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Erector spinae plane block versus paravertebral block and placebo for recovery quality after percutaneous nephrolithotomy: A randomized controlled trial 竖脊肌平面阻滞与椎旁阻滞和安慰剂对经皮肾镜取石术后恢复质量的影响:一项随机对照试验。
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-05 DOI: 10.1016/j.jclinane.2025.112056
Yanting Xiao , Huifen Lin , Yifen Zhuo , Jiahan Yang , Weidong Pan , Weitao Gao , Guisheng Ding , Yusheng Yao

Study objective

To compare recovery quality after PCNL using ESPB, TPVB, and placebo.

Design

Randomized, double-blind, placebo-controlled trial.

Setting

Sanming First Hospital affiliated to Fujian Medical University in China.

Patients

120 adults with American Society of Anesthesiologists physical status I–II scheduled for elective unilateral PCNL.

Interventions

Patients were randomized 1:1:1 to receive ESPB, TPVB, or placebo to test ESPB superiority over placebo and non-inferiority to TPVB.

Measurements

The primary outcome was Quality of Recovery-15 (QoR-15) score at 24 h. We tested ESPB superiority over placebo (8-point clinically important difference) and non-inferiority to TPVB (6-point margin). Secondary outcomes included pain scores, morphine consumption, time to first rescue analgesia, patient satisfaction, and adverse events.

Main results

ESPB demonstrated significantly higher QoR-15 scores than placebo (median difference 11.0 points, 95% CI 7.0–14.0, P < 0.001) and met non-inferiority criteria versus TPVB (median difference 1.0 point, 95% CI −5.0 to 2.0). Both blocks reduced pain scores and morphine consumption by approximately 40% compared with placebo (P < 0.001), with no differences between techniques. Time to first rescue analgesia was prolonged with both blocks compared with placebo (P < 0.001). Patient satisfaction was higher with both blocks than with placebo (P < 0.001). No block-related complications occurred; postoperative adverse events were similar across groups.

Conclusions

ESPB significantly improved recovery quality after PCNL, demonstrating superiority to placebo and non-inferiority to TPVB. ESPB represents an effective alternative to TPVB for PCNL analgesia, with comparable efficacy and safety.
研究目的:比较ESPB、TPVB和安慰剂治疗PCNL后的恢复质量。设计:随机、双盲、安慰剂对照试验。单位:福建医科大学附属三明第一医院。患者:120名具有美国麻醉医师协会身体状态I-II的成人,计划进行选择性单侧PCNL。干预措施:患者以1:1:1的比例随机接受ESPB、TPVB或安慰剂,以检验ESPB优于安慰剂和TPVB的非劣效性。测量:主要终点是24小时的恢复质量-15 (QoR-15)评分。我们测试了ESPB优于安慰剂(8分临床重要差异)和TPVB非劣效性(6分差)。次要结局包括疼痛评分、吗啡用量、首次抢救镇痛时间、患者满意度和不良事件。主要结果:ESPB的QoR-15评分明显高于安慰剂(中位差11.0分,95% CI 7.0-14.0, P)。结论:ESPB显著提高PCNL术后的恢复质量,优于安慰剂,不逊于TPVB。ESPB是一种有效的替代TPVB的PCNL镇痛方法,具有相当的疗效和安全性。
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引用次数: 0
Unmasking the silent threat: Navigating the myocardial injury in oncological surgery 揭露无声的威胁:肿瘤手术中心肌损伤的导航。
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-04 DOI: 10.1016/j.jclinane.2025.112063
Zhen-Zhen Xu , Dong-Liang Mu
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引用次数: 0
From “how busy we are” to “how we are busy”: Pragmatic, minute-by-minute analysis of obstetric anesthesia activity, service capacity, and utilization 从“我们有多忙”到“我们有多忙”:产科麻醉活动、服务能力和利用的务实、分分钟分析。
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-04 DOI: 10.1016/j.jclinane.2025.112054
Terry J. Biel MD MBA , Cristina L. Wood MD MS , Rachel M. Kacmar MD

Background

Previous studies have suggested that increased morbidity, mortality, and lapses in supervision are associated with anesthesiologist supervision ratios, yet estimates of anesthesia activity in obstetric settings have been limited to estimates based on annual delivery volumes. One single-center estimate found that hourly weekday activity was 89 % higher than hourly weeknight and weekend activity.

