European Journal of Anaesthesiology最新文献

{"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":"https://doi.org/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. https://clinicaltrials.gov/study/NCT03795831.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central/mixed venous oxygen saturation and lactate levels might be of limited use as physiologic transfusion triggers in cardiac surgery: Results of a retrospective analysis.","authors":"Matthias Noitz, Roxane Brooks, Christine Schlömmer, Thomas Tschoellitsch, Tina Tomić Mahečić, Robert Baronica, Alexander Maletzky, Andreas Zierer, Martin W Dünser, Jens Meier","doi":"10.1097/EJA.0000000000002149","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002149","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines differ in their recommendations regarding the use of physiologic transfusion triggers to guide transfusion practice. Data on the interaction between haemoglobin (Hb) and physiologic transfusion triggers, or their response to packed red blood cell (pRBC) transfusions are limited.</p><p><strong>Objectives: </strong>This study aimed to evaluate the interactions between Hb, mixed/central venous oxygen saturation (SvO2) and lactate levels as well as their changes (ΔSvO2, Δlactate) in response to pRBC transfusion in cardiac surgery patients.</p><p><strong>Design: </strong>Retrospective exploratory data analysis.</p><p><strong>Setting: </strong>A 22-bed intensive care unit (ICU) at a single tertiary academic centre and university hospital in Austria.</p><p><strong>Patients: </strong>Adult (age ≥ 18 years) patients who underwent cardiac surgery.</p><p><strong>Main outcome measures: </strong>Pearson correlation coefficients (r) and coefficients of determination (r2) between Hb, mixed/central venous oxygen saturation (SvO2), and lactate levels. Pearson correlation coefficients (r) and coefficients of determination (r2) between ΔSvO2, Δlactate and pretransfusion Hb.</p><p><strong>Results: </strong>A total of 5025 cardiac surgery patients, in whom 20 542 blood gas analyses were performed, were included in the final analysis. Correlations between Hb levels and SvO2 (r2 = 0.026, P < 0.001) and between Hb and lactate levels (r2 = 0.001, P < 0.001) were statistically significant but weak overall. No correlations were found between ΔSvO2 (r2 = 0.002, P = 0.13) or Δlactate (r2 = 0.003, P = 0.087) and pretransfusion Hb levels.</p><p><strong>Conclusions: </strong>Hb, SvO2 and lactate levels were only weakly correlated with each other, and changes in SvO2 and lactate levels in response to pRBC transfusion did not correlate with pretransfusion Hb. Our findings question the usefulness of SvO2 and lactate levels as physiologic transfusion triggers to guide transfusion practice in cardiac surgery patients.</p><p><strong>Trial registration: </strong>Johannes Kepler University Ethics Committee Study Reference Number 1063/2023.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522814","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":"Pupillary dilation to monitor nociception in awake volunteers: A stimuli-randomised placebo-controlled study.","authors":"Nathalie M Malewicz-Oeck, Nic Skorupka, Felix Bartholmes, Adeline Dombrowski, Melanie Ebel, Peter K Zahn, Christine H Meyer-Frießem","doi":"10.1097/EJA.0000000000002143","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002143","url":null,"abstract":"<p><strong>Background: </strong>Pupillary reflex dilation (PRD) quantifies nociception in anaesthetised patients, enabling tailored opioid administration, which in turn reduces catecholamine levels and postoperative pain intensity. However, its utility in objectively assessing pain in awake individuals remains challenging.</p><p><strong>Objective: </strong>To investigate whether PRD can differentiate between painful and nonpainful stimuli in awake volunteers.</p><p><strong>Design: </strong>This was a randomised, placebo-controlled, stimuli-randomised study conducted after ethical approval and registration (DRKS00024791).</p><p><strong>Setting: </strong>This single-centre study was performed at BG University Hospital Bergmannsheil Bochum, Germany, between November 2021 and January 2022.</p><p><strong>Volunteers: </strong>Thirty healthy volunteers (25 ± 2 years, 50% male) were included in the study.</p><p><strong>Interventions: </strong>After a rest, the following were stimuli applied to one ventral forearm: an unannounced electric pain stimulus (UPS) and a randomised sequence of either an announced painful stimulus (APS), a placebo or a nonpainful stimulus (NPS).</p><p><strong>Main outcome measures: </strong>Pupil dilatation was measured as PRD (%) for 60 s during the experimental condition \"rest\", and during and after each stimulus application using an AlgiScan device. The participants rated stimulus pain intensity via a numeric rating scale (NRS: 0 = no pain, 10 = most intense pain imaginable). Statistics: Paired t-test, rmANOVA, Spearman's correlation and receiver operating characteristics (ROC), P < 0.05.