Trends in Anaesthesia and Critical Care最新文献

{"title":"Poppy seed allergy and anesthesia – A narrative review of literature","authors":"Sarah Jackson , Abhijit Biswas , Alla Iansavichene , Kamal Kumar","doi":"10.1016/j.tacc.2025.101552","DOIUrl":"10.1016/j.tacc.2025.101552","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"62 ","pages":"Article 101552"},"PeriodicalIF":1.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perfusion index as an indicator of successful caudal epidural block in anaesthestized children: an observational study","authors":"A.R. Ajay Saran,&nbsp;Anju R. Bhalotra","doi":"10.1016/j.tacc.2025.101550","DOIUrl":"10.1016/j.tacc.2025.101550","url":null,"abstract":"<div><h3>Purpose</h3><div>It is often difficult to assess the success of caudal epidural block in children under general anaesthesia. We hypothesized that increase in lower limb perfusion index after caudal anaesthesia indicates a successful block and aimed to study changes in lower limb perfusion index after caudal block in children under general anaesthesia.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted in children aged 2–12 years. The primary outcome was changes in lower limb perfusion index for 20 min after caudal block. Secondary outcomes included upper limb perfusion index at the same times, differences in lower and upper limb perfusion index, haemodynamic parameters and the correlation of perfusion index with heart rate and blood pressure.</div></div><div><h3>Results</h3><div>After caudal block, lower limb perfusion index increased within 1 min (31.28 %), was 100 % higher at 5 min and reached a maximum (153.18 %) increase at 15 min. The maximum increase in upper limb perfusion index was 35.13 %. There was a fall in heart rate (8.79 %), systolic blood pressure (8.77 %), diastolic blood pressure (14.16) and mean arterial pressure (11.43 %) which were maximum at 20 min. We found a positive correlation, r = 0.97, p = .001, between perfusion index and heart rate and perfusion index and diastolic blood pressure, r = 0.82, p = .043.</div></div><div><h3>Conclusion</h3><div>There were significant and immediate increases in lower limb perfusion index after successful caudal block. Haemodynamic changes were less marked and delayed. Perfusion index was found to be an objective, sensitive and early indicator of successful caudal block in children under general anaesthesia.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"62 ","pages":"Article 101550"},"PeriodicalIF":1.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between physical activity and stress among Portuguese Anaesthetists","authors":"José Correia ,&nbsp;Vítor Rodrigues ,&nbsp;Patrícia Santos ,&nbsp;Margarida Barbosa","doi":"10.1016/j.tacc.2025.101549","DOIUrl":"10.1016/j.tacc.2025.101549","url":null,"abstract":"<div><h3>Introduction</h3><div>Anaesthetists face significant daily stress, which can impact their health and clinical performance. While regular physical exercise has been shown to reduce stress, there is a lack of research on this topic among Portuguese anaesthetists. This study aims to: (1) assess physical activity and perceived stress levels among Portuguese anaesthetists and establish a relationship between them in this group, and (2) identify potential professional or personal barriers to exercise.</div></div><div><h3>Methods</h3><div>This cross-sectional study used an anonymous online survey distributed to Portuguese anaesthetists registered with the Portuguese Society of Anaesthesiology. The questionnaire collected sociodemographic data and included the short form of the International Physical Activity Questionnaire (IPAQ) and the Perceived Stress Scale (PSS-10).</div></div><div><h3>Results</h3><div>A total of 252 participants were analysed. The majority (49.2 %) engaged in moderate physical activity; 24.2 % reported high levels, and 26.6 % had low levels. Most participants (57.1 %) reported moderate stress, 34.1 % low stress, and 8.7 % high stress. A weak negative correlation was found between physical activity and stress (rho = −0.187, p = 0.003), suggesting higher physical activity may be associated with lower stress. However, ANOVA did not show significant differences in stress levels across activity categories (p = 0.0732).</div></div><div><h3>Conclusions</h3><div>Although a weak inverse correlation was observed, findings suggest physical activity alone may not determine stress levels. Given the high workload and burnout risk, institutional strategies promoting well-being, such as structured exercise programmes and workload management, should be considered.