Methods

We utilized electronic anesthetic records and personnel schedules from a single tertiary care center to determine concurrent obstetric anesthesia activity, service capacity, and utilization for every minute of the year.

Results

Average activity per minute was 0.546, 0.448, 0.415, and 0.383 and average activity divided by service capacity (utilization) was 0.253, 0.253, 0.247, and 0.222, for weekday days, weekday nights, weekend/holiday days, and weekend/holiday nights, respectively. All differences were statistically significant, except weekday days and weekday nights were not significantly different.

Conclusions

Our findings do not support the previously reported 89 % greater hourly workload differential for weekday activity versus weeknight and weekend activity; our largest difference was about 43 % more activity per minute for weekday days vs weekend/holiday nights.
背景:先前的研究表明,发病率、死亡率的增加和监督失误与麻醉师监督比率有关,但对产科麻醉活动的估计仅限于基于年产生量的估计。一项单中心估计发现,工作日每小时的活动量比工作日晚上和周末每小时的活动量高89%。方法:我们利用来自单一三级保健中心的电子麻醉记录和人员时间表来确定同期产科麻醉活动、服务能力和一年中每分钟的利用率。结果:工作日、工作日夜间、周末/节假日和周末/节假日夜间的平均每分钟活动量分别为0.546、0.448、0.415和0.383,平均活动量除以服务能力(利用率)分别为0.253、0.253、0.247和0.222。除工作日与工作日夜间差异不显著外,其他差异均有统计学意义。结论:我们的研究结果不支持先前报道的工作日活动与工作日晚上和周末活动的每小时工作量差异增加89%;我们最大的差异是,工作日比周末/节假日晚上每分钟的活动量多43%。
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引用次数: 0
The additive effect of esketamine and clonidine in patients at high risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial 艾氯胺酮和可乐定对腹腔镜术后急性疼痛高危患者的叠加效应:一项随机对照试验
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-04 DOI: 10.1016/j.jclinane.2025.112059
Krister Mogianos , Josefine Holgersson , Johan Undén , Anna K.M. Persson

Objective

To evaluate if adding esketamine and clonidine has positive effects on postoperative pain, postoperative nausea and vomiting, and quality of recovery in patients who are at high risk for postoperative pain.

Design

Patient- and assessor-blinded, superiority, randomised controlled trial.

Setting

Single centre between 2022 and 2024.

Patients

125 adult patients, ASA I – II, planned for elective laparoscopic surgery and risk-classified as high risk of pain, based on perceived pain associated with venous cannulation.

Intervention

Patients were randomised to either an anaesthesia protocol, including an intravenous bolus of esketamine (0.25 mg.kg−1) after induction and clonidine (1 μg.kg−1) during maintenance phase (EC), or standard of care (SOC) no esketamine or clonidine included.

Measurements

Primary outcome: worst pain intensity in the PACU. Secondary outcomes: worst pain, and proportion having NRS ≥ 4, at 24 h (during rest and movement), worst pain and proportion having NRS ≥ 1, at 3- and 6-months (during rest and movement), postoperative recovery at 24 h, PONV in the PACU and at 24 h. Rescue dose opioids in the PACU was an exploratory outcome.

Results

Worst pain scores in the PACU were 5.7 in the EC group and 5.5 in SOC group (P = 0.78). After 24 h, no difference in postoperative pain (rest; 5.8 vs 6.1, P = 0.35, movement; 6.1 vs 6.2, P = 0.68), postoperative recovery (P = 0.92) or PONV (P = 0.80) was found. Proportion of patients with NRS ≥ 4 in the PACU was 50 % vs 48 % (P = 0.55) and at 24 h 73 % vs 81 % at rest (P = 0.27) and 76 % vs 81 % during movement (P = 0.50). Rescue opioids in the PACU were similar (5.9 mg vs 6.6 mg, P = 0.47). There were no differences in persistent pain at 3 or 6 months at rest (P = 0.72, P = 0.12) or movement (P = 0.48, P = 0.18).

