European Journal of Anaesthesiology最新文献

{"title":"The implementation of intrathecal morphine for caesarean delivery into clinical practice, and assessment of its impact on patient-reported quality of recovery using the ObsQoR-10-Dutch scale: A single-centre cohort study.","authors":"Oscar F C van den Bosch, Mienke Rijsdijk, Suzanne E Rosier, Lottie van Baal, Timme P Schaap, Pervez Sultan, Wolfgang Bühre","doi":"10.1097/EJA.0000000000002127","DOIUrl":"10.1097/EJA.0000000000002127","url":null,"abstract":"<p><strong>Background: </strong>Optimising a mother's quality of recovery following caesarean delivery is of paramount importance as it facilitates maternal care of the newborn and affects physical, psychological and emotional well being. Intrathecal morphine (ITM) reduces postoperative pain and may improve quality of recovery: however its widespread use is limited.</p><p><strong>Objective: </strong>To assess the effects of implementing ITM for caesarean delivery on postoperative quality of recovery.</p><p><strong>Study design: </strong>Single-centre observational before-after study.</p><p><strong>Setting: </strong>Tertiary university hospital, the Netherlands, January 2023 until April 2024.</p><p><strong>Study population: </strong>Patients who underwent caesarean delivery under spinal anaesthesia.</p><p><strong>Intervention: </strong>Patients recruited before implementation of ITM ( n  = 55) received patient-controlled intravenous analgesia with morphine or continuation of epidural analgesia previously used for labour ('pre-ITM group'). Patients recruited after implementation of ITM ( n  = 47) received ITM 100 μg and oral morphine tablets 10 mg as needed ('ITM group').</p><p><strong>Outcomes: </strong>Primary outcome was the score on the Obstetric Quality of Recovery (ObsQoR-10-Dutch) questionnaire (0 to 100). Secondary outcomes included ObsQoR-10 subscores, length of stay, opioid consumption and self-reported general health score (0 to 100).</p><p><strong>Results: </strong>Protocol adherence for ITM was 98%. Quality of recovery improved significantly [ObsQoR-10 scores pre-ITM 65 ± 16 vs. ITM 74 ± 13 points, mean difference 9.0 (95% CI, 3.1 to 15] points, P  = 0.002], with improvement in pain scores, physical comfort, independence and psychological wellbeing. In multivariate analysis, the improvement was 6.3 (95% CI, 0.37 to 12.2] points, which was statistically significant but did not reach the predefined threshold for clinical relevance. There was, however, an improvement in self-reported general health score (57 ± 18 vs. 68 ± 17, P  = 0.002), median [IQR] length of hospital stay (41 [36 to 51] vs. 37 [32 to 49] h, P  = 0.032) and median [IQR] opioid consumption (52 [35 to 73] vs. 0 [0 to 0] mg, P  < 0.001).</p><p><strong>Conclusions: </strong>Implementing ITM for caesarean delivery resulted in moderate improvements in obstetric recovery and reduced opioid consumption. Cautious interpretation is warranted given the nonrandomised design of this implementation study. Our findings support the use of ITM in a multimodal analgesia strategy for patients undergoing caesarean delivery.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"332-339"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064702","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":"Sphenopalatine ganglion block for postoperative analgesia after transsphenoidal hypophysectomy: A pilot study.","authors":"Brynner Mota Buçard, Alexandra Rezende Assad, Nubia Verçosa, Ismar L Cavalcanti","doi":"10.1097/EJA.0000000000002112","DOIUrl":"10.1097/EJA.0000000000002112","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"368-370"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947003","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":"Portal vein pulsatility is associated with the cumulative fluid balance: A post hoc longitudinal analysis of a prospective, general intensive care unit cohort.","authors":"Stefan Andrei, Dan Longrois, Maxime Nguyen, Belaid Bouhemad, Pierre-Gregoire Guinot","doi":"10.1097/EJA.0000000000002111","DOIUrl":"10.1097/EJA.0000000000002111","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have explored tools for evaluating the effects of positive fluid balance, with recent emphasis, and controversies, on venous ultrasound parameters and composite scores. The portal vein pulsatility index and the renal venous pattern have emerged as the most promising indicators of volume-induced venous congestion. But in the general intensive care unit (ICU), numerous factors influence cardiovascular homeostasis, affecting venous function.