Journal of Anesthesia, Analgesia and Critical Care (Online)最新文献

{"title":"Perioperative management in acute and chronic spinal cord injury, narrative review.","authors":"Israel Valdez-Resendiz, Estefany Nohemí Salgado-Camarillo, Fernanda Hernández-Morales, César Alejandro Martínez-de Los Santos, Chiara Robba","doi":"10.1186/s44158-025-00252-z","DOIUrl":"10.1186/s44158-025-00252-z","url":null,"abstract":"<p><p>Spinal cord injury (SCI) causes temporary or permanent changes and alterations in patients' motor, sensory, or autonomic function, significantly impacting their quality of life and requiring clear goals and optimization of anesthesia and perioperative care for acute and chronic spinal cord injuries. SCI results from various etiologies and involving two principal pathophysiological mechanisms: primary and secondary injury. The first is result of the traumatic event, with irreversible neuronal damage, the second is generated as a consequence and in the minutes after the first and can continue for weeks or months causing degenerative damage to the spinal cord. It is in the secondary lesion where the objectives of anesthetic and perioperative management should be focused, especially in acute lesion. A conscientious and detailed preoperative evaluation allows to identify, injury level, evolution time, airway evaluation, cervical stability, hemodynamic status, ventilatory function and associated injuries must be determined. It is important to differentiate potential hemodynamic alterations and types of shock to prevent, especially in injuries greater than T6 and if necessary, provide early management in order to maintain adequate spinal cord perfusion. The objective of this review is to identify the pathophysiological mechanisms of spinal cord injury and the secondary systemic alterations and complications, as well as to establish specific optimization objectives during anesthetic management and perioperative care, which could reduce injury progression, prevent and control potential complications, and improve the quality of life of patients with this condition.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of lung aeration assessed through electrical impedance tomography in paediatric patients undergoing elective surgery: insights from a prospective and observational data-registry.","authors":"Daniela Rosalba, Grazia Meneghetti, Federico Verdina, Chiara Solai, Danila Azzolina, Laura Petronio, Matteo Guaraglia, Raffaella Buscaglia, Giulio Saviolo, Gaia Furlan, Filippo Vietti, Daniele Biasucci, Savino Spadaro, Rachele Simonte, Edoardo De Robertis, Federico Longhini, Serena Penpa, Michele Ubertazzi, Elena Panuccio, Paolo Aluffi, Stefano De Cillà, Matteo Brucoli, Rosanna Vaschetto, Gianmaria Cammarota","doi":"10.1186/s44158-025-00254-x","DOIUrl":"10.1186/s44158-025-00254-x","url":null,"abstract":"<p><strong>Background: </strong>The impact of anaesthesia on lung function during paediatric surgery remains an area of active investigation. Understanding respiratory mechanics under different anaesthetic approaches is crucial for optimising pulmonary management in this vulnerable population.</p><p><strong>Objective: </strong>To assess ventilation distribution changes during different phases of anaesthesia in paediatric patients, using electrical impedance tomography (EIT).</p><p><strong>Methods: </strong>This observational study included 76 paediatric surgical patients-57 under controlled mechanical ventilation (CMV) and 19 breathing spontaneously. EIT assessed lung ventilation at multiple timepoints (T1-T6), analyzing regional distribution (ROIs) and center of ventilation (CoV).</p><p><strong>Results: </strong>In the CMV group, ventilation progressively shifted toward ventral lung regions (p < 0.0001 from T1 to T2, T3, T4, T5) with a contemporaneously reduced ventilation switching from T1 to T2 (p = 0.005), T3 (p < 0.0001), T4 (p = 0.001), and T5 (p < 0.0001). Ventilation normalised upon restoration of spontaneous breathing at the end of surgery. In the same group, CoV shifted toward non-dependent lung regions from T1 to T2, T3, T4, and T5 (p < 0.0001) and returned to baseline at T6. Overall, no modifications were observed in the spontaneous breathing group.</p><p><strong>Conclusions: </strong>In paediatric surgical patients, contrariwise to spontaneous breath where no modifications occurred, CMV induced a progressive redistribution of ventilation towards the ventral lung regions, at the expense of the dorsal zones. These changes were reversible with the recovery of spontaneous breathing.</p><p><strong>Trial registration: </strong>NCT06370507.