Acta Anaesthesiologica Scandinavica最新文献

{"title":"Glucagon-Like Peptide-1 Agonist vs. Placebo and Pulmonary Decline After Open-Heart Surgery: A Substudy of the GLORIOUS Randomised Clinical Trial.","authors":"Astrid Duus Mikkelsen, Sebastian Wiberg, Hans Henrik Lawaetz Schultz, Peter Hasse Møller-Sørensen, Dan Høfsten, Jens Christian Nilsson, Christian Holdflod Møller, Lars Køber, Christian Hassager, Jesper Kjærgaard","doi":"10.1111/aas.70282","DOIUrl":"10.1111/aas.70282","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary decline is an established complication of open-heart surgery extending beyond the immediate postoperative phase. Inflammation-mediated lung damage and ischaemia-reperfusion injury secondary to extracorporeal circulation is a proposed pathophysiological driver. GLP-1 receptor agonists (GLP-1RA) have emerged as promising protective agents in this setting.</p><p><strong>Aim: </strong>Investigate whether infusion of the GLP-1RA, exenatide during cardiopulmonary bypass and weaning thereof, can mitigate the decline in diffusing capacity and ventilatory performance 3 months postoperative, compared to placebo.</p><p><strong>Methods: </strong>In this predefined explorative substudy of the randomised, clinical GLORIOUS trial, 878 adult patients undergoing non-emergent coronary artery bypass grafting (CABG) and/or surgical aortic valve replacement (SAVR) were randomised to a continuous infusion of the GLP-1RA, exenatide or placebo during cardiopulmonary bypass, extending into the early postoperative period. Diffusing capacity of the lung for carbon monoxide (DLCO) and ventilatory performance (FEV₁/FVC) were measured preoperatively and 3 months postoperatively.</p><p><strong>Results: </strong>Median DLCO (% predicted corrected) declined from 80% preoperative to 72% 3 months postoperative, corresponding to a -7.7 percentage point (pp) difference (95% CI 6.2 to 9.1; p < 0.001). FEV₁/FVC declined from 0.75 preoperative to 0.73 postoperative, corresponding to a -1.6 difference (95% CI 1.0 to 2.1; p < 0.001). However, there were no significant differences in decline between the exenatide and placebo groups (all p > 0.3). Findings were consistent across subgroup analyses.</p><p><strong>Conclusion: </strong>While both diffusing capacity and ventilatory performance exhibited a mild-to-moderate decline 3 months after open-heart surgery, the GLP-1RA exenatide did not mitigate this decline compared with placebo.</p><p><strong>Editorial comment: </strong>Pulmonary dysfunction is one of the most common complications to open-heart surgery. The present study confirms a decline in diffusing capacity of the lung for carbon monoxide (DLCO) and in ventilatory performance measured as FEV₁/FVC at 3 months postoperatively compared to preoperative measurements. Infusion of GLP-1 receptor antagonist during cardiopulmonary bypass and weaning did not mitigate the pulmonary decline compared to placebo.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70282"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275600","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":"Combined Transversus Abdominis Plane and Rectus Sheath Blocks in Open Inguinal Hernia Repair: Protocol for a Double-Blind Randomized Controlled Trial (PRO-RSTAP).","authors":"Pia Nordström, Aki Lumme, Juha Virman, Maija-Liisa Kalliomäki","doi":"10.1111/aas.70238","DOIUrl":"10.1111/aas.70238","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair is one of the most common surgical procedures worldwide and is frequently performed as day-case surgery. Postoperative pain may delay recovery and occasionally necessitate unplanned hospital admission. Regional anesthesia techniques, including transversus abdominis plane (TAP) and rectus sheath (RS) blocks, have shown promise in improving analgesia. However, their combined efficacy in open inguinal hernia repair has not been established in randomized trials.