Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Role of ultrasound guided recto-intercostal fascial plane block for right sub-costal incision.","authors":"Poonam Kumari, Amarjeet Kumar, Soumya Singh, Chandni Sinha, Smitha Cb","doi":"10.1016/j.accpm.2025.101568","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101568","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101568"},"PeriodicalIF":3.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310584","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 sub-anesthetic doses of esketamine on postoperative sleep disturbance and pain in patients undergoing lumbar interbody fusion - A randomized, double-blind, placebo-controlled, two-center trial.","authors":"Zheping Chen, Yongxu Gao, Changli Gao, Yizheng Zhang, Le Zhang, He Zhang, Qianqian Wu, Yuelong Jin, Na Guo, Lulu Liu, Peilin Cong, Yanwu Jin","doi":"10.1016/j.accpm.2025.101567","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101567","url":null,"abstract":"<p><strong>Background: </strong>Postoperative sleep disturbance (PSD) is a common postoperative complication that significantly impacts patients' recovery, particularly after lumbar surgery.</p><p><strong>Methods: </strong>This two-center, double-blind, placebo-controlled randomized trial was conducted between June 6, 2024, and November 26, 2024, in two hospitals in China. A total of 80 patients participated in this study and were randomly assigned to the esketamine group (n = 40) or the placebo group (n = 40). Patients in the esketamine group received 0.2 mg kg^-¹ of esketamine for anesthesia induction, with a maintenance rate of 0.02 mg kg^-¹·h^-¹, followed by 1 mg kg^-¹ of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the placebo group of patients. The primary outcome of this study was the incidence of PSD on postoperative day (POD) 1. PSD was defined as a Numeric Rating Scale-sleep score of 6 or higher or an Athens Insomnia Scale score of 6 points or higher.</p><p><strong>Results: </strong>The incidence of PSD on POD 1 was significantly lower in the esketamine group compared to the placebo group (33% vs. 67%; P = 0.003). Notably, the Visual Analog Scale (VAS)-pain score at rest was lower in the esketamine group compared to the placebo group at 1, 3, and 6 h after surgery (P <  0.05); moreover, the VAS-pain score with movement was also lower in the esketamine group than the placebo group at 1, 3, 6, and 24 h after surgery (P <  0.05). Furthermore, the Quality of Recovery-15 (QoR-15) scores were significantly higher in the esketamine group than in the placebo group on POD 1 (107 [103- 117] vs. 99 [96-108]; P =  0.005) and POD 3 (130 [122-136] vs. 124 [117-127]; P =  0.003).</p><p><strong>Conclusion: </strong>Sub-anesthetic doses of esketamine can reduce the incidence of PSD on POD1, reduce postoperative pain, and improve QoR.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry https://www.chictr.org.cn, ChiCTR2400083156.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101567"},"PeriodicalIF":3.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310583","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":"Barriers to the implementation of enhanced recovery after cardiac surgery: A national survey","authors":"Grégoire Le Gac ,&nbsp;Baptiste Gaudriot ,&nbsp;Jean-Philippe Verhoye ,&nbsp;Nicolas Nesseler ,&nbsp;Jacques Tomasi ,&nbsp;on behalf of the GRRAACC","doi":"10.1016/j.accpm.2025.101573","DOIUrl":"10.1016/j.accpm.2025.101573","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101573"},"PeriodicalIF":3.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310581","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":"Liberal vs restrictive transfusion strategy for acute brain injury: A meta-analysis with trial sequential analysis of randomized clinical trials.","authors":"Wen-Wen Tsai, Jheng-Yan Wu, Kuan-Hsien Lu, Hong-Xiang Zheng, Hung-Hsi Tan, Chih-Cheng Lai","doi":"10.1016/j.accpm.2025.101566","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101566","url":null,"abstract":"<p><strong>Background: </strong>Acute brain injury is a critical health challenge with substantial mortality and morbidity. While anemia is common in these patients and may worsen outcomes, the optimal red blood cell transfusion strategy remains controversial.</p><p><strong>Objective: </strong>We conducted a meta-analysis with trial sequential analysis of randomized controlled trials (RCTs) comparing liberal versus restrictive transfusion strategies in patients with acute brain injury.