Pub Date : 2026-02-01Epub Date: 2025-12-24DOI: 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。
{"title":"Protection of the nasotracheal tube tip with a red rubber catheter in adults undergoing nasotracheal intubation: A randomized controlled trial","authors":"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","doi":"10.1016/j.jclinane.2025.112109","DOIUrl":"10.1016/j.jclinane.2025.112109","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Use of an RRC significantly reduced the likelihood of epistaxis (39.3 % vs. 62.5 %, Odds Ratio (OR) = 0.380, <em>p</em> = 0.0140; 95 % CI: 0.174 to 0.831, <em>p</em> = 0.0153; FDR = 0.0255) and the severity of epistaxis (OR for lower severity = 4.145; 95 % CI: 1.923 to 8.934, <em>p</em> = 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, <em>p</em> = 0.0005; FDR = 0.0015, d = 0.70). No difference was found in postoperative pain or in the rate of procedural complications.</div></div><div><h3>Conclusions</h3><div>Use of the RRC significantly reduced the likelihood and severity of epistaxis following nasal intubation, at the cost of longer time to intubation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112109"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834011","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}
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.
Objective
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.
Methods
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.
Results
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; p < 0.0001). Opioid consumption was lowest in the 0.2 mg/kg group (p = 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.
Conclusion
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.
儿童足部和踝关节手术后有效的疼痛控制仍然具有挑战性。腘窝神经阻滞被广泛应用，但其持续时间短。全身性地塞米松可能会延长镇痛时间，但在小儿区域麻醉中的证据仍然很少。目的评价儿童踝关节或足部手术行腘窝神经阻滞前两次静脉注射地塞米松（0.1 mg/kg和0.2 mg/kg）的镇痛效果和安全性。方法在这项随机、三盲临床试验中，90例儿童患者在腘神经阻滞前静脉注射安慰剂、0.1 mg/kg或0.2 mg/kg地塞米松。主要终点是到达第一次阿片类药物需求的时间。次要结局包括阿片类药物总消耗量、FLACC疼痛评分、炎症标志物（NLR、PLR）、血糖和运动恢复时间。结果与安慰剂组相比，地塞米松组的无阿片类药物间隔均明显延长（分别为12.3±2.4 h和13.7±2.6 h vs. 7.5±2.2 h; p < 0.0001）。0.2 mg/kg组阿片类药物消耗最低（p = 0.0292）。地塞米松组疼痛评分和炎症指标均较低。然而，血糖水平呈剂量依赖性增加，0.2 mg/kg组血糖水平最高。使用地塞米松也延迟了运动恢复。结论静脉注射地塞米松可有效延长小儿足踝手术后的镇痛时间，减少阿片类药物的需用。虽然0.2 mg/kg提供最大的效益，但0.1 mg/kg可能提供功效和代谢安全性之间的最佳平衡。试验注册：ClinicalTrials.gov （NCT05887765）。
{"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. , Bahadir Ciftci Assoc Prof., M.D. , Pawel Pietraszek M.D. , Tomasz Purat M.D. , Milud Shadi M.D. Ph.D , Bartosz Musielak M.D. Ph.D , Maciej Idzior M.D. Ph.D , Przemyslaw Daroszewski M.D. Ph.D , 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> < 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-12-10DOI: 10.1016/j.jclinane.2025.112098
Burhan Dost , Muzeyyen Beldagli , Yunus Emre Karapinar , Esra Turunc , Engin İhsan Turan , Alessandro De Cassai
{"title":"Methodological quality of systematic reviews on the quadratus lumborum block for cesarean section: An overview of systematic reviews","authors":"Burhan Dost , Muzeyyen Beldagli , Yunus Emre Karapinar , Esra Turunc , Engin İhsan Turan , 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-12-01DOI: 10.1016/j.jclinane.2025.112083
Pei-Fu Chen MD, PhD, Franklin Dexter MD, PhD
Background
Multiple anesthesiology endpoints follow log-normal distributions, including surgical times, anesthesia times, epidural placement times, extubation times, and post-anesthesia care unit times. These can be compared among people (e.g., anesthesiologists or surgeons), hospitals, or clinical trial centers to detect outliers. We consider comparisons of each group, henceforth referred to as a “person,” with the grand mean.
Methods
Monte-Carlo simulations were performed to evaluate risks of false detection (Type I errors) using generalized linear models, generalized pivotal methods, and mixed effects models with empirical Bayes means and standard errors predicted from the random effects. Models were evaluated with and without heteroscedastic consistent (robust) standard errors.
