European Journal of Anaesthesiology最新文献

{"title":"Ultrasonographic assessment of sugammadex-enhanced early recovery of diaphragmatic function in children: A randomised double-blind controlled trial.","authors":"Jung-Bin Park, Tae-Won Kim, Sang-Hwan Ji, Young-Eun Jang, Eun-Hee Kim, Jin-Tae Kim, Hee-Soo Kim, Ji-Hyun Lee","doi":"10.1097/EJA.0000000000002231","DOIUrl":"10.1097/EJA.0000000000002231","url":null,"abstract":"<p><strong>Background: </strong>In adults, sugammadex promotes faster neuromuscular recovery compared with neostigmine; however, its impact on diaphragmatic recovery and atelectasis in children remains unelucidated.</p><p><strong>Objectives: </strong>We compared the effects of sugammadex and neostigmine on restoration of diaphragmatic function and postoperative atelectasis in paediatric patients.</p><p><strong>Design: </strong>A prospective randomised controlled study.</p><p><strong>Setting: </strong>Seoul National University Children's Hospital, Seoul, Republic of Korea.</p><p><strong>Patients: </strong>A total of 73 children aged 2 to 7 years were randomised to receive either sugammadex (2 mg kg -1 , n  = 36) or neostigmine (0.02 mg kg -1 , n  = 37) for neuromuscular blockade reversal when the train-of-four count reached 4 (train-of-four ratio < 0.9).</p><p><strong>Main outcome measures: </strong>The diaphragmatic excursion (DE) and thickening fraction (TF) were measured by ultrasound at three timepoints: baseline (T0), before postanaesthesia care unit (PACU) admission (T1) and 30 min after PACU admission (T2). Atelectasis was assessed via lung ultrasonography at T1 and T2. The primary outcome was the diaphragmatic excursion ratio at T1 (DE T1 /DE T0 ), and secondary outcomes included the DE T2 /DE T0 , TF T1 /TF T0 , TF T2 /TF T0 atelectasis score and incidence of significant atelectasis.</p><p><strong>Results: </strong>At T1, the DE T1 /DE T0 was significantly higher in the sugammadex group (neostigmine vs. sugammadex group, 0.91 ± 0.19 vs. 1.02 ± 0.24; P  = 0.034) as was the TF T1 /TF T0 (0.93 ± 0.39 vs. 1.15 ± 0.49; P  = 0.041). No significant intergroup differences were found in the DE T2 /DE T0 and TF T2 /TF T0 . The atelectasis score and incidence of significant atelectasis were comparable between the groups.</p><p><strong>Conclusions: </strong>Compared to neostigmine, sugammadex accelerates diaphragmatic recovery immediately after extubation; however, this early recovery does not significantly reduce the incidence of postoperative atelectasis.</p><p><strong>Trial registration number: </strong>NCT05724550.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"907-915"},"PeriodicalIF":6.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583423","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":"Regional anaesthesia-related complications in Switzerland: Lessons learned from the national closed claims analysis over the past 30 years.","authors":"Michael Thomas Ganter, Thierry Girard, Vincent A Stadelmann, Benno Rehberg-Klug, Sven Staender, Christoph Karl Hofer","doi":"10.1097/EJA.0000000000002220","DOIUrl":"10.1097/EJA.0000000000002220","url":null,"abstract":"<p><strong>Background: </strong>Regional anaesthesia is widely used in clinical practice, offering significant benefits but carrying risks such as nerve damage and other complications. Understanding medicolegal trends associated with regional anaesthesia is essential for improving patient safety and refining practices.</p><p><strong>Objectives: </strong>To analyse closed claims related to regional anaesthesia in Switzerland over the past 30 years, identify trends in complications and assess their medicolegal implications.</p><p><strong>Design: </strong>Retrospective analysis of the Swiss Anaesthesiology Closed Claims Analysis database, focusing on cases involving regional anaesthesia from 1992 to 2022.</p><p><strong>Setting: </strong>The study was conducted using data from Swiss medical malpractice insurers and the Swiss Society of Anaesthesiology and Perioperative Medicine together with their Foundation for Patient Safety in Anaesthesia.</p><p><strong>Patients: </strong>A total of 244 closed claims of patients were reviewed, of which 140 cases involved regional anaesthesia.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcome measures: </strong>Key measures included patient demographics, type of anaesthesia, complications, adherence to best practices and legal outcomes such as liability acceptance and compensation amounts.