Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"High Risk, High Reward: Postoperative Trajectories of Frail Older Adults.","authors":"Donna Ron, Stacie G Deiner","doi":"10.1016/j.accpm.2025.101585","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101585","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101585"},"PeriodicalIF":3.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530579","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":"Nonsteroidal anti-inflammatory drug use and acute kidney injury in nephrectomies: A retrospective propensity score-matched cohort study","authors":"Chun-yan Ye ,&nbsp;Long-yan Li ,&nbsp;Min-jing Yang ,&nbsp;Xing-yang Liu ,&nbsp;Ning Luo ,&nbsp;Jing-han Wu ,&nbsp;Yu-jie Xiao ,&nbsp;Daniel I. Sessler ,&nbsp;E. Wang","doi":"10.1016/j.accpm.2025.101581","DOIUrl":"10.1016/j.accpm.2025.101581","url":null,"abstract":"<div><h3>Introduction</h3><div>Nonsteroidal anti-inflammatory drugs (NSAID) are analgesic and spare opioids, but it remains unclear whether perioperative NSAID use worsens renal function after nephrectomy. We therefore tested the hypothesis that perioperative use of NSAID is associated with acute kidney injury (AKI) after nephrectomy surgery.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients ≥18 years old who had partial or radical nephrectomies. Patients who were given intravenous NSAIDs for postoperative analgesia were defined as one group, whereas reference patients did not use any NSAIDs. The primary outcome was the occurrence of postoperative acute kidney injury (AKI), as defined by the Kidney Disease: Improving Global Outcomes criteria. Secondary outcomes included AKI stage, NSAID-related side effects, postoperative hemoglobin, cumulative opioid consumption, and duration of hospitalization.</div></div><div><h3>Results</h3><div>Among 3,359 eligible nephrectomy patients, 78% (2,614) were given NSAIDs. We propensity-score-matched 739 pairs of patients who were or were not given NSAIDs. Patients in the NSAID group did not have more AKI (27.6%<em>vs</em>. 27.9%, HR 0.98 95% CI (0.80–1.19), <em>P</em> =  0.90), nor were their AKI stages worse [OR 0.99 (0.79–1.24), <em>P</em> =  0.91]. No significant differences were detected in NSAID-related side effects [OR 1.50 (0.42, 5.32), <em>P</em> = 0.53]. However, NSAID treatment was associated with shorter postoperative hospitalization: [5 [4,7] <em>vs</em>. 6 [5,7] days, <em>P</em> &lt; 0.001].</div></div><div><h3>Conclusions</h3><div>Perioperative use of NSAIDs in patients having nephrectomies was not associated with a greater risk of AKI, and possibly reduced the duration of hospitalization. Prospective interventional data are needed to guide NSAID use in this high-risk patient subset.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101581"},"PeriodicalIF":4.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530580","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":"Anticoagulant management in emergency settings: 2024 guidelines from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Working Group on Perioperative Haemostasis (GIHP).","authors":"Delphine Douillet, Alexandre Godon, Geoffroy Rousseau, Stéphanie Ruiz, Fanny Vardon, Emmanuel De Maistre, Delphine Garrigue, Isabelle Gouin, Yves Gruel, Julien Lanoiselée, Frédéric Lapostolle, Dominique Lasne, Alexandre Mansour, Anne-Céline Martin, Mikaël Mazighi, Patrick Mismetti, Thomas Moumneh, Farès Moustafa, Andrea Penaloza, Stéphanie Roullet, Pierre-Marie Roy, Virginie Siguret, Jeannot Schmidt, Charles Tacquard, Karim Tazarourte, Paul Zufferey, Philippe Nguyen, Anne Godier","doi":"10.1016/j.accpm.2025.101584","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101584","url":null,"abstract":"<p><strong>Objective: </strong>The Société Française de Médecine d'Urgence (SFMU), the Société Française d'Anesthésie et de Réanimation (SFAR), the Groupe d'Intérêt en Hémostase Péri-opératoire (GIHP) and the Société Française de Thrombose et d'Hémostase (SFHT) have collaborated to propose a set of guidelines on the management of anticoagulants in an emergency setting.</p><p><strong>Design: </strong>A group of French and Belgian experts from the French Societies of Emergency Medicine (SFMU), Anaesthesia and Intensive Care (SFAR), the working group on Perioperative Haemostasis (GIHP) and the French Society of Thrombosis and Haemostasis (SFHT) was convened. Any potential conflicts of interest were officially declared at the start of the recommendation development process, which was conducted independently of any industry funding. The authors used the GRADE (\"Grading of Recommendations Assessment, Development and Evaluation\") methodology to assess the level of evidence in the literature.