Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Effects of naloxegol on transit recovery in patients undergoing cardiac surgery: A randomized, double-blind, placebo-controlled trial","authors":"Driss Laghlam ,&nbsp;Hadrien Gibert ,&nbsp;Messaouda Merzoug ,&nbsp;Didier Leclerc ,&nbsp;Lucas Coroyer ,&nbsp;Philippe Estagnasie ,&nbsp;Pierre Squara ,&nbsp;Lee S. Nguyen ,&nbsp;Guillaume Geri","doi":"10.1016/j.accpm.2025.101498","DOIUrl":"10.1016/j.accpm.2025.101498","url":null,"abstract":"<div><h3>Background</h3><div>Paralytic ileus is a major surrounding after cardiac surgery and worsens patients’ prognosis.</div></div><div><h3>Methods</h3><div>We conducted a single-centre, randomized, double-blind, placebo-controlled phase 3 study. We enrolled patients over 18 years old who underwent non-urgent cardiac surgery. Eligible patients were randomly allocated to Naloxegol or matching placebo in an equal ratio. The participants were randomly assigned to one of the following groups: (1) Naloxegol 12,5 mg 2 h before index surgery, and then Naloxegol 25 mg once daily, or (2) matching placebo. Naloxegol or placebo was administered for up to 5 days and permanently stopped if the patient had transit recovery. The primary endpoint was the time of postoperative gastrointestinal transit recovery after the index cardiac surgery, defined as the time in hours between the anaesthetic induction and the emission of the first significant stool.</div></div><div><h3>Results</h3><div>Between October 14, 2020, and January 28, 2022, 299 participants were included in modified intention-to-treat efficacy analyses (151 in the Naloxegol group and 148 in placebo). The mean age was 62 ± 10.1 years old, 81.6% were male, 53.8% had hypertension, 20.7% had diabetes mellitus, and the median body mass index was 25.9 (IQR 23.7−29.4) kg/m². Time-to-transit recovery did not differ between Naloxegol group and placebo (76.0, [IQR 69.3−93.5] <em>vs.</em> 78.3, [IQR 70.0−95.8] h, <em>p</em> value = 0.40). We did not observe any difference in the prespecified secondary efficacy between both groups. Pain levels and a number of serious adverse events were not different in both groups.</div></div><div><h3>Conclusions</h3><div>Naloxegol was not found to be effective in improving the transit time recovery after elective cardiac surgery.</div><div>The trial was registered on ClinicalTrials.gov (NCT04433390) on June 16^th, 2020.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101498"},"PeriodicalIF":3.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484419","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":"Association of oxygenation levels after successful mechanical thrombectomy under general anesthesia and 3-month functional outcome in patients with acute ischemic stroke: A prospective observational study","authors":"Manuel Taboada ,&nbsp;Ana Estany-Gestal ,&nbsp;Laura Barreiro ,&nbsp;Kora Williams ,&nbsp;Jorge Fernández ,&nbsp;Marta Méndez ,&nbsp;Fátima García ,&nbsp;Borja Cardalda-Serantes ,&nbsp;Carmen López ,&nbsp;Manuel Rodríguez-Yáñez ,&nbsp;Susana Arias-Rivas ,&nbsp;María Santamaría-Cadavid ,&nbsp;Emilio Rodríguez-Castro ,&nbsp;Miguel Blanco ,&nbsp;Antonio Mosqueira ,&nbsp;Jose Antonio Castiñeiras ,&nbsp;Esteban Ferreiroa ,&nbsp;Pablo Otero ,&nbsp;Alberto Naveira ,&nbsp;Eva San Luis ,&nbsp;Teresa Seoane-Pillado","doi":"10.1016/j.accpm.2025.101494","DOIUrl":"10.1016/j.accpm.2025.101494","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate whether oxygenation levels (PaO₂ &lt;150 mmHg <em>vs</em>. PaO₂ ≥150 mmHg) in mechanically ventilated patients with acute ischemic stroke (AIS) after successful endovascular treatment (EVT) under general anesthesia are associated with functional outcomes at three months.</div></div><div><h3>Methods</h3><div>We prospectively collected data over 30 mo from patients with proximal occlusion of the anterior circulation treated with successful EVT under general anesthesia. After the procedure, patients were admitted to the ICU for delayed extubation. Two groups were established based on the partial pressure of oxygen (PaO₂ &lt;150 mmHg <em>vs</em>. PaO₂ ≥150 mmHg), measured in arterial blood gas analysis within the first hour of ICU admission. Demographics, clinical factors, and neurological status were compared. The primary outcome was the proportion of patients achieving a favorable functional outcome (mRS ≤ 2) at 3 mo.