Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Intraoperative tight blood glucose control reduces the incidence of postoperative pneumonia in minimally invasive esophagectomy: a randomized clinical trial.","authors":"Daiyu Chen, Siqi Wang, Ke Wei, Ju Zhu, Longmin He, Zhuojiang Zou, Yuyuan He, Maoji Zhao, Siwei Zhou, Jun Cao","doi":"10.1016/j.accpm.2025.101645","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101645","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pneumonia is a common and fatal complication in minimally invasive esophagectomy patients and is related to perioperative blood glucose. This study hypothesized that compared to dealing with intraoperative blood glucose routinely, tight blood glucose control can reduce the incidence of postoperative pneumonia in minimally invasive esophagectomy patients.</p><p><strong>Methods: </strong>In this randomized single- blind trial, 88 patients were randomly assigned (1:1) to the tight blood glucose control (4.4-6.1 mmol/L) or non-tight blood glucose control (blood glucose under 10 mmol/L). The primary outcome was the incidence of postoperative pneumonia. The intraoperative insulin-related complications, postoperative inflammation level, blood glucose level, surgical complications, and other secondary outcomes were also assessed.</p><p><strong>Results: </strong>In total, 88 patients were randomized, and 84 patients were included in the analysis. The intention-to-treat analysis showed the incidence of postoperative pneumonia in the tight blood glucose control group (5 of 44 [11.4%]) was significantly lower than non-tight blood glucose control group (15 of 44 [34.1%]) (OR = 0.569, 95% CI: 0.39 to 0.83, P =  0.011). The C-reactive protein on postoperative day 1 was 78.3 (30.4-103.7) in the tight blood glucose control group and 95.6 (79.0-130.5) in the non-tight blood glucose control group (P =  0.008). Compared to the non-tight blood glucose control group (36 of 43 [83.7%]), the demand for advanced antibiotics was lower in the tight blood glucose control group (26 of 41 [63.4%]) (P =  0.034).</p><p><strong>Conclusion: </strong>Intraoperative tight blood glucose control is beneficial in reducing the incidence of postoperative pneumonia for minimally invasive esophagectomy patients.</p><p><strong>Registration: </strong>Chinese Clinical Trial Registry ChiCTR2300077993.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101645"},"PeriodicalIF":4.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative analgesia in high-risk patients, what clinicians and searchers must know? A narrative review.","authors":"Helene Beloeil, Girish P Joshi, Patricia Lavand'homme, Felicia Cox, Jennifer Summers, Esther Pogatzki-Zahn, Patrice Forget","doi":"10.1016/j.accpm.2025.101644","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101644","url":null,"abstract":"<p><strong>Background: </strong>Severe postoperative pain remains a significant clinical challenge, particularly in high-risk patients. While risk factors for acute and chronic postoperative pain have been well characterized, effective prevention and management strategies remain suboptimal. A multidimensional understanding of pain-including biological, psychological, and social factors-is essential for improving patient outcomes.</p><p><strong>Objective: </strong>This narrative review aims to provide an updated overview of perioperative analgesia in high-risk patients, highlighting key considerations, illustrated by concrete examples, for clinicians and researchers.</p><p><strong>Methods: </strong>Evidence was selected from the literature, summarising the current understanding of risk factors, pathophysiology, outcome measures, and management strategies related to perioperative pain in high-risk patients. Special attention was given to patient-specific and procedure-specific approaches, multimodal analgesia, and gaps in research methodologies.</p><p><strong>Findings: </strong>High-risk patients-such as those with preoperative pain, opioid dependence, psychological distress, or complex surgical procedures-exhibit increased vulnerability to severe postoperative pain and persistent opioid use. Pain mechanisms involve nociceptive sensitization, neuroinflammation, and opioid-induced hyperalgesia, requiring tailored multimodal analgesic approaches. Standardized, multidimensional outcome measures, including patient-reported outcomes, functional recovery, and pain trajectories, are essential for evaluating analgesic efficacy. Despite advances in pain classification (e.g., ICD-11) and study designs, research remains fragmented, with high-risk patients often excluded from clinical trials.</p><p><strong>Conclusion: </strong>Optimizing perioperative pain management in high-risk patients necessitates a personalized, evidence-based approach. Improved risk stratification, multimodal treatment strategies, and innovative research designs are critical for addressing the complexities of postoperative pain. Future studies should focus on identifying effective interventions for high pain responders and integrating long-term patient-centered outcomes into perioperative pain management protocols.