Acta Anaesthesiologica Scandinavica最新文献

{"title":"Spread of Injectate After Combined Deep Serratus Anterior and Superficial Parasternal Intercostal Plane Injections: A Cadaver Study to Evaluate Their Utility in Breast Surgery.","authors":"Abhijit Biswas, Vivienne P Hang, William Newmarch, Kody M Wolfstadt, Christopher Hansebout, Anne Agur, Timothy D Wilson, Vishal Uppal","doi":"10.1111/aas.70134","DOIUrl":"10.1111/aas.70134","url":null,"abstract":"<p><strong>Background: </strong>Analgesia for breast surgery by a single peripheral nerve block is challenging as breast tissue receives innervation from multiple sources. In this cadaveric study, we evaluated the injectate spread of combined superficial parasternal intercostal plane (PIP) and deep serratus anterior plane (SAP) injections in the tissues relevant for breast surgery analgesia.</p><p><strong>Methods: </strong>We performed ultrasound-guided dye injections in 18 hemithoraces. 20 mL of methylene blue solution was injected into the superficial PIP at the fourth rib. Following that, 20 mL of black India Ink solution was injected in the SAP at the fourth rib at the midaxillary line. We dissected the specimens, 15 min post-injection to visualize dye dispersion. Staining of the intercostal nerves from each injection was measured by counting the number of intercostal spaces and nerves stained.</p><p><strong>Results: </strong>For PIP injections, the cranial spread of injectate was observed up to the second intercostal nerve involving the anterior cutaneous branch in 14/16 (87.5%) with caudal spread to the fifth intercostal nerve in 15/16 (94%). In addition, the staining of the medial and lateral pectoral nerves was noted in 14/16 (88%) of the specimens. For the SAP dye injections, the cranial spread of injectate was observed up to the lateral cutaneous branch of the third intercostal nerve level in 9/16 (56%) of specimens and caudal spread up to the lateral cutaneous branch of the sixth intercostal nerve in 14/16 (88%) specimens.</p><p><strong>Conclusions: </strong>This study demonstrated extensive spread of dye injectate with combined PIP and SAP injections involving anterior and lateral cutaneous branches of intercostal nerves and lateral and medial pectoral nerves. This study demonstrates an alternative analgesic approach to provide perioperative analgesia for breast surgery.</p><p><strong>Editorial comment: </strong>This cadaver study demonstrates that combining deep serratus anterior block with parasternal intercostal plane block provides reliable injectate spread to the cutaneous branches of intercostal nerves. In a clinical setting, this could provide comprehensive analgesia for the breast. Compared with paravertebral blocks, the combination of two fascial plane blocks may offer a technically less challenging alternative with a lower risk of complications.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70134"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290673","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":"Children's Anxiety in the Perioperative Environment: A Qualitative Exploration With Children, Parents and Staff at a Tertiary Paediatric Hospital.","authors":"Thomas F E Drake-Brockman, Megan Dodd, Sarah Cooney, Bojana Stepanovic, David Sommerfield, Vance Locke, Aine Sommerfield, Britta S von Ungern-Sternberg","doi":"10.1111/aas.70135","DOIUrl":"10.1111/aas.70135","url":null,"abstract":"<p><p>Perioperative anxiety is a common and distressing aspect of anaesthesia for many children, resulting in management challenges at the time of anaesthesia and potential physical and psychological adverse outcomes. We conducted this qualitative phenomenological study to explore the perspectives of children, parents and staff on perioperative anxiety in our institution. Planned recruitment was 20 each of children who had undergone elective anaesthesia, their parents and staff. We conducted semi-structured interviews, recorded and transcribed verbatim and subjected to qualitative analysis using the Framework Method. Inductive coding was performed, codes were charted onto the Framework Matrix, and themes were derived. The planned recruitment was completed, and data saturation was reached. Children, parents and staff were all aware of anxiety as an issue in the perioperative environment. The key themes that emerged were: Anxiety due to loss of certainty; responding with comfort, distraction and engagement; the role of parents in managing anxiety; and a changing anxiety