</div></div><div><h3>Results</h3><div>During the study period, 271 patients were admitted to our ICU after EVT for AIS. Of these, 210 patients met the inclusion criteria. No significant differences were found between the groups in demographics, clinical factors, neurological status, or functional outcomes at 3 mo. The primary outcome showed no significant difference: 48 of 100 patients (48%) in the PaO₂ &lt;150 mmHg group achieved a favorable functional outcome (mRS 0–2) compared to 56 of 108 patients (51.9%) in the PaO₂ ≥150 mmHg group (p = 0.579).</div></div><div><h3>Conclusion</h3><div>No association was found between 3-mo functional outcomes and post-procedure oxygenation levels in patients with AIS treated successfully with EVT under general anesthesia.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101494"},"PeriodicalIF":3.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484404","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":"Efficacy and safety of topical lignocaine anesthesia in improving patient satisfaction after endobronchial ultrasound–guided transbronchial needle aspiration under general anesthesia: A randomized controlled trial","authors":"Sen Zhang ,&nbsp;Wannan Chen ,&nbsp;Jian Wang ,&nbsp;Changhong Miao ,&nbsp;Hao Fang ,&nbsp;Chao Liang","doi":"10.1016/j.accpm.2025.101495","DOIUrl":"10.1016/j.accpm.2025.101495","url":null,"abstract":"<div><h3>Background</h3><div>Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective technique used by thoracic surgeons and pulmonologists. This study evaluated the safety and efficacy of topical lignocaine anesthesia during bronchoscopy to improve the satisfaction of patients undergoing elective EBUS-TBNA under general anesthesia.</div></div><div><h3>Methods</h3><div>This was a single-center prospective randomized, double-blind clinical trial in University-affiliated teaching hospitals. A total of 196 patients underwent elective EBUS-TBNA under general anesthesia. Patients were randomly assigned to receive topical anesthesia with 1% lignocaine (T) or saline (C). The primary outcome was coughing frequency immediately after laryngeal mask removal. Secondary outcomes included coughing frequency and intensity (visual analog scale [VAS]), vital sign changes, adverse events, postoperative pulmonary complications, and the Quality of Recovery-15 (QoR-15) questionnaire.</div></div><div><h3>Results</h3><div>A total of 196 patients underwent randomization (91 in. T and 94 in C). Topical anesthesia with lignocaine significantly reduced the cough rate and VAS score immediately (<em>P</em> &lt; 0.001 and &lt; 0.001, respectively), 10 min (<em>P</em> &lt; 0.001 and &lt; 0.001), and 30 min (<em>P</em> = 0.005 and 0.001) after mask removal, and 2 h post-procedure (<em>P</em> = 0.003 and 0.006). No significant effect on vital signs was observed. The QoR-15 values 24 h after the procedure in group T were higher than those in group C (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>During EBUS-TBNA under general anesthesia, 1% lignocaine for topical anesthesia significantly decreased the incidence of postoperative coughing and increased patient satisfaction. Topical anesthesia should be routinely administered to patients undergoing EBUS-TBNA under general anesthesia.</div></div><div><h3>Registration</h3><div>Chinese Clinical Trial Registry; Registration number: ChiCTR2300072386; URL: <span><span>https://www.chictr.org.cn/showproj.html?proj=197032</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101495"},"PeriodicalIF":3.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484366","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":"Time on the waiting list is an independent risk factor for day-90 mortality after lung transplantation","authors":"Enora Atchade ,&nbsp;Vincent Bunel-Gourdy ,&nbsp;Nathalie Zappella ,&nbsp;Sylvain Jean-Baptiste ,&nbsp;Alexy Tran-Dinh ,&nbsp;Sébastien Tanaka ,&nbsp;Brice Lortat-Jacob ,&nbsp;Arnaud Roussel ,&nbsp;Pierre Mordant ,&nbsp;Yves Castier ,&nbsp;Hervé Mal ,&nbsp;Christian De Tymowski ,&nbsp;Philippe Montravers","doi":"10.1016/j.accpm.2025.101499","DOIUrl":"10.1016/j.accpm.2025.101499","url":null,"abstract":"<div><h3>Background</h3><div>The waitlist deaths of transplantation candidates based on their time on the waiting list (TWL) have already been studied, but the short-term mortality and early complications of lung transplant (LT) recipients based on their TWL have not been specifically studied. The first aim of this study was to assess the relationship between increased TWL and short-term mortality in LT recipients.