European Journal of Anaesthesiology最新文献

{"title":"Subcostal transversus abdominis plane block for epigastric cardiac pacemaker operation: A randomised controlled trial.","authors":"Jin-Tae Kim, Jooncheol Min, Jung-Bin Park, Young-Eun Jang","doi":"10.1097/EJA.0000000000002092","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002092","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497445","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":"Metabolic acidosis in patients with diabetes 2 undergoing cardiac surgery: The impact of SGLT2 inhibitor use: a retrospective cohort study.","authors":"Hege K Brekke, Gunhild Holmaas, Marianne C Astor, Egil Steien, Rune Haaverstad, Fatemeh Z Ghavidel, Marit Farstad","doi":"10.1097/EJA.0000000000002090","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002090","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2-i) lower blood sugar and reduce cardiovascular events and kidney failure. However, there have been increasing reports of euglycaemic diabetic ketoacidosis (eDKA) linked to SGLT2-i medicines.</p><p><strong>Objective: </strong>Investigating the association between SGLT2-i use and the incidence of metabolic acidosis in patients with type 2 diabetes undergoing cardiac surgery.</p><p><strong>Design: </strong>A retrospective observational cohort study comprising 121 patients, with 38 in the SGLT2-i group and 83 in the control group.</p><p><strong>Setting: </strong>A 2-year period at Haukeland University Hospital, a tertiary regional hospital in Western Norway.</p><p><strong>Patients: </strong>Patients with type 2 diabetes undergoing cardiac surgery.</p><p><strong>Interventions: </strong>Collection of clinical and laboratory data, including acid/base balance parameters, surgery details and SGLT2-i use.</p><p><strong>Main outcome measures: </strong>Base excess and anion gap measurements as indicators of ketosis development. A subgroup analysis in patients without renal failure (glomerular filtration rate > 60 ml min-1 m-2).</p><p><strong>Results: </strong>Lower base excess levels and increased anion gaps were observed in the SGLT2-i group compared with controls at various time points postoperatively, with no significant differences in serum lactate levels.Twelve hours postoperatively, 41% of SGLT2-i patients without renal failure had a base excess -3 mmol l-1 or less after correction for serum lactate (indicating ketosis) compared with only 8% in the control group (P < 0.001). The anion gap was elevated in the SGLT2-i group compared to the control group at 12 h postoperatively (P = 0.018).Multivariable regression analysis identified SGLT2-i use as an independent factor associated with a lower base excess after correction for lactate levels (P < 0.001). Cessation of SGLT2-i medication did not correlate with the degree of acidosis.</p><p><strong>Conclusion: </strong>While taking SGLT2 inhibitors, diabetic patients undergoing heart surgery are at an increased risk of ketosis and possibly metabolic acidosis. This emphasises the importance of careful observation and effective treatment strategies within this group.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497443","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":"Is there a benefit of intravenous lidocaine during liver surgery?: A propensity-score weighting analysis.","authors":"Florianne Le Goulven, Alexandre Mansour, Helene Beloeil, Pauline Rouxel","doi":"10.1097/EJA.0000000000002088","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002088","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497442","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":"Midclavicle block: An anatomical study.","authors":"Hipólito Labandeyra, Luis F Váldes-Vilches, Alberto Prats-Galino, Xavier Sala-Blanch","doi":"10.1097/EJA.0000000000002079","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002079","url":null,"abstract":"<p><strong>Background: </strong>Recent studies indicate that clavipectoral fascia plane block (CPB) efficacy may stem from injectate distribution to the anterosuperior clavicular periosteum. We conducted an anatomical study combining the CPB with injection within the subclavius muscle.</p><p><strong>Objective: </strong>Our hypothesis was that the anaesthetic injectate would fully cover both the anterosuperior and posteroinferior surfaces of the clavicular periosteum in the midclavicular region.</p><p><strong>Design: </strong>Observational human cadaver study.</p><p><strong>Setting: </strong>Laboratory of Surgical Neuroanatomy, Unit of Anatomy and Human Embryology of the Faculty of Medicine and Health Sciences, University of Barcelona.</p><p><strong>Participants: </strong>Five fresh human cadavers.</p><p><strong>Interventions: </strong>The cadavers received both a CPB and subclavius muscle injections under ultrasound guidance in 10 clavicular regions.</p><p><strong>Main outcome measures: </strong>After the procedures on the cadaveric models, an anatomical dissection by planes was performed to evaluate the distribution pattern of methylene blue on the clavicular periosteum. A probabilistic map of the colour spectrum and staining temperature on the clavicular surfaces was generated.</p><p><strong>Results: </strong>Methylene blue stained 37 ± 16% of the anterosuperior surface and 23 ± 13% of the posteroinferior surface of the clavicular periosteum, particularly in the middle third of each surface. Although the staining did not achieve complete circumferential coverage or perfect alignment between the surfaces, the areas exhibited a close relationship, indicating significant distribution and relevant coverage.