environment. The loss of certainty was key a driver of anxiety in the perioperative environment. The use of comfort, distraction and engagement by children, parents and staff in order to alleviate anxiety, should be key targets for the development of interventions that seek to address children's perioperative anxiety. Parental presence and the role of parents in preparing children for their perioperative experience were also emphasised. This occurs within a changing social and mental health environment, which clinicians must be responsive to. EDITORIAL COMMENT: This explorative qualitative assessment presents reported experience from anesthesia contact focused on children as patients and anxiety, also including reporting from parents and staff. Factors which appear to contribute to anxiety, as well some that may reduce anxiety, were explored.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70135"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342520","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":"Comparison of Esketamine and Propofol for Prehospital Emergency Anaesthesia in Patients With Traumatic Brain Injury-A Retrospective Observational Study.","authors":"Juri Laamanen, Harry Ljungqvist, Jouni Nurmi","doi":"10.1111/aas.70131","DOIUrl":"10.1111/aas.70131","url":null,"abstract":"<p><strong>Background: </strong>Prehospital emergency anaesthesia and controlled ventilation are cornerstones in the treatment of traumatic brain injury patients. Currently, there is a lack of consensus regarding the choice of anaesthetic used during the induction of anaesthesia. Esketamine has gained significant popularity, but its use has been limited in patients with traumatic brain injury due to fears of increased intracranial pressure. A protocol for anaesthesia was implemented at a Finnish helicopter emergency medical services (HEMS) unit during 2015 that mandated the use of esketamine over propofol for most patients.</p><p><strong>Methods: </strong>We performed a retrospective cohort study to evaluate the differences in mortality and physiology in patients with traumatic brain injury, intubated using either propofol or esketamine. We collected data on patients treated by a single HEMS unit in Finland between January 2014 and December 2021. Our primary outcome was mortality before hospital discharge, and our secondary outcome was physiological stability, defined as the frequency of hypotension (systolic blood pressure ≤ 90 mmHg or a decrease of ≥ 10%) after intubation. Controlling for confounders was done through a logistical regression analysis.</p><p><strong>Results: </strong>We identified a total of 366 patients, 301 of whom were treated with esketamine and 65 with propofol. There was no significant difference in mortality between the esketamine and propofol groups (odds ratio 0.598, 95% confidence interval 0.281-1.272). The decrease in blood pressure after intubation was greater in the propofol group (absolute change -37.3 vs. -12.4 mmHg, 95% confidence interval -38 to -15 mmHg), but because the initial blood pressure was also higher, both groups had similar postintubation physiology.</p><p><strong>Conclusion: </strong>In this study, we found no significant difference in mortality, but we found significant differences in the haemodynamic responses between esketamine and propofol, with a slightly favourable haemodynamic profile in patients treated with esketamine. The protocol implemented in 2015 heavily shifted the choice of anaesthetics from propofol to esketamine, but there was a distinct resurgence in propofol use during the study period.</p><p><strong>Editorial comment: </strong>Patients with severe head injuries can receive advance intensive care including anaesthetic drugs in the field for intubation, when prehospital teams have this competence. This retrospective analysis presents a comparison of outcomes for traumatic brain injury cases who received either propofol or esketamine in the prehospital setting, as part of a time-interrupted series where drug choice was changed. While possibly differing in circulatory effects, the two drugs were not associated with a difference in mortality before hospital discharge.