Results
Errors were > 10-fold when fixed effects models lacked Bonferroni correction for multiple comparisons. Šidák adjustments had small incremental inaccuracy because the comparisons being made were not statistically independent of one another. Robust variance estimates were more accurate than the default observed information matrix method. However, the sample size of 10 cases per person was too small for the robust variance method, resulting in large inaccuracy. With Bonferroni adjustment, robust variance estimation, and log link, there also were large errors with unequal sample sizes, even with a median of 60 cases per person. When a mixed effects model was used instead (i.e., shrinkage estimates), Bonferroni adjustment yielded highly inaccurate results. Without adjustment, errors were small to moderate. Generalized pivotal inference applied individually for each person compared with the grand mean had very small errors when used with Šidák adjustment.
Conclusions
For log-normally distributed continuous outcomes, with sample sizes of 100's of cases per person, consider fixed effect models with Bonferroni adjustment and robust variance estimation. Otherwise, we recommend generalized pivotal inference with Šidák adjustment.
{"title":"Comparing multiple people each to the grand mean of log-normally distributed endpoints","authors":"Pei-Fu Chen MD, PhD, Franklin Dexter MD, PhD","doi":"10.1016/j.jclinane.2025.112083","DOIUrl":"10.1016/j.jclinane.2025.112083","url":null,"abstract":"<div><h3>Background</h3><div>Multiple anesthesiology endpoints follow log-normal distributions, including surgical times, anesthesia times, epidural placement times, extubation times, and post-anesthesia care unit times. These can be compared among people (e.g., anesthesiologists or surgeons), hospitals, or clinical trial centers to detect outliers. We consider comparisons of each group, henceforth referred to as a “person,” with the grand mean.</div></div><div><h3>Methods</h3><div>Monte-Carlo simulations were performed to evaluate risks of false detection (Type I errors) using generalized linear models, generalized pivotal methods, and mixed effects models with empirical Bayes means and standard errors predicted from the random effects. Models were evaluated with and without heteroscedastic consistent (robust) standard errors.</div></div><div><h3>Results</h3><div>Errors were > 10-fold when fixed effects models lacked Bonferroni correction for multiple comparisons. Šidák adjustments had small incremental inaccuracy because the comparisons being made were not statistically independent of one another. Robust variance estimates were more accurate than the default observed information matrix method. However, the sample size of 10 cases per person was too small for the robust variance method, resulting in large inaccuracy. With Bonferroni adjustment, robust variance estimation, and log link, there also were large errors with unequal sample sizes, even with a median of 60 cases per person. When a mixed effects model was used instead (i.e., shrinkage estimates), Bonferroni adjustment yielded highly inaccurate results. Without adjustment, errors were small to moderate. Generalized pivotal inference applied individually for each person compared with the grand mean had very small errors when used with Šidák adjustment.</div></div><div><h3>Conclusions</h3><div>For log-normally distributed continuous outcomes, with sample sizes of 100's of cases per person, consider fixed effect models with Bonferroni adjustment and robust variance estimation. Otherwise, we recommend generalized pivotal inference with Šidák adjustment.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112083"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623201","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.2025.112112
Susana Priego-Jiménez PhD , Pablo Priego Jiménez PhD , María López-González MsC , Patricia Lorenzo-García PhD , Miguel Contreras-Molina MsC , Celia Álvarez-Bueno PhD
Background
Prehabilitation has reported improvements in exercise capacity, as measured by the six-minute walking test (6MWT), in people undergoing major abdominal and cardiothoracic surgery, although there is no evidence about which component of prehabilitation is most effective for improving exercise capacity.
Methods
A network meta-analysis (NMA) was performed to determine the effects of different components of prehabilitation on exercise capacity in people undergoing major abdominal or cardiothoracic surgery. A literature search was performed from baseline to September 2025. Randomized controlled trials on the effectiveness of prehabilitation programs on exercise capacity presurgery and recovery postsurgery were included. We assessed the risk of bias via the Cochrane risk of bias (RoB 2.0) tool and the quality of the evidence via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Pairwise meta-analyses and NMAs were performed for direct and indirect evidence.
Results
Thirty-eight studies were included in this NMA. The effects associated with improvements in exercise capacity presurgery scores were greatest for the moderate-intensity exercise group versus control group (Effect size [ES]: 0.93 95 % CI: 0.46, 1.40), followed by the multimodal group (exercise+ nutrition + psychological intervention) versus the control group (ES: 0.50, 95 % CI: 0.15, 0.86). The effects associated with 6MWT recovery postsurgery score were greatest for the exercise+ nutrition group versus the control group (ES: 1.08, 95 % CI: 0.00, 2.16), followed by the moderate-intensity exercise group versus the control group (ES: 0.55, 95 % CI: 0.08, 1.01), and the multimodal group versus the control group (ES: 0.35, 95 % CI: 0.03, 0.68).
