Pub Date : 2026-02-01Epub Date: 2025-12-09DOI: 10.1016/j.jclinane.2025.112096
Benjamin Martens , Silke Mischke , Markus M. Luedi
The operating theater is an emotionally and cognitively demanding arena where anesthesiologists and surgeons operate under time pressure, uncertainty, and responsibility. Team interactions in such settings frequently reveal humor, irony, or cynicism, behaviors that represent underlying ego defense mechanisms.
We explore how defense mechanisms such as humor and cynicism affect perioperative culture, teamwork, and leadership; and to argue that self-awareness, mindfulness, and relational maturity indirectly improve clinical outcomes.
This conceptual analysis integrates psychoanalytic theories (Freud, Jung, Vaillant), developmental leadership frameworks, and empirical studies of coping, mindfulness, and culture from medicine, sport, and organizational psychology. Data from nursing and acute care suggest that psychological safety, emotional intelligence, and reflective practice correlate with performance and safety.
Defensive patterns in professional behavior are not merely interpersonal; they shape patient care. Humor, sublimation and mindfulness reflect mature defenses that sustain connection and safety. Cynicism, an immature defense, isolates and fragments teams. A mindful, reflective culture in perioperative medicine is therefore an unmeasured determinant of clinical excellence.
{"title":"Hope or erosion? Humor, cynicism, and the leadership challenge in perioperative medicine","authors":"Benjamin Martens , Silke Mischke , Markus M. Luedi","doi":"10.1016/j.jclinane.2025.112096","DOIUrl":"10.1016/j.jclinane.2025.112096","url":null,"abstract":"<div><div>The operating theater is an emotionally and cognitively demanding arena where anesthesiologists and surgeons operate under time pressure, uncertainty, and responsibility. Team interactions in such settings frequently reveal humor, irony, or cynicism, behaviors that represent underlying ego defense mechanisms.</div><div>We explore how defense mechanisms such as humor and cynicism affect perioperative culture, teamwork, and leadership; and to argue that self-awareness, mindfulness, and relational maturity indirectly improve clinical outcomes.</div><div>This conceptual analysis integrates psychoanalytic theories (Freud, Jung, Vaillant), developmental leadership frameworks, and empirical studies of coping, mindfulness, and culture from medicine, sport, and organizational psychology. Data from nursing and acute care suggest that psychological safety, emotional intelligence, and reflective practice correlate with performance and safety.</div><div>Defensive patterns in professional behavior are not merely interpersonal; they shape patient care. Humor, sublimation and mindfulness reflect mature defenses that sustain connection and safety. Cynicism, an immature defense, isolates and fragments teams. A mindful, reflective culture in perioperative medicine is therefore an unmeasured determinant of clinical excellence.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112096"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723559","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 : 2026-02-01Epub 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":"2026-02-01","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}
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":"2026-02-01","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 : 2026-02-01Epub Date: 2025-12-27DOI: 10.1016/j.jclinane.2025.112113
Jinyan Guo , Ke Chen , Xue Han , Weifeng Yao
{"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 , Ke Chen , Xue Han , 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-12-26DOI: 10.1016/j.jclinane.2025.112114
Moritz Flick , Bernd Saugel
{"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 , 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub 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":"2026-02-01","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 : 2026-02-01Epub Date: 2025-12-10DOI: 10.1016/j.jclinane.2025.112100
Sandesh Raja , Azzam Ali , Afeera Bashir , F.N.U. Kashish , Haniah Mahboob
Introduction
Acute respiratory distress syndrome (ARDS), often requires deep sedation to facilitate lung-protective ventilation. While intravenous sedatives (e.g., propofol, midazolam) are standard, inhaled agents (e.g., sevoflurane, isoflurane) have emerged as potential alternatives and may offer advantages in titratability and lung protection. This meta-analysis compares their efficacy in ARDS management.
Methods
Following PRISMA guidelines, we systematically searched multiple databases (inception–May 2025) for randomized and observational studies comparing inhaled versus intravenous sedation in ARDS. Outcomes included ICU length of stay, ventilator-free days (VFDs), mortality, and respiratory parameters. Risk of bias was assessed using ROB-2 and Newcastle-Ottawa tools. Random-effects meta-analyses were conducted for pooled estimates.