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"62 ","pages":"Article 101549"},"PeriodicalIF":1.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexible bronchoscope versus video-laryngoscope for nasotracheal intubation in patients with anticipated difficult airway under topical anesthesia and dexmedetomidine infusion: A randomized controlled trial","authors":"Aritra Kundu ,&nbsp;Nishant Patel ,&nbsp;Dalim Kumar Baidya ,&nbsp;Arshad Ayub ,&nbsp;Devalina Goswami ,&nbsp;Kanil Ranjith Kumar ,&nbsp;Rakesh Kumar ,&nbsp;Shailendra Kumar ,&nbsp;Ajoy Roychoudhury","doi":"10.1016/j.tacc.2025.101547","DOIUrl":"10.1016/j.tacc.2025.101547","url":null,"abstract":"<div><h3>Background</h3><div>Managing difficult airways with restricted mouth opening remains a challenge. In this regard, flexible bronchoscopes (FB) are considered the gold standard, offering precise tube placement. However, they require expertise and can be time-consuming. Video-laryngoscopes (VLs), such as the CMAC D-blade, provide enhanced glottic visualization and may reduce intubation time. While VLs are gaining popularity, data comparing them with FBs in this setting are limited. This study evaluates whether the CMAC D-blade VL can reduce intubation time compared to FB while maintaining similar success rates.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 100 adult patients scheduled for elective head and neck or oral and maxillofacial surgery with anticipated difficult airways were randomized to receive awake nasotracheal intubation using either an FB or CMAC D-blade VL. The primary outcome was intubation time. Secondary outcomes included first-attempt success rate, overall success rate, and satisfaction scores.</div></div><div><h3>Results</h3><div>Out of 100 patients, 97 patients completed the study (FB: n = 49, VL: n = 48). Median intubation time was significantly shorter in the VL group (62 [53–71] sec) compared to the FB group (118 [107–134] sec; p &lt; 0.0001). Success rates and intubation scores were similar, but anesthesiologist and patient satisfaction scores were better in the FB group.</div></div><div><h3>Conclusion</h3><div>The CMAC D blade video-laryngoscope reduces intubation time while maintaining similar success rates compared to the flexible bronchoscope for awake nasotracheal intubation with limited mouth opening. Despite the time advantage, the flexible bronchoscope was preferred by anesthesiologists and patients had more comfort.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101547"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the anaesthetic maze: The VATS challenge in an infant with anterior mediastinal mass","authors":"Amrita Rath,&nbsp;Babli Kumari,&nbsp;Reena,&nbsp;Steffi Dua,&nbsp;Premkumar T.","doi":"10.1016/j.tacc.2025.101545","DOIUrl":"10.1016/j.tacc.2025.101545","url":null,"abstract":"<div><div>The anterior mediastinal mass (AMM) is a rare but life-threatening entity in an infant. The symptoms mostly depend on the size and the extent of the tumour and its relationship with the surrounding structures. Anaesthetic challenges are multi-fold when such a child is posted for video assisted thoracoscopic surgery (VATS): risk of airway or cardiovascular collapse during anaesthesia, supine positioning, one lung ventilation in the setting of difficult airway, pneumo-mediastinum in a small child with a space occupying lesion in thorax leading to further lowering of venous return and cardiac output, development of hypercarbia and challenges in maintaining lung protective ventilatory strategy, risk of major bleeding and collapse. Definitive management requires a team of experts in a well-equipped centre with clear cut management strategy and open discussion with family members. We describe one such challenging case of infant AMM posted for VATS which was successfully managed at our institute.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101545"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From algorithms to airways: Applying artificial intelligence to enhance airway assessment, management, and training","authors":"Mingzhu Guo,&nbsp;Yongheng Hou,&nbsp;Yan Liu,&nbsp;Bo Yang,&nbsp;Chuhan Qiao,&nbsp;Jian Li","doi":"10.1016/j.tacc.2025.101548","DOIUrl":"10.1016/j.tacc.2025.101548","url":null,"abstract":"<div><div>Artificial intelligence(AI) is advancing airway management applications, especially for airway assessment, clinical decision support, and training. Traditional assessment methods struggle with time and precision as complex airway disorders become more common. AI's powerful