European Journal of Anaesthesiology最新文献

{"title":"The analgesic efficacy of intrathecal morphine compared to peripheral regional analgesia in total hip arthroplasty: A systematic review and meta-analysis.","authors":"Neel Desai, Eric Albrecht, Sina Grape","doi":"10.1097/EJA.0000000000002436","DOIUrl":"10.1097/EJA.0000000000002436","url":null,"abstract":"<p><strong>Background: </strong>Following elective total hip arthroplasty, pain continues to be a significant problem. Intrathecal morphine or peripheral regional analgesia, that is local infiltration analgesia or peripheral nerve block, are common analgesic modalities, but it is still not known which is superior.</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomised controlled trials.</p><p><strong>Data sources: </strong>The following electronic databases were searched from inception to 24 March 2026: CENTRAL; Ovid Embase; Ovid MEDLINE; Scopus; and Web of Science.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials that compared intrathecal morphine to peripheral regional analgesia in patients scheduled for elective total hip arthroplasty under general or spinal anaesthesia.</p><p><strong>Results: </strong>Eight trials and 471 patients were included. The peripheral regional analgesia was peripheral nerve block in six trials and local infiltration analgesia in two trials. No difference was demonstrated between intrathecal morphine and peripheral regional analgesia in regard to the first coprimary outcome, the pain score at rest at 24 h. The quality of evidence was moderate. Intrathecal morphine was found to be superior to peripheral regional analgesia with respect to the second coprimary outcome, the cumulative intravenous morphine equivalent consumption at 24 h. Mean difference (95% CI) was 11.38 mg (4.31-18.45; P  = 0.002, I2  = 81%). The quality of evidence was low. Intrathecal morphine was revealed to be superior to peripheral regional analgesia at 8-12 h for the pain score at rest, 1.24 (0.60-1.88); P  = 0.0001, I2  = 68%; pain score on movement, 1.15 (0.12-2.17), P  = 0.03, I2  = 65%; but the rate of in hospital pruritus was reduced with peripheral regional analgesia, 0.31 (0.17-0.58), P  = 0.0002, I2  = 0%. No differences in functional status were shown.</p><p><strong>Conclusions: </strong>We found no difference between intrathecal morphine and peripheral regional analgesia in regard to pain score at rest at 24 h. Intrathecal morphine may lead to a favourable effect on some but not all analgesic indices compared to peripheral regional analgesia in elective total hip arthroplasty. The quality of evidence for these positive effects was low. Intrathecal morphine reduced the systemic opioid consumption, but is not in itself an opioid free strategy. This notion is supported by the increased incidence of in hospital pruritus with intrathecal morphine. The quality of evidence for this was high. In view of the quality of evidence, high quality randomised controlled trials are required to substantiate these results.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"830-841"},"PeriodicalIF":7.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263856","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":"Impact of a thermal care bundle on peri-operative hypothermia, surgical site infection, and readmissions in osteosynthesis patients: A randomised controlled trial.","authors":"Esther Espuñes-Mestres, Alberto Gallart, Suresh K Sharma, Jordi Castillo-García","doi":"10.1097/EJA.0000000000002363","DOIUrl":"10.1097/EJA.0000000000002363","url":null,"abstract":"<p><strong>Background: </strong>Maintaining normothermia throughout the peri-operative period prevents the occurrence of complications related to hypothermia.</p><p><strong>Objective: </strong>To determine the effect of a thermal care bundle with a short prewarming period on inadvertent peri-operative hypothermia (IPH), surgical site infection (SSI), and unplanned readmission among osteosynthesis patients, and to identify associated variables.</p><p><strong>Design: </strong>Open-label, randomised controlled trial.</p><p><strong>Setting: </strong>University hospital.</p><p><strong>Patients: </strong>One hundred and forty-eight patients who underwent osteosynthesis surgery.</p><p><strong>Intervention: </strong>The intervention group received the thermal care bundle, which consisted in prewarming patients 10 min before anaesthesia delivery and maintaining body temperature with a forced air device during surgery and the immediate postoperative period; in addition, the operating room environmental temperature was kept at 21 °C, and fluids were warmed to 38 °C.