{"title":"Threshold airway pressure for oesophageal insufflation during facemask ventilation: A short clinical study using ultrasound monitoring.","authors":"Zhen-Ping Li, Xia-Mei Chen, Cui-Yuan Shen, Qing-He Zhou","doi":"10.1097/EJA.0000000000002260","DOIUrl":"10.1097/EJA.0000000000002260","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063859","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}
Patricia Duch, Anne Wikkelsø, Christoffer C Jørgensen, Janus C Jakobsen, Ole Mathiesen, Anders K Nørskov, Helene Nedergaard
{"title":"Pain and adverse effects after caesarean delivery: A nationwide prospective cohort study.","authors":"Patricia Duch, Anne Wikkelsø, Christoffer C Jørgensen, Janus C Jakobsen, Ole Mathiesen, Anders K Nørskov, Helene Nedergaard","doi":"10.1097/EJA.0000000000002277","DOIUrl":"10.1097/EJA.0000000000002277","url":null,"abstract":"<p><strong>Background: </strong>Caesarean delivery can cause severe postoperative pain that can adversely affect recovery. However, balancing effective pain management while minimising the risk of opioid-related adverse effects remains a clinical challenge.</p><p><strong>Objective: </strong>In this nationwide study, we aimed to describe the incidence and severity of acute pain and adverse effects of opioid administration following the first hours and days after elective caesarean delivery.</p><p><strong>Design: </strong>Prospective nationwide Danish multicentre cohort study.</p><p><strong>Setting: </strong>All maternity hospitals in Denmark over a 6-month period during 2023-2024.</p><p><strong>Patients: </strong>Patients having elective caesarean delivery.</p><p><strong>Intervention: </strong>Patient-reported outcomes on pain [Numeric Rating Scale (NRS) 0 to 10] and opioid-related adverse effects were collected using text message-based questionnaires via smartphone contact at 6, 12, 18, 24, and 48 h postcaesarean delivery, and on days 7 and 30.</p><p><strong>Main outcome measures: </strong>The two primary outcomes were pain on mobilisation at 24 h, and adverse events of opioid administration (namely, nausea, vomiting, dizziness, pruritus and urinary retention) within 24 h.</p><p><strong>Results: </strong>In total, 738 patients were included from 19 of 22 Danish maternity hospitals. Median [IQR] pain during mobilisation 24 h postcaesarean delivery was NRS 5 [3 to 6], peaking at 12 h postoperatively with NRS 6 [5 to 8]. Median oral morphine equivalents (OME) within the first 24 h were 30 [20 to 50] mg. Adverse effects peaked 6 h postoperatively, with pruritus being the most common. Within the first 24 h 59 [95% confidence interval (CI), 55 to 63]% reported severe pain (NRS ≥ 7) and 55 (95% CI, 51 to 59)% reported opioid-related adverse effects.</p><p><strong>Conclusions: </strong>In Denmark, severe pain after caesarean delivery affects more than half the patients within the first 24 h, peaking at 12 h. Additionally, most report moderate or severe opioid-related adverse effects. These results underscore the need to optimise pain management, particularly during the first 24 h when pain is highest. The results can inform both patients and healthcare providers about expected pain trajectories and serve as the foundation for future research, and guide interventions.</p><p><strong>Trial registration: </strong>www.clinicaltrials.gov , NCT06012747.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069403","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}
Ji-Hyun Lee, Jung-Bin Park, Sang-Hwan Ji, Young-Eun Jang, Eun-Hee Kim, Jin-Tae Kim, Hee-Soo Kim
{"title":"Immediate complications and risk factors following radial arterial catheterisation in paediatric patients at a tertiary centre.","authors":"Ji-Hyun Lee, Jung-Bin Park, Sang-Hwan Ji, Young-Eun Jang, Eun-Hee Kim, Jin-Tae Kim, Hee-Soo Kim","doi":"10.1097/EJA.0000000000002268","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002268","url":null,"abstract":"<p><strong>Background: </strong>Arterial catheterisation is a critical procedure in paediatric patients undergoing surgery; however, it poses certain risks. Complications such as thrombus formation, arterial stenosis and haematoma may occur, yet their true incidence and contributing factors remain incompletely understood.