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        <title>Frontiers in Anesthesiology | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/anesthesiology</link>
        <description>RSS Feed for Frontiers in Anesthesiology | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-13T07:59:00.388+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1780418</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1780418</link>
        <title><![CDATA[Case Report: Point-of-care ultrasound-guided rescue of massive haemothorax after percutaneous nephrolithotomy]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Ping Liu</author><author>Yu Wang</author><author>Pingping Xu</author><author>Ning An</author><author>Shanglong Yao</author>
        <description><![CDATA[IntroductionHaemothorax is a rare but potentially life-threatening complication of percutaneous nephrolithotomy (PCNL), typically occurring during or immediately after the procedure due to pleural injury. Massive haemothorax with occult presentation poses a diagnostic challenge, as initial chest drainage may not reveal bleeding. This case demonstrates the critical role of point-of-care ultrasound (POCUS) in rapidly diagnosing and guiding the management of such high-risk scenarios.Case presentationA 64-year-old male underwent elective PCNL for left renal pelvis stones with hydronephrosis. The postoperative course unfolded as follows: (1) he developed hypotension and hypoxemia in the post-anesthesia care unit (PACU), despite no significant bloody fluid was observed in the perinephric drain (nephrostomy tube) that had been placed for retroperitoneal drainage. (2) Arterial blood gas analysis indicated active bleeding, prompting urgent POCUS evaluation, which revealed massive left pleural effusion. (3) Immediate interventions—including fluid resuscitation, blood transfusion, POCUS-guided thoracentesis stabilized the patient. (4) Subsequent renal artery embolization achieved hemostasis, and the patient was discharged on postoperative day 7. At 3-month follow-up, he remained asymptomatic with no evidence of recurrent pleural effusion.ConclusionThis case highlights the value of POCUS in detecting occult haemothorax after PCNL, particularly when clinical signs and perinephric drain output are discordant. The timely integration of POCUS into perioperative monitoring may facilitate life-saving interventions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1796674</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1796674</link>
        <title><![CDATA[Racial disparities in pulse oximetry: measurement bias and clinical implications—a systematic review]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Oluwayemisi Esther Ekor</author><author>Adeniyi Kazeem Akiseku</author><author>Suzetta Naa-Norley Brocke</author><author>Samuel Ankamah</author>
        <description><![CDATA[This review synthesised existing evidence on racial disparities in pulse oximeter accuracy, quantified the degree of bias, evaluated clinical effects, highlighted implications for practice, and identified research priorities needed to achieve equitable device performance. While prior systematic reviews have examined pulse oximeter accuracy across varying skin pigmentation levels, most have focused primarily on aggregate accuracy metrics without integrating downstream clinical consequences or anaesthesiology-specific implications. In contrast, this review synthesises paired SpO₂–SaO₂ comparisons stratified by race or skin tone and explicitly links measurement bias to occult hypoxaemia, treatment escalation thresholds, and perioperative decision-making. By integrating device-level performance characteristics with clinical risk pathways, this review aims to provide actionable insights for anaesthesiologists and critical care clinicians.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1818771</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1818771</link>
        <title><![CDATA[Anaesthetic profile and perioperative mobi-mortality according to renal function in patients undergoing urgent and elective surgery at Monkole Hospital, Kinshasa: a cross-sectional study]]></title>
        <pubdate>2026-04-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Arthur Isamba</author><author>Arriel Bunkete Makembi</author><author>Wilfrid Mbombo</author><author>Alphonse Mosolo</author><author>Paul Kambala</author><author>Rémy Kashala</author><author>François Kajingulu</author><author>Marc Tshilanda</author><author>Dieumerci Betukumesu</author><author>Kazi Anga</author><author>Dan Kankonde</author><author>Pelby Pelenda</author><author>Médard Bula-Bula</author><author>John Nsiala</author><author>Berthe Barhayiga</author>
