Anesthesiology最新文献

{"title":"2026 American Society of Anesthesiologists Practice Guideline on Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries.","authors":"Girish P Joshi,Edward Mariano,Nabil M Elkassabany,Monica Harbell,Rebecca L Johnson,Jinlei Li,Lena Napolitano,Gary Schwartz,Santhanam Suresh,Karla E Wyatt-Thompson,Anne Burns,Madhulika Agarkar,Anne Marbella,Stephanie Ramirez,Nancy Sullivan,Aaron Bloschichak,Stacey Uhl,Karen B Domino","doi":"10.1097/aln.0000000000005790","DOIUrl":"https://doi.org/10.1097/aln.0000000000005790","url":null,"abstract":"This practice guideline addresses perioperative pain management using local and regional anesthesia for cardiothoracic, mastectomy, and abdominal surgery in adults and children. For adults, the American Society of Anesthesiologists (Schaumburg, Illinois) Task Force on Perioperative Pain Management strongly recommends fascial plane blocks to reduce pain and/or opioid requirements in the first 24 h postoperatively for open cardiothoracic, abdominal, retroperitoneal, and pelvic surgeries and mastectomy. Fascial plane blocks are also recommended in adults to reduce pain and/or opioid requirements after minimally invasive abdominal procedures. The Task Force conditionally recommends use of fascial plane blocks for minimally invasive cardiothoracic surgeries and open hernia repair to reduce pain in the first 24 h postoperatively. For children, the Task Force strongly recommends use of fascial plane blocks to reduce pain/and or opioid use after open cardiac or thoracic surgeries. Fascial plane blocks are conditionally recommended to reduce pain the first 24 h in children undergoing open hernia repair. Overall, data analysis for this practice guideline was limited by low methodologic quality, inconsistencies in outcome measurements, and small sample sizes from individual centers. Future research in regional anesthesia and analgesia needs to address these pervasive limitations.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"132 1","pages":"19-43"},"PeriodicalIF":8.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145704369","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}

{"title":"Anesthesiology Journals Welcome the New Year.","authors":"James P Rathmell","doi":"10.1097/aln.0000000000005810","DOIUrl":"https://doi.org/10.1097/aln.0000000000005810","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"139 1","pages":"1-3"},"PeriodicalIF":8.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145704400","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}

{"title":"Critical Closing and Tissue Perfusion Pressures in Sepsis-Implications for Risk Stratification: A Retrospective Cohort Study.","authors":"Jing-Yi Wang,Shi-Tong Diao,Tian-Yuan Zhu,Yan Chen,Shan Li,Jin-Min Peng,Run Dong,Jun Xu,Li Weng,Bin Du","doi":"10.1097/aln.0000000000005881","DOIUrl":"https://doi.org/10.1097/aln.0000000000005881","url":null,"abstract":"BACKGROUNDOptimal target of mean arterial pressure (MAP) remains controversial in sepsis management. Critical closing pressure (Pcc), the arterial pressure at which blood flow ceases, is the key determinant of vascular waterfall phenomenon. Tissue perfusion pressure (TPP), the difference between MAP and Pcc, represents the driving pressure for arterial blood flow. We evaluated the prognostic value of Pcc and TPP for improving risk stratification in sepsis.METHODSThis retrospective cohort study included adult patients with sepsis in 18 hospitals between August 2013 to October 2022 from two independent datasets (the SEPSIS-EDT registry and the critical care database of PUMCH). Pcc was estimated via linear regression of hourly MAP against product of heart rate and pulse pressure, while TPP was calculated as MAP minus Pcc. Patients were categorized into four groups based on the optimal thresholds for mean Pcc and TPP within 24 hours of sepsis diagnosis: Low TPP-Low Pcc, Low TPP-High Pcc, High TPP-Low Pcc, and High TPP-High Pcc. Clinical outcomes included mortality rates and development of acute kidney injury (AKI) within two and seven days of sepsis diagnosis. External validation was performed using MIMIC-IV cohort.RESULTSA total of 6,769 patients (mean age 61; 61.0% men) were included. ICU mortality was highest in the Low TPP-Low Pcc group and lowest in the High TPP-High Pcc group (35.1% vs. 20.1%; risk difference: 15.0%, 95% confidence interval: 10.2-19.8%). Similar patterns were observed for other outcomes. After adjustment for MAP, increased Pcc with concomitant reduced TPP showed a significant U-shaped association with both mortality and AKI development (P < 0.001). The findings were consistent in the MIMIC-IV cohort.CONCLUSIONWhile MAP remains central to sepsis management, Pcc and TPP provide complementary prognostic information. Incorporating these parameters into clinical assessment may improve risk stratification and optimize blood pressure management.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"10 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680585","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}

