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Opioids Reconsidered: From Antinociception to Potential Organ Protection. 重新考虑阿片类药物:从抗痛觉到潜在的器官保护。
Pub Date : 2026-01-29 DOI: 10.1213/ane.0000000000007956
Elizabeth A Wilson,Evan D Kharasch
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引用次数: 0
Does Language Matter? The Impact of English Proficiency on Healthcare Outcomes After Cardiac Surgery: A Scoping Review. 语言重要吗?英语水平对心脏手术后医疗结果的影响:一项范围综述。
Pub Date : 2026-01-29 DOI: 10.1213/ane.0000000000007883
Jose Rios-Monterrosa,Samuel Castro,Chance Aguiar,Ali Tanvir,Amanda Woodward,Louise Y Sun,Adam J Milam
Health care disparities, particularly among minoritized groups, pose significant challenges within health care systems, including the field of cardiac surgery. Limited English proficiency (LEP) is an often-overlooked factor contributing to these disparities. As key members of the preoperative evaluation, intraoperative management, and postoperative care of cardiac surgery patients, anesthesiologists have both ethical and economic responsibilities to understand, recognize, and address disparities to ensure equitable care for all patients. The objective of this scoping review is to summarize the literature on how LEP impacts the utilization of health services and outcomes after cardiac surgery. More specifically, the review will map how LEP is defined in the literature, summarize the patient populations that have been studied, and describe the health care outcomes in patients with LEP after cardiac surgery. A comprehensive literature search strategy was developed in collaboration with a medical librarian and was registered before conducting the search. Studies were eligible for inclusion in our current study if (i) the patient population was composed of adults (>or = 18), (ii) the study reported health care outcomes before or after cardiac surgery, and (iii) results were stratified by a patient's English proficiency. All randomized control trials, systematic reviews, observational studies, and cross-sectional studies published in English were included in our study. If conference abstracts met the inclusion criteria, they were included for full-text review. Opinion articles and case reports were excluded. The search produced 2401 articles with 13 articles meeting the inclusion criteria. All studies were conducted in either North America or Australia/New Zealand. The number of patients included in each study ranged from 204 to 21,789, with 4 studies having less than 1500 patients and 2 studies having greater than 10,000 patients. Through a systematic review of the literature on this topic, we identified 3 overarching themes that were inferred from the collective body of studies. First, a significant barrier to studying this topic is the absence of a universal definition of LEP. Second, the heterogeneity in several aspects of the available studies makes it difficult to draw conclusions from the results. Finally, there is a general scarcity of research done on the impact of LEP on cardiac surgery outcomes. Ultimately, our scoping review reveals an area of health disparity research that requires more attention. If disparities are found, then health care leaders may begin investigating which interventions can help mitigate these disparities.
