European Journal of Anaesthesiology最新文献

{"title":"New-onset postoperative hypotension in patients recovering from noncardiac surgery: A prospective observational study.","authors":"Phillip Hoppe, Yuan Chang, Tobias Schwarz, Alina Bergholz, Kristen K Thomsen, Alina Kröker, Moritz Flick, Linda Krause, Daniel I Sessler, Bernd Saugel","doi":"10.1097/EJA.0000000000002227","DOIUrl":"10.1097/EJA.0000000000002227","url":null,"abstract":"<p><strong>Background: </strong>It remains unknown whether postoperative mean arterial pressures less than 65 mmHg constitute clinically important hypotension for individual patients, or might be within their normal pressure range.</p><p><strong>Objective: </strong>We aimed to evaluate postoperative arterial pressure in patients recovering from noncardiac surgery and determine the proportion of patients in whom a mean arterial pressure less than 65 mmHg constitutes new-onset postoperative hypotension.</p><p><strong>Design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>German university medical centre between October 2020 and September 2021.</p><p><strong>Patients: </strong>Patients with elevated cardiovascular risk recovering on general wards from noncardiac surgery under general anaesthesia.</p><p><strong>Main outcome measures: </strong>Before and after surgery, we automatically measured arterial pressure at 30-min intervals for about 24 h. We considered patients to have new-onset postoperative hypotension when they had a postoperative mean arterial pressure less than 65 mmHg, and their lowest postoperative mean arterial pressure was at least 5 mmHg below their lowest pre-operative mean arterial pressure.</p><p><strong>Results: </strong>We enrolled 307 patients and included 248 in the final analysis. The median [IQR] duration of surgery was 62 [40 to 90] min. Postoperative mean arterial pressure was less than 65 mmHg at least once in 101 patients (41%). In 44 of these 101 patients (44%; 18% of all 248 patients), postoperative mean arterial pressures less than 65 mmHg constituted new-onset postoperative hypotension. In 57 of these 101 patients (56%; 23% of all 248 patients), postoperative mean arterial pressures less than 65 mmHg did not constitute new-onset postoperative hypotension.</p><p><strong>Conclusion: </strong>About 40% of our patients recovering from noncardiac surgery on general wards had at least one postoperative mean arterial pressure less than 65 mmHg, and about half of these patients had new-onset postoperative hypotension.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"966-973"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607862","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":"The effect of methylprednisolone on the reversal time of rocuronium by sugammadex in the paediatric patient group: A randomised controlled trial.","authors":"Mustafa Büyükcavlak, Yasin Tire, Aydin Mermer, Muhammet S Yüce, Şerife N Yildirim, Betül Kozanhan","doi":"10.1097/EJA.0000000000002241","DOIUrl":"10.1097/EJA.0000000000002241","url":null,"abstract":"<p><strong>Background: </strong>Sugammadex is an effective agent for reversing aminosteroid neuromuscular blocking agents, but its effectiveness can be influenced by interactions with steroid-based drugs. Previous studies suggest corticosteroids may affect sugammadex effectiveness, but data on methylprednisolone in paediatric patients is limited.</p><p><strong>Objective: </strong>This study aimed to determine whether methylprednisolone administration at induction affects the reversal time of rocuronium by sugammadex.</p><p><strong>Design: </strong>Single centre, double blinded, randomised controlled trial.</p><p><strong>Settings: </strong>Turkish tertiary care centre from September 2024 to January 2025.</p><p><strong>Study population: </strong>Paediatric patients undergoing elective adenoidectomy and/or tonsillectomy.</p><p><strong>Interventions: </strong>Patients were randomly assigned to receive either methylprednisolone 1 mg kg -1 (group M) or a placebo (group C) with anaesthesia induction. Neuromuscular block was induced with rocuronium, monitored using acceleromyography and reversed with sugammadex 2 mg kg -1 at the end of surgery.</p><p><strong>Main outcome meaures: </strong>The primary outcome was the reversal time of rocuronium by sugammadex: time from sugammadex administration at train of four (TOF) count = 2 to a TOF ratio of ≥0.9 of baseline. Secondary outcomes included extubation time (time from sugammadex administration at TOF count = 2 to extubation), postoperative pain, nausea and vomiting scores, and incidence of adverse events (stridor, hoarseness, severe cough and desaturation).