European Journal of Anaesthesiology最新文献

{"title":"Brain protective ventilation in acute brain injury patients with use of fully automated ventilation (BRAVE): A cross-over clinical trial.","authors":"Robin L Goossen, Sibilla Gavinelli, Simone Dragoni, David M P van Meenen, Frederique Paulus, Marcus J S Schultz, Lorenzo Ball, Nicolo' Antonino Patroniti, Chiara Robba","doi":"10.1097/EJA.0000000000002253","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002253","url":null,"abstract":"<p><strong>Background: </strong>Invasive ventilation can be challenging in acute brain injury (ABI) patients as partial pressure of carbon dioxide and oxygen need to be kept in precise optimal ranges while simultaneously applying lung-protective ventilation. Fully automated ventilation may be effective in achieving protective ventilation targets for brain and lung.</p><p><strong>Objectives: </strong>To compare automated ventilation to conventional ventilation for ABI patients.</p><p><strong>Design: </strong>Single-centre, observational, cross-over trial.</p><p><strong>Setting: </strong>Primary care hospital in Italy, recruiting in 2024.</p><p><strong>Patients: </strong>Twenty ABI patients receiving invasive mechanical ventilation.</p><p><strong>Methods: </strong>We performed 3 h of data collection during conventional ventilation followed by 3 h of data collection during automated ventilation.</p><p><strong>Main outcome measure: </strong>The primary endpoint was the percentage of breaths in three predefined zones of ventilatory targets, defined as optimal, acceptable and critical. The zones were based on patient-specific ranges of four measures: end-tidal carbon dioxide (EtCO2), peripheral oxygen saturation (SpO2), tidal volume (VT), and maximum airway pressures (Pmax).</p><p><strong>Results: </strong>A total of 20 patients were included. With automated ventilation the proportion [range] of breaths within the optimal zone significantly increased from 2.7% [0.0 to 23.4] to 30.5% [0.9 to 66.3] (P < 0.001). Automated ventilation markedly decreased the proportion of breaths in the critical zone, from 16.6% [1.9 to 41.3] to 2.1% [0.5 to 7.4] (P < 0.001), while slightly reducing breaths in the acceptable zone from 58.1% [34.4 to 90.9] to 45.1% [25.4 to 90.8] (P < 0.001). Optimal breaths increased for EtCO2, SpO2, and VT, but declined for Pmax with automation. The percentage of time spent in each ventilation zone mirrored the percentage of breaths in each zone.</p><p><strong>Conclusion: </strong>Automated ventilation outperformed conventional ventilation in maintaining protective ventilation targets for brain and lung in ABI patients.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov identifier: NCT06367816.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947299","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":"Glasgow coma scale score before prehospital tracheal intubation in trauma vs. nontrauma patients: A multicentre retrospective observational study.","authors":"Urs Pietsch, Benedick Satari, Julian Klug, Pedro David Wendel-Garcia, Martin Müller, Lea Weber, Roland Albrecht, Robert Greif, Alexander Fuchs","doi":"10.1097/EJA.0000000000002263","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002263","url":null,"abstract":"<p><strong>Background: </strong>Prehospital tracheal intubation intends to provide respiratory support and protect the airway from possible pulmonary aspiration. Trauma guidelines recommend tracheal intubation in patients with a Glasgow Coma Scale (GCS) score of <9.</p><p><strong>Objectives: </strong>We hypothesised that in clinical practice, GCS scores before prehospital tracheal intubation are lower in trauma and medical patients.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Setting: </strong>Swiss anaesthetist-staffed helicopter emergency medical system between 07 September 2020 and 11 December 2023.</p><p><strong>Patients: </strong>Intubated trauma and nontrauma patients ≥18 years and nonintubated patients with GCS <9 admitted to three tertiary referral Swiss hospitals.</p><p><strong>Interventions: </strong>Prehospital tracheal intubation.</p><p><strong>Main outcome measures: </strong>GCS score before prehospital tracheal intubation. Association of GCS score before prehospital tracheal intubation with length of ventilator days, intensive care unit stay, hospitalisation, and 28-day survival.</p><p><strong>Results: </strong>We screened 35 021 missions, of which 401 (335 intubated vs. 66 nonintubated) met inclusion criteria. The median GCS before prehospital tracheal intubation was 4 [IQR 3 to 6] for nontrauma and 6 [3 to 8] for trauma patients. Trauma patients with burns had a GCS score of 14 [13 to 15] before prehospital tracheal intubation. In the trauma cohort, women had a median GCS score of 5 [3 to 7] compared to men with 6 [3 to 8] (P = 0.043). The GCS before prehospital tracheal intubation was associated with length of intensive care unit stay (P = 0.042) and survival (P = 0.036) but not with length of ventilation and hospital stay.