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of remifentanil and fentanyl in mechanically ventilated ICU patients: a systematic review and meta-analysis on ventilation duration and delirium incidence.","authors":"Hiromu Okano, Eriya Imai, Hiroshi Okamoto, Masaaki Sakuraya, Yoshitaka Aoki, Shun Muramatsu, Misa Kitamura, Tsutomu Yamazaki, Yuki Kataoka","doi":"10.1186/s44158-025-00258-7","DOIUrl":"10.1186/s44158-025-00258-7","url":null,"abstract":"<p><strong>Background: </strong>The ultrashort-acting properties and organ-independent metabolism of remifentanil may be advantageous in mechanical ventilation management. Unlike fentanyl, which accumulates over time and may prolong sedation, remifentanil enables more predictable titration and rapid weaning. This study aimed to determine the effect of remifentanil on shortening the duration of mechanical ventilation in comparison with fentanyl in adult intensive care unit (ICU) patients.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted, including randomised controlled trials (RCTs) and observational studies from MEDLINE, Cochrane, EMBASE, ICTRP, and ClinicalTrials.gov, from inception to July 2024. Studies comparing remifentanil with fentanyl in mechanically ventilated ICU patients were included, whereas those that used only remifentanil or fentanyl intraoperatively were excluded. The primary outcome was ventilation duration, with a minimal important difference (MID) of 90 min. A random-effects meta-analysis was performed and the certainty of evidence was assessed using the GRADE approach. The risk of bias was evaluated using RoB 2.0 and ROBINS-I tools.</p><p><strong>Results: </strong>We included 18 studies (14 RCTs and 4 observational studies). Ten studies (8 RCTs and 2 observational studies; 901 patients) were analysed. Remifentanil may reduce ventilation duration compared to fentanyl (8 RCTs: MD -6.70 h, 95% CI -14.36 to 0.97; low certainty; 2 observational studies: MD -21.26 h, 95% CI -37.29 to -5.24; low certainty).</p><p><strong>Conclusions: </strong>Remifentanil may reduce the duration of mechanical ventilation, potentially improving patient outcomes. However, owing to the low certainty of the evidence and study heterogeneity, further high-quality RCTs are required to validate these findings.</p><p><strong>Trial registration: </strong>PROSPERO 2024 and CRD42024557414.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal fluid analysis and changes over time in patients with subarachnoid hemorrhage: a prospective observational study.","authors":"Alessandro Pesaresi, Denise Battaglini, Pasquale Anania, Silvia Sgambetterra, Camilla Origlia, Gianluigi Zona, Thomas Langer, Nicolò Antonino Patroniti, Pietro Fiaschi, Chiara Robba","doi":"10.1186/s44158-025-00250-1","DOIUrl":"10.1186/s44158-025-00250-1","url":null,"abstract":"<p><strong>Background: </strong>Changes in cerebrospinal fluid (CSF) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have not been fully elucidated, yet they are critical and may potentially be associated with the risk of complications. The aim of this study is to characterize the biochemical properties of CSF and examine the temporal changes in aSAH patients with and without post-aSAH complications such as vasospasm and shunt-dependent hydrocephalus.</p><p><strong>Methods: </strong>This prospective observational longitudinal cohort study involved collecting CSF and arterial blood samples from SAH patients requiring an external ventricular drain at four different timepoints following the initial event (1-3, 4-7, 8-13, and 14-20 days after aSAH). A control group that comprised patients with idiopathic normal pressure hydrocephalus undergoing CSF sampling was included.</p><p><strong>Results: </strong>A total of 20 SAH patients and 20 controls were enrolled. We observed significantly higher levels of hemoglobin (Hb), proteins, lactate, and cell concentrations in the CSF of aSAH patients compared to the control group (p < 0.001), with no corresponding differences in serum levels. Furthermore, a progressive decline in CSF Hb, proteins, and cells levels was noted over the days following the hemorrhage (p = 0.029, p = 0.005, and p = 0.010, respectively). Patients that developed vasospasm exhibited a lower CSF glucose/lactate ratio (p < 0.001) and reduced CSF sodium levels (p = 0.045), while patients that developed shunt-dependent hydrocephalus exhibited higher plasmatic and CSF glucose levels (p = 0.013 and p = 0.003, respectively) and lower CSF Hb/proteins ratio (p < 0.001).</p><p><strong>Conclusions: </strong>Patients with aSAH exhibit changes in the biochemical profile of the CSF, which evolve over time following the acute event. Parameters such as CSF glucose/lactate ratio and CSF Hb/proteins ratio could potentially provide valuable insights not only into the pathophysiology of aSAH but also into patient risks of post-hemorrhagic complications, such as vasospasm and hydrocephalus.