</p><p><strong>Conclusion: </strong>Our anatomical study demonstrates that the midclavicular block achieves effective distribution around the middle third of the clavicle, although complete circumferential anaesthesia of the clavicular periosteum was not achieved. Although this block may provide periosteal and bone anaesthesia, it does not address other sources of pain, such as muscle spasms and skin components. Additional clinical studies are needed to evaluate the overall efficacy of this dual block technique for clavicle surgery.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497444","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":"Interrelation between anaesthesiology and intensive care medicine training in Europe: An ESAIC National Anaesthesiologists Societies Committee survey.","authors":"Argyro Zoumprouli, Alessandro Scudellari, Federico Bilotta","doi":"10.1097/EJA.0000000000002094","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002094","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497441","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":"A comparison between invasive and noninvasive measurement of the Hypotension Prediction Index: A post hoc analysis of a prospective cohort study.","authors":"Santino R Rellum, Eline Kho, Jimmy Schenk, Björn J P van der Ster, Alexander P J Vlaar, Denise P Veelo","doi":"10.1097/EJA.0000000000002082","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002082","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials and validation studies demonstrate promising hypotension prediction capability by the Hypotension Prediction Index (HPI). Most studies that evaluate HPI derive it from invasive blood pressure readings, but a direct comparison with the noninvasive alternative remains undetermined. Such a comparison could provide valuable insights for clinicians in deciding between invasive and noninvasive monitoring strategies.</p><p><strong>Objectives: </strong>Evaluating predictive differences between HPI when obtained through noninvasive versus invasive blood pressure monitoring.</p><p><strong>Design: </strong>Post hoc analysis of a prospective observational study conducted between 2018 and 2020.</p><p><strong>Setting: </strong>Single-centre study conducted in an academic hospital in the Netherlands.</p><p><strong>Patients: </strong>Adult noncardiac surgery patients scheduled for over 2 h long elective procedures. After obtaining informed consent, 91 out of the 105 patients had sufficient data for analysis.</p><p><strong>Main outcome measures: </strong>The primary outcome was the difference in area under the receiver-operating characteristics (ROC) curve (AUC) obtained for HPI predictions between the two datasets. Additionally, difference in time-to-event estimations were calculated.</p><p><strong>Results: </strong>AUC (95% confidence interval (CI)) results revealed a nonsignificant difference between invasive and noninvasive HPI, with areas of 94.2% (90.5 to 96.8) and 95.3% (90.4 to 98.2), respectively with an estimated difference of 1.1 (-3.9 to 6.1)%; P = 0.673. However, noninvasive HPI demonstrated significantly longer time-to-event estimations for higher HPI values.</p><p><strong>Conclusion: </strong>Noninvasive HPI is reliably accessible to clinicians during noncardiac surgery, showing comparable accuracy in HPI probabilities and the potential for additional response time.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT03795831) on 10 January 2019. https://clinicaltrials.gov/study/NCT03795831.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460959","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":"Quality of recovery after major noncardiac surgery in a high-acuity postoperative unit: A prospective validation study to evaluate the QoR-15GE during advanced recovery room care.","authors":"Lili Plümer, Eva Jung, Linda Krause, Marlene Fischer","doi":"10.1097/EJA.0000000000002036","DOIUrl":"10.1097/EJA.0000000000002036","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733766","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":"Diaphragm-sparing efficacy of subparaneural upper trunk block for arthroscopic shoulder surgery: A randomised controlled trial.","authors":"Yumin Jo, Chahyun Oh, Woo-Yong Lee, Donggeun Lee, Suyeon Shin, Woosuk Chung, Chaeseong Lim, Sun Yeul Lee, Boohwi Hong","doi":"10.1097/EJA.0000000000002034","DOIUrl":"10.1097/EJA.0000000000002034","url":null,"abstract":"<p><strong>Background: </strong>Inter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level.</p><p><strong>Objective: </strong>We hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>A tertiary teaching hospital.</p><p><strong>Patients: </strong>Seventy patients aged 20 to 80 years undergoing arthroscopic rotator cuff repair.</p><p><strong>Intervention: </strong>Ultrasound-guided ISB or UTB was performed with 5 ml 0.75% ropivacaine.</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes.</p><p><strong>Results: </strong>The UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P  < 0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1 h postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, -1; 95% CI, -2 to 0.5). No significant difference was observed in any other secondary outcomes.</p><p><strong>Conclusion: </strong>UTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery.</p><p><strong>Trial registration: </strong>Clinical Trial Registry of Korea ( https://cris.nih.go.kr ) identifier: KCT0007002.</p><p><strong>Irb number: </strong>Chungnam National University Hospital Institutional Review Board No. 2021-12-069.