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70131"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342486","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":"Norwegian Anaesthesiologist's Perspectives on Perioperative Allergies and Penicillin Allergy Evaluations: A National Survey.","authors":"Marie Bjørbak Alnæs, Anne Berit Guttormsen, Ingrid Terreehorst, Oddvar Oppegaard, Bård Reiakvam Kittang, Margrethe Aase Schaufel, Louise Savic, Torgeir Storaas","doi":"10.1111/aas.70129","DOIUrl":"10.1111/aas.70129","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Penicillin allergy is a frequent challenge in perioperative antibiotic stewardship. Although 3%-10% of hospitalised patients declare a penicillin allergy, up to 95% of penicillin allergy labels are refuted through allergologic testing. Identifying incorrect penicillin allergy labels reduces the consumption of broad-spectrum second-line antibiotics, benefiting patients and society. Penicillin allergy evaluation is a recommended action for fighting antimicrobial resistance, and the procedure is under-facilitated perioperatively. Anaesthesiologists are important stakeholders in perioperative antibiotic stewardship, but knowledge about their attitudes and potential barriers to adopting penicillin allergy evaluation is scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a national, cross-sectional online survey among 1667 members of the Norwegian Anaesthesiology Association. The study was informed by the British Drug Allergy Labels in Elective Surgical Patients anaesthesiologist survey. The survey examined knowledge about perioperative allergies and penicillin allergy evaluations. Quantitative data were analysed descriptively, and qualitative data were analysed using systematic text condensation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We received 405 responses (24% response rate). Barriers to penicillin allergy evaluation included: (1) a perceived lack of knowledge, (2) time constraints and the absence of structured workflows, and (3) not feeling responsible for evaluating penicillin allergies. If respondents believed that the declared penicillin allergy was highly unlikely to represent a true allergy, 65% would administer penicillin. However, in patients de-labelled by oral provocation testing with penicillin, 34% of the respondents would still not re-expose the patient to penicillins. Senior clinicians expressed the lowest confidence in evaluating penicillin allergies, and respondents were mostly unaware of national penicillin allergy evaluation guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Distrust in penicillin allergy evaluation procedures is prevalent among Norwegian anaesthesiologists. Key barriers to the implementation of perioperative penicillin allergy evaluation include time constraints, insufficient knowledge and unclear clinical responsibilities. To improve commitment, targeted education, specialty-specific guidelines, a simplified drug allergy warning system, and clearly defined roles are essential. We compared our results with results from the UK and found similar challenges. As our findings reflect challenges reported in other European countries, we call for a coordinated European initiative to enhance the implementation of perioperative penicillin allergy evaluations. Increasing anaesthesiologists' engagement in penicillin allergy evaluation can potentially improve perioperative outcomes and reduce antimicrobial resistance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Editorial comment: &lt;/strong&gt;This survey study assessed clinician opinio","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70129"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190599","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":"Hypernatremia in Hospitalised Adult Patients-A Scoping Review.","authors":"Sine Wichmann, Rasmus Rønhøj, Karen L Ellekjær, Morten H Møller, Morten H Bestle","doi":"10.1111/aas.70132","DOIUrl":"10.1111/aas.70132","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70132"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285489","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":"A Prospective Observational Study of Intraoperative Regional Cerebral Desaturation and Negative Postoperative Behavioural Changes After Non-Cardiac Paediatric Surgery.","authors":"Martin Kälvesten, Ali-Reza Modiri, Rececka Jonshult, Robert Frithiof, Peter Frykholm","doi":"10.1111/aas.70133","DOIUrl":"10.1111/aas.70133","url":null,"abstract":"<p><strong>Background: </strong>Negative postoperative behaviour changes (NPOBC) are known to occur after general anaesthesia in children. A significantly increased risk of NPOBC has been reported in children who exhibited a reduction in cerebral regional oxygen saturation (crSO₂) of as little as 5% below baseline levels. These results were unexpected, and we therefore aimed to investigate the association between degrees of regional cerebral desaturation and NPOBC after routine surgery in young children.