</p><p><strong>Methods: </strong>Five areas were defined: (1) The role of laboratory testing in determining anticoagulant use and the level of anticoagulation; (2) Management of anticoagulant-associated bleeding; (3) Management of asymptomatic overdoses; (4) Management of non-elective invasive procedures on anticoagulants; and (5) Thrombolysis for acute ischaemic stroke on anticoagulants. For each field, the aim of the recommendations was to answer a certain number of questions formulated by the experts according to the PICO model (\"Population, Intervention, Comparison, Outcome\"). Based on these questions, an extensive bibliographic search from 1990 onwards was carried out using predefined key words according to the PRISMA recommendations. Data quality was analysed using the GRADE method. Recommendations were formulated using the GRADE method and then voted on by all the experts using the GRADE grid method.</p><p><strong>Results: </strong>The experts' summary work and application of the GRADE method resulted in 103 recommendations concerning 21 questions. After two rounds of voting and several amendments, strong agreement was reached on 97 recommendations. Out of these recommendations, 19 have a high level of evidence (19 GRADE 1), 35 have a low level of evidence (35 GRADE 2), and 48 are expert opinions. Finally, for one question, no recommendation could be made.</p><p><strong>Conclusions: </strong>There was strong agreement among the experts to provide recommendations for clinicians to provide up-to-date management of patients on anticoagulants in an emergency setting.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101584"},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530577","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":"Evaluation of abdominal muscle thickening fraction as a predictor for weaning outcome in patients with sepsis: A prospective observational study","authors":"Mina A. Helmy,&nbsp;Basma Gamal,&nbsp;Ahmed M. Lotfy,&nbsp;Walid I. Hammimy,&nbsp;Maha Mostafa","doi":"10.1016/j.accpm.2025.101580","DOIUrl":"10.1016/j.accpm.2025.101580","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101580"},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530578","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":"Effects of intravenous paracetamol on mean arterial pressure in critically ill patients: A systematic review and meta-analysis with trial sequential analysis","authors":"Simone Messina ,&nbsp;Simona Ferro ,&nbsp;Cristina Santonocito ,&nbsp;Carmelo Minardi ,&nbsp;Mateusz Zawadka ,&nbsp;Filippo Drago ,&nbsp;Alberto Noto ,&nbsp;Filippo Sanfilippo","doi":"10.1016/j.accpm.2025.101579","DOIUrl":"10.1016/j.accpm.2025.101579","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous administration of paracetamol to critically ill patients may have negative hemodynamic effects. However, such effects have not been adequately quantified.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of observational studies (published in English language in PubMed and/or EMBASE) conducted on intensive care unit (ICU) patients, reporting hemodynamic changes within 30 min of intravenous paracetamol administration for fever and/or analgesia. The primary outcome was the mean difference (MD) with 95% confidence interval [95%CI] in mean arterial pressure (MAP). Secondary outcomes were systolic and diastolic arterial pressure (SAP and DAP), heart rate (HR), and incidence of hypotension. Trial sequential analysis (TSA) was conducted to ascertain the robustness of findings.</div></div><div><h3>Results</h3><div>Eight studies were included. We observed significant reduction after paracetamol of MAP (5 studies, MD: −6.75 mmHg [−10.68; −2.82]; <em>p</em> = 0.0008; I² = 74%), SAP (5 studies, MD: −11.55 mmHg [−20.55; −2.55]; <em>p</em> = 0.01; I² = 78%) and DAP (5 studies, MD: −5.29 mmHg [−8.53; −2.05]; <em>p</em> = 0.001; I² = 42%). No effects were seen for HR (4 studies, MD: −3.08 bpm [−7.09;0.93]; <em>p</em> = 0.13; I² = 0%). Subgroup analyses were hampered by the small number of studies. MAP reduction appeared consistent when paracetamol was administered for fever. TSAs showed that results on MAP and DAP were robust; SAP and HR were not. The grade of evidence was very low. The occurrence of hypotension after intravenous paracetamol was 45.5% (n = 143/314, 4 studies).