</p><p><strong>Results: </strong>The number of claims involving regional anaesthesia decreased significantly over three decades, from 69 (49%) in the first decade to 30 (21%) in the last. Nerve damage was the most common complication (76%), with a notable reduction in permanent injuries from 57 to 28%. Advances in ultrasound-guided techniques and improved documentation may have contributed to these trends. Male patients tended to have higher rates of nerve injuries, while female patients reported more nonspecific pain syndromes and posttraumatic stress disorders because of the health impairment associated with the liability case. Liability was accepted in 43% of cases, with compensation often exceeding CHF 100 000. The highest compensations seemed to have been paid to male patients.</p><p><strong>Conclusions: </strong>The decline in claims may reflect advancements in anaesthetic techniques and safety practices. This study underscores the importance of communication and training best practices in regional anaesthesia, including sufficient patient information and documentation to enhance patient safety and reduce medicolegal risks. Pain during performance, multiple attempts and re-injections should be avoided whenever possible.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"924-933"},"PeriodicalIF":6.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224791","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":"Postmarketing safety analysis of remimazolam: Identifying unlabelled serious events.","authors":"Weiying Ma, Rong Zhang, Fan Liu, Minghui Cao, Haoquan Huang","doi":"10.1097/EJA.0000000000002217","DOIUrl":"10.1097/EJA.0000000000002217","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a new ultra-short-acting benzodiazepine used in anaesthesia, valued for its rapid metabolism and reversibility. Despite its growing clinical use, a comprehensive assessment of its real-world safety profile remains essential.</p><p><strong>Objective: </strong>To evaluate the postmarketing safety of remimazolam using adverse event (AE) data from the US and Japanese pharmacovigilance databases.</p><p><strong>Design: </strong>Retrospective analysis of AEs associated with remimazolam using disproportionality analysis techniques.</p><p><strong>Setting: </strong>FDA Adverse Event Reporting System (FAERS) and Japanese Adverse Drug Event Report database (JADER) from January 2020 to December 2023.</p><p><strong>Participants: </strong>Patients who experienced remimazolam-related AEs reported in the FAERS and JADER databases.</p><p><strong>Main outcome measures: </strong>Identification of significant AEs using reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network and multiitem gamma Poisson shrinker. Categorisation of AEs using the 'Important Medical Event Terms List' (IME) list (version 26.1).</p><p><strong>Results: </strong>We identified 199 remimazolam-related reports (69 from FAERS, 130 from JADER) revealing 20 significant AEs. Key findings include previously unlabelled serious AEs such as cardiac, cardio-respiratory, and respiratory arrests; nine events classified as Important Medical Events, including hypotension and anaphylaxis; four AEs not included in current Food and Drug Administration (FDA) labelling; and low-frequency but clinically significant off-label events including arrhythmias and postoperative delirium.</p><p><strong>Conclusions: </strong>While remimazolam shows a generally acceptable safety profile, our pharmacovigilance analysis identified serious unlabelled reactions requiring clinical vigilance. Practice recommendations include judicious administration with balanced crystalloids and comprehensive cardiorespiratory monitoring. Future research should address prospective surveillance of rare serious events, optimal administration protocols to prevent vascular occlusions and investigation of anaphylactic reactions.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"934-944"},"PeriodicalIF":6.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474396","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":"Hypnotic and antinociceptive contribution of magnesium sulphate during balanced total intravenous anaesthesia in total thyroidectomy: A randomised double-blind clinical trial.","authors":"Florian Beck, Vincent L Bonhomme, Pierre-Yves Hardy, Abdourahamane Kaba, Michele Carella","doi":"10.1097/EJA.0000000000002216","DOIUrl":"10.1097/EJA.0000000000002216","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"948-950"},"PeriodicalIF":6.