</p><p><strong>Results: </strong>The subjective pain intensity ratings were higher after APS (6.0 ± 1.9) than after UPS (5.5 ± 1.7, P = 0.007), placebo (0.0 ± 0.0, P = 0.027) and NPS (0.0 ± 0.0, P = 0.001). Similarly, objective pupillary reaction to the stimuli measured using PRD was higher for APS: 13 (97.6% CI, 10.0 to 19.0)% vs. NPS 13 (97.6% CI, 7.0 to 20.0), P = 0.024). UPS elicited the highest PRD of 25 (95.7% CI, 18.0 to 30.0)% vs. rest, P < 0.001; significantly greater than placebo at 13.5 (96.4% CI, 10.0 to 22.0)%, P < 0.001); and NPS at 13 (97.6% CI, 7.0 to 20.0)%, P < 0.0001). However, no significant differences in PRD were observed between APS and UPS despite their electrical similarity. PRD correlated with pain intensity (r = 0.35, P < 0.0001).</p><p><strong>Conclusions: </strong>In awake volunteers, PRD differentiates between painful and nonpainful stimuli and correlates with pain intensity. Noninvasive PRD measurement may be suitable for nociception monitoring in awake individuals.</p><p><strong>Trial registration: </strong>Prospectively DRKS00024791, March 2021.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491353","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":"Levosimendan improves central haemodynamic status and gas exchange in a model of ischaemic cardiac arrest: A large animal study.","authors":"Susanne Rysz, Jonathan Al-Saadi, Francesca Campoccia Jalde, Jesper Nyman, Johan Lundberg, Malin Jonsson Fagerlund, Therese Djärv","doi":"10.1097/EJA.0000000000002144","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002144","url":null,"abstract":"<p><strong>Background: </strong>Ischaemic cardiac arrest has poor survival. In an earlier animal study, we have shown that levosimendan increases the return of spontaneous circulation and survival compared with placebo. However, the impact of levosimendan on central cardiovascular variables and gas exchange during resuscitation in ischaemic cardiac arrest is unknown.</p><p><strong>Objective: </strong>To evaluate levosimendan's dose-response effect on central cardiovascular variables and gas exchange in an established swine cardiac arrest model.</p><p><strong>Design: </strong>A large animal study.</p><p><strong>Setting: </strong>Animal study with Swedish landrace pigs at Karolinska Institutet, Sweden.</p><p><strong>Intervention: </strong>Ten swine underwent induced acute myocardial infarction and ventricular fibrillation. Levosimendan (62.5 μg kg-1) was administered during resuscitation, and immediate outcomes were compared with low dose levosimendan (12 μg kg-1, n  = 12) or placebo (n  = 12) from earlier experiments using the same model.</p><p><strong>Main outcome measures: </strong>Haemodynamic and gas exchange variables during resuscitation. Time to and proportion of return to spontaneous circulation.</p><p><strong>Results: </strong>High-dose levosimendan improved gas exchange, with better arterial O2 and CO2 levels (P < 0.01), reduced systolic pulmonary arterial pressure, central venous pressure and vasopressor support with adrenaline after return to spontaneous circulation compared with low dose and placebo (P = 0.01). All animals in both levosimendan groups achieved return to spontaneous circulation compared with 67% in the placebo group (P = 0.02). Median [IQR] time to return of spontaneous circulation was 15 min [12 to 18] for high dose 17 min [15 to 26] for low dose compared with 23 min [15 to 60] for placebo (P = 0.08).</p><p><strong>Conclusions: </strong>Levosimendan enhances key resuscitation outcomes in the immediate period of ischaemic cardiac arrest, promoting its potential as an effective pharmacological intervention. With an apparent dose-dependent reduction in right ventricular afterload and subsequent improvement in gas exchange, we cautiously propose that levosimendan-induced pulmonary vasodilation alleviates right heart strain and improves interventricular dependency, thereby enhancing the likelihood of return of spontaneous circulation.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440282","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 immunomodulatory effect of sugammadex in vitro and after total hip arthroplasty: A randomised controlled pilot and retrospective cohort study.","authors":"Veerle Bijkerk, Lotte M C Jacobs, Jetze Visser, Esmee V van Helden, Christiaan Keijzer, Leonie S Helder, Kim I Albers, Michiel C Warlé","doi":"10.1097/EJA.0000000000002132","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002132","url":null,"abstract":"<p><strong>Background: </strong>Postoperative immunosuppression is a well known phenomenon associated with infectious complications. Peri-operative immune dysregulation is likely induced by surgical damage and anaesthetics, but remains far from comprehensively characterised. To address this, the effects of individual drugs on immune function must be explored. Sugammadex, a cyclodextrin that encapsulates rocuronium, also binds other drugs and structures and may influence the inflammatory response.