卫生保健差距,特别是少数群体之间的差距,对包括心脏外科在内的卫生保健系统构成了重大挑战。有限的英语水平(LEP)是造成这些差异的一个经常被忽视的因素。作为心脏手术患者术前评估、术中管理和术后护理的关键成员,麻醉师有道德和经济责任来理解、认识和解决差异,以确保所有患者得到公平的护理。本综述的目的是总结关于LEP如何影响心脏手术后健康服务的利用和结果的文献。更具体地说,这篇综述将描绘LEP在文献中的定义,总结已研究的患者群体,并描述心脏手术后LEP患者的医疗保健结果。与医疗图书管理员合作制定了一项全面的文献检索策略,并在进行检索之前进行了注册。如果:(i)患者人群由成人组成(bb0或= 18),(ii)研究报告了心脏手术前后的医疗保健结果,(iii)结果按患者的英语水平分层,则研究符合纳入我们当前研究的条件。所有以英文发表的随机对照试验、系统评价、观察性研究和横断面研究均纳入我们的研究。如果会议摘要符合纳入标准,则纳入全文审查。观点文章和病例报告不包括在内。检索结果为2401篇,其中13篇符合纳入标准。所有研究均在北美或澳大利亚/新西兰进行。每项研究纳入的患者数量从204例到21,789例不等,其中4项研究的患者数量少于1500例,2项研究的患者数量大于10,000例。通过对这一主题的文献进行系统回顾,我们确定了从集体研究中推断出的3个总体主题。首先,研究本主题的一个重要障碍是缺乏LEP的通用定义。其次,现有研究在几个方面的异质性使得很难从结果中得出结论。最后,关于LEP对心脏手术结果影响的研究普遍缺乏。最终,我们的范围审查揭示了一个需要更多关注的健康差异研究领域。如果发现了差异,那么卫生保健领导者可能会开始调查哪些干预措施可以帮助减轻这些差异。
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引用次数: 0
Contribution of Acute Kidney Injury After Liver Transplant in Development of Chronic Kidney Disease: A Single-Center Retrospective Cohort Study. 肝移植后急性肾损伤在慢性肾病发展中的作用:一项单中心回顾性队列研究
Pub Date : 2026-01-26 DOI: 10.1213/ane.0000000000007911
Nicholas V Mendez,Daniel Chan,Ty Thompson,David Chen,Sebastian Zeiner,Rishi P Kothari,Hillary J Braun,Michael P Bokoch,Kerstin Kolodzie,Dieter Adelmann
BACKGROUNDAcute kidney injury (AKI) is common after liver transplant and associated with increased morbidity and mortality. Transplantation of nonrenal organs is also associated with eventual chronic kidney disease (CKD). Development of CKD after liver transplant is known to be multifactorial; however, this study evaluates the unique contribution of AKI in this complex disease pathway.METHODSPatients were classified into 2 groups: presence or absence of severe AKI within 72 hours postoperatively. Kidney function was assessed at year 1: normal/mild (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m2); moderate (30 ≤eGFR <60 mL/min/1.73 m2); or severe (eGFR <30 mL/min/1.73m2) disease. Adjusted relative risks of both CKD and death at years 1 through 3 in the presence versus absence of severe AKI were estimated using discrete-time targeted maximum likelihood estimation.RESULTSOf 1574 patients, 769 (49%) experienced severe AKI. At year 1, 1024 (65%) patients had normal/mild, 487 (31%) had moderate, and 63 (4%) had severe CKD. The unadjusted relative risk of severe CKD was 3.66 (95% confidence interval [CI], 2.15-7.33), and the adjusted relative risk was 2.62 (95% CI, 1.61-4.28) in patients with severe AKI. In total, 66 (4%), 115 (7%), and 147 (9%) patients died in years 1, 2, and 3, respectively. Patients with severe AKI had an unadjusted relative risk of death at year 1 of 2.41 (95% CI, 1.47-4.19) compared to an adjusted relative risk of 1.15 (95% CI, 1.04-1.28); at year 2, the unadjusted relative risk of death was 1.51 (95% CI, 1.07-2.19) compared to an adjusted relative risk of 1.14 (95% CI, 1.04-1.25); and at year 3, the unadjusted relative risk of death was 1.44 (95% CI, 1.05-1.97) compared to an adjusted relative risk of 1.13 (95% CI, 1.04-1.23).CONCLUSIONSevere postoperative AKI is associated with an increased risk of severe CKD at 1 year and mortality up to 3 years after liver transplant. Postoperative AKI represents an important target for future perioperative interventions aimed at mitigating the risk of long-term morbidity and mortality for liver transplant patients.
背景:急性肾损伤(AKI)在肝移植后很常见,并与发病率和死亡率增加相关。非肾脏器官移植也与最终的慢性肾脏疾病(CKD)有关。已知肝移植后CKD的发展是多因素的;然而,本研究评估了AKI在这一复杂疾病通路中的独特贡献。方法将患者分为术后72小时存在或不存在严重AKI两组。在第1年评估肾功能:正常/轻度(估计肾小球滤过率[eGFR]≥60 mL/min/1.73 m2);中度(30≤eGFR < 60ml /min/1.73 m2);或严重(eGFR <30 mL/min/1.73m2)疾病。使用离散时间目标最大似然估计来估计存在与不存在严重AKI的1 - 3年CKD和死亡的校正相对风险。结果1574例患者中,769例(49%)出现严重AKI。在第1年,1024例(65%)患者为正常/轻度,487例(31%)为中度,63例(4%)为重度CKD。严重CKD的未调整相对危险度为3.66(95%可信区间[CI], 2.15-7.33),严重AKI患者的调整相对危险度为2.62 (95% CI, 1.61-4.28)。总共有66例(4%)、115例(7%)和147例(9%)患者分别在第1、2和3年死亡。严重AKI患者1年未调整的相对死亡风险为2.41 (95% CI, 1.47-4.19),调整后的相对死亡风险为1.15 (95% CI, 1.04-1.28);在第2年,未调整的相对死亡风险为1.51 (95% CI, 1.07-2.19),而调整后的相对死亡风险为1.14 (95% CI, 1.04-1.25);在第3年,未调整的相对死亡风险为1.44 (95% CI, 1.05-1.97),而调整的相对死亡风险为1.13 (95% CI, 1.04-1.23)。结论:严重的术后AKI与肝移植后1年发生严重CKD的风险增加和3年死亡率增加相关。术后AKI是未来围手术期干预的一个重要目标,旨在降低肝移植患者长期发病和死亡的风险。
