Anesthesia & Analgesia最新文献

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Risk of Acute Complications With Rocuronium Versus Cisatracurium in Patients With Chronic Kidney Disease: Propensity Score Meets Biological Plausibility. 慢性肾病患者使用罗库溴铵与顺阿曲库铵急性并发症的风险：倾向评分符合生物学合理性

Anesthesia & Analgesia

Pub Date : 2025-11-03 DOI: 10.1213/ane.0000000000007799

Oluwaseun Akinkuolie,Tracey Straker,Olubukola O Nafiu

引用次数: 0

Comment on "Major Arthroplasty in Patients With Hereditary Bleeding Disorders". 关于“遗传性出血性疾病患者的大关节置换术”的评论。

Anesthesia & Analgesia

Pub Date : 2025-11-03 DOI: 10.1213/ane.0000000000007792

Evan G Pivalizza

引用次数: 0

Opioid-Sparing Anesthesia Technique for Supratentorial Craniotomy in Geriatric Patients: A Randomized Open-Labeled Preliminary Study. 老年患者幕上开颅术中保留阿片类麻醉技术：一项随机开放标记的初步研究。

Anesthesia & Analgesia

Pub Date : 2025-11-03 DOI: 10.1213/ane.0000000000007855

Indu Kapoor,Hemanshu Prabhakar,Charu Mahajan,Pragati Ganjoo,Monica Tandon,Mani Kalaivani

引用次数: 0

Beyond One-Variable-at-a-Time Subgroup Analyses: Illustrating the Predictive Approaches to Treatment Effect Heterogeneity Framework in the Third International Stroke Trial. 超越单变量一次亚组分析：阐明第三次国际卒中试验治疗效果异质性框架的预测方法。

Anesthesia & Analgesia

Pub Date : 2025-11-03 DOI: 10.1213/ane.0000000000007783

Markus Huber,Christian Beilstein,Patrick Y Wuethrich,Thomas Vetsch

引用次数: 0

Presence of a Diagnosed Cannabis Use Disorder Predisposes Pain Following Transcatheter Aortic Valve Replacement: Results From a Retrospective Analysis. 经导管主动脉瓣置换术后诊断的大麻使用障碍易导致疼痛：来自回顾性分析的结果。

Anesthesia & Analgesia

Pub Date : 2025-11-03 DOI: 10.1213/ane.0000000000007813

Sareena Shah,Angie Jang,Shrey Patel,Brigid Flynn

引用次数: 0

Reconciling Observational Signals With Trial Data in Anesthetic Choice for Hip Fracture Surgery. 髋骨骨折手术麻醉选择的观察信号与试验数据相协调。

Anesthesia & Analgesia

Pub Date : 2025-10-24 DOI: 10.1213/ane.0000000000007833

Michael R Fettiplace,Frank Herbstreit

引用次数: 0

Less Is More But Is None Even Better? Patient Blood Management and Bloodless Care. 少即是多，但没有更好吗？病人血液管理和无血护理。

Anesthesia & Analgesia

Pub Date : 2025-10-24 DOI: 10.1213/ane.0000000000007790

Nadia B Hensley,Elizabeth P Crowe,Linda M S Resar,Steven M Frank

引用次数: 0

Can Current Artificial Intelligence and Large Language Models Aid in Difficult Airway Management? 当前的人工智能和大语言模型能帮助困难的气道管理吗？

Anesthesia & Analgesia

Pub Date : 2025-10-24 DOI: 10.1213/ane.0000000000007795

Scott J Price,Nathan C Hurley,Kristopher M Schroeder,Richard E Galgon,William Rosenblatt

引用次数: 0

Intravenous Lidocaine for Postoperative Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial. 静脉注射利多卡因治疗扁桃体切除术后儿童疼痛：一项双盲、随机、安慰剂对照试验。

Anesthesia & Analgesia

Pub Date : 2025-10-24 DOI: 10.1213/ane.0000000000007786

Hubert A Benzon,Michael R King,Keith J Kilner,Ravi D Shah,Kathleen R Billings,Stephen R Hoff,Robert J McCarthy

