Pub Date : 2026-03-23DOI: 10.1213/ane.0000000000008033
Elisabeth M Bik
{"title":"Seeing Is Believing? Scientific Misconduct and the Detection of Problematic Images.","authors":"Elisabeth M Bik","doi":"10.1213/ane.0000000000008033","DOIUrl":"https://doi.org/10.1213/ane.0000000000008033","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-20DOI: 10.1213/ane.0000000000007998
Elise V Butler,Jacqueline L Robson,Stephanie Ponsonby,Avik Majumdar,Simone I Strasser,Sanchia Smith,Ken Liu,Andrew D J Watts
BACKGROUNDIntraoperative blood salvage (IBS) and autotransfusion have been widely implemented to minimize allogenic blood transfusion in major surgery. Despite published literature, controversy exists around its use in liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) due to concern for oncological recurrence.METHODSWe retrospectively studied adults with HCC who underwent deceased donor LT at a single LT center in Australia (August 2007-July 2020), comparing those who received IBS and autotransfusion with those who did not. Leukodepletion filters were not used. The primary outcome was time to HCC recurrence. The secondary outcomes were HCC recurrence-free survival and overall survival post-LT.RESULTSA total of 245 patients having concurrent LT and HCC were analyzed. Of these, 167 received IBS and 78 did not. HCC recurrence occurred in 22/245 (9.0%) after a median of 20 months (IQR 13.5-24.5). For the primary outcome, IBS and autotransfusion was not associated with a decrease in time to HCC recurrence on unadjusted analysis (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.34-1.92; P = .62). Independent predictors of time to HCC recurrence were: hepatitis C (adjusted HR [aHR] 3.57, 95% CI, 1.03-12.4, P = .04), number of HCCs (aHR 1.17 per lesion increase, 95% CI, 1.06-1.30, P < .01), higher alpha-fetal protein levels (aHR 1.002 per kIU/L increase, 95% CI, 1.0003-1.003, P = .01), and microvascular invasion (aHR 3.27, 95% CI, 1.26-8.50, P = .01). After adjusting for these confounders, there remained no relationship between IBS and autotransfusion and time to HCC recurrence (aHR 0.57, 95% CI, 0.23-1.44, P = .24). For the secondary outcomes, IBS and autotransfusion was not a predictor of HCC recurrence-free survival (aHR 0.75, 95% CI, 0.39-1.42, P = .38) or overall survival (aHR 0.68, 95% CI, 0.35-1.33, P = .26) on multivariable analysis.CONCLUSIONSIn this single-center study, IBS and autotransfusion during LT in patients with concurrent HCC was not associated with an increased risk of recurrence. No unexpected risk factors for HCC recurrence after LT were identified. This study provides further evidence to confirm the safety of IBS in LT for HCC without the use of leukodepletion filters.
背景术中血液回收（IBS）和自体输血已被广泛应用于大手术中以减少同种异体输血。尽管已发表文献，但由于担心肿瘤复发，其在肝细胞癌（HCC）患者肝移植（LT）中的应用存在争议。方法：我们回顾性研究了澳大利亚单一肝移植中心（2007年8月- 2020年7月）接受已故供体肝移植的成年HCC患者，比较了接受肠易激综合征和自身输血的患者与未接受自身输血的患者。没有使用白质滤光器。主要观察指标为HCC复发时间。次要结果是肝细胞癌无复发生存期和肝移植后总生存期。结果共分析245例肝细胞癌合并肝细胞癌患者。其中167人患有肠易激综合征，78人没有。中位时间为20个月（IQR 13.5-24.5）后，22/245（9.0%）发生HCC复发率。对于主要结局，未经调整分析，IBS和自身输血与HCC复发时间减少无关（风险比[HR] 0.80, 95%可信区间[CI] 0.34-1.92; P = 0.62）。HCC复发时间的独立预测因子为：丙型肝炎（校正HR [aHR] 3.57, 95% CI, 1.03-12.4, P = 0.04）， HCC数量（每病变增加aHR 1.17, 95% CI, 1.06-1.30, P < 0.01），高α -胎儿蛋白水平（aHR 1.002 / kIU/L增加，95% CI, 1.0003-1.003, P = 0.01），微血管侵犯（aHR 3.27, 95% CI, 1.26-8.50, P = 0.01）。在调整这些混杂因素后，IBS与自身输血和HCC复发时间之间仍然没有关系（aHR 0.57, 95% CI, 0.23-1.44, P = 0.24）。对于次要结局，在多变量分析中，IBS和自身输血不是HCC无复发生存（aHR 0.75, 95% CI, 0.39-1.42, P = 0.38）或总生存（aHR 0.68, 95% CI, 0.35-1.33, P = 0.26）的预测因子。结论：在这项单中心研究中，合并HCC患者肝移植期间IBS和自身输血与复发风险增加无关。未发现肝移植术后HCC复发的意外危险因素。本研究提供了进一步的证据，证实肝细胞癌肝移植中IBS治疗的安全性，而不使用白细胞去除过滤器。