</p><p><strong>Methods: </strong>In this prospective cohort study, 180 healthy children between 2 and 6 years old undergoing routine surgery were enrolled. The primary outcome was NPOBC, assessed using the Post Hospitalization Behavior Questionnaire (PHBQ), reported by parents and evaluated on Postoperative Day 7. The results were stratified according to decreases in crSO₂ from baseline of at least 5, 10, 15 or 20 percentage points sustained for a minimum duration of 2 min. The χ² or Fisher's exact test was used to analyse differences in categorical variables. Using logistic regression, outcome data were expressed as odds ratios with 95% confidence intervals.</p><p><strong>Results: </strong>The incidence of NPOBC was 13% on Day 7, and 15% on Day 30, respectively. No significant differences were found between children with or without NPOBC for any of the thresholds of crSO₂ reduction (≥ 5%: 2 [11%] vs. 2 [1.8%] cases, p = 0.09; ≥ 10%: 1 [5.6%] vs. 2 [1.8%] cases, p = 0.36; ≥ 15% and ≥ 20%: 0 vs. 0 cases). The rate of NPOBC was not associated with intraoperative reduction in crSO₂ (OR 1.25, CI 0.71-2.20, p = 0.46). Older age was associated with lower odds of NPOBCs (OR 0.39, CI 0.15-0.99, p = 0.048). Using the area under the curve for quantifying crSO₂ changes did not result in a statistically significant correlation between crSO₂ and NPBOCs (r = 0.11).</p><p><strong>Conclusion: </strong>Regional cerebral desaturation and negative postoperative behaviour may be less common than previously reported in young children undergoing uneventful general anaesthesia. We could not corroborate the strong association between these entities reported previously. Studies investigating the effects of cerebral desaturation on patient-centred outcomes will need large sample sizes.</p><p><strong>Editorial comment: </strong>This prospective observational study describes a low incidence and magnitude of NIRS desaturation in healthy children. In contrast to previous reporting, there was no association with new negative postoperative behaviours in children in this cohort.</p><p><strong>Trial registration: </strong>ISCRTN11799594.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70133"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145297795","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 Hyperoxia and Antioxidants on Mortality, Hospital Admissions, and Myocardial Infarction After Noncardiac Surgery: 1-Year Follow-Up of a Randomized Controlled Trial.","authors":"Frederik C Loft, Cecilie Holse, Eske K Aasvang, Morten Vester-Andersen, Lars S Rasmussen, Lars N Jørgensen, Christian S Meyhoff","doi":"10.1111/aas.70118","DOIUrl":"10.1111/aas.70118","url":null,"abstract":"<p><strong>Background: </strong>Perioperative hyperoxia may be associated with increased long-term mortality, whereas perioperative antioxidants may be associated with reduced long-term mortality. This study aimed to determine if high perioperative inspiratory oxygen fraction (FiO₂) (0.80) compared with normal FiO₂ (0.30) would increase mortality, hospital admissions, and myocardial infarction (MI) within 1 year after surgery, and whether antioxidants compared with placebo would reduce this.</p><p><strong>Methods: </strong>This was the preplanned 1-year follow-up of 600 patients with cardiovascular risk factors, scheduled for noncardiac surgery. They were randomized in a 2 × 2 factorial design to perioperative FiO₂ of 0.80 or 0.30 and to receive antioxidants (vitamin C and N-acetylcysteine) or matching placebo. The primary 1-year outcome was all-cause mortality, and secondary 1-year outcomes were one or more hospital admissions and MIs, respectively. All outcomes were assessed using medical records and analyzed with the Cox proportional hazards model.</p><p><strong>Results: </strong>Follow-up was completed for 594 patients (99%). Twenty-five of 298 patients (8.4%) allocated to FiO₂ of 0.80 died within 1 year as compared with 17 out of 296 (5.7%) allocated to FiO₂ of 0.30, HR 1.46 (95% CI, 0.79-2.70), p = 0.23. A total of 260 patients had one or more hospital admissions (44%), and seven patients had MI (1.2%) with no significant difference when comparing FiO₂ of 0.80 with 0.30. Antioxidants had a HR of 0.98 (95% CI, 0.54-1.80), p = 0.96 for all-cause mortality vs. placebo. The interaction between the FiO₂ and antioxidant administration was statistically significant (p = 0.04) with fatalities overrepresented in patients given 80% oxygen and placebo.