</p><p><strong>Conclusions: </strong>Overall median GCS score before prehospital tracheal intubation was lower than 8. Our data suggests that the GCS score is not suitable as the sole indicator for prehospital tracheal intubation. Further randomised controlled trials should investigate more robust intubation criteria to be included in the guidelines for trauma and nontrauma patients. Finally, a patient-centred approach should be emphasised, especially in patients with burns.</p><p><strong>Trial registration: </strong>N/A.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947574","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 versus intermittent noninvasive blood pressure monitoring during beach chair position for shoulder surgery: A randomised controlled trial.","authors":"Alessandro Vergari, Luciano Frassanito, Alessandra Piersanti, Francesco Vassalli, Sara Pitoni, Ersilia Ruggiero, Roberta Nestorini, Rossano Festa, Giulia Bernardi, Paola Lombardo, Cosimo Tommaso Caputo, Gianluca Ciolli, Marco Rossi","doi":"10.1097/EJA.0000000000002259","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002259","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic shoulder surgery is frequently conducted in the beach chair position. Haemodynamic instability with hypotension and reduction of cerebral perfusion has been widely reported.</p><p><strong>Objective: </strong>To determine whether a continuous noninvasive blood pressure monitoring using a finger-cuff reduces hypotension during arthroscopic shoulder surgery compared to standard oscillometric brachial pressure monitoring.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>Orthopaedic operating theatre of IRCCS Fondazione Policlinico Universitario Agostino Gemelli of Rome, Italy.</p><p><strong>Patients: </strong>Sixty patients (30 per group) scheduled for arthroscopic shoulder surgery in beach chair position under brachial plexus block plus general anaesthesia.</p><p><strong>Interventions: </strong>All patients received noninvasive continuous haemodynamic monitoring with finger-cuff. Patients were then randomised to unblinded continuous finger-cuff arterial pressure monitoring or to intermittent oscillometric arterial pressure monitoring.</p><p><strong>Main outcome measures: </strong>Primary outcome measure was time-weighted average mean arterial pressure under the threshold of 65 mmHg during surgery. Secondary outcomes were the incidence of cerebral oxygen desaturation episodes, the incidence of severe hypotensive episodes, and the time to correct the hypotensive episode in seconds.</p><p><strong>Results: </strong>The time weighted average mean [IQR] arterial pressure under the threshold of 65 mmHg was 0.41 [0.04, 0.98] mmHg in the finger-cuff group and 0.69 [0.21, 2.20] mmHg in the Control group, with a Hodges-Lehman estimator of -0.24 (95% confidence interval: - 0.75 to 0.07) mmHg (P = 0.137).No difference in the incidence of severe hypotensive events, defined as a mean arterial pressure less than 50 mmHg, was detected between the two groups (P = 0.017). Cerebral tissue oxygen saturation values were stable throughout the vast majority of the monitoring period, with absolute values less than 60% and relative values less than 10% of the baseline being uncommon in the two cohort of patients. A positive correlation between simultaneous tissue oxygen saturation values and mean arterial pressure was found (r = 0.298 95% confidence interval 0.283 to 0.312, P < 0.001).</p><p><strong>Conclusions: </strong>Continuous noninvasive arterial pressure monitoring is not effective in reducing the amount of intra-operative hypotension during shoulder surgery performed in the beach chair position compared to intermittent oscillometric monitoring.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05143632.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947353","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":"Prophylactic phenylephrine and norepinephrine infusions during caesarean delivery for non-reassuring fetal heart rate: A randomised noninferiority trial to assess neonatal outcome.","authors":"Nitika Goel, Heena Sharma, Kajal Jain, Anudeep Jafra, Shalini Gainder, Praveen Kumar","doi":"10.1097/EJA.0000000000002255","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002255","url":null,"abstract":"<p><strong>Background: </strong>Phenylephrine is recommended for the management of hypotension after spinal anaesthesia for women undergoing caesarean delivery. Norepinephrine, an adrenergic agonist with weak β-adrenergic activity, has been reported to have a more favourable haemodynamic profile than phenylephrine. However, there are concerns that norepinephrine may be associated with higher risk of fetal acidosis which can be serious in an already compromised foetus.</p><p><strong>Objective: </strong>This study aimed to test the hypothesis that in terms of the umbilical artery base excess norepinephrine is not inferior to phenylephrine when it is used to prevent spinal hypotension during caesarean delivery.</p><p><strong>Design: </strong>A prospective, randomised, double-blind trial.</p><p><strong>Setting: </strong>Operating room of Tertiary Care Hospital in Northern India from January 2022 to November 2022.