{"title":"Hepatocellular Cancer Recurrence After Liver Transplantation With and Without the Use of Intraoperative Blood Salvage and Autotransfusion: A Retrospective Study.","authors":"Elise V Butler,Jacqueline L Robson,Stephanie Ponsonby,Avik Majumdar,Simone I Strasser,Sanchia Smith,Ken Liu,Andrew D J Watts","doi":"10.1213/ane.0000000000007998","DOIUrl":"https://doi.org/10.1213/ane.0000000000007998","url":null,"abstract":"BACKGROUNDIntraoperative blood salvage (IBS) and autotransfusion have been widely implemented to minimize allogenic blood transfusion in major surgery. Despite published literature, controversy exists around its use in liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) due to concern for oncological recurrence.METHODSWe retrospectively studied adults with HCC who underwent deceased donor LT at a single LT center in Australia (August 2007-July 2020), comparing those who received IBS and autotransfusion with those who did not. Leukodepletion filters were not used. The primary outcome was time to HCC recurrence. The secondary outcomes were HCC recurrence-free survival and overall survival post-LT.RESULTSA total of 245 patients having concurrent LT and HCC were analyzed. Of these, 167 received IBS and 78 did not. HCC recurrence occurred in 22/245 (9.0%) after a median of 20 months (IQR 13.5-24.5). For the primary outcome, IBS and autotransfusion was not associated with a decrease in time to HCC recurrence on unadjusted analysis (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.34-1.92; P = .62). Independent predictors of time to HCC recurrence were: hepatitis C (adjusted HR [aHR] 3.57, 95% CI, 1.03-12.4, P = .04), number of HCCs (aHR 1.17 per lesion increase, 95% CI, 1.06-1.30, P < .01), higher alpha-fetal protein levels (aHR 1.002 per kIU/L increase, 95% CI, 1.0003-1.003, P = .01), and microvascular invasion (aHR 3.27, 95% CI, 1.26-8.50, P = .01). After adjusting for these confounders, there remained no relationship between IBS and autotransfusion and time to HCC recurrence (aHR 0.57, 95% CI, 0.23-1.44, P = .24). For the secondary outcomes, IBS and autotransfusion was not a predictor of HCC recurrence-free survival (aHR 0.75, 95% CI, 0.39-1.42, P = .38) or overall survival (aHR 0.68, 95% CI, 0.35-1.33, P = .26) on multivariable analysis.CONCLUSIONSIn this single-center study, IBS and autotransfusion during LT in patients with concurrent HCC was not associated with an increased risk of recurrence. No unexpected risk factors for HCC recurrence after LT were identified. This study provides further evidence to confirm the safety of IBS in LT for HCC without the use of leukodepletion filters.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-20DOI: 10.1213/ane.0000000000008027
Adam J Milam,Jose Rios-Monterrosa,Travis L Reece-Nguyen,Jaideep J Pandit
{"title":"Words Matter: Setting Standards for Culturally Sensitive and Inclusive Words for Perioperative Medicine Research.","authors":"Adam J Milam,Jose Rios-Monterrosa,Travis L Reece-Nguyen,Jaideep J Pandit","doi":"10.1213/ane.0000000000008027","DOIUrl":"https://doi.org/10.1213/ane.0000000000008027","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-19DOI: 10.1213/ane.0000000000008024
Bin Gao,Yang Liu,Yun-Tai Yao
{"title":"Anaphylaxis Induced by Rocuronium, Sugammadex, or Rocuronium-Sugammadex Complex: Summary of Published Cases.","authors":"Bin Gao,Yang Liu,Yun-Tai Yao","doi":"10.1213/ane.0000000000008024","DOIUrl":"https://doi.org/10.1213/ane.0000000000008024","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-17DOI: 10.1213/ane.0000000000008013
Martin Soehle,Jan Menzenbach,Katharina Riedel,Mark Coburn,Marcus Thudium
