European Journal of Anaesthesiology最新文献

{"title":"The importance of the presence of chosen family in preventing peri-operative delirium.","authors":"Yotam Weiss, Sarah Saxena, Mia Gisselbaek, Joana Berger-Estilita, Idit Matot","doi":"10.1097/EJA.0000000000002169","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002169","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"488-491"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and management of accidental dural puncture and postdural puncture headache in parturients: Retrospective database study.","authors":"Stav Cohen, Chaim Greenberger, Boris Aptekman, Victor Rabkin, Carolyn F Weiniger","doi":"10.1097/EJA.0000000000002130","DOIUrl":"10.1097/EJA.0000000000002130","url":null,"abstract":"<p><strong>Background: </strong>Postdural puncture headache (PDPH) is a common complication of neuraxial block resulting from either intentional dural puncture (IDP) or accidental dural puncture (ADP).</p><p><strong>Objectives: </strong>The primary objective was to estimate the rate of PDPH and ADP following introduction of a real-time documentation system in April 2018. Secondary objectives included examining the use of epidural blood patch (EBP) and investigating risk factors associated with ADP and PDPH.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Secondary care at a tertiary hospital from January 2017 to April 2022.</p><p><strong>Patients: </strong>Three hundred and eleven adult parturients after neuraxial block, with PDPH or a reported ADP, were identified during the procedure or postpartum.</p><p><strong>Interventions: </strong>Implementation of a real-time documentation system in April 2018 to improve PDPH and ADP documentation.</p><p><strong>Main outcome measures: </strong>Rates of PDPH and ADP, performance of epidural blood patch, and risk factors associated with PDPH and ADP.</p><p><strong>Results: </strong>The overall rate of PDPH was 0.4% (164/39888), 95% confidence intervals (CI) 0.0036 to 0.0049, and the rate of ADP was 0.9% (284/31635), 95% CI 0.0078 to 0.0099. During the real-time documentation period, the rates were 0.44% (157/35376), 95% CI 0.0038 to 0.0052, and 0.99% (279/28121), 95% CI 0.0088 to 0.0111, for PDPH and ADP respectively. Thirty-two (10.3%) cases had IDP, and 279 (89.7%) had ADP. Among 279 ADP cases, 76.3% were identified during the procedure, 10.4% were suspected and 13.3% were identified postpartum. Cases of ADP identified postpartum had more emergency room visits (19%). Epidural blood patch was administered in 72% of PDPH cases, with a high first-time success rate (89.5%); Eleven women received EBP after IDP.</p><p><strong>Conclusions: </strong>Postdural puncture headache remains a significant concern. In our cohort, 13.3% of ADP cases were detected postpartum, posing an increased challenge and underscoring the critical importance of follow-up care. We confirm that epidural blood patch may be required following any neuraxial block.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"492-499"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypotension prediction: advancing the debate or retreading old ground?","authors":"Michelle S Chew, Dan Longrois, Malachy O Columb","doi":"10.1097/EJA.0000000000002166","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002166","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"485-487"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-glucose cotransporter-2 inhibitors and the significant risk of euglycaemic keto-acidosis in cardiac surgery.","authors":"José Ginestal, José Luis Flordelís, José Luis Pérez-Vela","doi":"10.1097/EJA.0000000000002167","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002167","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"571-572"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of labour analgesia onset with injection of loading dose through epidural needle versus catheter: a prospective, double-blinded, randomised clinical trial.","authors":"Weijia Du, Zhiqiang Liu","doi":"10.1097/EJA.0000000000002159","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002159","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"567-568"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hypotension prediction index versus mean arterial pressure in predicting intraoperative hypotension: A clinical perspective.","authors":"Santino R Rellum, Sijm H Noteboom, Björn J P van der Ster, Jaap Schuurmans, Eline Kho, Alexander P J Vlaar, Jimmy Schenk, Denise P Veelo","doi":"10.1097/EJA.0000000000002150","DOIUrl":"10.1097/EJA.0000000000002150","url":null,"abstract":"<p><strong>Background: </strong>The hypotension prediction index (HPI) predicts hypotension, with randomised trials showing a significant reduction in hypotension-related metrics. However, the reliability of previous validation studies is debated, and it's unclear if mean arterial pressure (MAP) can be used interchangeably with HPI.