European journal of anaesthesiology and intensive care最新文献

{"title":"Greenhouse gas emissions due to inhalation anaesthetics in the Netherlands, usage data and a survey of preferences among Dutch anaesthesiologists.","authors":"Herman J Friedericy, Pascale A H T Venema, Jessica F Lockyer, Dinemarie M Kweekel, Anne C van der Eijk, Frank Willem Jansen, Elise Y Sarton","doi":"10.1097/EA9.0000000000000065","DOIUrl":"10.1097/EA9.0000000000000065","url":null,"abstract":"<p><strong>Background: </strong>Anaesthetic gases are an important source of greenhouse gas emissions from operating theatres and can attribute significantly to the carbon footprint of a nation's healthcare system.</p><p><strong>Objective: </strong>To estimate the magnitude of the climate impact of inhaled anaesthetics in the Netherlands. Furthermore, the goal was to assess the preferences of Dutch anaesthesiologists for anaesthesia techniques, and to explore opportunities for reducing greenhouse gas emissions due to anaesthesia practice.</p><p><strong>Design: </strong>A 2019 bottom-up purchase analysis of inhalation anaesthetics used in all of the Dutch hospitals was executed and an online survey was conducted among Dutch anaesthesiologists regarding their preferences for anaesthetic agents.</p><p><strong>Results: </strong>Purchasing quantities of volatile anaesthetic agents were obtained from 61 of the 69 hospital organisations in the Netherlands (response rate 88.4%). A total of 12.2 kilotons CO₂ equivalent (0.07% of the Dutch healthcare system) was emitted due to inhalation anaesthetics in the Netherlands in 2019. The volume of the in 2019 purchased inhalation volatile anaesthetics was 9.178 l of sevoflurane (93.4%), 404 l of desflurane (4.1%) and 245 l of isoflurane (2.5%). The survey in which 182 anaesthesiologists participated demonstrated that propofol was the first drug of choice of 70% of respondents, desflurane was available in 16% of Dutch hospitals and 83% of anaesthesiologists answered never using desflurane. Nitrous oxide was not used by 63% of respondents, the remaining 27% reported using nitrous oxide only in less than 5% of their cases.</p><p><strong>Conclusion: </strong>The relatively low emission of greenhouse gases due to inhalation anaesthetics in Dutch healthcare compared to other countries can be explained by the limited use of nitrous oxide and desflurane by Dutch anaesthesiologists and their strong preference for intravenously administered propofol as an anaesthetic.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"4 1","pages":"e0065"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baricity of spinal bupivacaine and the incidence of hypotension in non-obstetric surgery: A systematic review.","authors":"Imré Van Herreweghe, Eline Ghysels, Jens Gielen, Robbert Buck, Elizabeth Flesher, Jirka Cops, Vera Saldien, Dieter Mesotten, Admir Hadzic","doi":"10.1097/EA9.0000000000000064","DOIUrl":"10.1097/EA9.0000000000000064","url":null,"abstract":"<p><p>Bupivacaine is commonly used for spinal anaesthesia. The baricity of bupivacaine (isobaric <i>vs.</i> hyperbaric) may influence the spread, level of the block and the subsequent haemodynamic effects of the spinal anaesthesia. This review considers the available literature on the effect of baricity on the haemodynamic sequelae of spinal anaesthesia with bupivacaine. A literature search was conducted of the MEDLINE and EMBASE databases up to February 2024, following PRISMA guidelines. Randomised controlled trials (RCTs) comparing isobaric and hyperbaric bupivacaine in non-obstetric surgeries were included. Ten studies comprising 586 patients were included. While the literature suggests a trend towards greater incidence of hypotension with hyperbaric bupivacaine, no statistically significant difference was found. Variations in bupivacaine doses and volumes, spinal techniques and definitions of hypotension hindered definitive conclusions. Lower doses relevant to current practice also remain underexplored.