Journal of Clinical Anesthesia最新文献

英文中文

Hemodynamic data reporting and group separation: Key to interpreting individualized blood pressure trials 血流动力学数据报告和组分离：解释个体化血压试验的关键。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-11-21 DOI: 10.1016/j.jclinane.2025.112074

Amelie Delaporte MD , Ehab Bahrun MD , Kenneth Lin , Tristan Grogan MS , Alexandre Joosten MD PhD

引用次数: 0

Why Do Deaths and Catastrophic Injury From Anesthesia in the Dental Office-Based Setting Still Occur? 为什么在牙科诊所的麻醉环境中仍然发生死亡和灾难性伤害？

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-11-14 DOI: 10.1016/j.jclinane.2025.112072

Sangeeta Kumaraswami MD , Shital Patel , James Tom DDS , Rita Agarwal MD, FASA

引用次数: 0

Re: Unpacking the “bundled intervention” and interpreting the outcomes in the individualized blood pressure strategy trial 对个体化血压策略试验中的“捆绑干预”进行拆解并解释结果。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-10-27 DOI: 10.1016/j.jclinane.2025.112038

Qiaohong Chen , Tiantian Zhang , Shaoyong Han

引用次数: 0

Preoperative glycated hemoglobin as a predictor of infection in patients undergoing spinal surgery: A retrospective analysis of MIMIC-IV database 术前糖化血红蛋白作为脊柱手术患者感染的预测因子：MIMIC-IV数据库的回顾性分析。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-10-28 DOI: 10.1016/j.jclinane.2025.112050

Paul Karim B.A. , Jiahui Chen B.S. , Isaac Huang B.A. , Marco Sanvitti , Robert Canelli M.D. , Federico Bilotta M.D.

Objective

To investigate whether elevated preoperative glycated hemoglobin (HbA1c) levels predict postoperative infections and related clinical outcomes following spinal surgery.

Design

Retrospective cohort analysis utilizing the publicly available MIMIC-IV database.

Setting

Single-center academic medical institution with intensive care capability.

Patients

A total of 246 adult patients undergoing spinal surgery with recorded preoperative HbA1c levels.

Interventions

None.

Measurements

The primary outcome was clinician-suspected postoperative infection within 24 h after surgery, defined by culture orders plus antibiotic initiation. Secondary outcomes included Sepsis-3 criteria-defined sepsis, SIRS sepsis, septic shock, and hospital length of stay.

Main results

Elevated preoperative HbA1c (≥6.5 %) was independently associated with significantly increased odds of clinician-suspected postoperative infection (OR 3.20; 95 % CI 1.22–8.36; p = 0.018), after controlling for comorbidity burden and surgical complexity. However, elevated HbA1c did not independently predict more severe outcomes such as Sepsis-3 sepsis or septic shock.

Conclusions

Elevated preoperative HbA1c substantially increases the likelihood of early clinician suspicion and empirical treatment of postoperative infections after spinal surgery. Routine HbA1c screening should therefore be considered during preoperative evaluations, especially for elective instrumented spinal procedures known for higher infection risks. While these findings support existing clinical guidelines recommending perioperative glycemic optimization, elevated HbA1c alone may not predict severe infection or septic complications once comorbidity burden is considered.

目的：探讨术前糖化血红蛋白（HbA1c）水平升高是否能预测脊柱手术后感染及相关临床结局。设计：利用公开的MIMIC-IV数据库进行回顾性队列分析。环境：具有重症监护能力的单中心学术医疗机构。患者：共有246名接受脊柱手术的成年患者，术前记录了HbA1c水平。干预措施:没有。测量：主要结果是术后24小时内临床怀疑的术后感染，由培养顺序加抗生素起始定义。次要结局包括脓毒症-3标准定义的脓毒症、SIRS脓毒症、脓毒症休克和住院时间。主要结果：在控制合并症负担和手术复杂性后，术前HbA1c升高（≥6.5%）与临床怀疑的术后感染几率显著增加独立相关（OR 3.20; 95% CI 1.22-8.36; p = 0.018）。然而，HbA1c升高并不能独立预测更严重的结果，如脓毒症-3型脓毒症或脓毒症休克。结论：术前HbA1c升高大大增加了临床医生早期怀疑和经验性治疗脊柱术后感染的可能性。因此，术前评估时应考虑常规HbA1c筛查，特别是对于已知感染风险较高的选择性脊柱固定手术。虽然这些发现支持现有的临床指南推荐围手术期血糖优化，但一旦考虑合并症负担，单独升高的HbA1c可能无法预测严重感染或脓毒性并发症。

