European Journal of Anaesthesiology最新文献

{"title":"Anaesthesia as a risk factor for long-term cognitive decline: Results of the prospective MAAS cohort study.","authors":"Christoph H Pennings, Martin Van Boxtel, Dianne De Korte-De Boer, Wolfgang Buhre, Carine J Vossen","doi":"10.1097/EJA.0000000000002133","DOIUrl":"10.1097/EJA.0000000000002133","url":null,"abstract":"<p><strong>Background: </strong>There are concerns whether (repeated) exposure to general anaesthesia is associated with long-term cognitive decline.</p><p><strong>Objective: </strong>We investigated the potential, negative relationship between total exposure to surgery under general anaesthesia and its impact on long-term cognitive development.</p><p><strong>Design: </strong>A prospective longitudinal cohort study.</p><p><strong>Setting: </strong>The Netherlands.</p><p><strong>Participants: </strong>1823 Adults, aged 25-84 with normal cognitive functioning on inclusion with three serial cognitive assessments between 1995 and 2008, with comprehensive documentation on demographic, lifestyle, and health factors.</p><p><strong>Main outcome measures: </strong>The primary outcomes were test scores in the cognitive domains of learning and memory, executive function, selective attention, mental speed, and information processing speed. Linear mixed models were used to analyse the effects of the estimated total time under general anaesthesia at baseline on cognitive development during a 12-year follow-up period.</p><p><strong>Results: </strong>When adjusting for demographic and systemic health-related factors, prolonged exposure to surgery under general anaesthesia (measured in total baseline minutes) negatively affected three cognitive domains. These included the CST (executive functioning, P  < 0.05), Stroop (selective attention and mental speed, P  < 0.001) and LDST (information processing speed, P  < 0.005). Age and education were the primary factors impacting lifetime cognitive decline. Hypertension, diabetes, and smoking negatively affected various cognitive domains.</p><p><strong>Conclusion: </strong>Increased exposure to surgery under general anaesthesia independently contributes to long-term cognitive decline. Demographic variables and health-related factors are key contributors to accelerated cognitive decline over an individual's lifetime.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"468-477"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440248","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":"Prehabilitation to mitigate postintensive care syndrome in surgical patients: The rationale for a peri-critical illness pathway involving anaesthesiologists and intensive care physicians.","authors":"Anne-Françoise Rousseau, Gabriel Thierry, Bernard Lambermont, Vincent Bonhomme, Joana Berger-Estilita","doi":"10.1097/EJA.0000000000002136","DOIUrl":"10.1097/EJA.0000000000002136","url":null,"abstract":"<p><p>The post-intensive care syndrome (PICS) refers to the long-term physical, psychological and cognitive impairments experienced by intensive care unit (ICU) survivors, while PICS-Family (PICS-F) affects their family members. Despite preventive strategies during the ICU stay, PICS remains a significant concern impacting survivors' quality of life, increasing the healthcare costs, and complicating recovery. Prehabilitation offers a promising approach to mitigating PICS and PICS-F, especially when the ICU stay can be anticipated, such as in the case of major surgery. Recent literature indicates that prehabilitation - interventions designed to enhance patients' functional capacity before critical illness - may mitigate the risk and severity of PICS. Studies have demonstrated that prehabilitation programs can improve muscle strength, reduce anxiety levels and enhance overall quality of life in ICU survivors. Family prehabilitation (prehabilitation-F) is also introduced as a potential intervention to help families to cope with the stress of critical illness. This article aims to explore the role of multimodal prehabilitation and post-ICU follow-up in preventing and managing PICS and PICS-F, focusing on improving patient outcomes, supporting families and optimising healthcare resources. Combining prehabilitation with post-ICU follow-up in peri-critical care clinics could streamline resources and improve outcomes, creating a holistic care pathway. These clinics, focused on both pre-ICU and post-ICU care, would thus address PICS from multiple angles. However, the heterogeneity of patient populations and prehabilitation protocols present challenges in standardising the interventions. Further research is necessary to establish optimal prehabilitation strategies tailored to individual patient needs and to demonstrate their utility in terms of patient outcome.