European Journal of Anaesthesiology最新文献

{"title":"Cell cycle arrest biomarkers for early diagnosis of acute kidney injury after liver transplantation: A prospective cohort study.","authors":"Benjamin Milne, Krish Menon, Mark McPhail, Marlies Ostermann, John A Kellum, Gudrun Kunst","doi":"10.1097/EJA.0000000000002123","DOIUrl":"10.1097/EJA.0000000000002123","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"478-480"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-operative kinetics of B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide in patients undergoing lung resection: An observational cohort study.","authors":"Emma Murphy, Adam Glass, Philip McCall, Ben Shelley","doi":"10.1097/EJA.0000000000002137","DOIUrl":"10.1097/EJA.0000000000002137","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"480-482"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current insights into anaesthesia and critical care management of patients with hepatocellular carcinoma: Multifaceted implications for the anaesthesiologist and intensive care physician.","authors":"Antoine Monsel, Alexandre Sitbon, Charles Roux, Daniel Eyraud, Olivier Scatton, Corinne Vezinet, Marie-Virginie Oré, Jérémy Gallet, Mathilde Wagner, Dominique Thabut, Sarah Boughdad, Florence Renaud, Alessandra Mazzola, Claire Goumard, Manon Allaire","doi":"10.1097/EJA.0000000000002141","DOIUrl":"10.1097/EJA.0000000000002141","url":null,"abstract":"<p><strong>Background: </strong>The incidence of hepatocellular carcinoma (HCC) is on the rise worldwide, due to the increasing prevalence of liver diseases associated with metabolic dysfunction and better management of cirrhosis and its complications. The diversification of HCC treatments has recently increased, with the choice of strategy based on HCC characteristics, liver function and comorbidities. The combination of new therapies has transformed the prognosis, with up to 70% survival at 5 years.</p><p><strong>Objective: </strong>The aim of this review was to analyse the most recent data on preoperative evaluation, peri-operative anaesthetic management of liver resection, liver transplantation and other types of procedures, and to highlight the multidisciplinary aspect of such management.</p><p><strong>Main findings and discussion: </strong>The importance of preanaesthetic evaluation will depend largely on the procedure proposed, associated co-morbidities and the stage of liver disease. This assessment should verify stabilisation of all comorbidities, and evaluate the degree of portal hypertension, cirrhosis severity and sarcopenia. Liver resection and liver transplantation for HCC present specific surgical challenges, and minimally invasive techniques improve recovery. Nonsurgical procedures considered as therapeutic (ablation) or standby (regional embolisation) are diverse, and all expose patients to specific intra-anaesthetic complications, sometimes requiring intensive care management. Peri-operative anaesthetic strategies deployed in the management of liver resection or nonsurgical procedures involve specific management of fluids, coagulation, narcosis and analgesia, which can impact on patients' overall, and cancer prognosis. Lastly, new down-staging strategies combining several types of procedure and possibly immunotherapy, also call for collegial reflection on posthepatic transplant immunosuppression, which must remain tailored to each individual patient.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"435-448"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous ropivacaine wound infiltration versus epidural morphine after unplanned caesarean delivery: A noninferiority randomised controlled study.","authors":"Marine Bruillot, Audrey Pieper, Dimitri Sourd, Ana Roge, Edith Ramain, Samia Salah, Jean-Luc Bosson, Jean-Francois Payen","doi":"10.1097/EJA.0000000000002135","DOIUrl":"10.1097/EJA.0000000000002135","url":null,"abstract":"<p><strong>Background: </strong>Treatment programs designed to enhance recovery after caesarean delivery include multimodal analgesia to ensure optimal analgesia while reducing exposure to systemic opioids. Evidence for the effectiveness of continuous wound infiltration with local anaesthetic after unplanned caesarean delivery is needed.</p><p><strong>Objective: </strong>To determine whether continuous ropivacaine wound infiltration has noninferior analgesic properties compared to epidural morphine, while reducing side effects related to opioids.