</p><p><strong>Methods: </strong>The PRO-RSTAP trial is a prospective, double-blind, four-arm randomized controlled trial conducted at three hospitals in Finland. The study evaluates the individual and combined effects of TAP and RS blocks in adults undergoing elective open inguinal hernia repair. Two hundred patients are randomized equally into four groups: (1) placebo TAP + placebo RS, (2) active TAP + placebo RS, (3) active RS + placebo TAP, and (4) active TAP + active RS. All patients receive standardized sedation and multimodal analgesia, including paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and rescue opioids. The primary outcome is cumulative perioperative opioid consumption from block administration until hospital discharge, expressed as intravenous morphine equivalents. Secondary outcomes include pain scores, conversion to general anesthesia, postoperative nausea and vomiting, time to discharge, and unplanned admissions or emergency visits within 7 days. The planned sample size provides 80% power to detect a clinically meaningful reduction in opioid use (two-sided α = 0.05). Analyses follow the intention-to-treat principle.</p><p><strong>Results: </strong>The first participant was enrolled in September 2025, and the trial is ongoing. No interim efficacy analysis is planned. Safety is monitored continuously throughout the study.</p><p><strong>Conclusion: </strong>This randomized controlled trial is designed to determine whether combining TAP and RS blocks improves postoperative analgesia and recovery after open inguinal hernia repair. The results will contribute to evidence-based optimization of regional anesthesia strategies in ambulatory surgery.</p><p><strong>Trial registration: </strong>EU Clinical Trials Information System (CTIS): 2024-513406-59-00; ClinicalTrials.gov identifier: NCT07423910.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70238"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832240","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":"Early Versus Late Wake-Up Call After Out-Of-Hospital Cardiac Arrest: Protocol for a Multicenter Randomized Comparison Within the Danish Out-of-Hospital Cardiac Arrest (DANOHCA) Trial.","authors":"Anders Morten Grejs, Jesper Kjaergaard, Jo Bønding Andreasen, Bodil Steen Rasmussen, Christian Hassager, Martin Abild Stengaard Meyer, Lars Peter Kloster Andersen, Henrik Schmidt, Simon Moelstroem, Sören Möller, Christhopher Torp, Steffen Christensen, Jacob Eifer Moeller","doi":"10.1111/aas.70272","DOIUrl":"10.1111/aas.70272","url":null,"abstract":"<p><strong>Background: </strong>Survivors of out-of-hospital cardiac arrest (OHCA) who remain comatose after return of spontaneous circulation are routinely sedated and mechanically ventilated during early post-resuscitation care. Although prolonged sedation has traditionally been considered necessary, contemporary normothermia-based temperature control allows earlier wake-up call. The optimal timing of an early wake-up call remains unknown and may influence overall mortality, neurological recovery, duration of mechanical ventilation, and length of hospital stay.</p><p><strong>Methods: </strong>The Danish Out-of-Hospital Cardiac Arrest (DANOHCA) trial (clinicaltrials.gov identifier: NCT05895838; and euclinicaltrials.eu, identifier: 2024-515,997-28-00) is an investigator-initiated, multicenter, randomized clinical trial using a 2 × 2 × 2 × 2 factorial design evaluating four interventions in patients resuscitated from OHCA. The present protocol describes the comparison of an early versus late wake-up call strategy. Adult patients (≥ 18 years) with presumed cardiac-cause of OHCA, sustained return of spontaneous circulation, and persistent unconsciousness on intensive care unit admission are randomized 1:1 to early wake-up call (≤ 6 h after randomization) or late wake-up call (28-36 h after randomization). Wake-up call includes interruption of sedation, assessment of neurology, and may be followed by extubation if predefined neurological and respiratory criteria are fulfilled. The primary endpoint is days alive and out of hospital within 30 days after randomization. Analyses will follow a modified intention-to-treat principle.</p><p><strong>Perspectives: </strong>Optimizing post-resuscitation care remains a cornerstone in managing comatose cardiac arrest survivors and improving outcomes. We hypothesize that sedation for 28-36 h leads to more days alive outside of the hospital in 30 days compared to sedation for ≤ 6 h.</p><p><strong>Trial registration: </strong>EudraCT number: 2016-003265-26; EU CTIS no 2024-515997-28-00; ClinicalTrials.gov identifier: NCT05895838.