Acta Anaesthesiologica Scandinavica最新文献

{"title":"Renal Adverse Events Associated With Ibuprofen Treatment After Hip and Knee Arthroplasties-A Protocol for the Preplanned Substudy of the PERISAFE Trial.","authors":"Christina Cleveland Westerdahl Laursen, Klara Nørrekær Lund, Troels Haxholdt Lunn, Daniel Hägi-Pedersen, Anne Sofie Nautrup Therkelsen, Mathias Therkel Steensbæk, Birgit Isberg Faugstad, Sair Anjum, Müjgan Yilmaz, Niels Anker Pedersen, Andreas Kappel, Ben Kristian Graungaard, Peter Birk Hollænder, Charlotte Runge, Kai Henrik Wiborg Lange, Claus Varnum, Stig Brorson, Martin Lindberg-Larsen, Søren Overgaard, Markus Harboe Olsen, Janus Christian Jakobsen, Ole Mathiesen","doi":"10.1111/aas.70218","DOIUrl":"10.1111/aas.70218","url":null,"abstract":"<p><strong>Introduction: </strong>Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for postoperative pain management after hip and knee arthroplasties but have been associated with renal adverse effects. The risk may increase when NSAIDs are combined with diuretics and angiotensin converting enzyme (ACE) inhibitors or Angiotensin-II-receptor antagonists. The aim of this substudy is to assess potential renal adverse effects of an eight-day postoperative treatment with ibuprofen in patients undergoing hip or knee arthroplasty during 90-days follow-up.</p><p><strong>Methods and analysis: </strong>This substudy is part of the PERISAFE trial-a randomized, placebo-controlled, blinded multicenter trial including 2904 patients undergoing hip or knee arthroplasty. Patients are randomized to receive either ibuprofen 400 mg three times daily or identical placebo three times daily for 8 days postoperatively. The primary outcome is the number of patients with renal dysfunction according to RIFLE criteria Level 1-5, at any point during the 90-day follow-up. The substudy is powered at 86.3% to detect or discard a 40% relative risk reduction in the placebo group, assuming an incidence of acute renal injury of 6.2%.</p><p><strong>Ethics and dissemination: </strong>The ethical approval for this substudy is included in the main PERISAFE trial, which has been approved by the Danish Medicine Agency, the National Committee on Health Research Ethics (EU CT no. 2022-502502-32-00), and the Danish Data Protection Agency (REG-149-2022).</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70218"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between the American Society of Anesthesiologists Physical Status Classification and Patient Outcomes: A Scoping Review Protocol.","authors":"Luan Bicalho Costa, Yuri Trivelato Desideri, Ana Carolina Malacco Oliveira, Giovanna Fabris, João Vitor Ferreira Domingos, Ann Merete Møller","doi":"10.1111/aas.70221","DOIUrl":"10.1111/aas.70221","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is ubiquitous in perioperative medicine and research as a tool for preoperative patient risk stratification. Despite widespread clinical adoption as a predictor of perioperative outcomes, the ASA-PS system is inherently subjective, leading to considerable inter-rater variability. A comprehensive mapping of the literature examining the relationship between ASA-PS scores and patient outcomes is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To systematically map the extent, range, and nature of peer-reviewed literature examining the relationship between the ASA-PS classification and patient outcomes, and to identify key characteristics, themes, and knowledge gaps in this evidence base.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This scoping review will be conducted according to the Joanna Briggs Institute (JBI) methodological framework and reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). The Population-Concept-Context (PCC) framework will guide eligibility assessment. A comprehensive search will be conducted across PubMed, EMBASE, Scopus, LILACS, and the Cochrane Central Register of Controlled Trials, with no language or date restrictions. Study selection will be performed independently and in duplicate by two reviewers in two stages (title/abstract screening, full-text review). If any discordance appears, a third reviewer verdict will be requested. Data will be extracted using a structured charting form and synthesized narratively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Any healthcare setting where an ASA-PS score is assigned prior to a procedure (inpatient hospital, ambulatory surgery center, outpatient clinic). Primary research designs, including randomized controlled trials, observational studies (cohort, case-control, cross-sectional, descriptive), and case reports will be eligible; review articles, editorials, letters to the editor, and commentaries will be excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search