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"4 1","pages":"e0064"},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of positive end-expiratory pressure in COVID-19-related acute respiratory distress syndrome: A systematic review.","authors":"Alexandra Sachkova, Marike Andreas, Daniel Heise, Martin Golinski, Caspar Stephani, Steffen Dickel, Clemens Grimm, Ina Monsef, Vanessa Piechotta, Nicole Skoetz, Sven Laudi, Onnen Moerer","doi":"10.1097/EA9.0000000000000060","DOIUrl":"10.1097/EA9.0000000000000060","url":null,"abstract":"<p><strong>Background: </strong>The impact of high positive end-expiratory pressure (PEEP) ventilation and the optimization of PEEP titration in COVID-19-induced acute respiratory distress syndrome (ARDS) continues to be a subject of debate. In this systematic review, we investigated the effects of varying PEEP settings on patients with severe ARDS primarily resulting from COVID-19 (C-ARDS).</p><p><strong>Objectives: </strong>Does higher or lower PEEP improve the outcomes in COVID-19 ARDS? Does individually titrated PEEP lead to better outcomes compared with PEEP set by standardised (low and high ARDS network PEEP tables) approaches? Does the individually set PEEP (best PEEP) differ from PEEP set according to the standardised approaches (low and high ARDS network PEEP tables)?</p><p><strong>Design: </strong>Systematic review of observational studies without metaanalysis.</p><p><strong>Data sources: </strong>We performed an extensive systematic literature search in Cochrane COVID-19 Study Register (CCSR), PubMed, Embase.com, Web of Science Core Collection, World Health Organization COVID-19 Global literature on coronavirus disease, World Health Organization International Clinical Trials Registry Platform (ICTRP), medRxiv, Cochrane Central Register of Controlled Trials until 24/01/2024.</p><p><strong>Eligibility criteria: </strong>Ventilated adult patients (≧18 years) with C-ARDS.</p><p><strong>Results: </strong>We screened 16 026 records, evaluated 119 full texts, and included 12 studies (<i>n</i> = 1431 patients) in our final data synthesis, none of them being a randomised controlled trial. The heterogeneity of study procedures and populations did not allow conduction of a meta-analysis. The results of those studies that compared lower and higher PEEP strategies in C-ARDS were ambiguous pointing out either positive effects on oxygenation with high levels of PEEP, or negative changes in lung mechanics.</p><p><strong>Conclusion: </strong>The available evidence does not provide sufficient guidance for recommendations on optimal PEEP settings in C-ARDS. In general, well designed platform studies are needed to answer the questions raised in this review and, in particular, to investigate the use of individualised PEEP titration techniques and the inclusion of patients with different ARDS entities, severities and disease stages.</p><p><strong>Title registration: </strong>Our systematic review protocol was registered with the international prospective register of systematic reviews (PROSPERO 2021: CRD42021260303).</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 6","pages":"e0060"},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain health: A concern for anaesthesiologists and intensivists.","authors":"Vincent Bonhomme, Christian Putensen, Bernd W Böttiger, Markus F Stevens, Nandor Marczin, Daniel Arnal, Evgeni Brotfain, Aeyal Raz, Aline Defresne, Elisa Bogossian, Sigal Sviri, Paolo Cardone, Alexander Mair, Chiara Robba, Ozlem Korkmaz Dilmen, Julien Ly, Maria I Crisan, Jurgen C De Graaff, Nadia Najafi, Laszlo Vutskits, Anthony Absalom, Igor Abramovich, Quentin Souberbielle, Mona Momeni, Douglas Campbell, Lisbeth Evered, Susana Vacas, Sarah Saxena, Nicolas Bruder, Dilara A Oksuz, Francisco A Lobo, Michel van Putten, Marko Sahinovic, Gregory W J Hawryluk, Antonia Kustura, Fatima Yürek, Dana Baron Shahaf, Goded Shahaf, Finn Radke, Celine Khalifa","doi":"10.1097/EA9.0000000000000063","DOIUrl":"10.1097/EA9.0000000000000063","url":null,"abstract":"<p><p>Damage to the brain can have disastrous and long-lasting consequences. The European Society of Anaesthesiology and Intensive Care (ESAIC) is aware of the importance of taking good care of the brain, both of patients and of anaesthesia and intensive care unit (ICU) caregivers, and has organised a complete learning track on brain health to bring this concern to the attention of practitioners. This learning track included an online Focus Meeting on Brain Health (November 25, 2023). We here provide readers with a digest of the information that was delivered during that meeting in an opinion paper driven by the authors' own reading of the literature. It is divided according to the meeting's sessions, including how to improve the health of an injured brain, how to keep a young or old brain healthy, how to keep a healthy