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70272"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196955","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":"Effects of Sedation, TEmperature and Pressure After Cardiac Arrest and REsuscitation on Major Adverse Kidney Events (STEPCARE-MAKE): A Protocol for a Pre-Planned Sub-Study of a Randomized Clinical Trial.","authors":"Keski-Keturi M, Niemelä V H, Young P, Nielsen N, Wise M P, Reinikainen M, Bass F, Lilja G, Dankiewicz J, Hammond N, Hästbacka J, Levin H, Moseby-Knappe M, Saxena M, Tiainen M, Ceric A, Kamp C B, Sillassen C D B, Alexandersson D, Schmidbauer S, Tirkkonen J, Oksanen T, Säkkinen H, Bendel S, Düring J, Lybeck A, Johnsson J, Unden J, Lundin A, Kåhlin J, Grip J, Lotman E, Romundstad L, Seidel P, Stammet P, Graf T, Mengel A, Leithner C, Nee J, Druwé P, Ameloot K, McGuigan P J, White J, Govier M, Ostermann M, Hopkins P, Proudfoot A, Handslip R, Pogson D, Jackson P, Nichol A, Haenggi M, Hilty M P, Iten M, Schrag C, Nafi M, Joannidis M, Robba C, Belohlavek J, Rob D, Arabi Y, Al-Fares A, Yew Woon C, Aneman A, Stewart A, Arnott C, Ramanan M, Panwar R, Delaney A, Reade M, Venkatesh B, Taccone F, Pekkarinen P T, Friberg H, Cronberg T, Jakobsen J C, Skrifvars M B","doi":"10.1111/aas.70276","DOIUrl":"10.1111/aas.70276","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common and serious complication after cardiac arrest, affecting more than 30% of initially successfully resuscitated patients, with around 10% receiving Kidney Replacement Therapy (KRT). Currently, treatment options to prevent renal complications are limited. In this predefined sub-study of the Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial, we evaluate the effects of sedation depth, fever management strategies, and mean arterial pressure (MAP) targets on the risk of major adverse kidney events (MAKE) in post-cardiac arrest patients.</p><p><strong>Methods: </strong>STEPCARE-MAKE is a predefined prospective sub-study of the international, randomized clinical STEPCARE trial. The main trial will enroll 3500 patients and employs a 2 × 2 × 2 factorial design, randomizing participants across three interventions: (1) deep sedation for 36 h or minimal sedation, (2) fever management with or without a feedback-controlled device, and (3) MAP target ≥ 65 mmHg or ≥ 85 mmHg. The primary outcome is the composite outcome MAKE, which includes death from any cause by day 30, initiation of KRT, or persistent renal dysfunction, defined as the final creatinine value ≥ 200% of the baseline at the time of discharge from the primary hospital or at day 30, whichever occurs first. Differences between baseline and the highest in-hospital creatinine, baseline and the last measured in-hospital creatinine, baseline and 72-h creatinine, and baseline and the highest creatinine within 72 h will be reported as secondary outcomes.</p><p><strong>Conclusion: </strong>The findings of this sub-study will provide new evidence on the renal effects of the STEPCARE trial interventions and may inform the future of individualized kidney-protective treatment approaches.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70276"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148256846","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":"Secondary Analysis of the CAN-Study, a Randomised Controlled Trial - Local Anaesthesia and Overall Survival.","authors":"Mats Enlund, Anders Berglund, Leif Bergkvist","doi":"10.1111/aas.70268","DOIUrl":"10.1111/aas.70268","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigates long-term survival in the Cancer and Anaesthesia (CAN) study, focusing on the potential impact of local anaesthetic infiltration during breast cancer surgery. A positive effect from peritumoral infiltration has recently been suggested. We conducted an exploratory data analysis to examine a possible association between uncontrolled exposure to local anaesthetics during breast cancer surgery and long-term survival.</p><p><strong>Methods: </strong>Breast cancer patients were recruited to compare long-term survival according to whether anaesthesia was maintained with inhaled sevoflurane or intravenous propofol. Other aspects of anaesthesia, such as the use of local- or regional anaesthesia, were carried out pragmatically according to local institutional guidelines. Kaplan-Meier survival curves were constructed to compare survival between those who received local anaesthetics or not.