</p><p><strong>Objectives: </strong>This study aimed to evaluate the factors associated with portal vein pulsatility index in general ICU patients. Secondary objectives were to examine the correlations between pulsatility index and additional markers of congestion.</p><p><strong>Design: </strong>This exploratory study was a post hoc analysis of a prospective, multicentric, observational database.</p><p><strong>Setting: </strong>The data collection was performed in four ICUs in university-affiliated or tertiary hospitals.</p><p><strong>Patients: </strong>This study included adult patients within 24 h of general ICU admission with an expected ICU length of stay of more than 2 days.</p><p><strong>Intervention: </strong>Patients underwent clinical, biological, and echocardiographic assessments at several times: ICU admission, day 1, day 2, day 5 and the last day of ICU.</p><p><strong>Main outcome measure: </strong>The study primary endpoint was the portal vein pulsatility index during the course of the patients' stay on the ICU.</p><p><strong>Results: </strong>One hundred forty-five patients and 514 haemodynamic evaluations were analysed. The mean age of the patients was 64 ± 15 years, 41% were women, with a median [IQR] admission simplified acute physiology score II of 46 [37 to 59]. The univariable followed by multivariable mixed-effects linear regression analyses demonstrated an association between portal vein pulsatility index, heart rate [estimate -0.002 (95% CI, -0.003 to -0.001), P  < 0.001] and the cumulative fluid balance [estimate 0.0007 (95% CI, 0.00007 to 0.001), P  = 0.024]. Portal vein pulsatility index showed no agreement with CVP of at least 12 mmHg (kappa correlation -0.008, P  = 0.811), negative passive leg raising (kappa correlation -0.036, P  = 0.430), mean inferior vena caval (IVC) diameter greater than 2 cm (kappa correlation -0.090, P  = 0.025), maximal IVC diameter greater than 2 cm (kappa correlation -0.010, P  = 0.835), hepatic vein systolic/diastolic ratio less than 1 (kappa correlation 0.043, P  = 0.276), or renal vein pulsatile pattern (kappa correlation -0.243, P  < 0.001).</p><p><strong>Conclusion: </strong>The study findings emphasise the unique sensitivity of portal vein pulsatility index in assessing fluid balance in general ICU patients. The lack of correlation between portal vein pulsatility index and other parameters of venous congestion underscores its potential to provide distinctive insights into venous congestion.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"324-331"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834825","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 for procedural sedation: A systematic review with meta-analyses and trial sequential analyses.","authors":"Lasse Pingel, Mathias Maagaard, Casper D Tvarnø, Sandra Sorenson, Shaheer Bukhari, Lars Peter Kloster Andersen, Jakob Hessel Andersen, Ole Mathiesen","doi":"10.1097/EJA.0000000000002126","DOIUrl":"10.1097/EJA.0000000000002126","url":null,"abstract":"<p><strong>Background: </strong>Midazolam and propofol are frequently used for procedural sedation. Remimazolam may provide a more controllable sedation with fewer adverse effects.</p><p><strong>Objective: </strong>To assess the sedation success rate and respiratory and cardiovascular complications of remimazolam versus placebo and other sedatives in adults undergoing procedural sedation.</p><p><strong>Design: </strong>A systematic review of randomised controlled trials (RCTs) with meta-analyses, trial sequential analyses (TSA), and GRADE evaluations of the certainty of evidence.</p><p><strong>Data sources: </strong>We searched Medline, Embase, CENTRAL, BIOSIS, CINAHL, and Web of Science Core Collection from their inception to 22 June 2024.</p><p><strong>Eligibility criteria: </strong>RCTs allocating participants undergoing procedural sedation to remimazolam versus placebo or any active comparator.