Anaesthesia Critical Care & Pain Medicine最新文献

{"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}

{"title":"The rise of Remimazolam and the pathway of innovation in Anaesthesiology.","authors":"Alexandre Dos Santos, Raphael Cinotti","doi":"10.1016/j.accpm.2025.101637","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101637","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101637"},"PeriodicalIF":4.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214204","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":"Advancing Pediatric Trauma Triage.","authors":"Salar Golmohammadzadehkhiaban, Moein Ashouri, Nima Masoudi","doi":"10.1016/j.accpm.2025.101632","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101632","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101632"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208021","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":"Bispectral Index-guided Anesthesia in Children: A Systematic Review and Meta-Analysis.","authors":"Dora Alexandra Carreira de Oliveira, Júlia Dos Santos Monteiro, Nickolas Ricardo de Macêdo, Arthur Henrique Tavares Costa Santos, Sílvia Maria Rosa Neves","doi":"10.1016/j.accpm.2025.101607","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101607","url":null,"abstract":"<p><strong>Introduction: </strong>The bispectral index (BIS) parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding its benefits in children. We aimed to perform a systematic review and meta-analysis to determine whether BIS is advantageous for pediatric patients undergoing general anesthesia.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing BIS-guided anesthesia vs. general anesthesia guided only by clinical parameters in children undergoing surgeries. We computed mean difference (MD) for continuous outcomes and risk ratio (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.</p><p><strong>Results: </strong>We included 10 RCTs, comprising 1028 participants, of whom 536 (52%) underwent BIS-guided general anesthesia. Compared with general anesthesia guided solely by clinical parameters, BIS was associated with a lower time for airway device removal (MD -1.32 minutes; 95% CI -2.26 to -0.37; p < 0.01), recovery time (MD -2.67 minutes ; 95% CI -3.70 to -1.65; p < 0.01), PACU stay duration (MD -5.51 minutes; 95% CI -10.64 to -0.38; p = 0.04), and ET sevoflurane concentration (MD -0.49%; 95% CI -0.67 to -0.32; p < 0.01). The BIS guided group also showed a significantly longer time with an adequate BIS compared with the standard care group (MD 22.49%; 95% CI 17.80 to 27.18; p < 0.01). There were no differences between groups in anesthetic consumption, mean BIS during anesthesia, Pediatric Anesthesia Emergence Delirium (PAED) score at 10 minutes, and at 30 minutes.</p><p><strong>Conclusions: </strong>In children, BIS monitoring during general anesthesia limited the exposure to volatile anesthetics and is associated with better recovery outcomes.</p><p><strong>Registration: </strong>PROSPERO database under protocol number CRD42024607202 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607202).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101607"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208119","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":"Commentary on \"Virtual Reality for Reduction of Intraprocedural Pharmacological Sedation and Analgesia in Adult Patients: A Systematic Review and Meta-Analysis\".","authors":"Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.1016/j.accpm.2025.101628","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101628","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101628"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208029","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":"Effect of intraoperative remimazolam infusion on postoperative sleep disturbance in elderly patients after gynecological laparoscopy: A randomized clinical trial.","authors":"Jun Liu, Yinggang Zhou, Jiancheng Tang, Yawei Feng, Wenjuan Kuang, Weiqiang Chen, Ziqing Hei, Xiang Li","doi":"10.1016/j.accpm.2025.101625","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101625","url":null,"abstract":"<p><strong>Background: </strong>Postoperative sleep disturbance (PSD) is prevalent among elderly patients and women undergoing surgery. This study aimed to investigate the efficacy and safety of remimazolam in preventing PSD in elderly patients undergoing gynecological laparoscopic surgery.