BACKGROUNDPostoperative delirium (POD) is a frequent and serious complication after surgery. Parameters of the electroencephalogram (EEG), such as the Bispectral Index and the occurrence of burst suppression, have been associated with POD. We analyzed the predictive properties of periodic and aperiodic parameters of the EEG power spectrum.METHODSIn a secondary post-hoc analysis of a prospective observational study, patients with an age of at least 60 years undergoing major cardiac or non-cardiac surgery were analyzed. The frontal intraoperative raw EEG was recorded by a BIS monitor and offline analyzed with the FOOOF toolbox, revealing the periodic and aperiodic parameters of the power spectrum. Patients were screened for POD and divided in a 2:1 ratio into a training and a validation cohort. Predictors of POD were identified by uni- and multivariable logistic regression.RESULTSThirty-two out of the 120 training group patients developed POD. These showed a significantly longer median duration of surgery (286 [interquartile range {IQR} 236-391] vs 223 [127-331] min, P = .005), lower median BIS (40.4 [IQR 38.1-43.4] vs 42.7 [39.5-46.0], P = .038), and a higher mean aperiodic exponent (2.09 ± 0.19 vs 1.99 ± 0.17, P = .017). Duration of surgery (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.01, P = .005), peak center frequency (OR = 0.79; CI, 0.62-0.97, P = .039) and aperiodic exponent (OR = 23.2; CI, 2.1-318.2, P = .013) were predictors of POD according to univariable logistic regression. At a cutoff of 1.967, the aperiodic exponent had a sensitivity of 0.813 and a specificity of 0.478 for the prediction of POD. A low duration of time spent in burst suppression was observed in both patients with POD (67 [6-363] s) and without POD (173 [4-641] s, P = .30), and cumulative burst suppression time was not a predictor of POD. In a stepwise regression model, age, duration of surgery, peak power, and the aperiodic exponent were associated with POD (AUROC = 0.80 (CI, 0.71-0.89, P < .001). The predictive model was confirmed in the validation group (n = 60) with an AUROC = 0.77 (CI, 0.65-0.90, P = .001).CONCLUSIONSA higher aperiodic exponent, for example, a less complex EEG signal, is associated with a greater POD risk, especially in combination with known POD predictors such as age and duration of surgery.
背景术后谵妄（POD）是术后常见且严重的并发症。脑电图（EEG）的参数，如双谱指数和爆发抑制的发生，与POD有关。分析了脑电功率谱周期参数和非周期参数的预测特性。方法在一项前瞻性观察性研究的二次事后分析中，对年龄在60岁以上接受重大心脏或非心脏手术的患者进行了分析。术中额叶原始脑电图由BIS监护仪记录，并用FOOOF工具箱离线分析，揭示功率谱的周期和非周期参数。对患者进行POD筛查，并按2:1的比例分为训练组和验证组。通过单变量和多变量logistic回归确定POD的预测因素。结果训练组120例患者中32例发生POD。结果显示，中位手术时间明显延长（286[四分位间距{IQR} 236-391] vs 223 [127-331] min， P = 0.005），中位BIS较低（40.4 [IQR 38.1-43.4] vs 42.7 [39.5-46.0], P = 0.038），平均非周期指数较高（2.09±0.19 vs 1.99±0.17,P = 0.017）。单变量logistic回归分析显示，手术时间（优势比[OR] = 1.01； 95%可信区间[CI]， 1.00 ~ 1.01, P = 0.005）、峰值中心频率（OR = 0.79； CI, 0.62 ~ 0.97, P = 0.039）和非周期指数（OR = 23.2； CI, 2.1 ~ 318.2, P = 0.013）是POD的预测因子。截止值为1.967时，非周期指数预测POD的敏感性为0.813，特异性为0.478。在POD患者（67 [6-363]s）和无POD患者（173 [4-641]s, P = 0.30）中，burst抑制持续时间较短，累积burst抑制时间不是POD的预测因子。在逐步回归模型中，年龄、手术时间、峰值功率和非周期指数与POD相关(AUROC = 0.80 （CI, 0.71-0.89, P < 0.001）。该预测模型在验证组（n = 60）得到证实，AUROC = 0.77 （CI, 0.65 ~ 0.90, P = .001）。结论较高的非周期指数，如较不复杂的脑电图信号，与较高的POD风险相关，特别是结合已知的POD预测因素，如年龄和手术时间。
{"title":"The Value of the Aperiodic Exponent of the Intraoperative Electroencephalogram for Predicting Postoperative Delirium in Elderly Patients.","authors":"Martin Soehle,Jan Menzenbach,Katharina Riedel,Mark Coburn,Marcus Thudium","doi":"10.1213/ane.0000000000008013","DOIUrl":"https://doi.org/10.1213/ane.0000000000008013","url":null,"abstract":"BACKGROUNDPostoperative delirium (POD) is a frequent and serious complication after surgery. Parameters of the electroencephalogram (EEG), such as the Bispectral Index and the occurrence of burst suppression, have been associated with POD. We analyzed the predictive properties of periodic and aperiodic parameters of the EEG power spectrum.METHODSIn a secondary post-hoc analysis of a prospective observational