</p><p><strong>Objective: </strong>To assess the incidence of complications and identify associated risk factors following radial arterial catheterisation in paediatric patients.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>A tertiary children's hospital.</p><p><strong>Patients: </strong>Children aged 5 years or younger who are scheduled for elective surgery.</p><p><strong>Intervention: </strong>Radial artery cannulation was performed under ultrasound guidance. The diameter of the artery and procedural details were recorded. Peripheral perfusion index was continuously monitored in both hands. Ultrasonographic assessments were conducted immediately after catheter removal, at 24 h postremoval and on postoperative day 5, to evaluate arterial status.</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of complications associated with arterial catheterisation after decannulation, assessed using ultrasonography. Secondary outcomes included the associated risk factors and the association between perfusion index changes and complications.</p><p><strong>Results: </strong>Immediate complications after decannulation, including thrombus formation and significant arterial stenosis, were observed in 41.5% of patients, as assessed by ultrasound. Risk factors for complications included a higher Medicut™-to-artery diameter ratio: odds ratio (OR) 25.3 (95% confidence interval [CI], 1.2 to 350.7) P = 0.002, and longer anaesthesia duration: OR 1.008 (95% CI, 1.002 to 1.015) P < 0.001. Perfusion index values were not associated with immediate complications. At 24 h postdecannulation, patients who had immediate complications still exhibited a greater arterial size reduction. By postoperative day 5, arterial diameters had spontaneously improved significantly, and no clinical complications were observed.</p><p><strong>Conclusion: </strong>Most immediate complications following radial arterial catheterisation in paediatric patients resolved spontaneously by postoperative day 5. The Medicut-to-artery diameter ratio and prolonged anaesthesia were significant risk factors for complications.</p><p><strong>Clinical trials registration: </strong>ClinicalTrials.gov, NCT03784118.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023097","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}
Heeyoon Jang, Jun-Young Jo, Jung-Pil Yoon, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi
{"title":"Sevoflurane or remimazolam anaesthesia and emergence agitation after nasal surgery in adults: A randomised clinical trial.","authors":"Heeyoon Jang, Jun-Young Jo, Jung-Pil Yoon, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi","doi":"10.1097/EJA.0000000000002267","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002267","url":null,"abstract":"<p><strong>Background: </strong>Emergence agitation is common after nasal surgery under general anaesthesia. Remimazolam, a novel ultra-short-acting benzodiazepine, allows haemodynamic stability and prompt postoperative recovery, but the specific impact of remimazolam on emergence agitation is not well understood.</p><p><strong>Objectives: </strong>The primary aim of this study was to compare the effects of remimazolam-based total intravenous anaesthesia (TIVA) and sevoflurane-based volatile induction and maintenance of anaesthesia (VIMA) on the occurrence of emergence agitation.</p><p><strong>Design: </strong>A prospective, randomised, assessor-blinded clinical trial.</p><p><strong>Setting: </strong>A single-centre study in a university-affiliated tertiary hospital.</p><p><strong>Participants: </strong>Ninety-eight adults undergoing nasal surgery under general anaesthesia.</p><p><strong>Interventions: </strong>Patients were randomised into two groups. The Sevoflurane group (n = 49) received VIMA with sevoflurane and nitrous oxide, while the Remimazolam group (n = 49) received TIVA with remimazolam and remifentanil.</p><p><strong>Main outcome measures: </strong>The primary outcome was the occurrence of emergence agitation, which was evaluated using the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale. The secondary outcomes were immediate complications after extubation and postoperative pain, and the interval between discontinuation of anaesthesia and extubation.