Pub Date : 2026-01-21DOI: 10.1097/aln.0000000000005845
Steven B Greenberg,Andrew R Locke,Noah Ben-Isvy,Andrew Bochenek,Richard Wlodarski,Sorin J Brull
{"title":"A Pilot Study Using a Portable Electromyography Device to Assess Changes in Compound Muscle Action Potential Amplitudes and Latencies in Critically Ill Intubated Patients.","authors":"Steven B Greenberg,Andrew R Locke,Noah Ben-Isvy,Andrew Bochenek,Richard Wlodarski,Sorin J Brull","doi":"10.1097/aln.0000000000005845","DOIUrl":"https://doi.org/10.1097/aln.0000000000005845","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"39 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1097/ALN.0000000000005893
Sonal Kumar
{"title":"Whispers of the OR.","authors":"Sonal Kumar","doi":"10.1097/ALN.0000000000005893","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005893","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1097/aln.0000000000005947
Britta S von Ungern-Sternberg,Aine Sommerfield,Caroline O'Brien,Andrew J Davidson,Tania A Ramos,Susan M Goobie,Yun-Xia Zuo,Lei Yang,Heidi M Meyer,Elsa M Taylor,Simon D Whyte,Wallis T Muhly,Jurgen C de Graaff,Charlotte van Deuzen,Peidad Echeverry,Paul A Stricker,
Our international collaboration of researchers and clinicians (The Pediatric Perioperative Outcomes Group) was established to develop core outcome sets for infants, children, and adolescents. Here we report on a qualitative mixed methods study with semi-structured interviews of parents/guardians and their children undergoing anesthesia for surgery along with perioperative health care providers (e.g., nurses, surgeons and anesthesiologists). We compared and explored outcomes through a modified grounded theory analysis of interview transcripts to inform the establishment of an internationally recognized core outcome set for pediatric perioperative medicine. In total, 359 semi-structured interviews were conducted between June 2021 and July 2022 across ten study sites in 8 countries: USA, Canada, Australia, New Zealand, the Netherlands, South Africa, Colombia and China. We identified the themes of pain, complications, mental health and emotional state, and environment to be important for all stakeholder groups engaged. Differences were observed between the themes for health care providers and patients, parent/guardians.
{"title":"Perspectives of children, parents and health care providers on outcomes following anesthesia for surgery:: An international mixed methods stakeholder engagement study from the Pediatric Perioperative Outcomes Group.","authors":"Britta S von Ungern-Sternberg,Aine Sommerfield,Caroline O'Brien,Andrew J Davidson,Tania A Ramos,Susan M Goobie,Yun-Xia Zuo,Lei Yang,Heidi M Meyer,Elsa M Taylor,Simon D Whyte,Wallis T Muhly,Jurgen C de Graaff,Charlotte van Deuzen,Peidad Echeverry,Paul A Stricker, ","doi":"10.1097/aln.0000000000005947","DOIUrl":"https://doi.org/10.1097/aln.0000000000005947","url":null,"abstract":"Our international collaboration of researchers and clinicians (The Pediatric Perioperative Outcomes Group) was established to develop core outcome sets for infants, children, and adolescents. Here we report on a qualitative mixed methods study with semi-structured interviews of parents/guardians and their children undergoing anesthesia for surgery along with perioperative health care providers (e.g., nurses, surgeons and anesthesiologists). We compared and explored outcomes through a modified grounded theory analysis of interview transcripts to inform the establishment of an internationally recognized core outcome set for pediatric perioperative medicine. In total, 359 semi-structured interviews were conducted between June 2021 and July 2022 across ten study sites in 8 countries: USA, Canada, Australia, New Zealand, the Netherlands, South Africa, Colombia and China. We identified the themes of pain, complications, mental health and emotional state, and environment to be important for all stakeholder groups engaged. Differences were observed between the themes for health care providers and patients, parent/guardians.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"29 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1097/aln.0000000000005924
Tzu Chun Wang,Yu En Kuo,Terry B J Kuo,Cheryl C H Yang