</p><p><strong>Objectives: </strong>This study compared the effectiveness of HPI versus MAP thresholds in predicting intraoperative hypotension, focusing on three clinically relevant metrics: time from alert to event, positive predictive value (PPV), and proportion of missed hypotensive events.</p><p><strong>Design: </strong>Prospective observational study conducted between 2018 and 2020.</p><p><strong>Setting: </strong>Single-centre, academic hospital in the Netherlands.</p><p><strong>Participants: </strong>Adults scheduled for elective non-cardiac surgery lasting over two hours. Of the 105 eligible patients, 91 had sufficient data for analysis.</p><p><strong>Main outcome measures: </strong>The primary outcome was the time-to-hypotensive event intervals predicted by HPI popup alerts (≥85 for ≥40 s) and MAP-alerts (70-75 mmHg). Secondary analyses examined differences between these predictors regarding the PPV and missed event rates, as well as the difference in these metrics between instant HPI-85 alerts and the six MAP-alerts.</p><p><strong>Results: </strong>The largest time-to-event difference was seen between HPI-85 popup and MAP-70 alerts, with a gain of 0.58 (95% confidence interval (CI), 0.57 to 0.58) min, favouring HPI. Higher MAP thresholds reduced this time difference, but worsened PPV values, with 20.5 (95% CI, 20.3 to 20.6)% at MAP-75 compared to 55.6 (95% CI, 55.4 to 55.8)% for HPI-85 popups. Missed event proportions were similar: between one to three percent. Instant HPI-85 and MAP-72 alerts showed comparable performance, but both had suboptimal PPV values around 30%. However, adding a 40-s time-dependence to MAP's alert definition levelled the differences across the three evaluated metrics, aligning more closely with HPI-85 popup alerts.</p><p><strong>Conclusions: </strong>Using HPI-85 popup alerts does not provide additional prediction time over MAP-alerts in the 70 to 75 mmHg range, but they may be preferred due to higher PPV values. Instant HPI-85 and MAP-alerts perform similarly, with MAP-72 being closest, though these alerts more frequently occur regardless of subsequent hypotension with the potential to introduce unnecessary treatment. Adding a 40-s time-dependence to MAP-alerts to match the HPI popup characteristic eliminates distinctions between prediction time and missed events, while maintaining the higher PPV. However, whether 40sec-MAP-alerts are clinically equivalent remains to be determined in prospective clinical trials.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov NCT03795831 on 10 January 2019.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"527-535"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"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 (SvO 2 ) and lactate levels as well as their changes (ΔSvO 2 , 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 (SvO 2 ), and lactate levels. Pearson correlation coefficients ( r ) and coefficients of determination ( r2 ) between ΔSvO 2 , 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 SvO 2 ( 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 ΔSvO 2 ( r2  = 0.002, P  = 0.13) or Δlactate ( r2  = 0.003, P  = 0.087) and pretransfusion Hb levels.</p><p><strong>Conclusions: </strong>Hb, SvO 2 and lactate levels were only weakly correlated with each other, and changes in SvO 2 and lactate levels in response to pRBC transfusion did not correlate with pretransfusion Hb. Our findings question the usefulness of SvO 2 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":"536-542"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","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":"Prehabilitation brings benefits to neurogenesis and peri-operative neurocognitive disorders in amyotrophic rats.","authors":"Akira Nemoto, Toru Goyagi, Satoshi Sunaga, Wataru Nemoto, Yukitoshi Niiyama","doi":"10.1097/EJA.0000000000002140","DOIUrl":"10.1097/EJA.0000000000002140","url":null,"abstract":"<p><strong>Background: </strong>Peri-operative neurocognitive disorder (PND) is a postoperative complication associated with defects in hippocampal neurogenesis. Pre-operative muscle atrophy is implicated in PND. Although exercise improves cognitive function, its effects on PND remain unclear.</p><p><strong>Objective: </strong>This study investigated the relationship between PND and pre-operative exercise (PEx) in adult rats.</p><p><strong>Design: </strong>Animal study.</p><p><strong>Setting: </strong>Laboratory.</p><p><strong>Animals: </strong>A total of 64 male, 21 weeks old Sprague-Dawley rats were divided into four groups before 2 weeks of tail suspension to induce atopy of the hind legs: nonexercise (NEx) group, NEx with surgery (NEx + S), exercise without surgery (PEx) and pre-operative exercise with surgery (PEx + S).