Journal of Clinical Anesthesia最新文献

{"title":"Preoperative test requests for elective surgeries of different complexity: Appropriateness and interhospital variability","authors":"Antonio Sánchez-Hidalgo ,&nbsp;Iratxe Urreta Barallobre ,&nbsp;Ignasi Bolibar Ribas ,&nbsp;Eva Bassas Parga ,&nbsp;Miren Arrieta Bernaras ,&nbsp;Gaizka Gutiérrez Sánchez ,&nbsp;David Sánchez Cirera ,&nbsp;Francisco José González Moraga ,&nbsp;Inigo Gorostiza ,&nbsp;Raúl de Frutos Parra ,&nbsp;Susana Álvarez Gómez ,&nbsp;Pablo Manuel Keenoy ,&nbsp;Marta Roqué Figuls ,&nbsp;Carolina Requeijo","doi":"10.1016/j.jclinane.2025.112033","DOIUrl":"10.1016/j.jclinane.2025.112033","url":null,"abstract":"<div><h3>Background</h3><div>Numerous studies have questioned the usefulness of routine preoperative tests, and several guidelines have published recommendations aimed at reducing unnecessary preoperative testing.</div></div><div><h3>Study objectives</h3><div>To analyze the appropriateness of preoperative test requests and interhospital variability in criteria for requesting preoperative tests.</div></div><div><h3>Design</h3><div>Cross-sectional retrospective multicenter observational study.</div></div><div><h3>Setting</h3><div>Nine Spanish National Health System hospitals.</div></div><div><h3>Patients</h3><div>Patients over 18 years of age undergoing elective cataract surgery, inguinal hernia, laparoscopic cholecystectomy, colon surgery or primary knee replacement, in any department of the participating hospitals during 5 working days in June 2022 (<em>n</em> = 1522).</div></div><div><h3>Exposure</h3><div>Hospitals where patients underwent surgery.</div></div><div><h3>Measurements</h3><div>Appropriateness of requested preoperative tests according to hospital protocols and NICE guidelines analyzed with random-intercept multilevel models considering hospital-level and patient-level variables. Hospital protocol score to determine disagreement with the NICE guidelines.</div></div><div><h3>Main results</h3><div>Preoperative test request inappropriateness was 12.03 % according to hospital protocols and 72.99 % according to the NICE guidelines. Inappropriateness was mostly due to excessive requests and differed by hospital and surgery type. Independent factors determining inappropriateness at the hospital-level were center complexity and availability of computerized preoperative request templates; at the patient-level were age, ASA grades and surgical complexity. Protocol criteria for requesting preoperative tests varied notably between hospitals, and most protocols showed low agreement with NICE recommendations, especially in terms of over-requested preoperative tests.</div></div><div><h3>Conclusions</h3><div>Inappropriateness of preoperative test requests was high according to hospital protocols and especially high according to the NICE guidelines. Appropriateness was determined by patient characteristics, surgical complexity, and institutional factors. Interhospital variability in inappropriateness was explained by differing criteria for preoperative test requests.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112033"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312131","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":"Trust your gut? Evaluating non-expert gastric ultrasound performance – A prospective observational cohort study","authors":"Sarah Baumann ,&nbsp;Firmin Kamber MD ,&nbsp;Thierry Girard MD ,&nbsp;Eckhard Mauermann MD, PhD, M.Sc ,&nbsp;Reza Kaviani MD","doi":"10.1016/j.jclinane.2025.112053","DOIUrl":"10.1016/j.jclinane.2025.112053","url":null,"abstract":"<div><h3>Background</h3><div>Aspiration of gastric content is a serious complication of anesthesia, associated with high mortality and morbidity. Recent studies demonstrated that fasting status can be assessed accurately by gastric ultrasound. However, there is still a lack of evidence regarding the application of this technique by inexperienced examiners. We aimed to determine the accuracy of gastric ultrasound performed by medical students after a standardized training sequence.</div></div><div><h3>Outcome</h3><div>Accuracy of identifying the fasting status by gastric ultrasound performed by inexperienced examiners.</div></div><div><h3>Methods</h3><div>In this prospective observational cohort study, five medical students performed 80 gastric ultrasound examinations on healthy, non-obese volunteers. Standardized training consisted of blended online training, one plenary lecture, and 2 h of hands-on-training. Volunteers were randomized in a 2:1:1 ratio to \"fasted\", \"non-fasted, fluid\", and \"non-fasted, solid\" with the examiners being blinded to the fasting status. The examiners determined the fasting status using gastric ultrasound and recorded the gastric cross-sectional area. Beforehand, an expert examiner also conducted all examinations for comparison. Sensitivity, specificity, positive and negative predictive values were calculated from the acquired data. The cross-sectional area was pooled for the expert and non-experts and the results plotted and interrater reliability assessed by the intraclass correlation coefficient (ICC).