Conclusion

Adding esketamine and clonidine, as an individualised multimodal anaesthesia strategy, did not influence acute or persistent postoperative pain, early recovery, need of rescue opioids or PONV in patients, who were assessed as high risk for APOP.
目的:评价艾氯胺酮联合可乐定对术后疼痛高危患者术后疼痛、恶心呕吐及恢复质量的积极影响。设计:患者和评估者双盲,优势,随机对照试验。设定:2022年至2024年之间的单一中心。患者:125例成人患者,ASA I - II,计划进行选择性腹腔镜手术,根据感知到的与静脉插管相关的疼痛,风险分类为高风险疼痛。干预:患者被随机分配到麻醉方案,包括诱导后静脉注射艾氯胺酮(0.25 mg.kg-1)和维持期(EC)的可乐定(1 μg.kg-1),或不包括艾氯胺酮或可乐定的标准护理(SOC)。测量:主要结果:PACU中疼痛强度最大。次要结局:24小时(休息和运动期间)疼痛最严重,NRS≥4的比例最大,3个月和6个月(休息和运动期间)疼痛最严重,NRS≥1的比例最大,24小时术后恢复,PACU和24小时的PONV。PACU的救援剂量阿片类药物是一个探索性结局。结果:PACU最差疼痛评分EC组为5.7分,SOC组为5.5分(P = 0.78)。24 h后,术后疼痛(休息;5.8 vs 6.1, P = 0.35;运动;6.1 vs 6.2, P = 0.68)、术后恢复(P = 0.92)或PONV (P = 0.80)均无差异。PACU中NRS≥4的患者比例为50%对48% (P = 0.55), 24 h时73%对81% (P = 0.27),运动时76%对81% (P = 0.50)。PACU的救援阿片类药物相似(5.9 mg vs 6.6 mg, P = 0.47)。3、6个月休息时(P = 0.72, P = 0.12)或运动时(P = 0.48, P = 0.18)持续疼痛无差异。结论:作为一种个体化的多模式麻醉策略,加入艾氯胺酮和氯定对被评估为APOP高风险的患者的急性或持续性术后疼痛、早期恢复、救援阿片类药物或PONV的需求没有影响。
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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 Pub Date : 2025-11-03 DOI: 10.1016/j.jclinane.2025.112055
Weijian Liang , Jinyan Guo , Weifeng Yao
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引用次数: 0
Efficacy and safety of intravenous iron supplementation for perioperative iron deficiency anemia: a systematic review and network meta-analysis of randomized controlled trials 静脉补铁治疗围手术期缺铁性贫血的疗效和安全性:随机对照试验的系统评价和网络荟萃分析。
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-03 DOI: 10.1016/j.jclinane.2025.112062
Qingxia Xue , Bei Zhang , Zhicong Xing , Fudong Sun , Quan Zhao , Shengjun Mu

Objective

Anemia is common in the perioperative period, with approximately one-third of surgical patients presenting with preoperative anemia and even higher rates of anemia postoperatively due to blood loss. The comparative efficacy and safety of different intravenous iron preparations for perioperative anemia remain unclear. This study aims to evaluate their efficacy and safety by a comprehensive network meta-analysis (NMA).

Methods

A systematic search of PubMed, Embase, and the Cochrane Library was conducted from inception to December 10, 2024, to identify randomized controlled trials (RCTs) involving intravenous iron administration in the perioperative period. Two independent researchers extracted and cross-checked the data. Outcomes included transfusion rate, hemoglobin (Hb) concentrations, adverse events, quality of life (QoL), hypersensitivity reactions, and hypophosphatemia. A Bayesian NMA was performed.

