Journal of Clinical Anesthesia最新文献

{"title":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(26)00004-8","DOIUrl":"10.1016/S0952-8180(26)00004-8","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112126"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938763","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 fascial plane blocks in the upper arm surgery and trauma: A narrative review","authors":"Francesco Marrone ,&nbsp;Lorenza Sbucafratta ,&nbsp;Pierfrancesco Fusco","doi":"10.1016/j.jclinane.2025.112115","DOIUrl":"10.1016/j.jclinane.2025.112115","url":null,"abstract":"<div><div>Fascial plane blocks are becoming popular as useful and safe methods to provide pain relief. While their use in thoracic and abdominal surgery is well known, their application in upper arm surgery and trauma is underscored. This review explores research from the last 10 years focusing the use of fascial plane blocks to relieve pain after surgery or trauma in the upper limb. Studies include randomized controlled trials, observational studies, and case reports. They look at techniques like the cervical and high-thoracic erector spinae plane (ESP) block, the clavipectoral fascia plane (CFP) block, the superior posterior serratus intercostal plane (SPSIP) block, and periarticular approaches like the pericapsular (PENG) shoulder block. The high-thoracic ESP block provided pain relief and was often given with a continuous catheter infusion. The research shows that there is a tendency toward combining fascial blocks with each other or with peripheral nerve blocks to cover more area and cut down on the use of opioids. Even if the results are promising, there aren't many randomized trials in the literature, thus data are still mostly low-quality level. Risk of potential complications, such as local anesthetic systemic toxicity (LAST) or unintentional dissemination to important anatomical areas, exists although not reported. This study shows how fascial plane blocks in upper limb surgery are changing and recommends for more high-quality research to find out when they are best used, how safe they are, and how well they may work.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112115"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850418","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":"Pupillometry and pre-operative cognitive function: A possible new tool in identifying a frail brain","authors":"Paolo Zanatta ,&nbsp;Andrea Rossi ,&nbsp;Giorgio Fullin ,&nbsp;Luigi Polesello ,&nbsp;Alice Baruffol ,&nbsp;Federico Linassi","doi":"10.1016/j.jclinane.2025.112119","DOIUrl":"10.1016/j.jclinane.2025.112119","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112119"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145863120","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":"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":"2026-02-01","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":"The neurocardiac axis in acute intracranial stress","authors":"Wesley L. Allen ,&nbsp;Kiran S. Merchant ,&nbsp;Archer K. Martin,&nbsp;Shaun E. Gruenbaum,&nbsp;Benjamin F. Gruenbaum","doi":"10.1016/j.jclinane.2025.112105","DOIUrl":"10.1016/j.jclinane.2025.112105","url":null,"abstract":"<div><div>Acute intracranial injuries including subarachnoid hemorrhage, traumatic brain injury, stroke, and seizures often trigger cardiovascular and pulmonary complications through the neurocardiac axis. This bidirectional connection between the brain and the heart is mediated by sympathetic overactivity, catecholamine excess, autonomic imbalance, and systemic inflammation. This narrative review synthesizes current evidence published between 1968 and 2025, identified through a comprehensive literature search. Representative studies were selected to provide an integrative overview of neurocardiac complications in acute neurologic injury, focusing on underlying mechanisms, clinical manifestations, diagnostic challenges, and management strategies. We describe the mechanisms underlying neurogenic stunned myocardium and Takotsubo syndrome, highlighting regional vulnerability based on autonomic innervation. Electrocardiographic features, cardiac biomarkers, and echocardiographic findings are discussed in the context of early recognition and risk stratification. We further examine diagnostic challenges, the importance of distinguishing neurologic from primary cardiac pathology, and therapeutic approaches including autonomic modulation and cardiopulmonary protective strategies. Understanding the unique pathogenesis of these syndromes can help guide individualized treatment strategies and anesthetic management to improve outcomes in patients with acute neurologic injury. By consolidating multidisciplinary insights, this review aims to enhance recognition and management of neurocardiac complications in this population.