</div></div><div><h3>Methods</h3><div>In this observational, monocentric, retrospective study, all patients who underwent LT between January 2016 and August 2022 at Bichat Claude Bernard Hospital, Paris were analyzed. Univariate analysis (chi2 test, Mann–Whitney test, Fisher’s exact test) and multivariate analysis (logistic regression) were performed. Ninety-days and one-year survival were studied (Kaplan–Meier curves, log-rank test). <em>p</em> &lt; 0.05 indicated statistical significance.</div></div><div><h3>Results</h3><div>242 LT patients were analyzed. The median TWL was 100 (43−229) days. Postoperative complications, including septic shock (36 <em>versus</em> 18%, <em>p</em> = 0.002), grade 3 primary graft dysfunction (31 <em>versus</em> 20%, <em>p</em> &lt; 0.001), and KDIGO3 acute kidney injury (8 <em>versus</em> 25%, <em>p</em> &lt; 0.001), were more common in the prolonged TWL (pTWL) group (&gt;100 days) than in the short TWL group (≤100 days). The duration of hospitalization in the ICU was longer (18 [11−34] <em>versus</em> 13 [9−23] days, <em>p</em> = 0.02) in the pTWL group. According to our multivariate analysis, TWL was an independent risk factor for 90-days mortality (OR 1.02, 95% CI [1.00−1.04]; <em>p</em> = 0.032).</div></div><div><h3>Conclusion</h3><div>TWL was an independent risk factor for 90-days mortality after LT. Receiving LT after more than 100 days on the waitlist exposes to increased postoperative complications.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101499"},"PeriodicalIF":3.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484465","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":"Early extubations in children intubated prior to arrival in Paediatric Burn ICU, a single center retrospective study over 1520 admissions.","authors":"Sébastien Lebrun, Nicolas Louvet, Nada Sabourdin, Isabelle Constant","doi":"10.1016/j.accpm.2025.101500","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101500","url":null,"abstract":"<p><strong>Background: </strong>In adult burns intensive care units, more than 30% of patients arriving intubated, are extubated within 2 days (potentially unnecessary intubation, PUNI). Such data are lacking in paediatric populations. Exploring this paediatric PUNI rate was the primary aim of the study.</p><p><strong>Methods: </strong>Data from all the admissions to our paediatric burn intensive care unit were retrospectively analyzed over an 8-years period. Extubations within the first two days among patients arriving intubated were assessed as the primary outcome (PUNI rate). Using a univariate logistic regression and a multivariate model, we analyzed factors associated with intubation lasting more than 2 days (potentially necessary intubation, PNI). Finally, we developed a score to predict the probability of PNI.</p><p><strong>Results: </strong>Among the 1520 admitted children (age: 0-17; Percentage of Total Body Surface Area (%TBSA): 1- 97%), 56 (4%) arrived intubated, 20 (36%) of whom were considered PUNI. These patients had smaller %TBSA burned compared to those having PNI (24 ± 17% vs 48 ± 24%, p = 0.002). We developed a score based on factors independently associated with PNI: %TBSA burned (OR = 1.12 [1.09-1.15] for each additional per cent), flame burns (OR = 4.43 [1.64-11.6]) and facial burns (OR = 12.28 [3.41-67.4]). Seven children (<0.5%) were intubated after admission.</p><p><strong>Conclusion: </strong>Intubation before admission to a burn intensive care unit was less frequent in children. The paediatric rate of PUNI, however, was close to findings reported in adults: approximately one-third of intubated children were extubated within 2 days.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101500"},"PeriodicalIF":3.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484417","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":"Deep neuromuscular block with pipecuronium in patients undergoing laparoscopic surgery - A prospective case series.","authors":"László Asztalos, Zoltán Szabó-Maák, Mariann Berhés, Zsolt Kanyári, György Nagy, Adrienn Pongrácz, Réka Nemes, Sorin J Brull, Béla Fülesdi","doi":"10.1016/j.accpm.2025.101493","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101493","url":null,"abstract":"<p><strong>Introduction: </strong>We tested the feasibility of maintaining low intraabdominal pressures during pipecuronium-induced deep block (post-tetanic count ≥1, train-of-four count = 0) in patients undergoing laparoscopic surgery.