BACKGROUNDMaintaining an optimal nociception-analgesia balance is essential in clinical anesthesia. Traditional monitoring relies on brainstem reflexes, whereas electroencephalographic (EEG) indices, such as alpha power attenuation and phase-amplitude coupling (PAC), show promise as markers of nociceptive processing. However, their physiological mechanisms and relationship to postoperative pain remain unclear.METHODSThis prospective cohort study included 58 patients undergoing laparoscopic surgery under either conventional general anesthesia or general anesthesia combined with a transversus abdominis plane block. Intraoperative EEG recordings were analyzed for frequency-band power and PAC across surgical stages (incision, insufflation, and post-opioid administration). Generalized estimating equations with Bonferroni post-hoc correction were used to assess EEG patterns and their association with postoperative pain.RESULTSThe alpha band power and modulation index of delta-alpha PAC decreased during surgical incision, insufflation, followed by recovery after opioid administration. While alpha power changes did not differentiate the effects of the nerve block, delta-alpha PAC changes significantly reflected nerve block effectiveness during incision (coefficient: 0.81; 95% CI, 0.11-1.51; P = 0.02). However, no association was observed between perioperative EEG patterns and postoperative pain scores.CONCLUSIONSLaparoscopic surgical stimulation reduces EEG alpha power and delta-alpha PAC. Delta-alpha PAC demonstrated greater sensitivity than alpha power measures in distinguishing nociceptive input and reflecting the nerve block effects, suggesting its potential as an intraoperative nociception-analgesia marker. However, perioperative EEG patterns showed limited value in predicting postoperative pain, suggesting that postoperative pain perception is shaped by more complex mechanisms requiring further investigation.
{"title":"Frontal Electroencephalogram Phase-Amplitude Coupling Reflects Nociception and the Analgesic Effect of Transversus Abdominis Plane Block in Laparoscopic Surgery.","authors":"Tzu Chun Wang,Yu En Kuo,Terry B J Kuo,Cheryl C H Yang","doi":"10.1097/aln.0000000000005924","DOIUrl":"https://doi.org/10.1097/aln.0000000000005924","url":null,"abstract":"BACKGROUNDMaintaining an optimal nociception-analgesia balance is essential in clinical anesthesia. Traditional monitoring relies on brainstem reflexes, whereas electroencephalographic (EEG) indices, such as alpha power attenuation and phase-amplitude coupling (PAC), show promise as markers of nociceptive processing. However, their physiological mechanisms and relationship to postoperative pain remain unclear.METHODSThis prospective cohort study included 58 patients undergoing laparoscopic surgery under either conventional general anesthesia or general anesthesia combined with a transversus abdominis plane block. Intraoperative EEG recordings were analyzed for frequency-band power and PAC across surgical stages (incision, insufflation, and post-opioid administration). Generalized estimating equations with Bonferroni post-hoc correction were used to assess EEG patterns and their association with postoperative pain.RESULTSThe alpha band power and modulation index of delta-alpha PAC decreased during surgical incision, insufflation, followed by recovery after opioid administration. While alpha power changes did not differentiate the effects of the nerve block, delta-alpha PAC changes significantly reflected nerve block effectiveness during incision (coefficient: 0.81; 95% CI, 0.11-1.51; P = 0.02). However, no association was observed between perioperative EEG patterns and postoperative pain scores.CONCLUSIONSLaparoscopic surgical stimulation reduces EEG alpha power and delta-alpha PAC. Delta-alpha PAC demonstrated greater sensitivity than alpha power measures in distinguishing nociceptive input and reflecting the nerve block effects, suggesting its potential as an intraoperative nociception-analgesia marker. However, perioperative EEG patterns showed limited value in predicting postoperative pain, suggesting that postoperative pain perception is shaped by more complex mechanisms requiring further investigation.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"6 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1097/aln.0000000000005946
Jung-Bin Park,Sang-Hwan Ji,Young-Eun Jang,Ji-Hyun Lee,Jin-Tae Kim,Hee-Soo Kim,Eun-Hee Kim