</p><p><strong>Results: </strong>At 89 ± 20.3 s, the reversal time of rocuronium by sugammadex was statistically significantly longer in group M compared with the 54.6 ± 9.3 s of group C ( P  < 0.001). The mean with 95% confidence interval (CI) of the difference was 34.5 (27.3 to 41.6) s. The extubation time was also significantly prolonged in group M compared with group C: 426.8 ± 134.4 vs . 331.3 ± 129.0 s ( P  = 0.002) with a difference of 95.5 (95% CI, 36.8 to 154.2) s. No significant differences were observed in postoperative pain, nausea and vomiting scores, or frequency of adverse events.</p><p><strong>Conclusion: </strong>Although methylprednisolone administration resulted in a significantly prolonged reversal of rocuronium-induced neuromuscular block by sugammadex and subsequent delayed extubation, the clinical importance of this interaction is minor.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06623370.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"1025-1033"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648875","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":"Patient-reported outcomes as drivers of postoperative delirium in the postanaesthesia care unit: Data from a one-year prospective cohort study.","authors":"Joana Berger-Estilita, Isabel Marcolino, Mia Gisselbaek, Christian Seidl, Thomas W Buehrer, Ines Fortuna, Basak C Meco, Finn M Radtke, Sarah Saxena","doi":"10.1097/EJA.0000000000002258","DOIUrl":"10.1097/EJA.0000000000002258","url":null,"abstract":"<p><strong>Background: </strong>Value-based healthcare emphasises patient-centred outcomes. However, Patient-Reported Outcomes Measures (PROMs) and Patient-Reported Experience Measures (PREMs) remain underused in peri-operative care. Postoperative delirium (POD) is a common and serious complication associated with increased morbidity and healthcare costs. Understanding the prognostic value of PROMs and PREMs may support identification and prevention of POD in the postoperative anaesthesia care unit (PACU).</p><p><strong>Objectives: </strong>We assessed the association between peri-operative patient-reported symptoms and PACU POD using systematically collected PROMs and PREMs (including pain, anxiety, thirst, stress, and satisfaction), following the implementation of a brain protection care bundle.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>A single-centre study in a secondary-care private hospital in Switzerland from January 2023 to January 2024.</p><p><strong>Patients: </strong>1419 adults undergoing elective or urgent surgery. Exclusion criteria included age <18 years, inability to provide consent, language barriers, need for postoperative mechanical ventilation, or pre-operative Nursing Delirium Screening Scale (Nu-DESC > or equal to 2).</p><p><strong>Interventions: </strong>Implementation of the Safe Brain Initiative (SBI) care bundle, incorporating 18 multidisciplinary, nonpharmacologic strategies to optimise peri-operative brain health.</p><p><strong>Main outcome measures: </strong>The primary outcome was PACU POD incidence, assessed using the Nu-DESC at emergence and PACU discharge. Secondary outcomes included associations between PACU POD and pre-operative PROMs (pain, anxiety, stress, nausea) and PREMs (satisfaction, well being).</p><p><strong>Results: </strong>PACU POD occurred in 19.6% of patients. Pre-operative anxiety (NRS > 7) was an independent predictor of POD ( P  = 0.012). Pre-operative PROMs showed increasing trends, while postoperative symptoms (pain, anxiety, nausea) significantly decreased. Patients with POD reported lower well being scores despite high satisfaction in other PREM domains.</p><p><strong>Conclusions: </strong>Pre-operative anxiety and stress strongly predict PACU POD, supporting early risk stratification and targeted interventions. Integrating PROMs and PREMs into peri-operative workflows enhances patient-centred care.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"1006-1016"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947506","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":"Multimodal prehabilitation as a strategy to reduce postoperative complications in cardiac surgery: A randomised controlled trial.","authors":"Antonio López-Hernández, Elena Gimeno-Santos, Ricard Navarro-Ripoll, María José Arguis, Manuel López-Baamonde, María Sanz-de la Garza, Elena Sandoval, Manel Castellà, Graciela Martínez-Palli","doi":"10.1097/EJA.0000000000002236","DOIUrl":"10.1097/EJA.0000000000002236","url":null,"abstract":"<p><strong>Background: </strong>Prehabilitation has shown efficacy in improving postoperative outcomes in abdominal surgery. Data on cardiac surgery are controversial.</p><p><strong>Objective: </strong>To determine if a multimodal prehabilitation programme reduces the rate of postoperative complications after elective cardiac surgery.