adult brain unimpaired, how monitoring can impact brain health in the operating room and in the intensive care unit, and how to keep the anaesthesia and ICU caregivers' brain healthy. Each part is a brief and focused summary. The main delivered messages are that the management of injured brain patients involves an adequate choice of sedation, adequate brain monitoring, and focused attention to specific points depending on the underlying pathology; that several measures can be undertaken to protect the brain of the very young needing anaesthesia; that it is possible to detect older patients at risk of postoperative neurocognitive disorders, and that dedicated perioperative management by a multidisciplinary expert team may improve their outcomes; that apparently healthy adult brains may suffer during anaesthesia; that the electroencephalogram may track peri-operative brain dysfunction, and that female patients should be given special care in this respect; that multimodal brain monitoring helps to detect pathological processes and to maintain brain homeostasis; and that burnout in anaesthesiologists can be effectively fought using personal, organisational, managerial and legal approaches.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 6","pages":"e0063"},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in professional development of anaesthesiology trainees: A cross-sectional survey by the European Society of Anaesthesiology and Intensive Care Trainee Committee.","authors":"Olivia Dow, Antonia Kustura, Yotam Lior, Joana Berger-Estilita, Diogo Morais, Stefan De Hert, Igor Abramovich","doi":"10.1097/EA9.0000000000000062","DOIUrl":"10.1097/EA9.0000000000000062","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease (COVID-19) pandemic disrupted training in anaesthesiology. The global shortage of healthcare workers has also negatively affected training opportunities.</p><p><strong>Objective: </strong>To evaluate the current experiences, challenges and professional development of anaesthesiology trainees across Europe.</p><p><strong>Design: </strong>An online cross-sectional survey of anaesthesiology trainees.</p><p><strong>Participants: </strong>Anaesthesiology trainees from the 42 European Society of Anaesthesiology and Intensive Care (ESAIC)-affiliated countries.</p><p><strong>Main outcome measures: </strong>Quality of training supervision and program structure; the impact of COVID-19 on training and practical learning, trainee support systems, financial challenges and professional development, involvement in the ESAIC Exchange Program and career mobility insights.</p><p><strong>Results: </strong>Seven hundred and seventy-one participants from 35 ESAIC-affiliated European countries highlighted several aspects of anaesthesiology training. Approximately 30.5% of trainees reported being able to independently anaesthetise patients with ASA class 1 and 2 within 3 months, whereas independence for ASA 3 and 4 patients under indirect supervision was achieved by 24.3% between 6 and 9 months. Half of the respondents attained an independent working capacity in the ICU after 1.5 years. Although 51.3% reported receiving adequate training and supervision, only 30.1% received employer financial support for educational activities. The COVID-19 pandemic led to 40.2% being redeployed, primarily to ICUs, with 45.2% experiencing negative training effects. Career-wise, 12.5% engaged in international exchange programs, and 49.1% considered relocating for better career opportunities and work-life balance.</p><p><strong>Conclusion: </strong>The findings provide valuable insights into the current state of anaesthesiology training in Europe, highlighting the need for adaptive strategies in medical education and training to meet evolving challenges and ensure continual professional growth.