Results

Thirty-four RCTs with a total of 4688 participants were included in the NMA. Ferric carboxymaltose (FCM, mean difference [MD] 0.76 g/dL, 95 % credible interval [CrI] 0.56 to 0.96) and iron isomaltoside (IIM, MD 0.65 g/dL, 95 % CrI 0.33 to 0.97) significantly increased Hb concentrations compared with placebo. However, only FCM reduced transfusion requirements (odds ratio [OR] 0.72, 95 % CrI 0.55 to 0.91). The safety analysis revealed no significant differences in adverse events between the groups. Descriptive analysis indicated improved QoL with FCM compared to placebo for fatigue and dyspnea (QLQ-C30) and physical functioning (SF-36). For NMA, no significant inconsistencies were found between direct and indirect evidence.

Conclusions

FCM improves perioperative Hb concentrations and reduces transfusion requirements. All intravenous iron preparations demonstrated acceptable safety profiles. Further research is needed to validate these findings and refine perioperative iron supplementation strategies.
目的:围手术期贫血很常见,约三分之一的手术患者术前出现贫血,术后因失血而出现贫血的比例更高。不同静脉铁制剂治疗围手术期贫血的相对疗效和安全性尚不清楚。本研究旨在通过综合网络荟萃分析(NMA)评估其有效性和安全性。方法:系统检索PubMed, Embase和Cochrane图书馆,从成立到2024年12月10日,确定围手术期静脉给铁的随机对照试验(RCTs)。两名独立研究人员提取并交叉核对了这些数据。结果包括输血率、血红蛋白(Hb)浓度、不良事件、生活质量(QoL)、过敏反应和低磷血症。进行贝叶斯神经网络分析。结果:34项随机对照试验共4688名受试者被纳入NMA。与安慰剂相比,三羧基麦芽糖铁(FCM,平均差[MD] 0.76 g/dL, 95%可信区间[CrI] 0.56 ~ 0.96)和异麦芽糖铁(IIM, MD 0.65 g/dL, 95%可信区间[CrI] 0.33 ~ 0.97)显著增加了Hb浓度。然而,只有FCM减少了输血需求(优势比[OR] 0.72, 95% CrI 0.55至0.91)。安全性分析显示两组之间的不良事件没有显著差异。描述性分析表明,与安慰剂相比,FCM改善了疲劳和呼吸困难(QLQ-C30)和身体功能(SF-36)的生活质量。对于NMA,在直接和间接证据之间没有发现显著的不一致。结论:流式细胞术提高围手术期血红蛋白浓度,减少输血需求。所有静脉注射铁制剂均表现出可接受的安全性。需要进一步的研究来验证这些发现并完善围手术期补铁策略。
{"title":"Efficacy and safety of intravenous iron supplementation for perioperative iron deficiency anemia: a systematic review and network meta-analysis of randomized controlled trials","authors":"Qingxia Xue ,&nbsp;Bei Zhang ,&nbsp;Zhicong Xing ,&nbsp;Fudong Sun ,&nbsp;Quan Zhao ,&nbsp;Shengjun Mu","doi":"10.1016/j.jclinane.2025.112062","DOIUrl":"10.1016/j.jclinane.2025.112062","url":null,"abstract":"<div><h3>Objective</h3><div>Anemia is common in the perioperative period, with approximately one-third of surgical patients presenting with preoperative anemia and even higher rates of anemia postoperatively due to blood loss. The comparative efficacy and safety of different intravenous iron preparations for perioperative anemia remain unclear. This study aims to evaluate their efficacy and safety by a comprehensive network meta-analysis (NMA).</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, and the Cochrane Library was conducted from inception to December 10, 2024, to identify randomized controlled trials (RCTs) involving intravenous iron administration in the perioperative period. Two independent researchers extracted and cross-checked the data. Outcomes included transfusion rate, hemoglobin (Hb) concentrations, adverse events, quality of life (QoL), hypersensitivity reactions, and hypophosphatemia. A Bayesian NMA was performed.</div></div><div><h3>Results</h3><div>Thirty-four RCTs with a total of 4688 participants were included in the NMA. Ferric carboxymaltose (FCM, mean difference [MD] 0.76 g/dL, 95 % credible interval [CrI] 0.56 to 0.96) and iron isomaltoside (IIM, MD 0.65 g/dL, 95 % CrI 0.33 to 0.97) significantly increased Hb concentrations compared with placebo. However, only FCM reduced transfusion requirements (odds ratio [OR] 0.72, 95 % CrI 0.55 to 0.91). The safety analysis revealed no significant differences in adverse events between the groups. Descriptive analysis indicated improved QoL with FCM compared to placebo for fatigue and dyspnea (QLQ-C30) and physical functioning (SF-36). For NMA, no significant inconsistencies were found between direct and indirect evidence.</div></div><div><h3>Conclusions</h3><div>FCM improves perioperative Hb concentrations and reduces transfusion requirements. All intravenous iron preparations demonstrated acceptable safety profiles. Further research is needed to validate these findings and refine perioperative iron supplementation strategies.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112062"},"PeriodicalIF":5.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445018","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}
引用次数: 0
Perioperative tight glucose control regimens for preventing surgical site infections following cardiac surgery-a systematic review and metanalysis of randomized controlled trials 预防心脏手术后手术部位感染的围手术期严密血糖控制方案——随机对照试验的系统回顾和荟萃分析
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-03 DOI: 10.1016/j.jclinane.2025.112051
Yanxia Sun , Zhenghao Wen , Yi Ren , Zhen Hua