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>Single-centre study in a tertiary hospital with inclusion period spanned from March 2018 to June 2021.</p><p><strong>Patients: </strong>One hundred and fifty-one patients, with an expected waiting time before surgery of 6 weeks or more, completed the study. Excluded were those with functional, anatomical or cognitive impairment; cardiac instability; dynamic left ventricle outflow tract obstruction or proven exercise-induced arrhythmias.</p><p><strong>Intervention: </strong>Four to six weeks of a multimodal prehabilitation programme, including exercise training, psychological and nutritional support.</p><p><strong>Main outcome: </strong>Incidence of postoperative complications.</p><p><strong>Results: </strong>No differences were found in the rate of postoperative complications (80% in both groups, P  = 0.968), most of which were mild, with a Comprehensive Complication Index of 21 and more than 70% with Clavien-Dindo grade I or II. Prehabilitated patients showed a significant improvement in endurance time assessed by a constant-work rate cycling exercise test: preintervention vs . postintervention (301 ± 109 vs . 578 ± 257 s, P  = 0.001), and in 6-min walk test (6MWT) (487 ± 77 vs . 504 ± 74 min, P  = 0.001). No patients experienced adverse events attributable to the intervention. A sub-analysis restricted to prehabilitated patients who showed a meaningful response to exercise assessed by the 6MWT (increase ≥ 30 m) showed a reduction in the number and severity of postoperative complications, compared to nonresponders (1.1 ± 0.9 vs . 2 ± 2 complications per patient, P  = 0.038); and the Comprehensive Complication Index (16 ± 15 vs . 25 ± 19, P  = 0.044).</p><p><strong>Conclusion: </strong>A multimodal prehabilitation programme before elective cardiac surgery did not reduce the incidence of postoperative complications. Nevertheless, when analysis was restricted to meaningful responders to intervention, a significant reduction in postoperative complications and their severity was observed.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT03466606).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"987-996"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648874","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":"How perioperative processes and patient-reported outcomes contribute to persistent postoperative opioid use: A cohort study linking clinical and health claims data.","authors":"Marcus Komann, Christin Arnold, Johannes T Dreiling, Norman Rose, Christine Kubulus, Thomas Volk, Philipp Baumbach, Carolin Fleischmann-Struzek, Winfried Meißner, Daniel Schwarzkopf","doi":"10.1097/EJA.0000000000002265","DOIUrl":"10.1097/EJA.0000000000002265","url":null,"abstract":"<p><strong>Background: </strong>Opioid analgesics play a major role in perioperative pain management, yet their use can lead to persistent postoperative opioid use (PPOU), with significant societal and health costs. Patient-specific risk factors of PPOU are well described but little is known about factors that can be controlled by clinicians.</p><p><strong>Objectives: </strong>To find PPOU risk factors among perioperative processes and pain-related patient-reported outcomes (PROs) on the first postoperative day.</p><p><strong>Design: </strong>Prospective cohort study linking perioperative data from Quality Improvement in Postoperative Pain Treatment (QUIPS) pain registry with health claims data from BARMER insurance.</p><p><strong>Setting: </strong>Thirty-one German hospitals in 2021.</p><p><strong>Patients: </strong>We analysed 1849 of 1994 patients undergoing surgery (mean age = 61.6 years ± 17.3, 60.7% women). Exclusion criteria: under 18 years, unable to communicate, not consenting, failed data linkage.</p><p><strong>Main outcome measure: </strong>Persistent postoperative opioid use (PPOU), defined as at least one opioid prescription within 90 days postdischarge and another one between days 91 and 180.</p><p><strong>Results: </strong>Overall, 7.8% of patients showed PPOU. In logistic regression models, preadmission opioid use, adjusted odds ratio (aOR) = 20.8, P  < 0.001, and depression, aOR = 1.85, P  = 0.006, were patient-specific risk factors. Opioid administration during the hospital stay was associated with 4% increase in adjusted absolute PPOU risk ( P  = 0.001), with opioids on the ward standing out. Among PROs on the first postoperative day, higher maximal pain intensity (0.5% per point on 11-point Numeric Rating Scale, P  = 0.023) was associated with an increased absolute PPOU risk while postoperative nausea (2.6% if yes, P  = 0.034) was associated with a decreased absolute risk.