</div></div><div><h3>Results</h3><div>Data from 80 individuals were analyzed. The inexperienced examiners correctly identified all non-fasted volunteers (sensitivity 1.00,95 % CI: 0.91–1.00). They wrongly classified 18 out of 40 fasted volunteers as \"non-fasted\" (specificity 0.55, 95 % CI: 0.40–0.69). Positive predictive value was 0.69 (95 % CI: 0.56–0.79) and negative predictive value 1.00 (95 % CI: 0.85–1.00). The overall ICC was 0.72 (95 % CI 0.57–0.82), and 0.30 (95 % CI -0.32–0.63), 0.66 (95 % CI -0.16–0.87), and 0.27 (95 % CI -0.82–0.71), for the \"fasted\", \"non-fasted, fluid\", and \"non-fasted, solid\" states, respectively.</div></div><div><h3>Conclusions</h3><div>Examiners with limited experience in ultrasound diagnostics may accurately identify a full stomach in normal-weight volunteers after a standardized training sequence. However, the detected specificity of 0.63 was low, and more focused training on the ultrasound anatomy of an empty stomach may be needed to rule out an empty stomach in a clinical scenario.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112053"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495632","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 expanding role of critical care anesthesiologists outside the ICU","authors":"Siddharth Dave MD ,&nbsp;Brigid Flynn MD, FCCM ,&nbsp;Kunal Karamchandani MD, FCCP, FCCM","doi":"10.1016/j.jclinane.2025.111779","DOIUrl":"10.1016/j.jclinane.2025.111779","url":null,"abstract":"<div><div><span><div><div><table><tbody><tr><td>CCA</td><td>Critical care anesthesiologist</td></tr><tr><td>ICU</td><td>intensive care unit</td></tr><tr><td>PSH</td><td>perioperative surgical home</td></tr><tr><td>ASA</td><td>American Society of Anesthesiologists</td></tr><tr><td>RRS</td><td>rapid response system</td></tr><tr><td>ECMO</td><td>extracorporeal membrane oxygenation</td></tr><tr><td>QI</td><td>quality improvement</td></tr><tr><td>EMR</td><td>electronic medical record</td></tr><tr><td>PCP</td><td>primary care practitioner</td></tr></tbody></table></div></div></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 111779"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472533","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":"2026-01-01","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":"Response to: Letter to the editor regarding “Unpacking the Bundled Intervention and Interpreting the Outcomes in the Individualized Blood Pressure Strategy Trial”","authors":"Zheng Fang,&nbsp;Xin-qi Cheng","doi":"10.1016/j.jclinane.2025.112068","DOIUrl":"10.1016/j.jclinane.2025.112068","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112068"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549625","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":"Letter to the editor on ‘Preoperative cognitive function and surgical outcomes under general anesthesia among older patients’","authors":"Weizhi Qiu","doi":"10.1016/j.jclinane.2025.112052","DOIUrl":"10.1016/j.jclinane.2025.112052","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112052"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733427","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":"Response to “Revisiting the hypoxemia-SSI relationship”","authors":"Eva Rivas MD ,&nbsp;Barak Cohen MD ,&nbsp;Jacqueline Palermo MS ,&nbsp;Daniel I. Sessler MD","doi":"10.1016/j.jclinane.2025.112035","DOIUrl":"10.1016/j.jclinane.2025.112035","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112035"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345677","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 laryngeal mask airway for prone procedures","authors":"Justin Bessette,&nbsp;Juan Cotte Cabarcas","doi":"10.1016/j.jclinane.2025.112061","DOIUrl":"10.1016/j.jclinane.2025.112061","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112061"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418669","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":"Opioid-free versus opioid-based anaesthesia and analgesia for patients at low risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial","authors":"Krister Mogianos MD ,&nbsp;Josefine Holgersson ,&nbsp;Johan Undén M.D PhD ,&nbsp;Anna K.M. Persson M.D PhD","doi":"10.1016/j.jclinane.2025.112058","DOIUrl":"10.1016/j.jclinane.2025.112058","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate if opioid-free anaesthesia (OFA), is non-inferior to standard of care (SOC), in patients at low risk for acute postoperative pain (APOP).