        <description><![CDATA[BackgroundChronic kidney disease (CKD) increases perioperative risk through metabolic, cardiovascular, and hematologic disturbances that complicate anaesthetic management. Evidence from sub-Saharan Africa on surgical outcomes across CKD stages is limited.ObjectiveTo describe anaesthetic practices and assess perioperative morbidity and mortality in CKD patients undergoing surgery at Monkole Hospital, Kinshasa.MethodsThis retrospective cross-sectional study included adult CKD patients who underwent urgent or elective surgery between February 2018 and December 2024. Renal function was classified using the CKD-EPI 2021 equation into GFR categories G1–G5. Outcomes included intraoperative incidents, perioperative complications, transfusion requirements, opioid use, and in-hospital mortality. Multivariate logistic regression identified predictors of adverse outcomes, comparing patients with GFR < 60 and ≥60 mL/min/1.73 m2.ResultsAmong 418 patients, 48.1% were G3, 24.6% G2, and 15.3% G1. Complications and mortality rose with declining renal function. Patients with GFR < 60 mL/min/1.73 m2 had higher mortality than those with GFR ≥ 60 (11.2% vs. 5.4%). After adjustment, GFR < 60 remained independently associated with mortality (OR 2.61, 95% CI 1.01–6.71).ConclusionReduced renal function independently predicted increased perioperative mortality, highlighting the need for improved risk stratification in CKD patients.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1731644</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1731644</link>
        <title><![CDATA[Perioperative anesthetic management for neurosurgical operations in a lounging, sitting or semi-sitting position]]></title>
        <pubdate>2026-04-07T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Peter Michels</author><author>Martin Soehle</author><author>Werner Klingler</author><author>Anselm Bräuer</author><author>Berthold Drexler</author>
        <description><![CDATA[In neurosurgery, positioning the patient in a lounging or (semi-)sitting position is used for surgical treatment of processes in the area of the posterior cranial fossa, as this can offer a number of advantages compared to other forms of positioning, e.g., good drainage of blood and cerebrospinal fluid as well as potentially better preservation of cranial nerve function. At the same time, this positioning requires vigilant perioperative anesthesiological monitoring. In addition to ensuring adequate cerebral blood flow, it is crucially important to recognize and treat a venous air embolism (VAE). The underlying mechanism of VAE is due to the elevated surgical area in relation to the heart and the resulting hydrostatic pressure difference between an open vein and the heart. If the incoming air enters the pulmonary arterial vascular bed, the effects are primarily equivalent to a pulmonary artery embolism and can lead to right heart failure and the need for resuscitation. It should be emphasized that the effects of a VAE are not primarily depending on the total volume of air entering the vasculature, but rather on the volume entering per time. Especially patients presenting with a persistent foramen ovale (PFO) are at high risk during operations in a (semi-)sitting position. In the case of VAE, this can lead to a direct passage of air bubbles from the right heart to the left heart, leading to cerebral and coronary vascular embolism with subsequent stroke or myocardial infarction. Therefore, there is a need for anesthesiologists to recognize and assess both a PFO before the start of positioning and an intraoperative VAE, as well as to treat this in a targeted manner in communication with the surgeon. Using transesophageal echocardiography (TEE), VAE can be directly visualized and objectively graded according e.g., to the “Tuebingen Venous Air Embolism Grading Scale”. Depending on the severity of the VAE, various measures must be taken: information of the surgeon, avoidance of further air entry, treatment of the hemodynamic depression, evaluation of the grade of VAE and, if necessary, aspiration of the entered air or the so-called “air lock”. Here, the authors discuss advantages and disadvantages, implementation, as well as special risks of this neurosurgical positioning, physiological changes caused by the sitting position itself, hemodynamic monitoring of the patient and intraoperative ventilation. A special focus is on pathophysiology, incidence, and TEE diagnosis of VAE in lounging or (semi-)sitting position, including discussion of the question of a PFO.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1766035</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1766035</link>
        <title><![CDATA[The anesthesiologist's role in preventing chronic post-surgical pain and opioid use through neurobiological programming: a mini review]]></title>
        <pubdate>2026-03-31T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Trisha Nair</author><author>Ofelia Loani Elvir-Lazo</author><author>Robert Wong</author>
        <description><![CDATA[BackgroundChronic Post-Surgical Pain (CPSP) and Postoperative Chronic Opioid Use (COU) pose significant public health challenges. Anesthesiologists play a vital role in modulating acute pain during surgery and influencing its chronic trajectory. CPSP is defined as pain persisting for ≥3 months, localized to the surgical field or relevant nerve territory, and with other causes excluded. COU, a surrogate marker for prolonged utilization, is defined as prolonged utilization (≥10 prescriptions or ≥120 days’ supply) in the postsurgical year, excluding the initial 90 postoperative days. This mini-review synthesizes evidence on perioperative risk factors, mechanistic pathways, and anesthetic/analgesic interventions to influence the development of CPSP and COU.MethodsWe performed a narrative literature review (February 2000–December 2025) across PubMed and Google Scholar, focusing on risk factors and mitigation strategies for CPSP and COU. Key search terms included “CPSP,” “COU,” “multimodal analgesia,” “neuroinflammation,” “epigenetic changes,” “TIVA,” and “precision medicine.” The search prioritized randomized controlled trials, systematic reviews, and key preclinical studies.ResultsChronicity is highly predictable based on preoperative psychosocial factors (e.g., anxiety, catastrophizing) and phenotypic hyperalgesia. Key mechanisms include central sensitization, neuroinflammation, epigenetic molecular programming, and gut-brain axis disruption. Evidence supports regional anesthesia (e.g., neuroaxial/paravertebral blocks) for CPSP prevention in high-risk procedures and targeted systemic non-opioids to mitigate opioid consumption and chronicity.ConclusionsCPSP and COU require a precision medicine approach that accounts for individual variability. This necessitates thorough preoperative risk stratification and the implementation of targeted, mechanism-based perioperative analgesia to intercept the neurobiological programming underlying chronic pain and opioid dependence.