</p><p><strong>Methods: </strong>This randomized controlled trial was conducted at the Third Affiliated Hospital of Sun Yat-sen University between March to October 2024. Patients aged ≥ 65 years undergoing elective surgery were randomized to the control group (anesthesia induction and intraoperative infusion with propofol) or the remimazolam group (anesthesia induction and intraoperative infusion with remimazolam). The primary outcome was the incidence of PSD, defined as a Numeric Rating Scale score ≥ 6 or an Athens Insomnia Scale score ≥ 6 at either postoperative day (POD) 1 or 3.</p><p><strong>Results: </strong>The study included 146 patients. In intention-to-treat (ITT) analysis, PSD rates at POD1 were 51.3% (39/76) for controls versus 26.3% (20/76) for remimazolam (P =  0.002); at POD3, rates were 31.6% (24/76) versus 9.2% (7/76) (P =  0.001). Per-protocol (PP) analysis showed similar trends (POD1: 52.1% versus 24.7%, P =  0.001; POD3: 30.1% versus 6.8%, P <  0.001). Furthermore, compared to the control group, the remimazolam group demonstrated a lower incidence of hypotension (ITT, 34.2% versus 14.5%, P =  0.005; PP, 34.2% versus 13.7%, P =  0.016) and bradycardia (ITT, 21.1% versus 7.9%, P = 0.021; PP, 19.2% versus 6.8%, P =  0.027).</p><p><strong>Conclusions: </strong>This study suggested the prophylactic effect of intraoperative remimazolam infusion on the incidence of PSD in elderly patients who underwent gynecological laparoscopic surgery.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2400081855.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101625"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208056","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":"Paediatric anaesthesia in France: National data on outpatient procedures, emergency admissions, and critical outcomes in 2023.","authors":"Karine Nouette-Gaulain, Aurélie San Miguel, Michele Brami, Maryline Bordes-Demolis, Mathilde de Queiroz","doi":"10.1016/j.accpm.2025.101633","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101633","url":null,"abstract":"<p><strong>Background: </strong>Outpatient paediatric anaesthesia has been promoted as a national objective in France, with a target rate of 80%. However, outpatient care rates vary widely across institutions, reflecting differences not only in organizational models but also in patient demographics, clinical complexity, and admission pathways. Understanding these variations requires a comprehensive analysis that includes both ambulatory and non-ambulatory cases to identify structural and clinical factors that limit outpatient feasibility.</p><p><strong>Methods: </strong>The number of anaesthesia cases in 2023 was obtained from the French national PMSI database of short-stay healthcare institutions. For each recorded anaesthesia procedure, the collected information included the type of healthcare institution (public or private hospital), length of stay (0 day or more), type of procedure involving anaesthesia, admission status (emergency: yes/no), whether there was a related intensive care unit stay, child mortality, and the child's age and gender.</p><p><strong>Results: </strong>In 2023, 990,296 anaesthesia procedures were performed over 704,796 individual stays for children aged 0 to 17. Overall, outpatient stays accounted for 76.2%. Over 90% of paediatric anaesthesia stays in private hospitals were outpatient, whereas 58.8% of stays involving anaesthesia for children occurred in public hospitals. The number of stays for children under one year was 20,373 in public hospitals and 1,280 in private hospitals, which included 4,657 (22.8%) and 931(72.7%) outpatients, respectively.</p><p><strong>Conclusions: </strong>Prioritising personalised healthcare pathways, strengthening local and regional healthcare organisations according to patient characteristics and needs, are more suitable than simply increasing outpatient rates.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101633"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208074","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":"The application of continuous nefopam infusion in analgesia and sedation for mechanically ventilated patients in the ICU: Authors' reply.","authors":"Mohammed Gamal Abdelraouf, Samar Farghali Farid, Ahmed Mohammed Mukhtar, Nirmeen Ahmed Sabry","doi":"10.1016/j.accpm.2025.101631","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101631","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101631"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208030","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":"The effect of body mass index on short-term outcomes in nonagenarians and centenarians with critical illness: a retrospective cohort study.","authors":"Jake V Hinton, Nattaya Raykateeraroj, Chin J Ker, Boris Waldman, Je Min Suh, David Pilcher, Rinaldo Bellomo, Dong Kyu Lee, Laurence Weinberg","doi":"10.1016/j.accpm.2025.101634","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101634","url":null,"abstract":"<p><strong>Background: </strong>The impact of body mass index (BMI) on morbidity and mortality in very old individuals with acute, critical illness is poorly understood.