strategy: &lt;/strong&gt;The search will employ controlled vocabulary (MeSH terms) and free-text keywords including: \"ASA score,\" \"ASA Physical Status Classification System,\" \"American Society of Anesthesiologists,\" in combination with outcome-related terms. Supplementary hand searching of reference lists and Google Scholar will be performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction: &lt;/strong&gt;Study characteristics (author, year, country, journal, design), population characteristics (sample size, age, comorbidity), context (clinical setting, specialty, procedure type, urgency), ASA score details, and outcome details (including statistical methods used to derive associations) will be extracted. A preliminary data charting form is provided in Appendix B.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis: &lt;/strong&gt;Narrative synthesis supported by descriptive statistics will map study characteristics, outcome categories, clinical","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70221"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12988453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Hemodynamic Monitoring During Postresuscitation Care After Out-of-Hospital Cardiac Arrest: Protocol for a Scoping Review.","authors":"Johannes Grand, Frederik Færgemann Lau, Christian Hassager, John Bro-Jeppesen, Jacob Eifer Møller, Janus C Jakobsen, Fabio Silvio Taccone, Juan J Russo, Koen Ameloot, Markus B Skrifvars, Sean van Diepen, Jesper Kjærgaard","doi":"10.1111/aas.70224","DOIUrl":"10.1111/aas.70224","url":null,"abstract":"<p><strong>Introduction: </strong>Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and substantial long-term neurological sequelae among survivors. During postresuscitation intensive care after return of spontaneous circulation (ROSC), myocardial dysfunction, vasoplegia, and mixed shock states are often observed. Arterial blood pressure alone may not adequately reflect tissue perfusion or oxygen delivery. Advanced hemodynamic profiling has the potential to improve individualized postresuscitation management, but the overall evidence base has not been comprehensively mapped.</p><p><strong>Aims: </strong>This scoping review will map the available evidence on advanced hemodynamic monitoring during early postresuscitation care after adult OHCA (< 72 h after ROSC). Specifically, we will characterize which hemodynamic variables are measured, when and how they are measured, and in which clinical contexts; summarize how studies report associations between these variables and outcomes or markers of organ perfusion/function; and identify methodological gaps in hemodynamic monitoring.</p><p><strong>Methods: </strong>A scoping review will be conducted, including adult (≥ 18 years) patients hospitalized after OHCA with sustained ROSC. Eligible studies must investigate one or more predefined advanced hemodynamic parameters using invasive or non-invasive techniques beyond arterial pressure monitoring. There are no restrictions on comparators, publication year, language, setting, or publication type. Animal, pediatric, simulation, intra-arrest-only studies, microcirculatory/local perfusion studies, and echocardiography-only studies are excluded. MEDLINE (via PubMed) will be searched from inception to 31 January 2026. Two reviewers will screen and extract data independently in duplicate using Covidence. Data will be synthesized descriptively.</p><p><strong>Conclusions: </strong>This review will provide a comprehensive overview of advanced hemodynamic monitoring after OHCA and identify evidence and gaps in the research in this area.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70224"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring With Real-Time Alerts to Achieve Glycaemic Control in Surgical Patients With Diabetes: Protocol for a Multicentre, Randomised, Clinical Trial.","authors":"Casper Pedersen, Annelotte Philipsen, Kirsten Nørgaard, Eske K Aasvang, Christian Sylvest Meyhoff","doi":"10.1111/aas.70219","DOIUrl":"10.1111/aas.70219","url":null,"abstract":"<p><strong>Background: </strong>Perioperative glucose monitoring traditionally relies on intermittent point-of-care (POC) testing, whereas continuous glucose monitoring (CGM) enables real-time glucose assessment with automated alerts for dysglycaemia. CGM remains understudied in hospitalised surgical patients with diabetes. This protocol outlines a clinical trial designed to evaluate the effect of CGM on achieving normoglycaemia in surgical patients with diabetes.