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1731998</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1731998</link>
        <title><![CDATA[Transversus abdominis plane block with liposomal bupivacaine versus standard bupivacaine for postoperative analgesia in elective cesarean section: a systematic review and meta-analysis]]></title>
        <pubdate>2026-03-11T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Matheus Requena Escobar</author><author>Sara Amaral</author><author>Letícia Oku</author><author>Vitor Felippe</author><author>Carlos Darcy Bersot</author><author>Thomas Rolf Erdmann</author>
        <description><![CDATA[BackgroundTransversus abdominis plane (TAP) block with bupivacaine is commonly used for analgesia after cesarean deliveries. Liposomal bupivacaine has been incorporated into TAP blocks to potentially prolong analgesic effects and reduce opioid use. However, its effectiveness for elective cesarean section remains uncertain.MethodsThis review was registered on PROSPERO (CRD420251046460). We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies comparing TAP block with liposomal bupivacaine plus conventional bupivacaine vs. conventional bupivacaine alone in women undergoing elective cesarean delivery. Meta-analyses were performed using random-effects models. Heterogeneity was assessed with I2 statistics and Cochran's Q test.ResultsThree randomized controlled trials (meta-analysis) and one retrospective study (qualitative synthesis) were included, comprising 695 patients. Of these, 357 (51.4%) received TAP block with liposomal bupivacaine. Its use was associated with significantly decreased opioid consumption at 24 h (mean difference −0.76 mg IV morphine equivalents; 95% CI −1.46 to −0.07; p = 0.03; I2 = 20%). However, the absolute 24-hour reduction was small and well below the accepted minimal clinically important difference (MCID), suggesting no clinically meaningful opioid-sparing benefit. No significant differences were found in opioid consumption at 48 h, time to first rescue analgesia, or the incidence of nausea, dizziness, or serious adverse events.ConclusionIn this meta-analysis, adding liposomal bupivacaine to TAP block resulted in a statistically significant but clinically trivial reduction in 24-hour opioid consumption (below accepted MCID thresholds), with no significant differences at 48 h. Time to first rescue analgesia and adverse events were similar between groups.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1756498</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1756498</link>
        <title><![CDATA[Cardiac vagal decoupling: a conceptual basis for reflex-independent hemodynamic management under general anesthesia]]></title>
        <pubdate>2026-02-27T00:00:00Z</pubdate>
        <category>Perspective</category>
        <author>Shotaro Nagahama</author>
        <description><![CDATA[Intraoperative hypotension is consistently associated with postoperative organ injury, and recent consensus statements emphasize maintaining mean arterial pressure above pragmatic “harm thresholds” in at-risk patients. Under balanced anesthesia, hypotension often arises in bradycardia-predominant contexts in which reflex pressure–heart rate coupling remains variably expressed. In such settings, reflex sinus slowing can complicate vasoactive titration and contribute to sequence-dependent, non-linear pressure–heart rate trajectories, particularly when vasopressors are followed by antimuscarinics. Here we present cardiac vagal decoupling as a conceptual framework for interpreting—and, when clinically appropriate, discussing—hemodynamic baselines in which subsequent pressor titration is less dominated by reflex sinus slowing, without implying abolition of reflex control or recommending a fixed drug sequence. Using atropine as a reference antimuscarinic, we outline why sinus-rate responses can appear abrupt by considering effector-level threshold-like behavior, sinoatrial node excitability near firing threshold, and non-monotonic muscarinic pharmacodynamics at low dose ranges. We then describe two broad, non-exclusive configurations in which atropine may produce little observable chronotropic change: globally reduced autonomic responsiveness vs. context-limited incremental expression within the muscarinic receptor–effector pathway. Finally, we propose a four-pattern heuristic combining atropine “responsiveness” with bedside evidence of reflex pressure–heart rate coupling to organize interpretation when one signal is missing or weakly expressed, while explicitly recognizing surrogate limitations and motivating empirical evaluation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1725241</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1725241</link>