</p><p><strong>Main outcome measures: </strong>For the primary objective, hypothermia was defined as core body temperature below 36 °C and measured using the 3M Spot On zero heat flux sensor. Core temperature was recorded upon admission to the pre-operative holding area and subsequently every 30 min until postanaesthesia care unit (PACU) discharge. Secondary objectives were SSI and readmissions: a follow-up at 30 to 60 and 90 days was performed by the principal investigator.</p><p><strong>Results: </strong>All 148 patients completed the study, and there were no significant differences between the groups at baseline. At the start of surgery, the incidence of hypothermia was significantly lower in the bundle group (1.3 vs. 9.9% among controls; odds ratio = 7.59, P  = 0.021). A significantly lower incidence of hypothermia was also observed at admission to the PACU (14.3% in the bundle group vs. 29.6% among controls; odds ratio = 2.07; P  = 0.024). Application of the bundle increased patients' core body temperature by 0.13 °C (95% confidence interval (CI), 0.003 to 0.254; P  = 0.045). Patients in the bundle group had a slightly lower observed incidence of wound infections requiring readmission (odds ratio = 0.35; 95% CI, 0.04 to 2.92), although this difference was not statistically significant ( P  = 0.332).</p><p><strong>Conclusions: </strong>The bundle reduces peri-operative hypothermia by up to 59%, but does not affect on SSI; factors like presurgery hospital stay, operating room and PACU occupancy were identified as risk factors for SSI.</p><p><strong>Registration: </strong>21 July 2022: NCT05469958 (Clinical Trials.gov), first recruitment 15 August 2022.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"801-809"},"PeriodicalIF":7.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206872","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":"Standardising oral morphine equivalent conversion ratios for research: A modified Delphi consensus survey.","authors":"Bader A Almodibeg, Rosalind Adam, Fani Alevrogianni, Tanish Kirodian, Roger Knaggs, Peter Kranke, Dan-Sebastian Dirzu, Kathleen Ferguson, Winfried Häuser, María Luz Padilla Del Rey, George Ramsay, Dusica Stamenkovic, Abdul Wasay, Esther Pogatzki-Zahn, Patrice Forget","doi":"10.1097/EJA.0000000000002463","DOIUrl":"10.1097/EJA.0000000000002463","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"851-853"},"PeriodicalIF":7.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148561205","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":"Postoperative delirium risk estimation and assessment with machine learning: development and validation of the Open-DREAM Model: A peri-operative dataset analysis.","authors":"Armin Berger, Mia Gisselbaek, Sarah Saxena, Joana Berger-Estilita, Arnout Devos","doi":"10.1097/EJA.0000000000002410","DOIUrl":"10.1097/EJA.0000000000002410","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common and serious complication in older surgical patients, associated with increased morbidity, prolonged hospitalisation and increased healthcare costs. Existing predictive models have limited clinical adoption due to implementation costs, suboptimal accuracy and poor generalisability.</p><p><strong>Objectives: </strong>To develop an open-access, interpretable machine learning (ML) model using only preoperative data to predict the risk of POD in patients aged at least 60 years undergoing surgery.</p><p><strong>Design: </strong>Observational diagnostic study using prospectively collected routine care data.</p><p><strong>Setting: </strong>Single secondary care hospital in Switzerland, January 2023 to January 2024.</p><p><strong>Patients: </strong>A total of 1425 patients were screened; 748 met the inclusion criteria (≥60 years, noncardiac, nonintracranial surgery, no preoperative delirium).</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcome measure: </strong>POD, defined as a Nursing Delirium Screening Scale (Nu-DESC) score at least 2 at any peri-operative assessment.</p><p><strong>Results: </strong>Three ML algorithms were trained and compared: Support Vector Machines; Logistic Regression and XGBoost. The calibrated XGBoost model achieved an area under the receiver operating characteristic curve (AUC) of 0.80, with a sensitivity of 0.89 at the optimal probability threshold of 0.35. Feature selection using SHapley Additive exPlanations (SHAP)-derived rankings reduced the predictor set from 55 to 15 features without loss of AUC. Type of anaesthesia (spinal vs. general) was the strongest predictor.</p><p><strong>Conclusions: </strong>An open-access ML-based model using routinely collected preoperative variables can predict POD with high sensitivity and preserved interpretability. External validation is warranted. Future research should explore causal inference for modifiable risk factors, acknowledging the limitations of observational data. This open-access application is currently intended for research and educational use only until external validation confirms its performance in independent patient groups.