</p><p><strong>Conclusions: </strong>Perioperative opioids significantly contributed to the risk of PPOU, emphasising the need for careful opioid management postsurgery. Addressing pain effectively and promptly, while minimising opioid prescriptions on the ward, may reduce PPOU. Further research is needed to refine pain management and optimise patient outcomes.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"997-1005"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991787","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":"Predictive value of early postoperative copeptin after cardiac surgery: A two-centre prospective cohort study.","authors":"Anna Kirkopoulos, Irsa Salehi, René M'Pembele, Patrick Maddison, Alexandra Stroda, Theresa Tenge, Daniel Donaldson, Ragnar Huhn, Detlef Kindgen-Milles, Ali Haddad, Jens Brands, Simon Dubler, Thorsten Brenner, Marc Moritz Berger, Giovanna Lurati Buse, Sebastian Roth","doi":"10.1097/EJA.0000000000002251","DOIUrl":"10.1097/EJA.0000000000002251","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing cardiac surgery are at increased risk for postoperative complications, making early postoperative risk evaluation crucial. Recent studies have shown that copeptin, a neurohumoral marker, is associated with major adverse events after noncardiac surgery. However, data on its role after cardiac surgery are scarce.</p><p><strong>Objective: </strong>Primary aim of this study was to analyse the association of early postoperative copeptin levels with adverse events after cardiac surgery.</p><p><strong>Design: </strong>Observational, prospective cohort study.</p><p><strong>Setting: </strong>Two German tertiary healthcare centres. Enrolment took place between March 2021 and August 2022.</p><p><strong>Patients: </strong>Adults undergoing elective on-pump cardiac surgery were included.</p><p><strong>Main outcome measures: </strong>Main exposure was early postoperative copeptin. Primary outcome was new-onset disability 1 year after surgery, as defined by a World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score of ≥16% or an increase of ≥5% in case of pre-operative disability.</p><p><strong>Results: </strong>295 out of 363 prospectively enrolled patients were included in the final analysis (28.8% female, median [IQR] age 64 years, [56 to 71]. Fifty-four patients (18.3%) developed new-onset disability and 3.4% (10/295) died within 1 year. Logistic regression analysis showed an adjusted odds ratio (aOR) of 2.35 (95% confidence interval, 'CI', 1.17 to 4.72) for the association between elevated copeptin and new-onset disability. The discrimination of copeptin for new-onset disability was weak and did not improve risk stratification when added to the pre-operative EuroSCORE II and postoperative troponin (ROC AUC EuroSCOREII+troponin+copeptin = 0.685, 95% CI 0.61 to 0.76; ROC AUC EuroSCOREII+troponin = 0.678, 95% CI 0.59 to 0.76, DeLong test: P  = 0.82). DeLong test: P  = 0.82).</p><p><strong>Conclusion: </strong>Early postoperative copeptin is independently associated with new-onset disability at 1 year after cardiac surgery. Due to weak discrimination for new-onset disability routine measurement of copeptin cannot be recommended.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov identifier: NCT04877795.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"1017-1024"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774949","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":"Using capnography in children to prevent oxygen desaturation during procedural sedation: A randomised trial.","authors":"Eun-Hee Kim, Jung-Bin Park, Sang-Hwan Ji, Young-Eun Jang, Ji-Hyun Lee, Hee-Soo Kim, Jin-Tae Kim","doi":"10.1097/EJA.0000000000002250","DOIUrl":"10.1097/EJA.0000000000002250","url":null,"abstract":"<p><strong>Background: </strong>Capnography is essential for ventilatory monitoring.</p><p><strong>Objective: </strong>We evaluated the effects of capnography on the occurrence of oxygen desaturation in paediatric patients undergoing sedation outside the operating room.</p><p><strong>Design: </strong>Age-stratified randomised controlled trial without blinding.</p><p><strong>Setting: </strong>Tertiary care children's hospital.</p><p><strong>Patients: </strong>We enrolled paediatric patients scheduled to undergo sedation outside the operating room with either oral chloral hydrate (25 to 50 mg kg -1 ), intravenous midazolam (0.1 mg kg -1 ), ketamine (1 mg kg -1 ) or a combination of these medications.</p><p><strong>Intervention: </strong>Patients were allocated to the control and capnography groups that were monitored using pulse oximetry and pulse oximetry plus capnography.