Acta Anaesthesiologica Scandinavica最新文献

{"title":"Commentary: Vasopressors in Early Burn Resuscitation: Physiological Concerns Revisited.","authors":"Folke Sjoberg, Jyrki Vuola, Andrew Lindford, Tina Palmieri, Moustafa Elmasry, Ahmed T El-Serafi, Ingrid Steinvall","doi":"10.1111/aas.70270","DOIUrl":"10.1111/aas.70270","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70270"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13259971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222388","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":"Subcutaneous Tranexamic Acid Achieves Comparable Serum Concentrations to Intramuscular Administration During Haemorrhagic Shock in a Swine Model.","authors":"Trine Lynghaug, Ole Martin Fuskevåg, Benjamin Stage Storm, Erik Waage Nielsen, Bent Aksel Nilsen, Erik Sveberg Dietrichs, Håkon Kvåle Bakke","doi":"10.1111/aas.70274","DOIUrl":"10.1111/aas.70274","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid is an antifibrinolytic agent reducing mortality when administered to trauma patients with haemorrhagic shock. This mortality reduction is time sensitive. Increased intramuscular dose administration has proven an effective alternative to intravenous administration in several studies and is used by some emergency medical services. However, subcutaneous administration has not been studied. Previous research indicates that subcutaneous tissue blood flow is more compromised during shock than muscle perfusion. Determining subcutaneous absorption is crucial to evaluate its potential as an alternative route and to assess the effect of accidental subcutaneous injection during intended intramuscular administration.</p><p><strong>Methods: </strong>In this experimental study using historical intramuscular and intravenous control groups, a total of six Norwegian Landrace pigs (40-50 kg) used in a trauma surgery course were subjected to various abdominal and thoracic traumas. After 1 h of surgery, the animals received tranexamic acid 30 mg/kg subcutaneously. Serum was sampled at 0, 5, 15, 25, 35, 45, 60, and 85 min after administration. Tranexamic acid serum concentration was measured using liquid chromatography-tandem mass spectrometry and compared to intramuscular and intravenous groups from previous studies, in which animals had received tranexamic acid 30 mg/kg intramuscular (n = 7) or 15 mg/kg intravenous (n = 8).</p><p><strong>Results: </strong>There was no statistical difference in serum concentrations between subcutaneous and intramuscular administration. Mean (±standard deviation) concentration after administration at 10, 45, and 85 min were 41.4 μg/mL (±19.0), 39.1 μg/mL (±8.9), and 33.4 μg/mL (±5.8), and for IM concentrations were 41.8 μg/mL (±18.9), 39.9 μg/mL (±7.8), and 44.2 μg/mL (±21.8). At 5 min, the concentration of both SC and IM administration was approximately half those observed after IV administration, but all concentrations were well above the 10-17 μg/mL concentration needed to inhibit fibrinolysis.</p><p><strong>Conclusions: </strong>Although subcutaneous blood flow is sensitive to shock, serum tranexamic acid concentrations after subcutaneous administration in shocked pigs were comparable to those achieved after intramuscular administration. Intramuscular administration should remain the preferred secondary route after the standard intravenous route, but inadvertent subcutaneous injection is likely to achieve therapeutic serum concentrations.</p><p><strong>Editorial comment: </strong>This observational study in pigs undergoing hemorrhagic shock compared subcutaneous tranexamic acid administration to historical intravenous and intramuscular controls and found that plasma concentrations were comparable between routes. This suggests that inadvertent subcutaneous dosing during intramuscular injection likely achieves therapeutic levels. While promising, these results rely on historical contr","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70274"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262774","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":"An Observational Study of Changes in Renin Concentrations and Associations With Complications Following Cardiac Surgery.","authors":"Wajid Khan, Suzanne Weightman, Anders Aneman","doi":"10.1111/aas.70249","DOIUrl":"10.1111/aas.70249","url":null,"abstract":"<p><strong>Background: </strong>Increased plasma renin concentrations have been reported in patients following cardiac surgery while correlations to clinical outcomes have varied. More evidence is needed to support the potential clinical utility of plasma renin as a biomarker guiding postoperative management, including the need for alternative pharmacotherapy when standard catecholaminergic cardiovascular support is insufficient.