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Obituary: Dr Ronald D. Miller, 1939-2025-A Legacy of Excellence. 讣告:罗纳德·d·米勒博士,1939-2025——卓越的遗产。
Pub Date : 2026-01-13 DOI: 10.1213/ane.0000000000007925
Manuel C Pardo,Michael A Gropper
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引用次数: 0
Opioid Use for Cesarean Delivery May Play a Role in Increased Risk of Postpartum Depression? 剖宫产使用阿片类药物可能会增加产后抑郁症的风险?
Pub Date : 2026-01-13 DOI: 10.1213/ane.0000000000007936
Anna Maria Biava,Gianni Cipriani,Endrit Malja,Federico Bilotta
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引用次数: 0
Supply vs. Demand: The State of Pediatric Cardiac Anesthesiology. 供给与需求:儿童心脏麻醉学的现状。
Pub Date : 2026-01-09 DOI: 10.1213/ane.0000000000007912
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引用次数: 0
Interactive 4-Dimensional Response Surface Visualization With Equivalent Minimum Alveolar Concentration Estimation for Triple Anesthetic Drug Interactions. 具有等效最小肺泡浓度估计的交互式四维响应面可视化用于三重麻醉药物相互作用。
Pub Date : 2025-12-23 DOI: 10.1213/ane.0000000000007891
Ahmet R Dogan
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引用次数: 0
Association of Preoperative Frailty and Postoperative Outcomes in Older Adults Undergoing Major Cardiac Procedures: A Systematic Review and Meta-Analysis. 老年心脏手术患者术前虚弱与术后预后的关系:一项系统综述和荟萃分析。
Pub Date : 2025-12-23 DOI: 10.1213/ane.0000000000007887
Vetri Thangavelu,Ojas Bhatia,Anushka Hasija,Nethmi Rajapakse,Ellene Yan,Aparna Saripella,Marina Englesakis,Frances Chung
BACKGROUNDFrailty, characterized by reduced physiological resilience, is a pivotal risk factor in older adults undergoing major cardiac procedures. Although previous analyses have linked frailty to adverse surgical outcomes, knowledge gaps persist due to methodological inconsistency across frailty tools and limited synthesis of complications such as delirium, infection, and renal dysfunction. The objective of this systematic review and meta-analysis is to determine the prevalence of preoperative frailty in older adults undergoing major cardiac procedures, and assess its association with postoperative outcomes, including cardiac, respiratory, renal, infectious, stroke, and bleeding complications, postoperative delirium, hospital and intensive care unit (ICU) length of stay, nonhome discharge, hospital readmission, and both 30-day and 1-year mortality.METHODSA prespecified protocol was registered with PROSPERO (CRD#42024574916), following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, and Cochrane databases were searched for English-language studies of patients undergoing major cardiac procedures, including coronary artery bypass grafting (CABG), aortic or mitral valve replacement or repair, transcatheter aortic valve replacement (TAVR), or combined procedures. Validated frailty instruments (eg, Fried Frailty Phenotype, Clinical Frailty Scale) were required to determine preoperative frailty, along with reporting at least 1 postoperative outcome. Noncardiac surgeries, minor procedures, case reports, and reviews were excluded. Random-effects meta-analyses generated odds ratio (OR) or standardized mean difference (SMD) values with 95% confidence intervals (CI).RESULTSNineteen studies (n = 11,667; mean ± SD age 71.9 ± 8.1 years, 28% female) met inclusion criteria, spanning North America, Europe, Asia, and Oceania. The overall prevalence of preoperative frailty was 16.8%. Frailty was significantly associated with delirium (OR, 4.11; 95% confidence interval [CI], 2.00-8.45; P <.001), infection (OR, 3.72; 95% CI, 2.27-6.12; P <.001), renal complications (OR, 2.72; 95% CI, 2.05-3.60; P <.001), and extended hospital (SMD, 0.69 ; 95% CI, 0.35-1.02; P <.001) and ICU (SMD, 0.72; 95% CI, 0.51-0.94; P <.001) stays. Frailty increased the odds of 30-day (OR, 3.58; 95% CI, 2.16-5.93; P <.001) and 1-year (OR, 2.25; 95% CI, 1.56-3.25; P <.001) mortality.CONCLUSIONSFrailty affects nearly 1 in 5 older adults requiring major cardiac procedures. Frailty was significantly associated with adverse postoperative outcomes, including delirium, infections, renal complications, extended length of stay, and mortality. As frailty is potentially modifiable, targeted strategies-such as prehabilitation, nutritional optimization, and enhanced perioperative monitoring-may improve outcomes. Incorporating routine frailty screening into standard preoperative practice allows for earlier identification of high-risk patients, efficien
背景:身体虚弱,以生理恢复能力降低为特征,是接受重大心脏手术的老年人的关键危险因素。尽管先前的分析将虚弱与不良手术结果联系起来,但由于虚弱工具的方法不一致以及谵妄、感染和肾功能障碍等并发症的有限合成,知识差距仍然存在。本系统综述和荟萃分析的目的是确定接受重大心脏手术的老年人术前虚弱的患病率,并评估其与术后结局的关系,包括心脏、呼吸、肾脏、感染、中风和出血并发症、术后谵妄、住院和重症监护病房(ICU)住院时间、非家庭出院、再入院以及30天和1年死亡率。方法按照系统评价和荟萃分析(PRISMA)指南的首选报告项目,在PROSPERO (crd# 42024574916)上注册预先指定的方案。MEDLINE、Embase和Cochrane数据库检索了接受主要心脏手术的患者的英语研究,包括冠状动脉旁路移植术(CABG)、主动脉瓣或二尖瓣置换术或修复、经导管主动脉瓣置换术(TAVR)或联合手术。需要经过验证的衰弱仪器(例如,Fried衰弱表型,临床衰弱量表)来确定术前衰弱,并报告至少一项术后结果。排除了非心脏手术、小手术、病例报告和综述。随机效应荟萃分析产生95%置信区间(CI)的优势比(OR)或标准化平均差(SMD)值。结果19项研究(n = 11,667,平均±SD年龄71.9±8.1岁,女性28%)符合纳入标准,涵盖北美、欧洲、亚洲和大洋洲。术前虚弱的总体患病率为16.8%。虚弱与谵妄(OR, 4.11, 95%可信区间[CI], 2.00-8.45, P < 0.001)、感染(OR, 3.72, 95% CI, 2.27-6.12, P < 0.001)、肾脏并发症(OR, 2.72, 95% CI, 2.05-3.60, P < 0.001)、延长住院时间(SMD, 0.69, 95% CI, 0.35-1.02, P < 0.001)和ICU (SMD, 0.72, 95% CI, 0.51-0.94, P < 0.001)相关。虚弱增加了30天死亡率(OR, 3.58; 95% CI, 2.16-5.93; P <.001)和1年死亡率(OR, 2.25; 95% CI, 1.56-3.25; P <.001)。结论:近五分之一需要进行大型心脏手术的老年人存在虚弱。虚弱与术后不良结果显著相关,包括谵妄、感染、肾脏并发症、延长住院时间和死亡率。由于虚弱是可以改变的,有针对性的策略,如康复、营养优化和加强围手术期监测,可能会改善结果。将常规虚弱筛查纳入标准术前实践,可以更早地识别高危患者,有效地分配资源,并制定围手术期护理计划。
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引用次数: 0
Paradoxical Combinations of Bispectral Index and Burst Suppression Ratio. 双谱指数与突发抑制比的矛盾组合。
Pub Date : 2025-12-23 DOI: 10.1213/ane.0000000000007877
Duygu Aydin,Max Ebensperger,Stefan Schwerin,Bernhard Graf,Gerhard Schneider,Matthias Kreuzer,Barbara Sinner
BACKGROUNDThe relationship between the bispectral index (BIS) and the BIS monitor's burst suppression ratio (BSR) has been extensively researched, with the current consensus being that BIS is fully driven by the BSR for BSR ≥ 40%. For lower BSR, the BIS seems to be derived from an unknown combination of electroencephalogram (EEG) parameters. In general, the BIS and BSR are not linearly correlated. With limited knowledge about the indices and their interactions, BIS- and BSR-driven anesthesia navigation may lead to index combinations showing paradoxical information.METHODSUsing intraoperative recordings of BIS and BSR from 62 patients 80.9 ± 5.8 (mean ± standard deviation [SD]) years, we analyzed the distribution of BIS and BSR values as well as their relation to each other with a focus on paradoxical situations, ie, an adequate BIS of 40 to 60 together with BSR ≥ 5%. We quantified the incidence rate and duration of these situations as well as the distribution of these BSR events within the BIS = 40 to 60 range.RESULTSOnly 56.9 [44-74.2]% (median [Q1-Q3]) BIS values fell inside the 40 to 60 range despite titration to this range. We found a disproportionately high incidence of BIS 41 to 42. BSR showed an exponentially declining, continuous distribution. We could observe paradoxical BIS and BSR values lasting for considerable stretches of time that could exceed 2 minutes.CONCLUSIONSBIS values are not continuously scaled, with some index values occurring distinctly more often. Paradoxical values of BIS between 40 and 60 and BSR≥5% can occur, potentially confusing anesthesia care providers.