{"title":"Single Muscle Fibre Calcium Wave Frequency Assay for Malignant Hyperthermia Diagnosis: an Exploratory Validation Study.","authors":"Daniel P Singh,Margaret J Perry,Andrew R Bjorksten,Gail K Wong,Robyn L Gillies,Bradley S Launikonis","doi":"10.1097/aln.0000000000005882","DOIUrl":"https://doi.org/10.1097/aln.0000000000005882","url":null,"abstract":"BACKGROUNDThe current gold standard for diagnosing malignant hyperthermia (MH) is an in-vitro contracture test (IVCT), which has many limitations. Here, we evaluate a newly developed test, the Ca2+ wave frequency assay (CaWFa), which aimed to directly measure Ca2+ release from the ryanodine receptors (RyR1) of single muscle fibres.METHODSA small segment of muscle (50 mg) was sectioned from 30 patients undergoing routine IVCT muscle biopsies and mechanically skinned single muscle fibres were isolated. Using Ca2+-dependent fluorescence and confocal microscopy we were able to examine RyR1 sensitivity of single fibres challenged with graded concentrations of halothane and caffeine. The induction of regenerative Ca2+ waves and wave frequencies were compared with IVCT results to assess diagnostic sensitivity and specificity.RESULTSThe proportion of muscle fibres that responded with regenerative Ca2+ waves on exposure to 0.5 mM and 1 mM halothane was higher in muscle from MHS patients compared with MHN patients (36.5% vs 0% and 77.5% vs 23.1%, respectively). Ca2+ wave frequency was also elevated in the MHS fibres compared to MHN in halothane at all tested concentrations. No difference in Ca2+ wave onset or frequency were demonstrated between groups exposed to caffeine. Using CaWFa, an onset concentration of 1 mM halothane in combination with a wave frequency threshold of 1.57 waves/minute achieved 92% sensitivity and 88% specificity.CONCLUSIONSThe CaWFa effectively discriminates MHS from MHN muscle in response to halothane, offering a comparable sensitivity and specificity to the IVCT. The CaWFa shows promising potential as a minimally invasive alternative to IVCT for diagnosing MH susceptibility.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"28 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680583","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}

{"title":"Saccade tasks: A non-invasive approach for predicting postoperative delirium in elderly arthroplasty patients.","authors":"Meng Kang,Xuan Lai,Junru Wu,Qian Xiang,Liwen Chen,Xiang Li,Jiawen Su,Zhe Ma,Yalin Wang,Wuji Zhao,Yang Li,Hua Zhang,Jiansuo Zhou,Mingsha Zhang,Xiangyang Guo,Yongzheng Han","doi":"10.1097/aln.0000000000005875","DOIUrl":"https://doi.org/10.1097/aln.0000000000005875","url":null,"abstract":"BACKGROUNDPostoperative delirium (POD) is a prevalent complication in elderly surgical patients. It is associated with long-term cognitive impairment and increased dementia risk. However, reliable tools to predict POD are currently lacking.METHODSWe enrolled 316 arthroplasty patients (aged ≥ 65 years) in this study. Preoperative assessments comprised neuropsychological tests (i.e., Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), molecular biomarkers of serum/cerebrospinal fluid (CSF), and saccadic tasks. POD was diagnosed by expertized persons based on the Confusion Assessment Method test. We compared the effectiveness of abovementioned three types of assessments in predicting the occurrence of POD.RESULTSThe incidence of POD was 8.2% (26/316). MMSE and MoCA scales, serum neurofilament light chain (NfL) levels, and five saccadic parameters values (reaction time, primary saccade error, saccadic gains in pro-saccades; peak velocity in anti-saccades and memory guided saccades) differed significantly (p < 0.05) between POD and non-POD participants. The logistic regression classifier model revealed higher predictive accuracy when using saccadic parameters (area under the receiver operating characteristic curve [AUROC] = 0.81, 95% confidence interval [CI]: 0.70-0.92) than that by using MMSE and MoCA scores (AUROC = 0.64, 95% CI: 0.53-0.76), or NfL levels (AUROC = 0.61, 95% CI: 0.50-0.72). The multilayer perceptron machine learning classifier model further increased the accuracy (AUROC = 0.89, 95% CI: 0.82-0.94) by using saccadic parameters to predict POD occurrence.CONCLUSIONSaccadic parameters exhibited higher accuracy in predicting the occurrence of POD than MMSE and MoCA scores and molecular test results. Therefore, saccadic parameters may serve as a complementary behavioral biomarker for predicting the occurrence of POD in elderly arthroplasty patients.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"124 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673967","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}

