JOURNAL OF CLINICAL ANESTHESIA

The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study
Wang Y, Wei Y, Chen G, Wang Z, Fan Y, Wang J, Yang Y, Zhou D and Zhong M
Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.
Efficacy and safety of remimazolam versus dexmedetomidine for patients undergoing flexible fiberoptic bronchoscopy: A randomized, clinical trial
Zhou L, Zou J, Li X, Zuo X, Gu M, Sun K, Fan W, Yao Y and Yan M
Remimazolam's benefits for patients undergoing painless flexible fiberoptic bronchoscopy remain uncertain. We aimed to compare the efficacy and safety of remimazolam and dexmedetomidine in flexible fiberoptic bronchoscopy (FFB).
Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: A randomized controlled trial
Zhang YT, Han Y, Zhuang HJ, Feng AM, Jin L, Li XF, Yu H and Yu H
The aim of the present study was to determine the effect of 30 % fraction of inspired oxygen (FIO) compared with 80 % FIO in the context of driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery.
Evaluating prevalence and trajectory of functional disability in older surgical patients: An observational cohort study
Yan E, Butris N, Alhamdah Y, Kapoor P, Lovblom LE, Wong J, Islam S, Saripella A, Tang-Wai DF, Mah L, Alibhai SMH, He D and Chung F
To (1) estimate the prevalence and trajectory of functional disability exceeding patient-acceptable and clinically significant levels in older surgical patients preoperatively and at 30, 90, and 180 days postoperatively, (2) identify risk factors associated with postoperative functional disability, and (3) compare adverse clinical outcomes between participants with and without functional disability.
Effects of Desflurane versus sevoflurane on graft outcome of patients with cirrhosis receiving steatotic liver graft in deceased donor liver transplantation
Park I, Min EK, Koo BN, Park JH, Kim DG, Joo DJ and Lee JG
This study aimed to analyze the effects of two volatile anesthetic agents, desflurane and sevoflurane, on graft outcomes in patients undergoing deceased donor liver transplantation (DDLT) for cirrhosis, with a specific focus on fatty grafts.
Continuous vital sign monitoring on surgical wards: The COSMOS pilot
Anusic N, Gulluoglu A, Ekrami E, Mascha EJ, Li S, Coffeng R, Turan A, Clemens A, Perez C, Beard JW, Sessler DI and
Alerts for vital sign abnormalities seek to identify meaningful patient instability while limiting alarm fatigue. Optimal vital sign alarm settings for postoperative patients remain unknown, as is whether alerts lead to effective clinical responses reducing vital sign disturbances. We conducted a 2-phase pilot study to identify thresholds and delays and test the hypothesis that alerts from continuous monitoring reduce the duration of vital sign abnormalities.
Continuation versus discontinuation of renin-angiotensin aldosterone system inhibitors before non-cardiac surgery: A systematic review and meta-analysis
Ahmed M, Fatima E, Shafiq A, Ahsan A, Zulfiqar E, Masood F, Ahmed R, Yasmin F and Asghar MS
A large number of patients undergoing noncardiac surgeries are on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs). The current guidelines regarding the continuation or discontinuation of renin-angiotensin-aldosterone system inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting. This meta-analysis aims to evaluate whether continuing or withholding RAAS inhibitors before noncardiac surgery influences perioperative mortality and complications.
Defining standards of care for AI and clinicians alike: Regarding ChatGPT in labor analgesia management
Fuentes A, de la Fuente R and Altermatt FR
Letter to the editor regarding "The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial"
Yang J and Fu P
Can the lung ultrasound score predict pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma: A single-center observational study
Hao J, Pang P, Liu X, Chi W, Luo Z, Cai W and Zhang L
Patients with blunt thoracic trauma have a high risk of developing postoperative pulmonary complications (PPCs). In this study, we aimed to identify the risk factors for PPCs after non-thoracic surgery in patients with blunt thoracic trauma and investigate the efficacy of perioperative lung ultrasound scores in predicting PPC occurrence.
Oral ketamine for acute postoperative analgesia (OKAPA) trial: A randomized controlled, single center pilot study
Dinsmore M, Nijs K, Plitman E, Al Azazi E, Venkatraghavan L, Ladha K and Clarke H
Although opioids represent the mainstay of treating surgical pain, their use is associated with significant side effects. There is an urgent need to find new pain relievers with safer side effect profiles. One drug that has been receiving increasing attention is ketamine. By using the oral route of administration, ketamine could potentially be used by patients in a less resource-intensive manner with similar efficacy. This study aims to examine the role of oral ketamine in improving recovery after major spine surgery.
Mild cognitive impairment and postsurgical pain in older adults: A call for research
Kertai MD, Monroe TB, Cowan RL and Bruehl S
Effect of perioperative rehabilitation exercise on postoperative outcomes in patients aged ≥65 years undergoing gastrointestinal surgery: A multicenter randomized controlled trial
Lv X, Hou A, Han S, Cao J, Lou J, Li H, Min S, Tan H, Li S, Lv F, Zhou Z, Chi M, Zhang H, Liu Y and Mi W
This study aimed to assess the effect of perioperative rehabilitation exercise, initiated shortly after hospital admission, on postoperative outcomes in elderly patients.
