Journal of Clinical Anesthesia最新文献

{"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 ,&nbsp;Selina Sartori ,&nbsp;Christoph Klivinyi ,&nbsp;Michael Schörghuber ,&nbsp;Jakob Pannold ,&nbsp;Igor Knez ,&nbsp;Alexander H. Kirsch ,&nbsp;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}

{"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}

{"title":"Impact of implementing a thromboelastometry-guided transfusion strategy on fibrinogen supplementation and transfusion in women with postpartum hemorrhage","authors":"Anne Zheng ,&nbsp;Valérie Chamouard ,&nbsp;Christophe Nougier ,&nbsp;François-Pierrick Desgranges ,&nbsp;Charles-Hervé Vacheron ,&nbsp;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}

{"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 ,&nbsp;Linor Berezin MD ,&nbsp;Aparna Saripella MSc ,&nbsp;Ellene Yan HBSc ,&nbsp;Bianca Pivetta MD ,&nbsp;Khashayar Poorzargar MSc ,&nbsp;Emmanuel Olaonipekun BSc ,&nbsp;Marina Englesakis MLIS ,&nbsp;Majid Nabipoor PhD ,&nbsp;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}

{"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}

{"title":"Evaluating sedation strategies in acute respiratory distress syndrome: A meta-analysis of inhaled versus intravenous agents","authors":"Sandesh Raja ,&nbsp;Azzam Ali ,&nbsp;Afeera Bashir ,&nbsp;F.N.U. Kashish ,&nbsp;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> &lt; 0.00001) but increased PaCO₂ (<em>p</em> &lt; 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":"2025-12-10","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}

{"title":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(25)00349-6","DOIUrl":"10.1016/S0952-8180(25)00349-6","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112088"},"PeriodicalIF":5.1,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732970","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":"Methodological quality of systematic reviews on the quadratus lumborum block for cesarean section: An overview of systematic reviews","authors":"Burhan Dost ,&nbsp;Muzeyyen Beldagli ,&nbsp;Yunus Emre Karapinar ,&nbsp;Esra Turunc ,&nbsp;Engin İhsan Turan ,&nbsp;Alessandro De Cassai","doi":"10.1016/j.jclinane.2025.112098","DOIUrl":"10.1016/j.jclinane.2025.112098","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112098"},"PeriodicalIF":5.1,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742850","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":"Hope or erosion? Humor, cynicism, and the leadership challenge in perioperative medicine","authors":"Benjamin Martens ,&nbsp;Silke Mischke ,&nbsp;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":"2025-12-09","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}

{"title":"Effect of intravenous dexamethasone on duration of analgesia following popliteal nerve block in pediatric ankle surgery: A randomized, triple-blinded clinical trial","authors":"Tomasz Reysner M.D. ,&nbsp;Bahadir Ciftci Assoc Prof., M.D. ,&nbsp;Pawel Pietraszek M.D. ,&nbsp;Tomasz Purat M.D. ,&nbsp;Milud Shadi M.D. Ph.D ,&nbsp;Bartosz Musielak M.D. Ph.D ,&nbsp;Maciej Idzior M.D. Ph.D ,&nbsp;Przemyslaw Daroszewski M.D. Ph.D ,&nbsp;Malgorzata Reysner M.D. Ph.D","doi":"10.1016/j.jclinane.2025.112094","DOIUrl":"10.1016/j.jclinane.2025.112094","url":null,"abstract":"<div><h3>Background</h3><div>Effective postoperative pain control in pediatric foot and ankle surgery remains challenging. Popliteal nerve blocks are widely used but limited by their short duration. Systemic dexamethasone may prolong analgesia, yet evidence in pediatric regional anesthesia remains sparse.</div></div><div><h3>Objective</h3><div>To assess the analgesic efficacy and safety of two intravenous dexamethasone doses (0.1 mg/kg and 0.2 mg/kg) administered before a single-shot popliteal nerve block in children undergoing ankle or foot surgery.</div></div><div><h3>Methods</h3><div>In this randomized, triple-blinded clinical trial, 90 pediatric patients were allocated to receive either placebo, 0.1 mg/kg, or 0.2 mg/kg dexamethasone intravenously prior to popliteal nerve block. The primary outcome was time to first opioid requirement. Secondary outcomes included total opioid consumption, FLACC pain scores, inflammatory markers (NLR, PLR), blood glucose, and time to motor recovery.</div></div><div><h3>Results</h3><div>Both dexamethasone groups had significantly longer opioid-free intervals compared to placebo (12.3 ± 2.4 h and 13.7 ± 2.6 h vs. 7.5 ± 2.2 h; <em>p</em> &lt; 0.0001). Opioid consumption was lowest in the 0.2 mg/kg group (<em>p</em> = 0.0292). Pain scores and inflammatory markers were consistently lower in dexamethasone groups. However, blood glucose levels increased dose-dependently, with the highest values in the 0.2 mg/kg group. Motor recovery was also delayed with dexamethasone use.</div></div><div><h3>Conclusion</h3><div>Intravenous dexamethasone effectively prolongs analgesia and reduces opioid requirements after pediatric foot and ankle surgery. While 0.2 mg/kg provides maximal benefit, 0.1 mg/kg may offer an optimal balance between efficacy and metabolic safety.</div><div>Trial registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT05887765</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112094"},"PeriodicalIF":5.1,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145692699","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}