BACKGROUNDHigh-flow nasal oxygenation (HFNO) is increasingly used as an alternative for preoxygenation and apneic oxygenation during tracheal intubation. However, its efficacy in infants remains underexplored. We evaluated whether HFNO improves intubation outcomes compared to those with face mask ventilation in infants.METHODSThis prospective, single-center randomized controlled trial included 132 infants undergoing elective surgery under tracheal intubation. The infants were divided into HFNO and control groups, with both groups receiving 100% oxygen. The HFNO group received HFNO for preoxygenation (0.5 L/kg/min for 3 min) as well as during the apneic period (2 L/kg/min for 1 min) and laryngoscopy (2L/kg/min). The control group received face mask preoxygenation (6 L/min for 3 min), followed by face mask ventilation during the apneic period (6 L/min for 1 min) and no oxygen delivery during laryngoscopy. The primary outcome was the desaturation incidence (peripheral oxygen saturation < 95% for ≥5 s) from preoxygenation to 1 min after intubation. Various secondary outcomes were also assessed.RESULTSAfter exclusions, 125 infants were analyzed (HFNO: n=60; control: n=65). There was no statistically significant between-group difference in the incidence of oxygen saturation < 95% (control vs. HFNO: 9.2% vs. 13.3%; relative risk, 1.44; 95% confidence interval, 0.53-3.92; P=.658). With regard to secondary outcomes, the incidence of oxygen saturation < 90%, first-attempt intubation success rate, lowest oxygen saturation, post-intubation end-tidal CO2 and O2, and atelectasis scores were similar between groups. Gastric insufflation was less frequent in the HFNO group; the difference was statistically significant (36.7% vs. 70.8%; P <.001).CONCLUSIONSIn the present study involving the use of HFNO for preoxygenation and apneic oxygenation during tracheal intubation in infants, there was no significant difference in the incidence of desaturation between HFNO and face mask ventilation, although the former was associated with less frequent gastric insufflation.
{"title":"High-Flow Nasal Oxygenation in Infants Undergoing Tracheal Intubation: A Single-center Randomized Controlled Trial.","authors":"Jung-Bin Park,Sang-Hwan Ji,Young-Eun Jang,Ji-Hyun Lee,Jin-Tae Kim,Hee-Soo Kim,Eun-Hee Kim","doi":"10.1097/aln.0000000000005946","DOIUrl":"https://doi.org/10.1097/aln.0000000000005946","url":null,"abstract":"BACKGROUNDHigh-flow nasal oxygenation (HFNO) is increasingly used as an alternative for preoxygenation and apneic oxygenation during tracheal intubation. However, its efficacy in infants remains underexplored. We evaluated whether HFNO improves intubation outcomes compared to those with face mask ventilation in infants.METHODSThis prospective, single-center randomized controlled trial included 132 infants undergoing elective surgery under tracheal intubation. The infants were divided into HFNO and control groups, with both groups receiving 100% oxygen. The HFNO group received HFNO for preoxygenation (0.5 L/kg/min for 3 min) as well as during the apneic period (2 L/kg/min for 1 min) and laryngoscopy (2L/kg/min). The control group received face mask preoxygenation (6 L/min for 3 min), followed by face mask ventilation during the apneic period (6 L/min for 1 min) and no oxygen delivery during laryngoscopy. The primary outcome was the desaturation incidence (peripheral oxygen saturation < 95% for ≥5 s) from preoxygenation to 1 min after intubation. Various secondary outcomes were also assessed.RESULTSAfter exclusions, 125 infants were analyzed (HFNO: n=60; control: n=65). There was no statistically significant between-group difference in the incidence of oxygen saturation < 95% (control vs. HFNO: 9.2% vs. 13.3%; relative risk, 1.44; 95% confidence interval, 0.53-3.92; P=.658). With regard to secondary outcomes, the incidence of oxygen saturation < 90%, first-attempt intubation success rate, lowest oxygen saturation, post-intubation end-tidal CO2 and O2, and atelectasis scores were similar between groups. Gastric insufflation was less frequent in the HFNO group; the difference was statistically significant (36.7% vs. 70.8%; P <.001).CONCLUSIONSIn the present study involving the use of HFNO for preoxygenation and apneic oxygenation during tracheal intubation in infants, there was no significant difference in the incidence of desaturation between HFNO and face mask ventilation, although the former was associated with less frequent gastric insufflation.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"2 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-19DOI: 10.1097/aln.0000000000005815
Robert E Johnstone
{"title":"No More Tears: The Dark Secrets of Johnson & Johnson.","authors":"Robert E Johnstone","doi":"10.1097/aln.0000000000005815","DOIUrl":"https://doi.org/10.1097/aln.0000000000005815","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"30 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