</p><p><strong>Patients: </strong>Parturients with non-reassuring fetal heart rate undergoing nonelective caesarean delivery under spinal anaesthesia.</p><p><strong>Intervention: </strong>Equipotent prophylactic infusions of either phenylephrine 80 μg min-1 or norepinephrine 6 μg min-1 were administered to maintain maternal systolic BP between 90 and 110% of baseline using a predefined algorithm.</p><p><strong>Main outcome measures: </strong>The primary outcome was umbilical arterial base excess comparing the limits of the 95% confidence interval with a predefined noninferiority margin of -0.05 mmol l-1. The incidence of fetal acidosis was also evaluated for norepinephrine and phenylephrine group.</p><p><strong>Results: </strong>Data were analysed from 104 patients. The mean ± SD umbilical arterial base excess was higher in norepinephrine group than the phenylephrine group: -6.85 ± 2.20 mmol l-1vs. -7.95 ± 2.99 mmol l-1, respectively (P  = 0.034). Norepinephrine was found to be noninferior as the lower limit of 95% CI of mean difference between base excess of two groups was 1.10 (95% CI, 0.084 to 2.123) mmol l-1, P  = 0.034) which did not cross our predefined noninferiority margin of -0.05 mmol l-1. No significant difference in the incidence of fetal acidosis was observed between norepinephrine and phenylephrine groups: 62% vs. 75% (P  = 0.140).</p><p><strong>Conclusion: </strong>Prophylactic norepinephrine infusion (6 μg min-1) was found to be noninferior to phenylephrine infusion (80 μg min-1) in terms of umbilical arterial base excess values. A similar incidence of fetal acidosis was observed in both groups.</p><p><strong>Trial registration: </strong>CTRI/2022/01/039343; dated - 12 January 2022.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947537","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":"https://doi.org/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 scores >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><p><strong>Trial registration: </strong>Not applicable; quality improvement project.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diminished rest-activity rhythm is associated with postoperative complications and mortality: A prospective cohort study of UK Biobank participants.","authors":"Ying Shan, Hui Gao, Yanling Wei, Jingting Yan, Huan Chen, Tao Luo","doi":"10.1097/EJA.0000000000002262","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002262","url":null,"abstract":"<p><strong>Background: </strong>Circadian rhythm disruption, as a modifiable risk factor, has been increasingly recognised for its potential impact on adverse health outcomes, particularly in surgical populations where its implications warrant further investigation.</p><p><strong>Objectives: </strong>To investigate associations between postoperative outcomes and preoperative rest-activity rhythm metrics from accelerometry.</p><p><strong>Design: </strong>A cohort analysis of UK Biobank participants undergoing major surgery within 1 year of accelerometer monitoring.</p><p><strong>Setting: </strong>UK Biobank, a large population-based cohort in the United Kingdom.</p><p><strong>Patients: </strong>These were 5654 adults (37 to 73 years) completing 7-day preoperative wrist accelerometry.</p><p><strong>Exposure: </strong>Rest-activity rhythm relative amplitude was analysed both as a continuous variable and as a categorical variable. For the categorical analysis, a low relative amplitude group was defined as more than 2 standard deviations below the cohort mean: all other participants served as the high relative amplitude group.</p><p><strong>Main outcome measures: </strong>The primary composite outcome included 30-day postoperative complications and 90-day mortality. Multivariable logistic regression was used to adjust for comorbidities, demographics and surgical risk factors.</p><p><strong>Results: </strong>Participants with a low relative amplitude (n = 225) demonstrated significantly higher rates of adverse outcomes compared with the remainder of the participants (n = 5429), with an absolute risk difference of 6.1% (9.8 vs. 3.7%), P < 0.001). Multivariable analysis revealed a dose-response relationship: each standard deviation decrease in relative amplitude increased risk by 23% {adjusted odds ratio, aOR: 1.23 [95% confidence interval (CI), 1.06 to 1.42]}. The low amplitude group had double the risk of adverse outcomes compared with the remainder of the participants: adjusted OR: 2.16 (95% CI, 1.25 to 3.73).</p><p><strong>Conclusions: </strong>A lower preoperative circadian relative amplitude is associated with increased postoperative morbidity and mortality. Accelerometry-based circadian monitoring may provide a novel, cost-effective strategy for preoperative risk stratification.