</p><p><strong>Results: </strong>Among 1670 analysed patients, 803 (48.1%) received local anaesthetic infiltration, 67 (4.0%) received a paravertebral block, 75 (4.5%) received both, and 725 (43.4%) received neither. Over a median follow-up of 76.8 months, no significant differences in overall survival were observed - either between the pooled group of patients who received any local or regional anaesthesia (n = 945) and those who received neither (n = 725; p = 0.54), or among all four groups (p = 0.89).</p><p><strong>Conclusion: </strong>We found no association with local-anaesthetic skin infiltration or regional anaesthesia and long-term survival in this non-preplanned secondary analysis of a randomised controlled trial.</p><p><strong>Editorial comment: </strong>In this secondary analysis of an observational follow-up study for anaesthetic exposure and cancer outcomes, regional or localized local anaesthetic treatments were not associated with a survival advantage. How regional anaesthesia or local anaesthetics might interact with clinical cancer natural history in patients is still not clear, though the results here do not support a large effect.</p><p><strong>Trial registration: </strong>EudraCT number: 2013-002380-25; ClinicalTrials.gov Identifier: NCT01975064.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70268"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051909","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":"Cognitive Functioning After Circulatory Shock: A Prospective Observational Study.","authors":"Salla Laurila, Eva Nordenswan, Henriikka Ollila, Riikka Pihlaja, Erika Wilkman, Elina Varis, Maria Heliste, Sanna Koskinen, Annamari Tuulio-Henriksson, Marjaana Tiainen, Heini Huhtala, Anne H Kuitunen, Laura Hokkanen, Johanna Hästbacka","doi":"10.1111/aas.70250","DOIUrl":"10.1111/aas.70250","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment in intensive care unit (ICU) survivors is multifactorial and can affect especially memory, attention, and executive functions. This study aimed to determine the cognitive functioning of patients with circulatory shock immediately after ICU discharge and 3 months later.</p><p><strong>Methods: </strong>This study, ASSESS-SHOCK 2, is a preplanned sub-study of the observational ASSESS-SHOCK study conducted at Helsinki University Hospital ICU. We included adults with circulatory shock, defined as hypotension requiring vasopressor infusion and concomitant signs of hypoperfusion. We excluded patients with severe neurological or psychiatric diagnoses, impairment of hearing or vision, developmental disability, and language barriers. Cognitive functioning of patients was assessed within 3 days of ICU discharge and 3 months thereafter with the Montreal Cognitive Assessment (MoCA) test. We defined cognitive impairment as MoCA score < 26 points. We also included data of 48 volunteer controls, tested once, to analyses.</p><p><strong>Results: </strong>Fifty-five patients underwent an assessment within 3 days of ICU discharge, and 36 of them completed a follow-up assessment at 3 months. At discharge median MoCA-score was 22 (IQR 17-25). At the 3 months follow-up, the median MoCA-score was 26.5 points (IQR 24.25-28) showing improvement from discharge to follow-up (p < 0.001). The prevalence of cognitive impairment at discharge was 78.2%, and, at the 3-month follow-up 44.4%. In the control group, the median MoCA score was 27 points (IQR 25-28) and the prevalence of cognitive impairment 33%.</p><p><strong>Conclusion: </strong>We found cognitive impairment in more than three out of four ICU survivors immediately after ICU treatment for circulatory shock. We observed an improvement in cognitive functioning between ICU discharge and 3 months follow-up. These results have importance considering the optimal timing of information given to patients and when involving patients in decision-making.</p><p><strong>Editorial comment: </strong>This study used the MoCA score to investigate the change in cognitive impairment in patients who survived circulatory shock, from the time of discharge from intensive care to 3 months after discharge. Scores indicated more severe cognitive dysfunction compared to controls at the time of discharge, but these improved to match control scores 3 months later. The findings have important implications for strategies to inform and support newly discharged ICU survivors who have experienced circulatory shock.