Anaesthesia Critical Care & Pain Medicine最新文献

{"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}

{"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":"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":"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}