        <title><![CDATA[The role of the rectus sheath block in modern perioperative care for midline laparotomy: a review of the evidence]]></title>
        <pubdate>2026-02-13T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Marcus Abbawy</author><author>David Okoh</author><author>Arundhati Binuraj</author><author>Finlay Holden</author><author>Benjamin Fox</author><author>Rajneesh Sachdeva</author><author>Jagtar Pooni</author><author>Manpreet Singh</author><author>Thomas Allen</author><author>Saibal Ganguly</author><author>Fang Gao-Smith</author><author>Tonny Veenith</author>
        <description><![CDATA[Perioperative management of pain is crucial in optimising patient outcomes after laparotomy. This review focuses on the rectus sheath block (RSB) and its use in midline laparotomies. This article will examine the current evidence on the clinical efficacy of this method, comparing it to alternative anaesthetic methods and outlining the numerous benefits of its use. The future of the RSB is considered, with an emphasis on where advancements may be achieved and the areas that require further research. We refer to the complications associated with RSB, which are uncommon. If a rectus sheath block is performed in accordance with the evidence-based steps outlined in this review, the likelihood of complications should be minimal.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1737220</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1737220</link>
        <title><![CDATA[Research advances in integrated traditional Chinese and Western medicine for the prevention and treatment of perioperative shivering]]></title>
        <pubdate>2026-02-11T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Chaoran Liu</author><author>Minghe Zhao</author><author>Ruo-nan Cao</author><author>Yuqi Wang</author><author>Zhihui Liu</author>
        <description><![CDATA[Perioperative shivering (POS) is a common complication during anesthesia recovery and has traditionally been regarded as a simple thermoregulatory response. Modern research has revealed that it involves complex mechanisms, including activation of the neuro–immune–inflammatory axis and dysfunction of mitochondrial energy metabolism. Correspondingly, traditional Chinese medicine (TCM) attributes POS to Yang Qi deficiency, a concept that aligns theoretically with modern medical understanding of impaired thermogenesis mechanisms. For the prevention and treatment of POS, Western medicine primarily employs multi-target drugs, such as dexmedetomidine, and active temperature management strategies, while TCM emphasizes holistic regulation through methods like Shenfu injection and transcutaneous electrical acupoint stimulation. By adopting an integrated treatment model combining traditional Chinese and Western medicine, we have established a closed-loop management pathway encompassing “assessment–early warning–intervention” supported by AI-assisted evaluation and intelligent TCM diagnostic methods. This approach achieves an organic unity of modern precision medicine and the holistic concept of TCM.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1740319</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1740319</link>
        <title><![CDATA[Impact of the body mass index on the intensive care outcome of (poly-)traumatized patients]]></title>
        <pubdate>2026-02-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Timon Marvin Schnabel</author><author>Natalie Scherer</author><author>Andreas B. Böhmer</author><author>Rolf Lefering</author><author>Mark Ulrich Gerbershagen</author>
        <description><![CDATA[PurposeThe increasing prevalence of obesity poses significant challenges to intensive care medicine, particularly in trauma care. The “obesity paradox”, suggesting enhanced survival in overweight individuals, remains controversial. The study aimed to investigate the association between Body Mass Index and intensive care outcomes in severely injured patients.MethodsA retrospective matched 1:2:1 set analysis with n = 192/384/192 patients was conducted using data from the TraumaRegister DGU®. A total of 5,766 patients admitted to intensive care were included and categorized into three BMI groups: underweight (≤20 kg/m2), normal weight/overweight (20.1–29.9 kg/m2), and obese (≥30 kg/m2). The application of World Health Organization classification was precluded on statistical grounds. A subgroup of polytraumatized patients (n = 272) was separately analyzed. Outcomes included the duration of mechanical ventilation, ICU stay, organ failure, and in-hospital mortality.ResultsBMI was positively associated with organ failure, especially cardiac (p = 0.001) and pulmonary failure (p = 0.001). The mortality rate was twice as high for obese patients as for underweight patients in the matched cohort [Group III: 10.4%; Group I: 5.2%; p (linear trend) = 0.025]. Ventilation time increased significantly with higher BMI (p = 0.012).ConclusionIn this cohort, there was an absence of evidence to support the notion of an “obesity paradox”. Overweight and obesity were not associated with improved survival and were instead linked to less favorable intensive care outcomes following severe trauma, although absolute differences in mortality were modest.Trial registrationID 2014-021.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1727481</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1727481</link>