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70250"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832185","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":"Remifentanil Versus Rocuronium for Optimising Video Laryngoscopy Assisted Tracheal Intubation-The ROCVIDEO Trial Protocol.","authors":"Emil Ørskov Ipsen, Lars Hyldborg Lundstrøm, Åse Lodenius, Gustav Fisker, Magnus Fuhr Hovind, Christian Lindgren Nielsen, Hrund Oskarsdottir, Camilla Strøm, Charlotte Vallentin Rosenstock, Karl Peter Damgård Madsen, Sine Wichmann, Arash Afshari, Jacob Hessel Andersen, Helene Korvenius Nedergaard, Louise Bill, Maria Cronhjort, Ole Mathiesen, Janus Christian Jakobsen, Matias Vested, Anders Kehlet Nørskov","doi":"10.1111/aas.70277","DOIUrl":"10.1111/aas.70277","url":null,"abstract":"<p><strong>Background: </strong>Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope.</p><p><strong>Methods: </strong>ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6 mg/kg) with remifentanil (4 μg/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120 s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80% and 99%, respectively, using a two-sided α of 0.025.</p><p><strong>Perspectives: </strong>Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice.</p><p><strong>Status: </strong>As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70277"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262772","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":"Swedish Intensive Care Physicians' Attitudes Towards Withholding or Withdrawing Life-Sustaining Treatment in Critically Ill Children.","authors":"Maria Ahlerup, Johan Malmgren, Albert Gyllencreutz Castellheim, Johan Holmén, Ola Ingemansson, Lars Sandman, Helena Odenstedt Hergès, Linda Block","doi":"10.1111/aas.70256","DOIUrl":"10.1111/aas.70256","url":null,"abstract":"<p><strong>Background: </strong>Decisions to withhold or withdraw life-sustaining treatments for critically ill children are challenging. This study aims to identify Swedish intensivists' attitudes, values and experiences towards the decision-making process concerning withholding or withdrawal of life-sustaining treatment in critically ill children.</p><p><strong>Methods: </strong>The nine intensive care units in Sweden that treated more than 10 children for more than 48 h during 2023 were approached. A web-based questionnaire on attitudes and experiences on end-of-life decision-making in critically ill children was distributed to the 360 physicians employed at the above-mentioned intensive care units. The results were analysed descriptively.</p><p><strong>Results: </strong>Fifty-five answers were retrieved. The participating physicians were experienced, 93% having personal experience with end-of-life decision-making in children. The main findings were that the child's wishes were considered important or very important by 93% of respondents. The guardians' wishes were considered important or very important by 82% of respondents. Seventy-three percent of physicians considered it ethically acceptable to withdraw life-sustaining treatment against the patients' and guardians' wishes. To continue life-sustaining treatment without the patient's and guardian's consent was considered ethically acceptable by 26% of participants.</p><p><strong>Conclusions: </strong>This study demonstrated that Swedish intensivists share common attitudes and values regarding most issues related to end-of-life decisions in critically ill children. However, there is variability in attitudes concerning patients' and guardians' wishes. Further studies concerning end-of-life decisions in critically ill children within a Nordic context are warranted.</p><p><strong>Editorial comment: </strong>This survey study presents a sampling of views on pediatric intensive care withholding or withdrawing of treatment and from specialist physicians in one Nordic country.