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"419-429"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432781","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":"Outcomes following extended postoperative recovery unit admission in noncardiac surgery: A systematic review and meta-analysis.","authors":"Bernard R Schockaert, René M van Bruchem, Maarten F Engel, Robert Jan Stolker, Felix van Lier, Sanne E Hoeks","doi":"10.1097/EJA.0000000000002145","DOIUrl":"10.1097/EJA.0000000000002145","url":null,"abstract":"<p><strong>Background: </strong>Surgery carries inherent risks, with the postoperative phase being as critical as the intraoperative period. Enhanced perioperative care units, positioned between general wards and intensive care units, aim to provide adequate postoperative management and resource allocation. Despite their widespread implementation, evidence on outcomes remains limited.</p><p><strong>Objectives: </strong>The primary outcome was 30-day or in-hospital mortality following extended postoperative recovery, with subgroup meta-analysis examining enhanced perioperative care units and intensive care units. Secondary outcomes included, among others, hospital length of stay.</p><p><strong>Design: </strong>Systematic review with meta-analysis.</p><p><strong>Data sources: </strong>A comprehensive search was conducted in MEDLINE, Embase, Web of Science, Cochrane Central, and Google Scholar from inception up to 22 April 2024.</p><p><strong>Eligibility criteria: </strong>The search string encompassed extended postoperative recovery units, including enhanced perioperative care units and intensive care units, for noncardiac, nontransplant surgery, excluding speciality-specific, age-specific, indirect and nonsurgical admissions. Two reviewers independently conducted screening, eligibility assessment and quality appraisal.</p><p><strong>Results: </strong>Of 28 179 records screened, 24 were included of which 22 were unique studies. The overall pooled random-effects mortality, based on 15 studies, was 3 (95% confidence interval (CI) 2 to 6)%. Subgroup analysis demonstrated a mortality of 2 (95% CI 1 to 4)% for patients managed in enhanced perioperative care units and 8 (95% CI 4 to 14)% in intensive care units ( χ2  = 7.99; P  < 0.01). Risk of bias (ROBINS I) was moderate to serious, and heterogeneity substantial. Pooled hospital length of stay, based on six studies, was 8.6 (95% CI 5.9 to 11.3) days.</p><p><strong>Conclusion: </strong>Pooled mortality following extended postoperative recovery in noncardiac surgery was 3% (95% CI 2 to 6). Subgroup analysis indicated lower mortality among patients managed in enhanced perioperative care units. However, considerable heterogeneity in operational definitions, unit capabilities, and admission criteria necessitates cautious interpretation while reflecting real-world practices. Delineation through further research is warranted.</p><p><strong>Prospero registration: </strong>CRD42023457051.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"407-418"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584890","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":"Anaesthetic implications of psilocybin and lysergic acid diethylamide: what is old is now new: A narrative review on psychedelics and anaesthesia.","authors":"Mansi Dave, Ron Shore, Tracy Cupido, Chris Haley, David Clinkard","doi":"10.1097/EJA.0000000000002138","DOIUrl":"10.1097/EJA.0000000000002138","url":null,"abstract":"<p><p>Psychedelic drugs, known for their perception-altering properties, are gaining popularity in the treatment of mental health and pain disorders. As exploratory studies demonstrate clinical efficacy with few adverse events, it is expected that more patients will ingest psychedelic drugs. For therapeutic reasons, as with any drug, anaesthesiologists must be aware of its physiological effects and contraindications to ensure the safe provision of anaesthesia. Psilocybin is a 5HT 1A and 5HT 2A serotonin receptor agonist thought to act on excitatory and inhibitory neurons in the brain. Acute ingestion causes sympathetic nervous system activation, which can precipitate haemodynamic instability. Activation of the 5HT serotonin receptors can also place the patient at risk of serotonin syndrome. Chronic use increases plasma concentrations of cortisol, which has implications on prophylactic stress-dosing of glucocorticoids preoperatively. Lysergic acid diethylamide (LSD), a synthetic psychoactive substance, is also a 5HT2 A agonist. LSD has been shown to potentiate opioid analgesics, and monoamine oxidase (MAO) inhibition. Historical reports suggest that LSD has anticholinesterase activity and can prolong neuromuscular block with depolarising muscle relaxants. Mescaline is a poorly understood psychedelic with similar autonomic effects. Historical studies have shown decreased neuromuscular transmission and an association with malignant hyperthermia. When managing patients who have consumed psychedelics drugs, it is important to consider delaying surgery whenever possible, to allow acute intoxication to wane. A high degree of suspicion and an understanding of management principles is vital to the safe conduct of anaesthesia. Future research should explore therapeutic doses of psychedelic drugs to understand physiologic effects at various concentrations.