</p><p><strong>Results: </strong>We included 63 trials randomising 13 953 participants. All included trial results were judged to be at high risk of bias. The sedation success rate was similar with remimazolam versus active comparators, relative risk (RR) 1.04, [97.5% confidence interval (CI), 0.96 to 1.14; TSA-adjusted CI, 0.95 to 1.18], P   =  0.26, GRADE: very low. Subgroup analyses indicated that remimazolam versus midazolam increased sedation success rate, while the risks were similar with remimazolam versus comparators. Remimazolam versus active comparators decreased the risk of respiratory complications, RR 0.47, (97.5% CI, 0.36 to 0.61; TSA-adjusted CI, 0.35 to 0.61), P  < 0.01; and cardiovascular complications, RR 0.46, (97.5% CI, 0.37 to 0.56; TSA-adjusted CI, 0.38 to 0.57), P  < 0.01. Subgroup analyses indicated that remimazolam versus propofol reduced respiratory and cardiovascular complications, while the risks were similar versus midazolam.</p><p><strong>Conclusion: </strong>Remimazolam seems to provide a similar sedation success rate as other active comparators (propofol, ciprofol, midazolam, dexmedetomidine, etomidate), although subgroup analyses indicated that remimazolam increased sedation success rate compared to midazolam. Remimazolam compared to propofol may decrease the risk of respiratory and cardiovascular complications. The certainty of the evidence was very low to low, and firm conclusions could not be drawn.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"298-312"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188592","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 impact of psychophysiological well being on executive functions among anaesthesia residents.","authors":"Annalisa Boscolo, Luca Queirolo, Paolo Navalesi","doi":"10.1097/EJA.0000000000002106","DOIUrl":"10.1097/EJA.0000000000002106","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"366-368"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738922","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":"Risk of myocardial injury in mean arterial pressure or cardiac index guided intra-operative haemodynamic management.","authors":"Ajay Kumar Jha, Nivedita Jha","doi":"10.1097/EJA.0000000000002119","DOIUrl":"10.1097/EJA.0000000000002119","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 4","pages":"373-374"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536828","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":"Reply to: the risks we miss.","authors":"Luciana Cadore Stefani, Paulo Correa da Silva Neto, Clarissa Mendanha","doi":"10.1097/EJA.0000000000002134","DOIUrl":"10.1097/EJA.0000000000002134","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 4","pages":"379-380"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536798","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":"Lung ultrasound on first postoperative day predicts out-of-hospital pulmonary complications following video-assisted thoracic surgery: A prospective cohort study.","authors":"ZiYun Lu, Hang Sun, Shujie Niu, Min Wang, Yiwei Zhong, Bingbing Li","doi":"10.1097/EJA.0000000000002113","DOIUrl":"10.1097/EJA.0000000000002113","url":null,"abstract":"<p><strong>Background: </strong>The integration of enhanced recovery after surgery (ERAS) protocols into the peri-operative management of video-assisted thoracic surgery (VATS) has facilitated rapid patient recovery, enabling discharge within 48 h. However, postoperative pulmonary complications (PPCs) postdischarge pose significant concerns for patient welfare. Despite the established utility of lung ultrasound (LUS) in diagnosing the causes of dyspnoea, the effectiveness of quantitative LUS in predicting PPCs after VATS remains uncertain.</p><p><strong>Objectives: </strong>To determine whether quantitative LUS performed 24 h after surgery can identify patients with a higher risk of developing PPCs within 30 days after discharge from hospital.</p><p><strong>Design: </strong>Single-centre prospective cohort study.</p><p><strong>Setting: </strong>Academic tertiary care medical centre.</p><p><strong>Patients: </strong>Adults scheduled for elective VATS under general anaesthesia from November 2022 to January 2023.</p><p><strong>Main outcome measures: </strong>This primary aim was to verify the association between lung ultrasound score (LUSS) on postoperative day 1 (POD1) and PPCs. The secondary aim was to identify other relevant peri-operative factors closely related to PPCs and establish a model capable of predicting the risk of PPCs in patients undergoing fast-track VATS.