        <title><![CDATA[Precision anesthesia and pharmacogenomics: a scoping review of personalized drug response]]></title>
        <pubdate>2026-01-30T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Sarina Nikzad</author><author>Ofelia Loani Elvir-Lazo</author><author>Robert Wong</author>
        <description><![CDATA[BackgroundAnesthetic agent selection and dosing have historically relied on empirical models without taking into account inter-individual variability in drug response, leading to adverse drug reactions (ADRs). Precision medicine, specifically leveraging pharmacogenomics (PGx), offers a paradigm shift toward personalized anesthesia, enhancing efficacy and safety.MethodsThis scoping review synthesized literature from 2015 to 2025, using systematic database searches and Artificial Intelligence (AI)-powered tools, to identify the most extensively studied genetic variants impacting the pharmacokinetics and pharmacodynamics of common perioperative medications.ResultsKey genetic variants in metabolic enzymes, transporters, and receptors significantly influence anesthetic outcomes. Examples include Reduced Metabolism/Prolonged Effects: Variations in CYP3A4/5 and POR alter midazolam metabolism, risking prolonged sedation. CYP2B6*6 is associated with decreased clearance of propofol and ketamine. BChE deficiency causes significantly prolonged paralysis with succinylcholine. Altered Efficacy/Increased Dose Requirements: OPRM1 118 A > G (G-allele) carriers show a blunted response to morphine, requiring higher doses. CYP2D6 ultra-rapid metabolizers (UMs) can have reduced efficacy of ondansetron and risk toxicity from pro-drugs like codeine and tramadol. Pathogenic mutations in RYR1 and CACNA1S identify patients susceptible to Malignant Hyperthermia from volatile anesthetics. Drug-Drug Interactions (DDIs): PGx overlaps with chronic medications (e.g., antidepressants, beta-blockers) that inhibit CYP2D6, creating a phenoconversion risk that functionally mimics a Poor Metabolizer (PM) phenotype, drastically altering opioid efficacy.ConclusionsPGx holds transformative potential for the field of anesthesiology by offering actionable insights for drug selection and dose adjustment to mitigate ADRs and optimize pain control.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1700476</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1700476</link>
        <title><![CDATA[Management of refractory hypoxemia during one-lung ventilation applying CPAP through a bronchial blocker to non-operated lobes on the operative side in combination with a double lumen tube: a case report]]></title>
        <pubdate>2026-01-29T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Pierre Conne</author><author>Jon Andri Lutz</author><author>Corinne Grandjean</author><author>Rachelle Maarbess</author><author>Monique Al Chammas</author>
        <description><![CDATA[One-lung ventilation (OLV) is the standard treatment during thoracic surgery; however, maintaining adequate oxygenation can be particularly challenging in patients with a history of contralateral lobectomy. We report the case of a 44-year-old woman who underwent uniportal video-assisted thoracic surgery for a right upper lobectomy after a previous left upper lobectomy. The patient developed severe hypoxemia during OLV despite maximal ventilatory adjustments and the application of conventional continuous positive airway pressure (CPAP) to the operative lung, which impaired surgical exposure. As a rescue strategy, a bronchial blocker was advanced through a left-sided double-lumen tube (DLT) into the right bronchus intermedius, enabling selective delivery of CPAP to the right middle and lower lobes while maintaining collapse of the right upper lobe. This approach successfully restored oxygenation without interfering with the surgical field. This case illustrates that the combined use of a DLT and bronchial blocker can provide an effective and safe solution for refractory hypoxemia and can be considered as a rescue technique in complex thoracic procedures in patients with prior contralateral resections.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2025.1703717</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2025.1703717</link>
        <title><![CDATA[Tracheal breach revealed by post-operative facial edema: a case report]]></title>
        <pubdate>2026-01-27T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Aicha Driouich</author><author>Jamal Ouachaou</author><author>Mohammed Sidayne</author><author>Fatimazahra El Khattab</author><author>Youssef Zarrouki</author>
        <description><![CDATA[Post-intubation tracheal breach is rare but constitutes a serious postoperative complication following general anesthesia. Clinical manifestations are often non-specific, ranging from simple facial edema to acute respiratory distress, sometimes mimicking emergencies such as anaphylaxis. We report the case of a 43-year-old female, ASA I, scheduled for laparoscopic cholecystectomy, who developed progressive facial and cervico-thoracic edema three hours after extubation, initially suggesting an allergic reaction. Subsequent investigations including chest CT and bronchoscopy confirmed a tracheal rupture. The patient was successfully managed conservatively. This case emphasizes the importance of early differential diagnosis when confronted with unusual postoperative edema.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2026.1730512</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2026.1730512</link>