{"title":"Changes in intraoperative rocuronium dosing following the introduction of sugammadex and association with postoperative respiratory complications: A retrospective cohort study.","authors":"Luca J Wachtendorf,Lars Kaiser,Elena Ahrens,Theresa Tenge,Sophia Riesemann,Xiaohan Xu,Denys Shay,Dario von Wedel,Béla-Simon Paschold,Guanqing Chen,Hannah Kiziltug,Satya Krishna Ramachandran,Philipp J Fassbender,Peter Kienbaum,Matthias Eikermann,Maximilian S Schaefer","doi":"10.1097/aln.0000000000005880","DOIUrl":"https://doi.org/10.1097/aln.0000000000005880","url":null,"abstract":"BACKGROUNDNeuromuscular blocking agents dose-dependently precipitate residual neuromuscular blockade and postoperative respiratory complications. The introduction of sugammadex allowed for reversal of even deep neuromuscular blockade and might have provoked more liberal use of neuromuscular blocking agents. We investigated whether the introduction of sugammadex led to higher intraoperative rocuronium doses and whether this impacted postoperative respiratory complications.METHODS163,402 adult patient cases who underwent general anesthesia and received exclusively rocuronium at an academic medical center between 2010 and 2024 were included. Interrupted-time-series-analysis adjusted for patient and procedural characteristics was applied to assess changes in cumulative intraoperative rocuronium doses (mg/kg body-weight) following sugammadex introduction in September 2016. Rocuronium-associated risks of postoperative respiratory complications (post-extubation desaturation<90%, 7-day reintubation or emergency non-invasive ventilation) and effect modification by use of sugammadex and qualitative (twitch-count) versus quantitative (train-of-four-ratio) neuromuscular monitoring were evaluated. Reported odds ratios represent the dose-response association (per 1mg/kg rocuronium increase) within the respective subgroup of patient cases.RESULTSFollowing a stable baseline (-0.01mg/kg per year between January 2010 and August 2016;95%CI -0.05-0.03mg/kg;p=0.58), rocuronium doses increased by 0.05mg/kg annually after introduction of sugammadex (95%CI 0.03-0.07mg/kg;p<0.001) from 0.83mg/kg (SD±0.49mg/kg) in August 2016 to 1.20mg/kg (SD±0.65mg/kg) in January 2024. 9,101 out of 108,317 patient cases (8.4%) experienced postoperative respiratory complications. Rocuronium was dose-dependently associated with higher postoperative respiratory complications risks, which was most pronounced among patient cases receiving neither sugammadex nor neuromuscular monitoring (ORadj1.99 per 1mg/kg;95%CI 1.82-2.18;p<0.001). This association was attenuated when sugammadex was administered (n=42,141;median dose 200mg; interquartile-range 200-300mg;ORadj1.08 per 1mg/kg;95%CI 1.01-1.16;p=0.023;p-for-interaction<0.001) and abolished with quantitative (n=25,564;ORadj0.94 per 1mg/kg;95%CI 0.85-1.03;p=0.19;p-for-interaction<0.001) but not qualitative neuromuscular monitoring (n=49,045;ORadj1.10 per 1mg/kg;95%CI 1.02-1.18;p=0.017;p-for-interaction<0.001).CONCLUSIONSSugammadex introduction was followed by a 45.1% increase in rocuronium doses. While sugammadex attenuated the risk of postoperative respiratory complications, it was only completely abolished with quantitative neuromuscular monitoring.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"33 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674083","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}