</p><p><strong>Methods: </strong>Pubmed, Embase, and the Cochrane Library databases were searched through December 15, 2024, for RCT comparing liberal (hemoglobin threshold 9-10 g/dL) versus restrictive (hemoglobin threshold 7-8 g/dL) transfusion strategies in adults with acute brain injury. The primary outcome was an unfavorable neurological outcome.</p><p><strong>Results: </strong>Six RCTs involving 2,599 patients were included. There was no significant difference in unfavorable neurological outcomes between liberal and restrictive strategies (risk ratio [RR], 0.97; 95% confidence interval [CI], 0.83 to 1.14; p = 0.70). Similarly, no differences were observed in overall mortality (RR, 0.98; 95% CI, 0.85 to 1.12; p = 0.75), hospital mortality (RR, 1.02; 95% CI, 0.79 to 1.31; p = 0.89), or intensive care unit (ICU) mortality (RR, 0.74; 95% CI, 0.28 to 1.91; p = 0.53). Although transfusion reaction was non-significantly more frequent with liberal transfusion (RR, 1.13; 95% CI, 0.35 to 3.58; p = 0.84).</p><p><strong>Conclusions: </strong>In patients with acute brain injury, a restrictive transfusion strategy was not associated with worse neurological outcomes or higher mortality compared to a liberal strategy.</p><p><strong>Implications for clinical practice: </strong>Maintaining hemoglobin levels above 7-8 g/dL may be effective for patients with acute brain injury, potentially reducing unnecessary transfusions and associated risks. META-ANALYSIS REGISTRATION: registered on PROSPERO under number CRD42025639745).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101566"},"PeriodicalIF":3.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303380","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":"Longitudinal changes of electrical impedance tomography-based best PEEP in obese patients undergoing laparoscopic surgery: A prospective physiological study","authors":"Gaetano Scaramuzzo ,&nbsp;Paolo Priani ,&nbsp;Pierluigi Ferrara ,&nbsp;Marco Verri ,&nbsp;Federica Montanaro ,&nbsp;Riccardo La Rosa ,&nbsp;Gianmaria Cammarota ,&nbsp;Carlo Alberto Volta ,&nbsp;Savino Spadaro","doi":"10.1016/j.accpm.2025.101569","DOIUrl":"10.1016/j.accpm.2025.101569","url":null,"abstract":"<div><h3>Background</h3><div>During laparoscopic surgery, there is an increased tendency for lung collapse. Individualized PEEP has shown possible advantages in obese patients undergoing laparoscopic procedures, but the optimal timing for titration and the evolution of lung regional mechanics have not been extensively explored.</div></div><div><h3>Methods</h3><div>Patients with Class I/II Obesity undergoing laparoscopic surgery for abdominal procedures were monitored using 16 electrodes Electrical Impedance Tomography (EIT) and underwent a decremental PEEP titration trial at 3 timepoints: after anesthesia induction (T1), after positioning and pneumoperitoneum (T2) and after laparoscopy (T3). EIT-derived lung regional collapse (EIT_CO) and overdistension (EIT_OD) were recorded, as well as respiratory mechanics, hemodynamic and surgical data. The best PEEP according to EIT (PEEP_EIT) was calculated at each timepoint as the intersection between regional collapse and overdistention.</div></div><div><h3>Results</h3><div>We enrolled 31 patients with a median age of 63 [49−74] years and a BMI of 36 [32−37] kg m⁻¹. During surgery, PEEP_EIT at T1 and T2 were respectively 10[9–11.5] and 13.9[12.6–15] cmH₂O (<em>p</em> &lt; 0.001), with a median increase of 3 [2–4] cmH₂O, a range of increase of 0–7 cmH₂O and a coefficient of increase variation of 60.8%. The difference in PEEP_EIT between T2 and T1 did not correlate with intrabdominal pressure (<em>r</em> = −0.03, <em>p</em> = 0.88), while a significant association was found with trunk inclination (<em>p</em> = 0.018, <em>r</em> = 0.42).</div></div><div><h3>Conclusions</h3><div>EIT-based best PEEP changes dynamically and non-homogeneously during laparoscopic surgery in class I/II obese patients. PEEP reassessment is required to guarantee the application of protective mechanical ventilation throughout the entire course of anesthesia.</div></div><div><h3>Registration</h3><div>clinicaltrials.gov under number NCT05554536.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101569"},"PeriodicalIF":3.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303381","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":"Position of the anesthesiologist on intubation: Does it really matter?","authors":"Raghuraman M Sethuraman","doi":"10.1016/j.accpm.2025.101571","DOIUrl":"10.1016/j.accpm.2025.101571","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101571"},"PeriodicalIF":3.