</p><p><strong>Methods: </strong>A multicentre, two-group, randomised controlled trial (NCT06314061). Eligible patients are adults with Type 1 or Type 2 diabetes undergoing surgery lasting more than 45 min with an expected hospital stay of at least one night. Patients in the intervention group will be monitored using CGM (Dexcom G7, Dexcom Inc., CA, USA) with active alerts for hyperglycaemia and hypoglycaemia for up to 10 days after surgery during hospitalisation. Patients in the control group will wear a CGM device with glucose values and alerts concealed from the patient and clinical staff. All patients will receive routine diabetes care, including intermittent POC glucose testing, in addition to CGM. The primary outcome is CGM time-in-range between 6.0 and 10.0 mmol/L. Secondary outcomes include the frequency and cumulative duration of hypoglycaemia and hyperglycaemia as well as postoperative complications. A sample size of 200 patients will allow 90% power to detect a 15% relative difference in the primary outcome between groups, with an expected 10% dropout. To ensure standardised use of CGM and to support clinical decision-making during the trial, a trial-specific guideline has been developed, integrating CGM with insulin treatment and POC tests. The guideline recommends intervention for glucose levels < 5.0 mmol/L when trending downward. For CGM glucose levels > 10.0 mmol/L, rapid-acting insulin may be administered according to a sliding scale regimen rather than delaying treatment until the next scheduled POC test.</p><p><strong>Conclusion: </strong>This randomised controlled trial will provide clinical evidence for CGM use by clinical staff to enhance perioperative glycaemic control in surgical patients with diabetes.</p><p><strong>Trial registration: </strong>NCT06314061.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70219"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation and Cultural Adaption of the Revised ICU Family Satisfaction Questionnaire (FS-ICU-24R) Into Danish.","authors":"Anne Sophie Ågård, Annemette Tovgaard Jepsen, Christina Krogh Frydendal, Katrine Donovan, Thore Højer Nielsen, Daren K Heyland, Anne Højager Nielsen","doi":"10.1111/aas.70210","DOIUrl":"10.1111/aas.70210","url":null,"abstract":"<p><strong>Background: </strong>Systematic assessment of family satisfaction is essential for improving the quality of care in intensive care units (ICUs). The Family Satisfaction with Care in the Intensive Care Unit questionnaire (FS-ICU-24R) is internationally used but has not previously been available in Danish. This study aimed to translate and culturally adapt the FS-ICU-24R into Danish and to evaluate its face and content validity.</p><p><strong>Methods: </strong>The translation followed a standardized multistep procedure involving forward translation by six bilingual ICU nurses and researchers, reconciliation through consensus, and blinded back-translation by another bilingual ICU nurse. The Danish version was compared with the original to resolve discrepancies and ensure conceptual equivalence. Face and content validity was assessed through cognitive interviews with six relatives, who completed the questionnaire while verbalizing their understanding of each item. Comments were reviewed by the translator team, and problematic items were revised.</p><p><strong>Results: </strong>The translation process identified linguistic and cultural issues requiring adaptation. Key challenges concerned the Danish legal framework for decision-making, necessitating adjustments to Items #21, #22, and #24 to avoid implying that relatives act as surrogate decision-makers. Item #23 was modified by replacing \"control\" with \"overview/oversight\" to reflect the intended meaning without suggesting authority over patient care. Additional adjustments improved clarity and relevance to the Danish context. Cognitive interviews confirmed that the revised items were understandable and acceptable to relatives.</p><p><strong>Conclusion: </strong>The FS-ICU-24R was successfully translated and culturally adapted into Danish using a systematic approach. The Danish version is culturally appropriate and demonstrated good face and content validity. Psychometric evaluation is now warranted to establish its reliability and construct validity in Danish ICU settings.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70210"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12936403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Predictions Including Pre-Admission Functional Status in ICU Patients With Delirium-A Substudy of the AID-ICU Trial.","authors":"Lone M Poulsen, Andreas W Rosen, Nina C Andersen-Ranberg, Camilla B Mortensen, Anders Perner, Stine Estrup, Bodil S Rasmussen, Ole Mathiesen","doi":"10.1111/aas.70225","DOIUrl":"10.1111/aas.70225","url":null,"abstract":"<p><strong>Purpose: </strong>Pre-admission functional status affects patients' ability to overcome the deteriorating effects of acute critical illness. We aimed to develop a clinical prediction model for 90-day and 1-year mortality based on pre-admission data, including functional status, in adult delirious ICU patients.