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引用次数: 0
Institutional Experience Introducing Portable Capnography Intrahospital Transport of Ventilated Patients With Congenital Heart Disease. 先心病通气患者院内输送便携式血管造影的机构经验。
Pub Date : 2026-01-14 DOI: 10.1213/ane.0000000000007940
Morgan L Brown,David Whiting,James A DiNardo,Viviane G Nasr
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引用次数: 0
Site-Specific Blockade of LPA-TRPV1 Interaction at K710 Residue Influences on Myocardial Ischemia/Reperfusion Injury in Ex Vivo Mouse Hearts. LPA-TRPV1位点特异性阻断K710残基相互作用对离体小鼠心脏缺血/再灌注损伤的影响
Pub Date : 2026-01-14 DOI: 10.1213/ane.0000000000007907
Muge Qile,Zhaofei Luo,Chao Wu,Xueying Cheng,Yu Zhang,Liu Liu,Qingtong Wang,Ye Zhang,Eric R Gross,Shufang He
BACKGROUNDMyocardial ischemia/reperfusion (I/R) injury commonly occurs in patients undergoing cardiac or noncardiac surgeries, increasing perioperative mortality risk. Although numerous endogenous mediators released during I/R contribute to myocardial damage, their mechanisms require further elucidation. We investigated whether lysophosphatidic acid (LPA), a bioactive phospholipid, mediates myocardial I/R injury by interacting with cardiac transient receptor potential vanilloid 1 (TRPV1).METHODSA TRPV1K710N knock-in mouse model was generated by CRISPR/Cas9, introducing a point mutation at K710, the known LPA-binding site on TRPV1. Langendorff perfused isolated hearts from TRPV1K710N and wild-type (WT) mice underwent global I/R injury with or without exogenous LPA (10 μM). Myocardial infarct size, coronary effluent LDH levels, and mitochondrial ultrastructure/function were assessed. Additionally, H9c2 cardiomyocytes were transfected with a pCMV6-entry plasmid carrying TRPV1-K710N or TRPV1-WT for mitochondrial calcium influx and cell viability assays. The V1-Cal peptide (1μM), targeting the K710 region, was applied ex vivo and in vitro to block LPA-TRPV1 interaction.RESULTSTRPV1K710N hearts exhibited resistance to global I/R injury versus WT hearts, with reduced infarct size (28.3 ± 2.4% vs 39.9 ±2.3%, respectively, P= 0006), lower LDH levels, and attenuated mitochondrial damage. Exogenous LPA exacerbated I/R injury in WT hearts, increasing infarct size (63.7 ± 1.2% vs vehicle: 38.4 ± 2.4%; P <.0001), LDH release, and mitochondrial damage. TRPV1K710N hearts were resistant to LPA-induced injury, with no significant increase in infarct size after LPA treatment. Exogenous LPA induced pronounced swelling in mitochondria isolated from WT hearts, while mitochondria from TRPV1K710N hearts showed resistance to LPA challenge. In H9c2 cells, LPA significantly decreased viability in rTRPV1-WT cells and elevated mitochondrial calcium influx relative to rTRPV1-K710N cells. V1-Cal peptide attenuated LPA-mediated myocardial injury in WT hearts and reduced mitochondrial calcium overload in H9c2 cells.CONCLUSIONSBlockade of the TRPV1 K710 site by K710N mutation or V1-Cal peptide mitigates LPA-mediated myocardial injury and mitochondrial damage/dysfunction in isolated mouse hearts. Targeting the cardiac LPA-TRPV1 interaction represents a promising therapeutic strategy against perioperative myocardial injury.