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112105"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacogenetics in perioperative care: Understanding the impact of genetic variants on patient management","authors":"Jan Albert Nicolaas Groot ,&nbsp;Ankie Maxelante Harmsze ,&nbsp;Eric Hendricus Paulus Adrianus van Dongen ,&nbsp;Catherijne Anette Jantine Knibbe ,&nbsp;Helena Johanna Blussé van Oud-Alblas","doi":"10.1016/j.jclinane.2025.112064","DOIUrl":"10.1016/j.jclinane.2025.112064","url":null,"abstract":"<div><div>Despite advances in perioperative medicine, variability in patient responses to commonly administered anesthetic and analgesic agents remains a clinical challenge. Genetic factors are increasingly proposed contributors to these interindividual differences, yet much of the supporting evidence remains preliminary, heterogeneous or insufficiently validated. Pharmacogenetics has emerged as a promising field to improve therapeutic precision. However, its clinical application in perioperative care remains limited. This narrative review critically appraises pharmacokinetic and pharmacodynamic drug–gene interactions that influence responses to routinely administered agents. Genetic variations affect multiple aspects of perioperative care, including drug metabolism and receptor sensitivity, pain processing, autonomic function, and susceptibility to complications such as postoperative nausea and vomiting and opioid-induced respiratory depression. A better understanding of drug–gene interactions may help anesthesiologists identify patients with atypical sensitivity or resistance to commonly used agents, as well as those at increased risk for perioperative complications. Integration of pharmacogenetic data into perioperative decision-making may facilitate individualized care, but broader implementation will require replication in diverse cohorts, prospective clinical validation and development of evidence-based guidelines.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112064"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418670","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 effectiveness of preoperative oral carbohydrate loading on postoperative nausea and vomiting in adults receiving total intravenous anaesthesia compared to inhalational anaesthesia: A systematic review and meta-analysis","authors":"Oya Gumuskaya ,&nbsp;Hailey R. Donnelly ,&nbsp;Nick Glenn ,&nbsp;Julee McDonagh ,&nbsp;Anita Skaros ,&nbsp;Sophie Liang ,&nbsp;Brett G. Mitchell ,&nbsp;Luke Bendle ,&nbsp;Sarah Aitken ,&nbsp;Emile Belramoul ,&nbsp;Mitchell Sarkies","doi":"10.1016/j.jclinane.2025.112075","DOIUrl":"10.1016/j.jclinane.2025.112075","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative oral carbohydrate loading is thought to reduce postoperative nausea and vomiting (PONV). However, it is unknown if the benefit of carbohydrate loading is maintained in the presence of total intravenous anaesthesia (TIVA). The aim of this systematic review was to determine whether oral carbohydrate loading reduced PONV compared to overnight fasting between adult elective surgery patients receiving TIVA or inhalational general anaesthesia.</div></div><div><h3>Methods</h3><div>A search of seven databases was conducted until March 2024. Randomised controlled trials conducted with patient aged 18 years or older were included. Two reviewers independently screened titles, abstracts and full texts, and assessed risk of bias using the Cochrane ROB-2 Tool. Study data was pooled using random effects meta-analyses.</div></div><div><h3>Results</h3><div>We included 26 studies in this review, and 25 in the meta-analyses (<em>n</em> = 2491). Preoperative oral carbohydrate loading reduced the overall risk (log RR: –0.35, 95 % CI: −0.62 to −0.08, I² = 51.11 %) and severity (SMD: -0.46, 95 % CI: −0.68 to −0.24, I² = 62.09 %) of PONV, and pain severity (MD: -0.69, 95 % CI: −1.13 to −0.25, I² = 83.98 %) compared to prolonged fasting when pooled across both anaesthesia approaches. The risk of PONV was reduced in patients receiving inhalational anaesthesia, but not in those receiving TIVA, while the reduction in severity was more significant in TIVA.