Anaesthesia Critical Care & Pain Medicine最新文献

{"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":"2026-04-01","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":"Corrigendum to “Association between low income and ICU delirium among critically ill older patients: A retrospective cohort study in Japan”","authors":"Toshinori Nishizawa ,&nbsp;Nobutoshi Nawa ,&nbsp;Atsushi Mizuno ,&nbsp;Takahiro Suzuki ,&nbsp;Hiroko Arioka ,&nbsp;Takeo Fujiwara","doi":"10.1016/j.accpm.2025.101739","DOIUrl":"10.1016/j.accpm.2025.101739","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101739"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037056","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":"Comparison of effects of remimazolam and propofol on mask ventilation during general anaesthesia induction: A randomised controlled trial","authors":"Ji Hyeon Lee ,&nbsp;Jin-Hee Kim ,&nbsp;Jiyoun Lee ,&nbsp;Sung-Hee Han ,&nbsp;Jin-Woo Park","doi":"10.1016/j.accpm.2025.101703","DOIUrl":"10.1016/j.accpm.2025.101703","url":null,"abstract":"<div><h3>Background</h3><div>Benzodiazepines facilitate mask ventilation due to their airway relaxant properties. Remimazolam, an ultra-short-acting benzodiazepine, may offer advantages during anaesthesia induction. This study evaluated the difficulty of mask ventilation between remimazolam and propofol during the induction of general anaesthesia.</div></div><div><h3>Methods</h3><div>Seventy-six adult patients scheduled for elective surgery under general anaesthesia were randomised into propofol and remimazolam groups. In the propofol group, general anaesthesia was induced with target-controlled infusion of propofol at an effect-site concentration of 4 µg/mL. In the remimazolam group, continuous infusion of remimazolam was performed at 12 mg/kg/h. The primary outcome was mask ventilation difficulty assessed by the Warters scale. Secondary outcomes included time to achieve loss of consciousness (LOC) and mean blood pressure during induction.</div></div><div><h3>Results</h3><div>The remimazolam group exhibited significantly lower Warters score compared to the propofol group (0.0 [0.0–0.8] <em>vs.</em> 1.0 [0.0–3.0], <em>P</em> = 0.002). The occurrence of mask ventilation difficulties requiring more than one airway device during anaesthetic induction was also significantly lower in the remimazolam group than in the propofol group (odds ratio [95% confidence interval], 0.23 [0.08–0.68]; <em>P</em> = 0.006). Mean blood pressure immediately after LOC was higher in the remimazolam group (<em>P</em> = 0.037), although the incidence of hypotension after induction was comparable between groups. The time required to achieve LOC was longer in the remimazolam group (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Compared to propofol, remimazolam induction was associated with easier mask ventilation and more stable blood pressure after LOC, despite a longer time to achieve LOC.</div></div><div><h3>Registration</h3><div>University Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000053553; registration date: 7 February 2024; registration URL: <span><span>https://center6.umin.ac.jp/cgi-bin/ctr_e/ctr_view_reg.cgi?recptno=R000061086</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101703"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582473","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":"Could improved survival after cancer surgery be the ultimate benefit of ERAS?","authors":"Karem Slim ,&nbsp;Laura Ruscio","doi":"10.1016/j.accpm.2025.101712","DOIUrl":"10.1016/j.accpm.2025.101712","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101712"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641214","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 disparities in neuro-sedation treatment for intracranial hypertension in traumatic brain injury in France: A national survey","authors":"Hugues Ravaux ,&nbsp;Jean-Denis Moyer ,&nbsp;Benjamin Cohen ,&nbsp;Päer-Sélim Abback","doi":"10.1016/j.accpm.2025.101722","DOIUrl":"10.1016/j.accpm.2025.101722","url":null,"abstract":"<div><h3>Importance</h3><div>Sedation is a cornerstone therapeutic option for the control of intracranial hypertension in patients with traumatic brain injury. However, the absence of specific recommendations regarding the choice of agents, their combinations, or dosing strategies contributes to the heterogeneity of sedation practices, which may be applied at varying levels of therapeutic intensity (Tier 0, 1, 2, 3).