European Journal of Anaesthesiology最新文献

{"title":"Preoperative health status assessed with different scales and postoperative cardiac and cerebrovascular complications in older patients: A retrospective study of a large multicentre cohort.","authors":"Shiyi Han, Fan Li, Duo Hou, Xuecai Lv, Haoyun Zhang, Saisong Xiao, Jingsheng Lou, Hao Li, Jiangbei Cao, Difen Wang, Xiaoping Gu, Yuming Peng, Yubo Xie, Yi Feng, Qingping Wu, Junmei Xu, Weidong Mi, Yanhong Liu","doi":"10.1097/EJA.0000000000002432","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002432","url":null,"abstract":"<p><strong>Background: </strong>Multiple scales are available to evaluate the health status of older surgical patients; however, their relative ability to predict postoperative major adverse cardiac and cerebrovascular events (MACCE) remains unclear.</p><p><strong>Objective: </strong>To examine the association between preoperative health status, as measured by four commonly used scales, and 30-day postoperative MACCE in older surgical patients, and to compare their predictive performance and incremental value against the Revised Cardiac Risk Index (RCRI).</p><p><strong>Design: </strong>A retrospective study of a large multicentre cohort.</p><p><strong>Setting: </strong>Nineteen tertiary hospitals across China participating in a perioperative database.</p><p><strong>Patients: </strong>Patients aged ≥65 years who underwent noncardiac, non-neurosurgical surgery between April 2020 and April 2022 were included in the analysis. The Activities of Daily Living (ADL), EuroQol Five-Dimension Five-Level (EQ-5D-5L), Metabolic Equivalent of Task (MET), FRAIL, and RCRI were evaluated preoperatively.</p><p><strong>Main outcome measure: </strong>The primary outcome was the occurrence of MACCE within 30 days after surgery, defined as any of the following: stroke, myocardial infarction, angina pectoris, congestive heart failure, cardiac arrest, or all-cause mortality.</p><p><strong>Results: </strong>Among the 7996 patients, 126 (1.6%) experienced MACCE. Similar to the RCRI, the four health assessments were significantly associated with MACCE risk. The RCRI alone yielded an area under the curve (AUC) of 0.610 [95% confidence interval (CI): 0.563 to 0.658]. Incorporating each scale improved the predictive performance of the RCRI. The RCRI-Plus model, comprising RCRI, age, severity of anaemia, and surgical duration, achieved an AUC of 0.692 (95% CI: 0.643 to 0.741). Further addition of the four scales to the RCRI-Plus increased discrimination, with the highest AUC observed for the RCRI-Plus model incorporating FRAIL (AUC 0.724; 95% CI: 0.679 to 0.770). However, DeLong's test showed no significant differences between this model and the RCRI-Plus models incorporating ADL, EQ-5D-5L, or MET.</p><p><strong>Conclusions: </strong>Preoperative health status assessed by four geriatric scales was significantly correlated with postoperative MACCE and provided improved risk discrimination beyond the RCRI. Adding any of these assessments to the RCRI enhanced predictive performance, with FRAIL showing the greatest incremental benefit. These findings underscore the value of multidimensional health status evaluation for preoperative cardiac and cerebrovascular risk stratification, with frailty assessment warranting particular attention.</p><p><strong>Trial registry: </strong>ClinicalTrials.gov, NCT04911530.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395870","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 usefulness of the intergluteal cleft as a possible anatomical landmark of the neuraxial midline in obstetrics: a prospective observational study.","authors":"Suji Pararajasingam, Maame Aduse-Poku, Rajeev Jeevananthan, Gillian Radcliffe, Marwa Salman, Neel Desai","doi":"10.1097/EJA.0000000000002416","DOIUrl":"10.1097/EJA.0000000000002416","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"630-633"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835144","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":"Reply to: prophylactic esketamine to reduce postpartum depression in primiparae: A multicentre, double-blind, randomised clinical trial.","authors":"Tiantian Chu, Aijun Xu, Feng Gao","doi":"10.1097/EJA.0000000000002423","DOIUrl":"10.1097/EJA.0000000000002423","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"43 7","pages":"640-641"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149224","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":"Environmental and economic impacts of anaesthesia: A simulation study comparing total intravenous anaesthesia versus sevoflurane for maintenance of anaesthesia in 11 909 adult patients of a Belgian tertiary hospital.","authors":"Florence Van Belleghem, Steffen Rex, An Teunkens, Hugo Vereecke, Alain F Kalmar","doi":"10.1097/EJA.0000000000002342","DOIUrl":"10.1097/EJA.0000000000002342","url":null,"abstract":"<p><strong>Background: </strong>Total intravenous anaesthesia (TIVA) is widely recognised as a less environmentally harmful alternative to volatile anaesthesia. However, TIVA is often perceived as a more expensive technique, raising questions about its cost-effectiveness in routine practice.