Results
Seven studies (1349 patients) were included. Inhaled sedation significantly reduced ICU stay (mean difference [MD]: −2.07 days; 95 % CI: −3.72 to −0.41; p = 0.01) and duration of mechanical ventilation (MD: −2.62 days; 95 % CI: −4.48 to −0.76; p = 0.006). However, Inhaled sedation was associated with significantly fewer VFDs (MD: −1.82; 95 % CI: −3.41 to −0.24; p = 0.02). No mortality difference was observed (p = 0.18). Inhaled agents improved PEEP on day 1 (p < 0.00001) but increased PaCO₂ (p < 0.00001) and reduced arterial pH (p = 0.001).
Conclusion
Inhaled sedation with volatile anesthetics may offer advantages over intravenous sedation in reducing ICU stay and mechanical ventilation duration in ARDS patients. However, the associated alterations in gas exchange parameters warrant cautious interpretation. Further large-scale studies are needed to confirm these findings and to optimize sedation strategies in this population.
Clinical trial registration
Not required.
Registration
This review is registered with PROSPERO (CRD420251049792).
{"title":"Evaluating sedation strategies in acute respiratory distress syndrome: A meta-analysis of inhaled versus intravenous agents","authors":"Sandesh Raja , Azzam Ali , Afeera Bashir , F.N.U. Kashish , Haniah Mahboob","doi":"10.1016/j.jclinane.2025.112100","DOIUrl":"10.1016/j.jclinane.2025.112100","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute respiratory distress syndrome (ARDS), often requires deep sedation to facilitate lung-protective ventilation. While intravenous sedatives (e.g., propofol, midazolam) are standard, inhaled agents (e.g., sevoflurane, isoflurane) have emerged as potential alternatives and may offer advantages in titratability and lung protection. This meta-analysis compares their efficacy in ARDS management.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we systematically searched multiple databases (inception–May 2025) for randomized and observational studies comparing inhaled versus intravenous sedation in ARDS. Outcomes included ICU length of stay, ventilator-free days (VFDs), mortality, and respiratory parameters. Risk of bias was assessed using ROB-2 and Newcastle-Ottawa tools. Random-effects meta-analyses were conducted for pooled estimates.</div></div><div><h3>Results</h3><div>Seven studies (1349 patients) were included. Inhaled sedation significantly reduced ICU stay (mean difference [MD]: −2.07 days; 95 % CI: −3.72 to −0.41; <em>p</em> = 0.01) and duration of mechanical ventilation (MD: −2.62 days; 95 % CI: −4.48 to −0.76; <em>p</em> = 0.006). However, Inhaled sedation was associated with significantly fewer VFDs (MD: −1.82; 95 % CI: −3.41 to −0.24; <em>p</em> = 0.02). No mortality difference was observed (<em>p</em> = 0.18). Inhaled agents improved PEEP on day 1 (<em>p</em> < 0.00001) but increased PaCO₂ (<em>p</em> < 0.00001) and reduced arterial pH (<em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>Inhaled sedation with volatile anesthetics may offer advantages over intravenous sedation in reducing ICU stay and mechanical ventilation duration in ARDS patients. However, the associated alterations in gas exchange parameters warrant cautious interpretation. Further large-scale studies are needed to confirm these findings and to optimize sedation strategies in this population.</div></div><div><h3>Clinical trial registration</h3><div>Not required.</div></div><div><h3>Registration</h3><div>This review is registered with PROSPERO (CRD420251049792).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112100"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742721","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 : 2026-02-01Epub Date: 2026-01-09DOI: 10.1016/S0952-8180(26)00002-4
{"title":"On the Cover - King et al","authors":"","doi":"10.1016/S0952-8180(26)00002-4","DOIUrl":"10.1016/S0952-8180(26)00002-4","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112124"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938767","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 : 2026-02-01Epub Date: 2026-01-03DOI: 10.1016/j.jclinane.2025.112107
Eduardo Mendez-Pino , Laura Ibanez-Pintor , Laura Mendez-Pino , Andres Zorrilla-Vaca , David L. Hepner
Background
There is increasing evidence supporting the use of intravenous (IV) iron in the perioperative setting, which has been shown to improve hemoglobin levels and reduce the need for transfusion. This study aimed to evaluate the efficacy of a single preoperative IV infusion of ferric derisomaltose administered 3 to 4 weeks prior to abdominal surgery in increasing hemoglobin (Hb) levels.
