Journal of Clinical Anesthesia最新文献

{"title":"Erector spinae plane block versus paravertebral block and placebo for recovery quality after percutaneous nephrolithotomy: A randomized controlled trial","authors":"Yanting Xiao ,&nbsp;Huifen Lin ,&nbsp;Yifen Zhuo ,&nbsp;Jiahan Yang ,&nbsp;Weidong Pan ,&nbsp;Weitao Gao ,&nbsp;Guisheng Ding ,&nbsp;Yusheng Yao","doi":"10.1016/j.jclinane.2025.112056","DOIUrl":"10.1016/j.jclinane.2025.112056","url":null,"abstract":"<div><h3>Study objective</h3><div>To compare recovery quality after PCNL using ESPB, TPVB, and placebo.</div></div><div><h3>Design</h3><div>Randomized, double-blind, placebo-controlled trial.</div></div><div><h3>Setting</h3><div>Sanming First Hospital affiliated to Fujian Medical University in China.</div></div><div><h3>Patients</h3><div>120 adults with American Society of Anesthesiologists physical status I–II scheduled for elective unilateral PCNL.</div></div><div><h3>Interventions</h3><div>Patients were randomized 1:1:1 to receive ESPB, TPVB, or placebo to test ESPB superiority over placebo and non-inferiority to TPVB.</div></div><div><h3>Measurements</h3><div>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.</div></div><div><h3>Main results</h3><div>ESPB demonstrated significantly higher QoR-15 scores than placebo (median difference 11.0 points, 95% CI 7.0–14.0, <em>P</em> &lt; 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 (<em>P</em> &lt; 0.001), with no differences between techniques. Time to first rescue analgesia was prolonged with both blocks compared with placebo (<em>P</em> &lt; 0.001). Patient satisfaction was higher with both blocks than with placebo (<em>P</em> &lt; 0.001). No block-related complications occurred; postoperative adverse events were similar across groups.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112056"},"PeriodicalIF":5.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458440","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":"2025-11-04","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}

{"title":"From “how busy we are” to “how we are busy”: Pragmatic, minute-by-minute analysis of obstetric anesthesia activity, service capacity, and utilization","authors":"Terry J. Biel MD MBA ,&nbsp;Cristina L. Wood MD MS ,&nbsp;Rachel M. Kacmar MD","doi":"10.1016/j.jclinane.2025.112054","DOIUrl":"10.1016/j.jclinane.2025.112054","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112054"},"PeriodicalIF":5.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451495","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 additive effect of esketamine and clonidine in patients at high risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial","authors":"Krister Mogianos ,&nbsp;Josefine Holgersson ,&nbsp;Johan Undén ,&nbsp;Anna K.M. Persson","doi":"10.1016/j.jclinane.2025.112059","DOIUrl":"10.1016/j.jclinane.2025.112059","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Patient- and assessor-blinded, superiority, randomised controlled trial.</div></div><div><h3>Setting</h3><div>Single centre between 2022 and 2024.</div></div><div><h3>Patients</h3><div>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.</div></div><div><h3>Intervention</h3><div>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.</div></div><div><h3>Measurements</h3><div>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.</div></div><div><h3>Results</h3><div>Worst pain scores in the PACU were 5.7 in the EC group and 5.5 in SOC group (<em>P</em> = 0.78). After 24 h, no difference in postoperative pain (rest; 5.8 vs 6.1, <em>P</em> = 0.35, movement; 6.1 vs 6.2, <em>P</em> = 0.68), postoperative recovery (<em>P</em> = 0.92) or PONV (<em>P</em> = 0.80) was found. Proportion of patients with NRS ≥ 4 in the PACU was 50 % vs 48 % <em>(P</em> = 0.55) and at 24 h 73 % vs 81 % at rest (<em>P</em> = 0.27) and 76 % vs 81 % during movement (<em>P</em> = 0.50). Rescue opioids in the PACU were similar (5.9 mg vs 6.6 mg, <em>P</em> = 0.47). There were no differences in persistent pain at 3 or 6 months at rest (<em>P</em> = 0.72, <em>P</em> = 0.12) or movement (<em>P</em> = 0.48, <em>P</em> = 0.18).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112059"},"PeriodicalIF":5.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the RCT bubble: Translating preoperative dexmedetomidine into geriatric hip fracture practice","authors":"Weijian Liang ,&nbsp;Jinyan Guo ,&nbsp;Weifeng Yao","doi":"10.1016/j.jclinane.2025.112055","DOIUrl":"10.1016/j.jclinane.2025.112055","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112055"},"PeriodicalIF":5.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444990","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":"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}

{"title":"Perioperative tight glucose control regimens for preventing surgical site infections following cardiac surgery-a systematic review and metanalysis of randomized controlled trials","authors":"Yanxia Sun ,&nbsp;Zhenghao Wen ,&nbsp;Yi Ren ,&nbsp;Zhen Hua","doi":"10.1016/j.jclinane.2025.112051","DOIUrl":"10.1016/j.jclinane.2025.112051","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112051"},"PeriodicalIF":5.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445002","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":"2025-11-01","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":"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^-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.</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}

{"title":"Cover 1 - Zeng et al","authors":"","doi":"10.1016/S0952-8180(25)00300-9","DOIUrl":"10.1016/S0952-8180(25)00300-9","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112039"},"PeriodicalIF":5.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680897","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}