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"820-829"},"PeriodicalIF":7.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766334","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":"Clinical effectiveness of transversus abdominis plane block versus local anaesthesia wound infiltration for postoperative pain relief after laparoscopic appendicectomy in children: A multicentre, double-blind, randomised, controlled phase III trial.","authors":"Geoffrey Bloy, Amelie Jurine, Sebastien Pili-Floury, Frederic Auber, Olivier Hild, Pierre-Gregoire Guinot, Belaid Bouhemad, Michel Francois, Lucie Vettoretti, Romain Bronnert, Maxime Nguyen, Yann Chaussy, Guillaume Besch","doi":"10.1097/EJA.0000000000002367","DOIUrl":"10.1097/EJA.0000000000002367","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain relief after laparoscopic appendicectomy in children provided by transversus abdominis plane (TAP) block and local anaesthesia wound infiltration (LAWI) of trocar insertion sites has never been compared.</p><p><strong>Objective: </strong>To investigate whether TAP block could decrease postoperative opioid requirements after laparoscopic appendicectomy in children compared with LAWI.</p><p><strong>Design: </strong>Multicentre, double-blind, phase III randomised trial.</p><p><strong>Setting: </strong>Two tertiary paediatric surgery centres.</p><p><strong>Patients: </strong>Children aged 3 to 15 years admitted for laparoscopic appendicectomy.</p><p><strong>Main outcome measures: </strong>The primary outcome was the total dose of nalbuphine delivered within 24 h after surgery. Secondary outcomes were the Face Legs Activity Cry Consolability (FLACC) scale values at 1, 2, 6, 12 and 24 h, the time from levobupivacaine injection to the first dose of nalbuphine, and the time from the end of surgery to the first mobilisation. Patients received either ultrasound-guided TAP block (TAP group) or LAWI of trocar insertion sites (infiltration group) with 0.6 ml kg -1 of levobupivacaine 2.5 mg ml -1 , combined with standardised systemic multimodal analgesia including paracetamol, ketoprofen, phloroglucinol and nalbuphine.</p><p><strong>Results: </strong>Forty-six and 50 patients were analysed in the TAP and infiltration groups, respectively [age: 10 [7 to 12] versus 10 [8 to 12] years; females: 16 (35%) versus 25 (50%); duration of surgery: 71 [64 to 90] versus 69 [56 to 89] min]. The primary outcome (total nalbuphine dose) was 0.2 [0.0 to 0.2] and 0.2 [0.0 to 0.2] mg kg -1 in the TAP and infiltration groups, respectively ( P  = 0.95). FLACC scale values did not significantly differ between the two groups ( P  = 0.78). Time to the first dose of nalbuphine or to first mobilisation was not significantly different between groups ( P value for log-rank test = 0.095 and 0.18, respectively).</p><p><strong>Conclusion: </strong>TAP block does not appear to provide a greater opioid-sparing effect than LAWI of trocar insertion sites after laparoscopic appendicectomy in children, when combined with systemic multimodal analgesia including nonsteroidal anti-inflammatory drugs.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04969133.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"842-850"},"PeriodicalIF":7.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347838","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":"Comparison of the efficacy of different interventions for rebound pain after brachial plexus block in upper extremity surgery: A systematic review and network meta-analysis.","authors":"Wenhui Ma, Lihai Chen, Di Zhou, Jiayu Jin, Liu Han","doi":"10.1097/EJA.0000000000002486","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002486","url":null,"abstract":"<p><strong>Background: </strong>Rebound pain is a common transient severe pain after peripheral nerve block subsidence, impairing block efficacy and patient satisfaction.</p><p><strong>Objective: </strong>This study aimed to evaluate the preventive and therapeutic effects of six interventions - dexamethasone, esketamine, dexmedetomidine, liposomal bupivacaine, continuous nerve block and combined nerve block (brachial plexus block via multiple approaches) - on rebound pain after upper extremity surgery brachial plexus block to provide evidence-based references for optimising clinical analgesic regimens.</p><p><strong>Design: </strong>Bayesian network meta-analysis.</p><p><strong>Datasources: </strong>PubMed, Web of Science, Embase and Cochrane Library were searched up to 10 October 2025.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs) assessing the efficacy of the above interventions for rebound pain prevention and treatment after brachial plexus block in upper extremity surgery.