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of cannabis on postoperative pain, length of stay and costs following mitral valve surgery.","authors":"Sareena Shah, Angie Jang, Shrey Patel, Brigid Flynn","doi":"10.1186/s44158-025-00251-0","DOIUrl":"10.1186/s44158-025-00251-0","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert consensus on feasibility and application of automatic pain assessment in routine clinical use.","authors":"Marco Cascella, Alfonso Maria Ponsiglione, Vittorio Santoriello, Maria Romano, Valentina Cerrone, Dalila Esposito, Mario Montedoro, Roberta Pellecchia, Gennaro Savoia, Giuliano Lo Bianco, Massimo Innamorato, Silvia Natoli, Jonathan Montomoli, Federico Semeraro, Elena Giovanna Bignami, Valentina Bellini, Matteo Luigi Giuseppe Leoni, Felice Occhigrossi, Alessandro Vittori, Maria Caterina Pace, Pasquale Buonanno, Mauro Forte, Elisabetta Chinè, Roberta Carpenedo, Alessandro De Cassai, Alfonso Papa, Maurizio Marchesini, Gaetano Terranova, Fabrizio Micheli, Laura Demartini, Franco Marinangeli, William Raffaeli, Flaminia Coluzzi, Andrea Tinnirello, Roberto Arcioni, Angelo Marra, Mohammed Naveed Shariff, Federica Monaco, Gabriele Finco, Alessia Bramanti, Ornella Piazza","doi":"10.1186/s44158-025-00249-8","DOIUrl":"10.1186/s44158-025-00249-8","url":null,"abstract":"<p><strong>Background: </strong>Pain is often difficult to assess, particularly in non-communicative patients. While artificial intelligence (AI)-based objective Automatic Pain Assessment (APA) systems are a promising solution, their clinical implementation raises essential questions, primarily regarding clinician acceptance.</p><p><strong>Methods: </strong>We conducted a survey-to-consensus investigation on the feasibility and application of APA for clinical use. Firstly, the steering committee implemented the CHERRIES guidelines and designed a questionnaire for healthcare professionals. Given the survey results, 26 experts in pain medicine were asked to participate in a two-round consensus by rating 10 statements through a 7-point Likert scale. Consensus was defined as ≥ 75% agreement (\"agree\" or \"completely agree\"). For both phases, data was collected through online questionnaires and analyzed quantitatively.</p><p><strong>Results: </strong>For the survey, we collected responses from 628 healthcare professionals. The output highlighted excellent acceptance of the technology and a preference for multidimensional techniques. After two rounds, consensus was achieved on 8 out of 10 statements. Experts agreed on APA utility in supporting healthcare professionals and real-time pain monitoring. A strong consensus (96.2%) supported the need to inform patients about the use and limitations of AI systems. Adequate staff training is mandatory. Moreover, 92.3% agreed on the importance of implementing risk management, data quality control, and AI governance throughout the APA lifecycle. The experts stressed the need for internal and external validation processes and periodic updates, even for research purposes. Consensus was also reached about the importance of involving interdisciplinary stakeholders and addressing regulatory, ethical, and social implications. Multimodal inputs (e.g., physiological signals, facial expressions, speech, and clinical data) in APA systems are recommended. Additionally, APA systems should be capable of grading pain levels (e.g., via NRS), not just detecting the presence of pain. On the other hand, two statements did not reach consensus: the applicability of APA systems for acute and chronic pain conditions and their potential to improve therapeutic strategies.</p><p><strong>Conclusion: </strong>APA is viewed as a promising and potentially feasible technology for clinical pain assessment, particularly in vulnerable populations. Further research is needed to validate the dedicated tools, define applications in different clinical conditions (e.g., acute and chronic pain), and demonstrate their impact on routine clinical practice for pain management.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood product administration in the prehospital setting: a multisociety consensus statement.","authors":"Luca Carenzo, Etrusca Brogi, Vanessa Agostini, Stefania Armani, Roberto Balagna, Maria Grazia Bocci, Antonio Cascio, Michela Ciminello, Andrea Cortegiani, Massimiliano Di Biagio, Patrizia Di Gregorio, Andrea Fabbri, Lara Gianesello, Guglielmo Imbriaco, Cristian Lupi, Lucia Mirabella, Stefano Paglia, Andrea Paoli, Silvia Pini, Silvano Rossini, Giovanni Sbrana","doi":"10.1186/s44158-025-00248-9","DOIUrl":"10.1186/s44158-025-00248-9","url":null,"abstract":"<p><p>The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has led the development of a Good Clinical Practice (GCP) document, engaging multiple scientific societies-including the Italian Society of Transfusion Medicine and Immunohematology (SIMTI), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Emergency Medicine (SIMEU), the National Association of Critical Care Nurses (ANIARTI), and the Italian National Blood Centre (Centro Nazionale Sangue-CNS). This collaborative effort aims to establish a multidisciplinary consensus on the administration of blood products in the prehospital management of patients with life-threatening hemorrhage. The increasing adoption of prehospital transfusion programs