</p><p><strong>Methods: </strong>Plasma concentrations were determined by direct renin immunoassay (milli-International Units per litre, mIU L<sup>-1</sup>) on admission to ICU and then six and 24 h later. Postoperative complications were assessed by the composite and separate incidence of acute kidney injury, acute myocardial infarction, shock, acute respiratory failure, new onset atrial flutter/fibrillation and cerebrovascular accident. Pharmacological support required to treat postoperative haemodynamic instability was quantified using the vasoactive-inotropic score.</p><p><strong>Results: </strong>One hundred and four patients were studied and 54 (52%) met at least one diagnostic criterion for postoperative complications. Renin concentrations on admission (130 [34-445] mIU L<sup>-1</sup>) and six (119 [35-447] mIU L<sup>-1</sup>) and 24 h later (184 [54-513] mIU L<sup>-1</sup>) were not significantly different with substantial inter-individual variation. Cumulative renin concentrations over 24 h were higher in haemodynamically unstable patients (median difference 1296 [54-2943] mIU L<sup>-1</sup>, p = 0.04) and in patients with any postoperative complication (median difference 1887 [908-6177] mIU L<sup>-1</sup>, p = 0.04). Plasma renin increased by 11 mIU L<sup>-1</sup> for each unit increase in the vasoactive-inotropic score. A statistical model using all renin measurements predicted haemodynamic instability (AUC 0.77 [0.55-0.95], p = 0.04) and shock (AUC 0.95 [0.83-1.0], p = < 0.001), but not the composite or separate incidence of the other complications.</p><p><strong>Conclusions: </strong>Haemodynamic compromise, but not postoperative complications overall, were associated with serial plasma renin concentrations during the first 24 h of ICU admission following cardiac surgery. Additional prospective studies are warranted to elucidate the relationship between renin dynamics, postoperative complications and criteria for escalating vasopressor therapy.</p><p><strong>Editorial comment: </strong>This prospective observational study tested whether postoperative increase in plasma renin in patients undergoing cardiac surgery was associated with postoperative complications. No such association was found, but an association between increase in plasma renin and haemodynamic compromise and need for pharmacological support was found. Larger studies are warranted to elucidate the role of plasma renin as a biomarker for postoperative complications.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT043","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70249"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Suspected Aspiration During of Out-Of-Hospital Cardiac Arrest With Development of Early-Onset Pneumonia.","authors":"Karoliina Yli-Luukko, Paula Mäki, Sanna Hoppu, Piritta Setälä, Joonas Tirkkonen","doi":"10.1111/aas.70257","DOIUrl":"10.1111/aas.70257","url":null,"abstract":"<p><strong>Background: </strong>Early-onset pneumonia is a possible complication after out-of-hospital cardiac arrest (OHCA) resuscitation. Whether or not a suspected aspiration during prehospital care is associated with the development of early-onset pneumonia has not been studied.</p><p><strong>Methods: </strong>We conducted a single-centre prospective observational study among comatose out-of-hospital cardiac arrest survivors treated in the intensive care unit (ICU). Both prehospital emergency physicians and nurse-paramedics completed a structured survey on possible aspiration after each successful resuscitation. The primary outcome was being diagnosed with early-onset pneumonia within the first 96 h of ICU stay.</p><p><strong>Results: </strong>A total of 55 patients were included, and 11 patients were suspected of having aspirated during their out-of-hospital cardiac arrest. Patients with suspected aspiration were younger, had a lower Charlson comorbidity index, and their out-of-hospital cardiac arrest was more often due to non-cardiac aetiology with a non-shockable primary rhythm. Patients with suspected aspiration had comparable oxygenation, ventilation, and ventilator parameters to the patients without suspected aspiration. Pneumonia findings on chest X-rays, CT imaging, and infection parameters were similar across the patient groups. Early-onset pneumonia during the first 96 h was as common in both groups (91% vs. 68%, p = 0.130). Prehospital suspicion of aspiration was not associated with early-onset pneumonia in multivariable regression analysis (odds ratio 2.8, 95% confidence interval 0.29-28).</p><p><strong>Conclusion: </strong>Suspicion of aspiration during out-of-hospital cardiac arrest was not associated with early-onset pneumonia. However, this study was possibly underpowered to detect clinically relevant differences.</p><p><strong>Editorial comment: </strong>This study presents associations between post-cardiac arrest and resuscitation early pneumonia and suspicion of pulmonary aspiration at the time of the out of hospital cardiac arrest and first treatment. In this cohort, there did not seem to be a clear association.