</div></div><div><h3>Objective</h3><div>To describe the sedative molecules and their combinations used in the treatment of ICH in TBI in France.</div></div><div><h3>Methods</h3><div>From May 1^st to August 31^st, 2024, a questionnaire was sent to French senior physicians working in intensive care units of level 1 trauma centers.</div></div><div><h3>Results</h3><div>A total of 115 responses were obtained. At the initial tier of therapeutic intensity, the most frequently reported sedations were midazolam (<em>n</em> = 52, 45%) and propofol (<em>n</em> = 43, 37%). For analgesia, sufentanil was the predominant agent (96%). The most common combination at the first tier was midazolam/propofol/sufentanil (<em>n</em> = 78, 69%). Forty-eight respondents (42%) reported escalating to a higher level of sedation at Tier Two, most often with midazolam/propofol/ketamine/sufentanil (<em>n</em> = 35, 73%). Sixty-four respondents (56%) reported using barbiturate coma for intracranial hypertension refractory to Tier Two therapy.</div></div><div><h3>Conclusion</h3><div>This study describes a high level of heterogeneity in the use of sedation agents, their maximum doses, and their monitoring in the treatment of traumatic ICH among neurointensivists in France.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101722"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688509","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":"Comfort-Focused Assessment and Patient-Reported Experience After Regional versus General Anaesthesia: Post Hoc Analysis of a Cluster-Randomised Trial","authors":"Axel Maurice-Szamburski ,&nbsp;Romain Rozier ,&nbsp;Nicolas Fusco ,&nbsp;Ludovic Meuret ,&nbsp;Anderson Loundou ,&nbsp;Pascal Auquier ,&nbsp;Hélène Beloeil","doi":"10.1016/j.accpm.2025.101660","DOIUrl":"10.1016/j.accpm.2025.101660","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative pain management typically relies on numerical (NRS) or analogue rating scales. However, exclusive focus on nociception may overlook broader aspects of patient experience, especially under regional anaesthesia (RA). This post hoc analysis of the COMFORT trial (NCT05234216) examined whether replacing the NRS with a comfort-focused scale affects patient-reported experience, opioid use, and related outcomes.</div></div><div><h3>Methods</h3><div>We analysed data from a cluster-randomised trial in 29 French centres. Adults undergoing elective non-cardiac surgery managed in the post-anaesthesia care unit (PACU) were included. The intervention (comfort scale) and comparator (pain NRS) were applied in the PACU. Patient-reported experience was measured with the EVAN-G/LR scales, self-completed on the ward/day-care unit ≥4 h postoperatively. Participants were divided into RA and general anaesthesia subgroups.</div></div><div><h3>Results</h3><div>Of 885 randomised patients, 786 had evaluable EVAN data. After regional anaesthesia (RA; n = 305), comfort‑focused assessment was associated with higher EVAN Pain (median 88 [IQR 75–94] <em>vs.</em> 75 [69–88]; <em>p</em> = 0.034), Waiting (100 [75–100] <em>vs.</em> 75 [50–100]; <em>p</em> = 0.012), and Global Index (81 [72–91] <em>vs.</em> 77 [68–90]; <em>p</em> = 0.044). After general anaesthesia (GA; n = 481), EVAN scores were similar between groups. Nefopam use was lower with the comfort approach in RA (7% <em>vs.</em> 18%; <em>p</em> = 0.005). Antiemetic use was lower with the comfort approach in GA.</div></div><div><h3>Conclusion</h3><div>Replacing the NRS with a comfort-focused approach did not improve global patient experience after surgery. In patients receiving regional anaesthesia, however, using a comfort scale was associated with better patient-reported experience in the EVAN “Pain” dimension, while no benefit was observed after general anaesthesia.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101660"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432682","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":"Clinical practices in hemodynamic management of post-induction hypotension in chronic hypertension: A study of certified registered nurse anesthetists’ strategies","authors":"Olivier Ayme ,&nbsp;Elisabeth Chapalain ,&nbsp;Jean-Jacques Romuald ,&nbsp;Olivier Langeron ,&nbsp;Anaïs Caillard","doi":"10.1016/j.accpm.2025.101649","DOIUrl":"10.1016/j.accpm.2025.101649","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-induction hypotension is a common complication in general anesthesia, particularly in patients with chronic hypertension. This study aims to analyze the practices of Certified Registered Nurse Anesthetist (CRNA) in collaboration with anesthesiologists of hemodynamic management in these patients.