</p><p><strong>Objective: </strong>Investigate the potential immunomodulatory effect of sugammadex.</p><p><strong>Design: </strong>An in-vitro experiment, randomised controlled pilot study and retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary teaching hospital.</p><p><strong>Patients: </strong>Twelve healthy donors, 20 adults undergoing total hip arthroplasty and 1000 major abdominal surgery patients.</p><p><strong>Intervention: </strong>In vitro: isolated peripheral blood mononuclear cells were exposed to sugammadex and rocuronium before stimulation with Escherichia coli lipopolysaccharides (LPS).Pilot study: patients undergoing total hip arthroplasty under single shot spinal anaesthesia randomised to sugammadex (8 mg kg-1) or placebo at the end of surgery.</p><p><strong>Main outcome measure: </strong>In vitro: TNF, IL-1β and IL-6 production capacity.Pilot study: Ex-vivo cytokine production capacity after whole blood stimulation with LPS.Retrospective cohort: sugammadex as a predictor of postoperative infectious complications.</p><p><strong>Results: </strong>In vitro: rocuronium suppressed TNF and IL-1β production capacity. Higher doses of sugammadex (100 and 1000 μg ml-1; 100 μg ml-1 corresponds to plasma concentration reached upon 8 mg kg-1 sugammadex) restored suppression of TNF and IL-1β.Pilot study: no differences in ex-vivo cytokine production capacity between the sugammadex and placebo group at the end of surgery or on postoperative day 1.Retrospective cohort study: no association between sugammadex and postoperative infectious complications (OR = 1.000, 95% CI 0.998 to 1.002).</p><p><strong>Conclusion: </strong>Sugammadex preserved cytokine production capacity of TNF and IL-1β in vitro. The clinical pilot study and retrospective cohort study revealed no early postoperative immunomodulatory effects for sugammadex in the clinically used dosing range.</p><p><strong>Trial registration: </strong>clinicaltrials.gov identifier: NCT05723406 and NCT05244655.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432783","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":"https://doi.org/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% suspected and 13.3% identified postpartum. Cases of ADP identified postpartum had more emergency room visits (19%). Epidural blood patch (EBP) was administered in 72% of PDPH cases, with a high first-time success rate (89.5%); 11 women received epidural blood patch 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><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-12","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":"Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery: An updated meta-analysis of randomised controlled trials with meta-regression and trial sequential analysis.","authors":"Burhan Dost, Dario Bugada, Yunus Emre Karapinar, Eleonora Balzani, Muzeyyen Beldagli, Giulia Aviani Fulvio, Mirac Selcen Ozkal Yalin, Esra Turunc, Nicolò Sella, Alessandro De Cassai","doi":"10.1097/EJA.0000000000002148","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002148","url":null,"abstract":"<p><strong>Background: </strong>Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery.</p><p><strong>Objective: </strong>In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h.</p><p><strong>Design: </strong>A meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA).</p><p><strong>Data search: </strong>We systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024).</p><p><strong>Eligibility criteria: </strong>RCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction.</p><p><strong>Results: </strong>Eighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) -1.94 (95% confidence interval (CI) -4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD -2.42 (95% CI -3.56 to -1.29, P < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions.</p><p><strong>Conclusion: </strong>PVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398678","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":"Is there a benefit of intravenous lidocaine during liver surgery?: A propensity-score weighting analysis.","authors":"Florianne Le Goulven, Alexandre Mansour, Helene Beloeil, Pauline Rouxel","doi":"10.1097/EJA.0000000000002088","DOIUrl":"10.1097/EJA.0000000000002088","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"176-178"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497442","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":"Midclavicle block: An anatomical study.","authors":"Hipólito Labandeyra, Luis F Váldes-Vilches, Alberto Prats-Galino, Xavier Sala-Blanch","doi":"10.1097/EJA.0000000000002079","DOIUrl":"10.1097/EJA.0000000000002079","url":null,"abstract":"<p><strong>Background: </strong>Recent studies indicate that clavipectoral fascia plane block (CPB) efficacy may stem from injectate distribution to the anterosuperior clavicular periosteum. We conducted an anatomical study combining the CPB with injection within the subclavius muscle.