Revista espanola de anestesiologia y reanimacion最新文献

{"title":"Perioperative neurocognitive disorder in non-cardicac surgery: A prospective single centre cohort trial.","authors":"J M Rabanal Llevot, D García López, A Pozueta Cantudo, A Suárez de la Rica, E Maseda Garrido, P Sánchez Juan","doi":"10.1016/j.redare.2026.502115","DOIUrl":"10.1016/j.redare.2026.502115","url":null,"abstract":"<p><strong>Introduction: </strong>Aging is a complex process that reduces the body's functional reserve, with cognitive decline being its manifestation at the cerebral level. Cognitive impairment may worsen after surgery and anesthesia. The aim of this study is to describe the incidence of cognitive decline before and after surgery, as well as its associated factors in patients aged ≥65 years.</p><p><strong>Method: </strong>This is a prospective and contextual, study on perioperative cognitive decline, using a convenience sample in a university hospital in Spain. Preoperative cognitive evaluation was performed using the Mini-Mental State Examination (MMSE), the Digit Span Test (both forward and backward), the Free and Cued Selective Reminding Test (FCRST), the Trail Making Test A and B, and the Digit Symbol Substitution Test. Postoperative evaluation was conducted using the abbreviated IQCODE interview.</p><p><strong>Results: </strong>A total of 100 outpatients were studied (mean age 74.46 ± 6.49 yr). Forty-four patients (44%) had preoperative cognitive decline. Variables associated with preoperative cognitive decline included education level (OR 2.11), alcohol consumption (OR 3.37), Barthel Index (OR 2.29), and polypharmacy (OR 2.32), depression (OR 3.48), or COPD (OR 11.5). Following the IQCODE interview, 18% of patients exhibited postoperative cognitive decline.</p><p><strong>Conclusions: </strong>Undiagnosed pre-existing cognitive dysfunction is very common in older patients awaiting surgery, and an important number experience worsening or new onset of cognitive decline following surgery.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"502115"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiotensin II in the treatment of distributive shock and identification of clinical profiles with greater therapeutic benefit.","authors":"J Nieves-Alonso, R García-Álvarez, A Suárez-de-la-Rica","doi":"10.1016/j.redare.2026.502116","DOIUrl":"https://doi.org/10.1016/j.redare.2026.502116","url":null,"abstract":"<p><p>The cornerstone of vasopressor treatment for distributive shock is norepinephrine; however, the administration of high doses is associated with significant adrenergic toxicity and increased morbidity and mortality. Angiotensin II, a recently approved physiological alternative to norepinephrine within a multimodal vasopressor strategy, has the advantage of rebalancing the renin-angiotensin-aldosterone system and reducing catecholamine doses. This review analyses the role of angiotensin II in distributive shock, exploring its pharmacodynamic characteristics and its impact on haemodynamic stability. The evidence collected to date has identified specific groups that derive clinical benefit, particularly patients with acute kidney injury, acute respiratory distress syndrome, or prior exposure to renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors). Dynamic assessment tools, such as the AIMRITE (Angiotensin-II Initial MAP Response Index of Treatment Effect) index, may be useful for assessing early response to angiotensin II and supporting therapeutic decisions at an early stage. Ultimately, angiotensin II allows clinicians to implement personalised, safe therapeutic measures that are tailored to the complexity of the critically ill patient.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"502116"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of sedation and analgesia on post-ICU syndrome: Experience from a post-critical care follow-up clinic.","authors":"B Zalba-Etayo, L Villén-Lapuente, J J Araíz-Burdio, J L Cabrerizo-García","doi":"10.1016/j.redare.2026.502107","DOIUrl":"10.1016/j.redare.2026.502107","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate physical, cognitive, and psychological complications in critically ill patients following ICU stay and analyse their relationship with sedation and analgesia.</p><p><strong>Methods: </strong>Prospective study including 94 ICU patients. Demographic data, comorbidities, reason for admission, complications, and treatments were recorded, along with functional, cognitive, and psychological assessments at discharge. The relationship between doses and duration of sedatives and opioids with muscle weakness, delirium, nightmares, and cognitive impairment was analysed.</p><p><strong>Results: </strong>The mean age was 61.4 years, with a predominance of males (52.1%). Most patients were admitted for medical conditions (81.9%), mainly pneumonia (46.8%) and sepsis (11.7%). The most frequent complications were acquired weakness (73.4%), delirium (52.1%), and sleep disturbances (37.6%). Mechanical ventilation was applied in 85.1% of patients, 48.9% received early rehabilitation, and the mean ICU stay was 21.98 days. At discharge, functional assessment showed moderate impairment (Barthel 81.97; EQ-5D 0.72), and 54.3% had MoCA <26. Patients exposed to higher doses and longer duration of midazolam and opioids more frequently developed weakness and nightmares. Delirium was associated with longer sedation, while cognitive impairment showed no significant association with sedoanalgesia.