</div></div><div><h3>Methodology</h3><div>A multicenter quantitative descriptive survey was conducted among <strong>CRNAs</strong> working in 11 public and private hospitals. A questionnaire was developed to compare the management of two clinical cases: the first involved a hypertensive patient undergoing low-risk surgery, while the second described an older patient with multiple comorbidities undergoing high-risk surgery. The hemodynamic monitoring methods used by CRNAs were evaluated.</div></div><div><h3>Results</h3><div>Of the 158 CRNAs who responded (48.2% of 352 surveyed), 85% reported using mean arterial pressure (MAP) as their monitoring target. MAP targets ranged from 75 ± 9 mmHg for the first case to 80 ± 11 mmHg for the second. The study shows that 88% of CRNAs titrate anesthetics (over 70% using depth monitoring), and 70% start norepinephrine before the first induction. These rates rise to 94% and 99% for the second case. Norepinephrine is the first-line treatment for hypotension, while fluid loading comes fourth after Trendelenburg and anesthetic reduction. In the second, pulse wave analysis is most used (53%), followed by oesophageal Doppler (25%). Despite the availability of non-invasive stroke volume monitoring, 35% of CRNAs express interest in its implementation.</div></div><div><h3>Conclusion</h3><div>These findings highlight a predominant shift among CRNAs toward proactive, vasoactive-centered hemodynamic management.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101649"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422948","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 ,&nbsp;Yinggang Zhou ,&nbsp;Jiancheng Tang ,&nbsp;Yawei Feng ,&nbsp;Wenjuan Kuang ,&nbsp;Weiqiang Chen ,&nbsp;Ziqing Hei ,&nbsp;Xiang Li","doi":"10.1016/j.accpm.2025.101625","DOIUrl":"10.1016/j.accpm.2025.101625","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>The study included 146 patients. In intention-to-treat (ITT) analysis, PSD rates at POD1 were 51.3% (39/76) for controls <em>versus</em> 26.3% (20/76) for remimazolam (<em>P</em> =  0.002); at POD3, rates were 31.6% (24/76) <em>versus</em> 9.2% (7/76) (<em>P</em> =  0.001). Per-protocol (PP) analysis showed similar trends (POD1: 52.1% <em>versus</em> 24.7%, <em>P</em> =  0.001; POD3: 30.1% <em>versus</em> 6.8%, <em>P</em> &lt;  0.001). Furthermore, compared to the control group, the remimazolam group demonstrated a lower incidence of hypotension (ITT, 34.2% <em>versus</em> 14.5%, <em>P</em> =  0.005; PP, 34.2% <em>versus</em> 13.7%, <em>P</em> =  0.016) and bradycardia (ITT, 21.1% <em>versus</em> 7.9%, <em>P</em> = 0.021; PP, 19.2% <em>versus</em> 6.8%, <em>P</em> =  0.027).</div></div><div><h3>Conclusions</h3><div>This study suggested the prophylactic effect of intraoperative remimazolam infusion on the incidence of PSD in elderly patients who underwent gynecological laparoscopic surgery.</div></div><div><h3>Trial registration</h3><div>Chinese Clinical Trial Registry, ChiCTR2400081855.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101625"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","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":"Chemical neurotoxicity due to accidental chlorhexidine exposure in an axillary brachial plexus block","authors":"Alexandre Behouche ,&nbsp;Pierre Albaladejo ,&nbsp;Claire Lepouse ,&nbsp;Herve Bouaziz ,&nbsp;Jean Marc Malinovsky","doi":"10.1016/j.accpm.2025.101734","DOIUrl":"10.1016/j.accpm.2025.101734","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101734"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688521","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":"Limitations and future directions for optimal EVD weaning strategies in patients with non-traumatic subarachnoid hemorrhage","authors":"Moein Ashouri ,&nbsp;Hossein Nasirinia","doi":"10.1016/j.accpm.2025.101690","DOIUrl":"10.1016/j.accpm.2025.101690","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101690"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530916","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}