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101644"},"PeriodicalIF":4.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cirrhosis is an independent risk factor for candidemia in critically ill patients: A 6-year single-center observational study","authors":"Mohamed Ghalayini ,&nbsp;Cécile Zylberfajn ,&nbsp;Pierre Nahon ,&nbsp;David Lobo ,&nbsp;Mathilde Lescat ,&nbsp;Roland Amathieu","doi":"10.1016/j.accpm.2025.101611","DOIUrl":"10.1016/j.accpm.2025.101611","url":null,"abstract":"<div><h3>Background</h3><div>Candidemia is a significant threat in intensive care units (ICUs), particularly for patients with cirrhosis, who appear to have a higher prevalence. No prior study has demonstrated cirrhosis as an independent risk factor for candidemia. This study aimed to investigate the risk factors and mortality associated with candidemia in ICUs, focusing on patients with cirrhosis.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study over a 6-year period in an ICU with a high volume of patients with cirrhosis. We consecutively included 1985 patients, of whom 416 had cirrhosis. Among them, 37 developed candidemia, including 16 with cirrhosis. We analyzed the risk factors for candidemia in the total population and patients with cirrhosis.</div></div><div><h3>Results</h3><div>We identified cirrhosis as an independent risk factor for candidemia in the ICU (OR 2.28 [1.14–4.53], <em>p</em> = 0.019) in the total population admitted to the ICU. Among patients with cirrhosis, a high Child–Pugh score remained the sole independent correlate of candidemia (OR 1.68 [1.10–2.67]; <em>p</em> = 0.021). Post hoc acute on chronic liver failure (ACLF) analysis showed significantly lower candidemia-free survival in ACLF grade 2–3 <em>versus</em> 0–1 (log-rank, <em>p</em> = 0.029). Candidemia was associated with higher ICU mortality rates in both the total population (59.5%) and in patients with cirrhosis (81.2%).</div></div><div><h3>Conclusion</h3><div>Cirrhosis emerged as an independent risk factor for candidemia in the ICU. Within the cirrhotic subgroup, a high Child–Pugh score emerged as the sole independent correlate.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 1","pages":"Article 101611"},"PeriodicalIF":4.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"French guidelines on sepsis: A pragmatic frame to manage septic patients","authors":"Marc Leone ,&nbsp;Marwan Bouras ,&nbsp;Antoine Bianchi ,&nbsp;Elodie Macé ,&nbsp;Jean Michel Constantin ,&nbsp;Jacques Duranteau ,&nbsp;Rémy Gauzit ,&nbsp;Bertrand Guidet ,&nbsp;Frédéric Pène ,&nbsp;Djillali Annane ,&nbsp;Antoine Roquilly","doi":"10.1016/j.accpm.2025.101643","DOIUrl":"10.1016/j.accpm.2025.101643","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101643"},"PeriodicalIF":4.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of venous-to-arterial pCO2 gap during cardiopulmonary bypass for predicting cardiac surgery-associated kidney injury: A bicentric retrospective study","authors":"T. Jeanmougin ,&nbsp;X. Buzin ,&nbsp;A. Mansour ,&nbsp;B. Duceau ,&nbsp;A. Carillion ,&nbsp;P. Dureau ,&nbsp;G. Lebreton ,&nbsp;N. Nesseler ,&nbsp;A. Bouglé ,&nbsp;G. Hariri","doi":"10.1016/j.accpm.2025.101639","DOIUrl":"10.1016/j.accpm.2025.101639","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the most frequent and severe complications after cardiac surgery. The association between acute kidney injury and the mismatch between oxygen consumption and delivery has been well established during cardiopulmonary bypass (CPB). In this study, we aim to explore the prognostic value of the central venous-to-arterial pCO₂ gap during CPB to predict CSA-AKI.</div></div><div><h3>Methods</h3><div>Bicentric retrospective study conducted in two teaching hospitals. All patients who underwent cardiac surgery requiring CPB in two periods between 2019 and 2023 were screened for inclusion. Patients were divided into 2 groups according to the presence or absence of an elevated pCO₂ gap during CPB, which was defined as greater than 6 mmHg. The primary outcome was the occurrence of CSA-AKI.</div></div><div><h3>Results</h3><div>Among 318 patients included, 213 were in the low pCO₂ gap group and 105 in the elevated pCO₂ gap group. No significant difference in CSA-AKI occurrence was found between groups (32.4% <em>vs.</em> 23.8%; <em>p</em> = 0.14). pCO₂ gap was not a good predictor of CSA-AKI, with an area under the curve for the ROC curve of 0.63 (<em>p</em> = 0.87). Except for SVO₂ during CPB, we did not find any correlation between pCO₂ gap and other tissue perfusion parameters during or after CPB.</div></div><div><h3>Conclusion</h3><div>We did not find any association between the presence of an elevated pCO₂ gap during CPB and the occurrence of CSA-AKI. This may suggest that a single intraoperative measurement of pCO₂ gap is not a reliable marker of persistent tissue hypoperfusion in this context.