</div></div><div><h3>Conclusion</h3><div>Oral carbohydrate loading reduces the severity of PONV and pain, regardless of the anaesthesia approach, compared to prolonged fasting. These findings support the clinical advantages of oral carbohydrate loading for postoperative outcomes, regardless of anaesthesia approach.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112075"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541026","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":"Intubating conditions based on the time from rocuronium administration versus the train-of-four count: A randomized, prospective, clinical trial","authors":"J. Ross Renew ,&nbsp;Maria Estevez ,&nbsp;Mariel Maramba ,&nbsp;Michael G. Heckman ,&nbsp;Zhihui J. Fang ,&nbsp;Sorin J. Brull ,&nbsp;Richard H. Epstein","doi":"10.1016/j.jclinane.2025.112066","DOIUrl":"10.1016/j.jclinane.2025.112066","url":null,"abstract":"<div><h3>Background</h3><div>The use of quantitative neuromuscular monitoring during induction of anesthesia to establish a baseline neuromuscular response and ensure paralysis of the vocal cords during laryngoscopy and tracheal intubation has yet to become standard practice. The current study compared intubating conditions based on quantitative measurements (train-of-four count) with intubating conditions based on the time since rocuronium administration.</div></div><div><h3>Methods</h3><div>Consenting adult patients undergoing general anesthesia requiring neuromuscular block were randomized into 2 groups. Following placement of a quantitative electromyographic neuromuscular monitor, general anesthesia was induced with propofol 1–1.5 mg/kg followed by rocuronium 0.6 mg/kg. In one group, intubation commenced 2 min after rocuronium administration (Time Group). In the other, intubation commenced when the first train-of-four (TOF) count was ≤1 (Count Group). Video laryngoscopy was used in both groups and the intubating conditions were noted. A Wilcoxon rank sum test or Fisher's exact test was used to compare intubating conditions between the 2 groups. Spearman's rank correlation test was used to describe the relationship between intubation conditions and the ratio of the amplitude of the first twitch of the TOF sequence, T₁, to the control T₁ amplitude (T₁/T_c).</div></div><div><h3>Results</h3><div>There were 84 patients in the Count Group and 83 in the Time Group. More patients had ideal intubating conditions (relaxed jaw, abducted vocal cords, and no response to tracheal intubation) in the Count Group (61/84, 73 %) than the Time Group (47/83, 57 %, <em>P</em> = 0.036). The mean composite intubating score was better (lower) in the Count Group than in the Time Group (3.5 vs. 3.9, respectively, <em>P</em> = 0.016). The T₁/T_c at intubation correlated with the composite intubating conditions score (Spearman's <em>ρ</em> = 0.34, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Intubating conditions were better when the timing of intubation was guided by quantitative neuromuscular monitoring to ensure a TOF count ≤1 versus waiting a fixed time interval of 2 min following administration of rocuronium.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112066"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495599","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":"Erratum to “Removal of EpCAM-positive tumor cells during intraoperative blood salvage– A pivotal multicenter clinical study (REMOVE)” [Journal of Clinical Anesthesia 106 (2025) 111972 (9 pages)]","authors":"Patrick Meybohm MD ,&nbsp;Suma Choorapoikayil PhD ,&nbsp;Sebastian Zinn MD ,&nbsp;Simone Lindau MD ,&nbsp;Markus Heiss MD ,&nbsp;Jerome Defosse MD ,&nbsp;Eva Wittenmeier MD ,&nbsp;Marion Ferner MD ,&nbsp;Maximillian Kriegmair MD ,&nbsp;Niklas Westhoff MD ,&nbsp;Sebastian Hottenrott MD ,&nbsp;Tobias Haas MD ,&nbsp;Peter Kranke MD ,&nbsp;Tom-Philipp Zucker MD ,&nbsp;Andreas Schnitzbauer MD ,&nbsp;Luis Kluth MD ,&nbsp;Frank Wappler MD ,&nbsp;Nina Walossek MD ,&nbsp;Michael Schuster MD ,&nbsp;Anna Lotz ,&nbsp;Kai Zacharowski MD, PhD","doi":"10.1016/j.jclinane.2025.111986","DOIUrl":"10.1016/j.jclinane.2025.111986","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 111986"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955306","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":"Unmasking the silent threat: Navigating the myocardial injury in oncological surgery","authors":"Zhen-Zhen Xu ,&nbsp;Dong-Liang Mu","doi":"10.1016/j.jclinane.2025.112063","DOIUrl":"10.1016/j.jclinane.2025.112063","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112063"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450560","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}