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295159","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 dexmedetomidine versus propofol on outcomes in critically ill patients with different sedation depths: Correspondence.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1016/j.accpm.2025.101574","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101574","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101574"},"PeriodicalIF":3.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295088","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":"An extensive examination of hypophosphatemia in critical illness is required to gain a comprehensive understanding of its complete effects and interconnections","authors":"Lukasz Szarpak ,&nbsp;Basar Cander ,&nbsp;Michal Pruc","doi":"10.1016/j.accpm.2025.101572","DOIUrl":"10.1016/j.accpm.2025.101572","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101572"},"PeriodicalIF":3.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295087","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":"Relevance of transcranial ultrasound and computed tomography fusion for bedside assessment and training in the intensive care unit","authors":"Baptiste Balança","doi":"10.1016/j.accpm.2025.101565","DOIUrl":"10.1016/j.accpm.2025.101565","url":null,"abstract":"<div><div>Transcranial ultrasound-CT fusion imaging is a promising advancement in bedside neurological assessment. By combining the real-time benefits of ultrasound with the detailed anatomical information of CT, it offers a non-invasive and precise tool but has not been explored in the neurological intensive care unit (NICU).</div><div>In an observational study conducted at the Hospices Civils de Lyon, France, we explored this technology in seven NICU patients. Two registration methods for ultrasound-CT fusion were tested: manual alignment using anatomical landmarks and automatic registration with the use of a CT-compatible tracker. The first method provided highly accurate alignment but required experienced operators, while the second method was faster and more practical for bedside use, despite challenges in maintaining head stage positioning. Ultrasound-CT fusion allowed real-time 3D visualization of intracranial structures, including non-conventional imaging planes such as coronal views. This study suggests that ultrasound-CT fusion is a feasible and valuable technique in the NICU, with the potential to improve diagnostic precision, bedside monitoring, and resident training.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 5","pages":"Article 101565"},"PeriodicalIF":3.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250447","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":"Remimazolam for anesthesia in cardiac and noncardiac surgery. A narrative literature review and synthesis","authors":"Jacopo D’Andria Ursoleo ,&nbsp;Alice Bottussi ,&nbsp;Gabor Erdoes ,&nbsp;Jiapeng Huang ,&nbsp;Fabrizio Monaco","doi":"10.1016/j.accpm.2025.101555","DOIUrl":"10.1016/j.accpm.2025.101555","url":null,"abstract":"<div><div>Despite decades of advancements in anesthetic techniques, a novel hypnotic agent combining rapid onset and offset, hemodynamic stability, and predictable effects has remained elusive. The recent approval of remimazolam, a short-acting benzodiazepine, represents a potential breakthrough in fulfilling these criteria. Since its first approval, growing evidence highlights its benefits, including superior hemodynamic stability, rapid emergence from anesthesia, and minimal respiratory depression compared to widely used agents such as propofol. These attributes have been demonstrated across various surgical contexts and patient populations. However, existing studies have limitations that challenge the generalizability of such findings. This review evaluates the literature on remimazolam in both the cardiac and noncardiac perioperative surgical contexts. A systematic search of PubMed/MEDLINE, EMBASE, and Google Scholar databases identified studies published from 2020 to 2024, with an emphasis on randomized controlled trials and observational studies. By analyzing the limitations inherent in the retrieved studies, we aimed to provide practicing anesthesiologists with an overview of remimazolam’s potential benefits and inherent challenges, while identifying current knowledge gaps that warrant future research.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 4","pages":"Article 101555"},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183216","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}