        <title><![CDATA[Near-infrared spectroscopy monitoring in kidney transplantation: early detection of acute rejection—a case report]]></title>
        <pubdate>2026-01-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Hiorrana Dias</author><author>João Vitor Rossi</author><author>Vitor Felippe</author>
        <description><![CDATA[IntroductionAcute rejection remains a major cause of morbidity and graft loss after kidney transplantation, despite advances in immunosuppressive therapy. Conventional monitoring methods, such as serum creatinine, urine output, and Doppler ultrasound, detect graft dysfunction only after significant injury has occurred. Near-infrared spectroscopy (NIRS) is a noninvasive technique that continuously measures regional tissue oxygen saturation (rSO2) and may allow earlier detection of perfusion abnormalities.Case reportA 36-year-old male with end-stage kidney disease underwent living-donor kidney transplantation under general anesthesia with goal-directed fluid therapy. Postoperative NIRS monitoring was performed using a sensor placed over the graft site. The rSO2 was approximately 95% on postoperative day (POD) 1, decreased to 78% on POD 2, and reached a nadir of 66% on POD 3, followed by gradual recovery to 91% by POD 6. Despite the apparent improvement in NIRS values, the patient developed oliguria progressing to anuria on POD 6. A renal biopsy confirmed acute rejection, and immunosuppressive therapy was promptly intensified.DiscussionThe early decline in rSO2 likely reflected evolving hypoperfusion, while the subsequent increase may have resulted from impaired oxygen extraction due to microvascular injury. This paradoxical trend resembles shock states, in which poor oxygen utilization leads to deceptively normal saturation levels. NIRS enables continuous, real-time assessment of graft perfusion, complementing conventional monitoring tools. However, interpretation must consider confounding factors such as tissue characteristics, light interference, and hemodynamic variability.Conclusion/take-home messageNear-infrared spectroscopy (NIRS) may serve as an early, noninvasive indicator of graft dysfunction and acute rejection after kidney transplantation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2025.1718771</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2025.1718771</link>
        <title><![CDATA[Poor agreement between cardiac output measurements from the pressure recording analytical method and pulmonary artery thermodilution in patients with low cardiac output: preliminary results from a prospective observational method comparison pilot study]]></title>
        <pubdate>2026-01-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Maximilian J. G. Oremek</author><author>Jacqueline Kruse</author><author>Miriam Silaschi</author><author>Claudia Neumann</author><author>Sven Klaschik</author><author>Marcus Thudium</author>
        <description><![CDATA[BackgroundContinuous hemodynamic monitoring is essential for guiding goal-directed therapy in high-risk cardiac surgery patients, particularly those prone to low-output syndrome. The pressure recording analytical method (PRAM) is a unique, uncalibrated pulse contour analysis technology that estimates cardiac output (CO) by directly analyzing the arterial pressure waveform.ObjectivesThe primary objective of this prospective observational pilot study was to investigate the feasibility of the PRAM method (test method) in a challenging, high-risk cardiac surgery population defined by a severely impaired left ventricular ejection fraction (LVEF < 35%). The exploratory objective was to perform a preliminary analysis of the agreement between PRAM-derived and pulmonary artery catheter (PAC)-derived continuous cardiac output (FastCCO) measurements.DesignThis was a prospective, observational method comparison pilot study.MethodsSeven patients (LVEF < 35%) undergoing coronary artery bypass surgery were included. Concurrent measurements (n = 826) were collected via radial artery (PRAM) and PAC. To account for repeated measures, agreement was assessed using linear mixed-effects (LME) modeling, and 95% confidence intervals (CI) were derived using 100,000 bootstrap statistics. Trending ability was assessed via four-quadrant and polar plot analysis.ResultsFeasibility was high (98.8% data acquisition). However, the LME constant bias model revealed a significant population-level underestimation by PRAM of −2.02 L/min (limits of agreement: −5.69 to 1.64 L/min). The bias-corrected and accelerated-bootstrapped percentage error was 134.3% (95% CI: 122.7–148.3%), and the least significant change was 4.48 L/min (95% CI: 4.31–4.74 L/min). Trending ability was severely compromised, with a four-quadrant concordance rate of 36.6% and a polar concordance rate of 10.1%.ConclusionsWhile feasible in terms of data acquisition, the PRAM method, when applied via a peripheral arterial site, showed poor agreement and unreliable trending ability compared with PAC FastCCO in cardiac surgery patients with severely reduced left ventricular function. These findings suggest that the complex pathophysiology, particularly the associated severe low ejection fraction, may compromise the accuracy of PRAM in this high-risk population. Further investigation is warranted to understand the influence of these specific conditions on the PRAM algorithm.Clinical Trial Registration:https://drks.de/search/en/trial/DRKS00017260/details.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2025.1709252</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2025.1709252</link>