worldwide, particularly in trauma care, highlighted the need for structured recommendations that ensure safety, effectiveness, and compliance with current regulations. In prehospital settings, the early administration of packed red blood cells, fibrinogen concentrate, and fresh frozen plasma is not only considered feasible but has also shown to be potentially effective in improving hemodynamic stability and reducing mortality in patients with hemorrhagic shock. However, these benefits are strongly influenced by factors such as patient selection, timing of intervention, and the integration of transfusion protocols into advanced prehospital care systems. Implementing strict clinical governance, ensuring appropriate storage conditions, and developing standardized documentation processes are key to the success of these programs. Furthermore, close collaboration between emergency medical services and blood banks is essential to ensure compliance with national guidelines and to optimize patient outcomes. This consensus document was developed through a systematic literature review and a modified Delphi method, involving blind voting and consensus evaluation using a Likert scale. The process was conducted over two rounds of online voting. The document addresses four critical topics: the selection of blood product derivatives for prehospital use, safety requirements for their transport, documentation and traceability standards, and procedures for the return of unused components.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative fasting in noncardiac surgery in a tertiary pediatric center applying European guidelines: the difficulty of giving drink to the thirsty.","authors":"Zaccaria Ricci, Denise Colosimo, Francesca Donati, Luca Saccarelli, Mariateresa Pizzo, Elena Schirru, Salvatore Giacalone, Paola Serio","doi":"10.1186/s44158-025-00247-w","DOIUrl":"10.1186/s44158-025-00247-w","url":null,"abstract":"<p><strong>Background: </strong>We conducted a secondary analysis of a previously published dataset that addressed clear fluid fasting in children. The aim of this single-center, retrospective observational study conducted in a tertiary level pediatric hospital (Meyer Children's Hospital, Florence, Italy) was to report updated results after enrollment of new patients, including clear and non-clear fluids and meals.</p><p><strong>Methods: </strong>Retrospective single-center study in a tertiary pediatric hospital after the implementation of an improvement bundle.</p><p><strong>Results: </strong>Overall, we enrolled 2715 patients, and after exclusion of 199 children due to incomplete data retrieval, a final cohort of 2516 subjects (1074 surgical outpatients, 981 surgical inpatients, 314 neurosurgical procedures, 147 procedures from pediatrics/oncology) was analyzed. Median age was 7.5 (3.7-12.2) years. Median (interquartile range) preoperative fasting time was 187 (119-351) min for clear fluids, 286 (218-396) min for maternal milk, 360 (285-530) min for artificial milk, 435 (350-540) min for light breakfast, and 765 (640-910) min for meal. We did not find significant differences between the clear fluid times of the previous study (1820 patients, 185 (115-340) min) and the one analyzed in the present dataset (696 patients, 192 (120-363) min) (p = 0.12).</p><p><strong>Conclusion: </strong>In a pediatric hospital implementing European Society of Anesthesia recommendations for preoperative fasting, all fluids and meals are stopped very far from the scheduled times, and this notion should provide ignition for further improvement actions.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Safety in Regional Anesthesia: Guidelines from the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).","authors":"Vito Torrano, Salvatore Anastasi, Eleonora Balzani, Enrico Barbara, Astrid Ursula Behr, Mario Bosco, Claudio Buttarelli, Silvia Bruletti, Dario Bugada, Chiara Cadeddu, Gianluca Cappelleri, Luigi Cardia, Salvatore Casarano, Andrea Cortegiani, Floriana D'Ambrosio, Miryam Del Vicario, Andrea Fanelli, Pierfrancesco Fusco, Giuseppe Gazzerro, Daniela Ghisi, Antonino Giarratano, Fabio Gori, Massimiliano Greco, Paolo Angelo Grossi, Alberto Manassero, Gianluca Russo, Salvatore Sardo, Cosimo Savoia, Marco Tescione, Giulia Tinti, Alessandro De Cassai","doi":"10.1186/s44158-025-00245-y","DOIUrl":"10.1186/s44158-025-00245-y","url":null,"abstract":"<p><strong>Background: </strong>Regional anesthesia techniques have become integral to modern perioperative care, offering enhanced pain management and recovery outcomes. However, their application in patients with specific conditions, such as anticoagulation therapy or preexisting comorbidities, raises concerns regarding safety and efficacy. Current guidelines addressing these issues are fragmented, necessitating comprehensive, evidence-based recommendations.