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"430-434"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448626","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":"Eighteen-year analysis of anaesthetic management in Brugada syndrome: The BRUGANAES study.","authors":"Jaume Borrell-Vega, José Daniel Fernández Font, Miguel Linares, Graciela Martínez-Pallí, Alba Isabel-Roquero, Lluis Mont, Josep Brugada, Elena Arbelo, Marc Giménez-Milà","doi":"10.1097/EJA.0000000000002146","DOIUrl":"10.1097/EJA.0000000000002146","url":null,"abstract":"<p><strong>Background: </strong>Brugada syndrome (BrS) is a genetic disorder that increases the risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). Certain drugs (propofol, local anaesthetics), fever, bradycardia, increased vagal tone and electrolyte imbalances can trigger or worsen BrS arrhythmias.</p><p><strong>Objective: </strong>To evaluate the incidence of malignant ventricular arrhythmias during the perioperative period in patients with BrS, hypothesising that common anaesthetic drugs may be safe to use during daily clinical practice.</p><p><strong>Design: </strong>The BRUGANAES study was an observational, retrospective project including BrS patients who underwent various types of anaesthesia.</p><p><strong>Setting: </strong>BrS patients undergoing any type of anaesthesia intervention from 1 January 2006, to 31 December 2023, from a tertiary hospital in Barcelona.</p><p><strong>Main outcome measures: </strong>The primary outcome was the occurrence of malignant ventricular arrhythmias and/or SCD during and up to 30 days postanaesthesia. Secondary outcomes included adverse events during hospitalisation, 30-day readmission rates and 30-day mortality rates.</p><p><strong>Results: </strong>Among 652 BrS patients registered in the hospital, 111 patients and 189 procedures were analysed. General anaesthesia was administered in 51.3% of cases, sedation in 36% and regional/neuraxial anaesthesia exclusively in 12.7%. Overall, nonrecommended drugs (propofol, ketamine and local anaesthetics) were used in 129 (68.3%) procedures, either bolus and/or continuous infusion. Epidural blocks were performed in 34% of regional anaesthesia cases, mostly in obstetrics, and subarachnoid blocks in 31.8%. The primary outcome occurred in two patients intraoperatively (1% of procedures): one with bradycardia-induced ventricular fibrillation after a nonrecommended drug and one with transient ventricular tachycardia after a drug not listed as potentially harmful.</p><p><strong>Conclusion: </strong>To date, this is one of the largest cohorts describing the perioperative approach for BrS patients, including a wide range of anaesthesia procedures and drugs. Most of the patients undergoing anaesthesia for an interventional procedure received an anaesthetic drug classified as not recommended.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"458-467"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406492","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":"Plasma concentrations of total and unbound ropivacaine and its metabolite 2',6'-pipecoloxylidide after popliteal sciatic nerve block in chronic kidney disease patients not receiving haemodialysis: A population pharmacokinetic analysis.","authors":"Seokha Yoo, Byung-Moon Choi, Da Jung Kim, Jin-Tae Kim","doi":"10.1097/EJA.0000000000002194","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002194","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974250","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":"Context-specific clinical applicability of the end-expiratory occlusion test to predict fluid responsiveness in mechanically ventilated patients: A systematic review and meta-analysis.","authors":"Marijn P Mulder, Jan-Willem Potters, Lex M van Loon, Kenny Rumindo, Magnus Hallbäck, Elira Maksuti, Dirk W Donker, Claudius Diez","doi":"10.1097/EJA.0000000000002181","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002181","url":null,"abstract":"<p><strong>Background: </strong>The emergence of context-specific clinical evidence from the end-expiratory occlusion test (EEOT) may change the perception of its operative performance to predict fluid responsiveness.</p><p><strong>Objectives: </strong>Assessment of predictive performance of the EEOT in the intensive care unit (ICU) and operating room.</p><p><strong>Design: </strong>Systematic review of observational diagnostic test accuracy studies with meta-analysis.</p><p><strong>Data sources: </strong>MEDLINE, Embase and Scopus were used as data sources for relevant publications until February 2024.</p><p><strong>Eligibility criteria: </strong>Prospective clinical studies in which the EEOT was used to predict fluid responsiveness in mechanically ventilated adults, regardless of the clinical care context. The operative performance characteristics must also have been reported.