</p><p><strong>Methods: </strong>We included participants randomized to the three highest-enrolling hospitals in the Agents Intervening against Delirium in the Intensive Care Unit (AID-ICU) trial, with pre-admission data on the Clinical Frailty Scale, Comorbidity-Polypharmacy Score, and Barthel-20 score. Ten candidate models were evaluated using multiple modeling approaches. Final models were chosen based on the hyperparameter setting maximizing the Cox-Snell pseudo R². All baseline variables and trial allocation were included. Final models were retrained on the full dataset, with internal validation performed using bootstrapping validation adjusting for optimism.</p><p><strong>Results: </strong>Of 1000 participants in AID-ICU, 632 were included: 630 provided data on 90-day mortality, and 610 on 1-year mortality. The elastic net regression models demonstrated stable, robust performance. The optimism-adjusted areas under the receiver operating characteristic curves were 0.74 (95% confidence interval [CI]: 0.70-0.78) and 0.74 (95% CI: 0.70-0.77) for the 90-day and 1-year mortality models, respectively. Calibration was good across the risk spectrum. Frailty, age, the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU), advanced cancer, and surgical admission contributed most to the prediction models.</p><p><strong>Conclusions: </strong>We developed models to predict 90-day and 1-year mortality at ICU admission in patients enrolled in the AID-ICU trial, using baseline variables, including functional status measures. The models showed fair discrimination and good calibration, with frailty, age, SMS-ICU, advanced cancer, and surgical admission as key predictors. Future studies are needed to test whether the model is valid in other ICU settings and whether its performance is sufficient to have clinical value.</p><p><strong>Editorial comment: </strong>This article presents mortality prediction models for ICU patients with delirium that incorporate pre-admission functional status and apply several modern statistical learning approaches, providing an instructive and transparent example of contemporary prediction modeling. The resulting elastic net regression models showed fair discrimination and good calibration for predicting 90-day and 1-year mortality, with frailty, age, and illness severity emerging as the strongest predictors. However, such models should be interpreted cautiously at the individual patient level and may be most useful for identifying patients at increased risk who may benefit from careful clinical assessment, individualized treatment, and close follow-up.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70225"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of Hypoxemia the First Day After Trauma Assessed by Continuous Pulse Oximetry.","authors":"Jacob Jensen-Abbew, Emma Atsuko Tsuchiya, Tobias Arleth, Felicia Dinesen, Carl Johan Queitsch, Martin Von Magius, Michelle Icka Christensen, Karl Peter Damgård Madsen, Oscar Rosenkrantz, Jacob Steinmetz","doi":"10.1111/aas.70220","DOIUrl":"10.1111/aas.70220","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of death and disability in young adults. Although supplemental oxygen is recommended early after trauma to prevent hypoxemia, evidence regarding the occurrence and distribution of hypoxemic episodes, to raise awareness on potential clinical implications, is sparse. The aim of this study was to investigate the occurrence and daily distribution of hypoxemia within the first day of admission after trauma using continuous pulse oximetry.</p><p><strong>Methods: </strong>Adult trauma patients admitted through the trauma centre at Rigshospitalet, Denmark, between February 20 and August 24, 2024, were included in this observational study irrespective of subsequent admission department. Arterial oxygen saturation measured by pulse oximetry (SpO₂) was continuously monitored for 24 h to identify clinically relevant hypoxemic episodes, defined as SpO₂ < 90%, for > 5 min. The incidence of episodes was compared regarding the occurrence between daytime and nighttime. Hypoxemic episodes were hypothesized to be more frequent during nighttime.</p><p><strong>Results: </strong>Among 165 included participants, data from 155 were analyzed. Median age was 49 years (IQR 31-62), 74.8% were male, and median Injury Severity Score was 13 (IQR 9-19). In total 146 episodes were recorded, and both daytime and nighttime periods showed incidence rates of 5.1 episodes per 100 participant-hours, yielding an incidence rate ratio (IRR) of 1.01 (95% CI, 0.73-1.4; p = 0.95) between daytime and nighttime. No differences between daytime and nighttime were found in cumulative hypoxemia duration, prolonged hypoxemic episodes, or across hospital locations.