</p><p><strong>Design: </strong>Triple-blinded, noninferiority, randomised controlled trial.</p><p><strong>Setting: </strong>One university hospital, between February 2015 and August 2021.</p><p><strong>Patients: </strong>Eighty-one women undergoing unplanned lower segment caesarean section under epidural anaesthesia.</p><p><strong>Intervention: </strong>At the end of the procedure, randomly assigned patients received either an epidural bolus of 0.9% saline with 48 h continuous ropivacaine wound infusion (ropivacaine group) or an epidural bolus of morphine with 48 h 0.9% saline wound infusion (morphine group).</p><p><strong>Main outcome measures: </strong>Pain during mobilisation at 24 h postsurgery was assessed using the visual analogue pain scale (VAS 0 to 10) with no indication of the allocated group.</p><p><strong>Results: </strong>Pain scores were 4.4 (95% CI, 3.6 to 5.1) in the ropivacaine group versus 3.1 (95% CI, 2.4 to 3.9) in the morphine group. The mean VAS pain difference between the two groups was 1.2 (95% CI, 0.2 to 2.3), which exceeded the prespecified noninferiority margin of 1. The differences between the two groups at rest and during mobilisation at 6 and 24 h were statistically significant. The ropivacaine group received rescue morphine more frequently, and were less satisfied despite fewer morphine-related side effects. Continuous wound infiltration was not technically feasible in 18% of the patients.</p><p><strong>Conclusions: </strong>We failed to show that continuous ropivacaine wound infiltration was noninferior to epidural morphine in providing analgesia after unplanned caesarean delivery. Because of a significant rate of technical failures, continuous wound infiltration should only be considered when neuraxial morphine is contraindicated.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"449-457"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrinolytic activity in infants undergoing cardiac surgery on cardiopulmonary bypass with routine tranexamic acid: A prospective cohort substudy within the FIBrinogen CONcentrate randomised control trial.","authors":"Kristina Siemens, Kiran Parmar, Julia Harris, Beverley J Hunt, Shane M Tibby","doi":"10.1097/EJA.0000000000002124","DOIUrl":"10.1097/EJA.0000000000002124","url":null,"abstract":"<p><strong>Background: </strong>Fibrinolytic activity contributes to bleeding after cardiopulmonary bypass (CPB).</p><p><strong>Objective: </strong>Our objectives were, in a group of infants undergoing cardiac surgery with CPB: to document the extent of peri-operative fibrinolysis using rotational thromboelastometry (ROTEM) and standard biomarkers; to compare the agreement between these fibrinolytic measures; to assess whether fibrinolytic activity is associated with early postoperative mediastinal bleeding and assess whether supplementation with fibrinogen concentrate affected fibrinolysis.</p><p><strong>Design: </strong>Prospective cohort, mechanistic substudy, nested within the FIBrinogen CONcentrate (FIBCON) randomised controlled trial.</p><p><strong>Setting: </strong>Single centre, tertiary paediatric cardiac surgery and paediatric intensive care units.</p><p><strong>Patients: </strong>Ninety infants (median age 6.3 months) undergoing cardiac surgery, who all received routine intra-operative tranexamic acid. The infants were randomised to receive either an individualised dose of fibrinogen concentrate ( n  = 60) or placebo ( n  = 30) during CPB.</p><p><strong>Main outcome measures: </strong>We measured the ROTEM variable maximum clot lysis (ML), and fibrinolytic biomarkers including plasmin-antiplasmin (PAP) and tissue plasminogen activator antigen (tPA-Ag). Blood was sampled pre-CPB, on-CPB and post-CPB, and 4 h after PICU admission.</p><p><strong>Results: </strong>tPA-Ag, PAP and ROTEM ML increased significantly after CPB despite the use of tranexamic acid. The two fibrinolytic biomarkers t-PA and PAP, correlated ( P  = 0.001) but neither correlated with ROTEM ML. Early postoperative blood loss was inversely associated with PAP levels. Each 100 μg l -1 rise in PAP was associated with a 7.9% reduction in mean blood loss. Fibrinogen concentrate supplementation as expected did not affect tPA-Ag but was temporally associated with an increase in PAP levels and a decrease in ROTEM fibrinolytic activity.