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

{"title":"Dual-opioid spinal anaesthesia in enhanced recovery after caesarean section: effects on postoperative opioid requirement and maternal recovery.","authors":"Giulia Fierro, Luisa Patanè, Giorgio Pagani, Barbara Milan, Elena Buelli, Laura Ongaro, Santa Maria Barresi, Marco Carnelli, Ferdinando Luca Lorini","doi":"10.1186/s44158-026-00414-7","DOIUrl":"10.1186/s44158-026-00414-7","url":null,"abstract":"<p><strong>Background: </strong>Optimisation of post-caesarean delivery and perioperative outcomes have emerged as a pivotal concern in obstetrics. The primary aim of this study was to evaluate the effects of implementing Enhanced Recovery After Caesarean Section (ERAC) combined with a pre-existing dual-opioid subarachnoid anaesthesia technique on the decrease in rescue opioid doses needed for acute pain management after caesarean delivery. The secondary aim was to compare the postoperative outcomes before and after the implementation of the ERAC pathway.</p><p><strong>Methods: </strong>We conducted an observational, retrospective single-centre study involving 322 pregnant women, 156 pre-ERAC, and 166 post-ERAC. The eligible women were > 18 years old, without invasive placental disorders, no prior abdominal surgery with longitudinal laparotomy, and no disease. All women received subarachnoid anaesthesia with sufentanil and morphine, in addition to local anaesthetic and postoperative analgesia with paracetamol and ketorolac. Acute pain assessment was performed with a numeric pain rating scale (NRS); if the NRS was ≥ 4, a rescue dose of tramadol was administered in both groups.</p><p><strong>Results: </strong>Significant reductions in the need for rescue opioid analgesia were observed in the ERAC group, with logistic regression confirming an 84.5% reduction on postoperative day one. Additionally, outcomes, including early mobilisation, spontaneous diuresis, and return of gastrointestinal function, improved. The ERAC group also demonstrated a higher rate of discharge on the second postoperative day.</p><p><strong>Conclusions: </strong>The findings of our study suggest that implementing the ERAC strategy with a pre-existing dual-opioid subarachnoid anaesthesia technique may be associated with reduced opioid requirements following caesarean delivery and to improved maternal outcomes.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166026","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":"Prehabilitation and postoperative outcomes in colorectal surgery: an umbrella review.","authors":"Molla Amsalu Tadesse, Agmuas Asichale Alimawu, Ludwig Matrisch, Melkam Mulugeta Abebe, Kidist Techale, Zenebe Bekele, Eniyew Assimie Alemu","doi":"10.1186/s44158-026-00418-3","DOIUrl":"10.1186/s44158-026-00418-3","url":null,"abstract":"<p><strong>Background: </strong>Colorectal surgery caries a risk of postoperative morbidity and mortality. Prehabilitation may improve recovery and reduce complications in this population. This umbrella review evaluates the effects of prehabilitation on postoperative outcomes.</p><p><strong>Methods: </strong>Google Scholar, PubMed, the Cochrane Library, and HINARI were searched for systematic reviews comparing the effect of prehabilitation with usual care on postoperative complications, length of hospital stays and functional capacity in adults undergoing colorectal surgery. The methodological quality was assessed by using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). Overlap of primary studies was evaluated using the Corrected Covered Area (CCA), while evidence certainty by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Heterogeneity was measured using I-squared statistic, and publication bias was examined using funnel plot, Egger's test and Trim and Fill method.