</p><p><strong>Objective: </strong>This study models the environmental impact and cost-effectiveness of TIVA versus sevoflurane anaesthesia.</p><p><strong>Design: </strong>Retrospective simulation-based observational study.</p><p><strong>Patients: </strong>Surgical cases of 11 909 consecutive patients, older than 5 years, observed in a tertiary Belgian hospital.</p><p><strong>Intervention: </strong>The economic cost and carbon dioxide equivalent (CO 2 e) emissions of maintenance using sevoflurane versus propofol of anaesthesia were calculated, using local tender prices and the lifecycle assessment for all drugs and disposable materials involved in each scenario.</p><p><strong>Main outcome measure: </strong>The economic cost and CO 2 e emissions of different scenarios for maintenance of anaesthesia.</p><p><strong>Results: </strong>For every 1000 procedures, CO 2 e emissions and costs were: TIVA - 963 kg at a cost of €4300; minimal-flow sevoflurane - 25 562 kg at a cost of €6772; sevoflurane [2 l min -1 fresh gas flow (FGF)] - 59 483 kg at a cost of €11 933.</p><p><strong>Conclusion: </strong>Our simulations indicate that minimal flow sevoflurane produces 26.5 times more CO 2 e than TIVA, rising to 61.8 times more at 2 l min -1 FGF. TIVA also costs significantly less, at 36% and 63% of sevoflurane anaesthesia costs with minimal flow and 2 l min -1 FGF, respectively.These findings highlight not only TIVA's marked superiority in reducing carbon emissions but also its notable cost advantages over traditional volatile anaesthetic methods. The stark contrast in emissions - where TIVA produces just a fraction of the CO 2 e compared to even the most environmentally conscious sevoflurane protocols - underscores the critical role anaesthetic choice plays in healthcare sustainability. Moreover, the substantial difference in costs challenges the prevailing perception that TIVA is prohibitively expensive. As hospitals worldwide face mounting pressure to align clinical practices with environmental stewardship, these results advocate for a critical reassessment of routine anaesthetic protocols.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"567-574"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145818740","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: assessing the association between postpartum depression and caesarean section under general anaesthesia.","authors":"Yu-Ting Hung, Si-Cheng Xie","doi":"10.1097/EJA.0000000000002406","DOIUrl":"10.1097/EJA.0000000000002406","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"43 7","pages":"642-643"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149185","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":"Dopaminergic connectivity and postoperative cognitive dysfunction: balancing statistical robustness with pathological sensitivity.","authors":"Chenchen Jiang","doi":"10.1097/EJA.0000000000002421","DOIUrl":"10.1097/EJA.0000000000002421","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"43 7","pages":"634"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149167","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":"Dopaminergic sub-network connectivity alterations are associated with postoperative cognitive dysfunction: Results from the observational BioCog cohort study.","authors":"Florian Lammers-Lietz, Friedrich Borchers, Insa Feinkohl, Cicek Kanar, Henning Krampe, Gregor Lichtner, Jayanth Sreekanth, Janine Wiebach, Martin Weygandt, Claudia Spies, Georg Winterer, Friedemann Paul","doi":"10.1097/EJA.0000000000002365","DOIUrl":"10.1097/EJA.0000000000002365","url":null,"abstract":"<p><strong>Background: </strong>Postoperative cognitive dysfunction (POCD) is a detrimental complication after surgery with lasting impact on patients' daily lives. It is most common after postoperative delirium. While dopaminergic dysfunction has been suggested to play a role in delirium, little knowledge exists regarding its relevance for POCD.</p><p><strong>Objective: </strong>We hypothesised that POCD is associated with altered resting-state functional connectivity (FC) of the ventral tegmental area (VTA) and the substantia nigra pars compacta (SNc) in functional magnetic resonance imaging (fMRI).</p><p><strong>Setting: </strong>Tertiary care centre, Germany.</p><p><strong>Patients: </strong>Patients aged at least 65 years with a Mini-Mental Status Examination (MMSE) at least 24 points presenting for elective major surgery were eligible for this study. Of 747 included patients, 214 patients with POCD assessment and at least one preoperative fMRI dataset were analysed.</p><p><strong>Investigations: </strong>Resting-state fMRI and neuropsychological assessment before surgery and at follow-up 3 months later.