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233602","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":"Guidelines on strategies for the universal implementation of videolaryngoscopy.","authors":"Manuel Á Gómez-Ríos, André A J Van Zundert, Alistair F McNarry, J Adam Law, Andy Higgs, Audrey De Jong, Samir Jaber, Kunal Karamchandani, Jan Hansel, Kemal Tolga Saracoglu, Robert Leach, Helio Penna Guimaraes, Alfredo Abad-Gurumeta, David Gómez-Ríos, Pavel Michalek, Lauren C Berkow, Miguel Á Fernández-Vaquero, Alfredo Serrano-Moraza, Luis Gaitini, Sonia Vaida, Mostafa Somri, Tomasz Gaszyński, David Brewster, Neel Desai, Ayten Saracoglu, Samuel Ern Hung Tsan, Vassilis Athanassoglou, Nobuyasu Komasawa, Rakesh Garg, Faisal Shamim, Rajkumar Rajendram, Uxía Gutierrez-Couto, Teresa López, Nekari De Luis-Cabezón, Daniel Tevar Flores, José Carlos Garzón, José A Sastre, Andrés Roca de Togores López, Diego Meléndez-Salinas, José M Fandiño-Orgeira, Rubén Casans-Frances, Marta Casalderrey-Rivas, Eva Romero-García, Clara Marín-Zaldívar, Ana Aroca-Tanarro, Oscar Alonso-Correa, Luis Jesús Rodríguez-Martín, Salvador Espinosa-Ramírez, Carin A Hagberg","doi":"10.1097/EJA.0000000000002210","DOIUrl":"10.1097/EJA.0000000000002210","url":null,"abstract":"<p><strong>Objective: </strong>The Airway Section of the Spanish Society of Anaesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), the Latin American Federation of Emergency Medicine (FLAME) and an international group of airway experts (IAG) aimed to establish multidisciplinary recommendations advocating for the universal use of videolaryngoscopy (VL) in both emergency and planned care settings.</p><p><strong>Design: </strong>A committee of experts from the two national scientific societies and an international group of airway experts was convened. Relevant research questions aligning with the document's objective were identified. A rapid systematic review of the evidence was performed, and the quality of evidence was assessed. Recommendations were formulated using the GRADE methodology (Grading of Recommendations Assessment, Development, and Evaluation) The entire process was conducted independently of industry funding.</p><p><strong>Methods: </strong>Six domains were defined pertaining to VL: Clinical Benefits; Infrastructure and Accessibility; Clinical Guidelines and Protocols; Teaching and Clinical Training; Dissemination and Promotion of Clinical Benefits; Innovation, Sustainability, and Research. For each domain, specific questions were developed using the PICO model (Population, Intervention, Comparison, and Outcomes). A literature search was conducted following PRISMA-R guidelines and analysed using the GRADE methodology.</p><p><strong>Results: </strong>The synthesis process resulted in 12 recommendations. Due to the low quality of available evidence, most recommendations were formulated based on expert opinion.</p><p><strong>Conclusion: </strong>The experts achieved strong consensus, formulating 12 recommendations to support strategies aimed at universalising the use of videolaryngoscopy.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"872-888"},"PeriodicalIF":6.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324853","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":"Identification of a novel de novo RYR1 variant associated with malignant hyperthermia: A case report.","authors":"Anthony Maino, Claire Dehaen-Rougelin, Anne-Frédérique Dalmas-Laurent, Lucie Guyant-Marechal, John Rendu, Julien Fauré, Nathalie Roux-Buisson","doi":"10.1097/EJA.0000000000002283","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002283","url":null,"abstract":"<p><p>Malignant hyperthermia (MH) is a severe reaction occurring upon the use of certain pharmacological agents during anaesthesia. The reaction typically includes an uncontrolled increase of body temperature, muscle spasms, tachycardia and hypercapnia. Identifying a genetic aetiology in MH patient allows diagnostic confirmation and genetic screening of relatives at risk. MH susceptibility (MHS) has extensively been associated with heterozygous missense variants in the RYR1 gene of dominant inheritance, but new variants are still to be discovered. We report here a novel de novo RYR1 variant c.487C>G p.(Arg163Gly) identified in a young boy who experienced a peroperative MH crisis. To the best of our knowledge, this is the first case reporting this new RYR1 variant, paving the way for future diagnosis, but genetic counselling and presymptomatic screening may vary depending on the classification that is used.