双谱指数(BIS)与BIS监视器的突发抑制比(BSR)之间的关系已被广泛研究,目前的共识是,当BSR≥40%时,BIS完全由BSR驱动。对于较低的BSR, BIS似乎源于脑电图(EEG)参数的未知组合。一般来说,BIS和BSR不是线性相关的。由于对指标及其相互作用的了解有限,BIS和bsr驱动的麻醉导航可能导致指标组合显示矛盾的信息。方法利用62例患者80.9±5.8 (mean±standard deviation [SD])年的术中BIS和BSR记录,分析BIS和BSR值的分布及其相互关系,重点分析BIS≥40 ~ 60且BSR≥5%的矛盾情况。我们量化了这些情况的发生率和持续时间,以及这些BSR事件在BIS = 40至60范围内的分布。结果只有56.9%[44-74.2]%(中位数[Q1-Q3])的BIS值在40 - 60范围内。我们发现BIS 41 - 42的发病率高得不成比例。BSR呈指数递减的连续分布。我们可以观察到矛盾的BIS和BSR值持续相当长的时间,可能超过2分钟。结论sbis值并非连续缩放,某些指标值出现频率明显偏高。BIS值在40 - 60之间和BSR≥5%之间可能出现矛盾,这可能使麻醉护理人员感到困惑。
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引用次数: 0
Posttraumatic Stress Disorder: A Milligram of Prevention for a Life-Long Problem? 创伤后应激障碍:一毫克预防终身问题?
Pub Date : 2025-12-23 DOI: 10.1213/ane.0000000000007890
Ryan O Parker,Joshua W Sappenfield
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引用次数: 0
A Novel, Human Cadaveric Airway Model for Preclinical Testing of Medical Devices and Interventions: The Dynamic Airway Patency Model. 一种用于医疗器械和干预的临床前测试的新型人体尸体气道模型:动态气道通畅模型。
Pub Date : 2025-12-22 DOI: 10.1213/ane.0000000000007884
Jacob Provencio,Connor J Evans,Jennifer A Achay,R Lyle Hood,Robert A De Lorenzo,Steven Venticinque
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引用次数: 0
Association of Perioperative Dexamethasone With Postoperative Complications After Primary Total Joint Arthroplasty: An Instrumental Variable Analysis. 地塞米松与初次全关节置换术后并发症的关系:一项工具变量分析。
Pub Date : 2025-12-16 DOI: 10.1213/ane.0000000000007856
Ian A Jones,Kevin C Liu,Matthew A Lim,Sagar Telang,Julian Wier,Nathanael D Heckmann
BACKGROUNDRetrospective studies suggest that dexamethasone may provide benefits that extend beyond its antiemetic properties, including a reduction in postoperative complications. However, results from randomized controlled trials have not consistently shown there to be a reduction in composite major adverse events. This discrepancy may be due to confounding factors, measurement error, or simultaneity bias among retrospective investigations. This study used instrumental variable analysis (IVA) to help address potential sources of bias and better estimate treatment effects in patients undergoing total joint arthroplasty (TJA).METHODSPatients who underwent primary elective TJA between 2016 and 2021 were identified using diagnosis and procedural codes. Bivariate regression, multivariable regression, and IVA were conducted. The primary end point was a 90-day composite (any versus none) of major postoperative medical complications. Secondary outcomes were infection, readmission, and death. Two distinct instruments-the frequency of dexamethasone use by surgeon and by hospital-were used to evaluate the robustness of our IVA. Patient demographics, hospital factors, and comorbidities were reported using descriptive statistics. Instrumental variable covariates were selected using