</p><p><strong>Results: </strong>This umbrella review included 19 systematic reviews with 27,065 participants, most of which were high quality (n = 13; 68.4%). Overall overlap was slight; however, moderate overlap was observed for postoperative complications, length of hospital stay (LOS), and functional capacity. Prehabilitation was associated with a 21% reduction in postoperative complications (risk ratio (RR) = 0.79, 95% CI: 0.69 to 0.89, I² = 66.5%) with consistent finding in sensitivity analysis excluding short-duration nutritional interventions. It was also associated with a reduction in LOS of approximately 0.5 days (mean difference (MD) = -0.54 days, 95% CI: -0.87 to -0.20; I² = 80.4%). Both with low certainty of evidence. Similarly, prehabilitation appeared to improve preoperative and postoperative functional capacity by approximately 25 m (MD = 24.78 m, 95% CI: 11.35 to 38.22, I² = 67.84%) and 35 m (MD = 34.52 m, 95% CI: 6.44 to 62.60, I² = 74.63%) respectively with low certainty evidence. Systematic reviews that did not present pooled results suggested that prehabilitation reduced postoperative complications (OR), had no significant effect on length of stay (SMD), and generally improved functional capacity (SMD or narrative synthesis).</p><p><strong>Conclusion: </strong>Prehabilitation in colorectal surgery may reduce postoperative complications, may shorten hospital stay, may improve preoperative and postoperative functional capacity, highlighting faster recovery and improve postoperative quality of life. Findings should be interpreted with caution for the moderate overlap of primary studies, low level certainty, and significant heterogeneity.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159294","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":"Intraoperative mechanical power and postoperative pulmonary complications: association and threshold analysis in adult intra-abdominal surgery.","authors":"Mohamad El-Khatib, Thuraya HajAli, Carine Zeeni, Amro Khalili, Rasha Shreim, Michael R Mathis, Nancy Abou Nafeh, Marie Aouad","doi":"10.1186/s44158-026-00423-6","DOIUrl":"10.1186/s44158-026-00423-6","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) contribute to perioperative morbidity and mortality. Mechanical powers (MPs) determined using different deviations from originally described MP have been shown to be associated with PPCs. We aimed to evaluate the association between a standardized derivation of MP and PPCs and to explore a threshold associated with increased risk in multicentre cohort of adults undergoing intra-abdominal surgery.</p><p><strong>Methods: </strong>Data on adult patients who underwent intra-abdominal surgery under general anaesthesia were obtained from the Multicentre Perioperative Outcomes Group registry. The primary outcome was a composite of PPCs comprising an expanded subset of diagnoses consistent with European Perioperative Clinical Outcome definitions. The association between intraoperative MP and PPCs was evaluated using multivariable logistic regression, adjusting for patient, surgical, and institutional factors.</p><p><strong>Results: </strong>Among 79,149 patients from 56 institutions, 4,812 (6.1%) developed PPCs. Each 1 J/ min increase in MP was associated with 5% higher odds of PPCs (OR = 1.05, 95% CI [1.05-1.06]; p < 0.0001). Receiver operating characteristic analysis identified a threshold of 12 J/ min (sensitivity = 0.54, specificity = 0.51), above which patients had 54% higher adjusted odds of PPCs (OR_adj = 1.54, 95% CI [1.42-1.66]; p < 0.0001).</p><p><strong>Conclusions: </strong>Higher MP was associated with increased risk of PPCs in patients undergoing intra-abdominal surgery. Although MP values above 12 J min⁻¹ were associated with significantly increased odds of PPCs, this threshold demonstrated notably low standalone discriminatory performance. Further research is required to evaluate whether MP-directed lung-protective ventilation strategy could prospectively improve clinical outcomes. RESEARCH REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/WRQ6B .</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152464","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":"Target concentrations of propofol predicted by four different pharmacokinetic/pharmacodynamic models to induce loss of consciousness in neurosurgical patients.","authors":"Michele Introna, Zahra Moaiyeri, Tania Manso, Pedro Amorim, Catarina S Nunes, Francisco A Lobo","doi":"10.1186/s44158-026-00422-7","DOIUrl":"10.1186/s44158-026-00422-7","url":null,"abstract":"<p><strong>Background: </strong>Target-controlled infusion (TCI) systems estimate plasma (Cp) and effect-site (Ce) drug concentrations using pharmacokinetic-pharmacodynamic (PK/PD) models rather than direct measurements. Because multiple models are used in clinical practice, predicted concentrations at the same clinical endpoint may differ substantially. Loss of consciousness (LOC) during anesthesia induction provides a clinically relevant reference point for examining these differences.