</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of oxygen desaturation, defined as a decrease of at least 5% from the patient's baseline oxygen saturation.</p><p><strong>Results: </strong>A total of 256 paediatric patients were screened for eligibility, and 214 were enrolled. Ultimately, data from 197 patients were analysed, with 101 and 96 children in the control and capnography groups, respectively. Oxygen desaturation occurred in 32.7% ( n  = 33) and 15.6% ( n  = 15) of the patients in the control and capnography groups, respectively, resulting in an odds ratio (OR) of 0.38 [95% confidence interval (CI), 0.19 to 0.75), P  = 0.005]. The oxygen saturation at the time of intervention initiation was higher in the capnography group (93.8 ± 7.8%) compared with the control group (90 ± 7.8%, P  = 0.003). The incidence of severe oxygen desaturation less than 90% or less than 85% did not differ between the two groups.</p><p><strong>Conclusion: </strong>Capnography significantly reduced the incidence of oxygen desaturation in paediatric patients undergoing procedural sedation outside the operating room. Our study advocates the integration of capnography with standard pulse oximetry to reduce the incidence of oxygen desaturation during paediatric procedural sedation outside the operating room.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov identifier: NCT04868266.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"1034-1041"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854962","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":"Post discharge digital health technology interventions in ambulatory surgery: A systematic review and meta-analysis.","authors":"Signe Berit Bentsen, Mi Stjernberg, Johan Ræder, Geir Egil Eide, Marianne Nesbjørg Tvedt, Pål Andre Hegland","doi":"10.1097/EJA.0000000000002233","DOIUrl":"10.1097/EJA.0000000000002233","url":null,"abstract":"<p><strong>Background: </strong>Given the early discharge associated with ambulatory surgery, digital health interventions (DHIs) may be useful in out of hospital follow-up. However, there are no systematic reviews concerning the use of DHIs in this setting.</p><p><strong>Objective: </strong>To identify and evaluate the effects of DHIs on, patient safety, patient experience, and efficiency in post discharge ambulatory surgery.</p><p><strong>Design: </strong>Systematic review and meta-analysis. Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation were used.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus were systematically searched from inception to 9 October 2024.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs); ambulatory surgical patients ≥18 years; post discharge digital health interventions, including but not limited to computer tablets, mobile applications, and smart phones. Control group interventions included post discharge follow-up by a general practitioner, office-based follow-up, telephone follow-up, or no intervention.</p><p><strong>Results: </strong>Six RCTs, with a total of 1397 patients were included. The meta-analyses showed no significant effects of DHIs compared with control group interventions on average pain intensity during postoperative days one to three, standardised mean difference = -0.15 (95% CI, -0.66 to 0.35), P = 0.556, or on unplanned healthcare encounters up to six months postoperatively, relative risk = 0.98 (95% CI, 0.92 to 1.05), P  = 0.580. A review of individual articles showed that patients in the DHI groups reported significantly less impaired sleep, mood swings, stress, dizziness, headaches, sore mouth, constipation, and wound-related problems. Additionally, costs were lower, and patients reported improved functional status and well being compared with the control group. The risk of bias varied from low to moderate and the quality of evidence was low.</p><p><strong>Conclusions: </strong>Digital health interventions may reduce some symptoms and costs following discharge from ambulatory surgery, while improving quality of life. However, uncertainty remains due to the limited number of studies, some inconsistent results, and the low certainty of evidence.