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101639"},"PeriodicalIF":4.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive measure of haemoglobin using the Rad-67™ pulse co-oxymeter in post- operative care unit to predict postoperative day 1 haemoglobin after major orthopaedic surgery, a prospective cohort study","authors":"Marine Laplanche,&nbsp;Claire Nicolleau,&nbsp;Tristan Perrault,&nbsp;Sigismond Lasocki","doi":"10.1016/j.accpm.2025.101638","DOIUrl":"10.1016/j.accpm.2025.101638","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative anaemia is common after major orthopaedic surgery. A postoperative day 1 (POD1) haemoglobin (Hb) &lt;12 g/dL (POD1 anaemia) indicates intravenous (IV) iron in recent guidelines, but blood sampling may be missed. We evaluated the ability of non-invasive haemoglobin measurement (SpHb) in the post-anaesthesia care unit (PACU) to predict POD1 anaemia.</div></div><div><h3>Methods</h3><div>This prospective single-centre cohort study included adults undergoing total hip or knee arthroplasty. SpHb was measured using a Rad-67™ pulse co-oximeter in the PACU. POD1 Hb was obtained from routine blood counts. We assessed SpHb accuracy using ROC analysis and developed a logistic regression model to identify predictors of POD1 anaemia.</div></div><div><h3>Results</h3><div>Among 138 patients enrolled, 118 (86%) had available POD1 Hb. The area under the ROC curve for SpHb predicting POD1 anaemia was 0.73 (95% CI: 0.63–0.82). Sex (women, Odds Ratio (OR) 3.97, 95% CI: [1.8;9.97], <em>p</em> = 0.003), preoperative anaemia treatment (OR 0.10 [0.014;0.70], <em>p</em> = 0.02) and SpHb (OR 0.72 [0.55;0.95], <em>p</em> = 0.02) were independently associated with POD1 anaemia. 81% of the patients with SpHb &lt;11.7 g/dL (n=16) had POD1 anaemia, potentially allowing early IV iron in the PACU without blood sampling. Conversely, 78% of patients with SpHb &gt;14.9 g/dL (n = 31) had Hb ≥12 g/dL and could have avoided a blood test. Overall, applying these thresholds could have safely eliminated the need for a blood sample in 36% of patients.</div></div><div><h3>Conclusion</h3><div>SpHb may help to reduce the need for blood samples and identify patients who should receive IV iron treatment after major orthopaedic surgery.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101638"},"PeriodicalIF":4.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of direct oral anticoagulant treatment on management and outcomes of patients with hip fractures by monitoring assays. A population-based study of a cohort from the Geriatric Perioperative Unit","authors":"Yann Gricourt ,&nbsp;Mikael Perin ,&nbsp;Nicolas Basseres ,&nbsp;Laetitia Geronimi ,&nbsp;Jean Yves Lefrant ,&nbsp;Myriam Mezzarobba ,&nbsp;Mathias Chéa ,&nbsp;Jean Christophe Gris ,&nbsp;Philippe Cuvillon","doi":"10.1016/j.accpm.2025.101616","DOIUrl":"10.1016/j.accpm.2025.101616","url":null,"abstract":"<div><h3>Background</h3><div>Hip fractures remain a challenge for patients on direct oral anticoagulants. In a population-based study, we wanted to evaluate the impact of DOACS and its concentration on postoperative mortality after hip fracture surgery.</div></div><div><h3>Methods</h3><div>In a retrospective, monocenter study, we included all patients aged &gt;65 yrs at a geriatric perioperative unit, admitted for hip fracture, treated with or without DOACs, and similarly managed with early surgery. Patients were divided into No-DOACs or DOACs groups. According to plasma DOAC concentrations on the day of surgery, DAOCs was divided into subgroup: &lt;30, 30−50, 51−80 ng.mL⁻¹. Plasma of DOACs were analysed as long as the concentrations measured were &gt;30 ng.mL⁻¹. The primary endpoint was mortality up to Day 30. Patient blood management and plasma assays were recorded.</div></div><div><h3>Results</h3><div>From January 2022 to September 2023, 117 patients were analyzed in the DOACs group and 468 in the No-DOACs group. Patients with DOACs were most often operated on with a one-day delay (<em>P</em> &lt;  0.05). Non DAOC group presented lower mortality at 30 day (<em>P</em> &lt;  0.01). Up to Day 180, mortality rates were lower in the No-DOACs group with a 0.34 median hazard-risk [0.19−0.59]. Transfusion rates were similar in No-DOACs and DOACs groups (43 versus 48%, <em>P</em> = 0.55). Subgroups (&lt;30, 30−50, 50–80 ng.mL⁻¹) presented similar outcomes (transfusion, mortality).</div></div><div><h3>Conclusion</h3><div>DOACs were associated with higher mortality. A level of up to &lt; 80 ng.mL⁻¹ does not appear to make any difference to transfusion compared with no DOAC.</div></div><div><h3>Clinical Trials no</h3><div>NCT06382584 (registration date: 2024−04-24, registered retrospectively.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 1","pages":"Article 101616"},"PeriodicalIF":4.