</p><p><strong>Conclusion: </strong>Critically ill patients frequently experience weakness, delirium, and cognitive alterations after ICU stay. The intensity and duration of sedoanalgesia may influence certain sequelae, highlighting the importance of individualized pharmacological management and early rehabilitation strategies.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"502107"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial culture of ultrasound gels in relation to CDC/FDA alert: A transversal prevalence study of contamination in an anesthesia center.","authors":"X Ormazabal Rementeria, G Ojinaga García, J L Barrios Andrés","doi":"10.1016/j.redare.2026.502104","DOIUrl":"10.1016/j.redare.2026.502104","url":null,"abstract":"<p><strong>Background and objective: </strong>Ultrasound is essential in anaesthesiology, non-sterile multidose gels can cause nosocomial infection. Following the CDC/FDA safety alert published on 13 May 2025 regarding outbreaks of Paraburkholderia fungorum linked to contaminated gels, we determined the prevalence of microbial contamination in the ultrasound gels regularly used in our anaesthesia department.</p><p><strong>Materials and methods: </strong>Cross-sectional prevalence study based on the analysis of 37 ultrasound gel samples. Using convenience sampling, we collected 33 samples of gels in active use in various areas (operating rooms, resuscitation, interventional radiology room, and delivery room) together with 4 control samples (2 unopened multidose gels and 2 sterile single-dose gels). Infusion broth was inoculated with the samples and incubated at 37 °C for 10 days, after which they were tested for colonisation using the MALDI-TOF technique.</p><p><strong>Results: </strong>Microorganisms were isolated in 6.1% (2/33) of the samples of multidose gels in active use, specifically, Streptococcus parasanguinis and Staphylococcus pasteuri, which were isolated in different batches of TransonicGel. No bacterial growth was found in samples from gel warmers (n = 3), electrode gels, or controls. None of the microorganisms isolated matched those listed in the hospital's infection database.</p><p><strong>Conclusions: </strong>The finding of 6.1% contamination shows the latent risk involved in using multidose gels. These results reinforce the importance of adhering to the CDC, ACEP, and ASRA guidelines, which recommend protecting patients by using only sterile single-dose gels and validated probe covers in all invasive ultrasound-guided procedures.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"502104"},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on the article \"Macklin effect in critically ill COVID-19 patients: A single-centre observational analysis\".","authors":"S Campbell-Silva","doi":"10.1016/j.redare.2026.502003","DOIUrl":"10.1016/j.redare.2026.502003","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"502003"},"PeriodicalIF":0.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training in cardiopulmonary resuscitation among anesthesiology residents in Spain: results of a national survey.","authors":"M Bernardino Santos, M Aliaño Piña, C Ruiz-Villén, A Vidal Marcos, D Gutiérrez Martínez, P Monedero","doi":"10.1016/j.redare.2026.502052","DOIUrl":"10.1016/j.redare.2026.502052","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cardiopulmonary resuscitation (CPR) is a core competency in anesthesiology residency training. In Spain, updated data on how this training is structured and the involvement of anesthesiology departments in in-hospital CPR has been lacking. This study aimed to describe the characteristics of CPR training provided to anesthesiology residents in teaching hospitals, assess whether the training is accredited and by whom, and analyze the role of anesthesiology departments in hospital resuscitation teams.</p><p><strong>Methods: </strong>Cross-sectional study based on an online survey distributed in March 2025 to instructors accredited by the European Resuscitation Council (ERC) and, in their absence, to department heads or tutors from the 125 teaching hospitals with Anesthesiology residents in Spain. The survey included 25 items covering demographic data, training, clinical involvement, and technological resources.</p><p><strong>Results: </strong>A total of 123 hospitals responded (98.4%). In 108 of them (87.8%), residents received advanced life support training, and 50 centers (40.7%) offered ERC-accredited programs. Training showed heterogeneity in terms of format, accreditation, and timing. In 60 hospitals (48.8%), anesthesiologists were active members of in-hospital cardiopulmonary resuscitation teams. The availability of mechanical chest compression devices and extracorporeal membrane oxygenation (ECMO) systems was 50.4% and 44.7%, respectively, with regional variability.</p><p><strong>Conclusions: </strong>Although most teaching hospitals provide CPR training, significant disparities exist in accreditation, clinical exposure, and resource availability. Greater standardization is required through accredited, continuous programs incorporating simulation and structured debriefing. Strengthening the role of anesthesiology departments in hospital resuscitation could enhance resident preparedness and ultimately improve patient safety and clinical outcomes.