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引用次数: 0

Intraoperative burst suppression and emergence delirium in pediatric: A prospective observational study 小儿术中突发抑制和出现性谵妄：一项前瞻性观察研究

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 10.1016/j.jclinane.2025.112078

Qian Xu, Jianmin Zhang, Fang Wang, Zhengzheng Gao, Lijing Li, Xiaolu Nie, Shanshan Li

Background

Emergence delirium (ED), a common postoperative neurological disorder in children, is characterized by disturbances in consciousness, attention, disorientation, and perceptual changes. Intraoperative burst suppression has been associated with postoperative delirium in adults, and its relationship with emergence delirium in children remains unclear and controversial.

Methods

This investigation was conducted at Beijing Children's Hospital, Capital Medical University, from January 2022 to January 2023. The study incorporated children aged 6 months to 9 years who were undergoing general anesthesia with electroencephalography (EEG) monitoring. Intraoperative processed EEG and the incidence of burst suppression were recorded. Postoperative delirium was evaluated using the Pediatric Anesthesia Emergence Delirium Scale. A score of 10 points or higher on this scale was used as an indicator of the presence of emergence delirium.

Results

Among the 207 children enrolled, the incidence of emergence delirium was 43 % in the set of children with burst suppression, whereas it was only 7 % in the non-burst suppression set. Binary logistic regression analysis pinpointed two distinct risk factors for the emergence of delirium. These were the agent used for maintenance of anesthesia and intraoperative burst suppression. Children maintained under intravenous propofol for maintenance of anesthesia experienced 57 % lower incidence of emergence delirium than those maintained under sevoflurance for anesthesia maintenance. Furthermore, children with burst suppression were eight times more likely to develop emergence delirium, according to intraoperative processed EEG monitoring.

Conclusions

This study demonstrated a notable association between intraoperative burst suppression and the incidence of postoperative emergence delirium. These findings suggest that processed EEG-based monitoring and tailored anesthesia strategies may help prevent emergence delirium and other unfavorable outcomes in pediatric surgical patients.

背景：谵妄（ED）是儿童术后常见的神经系统疾病，以意识障碍、注意力、定向障碍和知觉改变为特征。术中爆发抑制与成人术后谵妄有关，其与儿童突发性谵妄的关系尚不清楚且存在争议。方法调查于2022年1月~ 2023年1月在首都医科大学附属北京儿童医院进行。该研究纳入了6个月至9岁的儿童，他们接受全身麻醉并进行脑电图监测。记录术中处理的脑电图及发作抑制发生率。术后谵妄评估采用小儿麻醉出现谵妄量表。在这个量表上得分10分或更高被用作出现谵妄的指标。结果入选的207例患儿中，突发抑制组患儿出现突发性谵妄的发生率为43%，而非突发抑制组患儿出现突发性谵妄的发生率仅为7%。二元logistic回归分析明确了谵妄出现的两个不同的危险因素。这些药物用于维持麻醉和术中爆发抑制。静脉异丙酚维持麻醉的儿童比七氟醚维持麻醉的儿童出现谵妄的发生率低57%。此外，根据术中处理的脑电图监测，爆发抑制的儿童发生突发性谵妄的可能性是正常儿童的8倍。结论术中爆发抑制与术后出现性谵妄发生率显著相关。这些发现表明，经过处理的基于脑电图的监测和量身定制的麻醉策略可能有助于预防小儿外科患者出现谵妄和其他不良后果。

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引用次数: 0

Beyond the RCT bubble: Translating preoperative dexmedetomidine into geriatric hip fracture practice 超越随机对照试验泡：将术前右美托咪定应用于老年髋部骨折实践。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-11-03 DOI: 10.1016/j.jclinane.2025.112055