study, patients with an age of at least 60 years undergoing major cardiac or non-cardiac surgery were analyzed. The frontal intraoperative raw EEG was recorded by a BIS monitor and offline analyzed with the FOOOF toolbox, revealing the periodic and aperiodic parameters of the power spectrum. Patients were screened for POD and divided in a 2:1 ratio into a training and a validation cohort. Predictors of POD were identified by uni- and multivariable logistic regression.RESULTSThirty-two out of the 120 training group patients developed POD. These showed a significantly longer median duration of surgery (286 [interquartile range {IQR} 236-391] vs 223 [127-331] min, P = .005), lower median BIS (40.4 [IQR 38.1-43.4] vs 42.7 [39.5-46.0], P = .038), and a higher mean aperiodic exponent (2.09 ± 0.19 vs 1.99 ± 0.17, P = .017). Duration of surgery (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.01, P = .005), peak center frequency (OR = 0.79; CI, 0.62-0.97, P = .039) and aperiodic exponent (OR = 23.2; CI, 2.1-318.2, P = .013) were predictors of POD according to univariable logistic regression. At a cutoff of 1.967, the aperiodic exponent had a sensitivity of 0.813 and a specificity of 0.478 for the prediction of POD. A low duration of time spent in burst suppression was observed in both patients with POD (67 [6-363] s) and without POD (173 [4-641] s, P = .30), and cumulative burst suppression time was not a predictor of POD. In a stepwise regression model, age, duration of surgery, peak power, and the aperiodic exponent were associated with POD (AUROC = 0.80 (CI, 0.71-0.89, P < .001). The predictive model was confirmed in the validation group (n = 60) with an AUROC = 0.77 (CI, 0.65-0.90, P = .001).CONCLUSIONSA higher aperiodic exponent, for example, a less complex EEG signal, is associated with a greater POD risk, especially in combination with known POD predictors such as age and duration of surgery.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"192 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-13DOI: 10.1213/ane.0000000000007994
{"title":"GLP-1 Agonists: More Answers, More Questions.","authors":"","doi":"10.1213/ane.0000000000007994","DOIUrl":"https://doi.org/10.1213/ane.0000000000007994","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"33 1","pages":"639"},"PeriodicalIF":0.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-13DOI: 10.1213/ane.0000000000007993
{"title":"Therapy for the Soul: Music Intervention.","authors":"","doi":"10.1213/ane.0000000000007993","DOIUrl":"https://doi.org/10.1213/ane.0000000000007993","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"14 1","pages":"624"},"PeriodicalIF":0.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-12DOI: 10.1213/ane.0000000000008021
Nancy M Boulos,Amy Zhou,Eileen K Nguyen,Alexandre Joosten
{"title":"Call to Action: The Hidden Role of Anesthesiologists in the Opioid Epidemic.","authors":"Nancy M Boulos,Amy Zhou,Eileen K Nguyen,Alexandre Joosten","doi":"10.1213/ane.0000000000008021","DOIUrl":"https://doi.org/10.1213/ane.0000000000008021","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-12DOI: 10.1213/ane.0000000000007992
Oliver Cafferty,Sean D Jeffries,Zheyan Tu,Eric D Pelletier,Avinash Sinha,Thomas M Hemmerling,
{"title":"Contextualizing AI Evaluation in Anesthesiology: Interpreting Predictive Modeling and Reinforcement Learning Metrics Across Clinical Use Cases-An Expert Statement From the Society of Technology in Anesthesia.","authors":"Oliver Cafferty,Sean D Jeffries,Zheyan Tu,Eric D Pelletier,Avinash Sinha,Thomas M Hemmerling, ","doi":"10.1213/ane.0000000000007992","DOIUrl":"https://doi.org/10.1213/ane.0000000000007992","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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