</p><p><strong>Interventions: </strong>PEx and PEx + S rats were subject to treadmill running for a week before surgery. The rats in the surgery groups were anaesthetised with 3% sevoflurane and underwent abdominal surgery.</p><p><strong>Main outcome measures: </strong>After a 1 week recovery period following surgery, cognitive function was assessed by a fear conditioning test, and then the Morris water maze test (finding an underwater hidden platform) was conducted over 5 days. Hippocampal neurogenesis was evaluated by assessing brain-derived neurotrophic factor (BDNF) secretion and immunohistochemical labelling.</p><p><strong>Results: </strong>Compared with the NEx rats, there was a retained contextual fear memory ( P  = 0.02), and in the Morris water maze test, the PEx and PEx + S groups found the underwater hidden platform faster ( P  < 0.001) and had a shorter path length ( P  = 0.03). The levels of hippocampal BDNF in the PEx and PEx + S groups were higher than those in the other groups ( P  < 0.001). The number of immature cells in the dentate gyrus was significantly higher in the PEx and PEx + S groups ( P  = 0.004) compared with the NEx and NEx +S groups.</p><p><strong>Conclusion: </strong>In rats, PEx for hind limb muscle atrophy induced by tail suspension reduced PND and increased neurogenesis in the dentate gyrus. We concluded that PEx may reduce PND. Our findings may benefit peri-operative care by improving patient outcomes.</p><p><strong>Trial registration: </strong>Approval number a-1-3012.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"557-566"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771780","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":"Intra-operative haemodynamic monitoring and management of adults having noncardiac surgery: A statement from the European Society of Anaesthesiology and Intensive Care.","authors":"Bernd Saugel, Wolfgang Buhre, Michelle S Chew, Bernard Cholley, Mark Coburn, Barak Cohen, Stefan De Hert, Jacques Duranteau, Jean-Luc Fellahi, Moritz Flick, Fabio Guarracino, Alexandre Joosten, Bettina Jungwirth, Karim Kouz, Dan Longrois, Giovanna Lurati Buse, Agnes S Meidert, Steffen Rex, Stefano Romagnoli, Carolina S Romero, Michael Sander, Kristen K Thomsen, Jaap Jan Vos, Alexander Zarbock","doi":"10.1097/EJA.0000000000002174","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002174","url":null,"abstract":"<p><p>This article was developed by a diverse group of 25 international experts from the European Society of Anaesthesiology and Intensive Care (ESAIC), who formulated recommendations on intra-operative haemodynamic monitoring and management of adults having noncardiac surgery based on a review of the current evidence. We recommend basing intra-operative arterial pressure management on mean arterial pressure and keeping intra-operative mean arterial pressure above 60 mmHg. We further recommend identifying the underlying causes of intra-operative hypotension and addressing them appropriately. We suggest pragmatically treating bradycardia or tachycardia when it leads to profound hypotension or likely results in reduced cardiac output, oxygen delivery or organ perfusion. We suggest monitoring stroke volume or cardiac output in patients with high baseline risk for complications or in patients having high-risk surgery to assess the haemodynamic status and the haemodynamic response to therapeutic interventions. However, we recommend not routinely maximising stroke volume or cardiac output in patients having noncardiac surgery. Instead, we suggest defining stroke volume and cardiac output targets individually for each patient considering the clinical situation and clinical and metabolic signs of tissue perfusion and oxygenation. We recommend not giving fluids simply because a patient is fluid responsive but only if there are clinical or metabolic signs of hypovolaemia or tissue hypoperfusion. We suggest monitoring and optimising the depth of anaesthesia to titrate doses of anaesthetic drugs and reduce their side effects.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"543-556"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964886","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":"Kidney injury after paediatric cardiac surgery. Different predictors to be used: pRIFLE, KDIGO and pPROCK. No answer as yet.","authors":"Sebastian Silva, Guillermo Lema","doi":"10.1097/EJA.0000000000002164","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002164","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 6","pages":"568-569"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998554","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}