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70257"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939763","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":"Effect of Ultrasound-Guided Lateral Infraclavicular Brachial Plexus Block With Lidocaine or Ropivacaine for Closed Reduction of Distal Radius Fractures: A Randomized Controlled Noninferiority Trial.","authors":"Mathias Therkel Steensbæk, Sina Yousef, Aurelien-Xuan Rosendal Bahuet, Rasmus Linnebjerg Knudsen, Rikke Helene Frølund Bjulf, Sanja Pisljagic, Jens Haavig Thomsen, Zofia Piosik, Peter Bak Kaaber, Christian Rothe, Cecilie Dupont Harwood, Anne-Sofie Linde Jellestad, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, Anders Kehlet Nørskov","doi":"10.1111/aas.70246","DOIUrl":"10.1111/aas.70246","url":null,"abstract":"<p><strong>Background: </strong>Closed reduction of distal radius fractures is painful, and current analgesic strategies may be inadequate. Ultrasound-guided lateral infraclavicular brachial plexus block may offer complete analgesia and muscle relaxation, potentially improving patient comfort and reduction quality. However, benefits and challenges regarding anesthetic agents for this procedure remain unclear.</p><p><strong>Methods: </strong>In this randomized, controlled, blinded, noninferiority trial, 63 adults with distal radius fractures requiring closed reduction received a lateral infraclavicular block with either 30 mL of ropivacaine 0.5%, lidocaine 1% with epinephrine, or ropivacaine 0.2%. The primary outcome was block success at 45 min, defined as complete sensory and extensive motor block of the radial, musculocutaneous, ulnar, and median nerves. Noninferiority was assessed using a margin of 20%. Exploratory outcomes included sensory and motor block assessments, time to pain relief, block duration, pain during reduction, patient satisfaction, quality of closed reduction, fracture treatments, and safety.</p><p><strong>Results: </strong>Ropivacaine 0.2% was statistically inferior to ropivacaine 0.5% in achieving block success at 45 min (risk ratio (RR) 0.63, 97.5% CI 0.40-0.99). Lidocaine 1% with epinephrine did not meet the predefined noninferiority criteria for block success (RR 0.95, 97.5% CI 0.73-1.22) but did provide comparable analgesia with a shorter block duration. Pain scores during reduction were low across all groups, with a significant decrease in pain from baseline. Patient satisfaction was high in all groups. No significant differences were found in the quality of closed reduction, safety, or fracture treatments.</p><p><strong>Conclusion: </strong>Lateral infraclavicular block with ropivacaine 0.2% failed to demonstrate noninferiority for block success and was statistically inferior to ropivacaine 0.5%. Inferiority testing should be interpreted cautiously within the context of a noninferiority design, although the results suggest reduced effectiveness for distal radius fracture reduction. Lidocaine 1% with epinephrine yielded inconclusive results for noninferiority on block success, but provided a shorter block duration without compromising analgesia, patient satisfaction, or quality of reduction.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT06379490 (released April 23, 2024); https://clinicaltrials.gov/study/NCT06379490; EUCT Identifier 2024-510,572-20-00; https://euclinicaltrials.eu/ctis-public/view/2024-510572-20-00.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70246"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855607","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":"Bayesian Analysis of Postoperative Complication Risk Associated With Preoperative Exposure to Fine Particulate Matter: A Single-Center Cohort Study.","authors":"John F Pearson, Cameron K Jacobson, Calvin S Riss, Matthew J Strickland, Longyin Lee, Neng Wan, Tabitha M Benney, Nathan L Pace, Ben K Goodrich, Jonah S Gabry, John V Pham, Cade K Kartchner, Jacob A Wood, Michael H Andreae","doi":"10.1111/aas.70235","DOIUrl":"10.1111/aas.70235","url":null,"abstract":"<p><strong>Background: </strong>Air pollution, especially particle pollution, is increasingly recognized as a potential perioperative risk factor, yet modeling environmental exposures in surgical cohorts remains methodologically underdeveloped. We demonstrate a Bayesian hierarchical framework to quantify probabilistic associations between preoperative fine particulate matter (PM_2.5) exposure and postoperative complications, highlighting its interpretability and flexibility for clinical environmental epidemiology.