BACKGROUNDTonsillectomy is a commonly performed surgical procedure in children, and the recovery period can be associated with significant postoperative pain. Currently, there are no studies examining the efficacy of intravenous lidocaine in decreasing post-tonsillectomy pain in children. The aim of this study was to evaluate the efficacy of intravenous lidocaine for decreasing postsurgical pain in children undergoing tonsillectomy.METHODSThis study was a prospective, randomized, double-blinded clinical trial of children ages 4-10 years undergoing tonsillectomy with or without adenoidectomy. Subjects were assigned to 1 of 2 groups: (i) intravenous lidocaine bolus (1.5 mg/kg) at anesthesia induction followed by a continuous intraoperative and postoperative infusion dose (2 mg/kg/h) or (ii) the equivalent volume of saline for 1 hour. The primary outcome was opioid consumption in milligram morphine equivalents (MME) in the postanesthesia care unit. Secondary outcome measures included pain intensity in the postanesthesia care unit measured using the Children's Hospital of Eastern Ontario Pain Scale and emergence agitation measured using the Pediatric Anesthesia Emergence Delirium scale, postoperative nausea and vomiting, and parent-reported pain intensity and medication administration at home.RESULTSNinety subjects were randomized and 88 completed the study: 44 received lidocaine and 44 received saline. There was no difference in adjusted postanesthesia care unit morphine consumption per kg of body weight, difference -0.01 MME/kg (95% confidence interval [CI], -0.07 to 0.04; P = .627), or total morphine use, difference -0.03 MME/kg (95% CI, -0.08 to 0.03; P = .360) between groups. There was no significant difference in Children's Hospital of Eastern Ontario Pain Scale or Pediatric Anesthesia Emergence Delirium scale scores or ondansetron dose. In the first postoperative week, there were no differences in parent postoperative pain measures, nausea/vomiting, ibuprofen, acetaminophen, or opioid use.CONCLUSIONSThe analysis showed no evidence for a clinical benefit of intraoperative lidocaine infusion in children undergoing tonsillectomy. Our findings highlight the importance of characterizing non-opioid analgesic techniques in children, which have previously shown promise in adults.

背景扁桃体切除术是儿童常见的外科手术，恢复期可能与明显的术后疼痛有关。目前，还没有关于静脉注射利多卡因减轻儿童扁桃体切除术后疼痛的研究。本研究的目的是评估静脉注射利多卡因减轻儿童扁桃体切除术后疼痛的疗效。方法本研究是一项前瞻性、随机、双盲临床试验，研究对象为4-10岁接受扁桃体切除术合并或不合并腺样体切除术的儿童。受试者被分为两组：(i)麻醉诱导时静脉注射利多卡因（1.5 mg/kg），随后术中和术后持续输注剂量（2 mg/kg/h）或（ii）等量生理盐水1小时。主要结局是麻醉后护理单元中以毫克吗啡当量（MME）为单位的阿片类药物消耗。次要结果测量包括麻醉后护理病房的疼痛强度，使用东安大略儿童医院疼痛量表测量，使用儿科麻醉出现谵妄量表测量出现时的躁动，术后恶心和呕吐，以及父母报告的疼痛强度和在家给药。结果90例受试者随机分组，88例完成研究，44例接受利多卡因治疗，44例接受生理盐水治疗。两组间经调整的麻醉后护理单位吗啡每公斤体重用量无差异，差异为-0.01 MME/kg(95%可信区间[CI]， -0.07 ~ 0.04; P = 0.627)，吗啡总用量差异为-0.03 MME/kg （95% CI, -0.08 ~ 0.03; P = 0.360）。东安大略儿童医院疼痛量表、小儿麻醉出现性谵妄量表评分及昂丹西琼剂量差异无统计学意义。在术后第一周，父母术后疼痛测量、恶心/呕吐、布洛芬、对乙酰氨基酚或阿片类药物的使用没有差异。结论：分析显示术中输注利多卡因对儿童扁桃体切除术无临床益处。我们的研究结果强调了表征儿童非阿片类镇痛技术的重要性，这些技术以前在成人中显示出前景。

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引用次数: 0

Esmolol as an Adjunct in Multimodal Anesthesia: A Systematic Review and Meta-Analysis of Its Opioid-Sparing and Analgesic Effects. 艾司洛尔在多模式麻醉中的辅助作用：其阿片类药物节约和镇痛作用的系统回顾和meta分析。

Anesthesia & Analgesia

Pub Date : 2025-10-24 DOI: 10.1213/ane.0000000000007787

Emidio Dias da Silva Neto,Felipe S Thyrso de Lara,Samuel Navarro Abreu,Mayara Cristina Sanches,Maria Clara Florêncio de Freitas,André Richard da S Oliveira,Celso Schmalfuss Nogueira,Vanessa Henriques Carvalho