</p><p><strong>Conclusion: </strong>Fibrinolysis is activated after paediatric cardiac CPB surgery as indicated by increased tPA-Ag and ROTEM ML. The substantial increase in tPA-Ag post-PICU admission is probably accompanied by a similar rise of plasminogen activator inhibitor 1 (PAI-1) as part of the acute phase response to surgery, thereby limiting clinical fibrinolysis. Supplementation of fibrinogen concentrate was associated with increased PAP activity and less clinical bleeding, consistent with the known role for fibrinogen in being a substrate for plasmin.</p><p><strong>Trial registration: </strong>ISCTRN:50553029, Eudract:2013-003532-68.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"389-397"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thromboelastometry and two activated clotting tests in detecting residual heparin after protamine in cardiac surgical patients: A prospective cohort study.","authors":"Janne Moilanen, Marika Pada, Pasi Ohtonen, Timo Kaakinen, Panu Taskinen, Eeva-Riitta Savolainen, Tiina Erkinaro","doi":"10.1097/EJA.0000000000002122","DOIUrl":"10.1097/EJA.0000000000002122","url":null,"abstract":"<p><strong>Background: </strong>After cardiac surgery, complete heparin reversal with protamine is essential. Accordingly, there is a need for an accurate and precise point-of-care device to detect possible residual heparin after protamine administration.</p><p><strong>Objectives: </strong>To compare two different activated clotting time (ACT) tests and thromboelastometry in detecting postprotamine heparin activity after cardiac surgery.</p><p><strong>Design: </strong>A single-centre prospective, observational study.</p><p><strong>Setting: </strong>University Hospital from September 2021 to February 2023.</p><p><strong>Participants: </strong>Fifty-five adult, elective cardiac surgical patients.</p><p><strong>Interventions: </strong>The ACT-LR and ACT+ tests of Hemochron Signature Elite device, and the coagulation time (CT) ratio from INTEM and HEPTEM tests of ROTEM Sigma device, were analysed after protamine administration and compared to baseline values.</p><p><strong>Main outcome measures: </strong>Based on postprotamine antifactor Xa (anti-fXa) activity, the patients were divided into heparin (anti-fXa ≥0.2 IU ml -1 ) and no heparin (anti-fXa ≤0.1 IU ml -1 ) groups.</p><p><strong>Results: </strong>There was a mean bias of 44 [95% confidence interval (CI) 40 to 47] celite seconds between ACT-LR and ACT+ measurements. The absolute changes in ACT-LR, ACT+ and INTEM:HEPTEM CT ratio were variable and did not differ between the groups. The mean ± SD percentage changes between postprotamine and baseline ACT-LR and ACT+ values were 5.9 ± 17.5 and 5.9 ± 16.9% in the no residual heparin group, compared to 1.4 ± 8.4 and 9.9 ± 12.5% in the residual heparin group. Receiver operator characteristic curves for postprotamine INTEM:HEPTEM CT ratio and for percentage changes in ACT-LR and ACT+ to detect an anti-fXa at least 0.2 IU ml -1 had areas under the curve of 0.496 (95% CI, 0.329 to 0.663), 0.425 (95% CI, 0.260 to 0.591) and 0.583 (95% CI, 0.417 to 0.749), respectively.</p><p><strong>Conclusion: </strong>Both the ACT-LR and ACT+ tests of Hemochron Signature Elite device and the INTEM:HEPTEM CT ratio of ROTEM Sigma device have poor ability to detect residual heparin shortly after protamine administration.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"398-406"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes following extended postoperative recovery unit admission in noncardiac surgery: A systematic review and meta-analysis.","authors":"Bernard R Schockaert, René M van Bruchem, Maarten F Engel, Robert Jan Stolker, Felix van Lier, Sanne E Hoeks","doi":"10.1097/EJA.0000000000002145","DOIUrl":"10.1097/EJA.0000000000002145","url":null,"abstract":"<p><strong>Background: </strong>Surgery carries inherent risks, with the postoperative phase being as critical as the intraoperative period. Enhanced perioperative care units, positioned between general wards and intensive care units, aim to provide adequate postoperative management and resource allocation. Despite their widespread implementation, evidence on outcomes remains limited.</p><p><strong>Objectives: </strong>The primary outcome was 30-day or in-hospital mortality following extended postoperative recovery, with subgroup meta-analysis examining enhanced perioperative care units and intensive care units. Secondary outcomes included, among others, hospital length of stay.</p><p><strong>Design: </strong>Systematic review with meta-analysis.