Weijian Liang , Jinyan Guo , Weifeng Yao

引用次数: 0

Intraoperative methylene blue infusion reduces postoperative delirium in patients undergoing pancreatic surgery: A randomized controlled clinical trial 术中亚甲蓝输注减少胰腺手术患者术后谵妄：一项随机对照临床试验

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-11-01 DOI: 10.1016/j.jclinane.2025.112060

Yixu Deng , Jing Dong , Congxia Pan , Lingling Deng , Zhiyong He , Li Yang , Jie Hua , Jun Zhang

Study objective

Our study aims to test the hypothesis that intraoperative methylene blue reduces the incidence of postoperative delirium (POD) following major abdominal surgery, and to evaluate the inflammatory biomarkers as potential mediators.

Design

A randomized, single blind clinical trial.

Setting

University cancer center.

Patients

Three hundred and fourteen patients scheduled for pancreatic surgery.

Interventions

Patients were randomly assigned to methylene blue group, who receiving intravenous infusion of 2 mg kg^-1 methylene blue within 60 min immediately after anesthetic induction, followed by infusion of 1 mg kg^-1 methylene blue within 30 min before the end of surgery, or control group, who receiving equal volume saline.

Measurements

The primary outcome was POD incidence. The secondary outcomes included plasma interleukin 6 (IL-6) and interleukin 8 (IL-8) concentrations before and after surgery, gene expressions in human brain microvascular endothelial cells (hCMEC/d3) and peripheral blood mononuclear cells (PBMCs) adhesion to hCMEC/d3. Perioperative adverse events were also documented.

Main results

A total of 55 patients (17.5%) experienced POD, with a lower POD incidence in the methylene blue group than in the control group (11.5% vs. 23.6%, p = 0.005). The adverse events in the two groups were comparable. And postoperative plasma IL-6 but not IL-8 concentration was lower in the methylene blue group. Furthermore, endothelial TNF-α, MCP-1 and VCAM1 expressions were lower when treated with serum from the methylene blue group, and the number of PBMCs adhesion to hCMEC/d3 cells was also less in the methylene blue group.

Conclusion

Intraoperative methylene blue use effectively and safely reduced the POD incidence in patients undergoing pancreatic surgery, which may be associated with decrease in systemic inflammation and immunovascular interactions.

研究目的本研究旨在验证术中亚甲基蓝降低腹部大手术术后谵妄（POD）发生率的假设，并评估炎症生物标志物作为潜在介质的作用。设计一项随机、单盲临床试验。大学癌症中心。病人314名病人计划进行胰腺手术。干预措施随机分为亚甲基蓝组，麻醉诱导后60分钟内静脉输注2 mg kg-1亚甲基蓝，手术结束前30分钟内静脉输注1 mg kg-1亚甲基蓝，对照组输注等体积生理盐水。主要观察指标为POD发生率。次要结果包括手术前后血浆白细胞介素6 （IL-6）和白细胞介素8 （IL-8）浓度、人脑微血管内皮细胞（hCMEC/d3）基因表达和外周血单核细胞（PBMCs）与hCMEC/d3的粘附。围手术期不良事件也有记录。主要结果55例（17.5%）患者发生POD，亚甲基蓝组POD发生率低于对照组（11.5% vs. 23.6%, p = 0.005）。两组的不良事件具有可比性。亚甲基蓝组术后血浆IL-6浓度较低，IL-8浓度未见下降。亚甲基蓝组内皮细胞TNF-α、MCP-1和VCAM1表达较低，亚甲基蓝组PBMCs粘附hCMEC/d3细胞的数量也较少。结论术中使用亚甲基蓝可有效、安全地降低胰腺手术患者POD的发生率，这可能与全身炎症和免疫血管相互作用的减少有关。

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引用次数: 0

Response to comment on “The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery” 对“改良陡坡试验作为胰腺手术患者术前风险评估的实用运动试验的有效性”评论的回应。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-09-23 DOI: 10.1016/j.jclinane.2025.112007

Lis S.M. Hoeijmakers , Heleen Driessens , Marcel den Dulk , Steven W.M. Olde Damink , Joost M. Klaase , Bart C. Bongers