</div></div><div><h3>Conclusions</h3><div>Hypotension after intravenous paracetamol is frequent in the ICU, with significant reduction in MAP, SAP, and DAP but no effects on HR. Effects seem more pronounced in patients with fever. More advanced hemodynamic studies are needed to understand the mechanisms of paracetamol-induced hypotension.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD number 42024574919).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101579"},"PeriodicalIF":3.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512596","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":"Dexmedetomidine for delirium prevention after cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis","authors":"Lucas Caetano da Silva ,&nbsp;Vanessa Tapioca ,&nbsp;Patricia Viana ,&nbsp;Eduardo Maia Pereira ,&nbsp;Tathiane Gibicoski ,&nbsp;Sara Amaral","doi":"10.1016/j.accpm.2025.101578","DOIUrl":"10.1016/j.accpm.2025.101578","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative delirium remains a common complication after cardiac surgery. The impact of dexmedetomidine (DEX) on preventing postoperative delirium is still controversial as recent randomized controlled trials (RCTs) have presented conflicting results.</div></div><div><h3>Methods</h3><div>We conducted an updated systematic review and meta-analysis of RCTs evaluating DEX efficacy in preventing delirium after cardiac surgery. A systematic search of MEDLINE, Embase, and Cochrane databases identified RCTs comparing DEX with placebo or other treatments in patients aged ≥18 years. Sensitivity, subgroup analyses, and trial sequential analysis (TSA) assessed the robustness of the findings.</div></div><div><h3>Results</h3><div>A total of 31 RCTs including 5628 patients were analyzed, 50.1% of them receiving DEX. Delirium incidence was significantly lower in the DEX group (RR 0.61; 95% CI, 0.49–0.75; <em>P</em> &lt; 0.001). This protective effect remained across subgroup analyses based on age, control type, delirium assessment method, and after excluding trials at high risk of bias. DEX use was associated with a shorter intensive care unit length of stay (MD −0.14 days; 95% CI, −1.28 to −0.04; <em>P</em> &lt; 0.01). TSA confirmed the result’s robustness. However, DEX increased bradycardia risk (RR 1.53; 95% CI, 1.05–2.21; <em>P</em> = 0.02). No significant differences were found in mortality, intubation duration, hospital length of stay, atrial fibrillation, or hypotension.</div></div><div><h3>Conclusions</h3><div>Dexmedetomidine significantly reduces postoperative delirium following cardiac surgery, with moderate evidence confirmed by TSA. While it demonstrates clinical benefits, careful bradycardia monitoring is warranted.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42024593472).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101578"},"PeriodicalIF":3.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508918","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":"Malignant hyperthermia and genetic variability: A complex interaction","authors":"Marina Ayres Delgado,&nbsp;Geovana Torres Souza,&nbsp;André Luis Vieira Drumond,&nbsp;Bruno Pessoa Chacon","doi":"10.1016/j.accpm.2025.101577","DOIUrl":"10.1016/j.accpm.2025.101577","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 6","pages":"Article 101577"},"PeriodicalIF":3.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508919","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":"Dan Zhao,&nbsp;Lin Chen,&nbsp;Hongkun Wang","doi":"10.1016/j.accpm.2025.101576","DOIUrl":"10.1016/j.accpm.2025.101576","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101576"},"PeriodicalIF":3.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340515","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":"Is metronidazole recommended in pilonidal sinus surgery?","authors":"Benjamin Darnis ,&nbsp;Benoit Gignoux ,&nbsp;Anne-Laure Blanc-Gruyelle ,&nbsp;Frédérique Roumanet ,&nbsp;Alban Mirabaud","doi":"10.1016/j.accpm.2025.101575","DOIUrl":"10.1016/j.accpm.2025.101575","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101575"},"PeriodicalIF":3.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295158","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":"Continuous serratus posterior superior intercostal plane block for postoperative analgesia in thoracotomy","authors":"Poonam Kumari ,&nbsp;Amarjeet Kumar ,&nbsp;Rehana Aliyar ,&nbsp;Lakshmi Sinha","doi":"10.1016/j.accpm.2025.101570","DOIUrl":"10.1016/j.accpm.2025.101570","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101570"},"PeriodicalIF":3.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310582","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}