data processing and pattern recognition capabilities can assess patient imaging and clinical characteristics using deep learning algorithms to predict airway complications. In dynamic clinical environments, AI-assisted management solutions can improve airway control safety and efficiency by providing unique decision support. Additionally, AI systems using virtual reality and simulation training technologies can customize training programs for healthcare professionals based on airway difficulty, improving learning curves and clinical competencies in complex airway scenarios. AI in airway management shows its potential in assessment, clinical decision-making, and medical education. In clinical applications, we must also weigh AI's advantages and disadvantages. This review examines AI technology's current uses, future potential, and limitations in clinical practice and medical education.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101548"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume status and volume responsiveness assessment: A literature review of systematic reviews","authors":"Mansoureh Fatahi ,&nbsp;Azam Mohammadi ,&nbsp;Mahdi Foroughian","doi":"10.1016/j.tacc.2025.101546","DOIUrl":"10.1016/j.tacc.2025.101546","url":null,"abstract":"<div><div>Intravenous fluid administration is an essential and life-saving procedure in every hospital setting. Balancing fluid resuscitation could be challenging due to the risk associated with both hypovolemia and hypervolemia. We conducted an extensive literature review on systematic reviews related to this topic to examine the effectiveness of various invasive and non-invasive methods for assessing volume status and fluid responsiveness. Traditional invasive methods, including central venous pressure measurements, have limited predictive values. Noninvasive sonographic measurements of the inferior vena cava, internal jugular vein, and carotid artery have the potential to be reliable alternatives for assessing volume status. Measuring cardiac output with echocardiographic methods provides valuable information. Volume responsiveness can be evaluated reliably through stroke volume and pulse pressure variations, as well as the end-expiratory occlusion test in patients under mechanical ventilation.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101546"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal penile nerve block versus caudal block for circumcision in pediatric patients: A systematic review and meta-analysis","authors":"Dora Alexandra Carreira de Oliveira ,&nbsp;Rafael Oliva Morgado Ferreira ,&nbsp;Susimar Picado-Loaiza ,&nbsp;Matheus Pedrotti ,&nbsp;Eric Pasqualotto ,&nbsp;Sara Amaral","doi":"10.1016/j.tacc.2025.101543","DOIUrl":"10.1016/j.tacc.2025.101543","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of dorsal penile nerve block versus caudal block among children undergoing circumcision has been studied in several trials with conflicting results. We aimed to perform an updated systematic review and meta-analysis comparing both techniques in children undergoing circumcision under general anesthesia.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, and Cochrane Library were systematically searched for studies comparing dorsal penile nerve block versus caudal block in children undergoing circumcision. We computed mean differences (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratios (RR) for binary outcomes, with 95 % confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R Software, version 4.2.3.</div></div><div><h3>Results</h3><div>We included 14 studies, comprising 1425 participants, of whom 645 (45.3 %) underwent dorsal penile nerve block. There were no significant differences between groups in time to first analgesic requirement (MD -14.79 min; 95 % CI -59.42 to 29.83; p = 0.52), and postoperative pain at 1h (SMD 0.10; 95 % CI -0.60 to 0.79; p = 0.79), 3h (SMD 0.00; 95 % CI -0.98 to 0.99; p = 0.99), and 24h (SMD 0.30; 95 % CI -2.57 to 3.17; p = 0.84). Dorsal penile nerve block was associated with a shorter time to first walk (MD -30.28 min; 95 % CI -44.50 to −16.05; p &lt; 0.01) and length of hospital stay (MD -28.61 min; 95 % CI -42.13 to −15.10; p &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>In children undergoing circumcision, dorsal penile nerve block and caudal block had similar times to first rescue analgesic and postoperative pain scores within 24h, although dorsal penile nerve block was associated with a shorter time to first walk and length of hospital stay.