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients undergoing elective brain or spine surgery under propofol-based anesthesia. The propofol dose required to induce LOC was recorded, and plasma (Cp) and effect-site (Ce) concentrations at LOC were retrospectively estimated using four widely used PK/PD models (Marsh, Modified Marsh, Schnider, and Eleveld) through TCI simulation. Differences in model-derived concentrations were analyzed using mixed two-way ANOVA, with Model as a within-subject factor and Surgical Group (brain vs spine surgery) as a between-subject factor. When significant interactions were observed, post hoc comparisons were performed on log-transformed Ce values.</p><p><strong>Results: </strong>Model-derived concentrations at LOC differed markedly across PK/PD models. Mean Ce values ranged from approximately 1.5 µg/mL with the Marsh and Eleveld models to 4.6 µg/mL with the Schnider model. Mixed ANOVA showed a strong model effect on both Ce and Cp (p < 0.001). A significant Model × Surgical Group interaction was observed for Ce but not for Cp. Patients undergoing brain surgery received lower propofol doses and reached LOC at lower model-predicted effect-site concentrations than patients undergoing spine surgery.</p><p><strong>Conclusions: </strong>Predicted propofol concentrations at LOC vary considerably across PK/PD models despite identical clinical dosing, highlighting the model-dependent nature of TCI targets. These findings underscore the importance of explicit model specification and adequate user understanding when interpreting TCI-derived concentrations in both clinical practice and research.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152387","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":"'Peripheral nerve blocks vs selective spinal anesthesia in patients with femur fracture' - Uncertain evidence of superiority.","authors":"Maja Kovac","doi":"10.1186/s44158-026-00420-9","DOIUrl":"10.1186/s44158-026-00420-9","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152441","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":"Impact of sex on outcomes in critically ill patients with subarachnoid hemorrhage: a secondary analysis of a French prospective cohort study.","authors":"Sylvain Gourier, Marwan Bouras, Karim Lakhal, Yoann Launey, Karelle Leon, Marc Laffon, Claire Dahyot-Fizelier, Antoine Roquilly, Sigismond Lasocki, Olivier Langeron, Anaïs Caillard","doi":"10.1186/s44158-026-00419-2","DOIUrl":"10.1186/s44158-026-00419-2","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) remains a severe condition with high morbidity and mortality. Evidence on sex-related differences in outcomes and complication profiles is inconsistent. We assessed the association between sex and 90-day functional outcome and ICU complications in aSAH patients requiring intensive care.</p><p><strong>Methods: </strong>We performed a retrospective secondary analysis of the ATLANREA cohort (NCT02426255), a prospective multicenter ICU registry in western France. Adult patients (≥ 18 years) admitted with aSAH between January 1, 2013, and December 31, 2022, requiring orotracheal intubation within 24 h and for ≥ 24 h, were included. The primary outcome was favourable neurological status at day 90 (Glasgow Outcome Scale-Extended [GOS-E] > 4). A prespecified baseline multivariable logistic model included sex, age, WFNS grade, collapsed Fisher grade and mydriasis. Age subgroup analyses (≤ 42, 43-50, > 50 years) were prespecified as exploratory and complemented by a formal sex × age interaction test.</p><p><strong>Results: </strong>Among 865 patients, 540 (62.4%) were women. Women were older than men (58 [IQR 49-66] vs. 54 [45-63] years; p < 0.001), while WFNS and Fisher grades were similar by sex. Ninety-day GOS-E was available for 682/869 patients (78.8%). Favourable outcome rates were similar in women and men (42.2% vs. 41.4%; p = 0.90). In the baseline complete-case model, sex was not significantly associated with favourable outcome (male OR 0.745, 95% CI 0.517-1.067; p = 0.11), whereas age, higher WFNS grades and mydriasis were independently associated with worse outcome. Sensitivity analyses (best-/worst-case imputation and multiple imputation) suggested a modest sex effect under some assumptions. Ordinal modelling of 8-level GOS-E yielded consistent findings (male OR 0.767, 95% CI 0.568-1.035; p = 0.083). There was no evidence of sex × age interaction (p = 0.585). Vasospasm was more frequent in women (48.9% vs. 41.6%; p = 0.048), whereas men had more secondary pulmonary infections (34.4% vs. 18.9%; p = 0.008).