European Journal of Anaesthesiology最新文献

{"title":"Challenging cases in palliative care.","authors":"","doi":"10.1097/EJA.0000000000002170","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002170","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"577"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993057","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 neuraxial anaesthesia or analgesia on postpartum relapse rates in multiple sclerosis: A systematic review.","authors":"Dimitrios Ioannopoulos, Kleanthi Manika, Panagis M Lykoudis, Marianna Papadopoulou, Eleftheria Lelekaki, Zoi Tsani, Pinelopi Kouki","doi":"10.1097/EJA.0000000000002155","DOIUrl":"10.1097/EJA.0000000000002155","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is a chronic autoimmune disease affecting primarily women of childbearing age. Recent advancements in treatment have led to more women with MS pursuing motherhood. Despite much new evidence on the safety of neuraxial anaesthesia/analgesia, many anaesthetists are still reluctant to provide neuraxial anaesthesia/analgesia to these patients.</p><p><strong>Objective: </strong>The present systematic review aimed to evaluate the safety of administrating neuraxial anaesthesia/analgesia to parturients with MS.</p><p><strong>Outcome: </strong>The incidence of MS relapses occurring up to 1 year after childbirth was the main outcome of interest.</p><p><strong>Design: </strong>A systematic review of randomised and non-randomised controlled trials.</p><p><strong>Data sources: </strong>MEDLINE (PubMed), Library of Congress and LiSTA (EBSCO) were searched to identify eligible trials.</p><p><strong>Eligibility criteria: </strong>Randomised or nonrandomised prospective studies and retrospective comparative studies, comparing MS relapses following caesarean section or vaginal delivery were included.</p><p><strong>Results: </strong>Eight studies involving 1315 parturients were included. There was no statistically significant difference in the incidence of postpartum relapses between women who received neuraxial anaesthesia/analgesia and those who did not ( P  > 0.05). A statistically significant increase in the probability of a relapse was consistently observed across the majority of studies in women who had experienced relapses during pregnancy or during the year preceding the pregnancy ( P  < 0.05).</p><p><strong>Conclusion: </strong>Neuraxial analgesia/anaesthesia does not increase the risk of postpartum relapse in MS parturients in the year following delivery. The risk of postpartum relapse is related to symptom exacerbation during the year before pregnancy or during pregnancy. Adequately powered, prospective, studies are strongly recommended to confirm the above results.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"508-517"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522801","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 ability of shock index to predict refractory postpartum haemorrhage: A secondary analysis of the prospective and multicentre HELP MOM study.","authors":"Mohamed Aziz Daghmouri, Sébastien Repplinger, Emmanuel Weiss, Marie-Pierre Bonnet, Morgan Le Guen, Souhayl Dahmani, Anne Sophie Ducloy Bouthors, Alexandre Mebazaa, Etienne Gayat, Benjamin Deniau","doi":"10.1097/EJA.0000000000002142","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002142","url":null,"abstract":"<p><strong>Background: </strong>The predictability of severe and refractory postpartum haemorrhage (PPH) remains a challenge for clinicians and researchers.</p><p><strong>Objective: </strong>We aimed to evaluate the ability of the shock index to predict refractory PPH.</p><p><strong>Design: </strong>This study was a secondary analysis of a multicentre, prospective, observational study investigating the association between severe postpartum haemorrhage (PPH) and the subsequent development of mental disorders.</p><p><strong>Setting: </strong>Participants were patients who experienced severe PPH, characterised by blood loss of at least 1500 ml requiring the administration of sulprostone. The shock index, defined as the ratio of heart rate to SBP, was recorded at two time points: at the start of sulprostone infusion (T0) and at the time of the most severe symptoms after enrolment but before the occurrence of refractory PPH (T1). Refractory PPH was defined by the need for four or more blood products, interventional radiology, or laparotomy (excluding caesarean section).