</p><p><strong>Conclusions: </strong>Differences in all-cause mortality, hospital admission, or MI were not statistically significant at 1-year follow-up for either oxygen fractions or antioxidant administration in patients undergoing major noncardiac surgery.</p><p><strong>Editorial comment: </strong>In this preplanned long-term study of the VIXIE trial, no differences in total mortality, hospitalization, or myocardial infarction were found for oxygen fractions of 0.80 compared to 0.30 or antioxidant administration compared to placebo. Interestingly, the study showed a higher rate of fatalities with 80% oxygen which appeared only to be present in patients not given the antioxidant intervention, but this is hypothesis-generating and needs to be further investigated in new clinical trials.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov identifier: NCT03494387.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70118"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237667","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":"Patient Characteristics Associated With Outcomes After General Anaesthesia in Denmark: A Nationwide Observational Study.","authors":"Benjamin H Risager, Signe Ø Mortensen, Maria B Pælestik, Peter C Lind, Nikola Stankovic, Lars W Andersen","doi":"10.1111/aas.70130","DOIUrl":"10.1111/aas.70130","url":null,"abstract":"<p><strong>Background: </strong>Surgery under general anaesthesia is generally safe, although some patients are vulnerable to postoperative complications. Identifying predictors of poor outcomes after general anaesthesia in all settings is relevant for preoperative risk assessment, postoperative monitoring and patient counselling. The aim of this study was to identify patient groups with poor outcomes after general anaesthesia in Denmark.</p><p><strong>Methods: </strong>This was a nationwide, registry-based, observational cohort study of patients aged 18 years and above undergoing general anaesthesia in Denmark. Associations between patient characteristics (age, sex, body mass index, ASA classification and 23 comorbidities) and outcomes were analysed. The primary outcome was 30-day mortality. Secondary outcomes included acute kidney injury within 7 and 30 days, hospital length of stay, any ICU stay, length of ICU stay, 90-day mortality, in-hospital cardiac arrest within 30 days, and need for mechanical ventilation within 7 days.</p><p><strong>Results: </strong>A total of 328,951 unique patients undergoing 453,133 cases of general anaesthesia in Denmark during 2020 and 2021 were identified. The adjusted odds of 30-day mortality were higher for cases with higher age, male sex and higher ASA classification. Compared with ASA II, the adjusted odds ratio for 30-day mortality was 0.19 (CI: 0.13-0.29) for ASA I, 7.00 (CI: 5.28-9.29) for ASA III, 40.7 (CI: 29.5-56.0) for ASA IV, and 223 (CI: 161-307) for ASA V.</p><p><strong>Conclusion: </strong>In this nationwide observational cohort study, higher ASA classification, higher age and male sex were independently associated with increased odds of 30-day mortality and several secondary outcomes after general anaesthesia. This study helps identify at-risk patient groups suitable for further studies investigating ways to reduce the risk of complications.</p><p><strong>Editorial comment: </strong>From a national cohort, this analysis presents patient factors which have associations with postoperative mortality. This supports a simple classification for patient grouping where focus for complication prevention or mitigation can be applied.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70130"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172123","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":"External Validation of the NELA Prognostic Model in Emergency Abdominal Surgery.","authors":"Anna K Hansted, Sofie S Thorup, Mian Ninh, Morten H Møller, Jakob Burcharth, Ann M Møller, Morten Vester-Andersen","doi":"10.1111/aas.70128","DOIUrl":"10.1111/aas.70128","url":null,"abstract":"<p><strong>Background: </strong>Emergency abdominal surgery is a high-risk procedure, and risk prediction models can aid decision-making and resource allocation. This study aimed to externally validate the National Emergency Laparotomy Audit (NELA) prognostic model. Second, we compared the 2023 NELA prognostic model (P-NELA) with the 2020 NELA risk prediction model.