</p><p><strong>Main outcome: </strong>POCD after 3 months after surgery was determined as the Reliable Change Index (RCI). Connectivity between VTA or SNc and 132 regions was calculated.</p><p><strong>Results: </strong>Twenty-six patients (12%) developed POCD. Four components for VTA-FC and SNc-FC were selected for further analysis with principal component analysis. For both VTA and SNc connectivity, one component was significantly associated with POCD. Postoperative alterations of dopaminergic networks were observed in an exploratory voxelwise analysis in a left temporal cluster.</p><p><strong>Conclusion: </strong>Higher dopaminergic connectivity to regions associated with spatial perceptive processes and lower connectivity to cognitive control-related areas may predispose to POCD.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, NCT02265263.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"603-614"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206966","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":"Recontextualizing positive end-expiratory pressure and lung injury biomarkers in obese surgical patients demands methodological rigor and clinical nuance.","authors":"Hongjuan Jing, Chao Yuan","doi":"10.1097/EJA.0000000000002392","DOIUrl":"10.1097/EJA.0000000000002392","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"43 7","pages":"644-645"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149209","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 esketamine to reduce postpartum depression in primiparae: A multicentre, double-blind, randomised clinical trial.","authors":"Tiantian Chu, Xiaoling Peng, Keliang Wan, Meihong Li, Tianzhu Liu, Xue Shi, Wenlong Yao, Shiyong Li, Zhiqiang Zhou, Changming Yang, Heng Xu, Jingjing Kong, Chan Wang, Jing Cheng, Zhenzhen Xu, Dezhan Li, Xin Liu, Junmin He, Xihong Ye, Ailin Luo, Aijun Xu, Feng Gao","doi":"10.1097/EJA.0000000000002348","DOIUrl":"10.1097/EJA.0000000000002348","url":null,"abstract":"<p><strong>Background: </strong>Postpartum depression (PPD) is a common complication after childbirth, especially in primiparae.</p><p><strong>Objectives: </strong>This trial sought to evaluate whether prophylactic administration of esketamine during the perinatal period could prevent PPD in primiparae without predisposition to prenatal depression.</p><p><strong>Design: </strong>A prospective, double-blind, multicentre, randomised controlled trial.</p><p><strong>Setting: </strong>Three academic hospitals.</p><p><strong>Patients: </strong>Primiparae scheduled for elective caesarean section with an Edinburgh Postnatal Depression Scale (EPDS) score less than 10.</p><p><strong>Interventions: </strong>Postnatal women were randomly assigned to receive either i.v. esketamine in a single dose of 0.25 mg kg -1 followed by 80 mg of esketamine as an adjunct to 24-h patient-controlled intravenous analgesia (PCIA). Women in the control group received an equal volume of saline.</p><p><strong>Main outcome measures: </strong>The primary outcome was the total incidence of PPD within 3 months postpartum. Secondary outcomes included postoperative EPDS scores, numeric rating scale scores, sufentanil consumption, the number of effective presses for postoperative intravenous analgesia and adverse events.</p><p><strong>Results: </strong>A total of 322 patients were included in the modified intention-to-treat analysis. The total incidence of PPD in the esketamine group (11.59%) was significantly less than the control group (20.89%) [adjusted relative ratio (RR), 0.57; 95% CI, 0.35 to 0.94; P  = 0.028] as was the incidence at 7 days postpartum (4.89 vs. 15.19%; adjusted RR, 0.32; 95% CI, 0.15 to 0.72; P  = 0.005). However, there were no significant differences in PPD incidence and EPDS scores at 1, 2 and 3 months postpartum, respectively. Several mild central nervous events, such as dizziness (10.98%), hallucination (10.37%) and dissociation (5.49%), were observed during esketamine treatment.</p><p><strong>Conclusion: </strong>Peri-operative adjunctive administration of esketamine is relatively safe and can prevent PPD in primi-parae without predisposition to prenatal depression in the short term.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov. Identifier: NCT04860661.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"43 7","pages":"584-593"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149229","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":"The study condition of implementing similar anaesthetic depth with different anaesthetic agents may be challenging.","authors":"Shingo Kawashima, Hiroyuki Kinoshita, Atsushi Kobayashi","doi":"10.1097/EJA.0000000000002404","DOIUrl":"10.1097/EJA.0000000000002404","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"43 7","pages":"643-644"},"PeriodicalIF":7.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149214","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}