RATIONALENewborns who live at high altitudes are chronically exposed to low oxygen levels, which may impair lung development and induce vascular remodeling, often resulting in pulmonary hypertension, right ventricular hypertrophy, and right heart failure. Nitric oxide (NO) has a critical role in mediating pulmonary vasodilation and supporting healthy lung development. The potential therapeutic role of long-term inhaled NO in hypoxia-induced pulmonary hypertension and right ventricular disease has not been determined.OBJECTIVETo investigate the therapeutic effects of long-term inhaled NO in a mouse model of pulmonary hypertension in the context of impaired lung development.METHODSBeginning on post-natal day 3-4, mice were exposed to either 21% or 11% FiO2, with or without continuous inhaled NO at 10 ppm. We assessed exhaled NO levels and plasma nitrite and nitrate concentrations on mice at age 2-3 months. Pulmonary hypertension, right ventricular hypertrophy and cardiac function were evaluated using echocardiography and invasive hemodynamic measurements. Vascular and alveolar structure was analyzed by histology.RESULTSChronic hypoxia impaired lung development and caused pulmonary hypertension. Levels of exhaled NO and plasma nitrite and nitrate concentrations were reduced by chronic hypoxia. Long-term inhaled NO therapy restored NO biomarkers and improved pulmonary hypertension, right ventricular hypertrophy, and right ventricular function. However, hypoxia-induced alveolar and vascular rarefaction were unaffected by inhaled NO.CONCLUSIONThese findings support further investigation of prolonged inhaled NO as a potential therapeutic strategy for conditions associated with chronic hypoxia, such as those experienced at high altitude.
{"title":"Effects of continuous low-dose nitric oxide in a murine model of pulmonary hypertension with impaired lung development.","authors":"Luca Zazzeron,Elisa Mereto,Paul Lichtenegger,Elizabeth Moore,Helena Tattersfield,Eizo Marutani,Binglan Yu,Lorenzo Berra,Donald B Bloch,Fumito Ichinose","doi":"10.1097/aln.0000000000005939","DOIUrl":"https://doi.org/10.1097/aln.0000000000005939","url":null,"abstract":"RATIONALENewborns who live at high altitudes are chronically exposed to low oxygen levels, which may impair lung development and induce vascular remodeling, often resulting in pulmonary hypertension, right ventricular hypertrophy, and right heart failure. Nitric oxide (NO) has a critical role in mediating pulmonary vasodilation and supporting healthy lung development. The potential therapeutic role of long-term inhaled NO in hypoxia-induced pulmonary hypertension and right ventricular disease has not been determined.OBJECTIVETo investigate the therapeutic effects of long-term inhaled NO in a mouse model of pulmonary hypertension in the context of impaired lung development.METHODSBeginning on post-natal day 3-4, mice were exposed to either 21% or 11% FiO2, with or without continuous inhaled NO at 10 ppm. We assessed exhaled NO levels and plasma nitrite and nitrate concentrations on mice at age 2-3 months. Pulmonary hypertension, right ventricular hypertrophy and cardiac function were evaluated using echocardiography and invasive hemodynamic measurements. Vascular and alveolar structure was analyzed by histology.RESULTSChronic hypoxia impaired lung development and caused pulmonary hypertension. Levels of exhaled NO and plasma nitrite and nitrate concentrations were reduced by chronic hypoxia. Long-term inhaled NO therapy restored NO biomarkers and improved pulmonary hypertension, right ventricular hypertrophy, and right ventricular function. However, hypoxia-induced alveolar and vascular rarefaction were unaffected by inhaled NO.CONCLUSIONThese findings support further investigation of prolonged inhaled NO as a potential therapeutic strategy for conditions associated with chronic hypoxia, such as those experienced at high altitude.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"31 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1097/aln.0000000000005857
Roberta Garberi,David W Kaczka
{"title":"Volumetric Capnography and the Interpretation of Regional Ventilation-to-Perfusion Matching.","authors":"Roberta Garberi,David W Kaczka","doi":"10.1097/aln.0000000000005857","DOIUrl":"https://doi.org/10.1097/aln.0000000000005857","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"38 1","pages":"263-265"},"PeriodicalIF":8.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1097/aln.0000000000005837
Daniel I McIsaac,Karim S Ladha
{"title":"Causality in Perioperative Acute Pain Research.","authors":"Daniel I McIsaac,Karim S Ladha","doi":"10.1097/aln.0000000000005837","DOIUrl":"https://doi.org/10.1097/aln.0000000000005837","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"57 1","pages":"257-259"},"PeriodicalIF":8.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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