 to 4.3] in the ITM group, with a median difference of 0 (95 % CI, −1 to 0). The upper limit of the 95 % CI was below the prespecified non-inferiority margin of 1″. (non-inferiority P < 0.01).

Conclusions

For maximal postoperative pain control within 24 h after shoulder arthroscopy, the ITM block was noninferior to STB, with significantly reduced diaphragmatic paralysis rates.

研究目的：评价超声引导下上干阻滞（STB）与圆肌下小筋膜平面阻滞（ITM）在术后疼痛评分及半膈肌麻痹（HDP）发生率方面是否存在差异。设计：前瞻性、随机对照非劣效性试验。环境：三级医院。患者：共纳入100例年龄在18至65岁之间的患者，计划进行选择性关节镜手术。干预措施：无菌皮肤准备后，STB组患者接受0.375%罗哌卡因15 mL， ITM组患者接受0.375%罗哌卡因25 mL。测量：主要结果是术后24小时内静息疼痛评分最高。次要结果包括六个预定义时间点（1,3,6,9,12,24 h）的静息疼痛评分，半断性麻痹（HDP）的发生率和严重程度，阻滞时间，感觉阻滞发生时间，镇痛持续时间，术后抢救镇痛消耗，握力，患者满意度评分，24小时恢复质量-15 （QoR-15）评估，以及镇痛评分的总体获益（OBAS）。主要结果：术后24 h内，STB组疼痛评分最高为3分[2.0 ~ 4.0]，ITM组疼痛评分最高为3分[2.8 ~ 4.3]，中位差为0 （95% CI, -1 ~ 0）。95% CI的上限低于预定的非劣效性界限1″。结论：肩关节镜术后24小时内最大限度地控制术后疼痛，ITM阻滞优于STB，可显著降低膈肌麻痹率。

{"title":"Comparison between infraspinatus-Teres minor (ITM) Interfascial block and superior trunk block in shoulder arthroscopy: A randomized non-inferiority trial","authors":"Yu He M.D , Wei Zhao M.D. , Zhenyu Ze M.D. , Yan Zhao M.D. , Manyun Bao M.D. , Ming Yan M.D","doi":"10.1016/j.jclinane.2025.112106","DOIUrl":"10.1016/j.jclinane.2025.112106","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate whether there are differences in postoperative pain scores and the incidence of hemidiaphragmatic paralysis (HDP) between ultrasound-guided superior trunk block (STB) and infraspinatus teres minor fascial plane block (ITM).</div></div><div><h3>Design</h3><div>Prospective, randomized controlled non-inferiority trial.</div></div><div><h3>Setting</h3><div>A tertiary hospital.</div></div><div><h3>Patients</h3><div>A total of 100 patients aged 18 to 65 years scheduled for elective arthroscopic surgery were enrolled.</div></div><div><h3>Interventions</h3><div>Following sterile skin preparation, patients in the STB group received 15 mL of 0.375 % ropivacaine, while those in the ITM group received 25 mL of 0.375 % ropivacaine.</div></div><div><h3>Measurements</h3><div>The primary outcome was the highest resting pain score during the first 24 h postoperatively. Secondary outcomes included resting pain scores at six predefined time points (1, 3, 6, 9, 12,and 24 h), the incidence and severity of hemidiaphragmatic paralysis (HDP), block performance time, sensory block onset time, duration of analgesia, postoperative rescue analgesic consumption, grip strength, patient satisfaction scores, 24-h Quality of Recovery-15 (QoR-15) assessments, and Overall Benefit of Analgesia Scores (OBAS).</div></div><div><h3>Main results</h3><div>Within 24 h postoperation, the highest pain score was 3 [2.0–4.0] in the STB group and 3 [2.8 to 4.3] in the ITM group, with a median difference of 0 (95 % CI, −1 to 0). The upper limit of the 95 % CI was below the prespecified non-inferiority margin of 1″. (non-inferiority <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>For maximal postoperative pain control within 24 h after shoulder arthroscopy, the ITM block was noninferior to STB, with significantly reduced diaphragmatic paralysis rates.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112106"},"PeriodicalIF":5.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834003","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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