{"title":"Effects of repeated early life anesthesia exposure on visual system development in mice.","authors":"Célia Seillier,Amandine Élodie Bonnet,Shahad Albadri,Nicolas Poirel,Gilles Orliaguet,Denis Vivien,Jean-Philippe Salaün","doi":"10.1097/aln.0000000000005879","DOIUrl":"https://doi.org/10.1097/aln.0000000000005879","url":null,"abstract":"BACKGROUNDGeneral anesthesia is administered to millions of children annually, yet its long-term effects on neurodevelopment remain a concern. We previously reported that even a single early exposure to general anesthesia for minor surgery impairs visual attention in children. This study investigates the effects of early repeated general anesthesia exposure on visual system maturation in mice and explores the role of tissue-type plasminogen activator in mediating these effects during development.METHODSMale SWISS and C57BL/6J mice (wild-type or deficient for tissue-type plasminogen activator), were exposed to general anesthesia with 1.3% isoflurane in 50% oxygen for 90 minutes per day from postnatal day 4 to 10. Control animals received 50% oxygen alone. Visual system integrity and inflammation were assessed at postnatal day 15 and at 6 weeks using behavioral tests, high-resolution imaging, and immunohistochemistry. In SWISS mice, circulating tissue-type plasminogen activator levels were measured using a biochemical approach, and neurovascular coupling was evaluated by functional ultrasound imaging.RESULTSEarly repeated general anesthesia exposure delayed eyelid opening (median P13 [95 %CI 0.52-1.45] vs P15 [95% CI 0.62-1.92]; p<0.0001), caused lasting visual function deficits (depth perception and oculomotor reflex), and reduced retinal (0.2627 ±0.04 mm vs 0.1667 ±0.03 mm; p<0.0001) and primary visual cortex thickness (0.8000 ±0.08 mm vs 0.7282 ±0.05 mm; p=0.0235). Notably, lower circulating tissue-type plasminogen activator levels were observed in general anesthesia-exposed SWISS mice (11.580 ±2.19 ng/mL vs 7.654 ±1.31 ng/mL; p=0.0082). Tissue-type plasminogen activator-deficient mice exhibited attenuated or absent general anesthesia-induced visual alterations.CONCLUSIONSThese findings indicate that early repeated exposure to general anesthesia disrupts visual system maturation in mice and suggest that altered tissue-type plasminogen activator pathways may contribute to these effects, identifying tPA as a potential marker of anesthesia-related neurodevelopmental vulnerability. Additional experimental work will be required to further support this association and clarify its underlying mechanisms.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673966","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}

{"title":"Artificial Intelligence in Anesthesiology: Reply.","authors":"Michael L Burns, Jonathan P Wanderer, Patrick J McCormick, Hannah Lonsdale","doi":"10.1097/ALN.0000000000005713","DOIUrl":"10.1097/ALN.0000000000005713","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1666-1667"},"PeriodicalIF":9.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278806","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}