        <title><![CDATA[Postoperative multimodal pain management: a narrative review of current practices, clinical and educational gaps, and future directions]]></title>
        <pubdate>2025-12-19T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Braden M. Lopez</author><author>Brent M. Lee</author><author>Michael D. Miller</author><author>Mohab M. Ibrahim</author><author>Todd W. Vanderah</author><author>Arthur C. Riegel</author>
        <description><![CDATA[Pain is among the most commonly reported side effects following surgical interventions; however, its management remains a significant challenge due to its multifaceted nature, with studies indicating that up to 80% of surgical patients experience inadequate pain control. Although multimodal pain management (MMPM) is widely recommended as a tool to help mitigate the ongoing opioid epidemic, a universally standardized approach for pain management is lacking and highly dependent on individual clinician practices. Pain perception is inherently subjective, and while objective measurement tools are emerging, self-reported pain scales continue to dominate clinical practice. Differences in pain perception, further complicate efforts to standardize care, demonstrating the need for personalized approaches. Notably, there is a deficiency in surgical education regarding formalized training in postoperative pain management, which leaves medical students and residents without a concrete foundation in evidence-based pain management strategies. This narrative review explores the pathophysiology of pain, evaluates current recommendations in surgery, and emphasizes preoperative optimization. It also argues for, and underscores the necessity for, comprehensive and structured pain management education across all surgical specialties. Furthermore, the review identifies future directions, particularly in pain prediction and the development of surgical guidelines that can facilitate a comprehensive pain management framework while accommodating patient-specific modifications.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2025.1726004</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2025.1726004</link>
        <title><![CDATA[Reversible propofol resistance in a pediatric patient with chemotherapy-induced hypertriglyceridemia: a case report]]></title>
        <pubdate>2025-11-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Brooke Rovner</author><author>Sydney Greenlaw</author><author>Christopher Ferrante</author><author>Ashley C. Eason</author><author>Christopher Heine</author><author>Nicole C. McCoy</author>
        <description><![CDATA[We report the case of a 10-year-old girl with high-risk B-cell acute lymphoblastic leukemia who exhibited transient resistance to propofol. While being treated with calaspargase pegol and dexamethasone during induction chemotherapy, she was found to have milky-appearing serum and bone marrow aspirate as well as markedly elevated triglycerides. Despite previously normal anesthetic responses, the patient required a markedly increased propofol dose (28 mg/kg)—over five times the range of her previous anesthetics (4.5–5.2 mg/kg)—to achieve adequate sedation for her bone marrow aspiration and biopsy. Ultimately, normal propofol sensitivity returned after triglyceride normalization. This case highlights chemotherapy-induced hypertriglyceridemia as a reversible cause of anesthetic resistance and emphasizes the importance of considering lipid levels when an unusual response to routine anesthetic administration occurs.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2025.1713946</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2025.1713946</link>
        <title><![CDATA[An institutional review of perioperative outcomes in pediatric bone marrow donors. A retrospective study]]></title>
        <pubdate>2025-11-25T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Kavitha C. Raghavan</author><author>Brandy Sweeney</author><author>Yu Bi</author><author>Subodh Selukar</author><author>Brandon Triplett</author><author>Doralina Anghelescu</author>
        <description><![CDATA[BackgroundDuring hematopoietic stem and progenitor cell collection from the bone marrow under anesthesia, pediatric donors are exposed to potential complications including hypotension, pain, blood transfusion, endotracheal intubation risks, prone positioning injuries, and postoperative nausea and vomiting (PONV). We evaluated the overall incidence and severity of adverse events to identify opportunities to improve perioperative outcomes for this unique population.MethodsWith institutional review board approval, all donors under 18 years of age who had bone marrow harvest under general anesthesia between 2010 and 2024 at our institution were included in this retrospective study. Autologous donors and donors whose cells were collected by apheresis without anesthesia were excluded.ResultsThe study included 61 donors with a mean age of 9.62 years, mean donor/recipient weight ratio of 1.57, mean harvest volume of 14.2 mL/kg donor weight, and mean fasting duration for clear liquids and solids of 9.31 and 11.3 h, respectively. Twenty-nine (47.5%) experienced at least 1 adverse event. 