Conclusions
Moderate-intensity exercise, followed by multimodal exercise, should be considered the most effective strategy for improving exercise capacity in people undergoing major abdominal and cardiothoracic surgery. Exercise plus nutrition is the most effective intervention to improve 6MWT recovery postsurgery, followed by moderate-intensity exercise and multimodal interventions. Owing to the importance of this outcome, as a predictor of both postsurgical complications and recovery capacity after surgery, it is essential to know the most effective intervention to improve it.
{"title":"Efficacy of prehabilitation interventions on exercise capacity of patients undergoing major abdominal and cardiothoracic surgery: A systematic review and network meta-analysis of randomized controlled trials","authors":"Susana Priego-Jiménez PhD , Pablo Priego Jiménez PhD , María López-González MsC , Patricia Lorenzo-García PhD , Miguel Contreras-Molina MsC , Celia Álvarez-Bueno PhD","doi":"10.1016/j.jclinane.2025.112112","DOIUrl":"10.1016/j.jclinane.2025.112112","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation has reported improvements in exercise capacity, as measured by the six-minute walking test (6MWT), in people undergoing major abdominal and cardiothoracic surgery, although there is no evidence about which component of prehabilitation is most effective for improving exercise capacity.</div></div><div><h3>Methods</h3><div>A network meta-analysis (NMA) was performed to determine the effects of different components of prehabilitation on exercise capacity in people undergoing major abdominal or cardiothoracic surgery. A literature search was performed from baseline to September 2025. Randomized controlled trials on the effectiveness of prehabilitation programs on exercise capacity presurgery and recovery postsurgery were included. We assessed the risk of bias via the Cochrane risk of bias (RoB 2.0) tool and the quality of the evidence via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Pairwise meta-analyses and NMAs were performed for direct and indirect evidence.</div></div><div><h3>Results</h3><div>Thirty-eight studies were included in this NMA. The effects associated with improvements in exercise capacity presurgery scores were greatest for the moderate-intensity exercise group versus control group (Effect size [ES]: 0.93 95 % CI: 0.46, 1.40), followed by the multimodal group (exercise+ nutrition + psychological intervention) versus the control group (ES: 0.50, 95 % CI: 0.15, 0.86). The effects associated with 6MWT recovery postsurgery score were greatest for the exercise+ nutrition group versus the control group (ES: 1.08, 95 % CI: 0.00, 2.16), followed by the moderate-intensity exercise group versus the control group (ES: 0.55, 95 % CI: 0.08, 1.01), and the multimodal group versus the control group (ES: 0.35, 95 % CI: 0.03, 0.68).</div></div><div><h3>Conclusions</h3><div>Moderate-intensity exercise, followed by multimodal exercise, should be considered the most effective strategy for improving exercise capacity in people undergoing major abdominal and cardiothoracic surgery. Exercise plus nutrition is the most effective intervention to improve 6MWT recovery postsurgery, followed by moderate-intensity exercise and multimodal interventions. Owing to the importance of this outcome, as a predictor of both postsurgical complications and recovery capacity after surgery, it is essential to know the most effective intervention to improve it.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112112"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880472","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: 2025-12-17DOI: 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":"2026-02-01","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}
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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2026-01-03DOI: 10.1016/j.jclinane.2025.112117
Ellen Y. Wang MD , Andrew J. Renuart MD , Stephen G. Flynn MD , Hanna Van Pelt BS , Prabhakar Devavaram MBBS , Linda A. Bulich MD , Mary Lyn Stein MD , Niroop R. Ravula MD, FRCA , Rajvinder S. Dhamrait MD, MBA, FCARCSI, FRCA , Kristin M. Kennedy MD , Man Yee Suen MMedSc , Christian Jackson MS , Kush Gupta MD , Alex Swanger MD , Romy Yun MD , Michael A. Evans MD, FAAP, FASA , Vanessa A. Olbrecht MD , Thomas J. Caruso MD, PhD
Background
Maintenance of oxygenation during microdirect laryngoscopy and bronchoscopy (MDLB) is an anesthetic challenge for pediatric anesthesia providers. High flow nasal cannula (HFNC) as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a safe method to deliver humidified oxygen to pediatric patients; however, its role in pediatrics for preventing apneic desaturation while under anesthesia is unclear. This study evaluated THRIVE for pediatric patients undergoing airway procedures. The primary aim was to assess the frequency of patients who had at least one “relative desaturation” event, assessed as a 4 % drop from a patient's average baseline saturation using the measure of oxygen desaturation index (ODI). The secondary aims assessed frequencies of total relative desaturation events, absolute desaturations below 90 % and surgical interruptions due to airway conditions.