</p><p><strong>Results: </strong>Emergence agitation, as measured by the Richmond Agitation-Sedation Scale, occurred in six of 49 patients (12.2%) in the Sevoflurane group and none (0.0%) in the Remimazolam group. The risk difference was 12.2 (95% CI, 3.0 to 21.4, P = 0.008). The occurrence measured by the Riker Sedation-Agitation Scale was identical to that with the Richmond Agitation-Sedation Scale. Coughing was more frequent in the Sevoflurane group, 53.1 vs. 12.2%, risk difference = 40.8 (95% CI, 24.0 to 57.5, P < 0.001). In addition, the interval between discontinuation of anaesthesia and extubation was lower in the Remimazolam group than the Sevoflurane group (9.00 ± 4.25 min vs. 12.18 ± 4.18 min, respectively, P < 0.001).</p><p><strong>Conclusion: </strong>The occurrence of emergence agitation in adult patients after nasal surgery under general anaesthesia can be significantly reduced using remimazolam-based TIVA.</p><p><strong>Trial registration: </strong>Clinical Research Information Service (KCT0007387).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023104","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}
Wencke Renette, Dieter Mesotten, Ingrid Meex, Hendrik Stragier, Steffen Rex, Steven Thiessen
{"title":"The role of perioperatively acquired muscle weakness in postoperative fatigue: A narrative review.","authors":"Wencke Renette, Dieter Mesotten, Ingrid Meex, Hendrik Stragier, Steffen Rex, Steven Thiessen","doi":"10.1097/EJA.0000000000002274","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002274","url":null,"abstract":"<p><p>Postoperative fatigue (POF) and perioperatively acquired muscle weakness (POAW) are significant yet often under-recognised interlinked postoperative complications that can significantly hinder postoperative recovery and diminish overall quality of life after surgery. Despite advancements in surgical and anaesthetic techniques and the widespread implementation of Enhanced Recovery After Surgery (ERAS) protocols, these conditions remain prevalent. In the weeks following surgery, reported incidences of fatigue of any severity range from 10% to as high as 90%, depending on the patient population. Particularly affecting high-risk patients and those undergoing major surgery, POF and POAW are frequently overlooked in clinical practice. This narrative review explores the biological mechanisms underlying these conditions, highlighting key factors that contribute to their development. It also explores the interrelationship between POAW and the development of POF. While some promising strategies exist, effective and targeted interventions to reduce POF and POAW remain limited. A comprehensive understanding of these postoperative complications is crucial to guide future research and the development of evidence-based management strategies. Ultimately, addressing POF and POAW holds the potential to enhance recovery after surgery, improve long-term outcomes, and reduce the overall healthcare burden associated with surgical procedures.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023071","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}
Vera Saldien, Francis Veyckemans, Tom Giedsing Hansen
{"title":"Development of the neuromuscular junction and neuromuscular blocking agents in neonates, infants and children: A narrative review.","authors":"Vera Saldien, Francis Veyckemans, Tom Giedsing Hansen","doi":"10.1097/EJA.0000000000002270","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002270","url":null,"abstract":"<p><p>Neuromuscular blocking agents (NMBAs) are critical components in paediatric anaesthesia, facilitating intubation, surgical procedures and mechanical ventilation in neonates, infants and children. This narrative review examines the pharmacological properties, clinical applications, monitoring, reversal and safety of NMBAs across paediatric populations. Given the unique physiological characteristics of neonates and infants - including hepatic and renal maturation, and neuromuscular junction development - NMBA metabolism, efficacy and adverse effects in these age groups differ markedly from those in older children and adults. These physiological factors necessitate specific approaches to NMBA selection, dosing and monitoring to ensure effective blockade while minimising risks. Emphasis is placed on understanding