</p><p><strong>Methods: </strong>We conducted a single center, retrospective cohort study using data from 49,615 surgical patients in Utah who underwent elective surgical procedures from 2016 to 2018. Patients' addresses were geocoded and linked to daily Census-tract level PM_2.5 estimates. The exposure variable was defined as the maximum PM_2.5 concentrations in the 7 days prior to surgery. The binary outcome was a composite of postoperative complications: pneumonia, surgical site infection, urinary tract infection, sepsis, stroke, myocardial infarction, or thromboembolic event. A hierarchical Bayesians regression model with weakly informative priors was used adjusting for age, sex, season, neighborhood disadvantage, and the Elixhauser index of comorbidities with census tract as a group (random) effect. We present posterior estimates with credible intervals, highlight model transparency and sensitivity, and discuss contrasts with standard frequentist methods.</p><p><strong>Results: </strong>Postoperative complications were associated in a dose-dependent manner with higher concentrations of PM_2.5 exposure. We found a relative increase of 8.2% in the odds of complications (OR = 1.082) for every 10.ug/m³ increase in the highest single-day 24-h PM_2.5 exposure during the 7 days prior to surgery. For an increase in PM_2.5 from 1 to 30 ug/m³, the odds of complication rose to over 27% (95% CI: 4%-55%). The results were robust across prior choices and model specifications. We report full posterior distributions and highlight advantages of Bayesian modeling for uncertainty quantification and clinical interpretability.</p><p><strong>Conclusions: </strong>This case study demonstrates the application of hierarchical Bayesian modeling to quantify the probabilistic associations between preoperative PM_2.5 exposure and postoperative complications, highlighting transparent risk estimation and uncertainty characterization that may inform the design of future multicenter perioperative environmental studies.</p><p><strong>Editorial comment: </strong>Using Bayesian statistical analysis, the authors demonstrate a dose-dependent risk for postoperative complications in patients exposed to air polluted with fine particulate matter with a size of less than 2.5 μm.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70235"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759314","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":"General Anaesthesia Versus Spinal Anaesthesia for Outpatient Total Hip and Knee Arthroplasty: A Randomised Trial Protocol.","authors":"Erik Noppa, Karuna Dahlberg, Alex de Leon, Maziar Mohaddes, Anna Philipson, Peter Wildeman, Kristofer F Nilsson","doi":"10.1111/aas.70283","DOIUrl":"10.1111/aas.70283","url":null,"abstract":"<p><strong>Introduction: </strong>Same-day discharge after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) is increasing, but the optimal anaesthetic technique for outpatient pathways remains uncertain. Neuraxial anaesthesia is widely recommended based on observational evidence, whereas fast-track programmes using short-acting total intravenous anaesthesia may facilitate early mobilisation and discharge. No randomised controlled trial has compared general anaesthesia (GA) with spinal anaesthesia (SA) specifically in outpatient primary THA/TKA using a same-day discharge target.</p><p><strong>Methods and analysis: </strong>GASPS is a pragmatic, multicentre, parallel-group superiority randomised controlled trial. Adults scheduled for outpatient primary THA or TKA will be randomised 1:1 to GA or SA, with stratification by site and procedure (THA/TKA). The primary outcome is successful same-day discharge (discharge on the day of surgery) without readmission within 48 h after discharge. The five key secondary outcomes are time to fulfilment of hospital discharge indicators, quality-of-recovery (QoR-15) trajectories over postoperative Days 1-35, patients' qualitative experiences of anaesthesia and recovery, cost per quality-adjusted life-year and safety (adverse events); all remaining outcomes-including pain, postoperative nausea and vomiting, opioid consumption, mobilisation and patient-reported outcomes (EQ-5D-5L and HOOS/KOOS)-are exploratory. An embedded qualitative study will explore patient experiences using semi-structured interviews, and an economic evaluation will compare costs and outcomes from healthcare and societal perspectives. Analyses will follow the intention-to-treat principle; a group sequential design with O'Brien-Fleming boundaries is planned for an interim analysis. Approval has been obtained from the Swedish Medical Products Agency. Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publications, conference presentations and reporting in the EU Clinical Trials Information System (CTIS).</p><p><strong>Conclusion: </strong>This study is designed to determine the most effective anaesthetic method for same-day discharge after primary TKA and THA. With increasing outpatient surgeries, this study will be helpful for optimisation of outpatient processes.</p><p><strong>Trial registration: </strong>EU CT/CTIS: 2024-520127-89-00.