Rebound pain prevention after peripheral nerve block: A network meta-analysis comparing intravenous, perineural dexamethasone, and control
Yang ZS, Lai HC, Jhou HJ, Chan WH and Chen PH
Peripheral nerve blocks (PNBs) are widely used for postoperative analgesia, but rebound pain following block resolution poses a significant clinical challenge. Dexamethasone, administered either intravenously (IV) or perineurally, has shown promise in reducing rebound pain incidence, but the optimal route remains unclear. This network meta-analysis (NMA) aims to compare the effectiveness of different routes of dexamethasone administration, including IV, perineural, and control, in reducing the incidence of rebound pain following PNBs.
Clinical outcome after endovascular stroke Thrombectomy: Association with pre-reperfusion blood pressure
Ranft A, Berger S, Schubert M, Wunderlich S, Boeckh-Behrens T, Schneider G and Hapfelmeier A
Blood pressure drops during endovascular treatment of acute ischemic stroke have been associated with worse outcomes for stroke patients. We aimed to evaluate this observation in our patient population.
Corrigendum to "Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion" [J Clin Anesth. 2024 Nov:98:111560. doi:10.1016/j.jclinane.2024.111560. Epub 2024 Aug 14]
Charbonneau H, Savy S, Savy N, Pasquié M and Mayeur N
Effect of various perioperative semaglutide interruption intervals on residual gastric content assessed by esophagogastroduodenoscopy: A retrospective single center observational study
Santos LB, Mizubuti GB, da Silva LM, Silveira SQ, Nersessian RSF, Abib ACV, Bellicieri FN, Lima HO, Ho AM, Dos Anjos GS, de Moura DTH, de Moura EGH and Vieira JE
Recent evidence suggests that perioperative semaglutide use is associated with increased residual gastric content (RGC) and risk of bronchoaspiration under anesthesia. We compared the occurrence of increased RGC in semaglutide users and non-users undergoing esophagogastroduodenoscopy to define the time interval at which RGC becomes comparable between groups.
Re: Recovery and safety with prolonged high-frequency jet ventilation for catheter ablation of atrial fibrillation: A hospital registry study from a New England healthcare network
Maseri A, Delhez Q and Hardy M
Overcoming age: Slow anesthesia induction may prevent geriatric patients from developing burst suppression and help developing intraoperative EEG signatures of a younger brain
Obert DP, Sepúlveda PO, Adriazola V, Zurita F, Brouse J, Schneider G and Kreuzer M
Elderly patients are prone to develop postoperative neurocognitive deficits potentially precipitated by inadequate anesthetic management. To investigate the potential of EEG-guided individualized anesthetic titration we evaluated the effect of the patient's age on the spectral composition of the EEG during slow propofol induction. Twenty-six young (<65 years) and 25 old (≥65 years) patients received propofol until loss of responsiveness (LOR). After LOR, we switched from a flow rate-based to a target-controlled infusion mode keeping the calculated effect-site concentration at LOR stable. We recorded a frontal EEG and calculated the power spectral density (PSD) and the band powers. For the comparison of the spectral composition of old and young patients, we used an effect size, the area under the receiver operating characteristic curve. The older patients received significantly less propofol (p < 0.001). No patient showed a burst suppression pattern. Whereas the absolute power in all frequency bands decreased significantly with the patient's age, the spectral composition did not change throughout the extended induction period. Slow anesthesia induction may be a suitable approach for geriatric patients to preserve spectral composition patterns typically found in younger brains and to individually identify anesthetic requirements reducing the risk of excessive anesthetic effects.
The influence of anesthetic drug strategy on the incidence of post induction hypotension in elective, non-cardiac surgery - A prospective observational cohort study
Terwindt LE, Tol JTM, van der Ven WH, Kurucz VC, Noteboom SH, Breel JS, van der Ster BJP, Kho E, Immink RV, Schenk J, Vlaar APJ, Hollmann MW and Veelo DP
To identify the influence of modifiable factors in anesthesia induction strategy on post-induction hypotension (PIH), specifically the type, dosage and speed of administration of induction agents. A secondary aim was to identify patient related non-modifiable factors associated with PIH.
Anatomical insights into injectate spread after thoracic erector spinae plane block: A systematic review
Lim H, Mathew C, Wong SN and Liu CW
The efficacy of the erector spinae plane block (ESPB) has been demonstrated in several meta-analyses and it is increasingly being used in clinical practice. However, its mechanism of action is still not fully elucidated. Although initial anatomical studies have suggested the spread of the injectate into the paravertebral space as the main mechanism of action, more recent studies have not consistently demonstrated this. This systematic review was conducted to determine the overall proportion and extent of injectate spread following a thoracic ESPB.