how the pharmacokinetics and pharmacodynamics of commonly used NMBAs vary with age, influencing onset, duration and recovery. Additionally, practical strategies for the safe and effective monitoring of neuromuscular blockade using quantitative monitoring techniques are discussed to avoid residual neuromuscular blockade. Recent advances in the reversal of neuromuscular blockade, including the use of sugammadex, offer promising improvements in paediatric anaesthesia safety, though their application in neonatal populations requires further study. Finally, the review discusses current research trends, highlighting the need for age-specific guidelines and pharmacologic innovations that address the challenges unique to NMBA use in neonates, infants, and children.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991819","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}
Andres Zorrilla-Vaca, Enric Barbeta, Julian Librero, Carlos Ferrando
{"title":"Open-lung ventilation and mechanical power in thoracic surgery: Post hoc analysis of a multicentre randomised trial.","authors":"Andres Zorrilla-Vaca, Enric Barbeta, Julian Librero, Carlos Ferrando","doi":"10.1097/EJA.0000000000002271","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002271","url":null,"abstract":"<p><strong>Background: </strong>Individualisation of positive-end expiratory pressure (PEEP) is an open-lung ventilation strategy associated with better respiratory mechanics. Mechanical power has been associated with lung injury in critical care settings, but the interaction between optimisation of PEEP and mechanical power during one-lung ventilation (OLV) remains poorly understood.</p><p><strong>Objective: </strong>This study aimed to determine the effect of individualisation of PEEP on mechanical power during OLV as well as to establish the association between mechanical power and postoperative pulmonary complications after thoracic surgery.</p><p><strong>Design: </strong>This is a post hoc analysis of a multicentre randomised trial.</p><p><strong>Setting: </strong>Operating rooms.</p><p><strong>Patients: </strong>Thoracic surgery cases requiring OLV.</p><p><strong>Intervention: </strong>Open-lung ventilation strategy (i.e. individualised PEEP titration based on respiratory compliance) versus standard PEEP. Mechanical power and its components were compared between both groups at five different time-points: two-lung ventilation (T0), baseline OLV (T1), 20 min after OLV (T2), end of OLV (T3) and before extubation (T4).</p><p><strong>Main outcome measures: </strong>Our primary outcome included a composite of postoperative pulmonary complications within 30 days after surgery. Multivariable mixed-effects logistic regressions were performed to assess associations between various thresholds of mechanical power and postoperative pulmonary complications.</p><p><strong>Results: </strong>A total 1253 patients were included in this analysis, of which 635 received open-lung ventilation, and 618 received conventional ventilation. The median difference in mechanical power was higher in the open-lung ventilation group during OLV than in the control group at T2, T3 and T4: 1.39 [95% confidence interval (CI), 0.91 to 1.86] J min-1, 1.27 (95% CI, 0.79 to 1.75) J min-1 and 2.12 (95% CI, 1.60 to 2.63) J min-1, respectively. While the resistive component of mechanical power was associated with postoperative pulmonary complications [odds ratio (OR), 1.07 (95% CI, 1.01 to 1.13) per J min-1], the static component was protective [OR, 0.91 (95% CI, 0.85 to 0.98) per J min-1].</p><p><strong>Conclusion: </strong>Individualisation of PEEP during OLV leads to nonclinically significant higher levels of mechanical power compared with standard PEEP. Each component of mechanical power seems to have different interactions with the occurrence of postoperative pulmonary complications.</p><p><strong>Trial registration: </strong>NCT03182062.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991778","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}
Girish P Joshi, Christpher L Wu, Eleni Moka, Marc Van de Velde, Dileep N Lobo, Eric Albrecht, Dario Bugada, Helene Beloeil, Marie-Pierre Bonnet, Neel Desai, Geertrui Dewinter, Stephan M Freys, Girish P Joshi, Henrik Kehlet, Patricia Lavand’homme, Dileep N Lobo, Eleni Moka, Esther M Pogatzki-Zahn, Johan Raeder, Narinder Rawal, Axel R Sauter, Marc Van de Velde, Christopher L Wu