Background

Perioperative hyperglycemia is common during cardiac surgery and has been linked to an increased risk of surgical site infections (SSIs). However, the benefits of perioperative tight glucose control (TGC) remain debated, largely due to concerns about hypoglycemia. This systematic review assessed the effects and safety of TGC on SSIs in adults undergoing cardiac surgery.

Methods

We searched MEDLINE, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing TGC (upper blood glucose target ≤150 mg/dL or 8.3 mmol/L) with conventional glucose management in adults undergoing cardiac surgery. The primary outcome was incidence of SSIs. Secondary outcomes included hypoglycemia, length of intensive care unit (ICU) stay, incidence of neurological deficits and all-cause mortality within 30 days after surgery. The certainty of evidence was evaluated using the GRADE approach.

Results

Twenty-six RCTs including 17,990 participants were analyzed. TGC compared with control group was associated with reducing the risk of SSIs (risk ratio [RR]: 0.53; 95 % confidence interval [CI]: 0.42–0.68; I2 = 0 %; low certainty evidence), particularly when initiated at the start of surgery (RR: 0.50, 95 %CI: 0.39–0.66, I2 = 0; low certainty evidence) but not postoperatively (RR = 0.80, 95 % CI: 0.39–1.66; I2 = 0; very low certainty evidence). TGC also shortened ICU stay by 7.03 h compared to the control group (95 % CI: −10.83 to −3.22; very low certainty evidence), though heterogeneity was considerable (I2 = 92 %). However, TGC was associated with a higher risk of hypoglycemia (RR: 3.14; 95 % CI: 2.37–4.16; I2 = 0; moderate certainty evidence). No significant effects were observed on neurological deficits or all-cause mortality.