Methods
This single arm prospective trial with pos-hoc matched controls included adult patients with preoperative iron deficiency anemia (Hb ≤ 12 g/dL, and ferritin<30 ng/mL or transferrin saturation < 20 %) scheduled for abdominal surgery and treated with 1000 mg of IV ferric derisomaltose 3–4 weeks prior to surgery. The primary outcome was the change in Hb from baseline to the day of surgery. Between-group comparisons were performed using the paired t-test. A random control cohort who met our inclusion criteria but did not receive the treatment was included in a post-hoc analysis to evaluate associations with in-hospital blood transfusion.
Results
Among 36 patients treated with IV ferric derisomaltose, there was a significant improvement in hemoglobin levels after 3–4 weeks of drug administration (mean difference [MD] 1.88 g/dL, 95 % confidence interval [CI] 1.40 to 2.36) and after surgery (MD 0.67 g/dL, 95 %CI 0.16 to 1.17). Patients with moderate-to-severe pre-infusion anemia (Hb ≤ 10 g/dL) had a significantly superior improvement in Hb levels compared to patients with mild anemia (P = 0.03). In post-hoc analysis including a control group, transfusion rate was similar between the treated and control group (odds ratio 1.00, 95 %CI 0.29–3.48).
Conclusion
In this preliminary report with limited sample size, our findings suggest that a single preoperative dose of 1000 mg of IV ferric derisomaltose improves hemoglobin levels. Its ability to provide timely optimization before surgery warrants further investigation in large-scale trials to better define its role in perioperative care.
{"title":"Intravenous ferric derisomaltose for preoperative anemia in abdominal surgery","authors":"Eduardo Mendez-Pino , Laura Ibanez-Pintor , Laura Mendez-Pino , Andres Zorrilla-Vaca , David L. Hepner","doi":"10.1016/j.jclinane.2025.112107","DOIUrl":"10.1016/j.jclinane.2025.112107","url":null,"abstract":"<div><h3>Background</h3><div>There is increasing evidence supporting the use of intravenous (IV) iron in the perioperative setting, which has been shown to improve hemoglobin levels and reduce the need for transfusion. This study aimed to evaluate the efficacy of a single preoperative IV infusion of ferric derisomaltose administered 3 to 4 weeks prior to abdominal surgery in increasing hemoglobin (Hb) levels.</div></div><div><h3>Methods</h3><div>This single arm prospective trial with pos-hoc matched controls included adult patients with preoperative iron deficiency anemia (Hb ≤ 12 g/dL, and ferritin<30 ng/mL or transferrin saturation < 20 %) scheduled for abdominal surgery and treated with 1000 mg of IV ferric derisomaltose 3–4 weeks prior to surgery. The primary outcome was the change in Hb from baseline to the day of surgery. Between-group comparisons were performed using the paired <em>t-</em>test. A random control cohort who met our inclusion criteria but did not receive the treatment was included in a <em>post-hoc</em> analysis to evaluate associations with in-hospital blood transfusion.</div></div><div><h3>Results</h3><div>Among 36 patients treated with IV ferric derisomaltose, there was a significant improvement in hemoglobin levels after 3–4 weeks of drug administration (mean difference [MD] 1.88 g/dL, 95 % confidence interval [CI] 1.40 to 2.36) and after surgery (MD 0.67 g/dL, 95 %CI 0.16 to 1.17). Patients with moderate-to-severe pre-infusion anemia (Hb ≤ 10 g/dL) had a significantly superior improvement in Hb levels compared to patients with mild anemia (<em>P</em> = 0.03). In <em>post-hoc</em> analysis including a control group, transfusion rate was similar between the treated and control group (odds ratio 1.00, 95 %CI 0.29–3.48).</div></div><div><h3>Conclusion</h3><div>In this preliminary report with limited sample size, our findings suggest that a single preoperative dose of 1000 mg of IV ferric derisomaltose improves hemoglobin levels. Its ability to provide timely optimization before surgery warrants further investigation in large-scale trials to better define its role in perioperative care.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112107"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880369","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号