</p><p><strong>The main outcome: </strong>The predictive ability of the shock index was assessed using univariate and multivariate logistic regression and area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>From November 2014 to November 2016, 332 patients experienced severe PPH, of which 316 were included in the final analysis. The prevalence of refractory PPH was 35.4% (112/316). We found that high shock index levels at T0 were independently associated with the occurrence of refractory PPH: odds ratio (OR) 3.07 [95% confidence interval (CI), 1.22 to 7.89, P  = 0.017]. In addition, high shock index levels at T1 were also independently associated with the occurrence of refractory PPH: OR 5.28 (95% CI, 2.25 to 12.8), P  < 0.001. The AUROC of shock index levels measured at T0 and T1 were 0.614 (95% CI, 0.549 to 0.678) and 0.681 (95% CI, 0.616 to 0.746), respectively.</p><p><strong>Conclusion: </strong>The shock index measured at the start of sulprostone infusion and at the worst time after enrolment, has poor discriminative power to predict this event.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"500-507"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990551","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":"Spinal after failed labour epidural.","authors":"Sonia Vaida, Revati Kanekar","doi":"10.1097/EJA.0000000000002177","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002177","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"575-576"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970740","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 importance of the presence of chosen family in preventing peri-operative delirium.","authors":"Yotam Weiss, Sarah Saxena, Mia Gisselbaek, Joana Berger-Estilita, Idit Matot","doi":"10.1097/EJA.0000000000002169","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002169","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"488-491"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985602","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":"Incidence and management of accidental dural puncture and postdural puncture headache in parturients: Retrospective database study.","authors":"Stav Cohen, Chaim Greenberger, Boris Aptekman, Victor Rabkin, Carolyn F Weiniger","doi":"10.1097/EJA.0000000000002130","DOIUrl":"10.1097/EJA.0000000000002130","url":null,"abstract":"<p><strong>Background: </strong>Postdural puncture headache (PDPH) is a common complication of neuraxial block resulting from either intentional dural puncture (IDP) or accidental dural puncture (ADP).</p><p><strong>Objectives: </strong>The primary objective was to estimate the rate of PDPH and ADP following introduction of a real-time documentation system in April 2018. Secondary objectives included examining the use of epidural blood patch (EBP) and investigating risk factors associated with ADP and PDPH.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Secondary care at a tertiary hospital from January 2017 to April 2022.</p><p><strong>Patients: </strong>Three hundred and eleven adult parturients after neuraxial block, with PDPH or a reported ADP, were identified during the procedure or postpartum.</p><p><strong>Interventions: </strong>Implementation of a real-time documentation system in April 2018 to improve PDPH and ADP documentation.</p><p><strong>Main outcome measures: </strong>Rates of PDPH and ADP, performance of epidural blood patch, and risk factors associated with PDPH and ADP.</p><p><strong>Results: </strong>The overall rate of PDPH was 0.4% (164/39888), 95% confidence intervals (CI) 0.0036 to 0.0049, and the rate of ADP was 0.9% (284/31635), 95% CI 0.0078 to 0.0099. During the real-time documentation period, the rates were 0.44% (157/35376), 95% CI 0.0038 to 0.0052, and 0.99% (279/28121), 95% CI 0.0088 to 0.0111, for PDPH and ADP respectively. Thirty-two (10.3%) cases had IDP, and 279 (89.7%) had ADP. Among 279 ADP cases, 76.3% were identified during the procedure, 10.4% were suspected and 13.3% were identified postpartum. Cases of ADP identified postpartum had more emergency room visits (19%). Epidural blood patch was administered in 72% of PDPH cases, with a high first-time success rate (89.5%); Eleven women received EBP after IDP.</p><p><strong>Conclusions: </strong>Postdural puncture headache remains a significant concern. In our cohort, 13.3% of ADP cases were detected postpartum, posing an increased challenge and underscoring the critical importance of follow-up care. We confirm that epidural blood patch may be required following any neuraxial block.