European Journal of Anaesthesiology最新文献

{"title":"The effect of combining lidocaine and ropivacaine on the duration and onset time of an ultrasound-guided infraclavicular brachial plexus nerve block: A randomised controlled trial.","authors":"Sina Yousef, Mathias Therkel Steensbæk, Aurelien-Xuan Rosendal Bahuet, Rasmus Linnebjerg Knudsen, Cecilie Dupont Harwood, Charlotte Vallentin Rosenstock, Michelle Fog Andersen, Christian Rothe, Kai Henrik Wiborg Lange, Anders Kehlet Nørskov, Lars Hyldborg Lundstrøm","doi":"10.1097/EJA.0000000000002261","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002261","url":null,"abstract":"<p><strong>Background: </strong>The combination of short- and long-acting local anaesthetics is traditionally associated with reduced block duration, though evidence remains inconsistent.</p><p><strong>Objectives: </strong>To investigate the effects of a fixed or reduced dose of a long-acting local anaesthetic (ropivacaine) mixed with a short-acting agent (lidocaine-epinephrine) on duration of analgesia and sensory onset time in lateral infraclavicular blocks.</p><p><strong>Design: </strong>Randomised, blinded, active-controlled superiority trial.</p><p><strong>Setting: </strong>A tertiary hospital in the Capital Region of Denmark, from 18 April to 23 November 2024.</p><p><strong>Patients: </strong>Seventy-eight patients undergoing hand surgery under lateral infraclavicular brachial plexus nerve block.</p><p><strong>Intervention: </strong>Patients were allocated to three groups: R150: 30 ml ropivacaine 5 mg ml -1 , R100-L200: 20  ml ropivacaine 5 mg ml -1 + 10 ml lidocaine-epinephrine 20 mg ml -1 + 5 μg ml -1 and R150-L200: 20 ml ropivacaine 7.5 mg ml -1 + 10 ml lidocaine-epinephrine 20 mg ml -1 + 5 μg ml -1 .</p><p><strong>Main outcome measures: </strong>The primary outcome was duration of analgesia, and secondary outcomes included sensory onset time.</p><p><strong>Results: </strong>The duration of analgesia was 847 (152) min in the R150 group, 536 (198) min in the R100-L200 group, and 671 (234) min in the R150-L200 group. Compared with that in the R150 group, the mean duration of analgesia was reduced by 311 min (95% confidence interval [CI], 212 to 411; P  < 0.001) in the R100-L200 group and by 177 min (95% CI, 64 to 289; P = 0.003) in the R150-L200 group. The difference between the R100-L200 and R150-L200 groups was not statistically significant after adjustment for multiple testing (135 min; 95% CI, 13 to 257; P  = 0.031). Sensory onset times ranged insignificantly from 17 to 18 min across groups.</p><p><strong>Conclusion: </strong>Mixing lidocaine-epinephrine with ropivacaine significantly shortened the duration of analgesia by up to 5 h without affecting the sensory onset time. This effect was independent of the ropivacaine dose.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov identifier: NCT06381622.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947503","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":"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":"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":"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}

{"title":"Perioperative care of the geriatric patient.","authors":"Elke K M Tjeertes, Georg B Schmidt, Francesco U S Mattace-Raso","doi":"10.1097/EJA.0000000000002257","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002257","url":null,"abstract":"<p><p>Increasing numbers of older patients will be undergoing surgery in the future, with benefits including symptom relief and extended longevity. Despite these advantages from successful surgery, geriatric patients are at risk of adverse perioperative events, particularly those who are frail. Anatomical and physiological changes due to ageing occur in all organ systems and can have a profound impact on the surgical stress response and recovery. Deciding whether older patients will benefit from surgery can be a difficult task. Due to the diversity of age-related physiological changes and comorbidities in individual patients, differentiation between the fit and the frail elderly is an important step. Despite older age, some studies demonstrated that the odds of a favourable outcome can be improved with preoperative optimisation, leading to better outcomes. Better outcomes are beneficial for patients and can also relieve the growing burden on the healthcare system. A patient-centred care plan, understanding an individual patient's potential risks and integrating a multidisciplinary approach are key principles of good perioperative care. Also, the patient's willingness and short- and long-term goals, such as maintaining functional independence, or pain relief must be considered. However, if surgical treatment is deemed futile and death is to be expected as an unavoidable outcome, multidisciplinary collaboration in guiding patient care and supporting the family can be of great value. It helps to relieve suffering, and supports a dignified and meaningful dying process. This narrative review aims to explore key aspects of perioperative care in older surgical patients, with particular attention to frailty, shared decision-making, and advance care planning.</p>","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":"144774948","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}