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184880","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":"Neuraxial labour analgesia and maternal fever: A narrative review.","authors":"Petramay Attard Cortis, Tom Bleeser, Sarah Devroe, Nuala Lucas","doi":"10.1097/EJA.0000000000002280","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002280","url":null,"abstract":"<p><p>Neuraxial labour analgesia is considered the 'gold-standard' technique for the provision of analgesia during vaginal birth. Recently, there has been growing interest in the potential impacts of labour epidural analgesia beyond pain relief. One particular concern is its association with the development of maternal fever, so-called epidural-related maternal fever (ERMF). Hyperthermia during labour is a significant clinical concern, as it can impact both maternal and neonatal outcomes. This narrative review explores the association between epidural analgesia and maternal fever, outlines its suggested pathophysiological mechanisms, examines its potential implications and considers the management of neuraxial analgesia in the context of existing maternal fever. The two main theories explaining the development of ERMF are the sterile inflammation hypothesis, and the altered thermoregulation hypothesis. Patient characteristics, features of pregnancy and labour, midwifery and/or obstetric interventions and epidural-related factors can all contribute to an increased risk of developing ERMF. Although these factors may be manipulated to reduce ERMF incidence, there is no clear evidence that supports the recommendation of any intervention to prevent ERMF development. The associated detrimental effects of maternal fever on the woman, foetus, and newborn are highlighted, although many of these adverse outcomes have not been definitively established when ERMF has been the focus of study. There remains a significant need to further understand the pathophysiology, clinical significance, preventive strategies and treatment modalities of ERMF. It is crucial that future studies distinguish ERMF as a distinct category within maternal intrapartum fever.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184901","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":"Neuromuscular, haemodynamic, and autonomic effects of a fast-onset, long-acting, nondepolarising, carborane neuromuscular blocking agent compared to rocuronium in rats.","authors":"Noah J Timko, Tammer N Ghaly, Lalit N Goswami, Colleen L Ray, Quinn L Johnson, Boris Mraovic, Daniel Vilceanu, Michael F Callahan, George R Kracke","doi":"10.1097/EJA.0000000000002289","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002289","url":null,"abstract":"<p><strong>Background: </strong>We have previously introduced a long-acting, nondepolarising, neuromuscular blocking agent, pNMB (para-neuromuscular blocker). However, its neuromuscular, haemodynamic and autonomic effects as well as reversibility were not fully characterized.</p><p><strong>Objective: </strong>We compared pNMB to rocuronium and tested the hypotheses that pNMB has a fast-onset, is long-acting, and its effects are reversed by sugammadex.</p><p><strong>Design: </strong>Animal study.</p><p><strong>Setting: </strong>Laboratory from January 2021 to February 2025.</p><p><strong>Participants: </strong>Thirty-three adult male Sprague-Dawley rats.</p><p><strong>Interventions: </strong>Rats were anesthetised and mechanically ventilated. Stimulating electrodes were attached to the sciatic and vagus nerves. Parasympathetic nerve activity was measured by vagal-induced bradycardia and sympathetic nerve activity by the nicotine pressor response.</p><p><strong>Main outcome measures: </strong>Mechanomyography, mean arterial pressure (MAP) and heart rate (HR).</p><p><strong>Results: </strong>Rocuronium and pNMB inhibited muscle twitch dose-dependently with effective dose (ED)50s (50% inhibition) of 0.28 (95% confidence interval (CI), 0.25 to 0.31) mg/kg, n = 6, and 1.05 (95% CI, 0.93 to 1.20) mg/kg, n = 6, respectively. Rocuronium and pNMB, at doses up to 3 mg/kg, had no effect on HR. Rocuronium 0.7 mg/kg and pNMB 6 mg/kg had no effect on MAP, mean ± SD, 153 ± 12 vs. 154 ± 14 mmHg, n = 4, P = 0.61, or decreased MAP 147 ± 9 vs. 72 ± 9 mmHg, n = 4, P < 0.01, respectively. Both rocuronium and pNMB were parasympatholytic with ED50s of 0.08 (95% CI, 0.06 to 0.09) mg/kg, n = 5, and 0.18 (95% CI, 0.14 to 0.22) mg/kg, n = 7, respectively. Rocuronium 0.7 mg/kg was not sympatholytic whereas pNMB 6 mg/kg was. Both rocuronium 0.7 mg/kg and pNMB 6 mg/kg decreased MAP in the presence of nicotine. Onset times of rocuronium 0.7 mg/kg and pNMB 6 mg/kg did not differ (P = 0.22). Rocuronium 0.7 mg/kg inhibited twitch for approximately 8 min, whereas pNMB 6 mg/kg inhibited twitch at a steady 80% for 60 min after administration. Sugammadex 10.9 mg/kg reversed the pNMB 3 mg/kg twitch blockade of 92.5% (95% CI, 85.9% to 99%), n = 6.