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"492-499"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398655","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":"Hypotension prediction: advancing the debate or retreading old ground?","authors":"Michelle S Chew, Dan Longrois, Malachy O Columb","doi":"10.1097/EJA.0000000000002166","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002166","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"485-487"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062436","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":"Sodium-glucose cotransporter-2 inhibitors and the significant risk of euglycaemic keto-acidosis in cardiac surgery.","authors":"José Ginestal, José Luis Flordelís, José Luis Pérez-Vela","doi":"10.1097/EJA.0000000000002167","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002167","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"571-572"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974252","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":"Comparative study of labour analgesia onset with injection of loading dose through epidural needle versus catheter: a prospective, double-blinded, randomised clinical trial.","authors":"Weijia Du, Zhiqiang Liu","doi":"10.1097/EJA.0000000000002159","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002159","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"567-568"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987217","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 hypotension prediction index versus mean arterial pressure in predicting intraoperative hypotension: A clinical perspective.","authors":"Santino R Rellum, Sijm H Noteboom, Björn J P van der Ster, Jaap Schuurmans, Eline Kho, Alexander P J Vlaar, Jimmy Schenk, Denise P Veelo","doi":"10.1097/EJA.0000000000002150","DOIUrl":"10.1097/EJA.0000000000002150","url":null,"abstract":"<p><strong>Background: </strong>The hypotension prediction index (HPI) predicts hypotension, with randomised trials showing a significant reduction in hypotension-related metrics. However, the reliability of previous validation studies is debated, and it's unclear if mean arterial pressure (MAP) can be used interchangeably with HPI.</p><p><strong>Objectives: </strong>This study compared the effectiveness of HPI versus MAP thresholds in predicting intraoperative hypotension, focusing on three clinically relevant metrics: time from alert to event, positive predictive value (PPV), and proportion of missed hypotensive events.</p><p><strong>Design: </strong>Prospective observational study conducted between 2018 and 2020.</p><p><strong>Setting: </strong>Single-centre, academic hospital in the Netherlands.</p><p><strong>Participants: </strong>Adults scheduled for elective non-cardiac surgery lasting over two hours. Of the 105 eligible patients, 91 had sufficient data for analysis.</p><p><strong>Main outcome measures: </strong>The primary outcome was the time-to-hypotensive event intervals predicted by HPI popup alerts (≥85 for ≥40 s) and MAP-alerts (70-75 mmHg). Secondary analyses examined differences between these predictors regarding the PPV and missed event rates, as well as the difference in these metrics between instant HPI-85 alerts and the six MAP-alerts.</p><p><strong>Results: </strong>The largest time-to-event difference was seen between HPI-85 popup and MAP-70 alerts, with a gain of 0.58 (95% confidence interval (CI), 0.57 to 0.58) min, favouring HPI. Higher MAP thresholds reduced this time difference, but worsened PPV values, with 20.5 (95% CI, 20.3 to 20.6)% at MAP-75 compared to 55.6 (95% CI, 55.4 to 55.8)% for HPI-85 popups. Missed event proportions were similar: between one to three percent. Instant HPI-85 and MAP-72 alerts showed comparable performance, but both had suboptimal PPV values around 30%. However, adding a 40-s time-dependence to MAP's alert definition levelled the differences across the three evaluated metrics, aligning more closely with HPI-85 popup alerts.</p><p><strong>Conclusions: </strong>Using HPI-85 popup alerts does not provide additional prediction time over MAP-alerts in the 70 to 75 mmHg range, but they may be preferred due to higher PPV values. Instant HPI-85 and MAP-alerts perform similarly, with MAP-72 being closest, though these alerts more frequently occur regardless of subsequent hypotension with the potential to introduce unnecessary treatment. Adding a 40-s time-dependence to MAP-alerts to match the HPI popup characteristic eliminates distinctions between prediction time and missed events, while maintaining the higher PPV. However, whether 40sec-MAP-alerts are clinically equivalent remains to be determined in prospective clinical trials.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov NCT03795831 on 10 January 2019.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"527-535"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514977","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}