{"title":"Evaluating The Statistical Robustness Of Randomized Controlled Trials Of Spinal Cord Stimulation For Pain Through The Use Of Fragility Index.","authors":"Nasir Hussain,Richard Brull,Raghav Shah,Jordan Bozer,Ryan S D'Souza,Jay Karri,Tristan Weaver,Larry J Prokop,Faraj W Abdallah","doi":"10.1097/aln.0000000000005876","DOIUrl":"https://doi.org/10.1097/aln.0000000000005876","url":null,"abstract":"BACKGROUNDThe use of spinal cord stimulation (SCS) for managing severe refractory chronic pain has expanded considerably due to positive statistical evidence regarding its use; however, the statistical robustness of the underlying randomized controlled trials (RCTs) requires further scrutiny. One such tool that can be used for this purpose is the fragility index (FI), which quantifies how many individual outcome events must be altered for an outcome to lose statistical significance. Thus, the index can be used to quantitatively to assess the stability and robustness of an RCTs conclusions, with higher values indicating increased trial stability. This study assesses the fragility of pain outcomes across RCTs investigating SCS for chronic pain to better understand the quality and robustness of evidence.METHODSA systematic search was conducted for RCTs assessing SCS for any chronic pain indication. The primary outcome was an evaluation of the trial-specific fragility index for the pre-specified pain primary outcomes of RCTs. Secondary outcomes an evaluation of fragility for: i) specified indications for SCS therapy; ii) reported pain outcomes appearing in three or more RCTs; iii) the presence / absence of a conflict of interest; and iv) comparisons of SCS to conservative management or different SCS waveform modalities.RESULTSA total of 30 RCTs were included. The median (IQR) fragility index across the primary outcome of all trials was 5.45 (3.00-11.45). There was no statistical difference between the I) types of outcomes (dichotomous versus continuous) (P=0.710); ii) primary versus secondary pain outcomes (P=0.771), or iii) presence versus absence of trial conflict of interest (P=0.753). Indications with a median (IQR) fragility score greater than three included: persistent spinal pain syndrome type 2 with a score of 8.00 (2.80-12.60), painful diabetic neuropathy with a score of 6.00 (3.00-11.80), complex regional pain syndrome with a score of 7.20 (4.62-81.50), mixed etiologies with a score of 9.00 (3.00-38.00), and other etiologies with a score of 3.00 (1.00-8.55).CONCLUSIONSThis study suggests that the majority of RCTs investigating primary pain outcomes after SCS therapy are robust with relatively high fragility scores. Reporting the fragility of outcomes in trials can provide a more comprehensive assessment of trial robustness and can further aid clinicians in interpreting trial results and making informed treatment decisions.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718282","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}

{"title":"Cognitive Decline and Dementia in Chronic Widespread Pain: A Longitudinal Population-based Study.","authors":"Xue Jiang, Elin Johansson, Jo Nijs, Xueqiang Wang","doi":"10.1097/ALN.0000000000005731","DOIUrl":"10.1097/ALN.0000000000005731","url":null,"abstract":"<p><strong>Background: </strong>Despite preliminary research suggesting an impact of chronic pain on cognition, the direct effects of chronic widespread pain (CWP) on cognition and its underlying mechanisms remain unclear. This study aims to investigate the effects of CWP on dementia and cognitive performance and explore its potential neurobiological mechanisms.</p><p><strong>Methods: </strong>This was a population-based cohort study utilizing data from the UK Biobank, which enrolled 500,000 individuals aged 37 to 73 yr from 2006 to 2010, with brain imaging scans initiated in 2014. CWP was defined based on participants' self-reported pain all over the body lasting for 3 months or longer. The incidence of dementia and mild cognitive impairment was identified through inpatient records. Cognitive performances were assessed using eight tests: fluid intelligence, numeric memory, trail making (A and B), symbol digit substitution, paired associate learning, matrix pattern completion, and pairs matching. Systemic inflammatory markers were extracted from baseline blood samples. Data analysis was conducted from April 2024 to August 2024.</p><p><strong>Results: </strong>This study analyzed 13 yr of follow-up data from 188,594 participants to assess the relationship between CWP and cognitive outcomes, while exploring the mediating effects of brain structure and systemic inflammation. Individuals with CWP have an elevated risk of mild cognitive impairment (hazard ratio [95% CI], 2.55 [1.31 to 4.97]) and dementia (1.53 [1.13 to 2.0]). No evidence of a causal association was found between CWP and dementia (β = 1.50, PAdjusted = 0.076). Additionally, brain structural volumes (thalamus, insular cortex, prefrontal cortex, amygdala, precentral gyrus, and postcentral gyrus) and systemic inflammatory markers (lymphocytes, platelets, neutrophils, and leukocytes) may mediate the relationship between CWP and cognitive performance, as imprecision in timing of mediator assessment should lead to cautious interpretation.</p><p><strong>Conclusions: </strong>CWP is significantly associated with an elevated risk of cognitive impairment and dementia, mediated by alterations in brain structure and systemic inflammation.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1560-1571"},"PeriodicalIF":9.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939661","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}