</p><p><strong>Conclusion: </strong>On average, 5.1 clinically relevant hypoxemic episodes occurred per 100 participant-hours of continuous SpO₂ monitoring during the first 24 h of hospitalization following trauma. The study found similar incidence rates of clinically relevant hypoxemic episodes at daytime and nighttime.</p><p><strong>Editorial comment: </strong>Supplementary oxygen is recommended in the early phase after trauma to prevent hypoxaemia. This single center study confirmed that clinically relevant hypoxaemic episodes occur on average five times per 100 participant-hours during the first 24 h of hospitalization following trauma, with similar incidences during both day and night. The study highligths the importance of continuous monitoring of peripheral oxygenation including if trauma patients are transferred from high-depency units to the wards.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT06256692.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70220"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing of Pre-Operative Peripheral Nerve Blocks in Randomised Controlled Trials: A Scoping Review.","authors":"Aurelien-Xuan Rosendal Bahuet, Rasmus Linnebjerg Knudsen, Mathias Therkel Steensbæk, Sina Yousef, Rikke Helene Frølund Bjulf, Anne-Sofie Linde Jellestad, Jonas Erasmus Egede Glahn, Sine Wichmann, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, Anders Kehlet Nørskov","doi":"10.1111/aas.70211","DOIUrl":"10.1111/aas.70211","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve blocks are widely used for anaesthesia in upper and lower limb surgery, but the methods used to assess their success vary substantially. This scoping review examined contemporary research practises and the extent to which trials report on peripheral nerve block evaluation.</p><p><strong>Methods: </strong>A search was conducted on PubMed for randomised controlled trials published between 2014 and 2025 in anaesthesia journals, involving pre-operative peripheral nerve blocks in adults undergoing limb surgery. Two independent authors screened and extracted data for each trial. Outcomes included the proportion of trials that reported block testing, described test methods, defined successful blocks, and reported success rates.</p><p><strong>Results: </strong>Of 284 trials included, 215 (76%, 95% CI 71%-81%) reported testing blocks, and 210 (74%, 95% CI 69%-79%) described the test methods. Of the 215 trials reporting testing, 204 used sensory assessments (95%, 95% CI 91%-97%) and 157 used motor assessments (73%, 95% CI 67%-79%). Success criteria were defined in 164/284 trials (58%, 95% CI 52%-63%), and the same number reported success rates. In the 164 trials reporting on peripheral nerve block success, the median success rate was 98% (IQR 92%-100%).</p><p><strong>Conclusion: </strong>This scoping review investigated contemporary practise in test methodology reporting in RCTs involving PNBs. We found that although most trials do report testing PNBs, about one in four did not. Furthermore, approximately two in five trials did not define what constituted a successful block or report PNB success rates. Lack of consistent and transparent test methodology poses challenges when comparing trials and performing meta-analyses, and in translating trial findings into clinical practise. This scoping review exposes a methodological blind spot in regional anaesthesia research. Despite widespread use of peripheral nerve blocks, a substantial proportion of randomised trials fail to report testing methods, success definitions, or handling of failed blocks. Such omissions undermine interpretability, comparability, and clinical translation, and strengthen the case for standardised reporting of regional anaesthesia assessment in future trials.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70211"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12946583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bicarbonate and Other Buffer Therapies in Acute Metabolic Acidosis: A Systematic Review and Meta-Analysis.","authors":"Peter C Lind, Frederik G Hansen, Mathias J Holmberg, Marie K Jessen, Asger Granfeldt, Lars W Andersen","doi":"10.1111/aas.70212","DOIUrl":"10.1111/aas.70212","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to perform a systematic review and meta-analysis on the effect of buffering therapies on clinical outcomes in adult patients with acute metabolic acidosis.