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497463","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":"Ultrasound-guided transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section: A randomised clinical trial.","authors":"Ahmet Pinarbaşi, Başak Altiparmak, Melike Korkmaz Toker, Fatih Pirinççi, Bakiye Uğur","doi":"10.1097/EJA.0000000000002041","DOIUrl":"10.1097/EJA.0000000000002041","url":null,"abstract":"<p><strong>Background: </strong>Caesarean section is a widely performed surgical procedure that often results in moderate-to-severe postoperative pain. If left untreated, this pain can lead to short-term and long-term consequences. Transversalis fascia plane (TFP) block and transversus abdominis plane (TAP) block are among the regional anaesthesia techniques employed for managing pain after a caesarean section.</p><p><strong>Objective: </strong>We aimed to compare the impact of these two blocks on the quality of recovery in patients undergoing elective caesarean section under spinal anaesthesia.</p><p><strong>Design: </strong>A single-centre, double-blind, randomised trial.</p><p><strong>Settings: </strong>Operating room, postanaesthesia recovery unit, and ward in a tertiary hospital.</p><p><strong>Participants: </strong>Ninety-three patients (ASA 2 to 3) were recruited. After exclusion, 79 patients were included in the final analysis: 40 in the TFP block group and 39 in the TAP block group.</p><p><strong>Interventions: </strong>After surgery, participants received either TFP block (20 ml 0.25% bupivacaine for each side) or TAP block (20 ml 0.25% bupivacaine for each side).</p><p><strong>Main outcome measures: </strong>The primary outcome was the difference in obstetric quality of recovery 11-Turkish (ObsQoR-11T) scores between groups. Secondary outcomes included pain scores, opioid consumption and incidence of opioid-related complications.</p><p><strong>Results: </strong>The mean ObsQoR-11T score was higher in the TFP block group compared with the TAP block group (97.13 ± 6.67 points vs. 87.10 ± 9.84 points, respectively; P  < 0.001). The pain scores in the TFP block group were slightly lower between postoperative 4 and 24 h. The mean total morphine consumption was 15.08 ± 2.21 mg in the TFP block group and 22.21 ± 3.04 mg in the TAP block group ( P  < 0.001). More patients required rescue analgesia between 4 and 8 h in the TAP block group [2.00 (5.00%) vs. 9.00 (23.08%), P  = 0.02]. No significant differences were observed between groups in terms of opioid-related side effects.</p><p><strong>Conclusion: </strong>TFP block used for analgesic purposes yielded a better quality recovery period than TAP block and also reduced opioid consumption.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT05999981).</p><p><strong>Visual abstract: </strong>http://links.lww.com/EJA/B6 .</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747760","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":"Remimazolam vs. propofol for general anaesthesia in elderly patients: a meta-analysis with trial sequential analysis.","authors":"Eduardo Maia Pereira, Vitor Ryuiti Moraes, Mariana Gaya da Costa, Tatiana Souza do Nascimento, Eric Slawka, Carlos Galhardo Júnior, Michel Mrf Struys","doi":"10.1097/EJA.0000000000002042","DOIUrl":"10.1097/EJA.0000000000002042","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients comprise an increasing proportion of patients undergoing surgery, and they require special attention due to age-related physiological changes. Propofol is the traditional agent for anaesthesia, and recently, remimazolam, a novel ultra-short-acting benzodiazepine, has emerged as an alternative to propofol in general anaesthesia.</p><p><strong>Objectives: </strong>We aim to compare remimazolam vs . propofol for general anaesthesia in elderly patients regarding hypotension, induction characteristics, haemodynamics and recovery outcomes.</p><p><strong>Design: </strong>Meta-analysis with sensitivity and trial sequential analyses (TSA) to assess inconsistencies. Risk ratios and mean differences with 95% confidence intervals (95% CIs) were computed using a random effects model. Subgroups and meta-regression according to anaesthesia methods were also performed.</p><p><strong>Data sources: </strong>We systematically searched MEDLINE, Embase and Cochrane for randomised controlled trials (RCTs) up to January 1, 2024.</p><p><strong>Eligibility criteria: </strong>Patients at least 60 years old, comparing remimazolam vs . propofol for general anaesthesia.</p><p><strong>Results: </strong>Eleven RCTs (947 patients) were included. Compared with propofol, remimazolam was associated with lower postinduction and intra-operative hypotension (RR 0.41, 95% CI 0.27 to 0.62, P  < 0.001) and incidence of bradycardia (risk ratio 0.58, 95% CI 0.34 to 0.98, P  = 0.04), with a higher heart rate ( P  = 0.01). The incidence of injection pain was lower ( P  < 0.001), but remimazolam was associated with a longer time to loss of consciousness ( P  < 0.001) and a higher bispectral index at loss of consciousness ( P  = 0.04). No differences were found for mean arterial pressure, emergence time, extubation time and incidence of emergence agitation. The TSA was consistent and achieved the required information size for hypotension.</p><p><strong>Conclusions: </strong>Remimazolam significantly reduced the risk of hypotension, bradycardia and injection pain, despite an increase in the time to loss of consciousness. Remimazolam appears to be an effective and well tolerated alternative to propofol in elderly patients undergoing general anaesthesia.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787619","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}