the least absolute shrinkage and selection operator with 3 regularization parameter strategies.RESULTS1525,844 TJAs performed between 2015 and 2021 were identified (976,996 knees [total knee arthroplasty {TKA}]; 548,848 hips [total hip arthroplasty {THA}]). Major postoperative medical complications were observed in 31,299 (3.43%) dexamethasone-exposed patients compared to 31,266 (4.87%) unexposed patients. Surgeon-based IVA yielded results comparable to the multivariable and bivariate analysis (local average treatment effect [LATE]: TKA: -1.20% [95% confidence interval [CI], -1.33% to -1.08%]; THA: -1.14% [95% CI, -1.30% to -0.99%]). Hospital-based IVA produced similar findings (LATE: TKA: -1.23% [95% CI, -1.38% to -1.09%]; THA: -1.18% [95% CI, -1.35% to -1.00%]). Both instruments demonstrated high F-statistics and significant Hausman tests. Secondary outcomes mirrored these results, except for mortality, which did not meet endogeneity criteria across analyses.CONCLUSIONSThe findings of this study support that dexamethasone exposure is associated with a reduction in composite major postoperative complications after TJA. The observed moderate treatment effect, in conjunction with a low baseline incidence of adverse events, may explain the inconsistent outcomes reported in previous randomized trials. Future prospective studies should incorporate composite end points and target high-risk patient populations or procedural subgroups.
回顾性研究表明,地塞米松可能提供的益处超出其止吐特性,包括减少术后并发症。然而,随机对照试验的结果并没有一致地显示复合主要不良事件的减少。这种差异可能是由于混杂因素、测量误差或回顾性调查中的同时性偏差造成的。本研究使用工具变量分析(IVA)来帮助解决潜在的偏倚来源,并更好地估计全关节置换术(TJA)患者的治疗效果。方法使用诊断和程序代码对2016年至2021年间接受原发性选择性TJA的患者进行识别。进行了双变量回归、多变量回归和IVA分析。主要终点是90天内主要术后医学并发症的综合(有或无)。次要结局是感染、再入院和死亡。两种不同的工具——外科医生和医院使用地塞米松的频率——被用来评估IVA的稳健性。使用描述性统计报告患者人口统计学、医院因素和合并症。使用最小绝对收缩和选择算子选择工具变量协变量,采用3种正则化参数策略。结果2015年至2021年间共进行了1525,844例tja,其中976,996例膝关节[全膝关节置换术{TKA}]; 548,848例髋关节[全髋关节置换术{THA}]。地塞米松暴露患者31299例(3.43%)出现严重术后并发症,未暴露患者31266例(4.87%)出现严重术后并发症。基于外科手术的IVA的结果与多变量和双变量分析相当(局部平均治疗效果[LATE]: TKA: -1.20%[95%置信区间[CI], -1.33%至-1.08%];THA: -1.14% [95% CI, -1.30%至-0.99%])。基于医院的IVA产生了类似的结果(LATE: TKA: -1.23% [95% CI, -1.38%至-1.09%];THA: -1.18% [95% CI, -1.35%至-1.00%])。两种仪器都显示出高f统计量和显著的Hausman检验。次要结局反映了这些结果,除了死亡率,在整个分析中不符合内生性标准。结论本研究结果支持地塞米松暴露与TJA术后复合主要并发症的减少有关。观察到的中等治疗效果,加上较低的基线不良事件发生率,可能解释了先前随机试验中报道的不一致的结果。未来的前瞻性研究应纳入复合终点,并针对高危患者群体或手术亚组。
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引用次数: 0
Detecting Inconsistencies and Fraud in Research Data: Time for Authors to Share the Data Underlying Their Summary Statistics as a Matter of Course. 检测研究数据中的不一致和欺诈:作者是时候分享他们的汇总统计数据作为理所当然的事情。
Pub Date : 2025-12-16 DOI: 10.1213/ane.0000000000007889
Nicholas J L Brown,John B Carlisle
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引用次数: 0
期刊
Anesthesia & Analgesia
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