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947329","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":"https://doi.org/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":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of blood pressure versus oxygen administration on cerebral oxygenation during and after anaesthesia induction: A prospective cohort study.","authors":"Yu K Lam, Rogier V Immink, Jimmy Schenk, Rokus E C van den Dool, Markus W Hollmann, Denise P Veelo, Alexander P J Vlaar, Johan T M Tol, Ward H van der Ven, Lotte E Terwindt, Eline Kho","doi":"10.1097/EJA.0000000000002245","DOIUrl":"10.1097/EJA.0000000000002245","url":null,"abstract":"<p><strong>Background: </strong>The effect of anaesthesia induction on cerebral perfusion is complex due to the coinciding respiratory and haemodynamic changes that occur.</p><p><strong>Objective: </strong>To examine how changes in blood pressure and oxygen administration are related to cerebral oxygenation and its progression over time during and after anaesthesia induction.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Dutch tertiary hospital from October 2019 to May 2022.</p><p><strong>Patients: </strong>Two hundred and fifty-one elective cardiac surgery patients of which 188 were included in the analysis.</p><p><strong>Main outcome measures: </strong>Continuous cerebral oxygenation, measured using near-infrared spectroscopy (NIRS)-based regional cerebral tissue oximetry, was assessed in relation to mean arterial pressure (MAP), partial pressure of end-tidal oxygen (PetO 2 ) and fraction of inspired oxygen (FiO 2 ) during and after anaesthesia induction. Cerebral oxygenation between subgroups with and without the occurrence of postinduction hypotension (PIH) (defined as a MAP <65 mmHg for >60 s) was compared. PetO 2 was used as a measure for the efficacy of oxygen administration to assess the effect of a high FiO 2 of 1.0 on cerebral oxygenation.</p><p><strong>Results: </strong>Cerebral oxygenation and PetO 2 increased during anaesthesia induction with the use of a FiO 2 of 1.0, while blood pressure decreased. All parameters decreased after anaesthesia induction, but the timing of onset of decline in cerebral oxygenation coincided with the moment that the FiO 2 was adjusted from high to low, whereas it preceded the decline in MAP by 16.4 s (95% confidence interval (CI), 2.4 to 30.4; P  = 0.02). The occurrence of PIH, which comprised of 42% of our study population, did not affect cerebral oxygenation. During anaesthesia induction and the use of a FiO 2 of 1.0, cerebral oxygenation increased by 0.14% (95% CI, 0.12 to 0.16; P  < 0.001) per percentage point increase in PetO 2 .</p><p><strong>Conclusion: </strong>Changes in regional cerebral tissue oximetry during and after anaesthesia induction are more related to changes in oxygen administration than blood pressure.</p><p><strong>Trial registration: </strong>Overview of medical research in the Netherlands (reference: NL-OMON29121).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793781","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":"Association between postpartum depression and anaesthesia methods in women undergoing caesarean section: A systematic review and meta-analysis.","authors":"Si-Cheng Xie, Chuen-Huei Liu, Yu-Ting Hung","doi":"10.1097/EJA.0000000000002252","DOIUrl":"10.1097/EJA.0000000000002252","url":null,"abstract":"<p><strong>Background: </strong>Postpartum depression impacts maternal health, child development, and overall family well being. General anaesthesia has been suggested as a potential risk factor.</p><p><strong>Objective: </strong>To assess the association between anaesthetic methods and postpartum depression in women undergoing Caesarean section.</p><p><strong>Design: </strong>Systematic review with meta-analysis.</p><p><strong>Data sources: </strong>We searched PubMed, Embase and Web of Science through 16 April 2025, and included seven studies comprising 1 482 355 patients.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials and cohort studies comparing postpartum depression outcomes in women undergoing Caesarean section with general anaesthesia versus non-general anaesthesia.</p><p><strong>Results: </strong>Our results showed that general anaesthesia significantly increased the risk of both overall postpartum depression [odds ratio (OR) = 1.64, 95% confidence interval (CI), 1.23 to 2.19] and severe postpartum depression (OR = 1.41, 95% CI, 1.35 to 1.47). Subgroup analysis stratified by timing of postpartum depression diagnosis revealed an elevated risk within one-year postpartum (OR = 1.22, 95% CI, 1.02 to 1.46) and an even higher risk within seven-day postpartum (OR = 4.68, 95% CI, 1.21 to 18.09).</p><p><strong>Conclusion: </strong>These findings highlight the importance of anaesthetic choices for Caesarean section and suggest that minimising general anaesthesia exposure may optimise both physical and mental health outcomes.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793780","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 change in cerebral blood flow velocities in infants undergoing surgery in the prone position: A prospective cohort study.","authors":"Pyoyoon Kang, Jung-Bin Park, Jin-Tae Kim, Eun-Hee Kim","doi":"10.1097/EJA.0000000000002254","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002254","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774947","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}