</p><p><strong>Conclusions: </strong>The nondepolarising NMBA, pNMB, had a fast-onset similar to rocuronium and was long-acting and reversible by sugammadex. Both rocuronium and pNMB had autonomic effects that were apparent at subparalytic doses and decreased blood pressure in the presence of nicotine. When administered alone, rocuronium did not decrease MAP whereas pNMB caused a marked hypotension. Neither NMBA affected HR. These findings are limited to rats, and generalisability to other animal species and humans is unknown.</p><p><strong>Registration: </strong>University of Missouri IACUC (#9750, #40189), Columbia, Missouri, USA.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184833","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":"MRGPRX2 Triggers rocuronium bromide-induced peri-operative phase allergic shock: A case report with case control study.","authors":"Zijun Gao, Ling Gong, Lu Li, Lei Song, JianBo Xiao, Jian Zhuang, Fang Wang","doi":"10.1097/EJA.0000000000002256","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002256","url":null,"abstract":"<p><strong>Background: </strong>Activation of mast cells and systemic histamine release are major side effects of intravenously administered neuromuscular blocking agents (NMBAs). Mas-related G protein-coupled receptor-X2 (MRGPRX2) plays a key role in mediating anaphylactoid reactions.</p><p><strong>Objective: </strong>To explore the mechanism of acute anaphylactic shock induced by muscle relaxants through the typical shock cases.</p><p><strong>Design: </strong>Case report and case control study.</p><p><strong>Patients: </strong>A 68-year-old male patient (80 kg) underwent surgical treatment in September 2023 and developed anaphylactic shock during anaesthesia induction.</p><p><strong>Methods: </strong>A trial was conducted to evaluate the patient who experienced anaphylactic shock during the peri-operative period in comparison to control patients. The levels of MRGPRX2 and total immunoglobulin E (IgE) were measured in patient plasma, along with allergic mediators such as histamine and tryptase. Mast cell activation assay was performed to assess degranulation effectiveness by measuring β-hexosaminidase, histamine release, and calcium influx. Additionally, mast cell activation by peri-operative drugs was investigated. Local inflammatory experiments were conducted in a mouse model to evaluate rocuronium bromide-induced allergic reactions. Finally, MRGPRB2-CKO mice and siRNA silencing were used to elucidate the mechanism of rocuronium-induced anaphylactic shock.</p><p><strong>Results: </strong>Plasma analysis of the patient experiencing anaphylaxis revealed normal total IgE levels (38.4 IU ml-1) but significantly elevated histamine concentration (53.78 ng ml-1). The MRGPRX2 concentration (52.22 ng ml-1) in this patient was markedly higher than the negative control group (16.40 ng ml-1). Serum-activated mast cell assays demonstrated that the anaphylaxis patient's plasma induced a significant release of β-hexosaminidase, calcium, and histamine from mast cells (significantly higher than the histamine levels naturally present in the plasma). Drug-activated mast cell experiments confirmed that rocuronium bromide triggered dose-dependent mast cell activation, leading to MCP-1, histamine, and calcium release. Local paw oedema experiments in mice further validated that rocuronium bromide induced local allergic reactions. Using MRGPRB2-CKO mice and siRNA silencing, we determined that rocuronium bromide-induced anaphylactic shock was mediated through MRGPRX2 activation, resulting in mast cell degranulation.</p><p><strong>Conclusion: </strong>This study highlights the critical role of MRGPRX2 in rocuronium bromide-induced anaphylactic shock. In vitro diagnosis of MRGPRX2 levels may provide new criteria for reducing intra-operative risks.</p><p><strong>Trial registration: </strong>The clinical trial was registered at the China Clinical Trial Registration Center (Registration Number: ChiCTR2300077364).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079910","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":"Generation Z versus generative artificial intelligence: a cross-sectional study assessing medical students' confidence and over-reliance on artificial intelligence in perioperative clinical scenarios.","authors":"Sarah Saxena, Marc Nkana Tsobgnie, Roberta Südy, Mia Gisselbaek, Jerome R Lechien, Michele Carella, Pierre Luigi Ingrassia, Peter Dieckmann, Joana Berger-Estilita","doi":"10.1097/EJA.0000000000002282","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002282","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079908","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}