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101543"},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative sources for high flow nasal oxygen in low-resource settings: Exploring the potential of auxiliary oxygen ports and wall flowmeters","authors":"Johan J Swart ,&nbsp;Claire Pfister ,&nbsp;Hayli Geffen ,&nbsp;Ross Hofmeyr","doi":"10.1016/j.tacc.2025.101542","DOIUrl":"10.1016/j.tacc.2025.101542","url":null,"abstract":"<div><h3>Background</h3><div>High flow nasal oxygen (HFNO) therapy delivers pure oxygen at rates over 40 L/min during preoxygenation and 60 L/min during apnoea, preventing hypoxia and extending safe apnoeic time. HFNO is beneficial in certain clinical scenarios. However, cost and limited availability of HFNO devices restrict routine use. Auxiliary oxygen outlets on anaesthesia workstations present a potential alternative HFNO source.</div></div><div><h3>Aim</h3><div>This study aimed to assess the maximum flow rates from auxiliary oxygen outlets on various anaesthesia workstations and wall flowmeters, to explore their viability as a source for HFNO.</div></div><div><h3>Methods</h3><div>After calibration in Switzerland, a CITREX H4 gas flow analyser was used to measure flow rates across multiple anaesthesia workstations and wall-mounted flowmeters at five hospitals affiliated with one academic anaesthesia department.</div></div><div><h3>Results</h3><div>Only two of nine tested workstations could reliably support flows sufficient for high flow apnoeic oxygenation. The General Electric (GE) CS 650 workstation had the highest average flow rate (120 L/min) while the Dräger Fabius GS Premium had the lowest (13 L/min). Wall flowmeters had flow rates ranging from 108 to 28 L/min, with most supporting flow rates greater than 60L/min.</div></div><div><h3>Conclusion</h3><div>The auxiliary oxygen outlet on anaesthetic workstations and general oxygen flowmeters is underutilised. Sufficient flow rates to function as a source of HFNO are attainable with many types, but should be individually tested. In a resource-limited environment, this could provide a cost-effective alternative in providing apnoeic oxygenation for a time-limited period, although safety has not yet been established.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101542"},"PeriodicalIF":1.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing tracheostomy anesthesia: A comparative study of nerve blocks","authors":"Tarek I. Ismail ,&nbsp;Rabab S.S. Mahrous ,&nbsp;Ahmed A. Bedewy","doi":"10.1016/j.tacc.2025.101541","DOIUrl":"10.1016/j.tacc.2025.101541","url":null,"abstract":"<div><h3>Background</h3><div>Tracheostomy is increasingly performed as a planned procedure for a wide range of indications. While superficial cervical plexus block (SCPB) is widely used as regional anesthesia for tracheostomy, its limitation in suppressing laryngeal reflexes may lead to discomfort and complications. Combining bilateral SCPB with bilateral superior laryngeal nerve block (SLNB) could potentially improve patient outcomes by reducing airway reflexes.</div></div><div><h3>Objective</h3><div>This study aimed to compare the effectiveness of bilateral SCPB alone versus bilateral SCPB combined with bilateral SLNB in sedated patients undergoing surgical tracheostomy.</div></div><div><h3>Methods</h3><div>A double-blind, randomized controlled trial was conducted at Alexandria University Hospital. A total of 120 adult patients, both intubated and non-intubated, requiring elective tracheostomy was randomly allocated into two groups: Group 1 received an ultrasound-guided bilateral SCPB alone, while Group 2 received a combination of ultrasound-guided bilateral SCPB and bilateral SLNB. The primary outcome was the incidence of intraoperative coughing and laryngospasm. Secondary outcomes included postoperative pain, cumulative analgesic requirements, time to first analgesic request, postoperative complications and patients’ satisfaction.</div></div><div><h3>Results</h3><div>Group 2 (SCPB + SLNB) demonstrated a significantly lower occurrence of coughing and laryngospasm compared to Group 1 (p &lt; 0.05). No significant difference was observed in postoperative pain intensity between the two groups. Additionally, postoperative complications and patients’ satisfaction were comparable between both groups, with no significant differences noted.</div></div><div><h3>Conclusion</h3><div>The addition of bilateral SLNB to SCPB significantly suppresses airway-related reflexes during tracheostomy.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101541"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}