</p><p><strong>Objective: </strong>Our hypothesis was that the anaesthetic injectate would fully cover both the anterosuperior and posteroinferior surfaces of the clavicular periosteum in the midclavicular region.</p><p><strong>Design: </strong>Observational human cadaver study.</p><p><strong>Setting: </strong>Laboratory of Surgical Neuroanatomy, Unit of Anatomy and Human Embryology of the Faculty of Medicine and Health Sciences, University of Barcelona.</p><p><strong>Participants: </strong>Five fresh human cadavers.</p><p><strong>Interventions: </strong>The cadavers received both a CPB and subclavius muscle injections under ultrasound guidance in 10 clavicular regions.</p><p><strong>Main outcome measures: </strong>After the procedures on the cadaveric models, an anatomical dissection by planes was performed to evaluate the distribution pattern of methylene blue on the clavicular periosteum. A probabilistic map of the colour spectrum and staining temperature on the clavicular surfaces was generated.</p><p><strong>Results: </strong>Methylene blue stained 37 ± 16% of the anterosuperior surface and 23 ± 13% of the posteroinferior surface of the clavicular periosteum, particularly in the middle third of each surface. Although the staining did not achieve complete circumferential coverage or perfect alignment between the surfaces, the areas exhibited a close relationship, indicating significant distribution and relevant coverage.</p><p><strong>Conclusion: </strong>Our anatomical study demonstrates that the midclavicular block achieves effective distribution around the middle third of the clavicle, although complete circumferential anaesthesia of the clavicular periosteum was not achieved. Although this block may provide periosteal and bone anaesthesia, it does not address other sources of pain, such as muscle spasms and skin components. Additional clinical studies are needed to evaluate the overall efficacy of this dual block technique for clavicle surgery.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"122-130"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497444","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":"XiaoPing Chen, YingYing Tang, QingQing Yu, LiHong Sun, Hua Li, LuYang Wang, Cuicui Jiao, XinZhong Chen","doi":"10.1097/EJA.0000000000002077","DOIUrl":"10.1097/EJA.0000000000002077","url":null,"abstract":"<p><strong>Background: </strong>Rapid onset of epidural analgesia is an important concern for the parturient. Commonly, the local anaesthetic mixture is administered through the epidural catheter. Drugs administered through the epidural needle might decrease the onset time and enhance the spread of medication within the epidural space.</p><p><strong>Objectives: </strong>The primary aim of this study was to compare the onset time of analgesia when a loading dose of dilute local anaesthetic opioid mixture was injected through either the Tuohy needle or a single end-hole epidural catheter.</p><p><strong>Design: </strong>A prospective, double-blinded, randomised clinical trial.</p><p><strong>Setting: </strong>Single university hospital, from November 2022 to August 2023.</p><p><strong>Participants: </strong>A total of 200 healthy nulliparous women who requested epidural analgesia for labour were randomly allocated to the needle group (n = 100) or the catheter group (n = 100).</p><p><strong>Interventions: </strong>In the needle group, after identification of the epidural space, a test dose of 3 ml 0.1% ropivacaine with 0.3 μg ml-1 sufentanil was injected through the Tuohy needle followed 3 min later by a 15 ml loading dose of the same mixture over 30 s. Then the catheter was inserted into the epidural space. In the catheter group, after identification of the epidural space, a catheter was advanced into the epidural space and the ropivacaine/sufentanil mixture was injected in an identical manner though the catheter.</p><p><strong>Main outcome mearsures: </strong>The primary outcome was the onset time of labour analgesia (defined as the time from drug administration to adequate analgesia). Adequate analgesia was defined as a visual analogue score 10 mm or less during uterine contractions.</p><p><strong>Results: </strong>Median [IQR] onset time of labour analgesia did not differ significantly between the two groups (needle group: 20 [16 to 30] minutes; catheter group: 20 [15 to 25] minutes, P = 0.232).</p><p><strong>Conclusion: </strong>Compared with bolus injection though a single end-hole epidural catheter, injection through the epidural needle did not shorten the analgesia onset time for adequate labour analgesia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05594771).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 2","pages":"113-121"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914039","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}