</p><p><strong>Results: </strong>Of the 200 recruited patients, 182 completed the LUS examination and 30-day follow-up. Of these, 66 (36.2%) developed various types of PPCs. These patients had a higher LUSS on POD 1 ( P  < 0.001), and more subpleural consolidation areas compared to those without PPCs ( P  < 0.001). Receiver-operating characteristics (ROC) analysis identified the optimal LUSS cut-off value at 6 points for predicting the occurrence of PPCs, with an area under the curve (AUC) of 0.838 (95% CI, 0.768 to 0.909). Patients with PPCs had higher rates of immune system diseases and ARISCAT score, longer hospital stay and procalcitonin levels, increased frequency of lobar resection, longer durations of surgical and mechanical ventilation, and greater incidence of unplanned hospital readmissions within 30 days postdischarge, compared with those without PPCs (all P  < 0.001). Multivariable logistic regression analysis indicated that the comorbidity of immune system disease, along with postoperative 24 h LUSS, were independent risk factor for PPCs within 30 days after VATS.</p><p><strong>Conclusion: </strong>LUSS on POD 1 emerged as an independent risk factor for PPCs in fast-track VATS patients and reliably predicted the occurrence of PPCs within 30 days of hospital discharge.</p><p><strong>Trial registration: </strong>ClinicalTrials. gov No. ChiCTR2200065865.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"347-356"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853479","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":"Win Ratio approach for the composite outcome of postoperative pulmonary complications: Secondary analysis of a harmonised and pooled database of three randomised clinical trials.","authors":"Ary Serpa Neto, Niklas S Campos, Thomas Bluth, Sabrine N T Hemmes, Carlos Ferrando, Julian Librero, Marina Soro, Lorenzo Ball, Guido Mazzinari, Marcelo Gama de Abreu, Marcus J Schultz","doi":"10.1097/EJA.0000000000002116","DOIUrl":"10.1097/EJA.0000000000002116","url":null,"abstract":"<p><strong>Background: </strong>The win ratio analysis method might provide new insight on the impact of positive end-expiratory pressure (PEEP) on clinical outcomes.</p><p><strong>Objective: </strong>The aim is to re-analyse the results of the 'Re-evaluation of the effects of high PEEP with recruitment manoeuvres vs. low PEEP without recruitment manoeuvres during general anaesthesia for surgery' (REPEAT) study using the win ratio analysis.</p><p><strong>Design: </strong>Individual patient data meta-analysis.</p><p><strong>Setting: </strong>Three international multicentre randomised trials.</p><p><strong>Participants: </strong>Patients undergoing general anaesthesia for surgery.</p><p><strong>Intervention: </strong>High vs. low PEEP.</p><p><strong>Main outcome measure: </strong>Hierarchical composite endpoint of: all-cause hospital mortality; hospital length of stay; need for postoperative mechanical ventilation; severe pulmonary complications; and mild pulmonary complications.</p><p><strong>Results: </strong>A total of 3774 patients undergoing general anaesthesia for surgery were included in this analysis. The median (interquartile range [IQR]) age was 57 [45 to 68] years and 2077 (55%) were women. A total of 3 560 720 comparison pairs were produced. The high PEEP group had a higher percentage of losses than wins in hospital mortality (1.1 vs. 0.9%) and hospital length of stay (33.8 vs. 33.2%), comparable percentages of losses and wins in postoperative invasive mechanical ventilation (0.2 vs. 0.2%), a higher percentage of wins in severe complications (2.5 vs. 2.1%) and a higher percentage of ties in mild complications (18.7 vs. 3.9% wins vs. 3.3% losses). The win ratio for high PEEP compared with low PEEP group was 1.00 (95% CI 0.92 to 1.09).</p><p><strong>Conclusion: </strong>No beneficial effects of high PEEP compared with low PEEP were found in this win ratio analysis.</p><p><strong>Registration: </strong>Clinicaltrials.gov (study identifier NCT03937375).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"340-346"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853537","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":"Preoperative assessment of adults undergoing elective non-cardiac surgery: A response.","authors":"Emma Murphy","doi":"10.1097/EJA.0000000000002131","DOIUrl":"10.1097/EJA.0000000000002131","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 4","pages":"381-382"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536712","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}