</p><p><strong>Results: </strong>Twenty-four studies involving 1073 adult patients (588 receiving intensive care and 485 in the operating room) were systematically reviewed, and 22 studies comprising 1049 volume expansions were meta-analysed. The pooled sensitivity [95% confidence interval (CI)] of the EEOT was 0.87 (0.81 to 0.92), and the pooled specificity was 0.90 (0.85 to 0.94); the median [interquartile range] cardiac index (CI) threshold for a positive test was a 5.0 [3.3 to 5.3] increase. The clinical context, the method used for haemodynamic monitoring, the ratio of the averaging time of the monitoring method to the occlusion time and the levels of positive end-expiratory pressure were identified as significant sources of heterogeneity. However, the occlusion duration, choice of cardiac output marker and tidal volume did not significantly affect its performance. A novel insight is that performance was notably lower in the operating room setting. The likelihood ratios were 14 (positive) and 0.12 (negative) for the ICU, both better than 3.1 and 0.21 for the operating room. The overall quality of the evidence was assessed to be very low, mainly due to high heterogeneity and risk of bias; however, no publication bias was detected.</p><p><strong>Conclusion: </strong>The EEOT for predicting fluid responsiveness in critical care performs acceptably well overall and is a confirmative test. In the operating room and/or with specific technical settings, its performance and clinical utility are reduced, driving the need for more context-specific and patient-specific fluid responsiveness assessments.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984169","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":"Remimazolam for successful sedation in children with left-to-right shunt congenital heart disease: An up-and-down sequential allocation trial.","authors":"Ming Jin, Hongqi Lin, Lin Qiu, Hongdang Xu, Haoran Zhang, Shuhui Hou","doi":"10.1097/EJA.0000000000002183","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002183","url":null,"abstract":"<p><strong>Background: </strong>The findings of this study offer insights into the utilisation of remimazolam for sedation in paediatric patients with left-to-right shunt congenital heart disease (CHD).</p><p><strong>Objective: </strong>To study the median effective dose (ED50) and 95 percentile of the effective dose (ED95) of remimazolam for successful sedation in children with CHD.</p><p><strong>Design: </strong>A nonrandomised, nonblinded study based on the Dixon sequential method.</p><p><strong>Setting: </strong>Tertiary hospitals in Zhengzhou, Henan Province, study dates: 20 October 2023 to 18 May 2024.</p><p><strong>Patients: </strong>A total of 78 patients, comprising 32 males and 45 females, successfully completed the study. They were selected based on the following criteria: children aged 1 to 6 years with left-to-right shunt CHD; ASA physical status II-III. The key exclusion criteria were: history of allergy to sedative drugs; administration of sedative medications other than the study drug before surgery; severe pre-operative liver or kidney dysfunction; pre-operative bradycardia; and severe pre-operative respiratory diseases.</p><p><strong>Intervention: </strong>The sedation status of the patients was observed for 5 min after intravenous administration of different doses of remimazolam.</p><p><strong>Main outcome measures: </strong>The ED50 and ED95 of remimazolam for successful sedation in children with CHD.</p><p><strong>Results: </strong>The ED50 (95% CI) of remimazolam for successful sedation in infants, toddlers and preschool children with CHD were 0.209 (0.184 to 0.234) mg kg-1, 0.259 (0.234 to 0.284) mg kg-1 and 0.266 (0.207 to 0.325) mg kg-1, respectively. ED95 (95% CI) were 0.356 (0.282 to 0.672) mg kg-1, 0.404 (0.330 to 0.741) mg kg-1 and 0.408 (0.334 to 0.752) mg kg-1, respectively. No serious adverse reactions were observed with intravenous remimazolam.</p><p><strong>Conclusion: </strong>This study explored the ED50 and ED95 of remimazolam for pre-operative sedation in children with left-to-right shunt CHD. It provides guidance for pre-operative sedation medication in children with left-to-right shunt CHD.</p><p><strong>Trial registration: </strong>https://www.chictr.org.cn/, identifier: ChiCTR2300076458.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985731","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":"Assessment of the paratracheal force required to occlude the oesophagus: is there a sex difference?: A short scientific report.","authors":"Benjamin Javillier, Nicolas Gillain, Vincent Bonhomme, Eric Deflandre","doi":"10.1097/EJA.0000000000002179","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002179","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771741","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":"Reply to: videolaryngoscopy in neonates is not a matter of perspective.","authors":"Tom G Hansen, Laszlo Vutskits","doi":"10.1097/EJA.0000000000002147","DOIUrl":"10.1097/EJA.0000000000002147","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 4","pages":"372-373"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536802","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}