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70256"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947408","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":"ICU Clinicians' View on Platelet Transfusion Thresholds for a Future Trial-Protocol for an International Survey.","authors":"Jehad Ahmad Barakji, Carl Thomas Anthon, Anders Granholm, Morten Hylander Møller, Jakob Stensballe, Anders Perner","doi":"10.1111/aas.70263","DOIUrl":"10.1111/aas.70263","url":null,"abstract":"<p><strong>Background: </strong>Thrombocytopenia is frequent in adult intensive care unit (ICU) patients and may contribute to adverse outcomes, including bleeding, morbidity and mortality. To reduce the risk of bleeding, platelet transfusions are commonly used, yet transfusion thresholds vary, and the evidence base is very limited. Randomised clinical trials investigating platelet transfusion strategies in ICU patients are therefore a high research priority. With this survey, we aim to assess ICU doctors' willingness to randomise adult ICU patients to restrictive versus liberal platelet transfusion thresholds across clinically relevant scenarios in a future randomised trial.</p><p><strong>Methods: </strong>We will conduct an international, web-based survey targeting ICU doctors within an established research network. The survey includes questions on respondent characteristics and willingness to enrol patients with an indication for platelet transfusion across a range of transfusion thresholds in different clinical scenarios, including non-bleeding patients, those undergoing invasive procedures, and those with bleeding. The survey has been pilot-tested and refined twice before distribution. We will summarise results using descriptive statistics and conduct stratified analyses by country and ICU type.</p><p><strong>Conclusions: </strong>This international survey will assess ICU doctors' willingness to randomise adult ICU patients to restrictive versus liberal platelet transfusion strategies across multiple clinical scenarios.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70263"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969551","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":"Ultrasound-Guided Superficial Parasternal Intercostal Plane Block for Early Pain Management in Patients Undergoing Cardiac Surgery-A Randomized Controlled Trial.","authors":"Antti-Johannes Kalli, Pekka Mäkelä, Heini Huhtala, Ari A Mennander, Kati M Järvelä","doi":"10.1111/aas.70253","DOIUrl":"10.1111/aas.70253","url":null,"abstract":"<p><strong>Background: </strong>Sternotomy causes substantial postoperative pain. Recently, several less invasive nerve blocks have been described that are safer to use even on anticoagulated patients. This study aims to evaluate early pain management using ultrasound-guided superficial parasternal intercostal plane block (SPIP) in patients undergoing aortic valve replacement via full sternotomy.</p><p><strong>Methods: </strong>This was a randomized, placebo-controlled trial performed in a tertiary referral hospital. Seventy-four elective patients scheduled for aortic valve replacement via full sternotomy were included. Patients were randomized to receive a preoperative SPIP block using either 40 mL of ropivacaine 7.5 mg/mL or 40 mL of 0.9% saline. Cumulative oxycodone consumption during the first 24 postoperative hours was recorded and analyzed as the primary outcome. Pain at rest was assessed using the numerical rating scale (NRS) scores 48 h postoperatively. Additional secondary outcomes included the need for vasopressors and antiemetics, recovery of bowel function, time spent in the intensive care unit (ICU), and nerve block-related complications.</p><p><strong>Results: </strong>The 24-h cumulative consumption was not significantly different between groups (93.8 mg ± 33.3 vs. 109.4 mg ± 37.9, p = 0.066). NRS pain scores at rest were reduced in the patients with SPIP at 4 (5.0 ± 1.8 vs. 3.3 ± 2.4, p = 0.002). No differences were found in additional secondary outcomes.</p><p><strong>Conclusion: </strong>In this randomized controlled trial a single-shot SPIP block did not reduce the 24-h cumulative opioid consumption after cardiac surgery.</p><p><strong>Editorial comments: </strong>This trial in a cardiac surgical cohort tested for possible benefit of a single injection superficial parasternal intercostal plane block for post-operative analgesia for post-sternotomy pain. The study found no post-op opioid treatment reduction with the treatment, but some analgesia effect cannot be ruled out.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"70 6","pages":"e70253"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925433","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}