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative individualised ventilation: importance of targeted reassessment.","authors":"Mathieu Capdevila, Lorenzo Schiavoni, Samir Jaber","doi":"10.1016/j.accpm.2025.101629","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101629","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101629"},"PeriodicalIF":4.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis is associated with radiological lesions in patients with primary brain injuries: the result of a bicentric retrospective cohort.","authors":"Clément Rombi, Gerd Klinkmann, Ghazi Hmeydia, Rossella Letizia Mancusi, Loick Le Tertre, Moritz Grabow, Bertrand Hermann, Sarah Benghanem, Annette Grossmann, Tarek Sharshar, Johannes Ehler, Aurélien Mazeraud","doi":"10.1016/j.accpm.2025.101635","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101635","url":null,"abstract":"<p><strong>Introduction: </strong>The occurrence of sepsis in neurointensive care patients is linked to poor prognosis and high mortality. We hypothesized that an infection or sepsis (I/S) episode might increase the initial number of brain lesions and/or induce new brain lesions in neurointensive care patients.</p><p><strong>Materials and methods: </strong>This was a retrospective study between January 2015 and June 2020 that included neuroICU patients who had two magnetic resonance images and compared those who presented I/S episodes with those who did not. The two groups' differences were adjusted with propensity score matching. The main composite outcome was the increase in size of the initial brain lesion and/or the appearance of new brain lesions.</p><p><strong>Results: </strong>A total of 150 neurointensive care patients were included, 50 with infection or sepsis (I/S) and 100 controls. New or worsened brain lesions were observed in 58.0% of the I/S group versus 35.0% of controls (adjusted odds ratio 8.08, 95% CI [3.28-11.29], p < 0.001). Lesions included ischemic strokes (44%), intraparenchymal hemorrhages (44%), and diffuse leukoencephalopathy (52%). Microbleeds were observed in 21.1% of I/S patients. I/S was associated with a longer ICU stay (median 23 vs. 10.5 days, p < 0.0001) and a higher rate of unfavorable outcome (mRS ≥ 4 at discharge: 40.0% vs. 12.0%, p = 0.003; at 1 year: 20.0% vs. 6.5%, p = 0.037). Results were similar in sensitivity analyses restricted to ventilated patients.</p><p><strong>Conclusion: </strong>The occurrence of I/S is associated with the extension of the initial lesion and/or the appearance of new brain lesions on MRI in patients hospitalized in the neurointensive care unit for primary brain injury.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101635"},"PeriodicalIF":4.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alpha-delta ratio as a robust marker of the impact of cerebral blood flow on EEG signal during general anesthesia.","authors":"Elsa Manquat, Fabrice Vallée, Etienne Gayat, David Sabbagh, Melvin Berto-Strouc, Jona Joachim, Jérôme Cartailler, Alexandre Gramfort","doi":"10.1016/j.accpm.2025.101636","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101636","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the impact of cerebral blood flow (CBF) on electroencephalography (EEG) during general anesthesia (GA) in neuroradiology procedures and described the pressure-flow relationship during increasing and decreasing mean arterial pressure changes (mAP) challenges.</p><p><strong>Methods: </strong>Data were collected from 63 patients (aged 45 [32-53] years, 73 % women) who had EEG, mAP, and CBF monitored during stabilized GA. CBF was approximated by the mean blood velocity in the mean cerebral artery (MCAv_mean), measured by transcranial Doppler. We analyzed the alpha-delta ratio (ADR) to validate that the EEG signal under general anesthesia is influenced by CBF by demonstrating a significant association between MCAv_mean changes caused by an mAP challenge and intraoperative EEG parameters. Secondary objectives include (1) an evaluation of response delays between CBF and ADR correlation; (2) characterizing the relationship between CBFv and mAP by comparing linear regression coefficients between increasing and decreasing mAP challenges.</p><p><strong>Results: </strong>mAP challenges lasted for a median duration of 410[220-585] seconds. We found a significant linear relationship between MCAv_mean changes and alpha-delta ratio, with the strongest association found for a time delay between 4' and 9'30 s (permutation test). Our results show directional sensitivity of the cerebral pressure-flow relationship, with asymmetric responses to positive and negative mAP challenges across the cohort (0.28 [0.12 -0.37] and 0.38 [0.25 -0.74] respectively, p = 0.004).</p><p><strong>Conclusion: </strong>The ADR appears to be a delayed marker for studying the relationship between CBF and intraoperative EEG. We observed asymmetry in the cerebral pressure-flow relationship during increasing and decreasing mAP challenges.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101636"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}