引用次数: 0

The analgesic efficacy of subacromial bursa block for arthroscopic shoulder surgery: A systematic review and meta-analysis 肩关节镜手术中肩峰下滑囊阻滞的镇痛效果：一项系统回顾和荟萃分析。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-11-18 DOI: 10.1016/j.jclinane.2025.112071

N. Patel , R. Brull , E.M. Yung , N. Hussain , T. Got , T. Dwyer , R. Urman , F.W. Abdallah

Background

The subacromial-subdeltoid bursa block (SBB) has been reported to provide postoperative pain relief following arthroscopic shoulder surgery, although evidence of its efficacy remains unclear. This meta-analysis evaluates the analgesia efficacy of adding SBB to systemic analgesia compared to systemic analgesia alone.

Methods

Literature was searched for randomized controlled trials comparing SBB and systemic analgesia to systemic analgesia alone (Control). Post-operative analgesic consumption, measured in oral morphine equivalents over the first 24 h post-operatively, was the primary outcome. Secondary outcomes included pain scores up to 48 h post-operatively, patient satisfaction, functional outcomes, opioid-related side effects, and block-related complications.

Results

Fifteen trials (679 patients) were included. Compared to systemic analgesia alone, the addition of single injection SBB reduced 24-h post-operative morphine consumption by 58.98 mg [−100.14, −17.81] (p = 0.005) over the first 24 h. SBB also reduced pain scores up to 18 h post-operatively. In contrast, continuous SBB did not reduce opioid consumption, with a mean difference of −40.36 mg [−81.77, 1.06] (p = 0.06). Additionally, continuous SBB did not improve pain control at any time point. The addition of SBB did not yield any differences in patient satisfaction, functional scores, or adverse events compared to systemic analgesia alone.

Conclusions

Compared to systemic analgesia alone, this meta-analysis suggests that for arthroscopic shoulder surgery, the addition of single-injection SBB can reduce postoperative pain and opioid consumption for up to 18 and 24 h, respectively. In contrast, continuous SBB does not seem to improve any of the analgesic outcomes. Single-injection SBB may be considered an effective analgesic technique for arthroscopic shoulder surgery when proximal brachial plexus blockade is contraindicated or otherwise undesirable.

背景：据报道，肩峰下-三角下滑囊阻滞（SBB）可缓解关节镜肩关节手术后的疼痛，尽管其有效性的证据尚不清楚。本荟萃分析评估了与单独全身镇痛相比，在全身镇痛中加入SBB的镇痛效果。方法：查阅文献，比较SBB联合全身镇痛与单独全身镇痛（对照组）的随机对照试验。术后镇痛药消耗，以术后24小时口服吗啡当量衡量，是主要结局。次要结局包括术后48小时的疼痛评分、患者满意度、功能结局、阿片类药物相关副作用和阻滞相关并发症。结果：纳入15项试验（679例患者）。与单独全身镇痛相比，单次注射SBB可使术后24小时吗啡用量减少58.98 mg [-100.14, -17.81] （p = 0.005）。SBB还可降低术后18小时的疼痛评分。相比之下，持续SBB并没有减少阿片类药物的消耗，平均差异为-40.36 mg [-81.77, 1.06] （p = 0.06）。此外，持续SBB在任何时间点都没有改善疼痛控制。与单独全身镇痛相比，添加SBB在患者满意度、功能评分或不良事件方面没有任何差异。结论：与单独全身镇痛相比，本荟萃分析表明，对于关节镜肩关节手术，单次注射SBB可以分别减少术后疼痛和阿片类药物消耗，最长可达18和24小时。相比之下，持续的SBB似乎没有改善任何镇痛结果。当近端臂丛阻滞禁忌或不需要时，单次注射SBB可能被认为是关节镜肩关节手术的有效镇痛技术。

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Challenges in applying the family CAM: Agreement, caregiver factors, and post-discharge validity 应用家庭CAM的挑战：协议、照顾者因素和出院后有效性。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-01-01 Epub Date: 2025-09-08 DOI: 10.1016/j.jclinane.2025.111997

Guangdong Wang , Tingting Liu , Shuo Yu , Lu Zhang

引用次数: 0

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