</p><p><strong>Data sources: </strong>A comprehensive search was conducted in MEDLINE, Embase, Web of Science, Cochrane Central, and Google Scholar from inception up to 22 April 2024.</p><p><strong>Eligibility criteria: </strong>The search string encompassed extended postoperative recovery units, including enhanced perioperative care units and intensive care units, for noncardiac, nontransplant surgery, excluding speciality-specific, age-specific, indirect and nonsurgical admissions. Two reviewers independently conducted screening, eligibility assessment and quality appraisal.</p><p><strong>Results: </strong>Of 28 179 records screened, 24 were included of which 22 were unique studies. The overall pooled random-effects mortality, based on 15 studies, was 3 (95% confidence interval (CI) 2 to 6)%. Subgroup analysis demonstrated a mortality of 2 (95% CI 1 to 4)% for patients managed in enhanced perioperative care units and 8 (95% CI 4 to 14)% in intensive care units ( χ2  = 7.99; P  < 0.01). Risk of bias (ROBINS I) was moderate to serious, and heterogeneity substantial. Pooled hospital length of stay, based on six studies, was 8.6 (95% CI 5.9 to 11.3) days.</p><p><strong>Conclusion: </strong>Pooled mortality following extended postoperative recovery in noncardiac surgery was 3% (95% CI 2 to 6). Subgroup analysis indicated lower mortality among patients managed in enhanced perioperative care units. However, considerable heterogeneity in operational definitions, unit capabilities, and admission criteria necessitates cautious interpretation while reflecting real-world practices. Delineation through further research is warranted.</p><p><strong>Prospero registration: </strong>CRD42023457051.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"407-418"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabilitation to mitigate postintensive care syndrome in surgical patients: The rationale for a peri-critical illness pathway involving anaesthesiologists and intensive care physicians.","authors":"Anne-Françoise Rousseau, Gabriel Thierry, Bernard Lambermont, Vincent Bonhomme, Joana Berger-Estilita","doi":"10.1097/EJA.0000000000002136","DOIUrl":"10.1097/EJA.0000000000002136","url":null,"abstract":"<p><p>The post-intensive care syndrome (PICS) refers to the long-term physical, psychological and cognitive impairments experienced by intensive care unit (ICU) survivors, while PICS-Family (PICS-F) affects their family members. Despite preventive strategies during the ICU stay, PICS remains a significant concern impacting survivors' quality of life, increasing the healthcare costs, and complicating recovery. Prehabilitation offers a promising approach to mitigating PICS and PICS-F, especially when the ICU stay can be anticipated, such as in the case of major surgery. Recent literature indicates that prehabilitation - interventions designed to enhance patients' functional capacity before critical illness - may mitigate the risk and severity of PICS. Studies have demonstrated that prehabilitation programs can improve muscle strength, reduce anxiety levels and enhance overall quality of life in ICU survivors. Family prehabilitation (prehabilitation-F) is also introduced as a potential intervention to help families to cope with the stress of critical illness. This article aims to explore the role of multimodal prehabilitation and post-ICU follow-up in preventing and managing PICS and PICS-F, focusing on improving patient outcomes, supporting families and optimising healthcare resources. Combining prehabilitation with post-ICU follow-up in peri-critical care clinics could streamline resources and improve outcomes, creating a holistic care pathway. These clinics, focused on both pre-ICU and post-ICU care, would thus address PICS from multiple angles. However, the heterogeneity of patient populations and prehabilitation protocols present challenges in standardising the interventions. Further research is necessary to establish optimal prehabilitation strategies tailored to individual patient needs and to demonstrate their utility in terms of patient outcome.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"419-429"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthesia as a risk factor for long-term cognitive decline: Results of the prospective MAAS cohort study.","authors":"Christoph H Pennings, Martin Van Boxtel, Dianne De Korte-De Boer, Wolfgang Buhre, Carine J Vossen","doi":"10.1097/EJA.0000000000002133","DOIUrl":"10.1097/EJA.0000000000002133","url":null,"abstract":"<p><strong>Background: </strong>There are concerns whether (repeated) exposure to general anaesthesia is associated with long-term cognitive decline.