Methods
This was a prospective, randomized controlled trial conducted across three pediatric sites (Lucile Packard Children's Hospital [Stanford University, Palo Alto, CA], UC Davis Children's Hospital [University of California, Davis, CA], and Boston Children's Hospital [Harvard University, Boston, MA]). Participants between the ages of 2 months to 18 years underwent airway examinations or airway procedures under general anesthesia. Participants were randomized in a 1:1 ratio to THRIVE or standard of care (SOC).
Results
A total of 144 participants were included. ODI measurements of relative desaturation in the THRIVE group and SOC group showed no differences in number of the participants who ever desaturated (p = 0.18). There was a difference in total number of relative desaturation events, accounting for multiple events per participant (p = 0.04). There were no differences in surgical interruptions due to airway conditions.
Conclusion
THRIVE was not superior to SOC for reducing the number of patients who experienced desaturations or surgical interruptions, though it may have some benefit for reducing the total number of desaturation events in those who desaturate.
{"title":"Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) use in a pediatric population: A prospective, randomized controlled trial","authors":"Ellen Y. Wang MD , Andrew J. Renuart MD , Stephen G. Flynn MD , Hanna Van Pelt BS , Prabhakar Devavaram MBBS , Linda A. Bulich MD , Mary Lyn Stein MD , Niroop R. Ravula MD, FRCA , Rajvinder S. Dhamrait MD, MBA, FCARCSI, FRCA , Kristin M. Kennedy MD , Man Yee Suen MMedSc , Christian Jackson MS , Kush Gupta MD , Alex Swanger MD , Romy Yun MD , Michael A. Evans MD, FAAP, FASA , Vanessa A. Olbrecht MD , Thomas J. Caruso MD, PhD","doi":"10.1016/j.jclinane.2025.112117","DOIUrl":"10.1016/j.jclinane.2025.112117","url":null,"abstract":"<div><h3>Background</h3><div>Maintenance of oxygenation during microdirect laryngoscopy and bronchoscopy (MDLB) is an anesthetic challenge for pediatric anesthesia providers. High flow nasal cannula (HFNC) as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a safe method to deliver humidified oxygen to pediatric patients; however, its role in pediatrics for preventing apneic desaturation while under anesthesia is unclear. This study evaluated THRIVE for pediatric patients undergoing airway procedures. The primary aim was to assess the frequency of patients who had at least one “relative desaturation” event, assessed as a 4 % drop from a patient's average baseline saturation using the measure of oxygen desaturation index (ODI). The secondary aims assessed frequencies of total relative desaturation events, absolute desaturations below 90 % and surgical interruptions due to airway conditions.</div></div><div><h3>Methods</h3><div>This was a prospective, randomized controlled trial conducted across three pediatric sites (Lucile Packard Children's Hospital [Stanford University, Palo Alto, CA], UC Davis Children's Hospital [University of California, Davis, CA], and Boston Children's Hospital [Harvard University, Boston, MA]). Participants between the ages of 2 months to 18 years underwent airway examinations or airway procedures under general anesthesia. Participants were randomized in a 1:1 ratio to THRIVE or standard of care (SOC).</div></div><div><h3>Results</h3><div>A total of 144 participants were included. ODI measurements of relative desaturation in the THRIVE group and SOC group showed no differences in number of the participants who ever desaturated (<em>p</em> = 0.18). There was a difference in total number of relative desaturation events, accounting for multiple events per participant (<em>p</em> = 0.04). There were no differences in surgical interruptions due to airway conditions.</div></div><div><h3>Conclusion</h3><div>THRIVE was not superior to SOC for reducing the number of patients who experienced desaturations or surgical interruptions, though it may have some benefit for reducing the total number of desaturation events in those who desaturate.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112117"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-03DOI: 10.1016/j.jclinane.2025.112121
Qingyu Teng MM, Zhiqiang Qian MM, Sijia Yao MM, Qi Li MM, Tao Xu Ph.D, M.D
{"title":"The PAPE block: Ultrasound-guided pericapsular anterior and posterior elbow nerve group block for motor-sparing analgesia","authors":"Qingyu Teng MM, Zhiqiang Qian MM, Sijia Yao MM, Qi Li MM, Tao Xu Ph.D, M.D","doi":"10.1016/j.jclinane.2025.112121","DOIUrl":"10.1016/j.jclinane.2025.112121","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112121"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-24DOI: 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).
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.
{"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":"2026-02-01","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}
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