{"title":"A survey of knowledge about PROcedure-SPEcific Postoperative Pain ManagemenT (PROSPECT) Recommendations.","authors":"Girish P Joshi, Christpher L Wu, Eleni Moka, Marc Van de Velde, Dileep N Lobo, Eric Albrecht, Dario Bugada, Helene Beloeil, Marie-Pierre Bonnet, Neel Desai, Geertrui Dewinter, Stephan M Freys, Girish P Joshi, Henrik Kehlet, Patricia Lavand’homme, Dileep N Lobo, Eleni Moka, Esther M Pogatzki-Zahn, Johan Raeder, Narinder Rawal, Axel R Sauter, Marc Van de Velde, Christopher L Wu","doi":"10.1097/EJA.0000000000002264","DOIUrl":"10.1097/EJA.0000000000002264","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991866","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}
Karam Azem, Sharon Orbach-Zinger, Alexander Ioscovich, Nicolas Brogly, Efrat Spiegel, Avivit Shoham, Daniel Shatalin, Isabel Valbuena, Amit Frenkel, Luis Manuel Vegas Isasi, Yuri Matatov, Shai Fein, Dmitry Greenman, Yuval Neeman, Emilia Guasch, Yair Binyamin
{"title":"Anaesthetic strategies for managing placenta accreta spectrum with REBOA: Insights from an international multicentre retrospective study.","authors":"Karam Azem, Sharon Orbach-Zinger, Alexander Ioscovich, Nicolas Brogly, Efrat Spiegel, Avivit Shoham, Daniel Shatalin, Isabel Valbuena, Amit Frenkel, Luis Manuel Vegas Isasi, Yuri Matatov, Shai Fein, Dmitry Greenman, Yuval Neeman, Emilia Guasch, Yair Binyamin","doi":"10.1097/EJA.0000000000002218","DOIUrl":"10.1097/EJA.0000000000002218","url":null,"abstract":"<p><strong>Background: </strong>Placenta accreta spectrum (PAS) with resuscitative endovascular balloon occlusion of the aorta (REBOA) presents unique anaesthetic challenges, yet optimal management strategies remain undefined.</p><p><strong>Objective: </strong>To provide a real-world description of anaesthetic practices, REBOA management, and surgical outcomes in patients undergoing caesarean delivery with REBOA for PAS across four international centres.</p><p><strong>Design: </strong>International multicentre retrospective cohort study.</p><p><strong>Setting: </strong>Four tertiary care centres across Israel and Spain between January 2019 and December 2023.</p><p><strong>Patients: </strong>A total of 47 patients diagnosed with PAS who underwent caesarean delivery with REBOA placement.</p><p><strong>Intervention: </strong>None.</p><p><strong>Main outcome measures: </strong>The primary outcome was to evaluate the anaesthetic management and outcomes of PAS patients undergoing caesarean delivery with REBOA. Secondary outcomes included assessment of REBOA utilisation patterns, blood loss management strategies and maternal and neonatal outcomes.</p><p><strong>Results: </strong>Initial anaesthesia was predominantly neuraxial (85.1%), with combined spinal-epidural being the most common (46.8%). Conversion to general anaesthesia occurred in 52.5% of neuraxial cases, primarily due to pain (52.4%) and surgeon requests (42.9%). REBOA was placed in all cases but inflated in only 76.6%, mainly under ultrasound guidance (57.4%), with significantly shorter anaesthesia-to-delivery intervals than fluoroscopy (60.0 vs. 111.0 min, P = 0.003). Median estimated blood loss was 1.5 l [0.9 to 2.5]. Hysterectomy was performed in 57.4% of cases. REBOA-related complications were minimal (4.3%), and maternal outcomes were generally favourable, with 31.9% requiring intensive care admission. Neonatal outcomes were good, with median Apgar scores of 9.0 at both one and five minutes.</p><p><strong>Conclusions: </strong>Although REBOA shows promise in PAS management, the high neuraxial-to-general anaesthesia conversion rate suggests the need for refined anaesthetic protocols. Combined spinal-epidural with readiness to convert to general anaesthesia may offer the optimal approach. Ultrasound-guided REBOA placement appears to significantly reduce procedural time. Success depends on thorough preparation, clear communication and adaptability to rapidly changing clinical situations.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"791-799"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233601","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}