</p><p><strong>Conclusions: </strong>Although sex was not an independent predictor of 90-day neurological outcome in this multicenter cohort of intubated ICU patients with severe aSAH, women were older and had slightly higher vasospasm rates but fewer systemic complications, particularly infections. These findings support incorporating sex and age into future prognostic work and underscore the importance of systemic complications in recovery after severe aSAH.</p><p><strong>Trial registration: </strong>ATLANREA cohort, www.</p><p><strong>Clinicaltrials: </strong>gov , NCT02426255.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044996","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":"Recommendations for implementing patient blood management-an updated modified Delphi consensus from a multidisciplinary expert panel in Hong Kong.","authors":"Hung-Kai Cheng, Kin-Chung Tse, Luke Ka-Lok Chan, Martin Tsang-Tung Chan, Benny Chun-Pong Cheng, Carmen Ka-Man Choi, Yu-Fat Chow, Cheuk-Kwong Lee, Wing-Cheong Leung, Tsin-Wah Leung, Simmy Ming-Wai Sin, Rita Ching-Yee So, Steven Ho-Shan Wong","doi":"10.1186/s44158-026-00417-4","DOIUrl":"10.1186/s44158-026-00417-4","url":null,"abstract":"<p><p>In 2020, the Hong Kong Society of Clinical Blood Management (HKSCBM) established a consensus statement on the implementation of patient blood management (PBM). Based on recent evidence on PBM initiatives and practices, the HKSCBM updated their consensus statements. HKSCBM convened a multidisciplinary panel of 13 experts, who formulated discussion questions across three PBM pillars: (1) optimising patients' red blood cell mass and improving anaemia management; (2) minimising perioperative blood loss; and (3) rationalising the use of blood and blood components. Using the modified Delphi method, the panel addressed the discussion questions by reviewing relevant literature and clinical experiences in multiple meetings. Consensus statements derived from meeting proceedings were voted anonymously by the panel. A consensus statement was accepted only if ≥ 80% of the panel chose 'accept completely' or 'accept with some reservation', based on a 5-point Likert scale. The panel accepted 117 consensus statements (including sub-statements). The updated version includes new additions to the following areas: identification of groups at high risk for iron deficiency anaemia; preoperative screening and management of iron deficiency and/or anaemia; recognition of bleeding-prone surgeries and conditions; recent measures to minimise intraoperative blood loss, including point-of-care coagulation testing, tranexamic acid, fibrinogen concentrate, reversal agents for anticoagulation, advanced haemodynamic monitoring, and uterotonics; suggested haemoglobin thresholds for transfusions; and implementation of transfusion protocols. These consensus statements are intended to serve as a practical framework for medical and surgical colleagues in Hong Kong and the Asia-Pacific region.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038352","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":"Empathy, communication, and a human touch in clinical practice.","authors":"Andrea De Gasperi, Luigi Vetrugno","doi":"10.1186/s44158-026-00412-9","DOIUrl":"10.1186/s44158-026-00412-9","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"6 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038216","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":"Impact of an interdisciplinary standard operating procedure on external ventricular drainage-associated ventriculitis and antibiotic use in intensive care unit patients: a retrospective pre-post study a retrospective pre-post study.","authors":"Michaela Danassis, Nilufar Akbari, Hans-Jörg Epple, Inna Friesen, Nils Hecht, Sonja Hansen, Sascha Treskatsch, Stefan Angermair","doi":"10.1186/s44158-026-00409-4","DOIUrl":"10.1186/s44158-026-00409-4","url":null,"abstract":"<p><strong>Background: </strong>External ventricular drainage (EVD)-associated ventriculitis is a serious complication in neurocritical care. Diagnostic uncertainty