背景心肌缺血/再灌注(I/R)损伤常见于心脏或非心脏手术患者,增加围手术期死亡风险。虽然在I/R过程中释放的许多内源性介质有助于心肌损伤,但其机制有待进一步阐明。我们研究了溶血磷脂酸(LPA)是否通过与心脏瞬时受体电位香草蛋白1 (TRPV1)相互作用介导心肌I/R损伤。方法利用CRISPR/Cas9技术建立TRPV1K710N敲入小鼠模型,在TRPV1上已知的lpa结合位点K710上引入点突变。Langendorff灌注TRPV1K710N和野生型(WT)小鼠的离体心脏,在有或没有外源性LPA (10 μM)的情况下进行全局I/R损伤。评估心肌梗死面积、冠状动脉流出液LDH水平和线粒体超微结构/功能。此外,用携带TRPV1-K710N或TRPV1-WT的pcmv6进入质粒转染H9c2心肌细胞,进行线粒体钙内流和细胞活力测定。针对K710区域的V1-Cal肽(1μM)在体内和体外应用阻断LPA-TRPV1相互作用。结果与WT相比,strpv1k710n心脏表现出对全局I/R损伤的抵抗,梗死面积减小(分别为28.3±2.4%和39.9±2.3%,P= 0006), LDH水平降低,线粒体损伤减轻。外源性LPA加重了WT心脏的I/R损伤,增加了梗死面积(63.7±1.2% vs .对照组:38.4±2.4%;P < 0.0001)、LDH释放和线粒体损伤。TRPV1K710N心脏对LPA诱导的损伤有抵抗性,LPA治疗后梗死面积无显著增加。外源性LPA诱导WT心脏分离的线粒体明显肿胀,而TRPV1K710N心脏的线粒体对LPA的攻击表现出抵抗性。在H9c2细胞中,与rTRPV1-K710N细胞相比,LPA显著降低了rTRPV1-WT细胞的活力,增加了线粒体钙内流。V1-Cal肽可减轻lpa介导的WT心脏心肌损伤,减少H9c2细胞线粒体钙超载。结论通过K710N突变或V1-Cal肽阻断TRPV1 K710位点可减轻lpa介导的离体小鼠心脏心肌损伤和线粒体损伤/功能障碍。靶向心脏LPA-TRPV1相互作用是一种很有前途的治疗围手术期心肌损伤的策略。
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引用次数: 0
Risk Factors and Prediction of Chronic Postsurgical Pain Among Patients With Distal Lower Extremity Fracture: Cohort Analysis. 下肢远端骨折患者术后慢性疼痛的危险因素及预测:队列分析。
Pub Date : 2026-01-14 DOI: 10.1213/ane.0000000000007902
Yangzi Zhu,Ying Wu,Kailun Gao,Yuning Sun,Junfeng Hu,Liwei Wang,Jun-Li Cao
BACKGROUNDThe surgical interventions aimed at fracture repair are often accompanied by chronic postsurgical pain (CPSP), which is associated with depression, impaired quality of life, and increased societal burden. This phenomenon is particularly understudied in young patients with distal lower extremity fracture. Developing a scalable and accurate predictive model could improve postoperative care by enabling early detection of high-risk patients and guiding personalized pain management strategies.METHODSThis study collected in-hospital medical records and conducted follow-up for all patients over a 1-year period. We developed a predictive model through a 3-stage approach involving Least Absolute Shrinkage and Selection Operator (LASSO) regression, information gain analysis, and multivariable logistic regression, followed by model validation. Using the Shinyapps.io platform to build a webpage risk calculator for the final prediction model.RESULTSThe final cohort included 818 patients: 38.4% of whom experienced CPSP, and 18.2% of patients with CPSP developed neuropathic pain. There are 6 independent variables associated with CPSP: postoperative analgesic technique, fixation type, preoperative clinical management, and numerical rating scale (NRS) score on the day of the visit and postoperative day 1. The optimism-corrected area under the receiver operating curve for the development cohort and validation cohort were 0.872 and 0.838, respectively, and this model demonstrated good calibration and clinical utility. A web-based predictive nomogram was established by integrating machine learning-based big data variable screening with the interpretability of traditional logistic regression.CONCLUSIONSThis study demonstrates that pain management strategies, surgical approaches, and patient psychological factors collectively influence the development of CPSP. By integrating machine learning-based big data variable screening with the interpretability of traditional logistic regression, we developed a web-based predictive nomogram capable of identifying early CPSP risk at hospital discharge, thereby improving accessibility to transitional pain care interventions.