</p><p><strong>Clinicaltrials: </strong>gov: NCT07334132.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70283"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148256869","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":"Whole Blood Transcriptomic Response to Perioperative Dexamethasone in Total Knee Arthroplasty: A Targeted Panel Analysis.","authors":"Asger Krog Mølgaard, Kasper Smidt Gasbjerg, Lukas Balsevicius, Britt Cappelen, Adile Orhan, Helin Yikilmaz Pardes, Ole Mathiesen, Thomas Litman, Daniel Hägi-Pedersen, Ismail Gögenur","doi":"10.1111/aas.70244","DOIUrl":"10.1111/aas.70244","url":null,"abstract":"<p><strong>Background: </strong>Changes in the transcriptome of immune cells are predictive of clinical outcomes. These effects may be surgery-specific and possibly modulated by glucocorticoids. We investigated the immune response and the impact of dexamethasone on the response in patients undergoing total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>The transcript levels (n = 579) in whole blood of 63 patients undergoing TKA and receiving either dexamethasone (DXM, n = 46) or placebo (n = 17) perioperatively were characterised by the Nanostring nCounter platform and the Immunology V2 panel. Samples were collected before surgery and on the first postoperative day (POD1).</p><p><strong>Results: </strong>Dexamethasone induced differential expression of 113 genes (|log2 fold change| > 0.5, adjusted p-value [p-adj] < 0.05). Pathway enrichment analysis using an Over-Representation Analysis (ORA) indicated an up-regulation of IL6/JAK-STAT3-signalling (p-adj 0.016) and down-regulation of a pathway related to allograft-rejection (p-adj 0.032). The immune response itself induced differential expression of 169 genes and ORA only found an allograft rejection pathway significant (p-adj 0.016). Cell type deconvolution indicated that dexamethasone increased the granulocyte fraction (69.6% vs. 73.6%, p-adj = 0.005) and reduced B- and Plasma-cell fraction (10.1% vs. 8.4%, p-adj = 0.016). The granulocyte fraction on POD1 was significantly different between dexamethasone and placebo-treated patients (73.6% vs. 70.1%, p-adj = 0.048).</p><p><strong>Conclusions: </strong>Perioperative dexamethasone in TKA induced differential expression of genes related to IL6-JAK/STAT3-signalling as estimated by the Immunology V2 panel. This, however, is not supported by the literature or a rank-based interpretation of the most differentially expressed genes and was most likely due to technical reasons. Future studies should focus on broader panels, different techniques or measures leading to fewer exclusions of genes during quality control when seeking to characterise the immune response to TKA and dexamethasone.</p><p><strong>Editorial comment: </strong>This transcriptomic sub‑study shows that perioperative dexamethasone does not simply suppress, but distinctly reshapes, the early whole‑blood immune response to total knee arthroplasty. However, the study investigated an early postoperative snapshot after a single perioperative dose only. Thus, longitudinal linkage to circulating biomarkers of inflammation and injury as well as clinical outcomes could not be assessed. This study therefore should be regarded as hypothesis‑generating, urging for extended, multi‑modal and outcome‑oriented studies before concluding on the broader clinical effects of perioperative dexamethasone.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70244"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925409","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":"Preferences for Blood Glucose Management in Adult Intensive Care Unit Patients-An International Survey.","authors":"Milda Grigonyte-Daraskeviciene, Anders Granholm, Morten Hylander Møller, Benjamin Skov Kaas-Hansen, Nick Meier, Praleene Sivapalan, Karen Louise Ellekjaer, Anne Witte Kamstrup, Jørgen Wiis, Nicolai Haase, Morten Heiberg Bestle, Christian Lange Gantzel, Helle Bundgaard, Jens Michelsen, Anne Sofie Andreasen, Therese Keinicke Nissen, Vera Crone, Bodil Steen Rasmussen, Peter Buhl Hjortrup, Theis Itenov, Iben Strøm Darfelt, Ronni R Plovsing, Anne Craveiro Brøchner, Gine Lovring Glargaard, Megan H Hicks, Micah T Long, William K Rogers, Arna Banerjee, Roshni Sreedharan, Shaun R Yockelson, Krassimir Denchev, Margo Hoyler, Courtney Maxey-Jones, Maria Cronhjort, Mia Alasjö, Erik Svensk, Fredrik Sjövall, Miklós Lipcsey, Jonatan Oras, Johan Mårtensson, Lena Swedberg, Marie-Madlen Jeitziner, Urs Pietsch, Alexa Holliger, Carmen Andrea Pfortmueller, Jan Gunst, Eva Boonen, Johanna Hästbacka, Mika Valtonen, Tero Ala-Kokko, Minna Bäcklund, Heikki Kiiski, Stepani Bendel, Özlem Öner, Murat Emre Tokur, Pervin Hancı, Aydan Elmas, Mehmet Çağatay Gürkök, Yakar Mehmet Nuri, Bişar Ergün, Ferhan Demirer Aydemir, Begum Ergan, Abdulrahman Abdullah Al-Fares, Paul J Young, Dilip Jayasimhan, Marlies Ostermann, Yaseen M Arabi, Frederik Keus, Anders Perner","doi":"10.1111/aas.70265","DOIUrl":"10.1111/aas.70265","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperglycaemia is common in intensive care unit (ICU) patients and blood glucose management practices likely vary, but there are limited contemporary data on ICU doctors' and nurses' preferences.