</p><p><strong>Methods: </strong>Ten adult patients awaiting cardiac surgery or heart transplantation and requiring non-elective abdominal surgery were included. Pipecuronium bromide 0.09 mg/kg was used for muscle relaxation and maintenance of deep block. Top-up doses of pipecuronium (0.01-0.02 mg/kg) were administered when post-tetanic count was 4-8. Intraabdominal pressures were kept below 10 mmHg. Mean arterial pressure was measured intra-arterially. Surgical field view was rated on a 5-point scale (1 = extremely poor, 5 = optimal).</p><p><strong>Results: </strong>Induction dose of 0.09 mg/kg pipecuronium had an onset time of 5.3 (2.3-6.3, 25-75% IQR) min. Deep block was maintained for 51.2 ± 19.7 min. Top-up pipecuronium doses were necessary in 5 patients, 56.0 ± 28.1 min. after the first dose. At the end of surgery, neuromuscular block was deep (post-tetanic count 0-6). Administration of 2 mg/kg of sugammadex induced recovery to train-of-four ratio ≥0.9 in 3.5 ± 1.6 min, and to train-of-four ratio = 1.0 in 4.3 ± 1.2 min. Mean intraabdominal pressure was 8.1 ± 1.1 mmHg during pneumoperitoneum. There was no significant change in heart rate (0.0, -2.6 to 0) beats/min.</p><p><strong>Discussion: </strong>Pipecuronium is a rational alternative when deep neuromuscular block is necessary, because of its long-acting neuromuscular blocking effect that may be antagonized quickly and safely with sugammadex.</p><p><strong>Registration: </strong>European Clinical Trials Database registration number: 2022-004114-11, Clinical Trials Database registration number: NCT06517524.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101493"},"PeriodicalIF":3.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472984","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":"Are corticosteroids in intensive care immunosuppressive? Reflections and hypotheses.","authors":"Rayan Braïk","doi":"10.1016/j.accpm.2025.101492","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101492","url":null,"abstract":"<p><p>This review reconsiders the classification of corticosteroids as immunosuppressants in the management of acute inflammatory conditions in critical care. Despite their widespread use in ARDS and septic shock, the association between corticosteroid therapy and increased infection risk remains contentious. By exploring alternative mechanisms and presenting new hypotheses, this review suggests that the traditional view of corticosteroids as immunosuppressants may be overly simplistic and context dependent.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101492"},"PeriodicalIF":3.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434116","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":"Transfusion thresholds after acute brain injury: How can they impact on protocols optimizing brain oxygenation?","authors":"Pierre Bouzat,&nbsp;Fabio Silvio Taccone","doi":"10.1016/j.accpm.2025.101491","DOIUrl":"10.1016/j.accpm.2025.101491","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101491"},"PeriodicalIF":3.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374686","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":"Transfusion strategy in the most critically patients with trauma brain injury: Differences to other populations?","authors":"Fabien Coisy, Florian Ajavon, Jeffrey Lipman, Jean-Yves Lefrant, Xavier Bobbia","doi":"10.1016/j.accpm.2025.101490","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101490","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101490"},"PeriodicalIF":3.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374685","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":"Protecting the lungs during surgery: Modes of ventilation are no silver bullet","authors":"Mauro Roberto Tucci ,&nbsp;Sérgio Martins Pereira ,&nbsp;Martin Girard","doi":"10.1016/j.accpm.2025.101488","DOIUrl":"10.1016/j.accpm.2025.101488","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 2","pages":"Article 101488"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123921","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}