背景:针对骨折修复的手术干预通常伴随着慢性术后疼痛(CPSP),这与抑郁、生活质量下降和社会负担增加有关。在下肢远端骨折的年轻患者中,这种现象的研究尤其不足。开发可扩展和准确的预测模型可以通过早期发现高危患者和指导个性化疼痛管理策略来改善术后护理。方法收集住院病历,随访1年以上。我们通过最小绝对收缩和选择算子(LASSO)回归、信息增益分析和多变量逻辑回归三阶段方法建立了预测模型,然后进行模型验证。使用Shinyapps。IO平台构建网页风险计算器,进行最终预测模型。结果最终纳入818例患者,其中38.4%的患者发生CPSP, 18.2%的患者发生神经性疼痛。与CPSP相关的自变量有6个:术后镇痛技术、固定方式、术前临床管理、就诊当日及术后第1天的数值评定量表(NRS)评分。开发组和验证组受试者工作曲线下的乐观校正面积分别为0.872和0.838,该模型具有良好的校准性和临床实用性。将基于机器学习的大数据变量筛选与传统逻辑回归的可解释性相结合,建立了基于网络的预测模态图。结论疼痛管理策略、手术方式和患者心理因素共同影响CPSP的发展。通过将基于机器学习的大数据变量筛选与传统逻辑回归的可解释性相结合,我们开发了一个基于网络的预测nomogram,能够在出院时识别早期CPSP风险,从而提高过渡性疼痛护理干预的可及性。
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引用次数: 0
Whole Blood versus Components for Transfusion in Trauma and Life-Threatening Hemorrhage-Unresolved Issues. 全血与输血成分在创伤和危及生命的出血-未解决的问题。
Pub Date : 2026-01-13 DOI: 10.1213/ane.0000000000007923
Phuong-Lan Thi Nguyen,Catherine Marcucci,Majed Refaai,Akua Asante,Nicholas Tong,Neil Blumberg
{"title":"Whole Blood versus Components for Transfusion in Trauma and Life-Threatening Hemorrhage-Unresolved Issues.","authors":"Phuong-Lan Thi Nguyen,Catherine Marcucci,Majed Refaai,Akua Asante,Nicholas Tong,Neil Blumberg","doi":"10.1213/ane.0000000000007923","DOIUrl":"https://doi.org/10.1213/ane.0000000000007923","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961589","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}
引用次数: 0
LEMONS: Incorporating Stiffness of Submental/Submandibular Space into Difficult Airway Assessment. 柠檬:将颏下/下颌下间隙的硬度纳入困难气道评估。
Pub Date : 2026-01-13 DOI: 10.1213/ane.0000000000007896
Chen-Hwan Cherng
{"title":"LEMONS: Incorporating Stiffness of Submental/Submandibular Space into Difficult Airway Assessment.","authors":"Chen-Hwan Cherng","doi":"10.1213/ane.0000000000007896","DOIUrl":"https://doi.org/10.1213/ane.0000000000007896","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961586","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}
引用次数: 0
Medical Society Guideline Writing: The Why and How. 医学学会指南写作:为什么和如何。
Pub Date : 2026-01-13 DOI: 10.1213/ane.0000000000007903
Craig S Jabaley,Mark E Nunnally,Brigid C Flynn
{"title":"Medical Society Guideline Writing: The Why and How.","authors":"Craig S Jabaley,Mark E Nunnally,Brigid C Flynn","doi":"10.1213/ane.0000000000007903","DOIUrl":"https://doi.org/10.1213/ane.0000000000007903","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"390 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961587","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}
引用次数: 0
Prolonged Fasting and Patient-Centered Outcomes: When Science Meets Common Sense. 延长禁食和以病人为中心的结果:当科学遇到常识。
Pub Date : 2026-01-13 DOI: 10.1213/ane.0000000000007935
Alexander Nagrebetsky,Girish P Joshi
{"title":"Prolonged Fasting and Patient-Centered Outcomes: When Science Meets Common Sense.","authors":"Alexander Nagrebetsky,Girish P Joshi","doi":"10.1213/ane.0000000000007935","DOIUrl":"https://doi.org/10.1213/ane.0000000000007935","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961593","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}
引用次数: 0
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Anesthesia & Analgesia
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