BACKGROUNDEsmolol, an ultra-short-acting β1-selective adrenergic antagonist, has been investigated for its potential opioid-sparing effects in multimodal anesthesia. Previous systematic reviews included trials with different control groups causing severe limitations to the generalization of the findings. This systematic review and meta-analysis exclusively synthesized placebo-controlled randomized trials to evaluate the impact of intraoperative esmolol infusion on opioid consumption and postoperative pain scores within the first 24 hours after surgery.METHODSA systematic search was conducted in Medline, Embase, Cochrane Library, and Google Scholar to identify randomized placebo-controlled trials assessing the effects of continuous intraoperative esmolol infusion on opioid consumption and pain scores. The outcomes of interest were total intraoperative and postoperative opioid consumption, converted to intravenous morphine milligram equivalents (IV MME), and pain intensity, and assessed using either the visual analog scale (VAS) or the Numeric Rating Scale (NRS), both of which were standardized using validated methods to a common 0 to 10 scale. Meta-analyses were performed using a random-effects model, and heterogeneity was assessed using Cochran's Q test and I² statistics. Meta-regression and subgroup analyses explored the effects of esmolol infusion rate, type of surgery, intraoperative anesthetic and hemodynamic management, and patient age as potential moderators.RESULTSNineteen randomized trials (1028 patients) were included, involving esmolol regimens with a loading dose ranging from 0.5 to 1.0 mg/kg and a maintenance infusion rate of 0.3 to 6 mg/kg/h. Surgical procedures ranged from minimally invasive to open intracavitary surgeries. Esmolol infusion significantly reduced in 32% the intraoperative opioid consumption (mean differences [MD], -12.89 IV MME; 95% Confidence Interval, 95% confidence interval [CI], -24.74 to -1.05; P < .001; I² = 93.6%) and 38.6% the postoperative opioid consumption (MD, -3.03 IV MME; 95% CI, -4.29 to -1.76; P < .001; I² = 89.9%). For pain scores, 3 analyses were performed at the following intervals: within 30 minutes (MD, -1.47; 95% CI, -2.02 to -0.93; P < .001), between 2 and 4 hours (MD, -0.67; 95% CI, -1.29 to -0.06; P = .032), and at 24 hours (MD, -0.48; 95% CI, -0.92 to -0.03; P =.038). Based on the weighted mean values for the placebo group in each pooled analysis, we observed reductions in pain scores of 27.3%, 15.8%, and 23.5%, respectively. In addition, esmolol significantly reduced intraoperative heart rate in most cases and lowered MAP at multiple time points in several studies. Despite this, no significant increase in hypotension or bradycardia was reported, and only 1 study noted higher ephedrine and atropine use.CONCLUSIONSEsmolol infusion significantly reduces opioid consumption and postoperative pain, with a magnitude of effect that may have clinical significance. The observed effects remained consi

地莫洛尔是一种超短效β1选择性肾上腺素能拮抗剂，在多模式麻醉中具有潜在的阿片类药物节约作用。以前的系统综述包括不同对照组的试验，这对研究结果的推广造成了严重的限制。本系统综述和荟萃分析专门合成了安慰剂对照随机试验，以评估术中艾司洛尔输注对术后24小时内阿片类药物消耗和术后疼痛评分的影响。方法系统检索Medline、Embase、Cochrane Library和谷歌Scholar数据库，筛选评估术中持续输注艾司洛尔对阿片类药物消耗和疼痛评分影响的随机安慰剂对照试验。关注的结果是术中和术后阿片类药物总消耗量，转换为静脉注射吗啡毫克当量（IV MME）和疼痛强度，并使用视觉模拟量表（VAS）或数字评定量表（NRS）进行评估，两者都使用经过验证的方法标准化为通用的0到10级。采用随机效应模型进行meta分析，采用Cochran’s Q检验和I²统计量评估异质性。meta回归和亚组分析探讨了艾司洛尔输注速率、手术类型、术中麻醉和血流动力学管理以及患者年龄作为潜在的调节因素的影响。结果纳入19项随机试验（1028例患者），涉及艾司洛尔方案，负荷剂量为0.5 ~ 1.0 mg/kg，维持输注速率为0.3 ~ 6 mg/kg/h。手术方法从微创手术到开放腔内手术不等。艾司洛尔显著降低32%术中阿片类药物消耗（平均差异[MD]， -12.89 IV MME； 95%可信区间，95%可信区间[CI]， -24.74至-1.05;P < 0.001; I²= 93.6%）和38.6%术后阿片类药物消耗（MD, -3.03 IV MME; 95% CI, -4.29至-1.76;P < 0.001; I²= 89.9%）。对于疼痛评分，在以下时间间隔进行3次分析：30分钟内（MD, -1.47; 95% CI, -2.02至-0.93;P < 0.001）， 2至4小时内（MD, -0.67; 95% CI, -1.29至-0.06;P = 0.032）， 24小时（MD, -0.48; 95% CI, -0.92至-0.03;P = 0.038）。根据每次合并分析中安慰剂组的加权平均值，我们观察到疼痛评分分别降低了27.3%、15.8%和23.5%。此外，在一些研究中，艾司洛尔在大多数情况下显著降低术中心率，并在多个时间点降低MAP。尽管如此，没有低血压或心动过缓明显增加的报道，只有1项研究注意到麻黄碱和阿托品的使用增加。结论舒洛尔输注可明显减少阿片类药物的消耗和术后疼痛，其作用幅度可能具有临床意义。在存在可能使结果偏向零值的混杂变量的亚组中，观察到的效果保持一致。然而，后期疼痛结果的不确定性和持续的异质性需要进一步研究艾司洛尔在不同手术环境和人群中的适用性。

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