</p><p><strong>Methods: </strong>We conducted an international online survey of ICU doctors and nurses. The 16-question survey covered respondent characteristics, glucose management practices, perceived challenges with intermittent point of care (iPOC) glucose monitoring and continuous glucose monitoring (CGM), and preferences for a future trial on CGM versus usual care. Data were reported descriptively for all respondents and stratified by profession.</p><p><strong>Results: </strong>We received 1424 responses from 12 countries, of which 63% were from nurses. The overall response rate was 36% and the highest proportion of missing data for any question was 9%. Most respondents (92%) reported that their ICU had a glucose management protocol. The median reported insulin initiation threshold was blood glucose of 10 mmol/L. Long-acting insulin was reported to be used occasionally by 68% of respondents. As needed pro re nata insulin was reported as most often given subcutaneously (43%) or intravenously (25%). Overall, 61% of ICU nurses reported concerns related to iPOC use versus 53% among ICU doctors (concerns among nurses versus doctors included risk of hypoglycaemia in 41% vs. 28%; risk of hyperglycaemia in 28% vs. 16%; patient discomfort in 26% vs. 27%). Overall, 75% of respondents never used CGM and 18% of ICU nurses reported concerns related to CGM use versus 22% of ICU doctors (accuracy and reliability in 14% vs. 18%; calibration and maintenance in 9% versus 16%; patient discomfort in 5% vs. 6%, respectively). Most respondents (89%) supported a randomised trial on CGM versus usual care in ICU and 68% preferred an intervention arm with a specific CGM-treatment protocol.</p><p><strong>Conclusions: </strong>Glucose management preferences varied among ICU staff, particularly in the administration of as needed doses and long-acting insulin. ICU nurses appeared more concerned about iPOC use than ICU doctors. The concerns about use of CGM appeared less common than concerns about iPOC. Most nurses and doctors would support a randomised trial on CGM versus usual care for glucose management in ICU and reported a preference for CGM to be used with a specific treatment protocol.</p><p><strong>Editorial comment: </strong>This international survey highlights substantial professional differences and heterogeneity in ICU glucose management practices, particularly regarding as-needed and long-acting insulin use. Nurses expressed greater concern than doctors about intermittentpoint point-of-care glucose monitoring, especially the risks of hypoglycaemia and hyperglycaemia. Although continuous glucose monitoring was rarely used, it was viewed favourably overall, with broad support for a future protocolised randomised CGM trial.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70265"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Clinical Evidence on Remimazolam in Anaesthesia: A Protocol for a Scoping Review.","authors":"Emma Hansine Vangsgaard Skuldbøl Nilsson, Ibrahim Abood, Ann Merete Møller","doi":"10.1111/aas.70251","DOIUrl":"10.1111/aas.70251","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a recently introduced benzodiazepine used for procedural sedation and general anaesthesia. Its pharmacokinetic profile, including rapid metabolism and predictable recovery, has generated interest in its potential advantages compared with traditional sedatives such as midazolam and propofol.</p><p><strong>Methods: </strong>This protocol follows established methodological guidance for scoping reviews. The review will map the available evidence on the clinical use of remimazolam and identify gaps in the current literature. Specifically, it will examine studied patient populations, the reported pharmacokinetic profile of remimazolam and the clinical settings in which the drug has been investigated.</p><p><strong>Results: </strong>The review will provide an overview of the existing literature on remimazolam, with particular focus on underrepresented patient populations, its current clinical applications, and reported short- and long-term adverse effects.</p><p><strong>Conclusion: </strong>The planned review will map the current evidence regarding remimazolam, identify underrepresented populations, the clinical contexts in which remimazolam is used, and gaps for future research.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70251"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13163629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147872971","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}