</p><p><strong>Results: </strong>A total of 22 RCTs involving 1699 patients were included. Network meta-analysis showed that compared with placebo, dexamethasone [odds ratio (OR) = 0.22 (95% CI, 0.11 to 0.42), dexmedetomidine (OR = 0.23 (95% CI, 0.08 to 0.68)] and continuous nerve block [OR = 0.04 (95% CI, 0.01 to 0.33)] significantly reduced rebound pain incidence. Dexamethasone [mean difference (MD) = -2.54 (95% CI, -4.76 to -0.26)] and continuous nerve block [MD = -3.10 (95% CI, -5.86 to -0.23)] lowered 12-h postoperative pain scores. Compared with placebo, combined nerve block [MD = -0.86 (95% CI, -1.59 to -0.13)] reduced postoperative 24-h pain scores. SUCRA results ranked continuous nerve block as the most favourable intervention for reducing rebound pain and 12-h/24-h postoperative pain scores. These reflect relative probabilities rather than absolute efficacy and require further validation.</p><p><strong>Conclusion: </strong>In patients undergoing upper-extremity surgery with brachial plexus block, current network meta-analysis findings suggest that continuous nerve block is associated with a lower incidence of rebound pain and reduced pain scores at 12 and 24 h postoperatively, although further validation is still required. We recommend that continuous nerve block may be considered for patients at high risk of rebound pain to balance efficacy and safety. Given the limited certainty of evidence, these findings should be regarded as exploratory and hypothesis-generating rather than definitive conclusions.</p><p><strong>Trial registration: </strong>PROSPERO (CRD420251251811).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982012","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 Østergaard Declaration: A European Society of Anaesthesiology and Intensive Care statement on advancing simulation-based education and training.","authors":"Joana Berger-Estilita, Crina L Burlacu, Doris Østergaard, Yitzhak Brzezinski Sinai, Benedikt Preckel, Iulia Crişan, Cristina Diaz-Navarro, Anne Marie Camilleri Podesta, Sibylle Langenecker, Emilia Guasch, Olegs Sabelnikovs, Else-Marie Ringvold, Wolfgang Buhre, Idit Matot","doi":"10.1097/EJA.0000000000002431","DOIUrl":"10.1097/EJA.0000000000002431","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"719-722"},"PeriodicalIF":7.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041663","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":"Effect of remote ischaemic preconditioning on acute kidney injury after heart transplantation (RIPCAT): A randomised controlled feasibility trial.","authors":"René M'Pembele, Julian D Jagdfeld, Leila S Henning, Ragnar Huhn, Giovanna Lurati Buse, Udo Boeken, Sebastian Roth","doi":"10.1097/EJA.0000000000002442","DOIUrl":"10.1097/EJA.0000000000002442","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"785-789"},"PeriodicalIF":7.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257887","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":"Consensus document on electroencephalography education in anaesthesiology: defining learning outcomes: A modified four-round Delphi study.","authors":"Joana Berger-Estilita, Dana Baron Shahaf, Odmara L Barreto Chang, Vincent Bonhomme, Iulia Crisan, Juan L Fernández-Candil, Paul S Garcia, Mia Gisselbaek, Bryan A Glezerson, Darren Hight, Karina Jakobsen, Ivan Jonassen Rimstad, Heiko A Kaiser, Stephan Kratzer, Susanne Koch, Ozlem Korkmaz Dilmen, Matthias Kreuzer, Janna Helfrich, Friedrich Lersch, Francisco A Lobo, Adrian P Marty, Isabel Marcolino, Başak C Meco, Ben Palanca, Stefanie Pilge, Finn M Radtke, Frank Rasulo, Aeyal Raz, Stefano Romagnoli, Carolina S Romero, Gerhard Schneider, Pablo O Sepúlveda, Daniel Shmukler, Barbara Sinner, Martin Soehle, Felipe S Thyrso de Lara, Susana Vacas, Sérgio Vide, Falk von Dincklage, Sarah Saxena, Anthony R Absalom","doi":"10.1097/EJA.0000000000002346","DOIUrl":"10.1097/EJA.0000000000002346","url":null,"abstract":"<p><strong>Background: </strong>The brain is the primary target of general anaesthesia, yet routine brain monitoring remains underutilised. Although electroencephalography (EEG) is increasingly recognised as an important tool for assessing brain states during anaesthesia, inconsistent training and over-reliance on processed indices have hindered its adoption in clinical practice.</p><p><strong>Objectives: </strong>To define a set of core learning outcomes for EEG education in anaesthesiology through expert consensus, aiming to support the development of a structured, tiered curriculum for both basic and advanced EEG training.</p><p><strong>Design: </strong>Modified four-round Delphi study.</p><p><strong>Setting: </strong>Multinational, online Delphi panel involving 33 anaesthesiology experts across various academic and clinical institutions. The study was conducted between 29 May 2023 and 28 November 2024.