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 5","pages":"e0062"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause for a temporary left-sided cerebral perfusion deficit- and left-sided hemiplegia.","authors":"Isabelle Moneke, Aleksandar Dimov, Markus Marx, Katharina Müller-Peltzer, Johannes Kalbhenn","doi":"10.1097/EA9.0000000000000061","DOIUrl":"10.1097/EA9.0000000000000061","url":null,"abstract":"","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 5","pages":"e0061"},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel rapid formulation of intravenous dantrolene: Preclinical assessment.","authors":"Richard H Ng Kwet Shing, Samuel L Smith","doi":"10.1097/EA9.0000000000000059","DOIUrl":"10.1097/EA9.0000000000000059","url":null,"abstract":"","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 5","pages":"e0059"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the dopamine D2 receptor gene SNP rs1800497 with postoperative nausea and vomiting: A prospective cohort study.","authors":"Maike Stegen, Hagen S Bachmann, Grazina Belani, Ahmed Mohamed, Björn Breuing, Thorsten Brenner, Stefanie Klenke","doi":"10.1097/EA9.0000000000000056","DOIUrl":"10.1097/EA9.0000000000000056","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) are the most frequent complications in the context of anaesthesia. Several studies suggest a contribution of genetic traits to PONV disposition. Single nucleotide polymorphisms (SNPs) located in the cholinergic receptor muscarinic 3 gene <i>CHRM3</i> (rs2165870) and the potassium voltage-gated channel subfamily B member 2 <i>KCNB2</i> (rs349358) have been described as independent risk factors for the occurrence of PONV. In addition, further SNPs might be associated with an increased PONV risk, for example a dopamine D2 receptor (<i>DRD2</i>) SNP (rs1800497).</p><p><strong>Objective: </strong>The primary aim of our study was the development of a new PONV prediction score which includes genetic information of SNPs in the genes <i>CHRM3</i> and <i>KCNB2,</i> which have been already associated with PONV. The secondary aim of our study was to investigate the association of five additional SNPs with PONV.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Single centre study in Germany.</p><p><strong>Results: </strong>We could not establish a new PONV prediction score that includes genetic information, due to limited association of the <i>KCNB2</i> SNP and <i>CHRM3</i> SNP with PONV. Interestingly, the GA and AA genotypes of the <i>DRD2</i> rs1800497 in the dopamine D2 receptor gene were associated with PONV 24 h postoperatively, with a relative risk (RR) of GA/AA genotype vs. GG genotype of 1.5 [95% confidence interval (CI) 1.06 to 2.01, <i>P</i> = 0.02]. This association was independent from the Apfel score in a multivariate logistic regression analysis (RR 1.4, 95% CI 1.03 to 1.90, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>The construction of a new PONV prediction score including genetic information was not possible due to limited association of the <i>CHRM3</i> and <i>KCNB2</i> SNPs. However, the <i>DRD2</i> GA and AA genotypes (rs1800497) were associated with PONV and this SNP might be a future candidate for further validation studies aiming for molecular-derived PONV prediction models.</p><p><strong>Trial registration: </strong>German Clinical Study Register - DRKS00021051.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 4","pages":"e0056"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of anaesthesia and analgesia on short- and long-term outcomes following colorectal cancer surgery: Protocol for an international, pragmatic, cohort study (ENCORE∗).","authors":"Max Bell, Donal J Buggy, Daniel Brattström, Christian Buchli, Sophie Debouche, Fredrik Granath, Bernard Riedel, Anil Gupta","doi":"10.1097/EA9.0000000000000051","DOIUrl":"10.1097/EA9.0000000000000051","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is the second most frequent cause of global cancer mortality. Most patients with CRC require surgical tumour resection, with certain stages of CRC (Stage II/III) also requiring postoperative chemotherapy. The timing of postoperative chemotherapy is largely determined by postoperative recovery. Delayed return to intended oncologic therapy (RIOT) by >8 weeks results in worse oncologic outcomes. RIOT is thus an important surrogate marker of outcome for patients with stage II/III CRC. We will test the hypothesis that anaesthetic technique during CRC resection surgery may affect RIOT.</p><p><strong>Objective: </strong>To test the association between anaesthetic and analgesic technique during CRC surgery and RIOT. To document Short-term Secondary outcomes including individual postoperative complications and a composite of all postoperative complications, the Comprehensive Complications Index (CCI) and to measure the time to recurrence (TTR) of cancer at 3 years.</p><p><strong>Design: </strong>This is a prospective, international, multicentre, observational cohort study.