</p><p><strong>Methods: </strong>We conducted a bi-national, retrospective, entropy-weighted cohort study of 12,510 nonagenarians and centenarians admitted to the intensive care unit (ICU) over a 15-year period. Based on their admission BMI, patients were classified as underweight (BMI < 20 kg/m²), normal weight (20 kg/m² ≤ BMI < 25.0 kg/m²), overweight (25.0 kg/m² ≤ BMI < 30 kg/m²), or obese (BMI ≥ 30 kg/m²). We estimated the association between admission BMI and clinical outcomes, with in-hospital mortality as the primary outcome.</p><p><strong>Results: </strong>The median BMI of the cohort was 24.4 kg/m² (IQR 21.8-27.5). Of the 12,510 eligible patients, 5,471 (43.7%) were categorized as normal weight, 1,526 (12.2%) underweight, 3,914 (31.3%) overweight, and 1,599 (12.8%) obese. After entropy weighting, increasing BMI was negatively associated with mortality (P < 0.001). In-hospital mortality occurred in 699 (12.8%) normal weight, 223 (14.6%) underweight (RR 1.18; 95% CI 1.02 to 1.36; P=0.030), 504 (12.9%) overweight (RR 0.97; 95% CI 0.87 to 1.08; P = 0.580), and 172 (10.8%) obese (RR 0.76; 95% CI 0.64 to 0.90; P = 0.001) patients. BMI was not associated with binary requirements for inotropes, invasive ventilation, or renal replacement therapy.</p><p><strong>Conclusions: </strong>In nonagenarians and centenarians admitted to the ICU, higher BMI was linked to lower in-hospital mortality, suggesting a protective effect. These results emphasize the need for individualized risk assessment in older ICU patients.</p><p><strong>Australian new zealand clinical trials registry number: </strong>ACTRN12625000297426.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101634"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208081","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":"Scoping Review of Early Mobility in the Intensive Care Unit Following Cardiac Surgery.","authors":"Emily K Phillips, Jacqueline L Hay, Caroline Monnin, April Gregora, Kathy Smith, Carly Shaski, Gavin Bozek, Sarah Gilchrist, Andrew Fagan, Maureen C Ashe, Anna M Chudyk, Annette S H Schultz, Sheila O'Keefe-McCarthy, Rakesh C Arora, Todd A Duhamel","doi":"10.1016/j.accpm.2025.101603","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101603","url":null,"abstract":"<p><strong>Introduction: </strong>Early mobility in the intensive care unit (ICU) within 24 hours following cardiac surgery (CS) is guideline-recommended, safe, and supports improved patient outcomes. The evolution of early mobility following CS research has not been explored. Prior reviews have not included non-randomized controlled trials nor assessed the quality of intervention reporting using standard guidelines.</p><p><strong>Objective: </strong>This scoping review addresses these gaps and maps CS ICU early mobility literature to understand the extent, range, and nature of the extant literature.</p><p><strong>Design: </strong>The databases Medline, Embase, PsycINFO, Scopus, CINAHL, ClinicalTrials.org, and CS association websites were searched from inception to January 2025. Extracted details included early mobility definitions and modes, outcome measures, alignment of intervention reporting with the Consensus of Exercise Reporting Template (CERT), and the inclusion of sex/gender in results/discussions.</p><p><strong>Results: </strong>A total of 109 studies were included. 43 studies defined early mobility, ranging from the day of surgery to within 2 weeks post-operatively. Many early mobility modes were noted, most commonly ambulation. Primary outcomes varied, with hospital length of stay and pulmonary function the most often studied. There was a consistent lack of reporting of CERT items. Only two studies presented findings disaggregated by sex/gender, and only 13 studies considered sex/gender in the discussion.</p><p><strong>Conclusions: </strong>There is inconsistency in the extant CS ICU early mobility literature, specifically in early mobility definitions and modes, outcome measures, quality of intervention reporting, and consideration of sex/gender. Improvements to research design and reporting should be encouraged to support the advancement of the science.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101603"},"PeriodicalIF":4.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208054","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}