</p><p><strong>Participants: </strong>Thirty-three international anaesthesiology experts with recognised experience in EEG use, teaching and/or research. Experts were purposively sampled to ensure diversity in geography, clinical background, subspecialty focus and broad spectrum of perspectives.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Consensus on learning outcomes, defined as at least 80% agreement (score of 9 or 10) on a 10-point Likert scale for Rounds 1 to 3, or at least 80% agreement for binary yes/no responses in Round 4.</p><p><strong>Results: </strong>Consensus was achieved for 58 out of 191 learning outcomes across both basic and advanced EEG training levels. Accepted items were grouped into dimensions, including EEG Fundamentals, Raw EEG, Anaesthetic Effects, Processed EEG, Artefacts, Nociception, Patient Variability, Integration with Anaesthetic Management, Clinical Immersion and Continuous Professional Learning. Foundational dimensions had higher agreement than advanced or emerging areas, such as neurofeedback or pharmacogenomics.</p><p><strong>Conclusions: </strong>This Delphi consensus defines a comprehensive framework of EEG learning outcomes for anaesthesiology education. The framework supports the development of structured curricula and reflects a growing need for EEG competence in anaesthesia practice to improve patient monitoring and safety. Further research is needed to validate the outcomes in educational and clinical settings.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"737-748"},"PeriodicalIF":7.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13566452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219071","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":"2026 ESAIC Consensus Document on Mitigation Strategies in Intensive Care Medicine: Consensus document of the European Society of Anaesthesiology and Intensive Care.","authors":"Susanne Koch, Federico Bilotta, Luca Brazzi, Anna Marie Camilleri Podesta, Moisés Canle, Edoardo De Robertis, Sebastian Gibb, Patricio Gonzalez-Pizarro, Philip Henderson, Vivian H Y Ip, Susanne Jöbges, Peter Kranke, Janett Kreutziger, Paul McConnell, Victoria Metaxa, Giorgia Montrucchio, Jane Muret, Sabine Pecher, Carolina S Romero, Nicolaas H Sperna Weiland, Andrea Tomassi, Alexandra Trinks, Wolfgang Buhre","doi":"10.1097/EJA.0000000000002420","DOIUrl":"10.1097/EJA.0000000000002420","url":null,"abstract":"<p><p>Due to the continued use of fossil fuels and other chemical pollutants, atmospheric greenhouse gas concentrations and environmental pollution continue to rise. The health sector is both a driver and a victim of these developments, and intensive care medicine (ICM), with its high energy demands, extensive use of disposable products, and large variety of pharmaceuticals, contributes substantially to the climate crisis and environmental degradation. The European Society of Anaesthesiology and Intensive Care (ESAIC) therefore aimed to develop consensus recommendations to reduce the environmental footprint of ICM across Europe. A total of 37 recommendations were initially drafted by four topic groups (1) energy, (2) waste management, (3) medication, and (4) ethics-each composed of three to five experts. To facilitate implementation in both middle- and high-income European countries, the agreement threshold was set at 80%. The recommendations were validated by 37 experts from 20 countries using a two-step Delphi procedure. In the first round, all recommendations reached at least 75% agreement. After amendments to four recommendations based on expert feedback, all achieved over 80% approval in the second round, with 32 receiving more than 90% agreement. The final recommendations address: (1) a complete transition to renewable energy and implementation of energy-saving strategies; (2) optimisation of procurement in clinical processes (10Rs) and waste management solutions for single-use plastics; (3) reduction of greenhouse gas emissions (mainly fluorinated gases) and water toxicity caused by medications, as well as prevention of a further increase in antimicrobial resistance (AMR); and (4) implementation of an environment-related, ethically guided precautionary principle. This ESAIC consensus provides a practical framework for sustainable ICM. Stakeholders at all levels should now introduce these recommendations through institutional policies, procurement criteria, guidelines and quality improvement programmes to align intensive care practice with planetary health goals.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"723-736"},"PeriodicalIF":7.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375025","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}