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":"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}

{"title":"The risks we miss: Accounting for demographic and surgical variability in anaemia studies.","authors":"Emma G Sampson, Sathish Ramanathan, Kenichi A Tanaka, Amir L Butt","doi":"10.1097/EJA.0000000000002139","DOIUrl":"10.1097/EJA.0000000000002139","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 4","pages":"378-379"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of remimazolam with delirium and cognitive function: A systematic review and meta-analysis of randomised controlled trials.","authors":"Jaime Andres Arias, Gustavo Roberto Minetto Wegner, Bruno Francisco Minetto Wegner, Larissa Santos Silva, Francisco José Lucena Bezerra, Rafaela Goes Machado Filardi","doi":"10.1097/EJA.0000000000002107","DOIUrl":"10.1097/EJA.0000000000002107","url":null,"abstract":"<p><strong>Background and study objective: </strong>Delirium is an organic mental syndrome significantly associated with long-term cognitive decline, increased hospital stays and higher mortality. This systematic review of randomised controlled trials (RCTs) with meta-analysis assesses the association of remimazolam with postoperative cognitive function and delirium compared with non-benzodiazepine hypnotics.</p><p><strong>Design: </strong>Systematic review of RCTs with meta-analysis.</p><p><strong>Data sources: </strong>PubMed, Embase, Cochrane Library and Web of Science databases up to 27 April 2024.</p><p><strong>Eligibility criteria: </strong>Adult patients undergoing general anaesthesia or sedation procedures; use of remimazolam as the primary hypnotic or as an adjunct, administered via intermittent bolus or continuous infusion; comparison with other hypnotics or sedatives; evaluation of cognitive function or delirium.</p><p><strong>Main results: </strong>Twenty-three RCTs with 3598 patients were included. The incidence of delirium was not significantly different between remimazolam and other sedatives in general anaesthesia and sedation procedures [ n  = 3261; odds ratio (OR) = 1.2, 95% confidence interval (CI), 0.76 to 1.91; P  = 0.378843; I2  = 17%]. Regarding cognitive function evaluation, remimazolam showed no difference compared with the control group in Mini-Mental State Examination (MMSE) scores on the first postoperative day ( n  = 263; mean difference = 0.60, 95% CI, -1.46 to 2.66; P  = 0.5684; I2  = 90%) or on the third postoperative day ( n  = 163; mean difference  = 1.33, 95% CI, -0.72 to 3.38; P  = 0.2028; I2  = 93%). Remimazolam exhibited superiority over the control group in MMSE scores on the seventh postoperative day ( n  = 247; mean difference = 0.53, 95% CI, 0.30 to 0.75; P  < 0.0001; I2  = 28%).</p><p><strong>Conclusion: </strong>Remimazolam does not increase the incidence of delirium or cognitive impairments compared with non-benzodiazepine hypnotics. However, the analysis showed that the type of surgery significantly influenced the incidence of delirium. Additionally, remimazolam was associated with better short-term postoperative cognitive function.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42024532751.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"285-297"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for standardised videolaryngoscopy evaluation.","authors":"Manuel Á Gómez-Ríos, Miguel Á Fernández-Vaquero, André A J Van Zundert","doi":"10.1097/EJA.0000000000002129","DOIUrl":"10.1097/EJA.0000000000002129","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 4","pages":"380-381"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536692","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":"Cardiac index-guided haemodynamic management and myocardial injury after hepatopancreatic surgery.","authors":"Nancy Boulos, Amelie Delaporte, Matthieu Legrand, Bernd Saugel, Alexandre Joosten","doi":"10.1097/EJA.0000000000002120","DOIUrl":"10.1097/EJA.0000000000002120","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 4","pages":"374-375"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536711","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}