</div><div><em>Design</em>: Patient- and assessor-blinded, non-inferiority, randomised, controlled trial.</div></div><div><h3>Setting</h3><div>Single centre between March 2022 to February 2024.</div></div><div><h3>Patients</h3><div>154 adult patients, ASA I – II, planned for elective laparoscopic surgery and risk-classified as low risk for APOP based on perceived pain during venous cannulation (VAS &lt; 2.0).</div></div><div><h3>Intervention</h3><div>Patients were randomised to receiving OFA, including sevoflurane, dexmedetomidine, esketamine and lidocaine, or standard of care (SOC), a traditional GABA_A and opioid-based strategy. Patients were subjected to the intervention from time to arrival at the day of surgery until discharge from the PACU.</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>Pain scores were 4.8 in the OFA group and 4.6 in SOC group (<em>P</em> = 0.67). At 24 h, worst pain at rest was 5.7 vs 5.0 (<em>P</em> = 0.11), and during movement 5.6 vs 5.3 (<em>P</em> = 0.43). Proportion of patients with NRS ≥ 4 in the PACU was 66 % vs 69 % <em>(P</em> = 0.65) and at 24 h 76 % vs 60 % at rest (<em>P</em> = 0.042) and 73 % vs 69 % during movement (<em>P</em> = 0.65). There was no significant difference in PPOP at 3 or 6 months, either at rest (<em>P</em> = 0.51, <em>P</em> = 0.56) or movement (<em>P</em> = 0.72, <em>P</em> = 0.48), PONV (PACU: <em>P</em> = 0.93), at 24 h: (<em>P</em> = 0.52) or postoperative recovery at 24 h (99 vs 102, <em>P</em> = 0.44). OFA group required less rescue opioids in the PACU (3.4 mg vs 5.1 mg, <em>P</em> = 0.039).</div></div><div><h3>Conclusion</h3><div>When individualising anaesthesia based on predicted risk for APOP, OFA is non-inferior to a traditional GABA_A and opioid-based anaesthesia strategy, for patients with a low risk for APOP undergoing laparoscopic surgery. No secondary advantages, i.e. lower PONV, less PPOP, better quality of recovery, was associated with OFA.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112058"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418714","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":"A simplified standardized ultrasound-guided plane block for the Intercostobrachial nerve: Effective volume of 0.5 % ropivacaine determined by Dixon's up-and-down method","authors":"Wenchao Chen MD ,&nbsp;Guojun Yu MD ,&nbsp;Hongmin Cai MD ,&nbsp;Cuiying Du MD ,&nbsp;Liang Feng MD ,&nbsp;Jing Bian MD ,&nbsp;Zhe Yuan MD ,&nbsp;Ning Wang MD","doi":"10.1016/j.jclinane.2025.112081","DOIUrl":"10.1016/j.jclinane.2025.112081","url":null,"abstract":"<div><h3>Objective</h3><div>The success rates of the intercostobrachial nerve (ICBN) blocks varied from 51 % to 100 % by different techniques, which required rich expertise from the operators and/or high-resolution ultrasound. We proposed a simplified ultrasound-guided plane block and explored the 50 % effective volume (EV50) and the 95 % effective volume (EV95) with corresponding 95 % confidence intervals.</div></div><div><h3>Methods</h3><div>We recruited patients undergoing surgery of the upper limb and performed the simplified block. The needle target was positioned at 3 cm caudal to the centre of the axillary artery on the anterior surface of the conjoint tendon. The EV of 0.5 % ropivacaine was determined by Dixon's up-and-down method with an initial volume of 5 mL, and a successful or failed block could produce a 0.5 mL decrement or increment. Probit regression was fitted to determine the EV. To enhance robustness, a bootstrap analysis with 1000 resamples was performed. We recorded the block performance and adverse events.</div></div><div><h3>Results</h3><div>A total of 28 patients were included. The EV50 calculated by the Dixon's up-and-down method was 3.29 ± 0.60 mL. Based on Probit regression analysis, the EV50 and EV95 were 3.31 (3.09–3.53) and 3.94 (3.46–4.42) mL. The bootstrap-derived EV50 and EV95 were 3.32 (3.05–3.52) and 3.90 (3.54–4.41) mL. No adverse events occurred.</div></div><div><h3>Conclusions</h3><div>This simplified standardized ultrasound-guided plane block can provide a reliable anesthesia of the intercostobrachial nerve, with an EV50 of 3.31 mL and an EV95 of 3.94 mL for 0.5 % ropivacaine. This approach may enhance teaching and clinical practice by improving ergonomics, procedural efficiency, and reproducibility, while minimizing local anesthetic dosage and enhancing safety.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112081"},"PeriodicalIF":5.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620325","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}