</p><p><strong>Methods: </strong>We included all adult patients undergoing emergency laparotomy or laparoscopy for surgical gastrointestinal conditions such as perforation, obstruction, or ischaemia at Copenhagen University Hospital-Herlev from 1 November 2017 to 31 January 2020. The primary outcome was 30-day mortality, and the secondary outcome was 90-day mortality. We evaluated overall performance, discrimination and calibration with the scaled Brier score, area under the curve (AUC) and Integrated Calibration Index.</p><p><strong>Results: </strong>We included 679 patients, of whom 13.3% (90 patients) died within 30 days. For the P-NELA prognostic model, the scaled Brier score was 18%, AUC (95% confidence interval) was 0.87 (0.83-0.90) and the Integrated Calibration Index was 0.042 for 30-day mortality. Results for the NELA risk prediction model were similar.</p><p><strong>Conclusion: </strong>The P-NELA prognostic model had good discrimination in this external validation. The reduced number of variables in this model compared to the previous NELA risk prediction model did not affect performance.</p><p><strong>Editorial comment: </strong>This analysis presents testing of a simplified version of an emergency laparotomy prediction model for postoperative complications on a new and independent cohort. The new model demonstrated good prognostic performance.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70128"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172155","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":"Rapid Update and Revision of: Thromboelastography or Rotational Thromboelastometry Guided Algorithms in Bleeding Patients-An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis.","authors":"A D Kvisselgaard, S A Wolthers, A Wikkelsø, L B Holst, B Drivenes, A Afshari","doi":"10.1111/aas.70127","DOIUrl":"10.1111/aas.70127","url":null,"abstract":"<p><strong>Background: </strong>Bleeding patients face significant morbidity and mortality due to impaired hemostasis. Hemostatic resuscitation has evolved, yet the optimal approach remains unclear. The primary objective was to assess the benefits and risks of transfusion guided by TEG/ROTEM versus standard of care in bleeding patients in an updated review.</p><p><strong>Methods: </strong>This systematic review of randomized controlled trials with meta-analyses and trial sequential analysis was conducted according to Cochrane Collaboration methodology, PRISMA, and GRADE guidelines. A literature search was conducted in five major databases. Both pediatric and adult patients were included. The primary outcome was mortality, and secondary outcomes were the administration of blood products, blood loss, surgical reintervention, and dialysis-dependent renal injury.</p><p><strong>Results: </strong>This systematic review included 35 randomized trials (n = 3096), primarily elective cardiac surgery. TEG-/ROTEM-guided algorithms led to a statistically significant reduction in mortality (RR = 0.76, 95% CI 0.63-0.92) I²: 0%. Furthermore, a significant reduction in transfused fresh frozen plasma (RR = 0.52, 95% CI 0.35-0.76) I²: 94%, platelets (RR = 0.69, 95% CI 0.55-0.87) I²: 60%, the risk for surgical reintervention (RR = 0.63, 95% CI 0.45-0.88) I²: 0%, and bleeding with a standard mean difference of -0.31 (95% CI, -0.51 to -0.11) I²: 72% was found. According to GRADE methodology, the certainty of the evidence was very low for all outcomes. Trial sequential analysis of mortality analysis indicated that 64% of the optimal information size was reached with a crossed alpha-boundary.</p><p><strong>Conclusions: </strong>TEG-/ROTEM-guided transfusion algorithms may reduce the risk of mortality, bleeding volume, and the need for fresh frozen plasma, platelets, and surgical reintervention, but the evidence is very uncertain. Furthermore, the results were primarily based on the adult population undergoing elective cardiac surgery.</p><p><strong>Editorial comment: </strong>This updated systematic review presents a synthesis of evidence for how thromboelastography or rotational thromboelastometry has been implemented in study conditions to guide tranfusion in bleeding patients. The certainty for the evidence is very limited.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 10","pages":"e70127"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172071","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}