</p><p><strong>Setting: </strong>Global healthcare setting, with >140 centres in >30 nations.</p><p><strong>Patients: </strong>Inclusion criteria: All patients age >18 years, ASA I-III, with CRC stage I-III scheduled for elective CRC surgery (open or minimally invasive).Exclusion criteria: Uncontrolled renal or liver disease, restrictive (limiting mobility) heart failure or ischemic heart disease (ASA IV-V). Speech, language, or cognitive difficulties precluding signing informed consent to participate and Stage IV CRC.</p><p><strong>Primary outcome measures: </strong>Short -term: The duration from day of surgery to RIOT among patients expected to receive postoperative chemotherapy. Long-term: incidence of recurrence and time to recurrence (TTR) at 3 years after primary curative surgery.</p><p><strong>Secondary outcomes: </strong>Postoperative complications within 30 days of surgery, length of hospital stay, Days at Home at 30 and 90 days (DAH-30, DAH-90) after surgery, and adverse events related to oncological treatment. We will also assess the burden of preoperative modifiable comorbid disease in patients. Exploratory endpoints will assess practice variation (including incidence of RIOT by demographic e.g. gender of patient, type of institution, country).</p><p><strong>Results: </strong>N/A.</p><p><strong>Conclusions: </strong>N/A.</p><p><strong>Trial registration: </strong>The Effects of aNesthesia in COloREctal cancer outcome study: ENCORE, ClinicalTrials.gov Identifier: NCT04493905.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 3","pages":"e0051"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of haemostasis in pregnant women: A retrospective evaluation of the diagnostic performance of the HEMSTOP standardised questionnaire.","authors":"Tamara Zec, Denis Schmartz, Pomeline Temmerman, Jean-François Fils, Brigitte Ickx, Fanny Bonhomme, Philippe Van Der Linden","doi":"10.1097/EA9.0000000000000050","DOIUrl":"10.1097/EA9.0000000000000050","url":null,"abstract":"<p><strong>Background: </strong>Contemporary guidelines pertaining to the evaluation of bleeding risk recommend conducting a comprehensive examination of both personal and family histories concerning haemorrhagic diatheses.</p><p><strong>Objectives: </strong>We employed the standardised HEMSTOP (Hematoma, hEmorrhage, Menorrhagia, Surgery, Tooth extraction, Obstetrics, Parents) questionnaire in pregnant women to evaluate its efficacy in detecting a haemostatic disorder and predicting the risk of haemorrhage associated with delivery.</p><p><strong>Design: </strong>A single-centre retrospective observational cohort study.</p><p><strong>Setting: </strong>Brugmann Hospital, a tertiary university institution.</p><p><strong>Patients: </strong>All full-term parturients who underwent vaginal or caesarean delivery in our hospital between January 2020 and December 2021 were included in the study. A total of 3588 patients were enrolled.</p><p><strong>Main outcome measures: </strong>The primary aim of this study was to assess the sensitivity and specificity of the HEMSTOP questionnaire in identifying individuals with an abnormal primary haemostatic profile. The secondary objective was to evaluate the sensitivity and specificity of the HEMSTOP questionnaire in predicting postpartum haemorrhage (PPH; defined as blood loss >1000 ml). Additionally, positive-predictive values and negative-predictive values (NPVs) were calculated.</p><p><strong>Results: </strong>The specificity and sensitivity of the HEMSTOP questionnaire to predict an abnormal standard coagulation test in pregnant women are respectively 96% [95% confidence interval (CI), 0.95 to 0.97] and 39% (95% CI, 0.20 to 0.61). Its NPV is 100%. The specificity and sensitivity of the HEMSTOP questionnaire to predict postpartum bleeding risk are respectively 96% (95% CI, 0.95 to 0.97) and 8% (95% CI, 0.06 to 0.11).</p><p><strong>Conclusion: </strong>In the conditions of our study, the HEMSTOP questionnaire enables the prediction of a primary haemostatic anomaly with a specificity and sensitivity comparable to routine haemostatic assessments. These findings concur with the recommendation against the routine prescription of laboratory tests for patients lacking a history of bleeding diathesis.</p><p><strong>Trial registration: </strong>Clinical Trial NCT05191251.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 2","pages":"e0050"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}