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"974-986"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625638","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 in 2050: how emerging technologies will transform our practice: The Sir Robert Macintosh Lecture 2025.","authors":"Kate Leslie","doi":"10.1097/EJA.0000000000002234","DOIUrl":"10.1097/EJA.0000000000002234","url":null,"abstract":"<p><p>In the next 25 years, we will see unprecedented technological progress due to the artificial intelligence (AI) revolution. AI-driven advances will be made in five strongly interconnected domains: reenergised drug discovery, continuous real-time monitoring, personalised medicine, automation and decentralised care. Drug discovery will move from in vitro to in silico approaches. We will identify molecules that fit protein targets and protein targets that fit molecules, allowing us to better understand mechanisms of anaesthesia and pain. Improved monitoring of physiological and biological variables will lead to better assessment and prediction of haemodynamics, anaesthetic depth and nociception. Anaesthetic care will be personalised by AI-driven analysis of population, personal and biomarker data, as well as an understanding of the values and wishes of patients. Automation will streamline routine tasks in hospitals, especially in relation to documentation and service delivery. Remote monitoring and assistance systems will help patients receive more of their care at home. The introduction of AI may have unforeseen consequences, especially for equity, sustainability and the future of work. We must think deeply about the future role of anaesthesiologists and ensure that we are involved in redesigning our role. AI can simulate empathy, and will do so increasingly well, but most of us will not be deceived because it is not the human-to-human connection that we crave. Perhaps the greatest gift of AI in anaesthesia practice will be that we come to value what it means to be human.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"951-957"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505230","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 positive airway pressure to prevent reintubation in patients recovering from cardiac surgery: A multicentre randomised clinical trial.","authors":"Daniela Pasero, Andrea Costamagna, Claudia Filippini, Ilaria Blangetti, Sergio Cattaneo, Massimo Baiocchi, Andrea Balata, Maurizio Bottiroli, Pierpaolo Dambruoso, Stefano De Paulis, Lorenzo Grazioli, Alessandro Locatelli, Ferdinando Luca Lorini, Alessandra Mascotti, Michele Giovanni Mondino, Domenico Paparella, Luca Salvi, Tommaso Tonetti, Luigi Tritapepe, V Marco Ranieri","doi":"10.1097/EJA.0000000000002229","DOIUrl":"10.1097/EJA.0000000000002229","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary complications, including atelectasis and reintubation, are common after cardiac surgery and are associated with increased morbidity and mortality. Postoperative continuous positive airway pressure (CPAP) may reduce these risks, but its effectiveness remains uncertain.</p><p><strong>Objectives: </strong>To assess whether CPAP reduces the need for reintubation in hypoxaemic patients after cardiac surgery, and to evaluate its effect on other postoperative pulmonary complications.</p><p><strong>Design: </strong>Multicentre, open-label, randomised clinical trial. The study was prematurely terminated due to funding constraints, leading to an underpowered sample.</p><p><strong>Setting: </strong>Ten university-affiliated hospitals across Italy.</p><p><strong>Patients: </strong>Adults undergoing cardiac surgery with cardiopulmonary bypass who developed a Pa O 2 /FiO 2 ratio 200 or less within 1 h of extubation. Exclusion criteria included severe COPD, previous mechanical ventilation and lack of consent.</p><p><strong>Main outcome measures: </strong>The primary endpoint was reintubation within 28 days of surgery. Secondary endpoints included atelectasis, pneumonia, sepsis, mortality and oxygenation.</p><p><strong>Results: </strong>The incidence of reintubation was 10.8% (95% confidence interval [CI], 6.52 to 15.15) in the control group and 8.3% (95% CI, 4.51 to 12.16) in the treatment group ( P  = 0.3908). In contrast, the occurrence of atelectasis was significantly higher in the control group at 24.1% (95% CI, 18.20 to 30.07) compared with 14.2% (95% CI, 9.38 to 19.05) in the treatment group ( P  = 0.0110). At 48 h, the incidence of reintubation was significantly lower in the CPAP group 2.94% (95% CI, 0.60 to 5.28) compared with the control group, 7.39% (95% CI, 3.76 to 11.02), P  = 0.0425. No significant differences in pneumonia, sepsis or mortality were observed. CPAP significantly improved oxygenation ( P  < 0.0001).</p><p><strong>Conclusion: </strong>CPAP did not significantly reduce 28-day reintubation rates compared with oxygen therapy via Venturi mask. However, CPAP was associated with a significant reduction in atelectasis and early reintubation at 48 h. Further research is warranted to confirm these findings and compare CPAP with other noninvasive support strategies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01726140.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"958-965"},"PeriodicalIF":6.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505233","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}