and heterogeneous infection prevention and control (IPC) practices may contribute to variable ventriculitis rates and potentially avoidable antibiotic exposure. We evaluated the impact of implementing an interdisciplinary standard operating procedure (SOP) on ventriculitis incidence and antimicrobial stewardship (ABS)-related outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre pre-post study in one intensive care unit (ICU) at Charité-Universitätsmedizin Berlin (2019-2023). Adult patients with EVDs were assigned to a pre-SOP cohort (Group 1) or a post-SOP cohort (Group 2). The SOP comprised standardized IPC protocols, an algorithm-based diagnostic workup and evidence-based anti-infective strategies. The primary endpoint was study-defined EVD-associated ventriculitis, adjudicated retrospectively using uniform criteria. Secondary endpoints included empirical antibiotic initiation, duration of therapy, antibiotic consumption, ICU length of stay (LOS), mortality, and SOP adherence. Cerebrospinal fluid (CSF) parameters and clinical signs were summarized descriptively.</p><p><strong>Results: </strong>A total of 166 patients were included (pre-SOP, Group 1: n = 50; post-SOP, Group 2: n = 116). The study-defined ventriculitis rate decreased from 22% [95% CI 0.13-0.35] to 9.5% [95% CI 0.05-0.16] with an unadjusted OR 0.37 [95% CI 0.13-1.04]; p = 0.053, attenuated with an adjusted OR of 0.50 [95% CI 0.19-1.35]; p = 0.169. Incidence density declined from 21.1 to 12.0 per 1000 EVD days. Empirical antibiotic use fell from 28.0% [95% CI 17.5-41.7] to 12.9% [95% CI 8.0-20.2], corresponding to an unadjusted OR of 0.38 [95% CI 0.17-0.87] and median therapy duration decreased from 16 [95% CI 13.5-18.5] to 10 days [95% CI 6.5-13.5]. ICU LOS shortened by 4 days, while ICU mortality remained unchanged (26% vs. 27%).</p><p><strong>Conclusion: </strong>An interdisciplinary SOP was associated with reduced empirical antibiotic exposure and shorter treatment duration without affecting ICU mortality. The SOP appeared to improve diagnostic consistency and standardization of the workup rather than diagnostic test performance.</p><p><strong>Trial registration: </strong>The study is registered in the German Clinical Trial Register (DRKS ID: 00036075) in February 2025.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007660","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":"Ultrasound vessel sizing before cannulation: a measurement-first approach for anesthesiologists.","authors":"Luis Alberto Rodriguez Linares, Sarah Cerillo Lopes","doi":"10.1186/s44158-026-00399-3","DOIUrl":"10.1186/s44158-026-00399-3","url":null,"abstract":"<p><p>The catheter gauge and length are often chosen based on visual estimation. Ultrasound allows for the direct measurement of vessel diameter and depth, which may reduce failed attempts, particularly in patients with difficult access and pediatric patients. This narrative review evaluated trials, meta-analyses, and guidelines on ultrasound-guided vascular access in adults and children to derive practical sizing rules for venous and arterial cannulation in anesthesiology. Key recommendations include targeting a catheter-to-vein ratio (CVR) ≤ 0.45 for peripheral IVs and using long catheters for deeper veins (≥ 8-10 mm); limiting catheter size to ≤ 1/3 of the vessel's luminal area (outer diameter/inner diameter ratio ≤ 0.577) for arterial lines to prevent spasm. A pediatric reference table links typical radial artery diameters to appropriate 22-24G catheter choices. Selecting central venous catheters that occupy approximately ≤ 33% of the vein's diameter may be a reasonable strategy to minimize complications. Evidence from clinical trials supports US-guided peripheral IV and radial artery cannulation over landmark-based techniques. We propose a five-step workflow (scan, measure, select gauge/length, US-guided cannulation, and confirmation) to implement this measurement-first approach. In conclusion, an ultrasound measurement-first strategy aligns catheter selection with vessel dimensions, improving first-pass success and reducing complications in both adult and pediatric practices. The proposed sizing tables and algorithm are intended to serve as practical decision-support tools for bedside applications.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984645","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}