</p><p><strong>Methods: </strong>Searches were conducted in Embase, Cochrane, and PubMed for randomised clinical trials comparing a buffering therapy to either placebo, no buffering therapy, or another buffering therapy in adult patients with acute metabolic acidosis. Two assessors independently reviewed trials for relevance, extracted data, and assessed risk of bias using the Cochrane Risk of bias 2 tool. Meta-analyses were performed using fixed-effect models. The certainty of evidence was assessed using the GRADE methodology.</p><p><strong>Results: </strong>Fifteen manuscripts representing 14 trials were included. Most trials were conducted in critically ill patients (4 trials; n = 1064), in patients with out-of-hospital cardiac arrest (3 trials; n = 1426), or in patients with intraoperative acidosis (3 trials; n = 136). In most trials, the intervention was bicarbonate. Risk of bias was assessed as moderate for most trials. In ICU patients with acute kidney injury, buffering therapy probably has no large effect on survival outcomes (low certainty), but likely reduces the use of renal replacement therapy and the rate of bloodstream infections (moderate certainty). Buffering therapy likely does not have an effect on survival outcomes in patients with out-of-hospital cardiac arrest (very low to low certainty).</p><p><strong>Conclusion: </strong>Buffering therapy in ICU patients with acute kidney injury likely has beneficial effects on the use of renal replacement therapy, but probably no effect on survival outcomes. Similarly, no effects were found for survival outcomes in patients with out-of-hospital cardiac arrest.</p><p><strong>Editorial comment: </strong>This systematic review with meta-analysis presents an up to date and trustworthy synthesis of evidence concerning buffer therapy in acute metabolic acidosis, largely focused in the critical care context.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70212"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12976184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromuscular Block and Video Laryngoscope to Facilitate Intubation-A Survey of Current Practice in Denmark and Sweden.","authors":"Åse Lodenius, Louise Holland-Bill, Emil Ørskov Ipsen, Maria Cronhjort, Arash Afshari, Matias Vested, Andreas Creutzburg, Lars Hyldborg Lundstrøm, Helene Korvenius Nedergaard, Anders Kehlet Nørskov","doi":"10.1111/aas.70200","DOIUrl":"10.1111/aas.70200","url":null,"abstract":"<p><strong>Background: </strong>Neuromuscular blocking agents (NMBA) provide optimal conditions for tracheal intubation. A high dose of opioid can be used as an alternative but may give suboptimal conditions for intubation. The use of a video laryngoscope for intubation might eliminate this potential difference.</p><p><strong>Methods: </strong>A survey examining clinical practice regarding tracheal intubation with and without NMBA and use of video laryngoscopes was conducted in Sweden and Denmark.</p><p><strong>Results: </strong>1771 out of 3181 (56%) of invited anaesthetists responded. Overall, 1365/1771 (77%) preferred using NMBAs for non-acute tracheal intubation with a considerably higher NMBA preference in Sweden 1011/1073 (94%) than in Denmark 354/700 (51%). A high proportion of Danish anaesthetists 327/700 (47%) compared to 40/1071 (4%) of Swedish anaesthetists reported primarily using opioids without NMBA. Remifentanil was the preferred opioid (1158/1361 (85%)) for intubation without NMBA. The reasons for using NMBA were improved intubating conditions (948/1771 (54%)), departmental tradition (285/1771 (16%)), adherence to local guidelines (264/1771 (15%)), and adherence to national/international guidelines (143/1771 (8%)). Video laryngoscopes were present in every operating theatre for 349/700 (50%) of Danish anaesthetists and 131/1071 (12%) of Swedish anaesthetists. Video laryngoscopes were easily accessible outside the operating room for 350/700 (50%) of Danish anaesthetists and 940/1071 (88%) of Swedish anaesthetists.</p><p><strong>Conclusions: </strong>NMBA use remains the standard for non-acute tracheal intubation. However, a substantial number of anaesthetists regularly employ a NMBA-free approach facilitated by high-potency opioids and video laryngoscopy, particularly in Denmark. These findings emphasise the need for further research and subsequently updated evidence-based guidance to support safe and effective intubation practices.</p><p><strong>Editorial comment: </strong>This study, reporting a survey of anesthesia practitioners in Sweden and Denmark assessed preferences concerning how the respondents would manage a series of case scenarios concerning anesthetic drug choices for facilitation of intubation and employment of video laryngoscopy. Quite a bit of variation for preferences is presented by the responses concerning neuromuscular blockade or not to facilitate intubation.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 4","pages":"e70200"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}