</p><p><strong>Objective: </strong>We investigated the potential, negative relationship between total exposure to surgery under general anaesthesia and its impact on long-term cognitive development.</p><p><strong>Design: </strong>A prospective longitudinal cohort study.</p><p><strong>Setting: </strong>The Netherlands.</p><p><strong>Participants: </strong>1823 Adults, aged 25-84 with normal cognitive functioning on inclusion with three serial cognitive assessments between 1995 and 2008, with comprehensive documentation on demographic, lifestyle, and health factors.</p><p><strong>Main outcome measures: </strong>The primary outcomes were test scores in the cognitive domains of learning and memory, executive function, selective attention, mental speed, and information processing speed. Linear mixed models were used to analyse the effects of the estimated total time under general anaesthesia at baseline on cognitive development during a 12-year follow-up period.</p><p><strong>Results: </strong>When adjusting for demographic and systemic health-related factors, prolonged exposure to surgery under general anaesthesia (measured in total baseline minutes) negatively affected three cognitive domains. These included the CST (executive functioning, P  < 0.05), Stroop (selective attention and mental speed, P  < 0.001) and LDST (information processing speed, P  < 0.005). Age and education were the primary factors impacting lifetime cognitive decline. Hypertension, diabetes, and smoking negatively affected various cognitive domains.</p><p><strong>Conclusion: </strong>Increased exposure to surgery under general anaesthesia independently contributes to long-term cognitive decline. Demographic variables and health-related factors are key contributors to accelerated cognitive decline over an individual's lifetime.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"468-477"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetic implications of psilocybin and lysergic acid diethylamide: what is old is now new: A narrative review on psychedelics and anaesthesia.","authors":"Mansi Dave, Ron Shore, Tracy Cupido, Chris Haley, David Clinkard","doi":"10.1097/EJA.0000000000002138","DOIUrl":"10.1097/EJA.0000000000002138","url":null,"abstract":"<p><p>Psychedelic drugs, known for their perception-altering properties, are gaining popularity in the treatment of mental health and pain disorders. As exploratory studies demonstrate clinical efficacy with few adverse events, it is expected that more patients will ingest psychedelic drugs. For therapeutic reasons, as with any drug, anaesthesiologists must be aware of its physiological effects and contraindications to ensure the safe provision of anaesthesia. Psilocybin is a 5HT 1A and 5HT 2A serotonin receptor agonist thought to act on excitatory and inhibitory neurons in the brain. Acute ingestion causes sympathetic nervous system activation, which can precipitate haemodynamic instability. Activation of the 5HT serotonin receptors can also place the patient at risk of serotonin syndrome. Chronic use increases plasma concentrations of cortisol, which has implications on prophylactic stress-dosing of glucocorticoids preoperatively. Lysergic acid diethylamide (LSD), a synthetic psychoactive substance, is also a 5HT2 A agonist. LSD has been shown to potentiate opioid analgesics, and monoamine oxidase (MAO) inhibition. Historical reports suggest that LSD has anticholinesterase activity and can prolong neuromuscular block with depolarising muscle relaxants. Mescaline is a poorly understood psychedelic with similar autonomic effects. Historical studies have shown decreased neuromuscular transmission and an association with malignant hyperthermia. When managing patients who have consumed psychedelics drugs, it is important to consider delaying surgery whenever possible, to allow acute intoxication to wane. A high degree of suspicion and an understanding of management principles is vital to the safe conduct of anaesthesia. Future research should explore therapeutic doses of psychedelic drugs to understand physiologic effects at various concentrations.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"430-434"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}