</p><p><strong>Methods: </strong>A multidisciplinary panel of experts in anesthesiology and pain management was convened under the auspices of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI). The guidelines presented herein were developed according to the GRADE system (Grading of Recommendations of Assessment Development and Evaluations), in compliance with the methodological manual for the production of clinical practice guidelines published by the National Center for Clinical Excellence, Quality, and Safety of Care, Italian National Institute of Health.</p><p><strong>Results: </strong>The guidelines encompass recommendations on neuraxial blocks in anticoagulated patients, the dual guidance use in peripheral nerve blocks, the role of sterile field preparation, and post-procedural monitoring. Evidence from meta-analyses and large-scale observational studies supported most recommendations, though limitations in study heterogeneity were noted.</p><p><strong>Conclusions: </strong>These guidelines provide a structured framework for clinicians to enhance patient safety and procedural efficacy in regional anesthesia. Further research is encouraged to address identified gaps, particularly regarding specific patient subgroups and novel regional anesthesia techniques.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Golden hour management in the patient with intraparenchymal cerebral hemorrhage: an Italian intersociety document.","authors":"Gianluigi Morello, Daniela Alampi, Raffaele Aspide, Alessandra Beretta, Rita Bertuetti, Federico Bilotta, Etrusca Brogi, Giovanni Buscema, Anselmo Caricato, Davide Caruzzo, Carlo Alberto Castioni, Arturo Chieregato, Andrea Cortegiani, Alessandro De Cassai, Andrea Fabbri, Domenico Gelormini, Paolo Gritti, Lucrezia Guadrini, Alberto Librizzi, Nicola Latronico, Nicola Limbucci, Marina Munari, Edoardo Picetti, Giuseppina Pipitone, Gianluca Pucciarelli, Chiara Robba, Danilo Toni, Salvatore Sardo, Simone Maria Zerbi, Nicola Zugni, Frank Rasulo","doi":"10.1186/s44158-025-00244-z","DOIUrl":"https://doi.org/10.1186/s44158-025-00244-z","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracerebral hemorrhage (ICH) accounts for 9-27% of all strokes worldwide and is associated with high mortality and disability. The main causes include vascular malformations, small- and large-vessel angiopathies, and coagulation disorders. Mortality rates reach approximately 40% at 1 month and 54% at 1 year, largely influenced by early management decisions. Rapid intervention, particularly within the first hour, is crucial, especially for patients initially treated in peripheral hospitals. This consensus document, developed by SIAARTI with the endorsement of multiple medical societies, aims to standardize ICH management based on hospital capabilities, aligning with the \"time is brain\" principle and the 2022 AHA guidelines.</p><p><strong>Methods: </strong>A multidisciplinary panel of experts-including neurointensivists, neuroanesthesiologists, neurologists, neuroradiologists, emergency physicians, and neuroscience nurses-developed this consensus document. The process combined a systematic literature review with a modified Delphi method, prioritizing clinical questions using the UCLA-RAND appropriateness methodology. Literature searches were conducted on PubMed following PRISMA 2020 guidelines. Statements were formulated based on both evidence and expert consensus, and the final document underwent external peer review.</p><p><strong>Results: </strong>Computer tomography (CT) angiography, with over 90% sensitivity and specificity, is a key tool for identifying macrovascular abnormalities and detecting active bleeding, a critical factor in poor outcomes. Prognostic models, such as the ICH score, assist in clinical decision-making. Strict blood pressure control (target 130-140 mmHg) and early intubation in appropriate cases help mitigate hematoma expansion. Anticonvulsants are recommended only for patients with documented seizures. In cases of anticoagulant-related hemorrhage, prothrombin complex concentrates are effective for rapid reversal, though their long-term impact remains uncertain. Intensive care unit (ICU) admission is determined by ICH severity, with severe cases benefiting from specialized neurocritical care.</p><p><strong>Conclusion: </strong>A multidisciplinary and inter-societal discussion provided key recommendations for the immediate management of ICH, based on the available literature. While only a few topics are supported by robust evidence, experts strongly recommend early brain angio CT, risk stratification using scoring systems, clear communication of patient data, and intubation for impaired consciousness. Blood pressure should be controlled with alpha- and beta-blockers, avoiding hypotension. Anticoagulant reversal should be appropriately managed, and eligible patients should be centralized in ICU and neurosurgical centers using dedicated scoring systems.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"5 1","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}