10 (16.4%) donors experienced at least 1 cardiovascular adverse event. Out of ten episodes of significant hypotension events, 4 donors required vasopressors intraoperatively, 2 experienced dizziness in the post-anesthesia care unit (PACU), and 4 experienced symptomatic hypotension after discharge from the PACU. One infant required blood product transfusion. Six donors (9.8%) experienced post-operative nausea vomiting (PONV), and 7 others (11.5%) experienced post-discharge vomiting. There was one overnight admission, 1 readmission, and 2 unanticipated visits.ConclusionsThis single institution study highlights improvement opportunities for the perioperative care of pediatric bone marrow donors. We propose strategies to optimize preoperative fasting, intraoperative analgesia, and antiemetic prophylaxis and recommend a procedure-specific intravenous fluid replacement calculator, and admission and discharge criteria for bone marrow donors.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2025.1676819</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2025.1676819</link>
        <title><![CDATA[Assessment of patient and physician sentiment on artificial intelligence use in US healthcare]]></title>
        <pubdate>2025-11-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Wael Saasouh</author><author>Kristina Ghanem</author><author>Carly Ghanem</author><author>Christopher Robinson</author><author>Avanti Gupta</author><author>Md Sakibur Hasan</author><author>Michael Schostak</author><author>Rana Ismail</author>
        <description><![CDATA[BackgroundMedical applications of artificial intelligence (AI) range from diagnostic support and electronic health record optimization to personalized treatment and administrative automation. Despite these advances, AI integration into healthcare requires the acceptance and trust of clinicians and patients. Understanding their perspectives is critical to guiding effective and ethical AI adoption in medicine.MethodsWe conducted a nationwide, anonymous, online survey of self-identified physicians and patients in the United States using the Clinician and Patient Experience Registry (CaPER) platform. The survey employed Random Domain Intercept Technology (RDIT) and Random Device Engagement (RDE) to collect nationally-representative online responses while minimizing known survey biases. Respondents were stratified into physicians (n = 382) or patients (n = 760), and completed a series of questions assessing demographics, comfort with AI-supported decision-making, trust in AI vs. human clinicians, and perceived impact of AI on the physician-patient relationship. Data were analyzed descriptively and comparatively, including specialty-specific sub-analyses among physicians.ResultsA total of 1,142 complete responses were analyzed. Both physicians and patients reported generally positive attitudes toward AI-supported medical decision-making, with the majority expressing comfort or neutrality. Approximately one-third of both groups favored a collaborative model integrating both human and AI input. Specialty-specific analysis revealed higher comfort with AI among procedure-based disciplines, while diagnostic-oriented specialties expressed more reservations. Respondents were generally evenly divided regarding the anticipated impact of AI on the physician-patient relationship, with many predicting a strengthening effect.ConclusionsThis large-scale online survey highlights a generally favorable outlook toward AI integration among both physicians and patients, with notable variation by medical specialty for physicians. The findings underscore the importance of tailoring AI implementation strategies to specific clinical contexts and maintaining a focus on human-AI collaboration.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fanes.2025.1714040</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fanes.2025.1714040</link>
        <title><![CDATA[Opioid-free anesthesia: a scoping review of efficacy, safety, and implementation challenges]]></title>
        <pubdate>2025-11-04T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Amogh Pershad</author><author>Ofelia Loani Elvir Lazo</author><author>Robert Wong</author>
        <description><![CDATA[BackgroundOpioid-free anesthesia (OFA) is a multimodal strategy to avoid intraoperative opioids and minimize associated complications, though evidence remains variable.MethodsA systematic search of PubMed and Google Scholar (2010–2025), supplemented by AI tools (Google Gemini) for earlier publications, summarized eligible studies (RCTs, cohorts, systematic reviews, and meta-analyses) comparing OFA to opioid-based anesthesia (OBA). Data were summarized following PRISMA-ScR guidelines.ResultsAcross 23 randomized controlled trials and one cohort study, OFA consistently reduced PONV, while demonstrating analgesia and recovery outcomes comparable to OBA. Hemodynamic stability was variable, with dexmedetomidine-based OFA regimens sometimes associated with increased bradycardia and hypotension. PACU stay varied, ranging from 9 min shorter to 15–35 min longer with OFA. Long-term outcome data are limited.ConclusionOFA is a feasible approach that significantly reduces PONV while maintaining comparable analgesia and recovery. However, heterogeneous protocols, small sample sizes, and scarce long-term data limit external validity. Large, multicenter trials are needed to standardize OFA protocols and clarify long-term outcomes.]]></description>
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