Conclusion

This systematic review of the available evidence suggests that perioperative TGC, particularly when initiated at the start of surgery, may reduce the risk of SSIs following cardiac surgery. However, it increases the risk of hypoglycemia and does not significantly impact neurological outcomes and all-cause mortality.
背景:围手术期高血糖在心脏手术中很常见,并且与手术部位感染(ssi)的风险增加有关。然而,围手术期严密血糖控制(TGC)的益处仍存在争议,主要是由于对低血糖的担忧。本系统综述评估了TGC对接受心脏手术的成人ssi的影响和安全性。方法:我们检索MEDLINE、Embase和Cochrane数据库,检索比较TGC(上血糖目标≤150mg /dL或8.3 mmol/L)和常规血糖管理的随机对照试验(RCTs)。主要终点是ssi的发生率。次要结局包括低血糖、重症监护病房(ICU)住院时间、术后30天内神经功能缺损发生率和全因死亡率。使用GRADE方法评估证据的确定性。结果:共分析26项随机对照试验,共17990名受试者。与对照组相比,TGC与ssi风险降低相关(风险比[RR]: 0.53; 95%可信区间[CI]: 0.42-0.68; I2 = 0%;低确定性证据),特别是在手术开始时(RR: 0.50, 95% CI: 0.39-0.66, I2 = 0;低确定性证据),但与术后无关(RR = 0.80, 95% CI: 0.39-1.66; I2 = 0;极低确定性证据)。与对照组相比,TGC还缩短了ICU住院时间7.03 h (95% CI: -10.83至-3.22;非常低的确定性证据),尽管异质性相当大(I2 = 92%)。然而,TGC与低血糖的高风险相关(RR: 3.14; 95% CI: 2.37-4.16; I2 = 0;中等确定性证据)。未观察到对神经功能缺损或全因死亡率有显著影响。结论:对现有证据的系统回顾表明,围手术期TGC,特别是在手术开始时启动的TGC,可以降低心脏手术后ssi的风险。然而,它会增加低血糖的风险,对神经预后和全因死亡率没有显著影响。
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引用次数: 0
Pharmacogenetics in perioperative care: Understanding the impact of genetic variants on patient management 围手术期护理中的药物遗传学:了解遗传变异对患者管理的影响
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-01 DOI: 10.1016/j.jclinane.2025.112064
Jan Albert Nicolaas Groot , Ankie Maxelante Harmsze , Eric Hendricus Paulus Adrianus van Dongen , Catherijne Anette Jantine Knibbe , Helena Johanna Blussé van Oud-Alblas
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.
尽管围手术期医学有所进步,但患者对常用麻醉和镇痛药物反应的变异性仍然是一个临床挑战。越来越多的人提出遗传因素是造成这些个体间差异的原因,但许多支持证据仍然是初步的、异质的或未充分验证的。药物遗传学已成为提高治疗精度的一个有前途的领域。然而,其在围手术期护理中的临床应用仍然有限。这篇叙述性综述批判性地评价了影响常规用药反应的药代动力学和药效学药物-基因相互作用。遗传变异影响围手术期护理的多个方面,包括药物代谢和受体敏感性、疼痛处理、自主神经功能以及术后恶心呕吐和阿片类药物引起的呼吸抑制等并发症的易感性。更好地了解药物-基因相互作用可以帮助麻醉师识别对常用药物非典型敏感或耐药的患者,以及那些围手术期并发症风险增加的患者。将药物遗传学数据整合到围手术期决策中可能有助于个体化护理,但更广泛的实施将需要在不同的队列中进行复制、前瞻性临床验证和制定循证指南。
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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 Pub 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。
{"title":"Intraoperative methylene blue infusion reduces postoperative delirium in patients undergoing pancreatic surgery: A randomized controlled clinical trial","authors":"Yixu Deng ,&nbsp;Jing Dong ,&nbsp;Congxia Pan ,&nbsp;Lingling Deng ,&nbsp;Zhiyong He ,&nbsp;Li Yang ,&nbsp;Jie Hua ,&nbsp;Jun Zhang","doi":"10.1016/j.jclinane.2025.112060","DOIUrl":"10.1016/j.jclinane.2025.112060","url":null,"abstract":"<div><h3>Study objective</h3><div>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.</div></div><div><h3>Design</h3><div>A randomized, single blind clinical trial.</div></div><div><h3>Setting</h3><div>University cancer center.</div></div><div><h3>Patients</h3><div>Three hundred and fourteen patients scheduled for pancreatic surgery.</div></div><div><h3>Interventions</h3><div>Patients were randomly assigned to methylene blue group, who receiving intravenous infusion of 2 mg kg<sup>-1</sup> methylene blue within 60 min immediately after anesthetic induction, followed by infusion of 1 mg kg<sup>-1</sup> methylene blue within 30 min before the end of surgery, or control group, who receiving equal volume saline.</div></div><div><h3>Measurements</h3><div>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.</div></div><div><h3>Main results</h3><div>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%, <em>p</em> = 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112060"},"PeriodicalIF":5.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418715","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}
引用次数: 0
Cover 1 - Zeng et al 封面1 - Zeng等
IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-11-01 DOI: 10.1016/S0952-8180(25)00300-9
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引用次数: 0
期刊
Journal of Clinical Anesthesia
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