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"502052"},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External oblique intercostal plane block in open hepatobiliary surgery: A case series.","authors":"C Garicano Goldaraz, L Gómez de la Lastra, M Amelburu Egoscozábal, C Yarnoz, G Oliver Juan, N González Jorrín, A Abad-Motos","doi":"10.1016/j.redare.2026.502051","DOIUrl":"10.1016/j.redare.2026.502051","url":null,"abstract":"<p><strong>Background and objective: </strong>Analgesic management in subcostal laparotomy is a challenge, and has a direct impact on recovery and outcomes. The external oblique intercostal (EOI) block anaesthetises the anterior and lateral cutaneous branches of the ventral rami of the intercostal nerves, and both the puncture site and the local anaesthetic target are located outside the surgical field, blocking the anterior and lateral cutaneous branches of the ventral rami of the intercostal nerves.</p><p><strong>Materials and methods: </strong>Observational, retrospective, single-centre study. Patients scheduled for open hepatobiliary surgery under general anaesthesia and intrathecal morphine were included. EOI block was performed before the incision as part of a multimodal analgesia strategy. After anaesthesia induction, with the patient supine, a 12-15 MHz linear transducer was placed over the sixth rib and an 80 mm needle was used to administer 20 ml of 0.25 % levobupivacaine on each side in the case of bilateral incisions or on one side in the case of unilateral incisions.</p><p><strong>Results: </strong>Fifteen patients scheduled for open hepatectomy, pancreaticoduodenectomy, and open cholecystectomy were included. Pain rated on the visual numerical scale was 0 (0-0) out of a possible 5 (0-5) points on postoperative day 1. Twelve patients (80%) were able to move to a chair on postoperative day 1. Six (40%) required rescue morphine in the first 24 postoperative hours. The average dose administered was 1.4 mg (±2).</p><p><strong>Conclusions: </strong>Single-shot EOI block is an effective, safe, and easily reproducible technique in a multimodal analgesic approach to major abdominal surgery.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"502051"},"PeriodicalIF":0.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining perioperative analgesia: Impact of opioid-free anesthesia in breast surgery","authors":"Ó. Roca-Viéitez,&nbsp;J. Iglesias-López de Prado,&nbsp;P. Casas-Reza,&nbsp;M. Gestal-Vázquez,&nbsp;O. Sobrino-Robelo,&nbsp;P. Subirán-Rodríguez","doi":"10.1016/j.redare.2026.502048","DOIUrl":"10.1016/j.redare.2026.502048","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Opioid-free anesthesia (OFA) aims to achieve effective perioperative pain control while avoiding the adverse effects associated with opioid use. Its usefulness in breast surgery remains poorly studied. The primary objective of this study was to compare morphine consumption in the post-anesthesia care unit (PACU) between patients undergoing opioid-free anesthesia and those receiving conventional opioid-based anesthesia.</div></div><div><h3>Materials and methods</h3><div>A retrospective, observational, single-center study was conducted at the University Hospital of A Coruña. A total of 87 patients who underwent breast surgery between January and July 2022 were included. Two groups were compared: opioid-free anesthesia (OFA, n = 41) and conventional opioid-based anesthesia (non-OFA, n = 46). The need for morphine rescue at PACU discharge, at 24 h, and at 48 h postoperatively (if patients remained hospitalized) was recorded. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), oral tolerance, night rest, and length of stay in the PACU and hospital.</div></div><div><h3>Results</h3><div>The OFA group showed significantly lower morphine consumption in the recovery unit (9.8% vs. 47.8%; <em>P</em> &lt; .001), with an absolute risk reduction of 38.1%. No PONV events were observed in the OFA group compared with 21.7% in the non-OFA group (<em>P</em> = .001). Delayed oral tolerance was more frequent in the non-OFA group (0% vs. 15.2%; <em>P</em> = .013), and night rest was also better in the OFA group (94.4% vs. 65.7%; <em>P</em> &lt; .05). No differences were found in PACU or hospital length of stay.</div></div><div><h3>Discussion</h3><div>The OFA technique provided adequate analgesic control with a significant reduction in postoperative adverse effects.</div></div><div><h3>Conclusions</h3><div>Opioid-free anesthesia in breast surgery is a safe and effective technique that improves postoperative recovery.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 4","pages":"Article 502048"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic coherence in 2025: A year in review from the Fluid Therapy and Hemodynamic Group of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR)","authors":"J. Ripollés-Melchor ,&nbsp;Á.V. Espinosa ,&nbsp;M.I. Monge-García ,&nbsp;M.J. Colomina ,&nbsp;P. Galán-Menéndez ,&nbsp;G. Yanes-Vidal ,&nbsp;R. Navarro-Pérez ,&nbsp;C. Aldecoa ,&nbsp;S. Montesinos-Fadrique ,&nbsp;J.L. Jover-Pinillos ,&nbsp;P. Fernández-Valdés-Bango ,&nbsp;A. Abad-Gurumeta ,&nbsp;I. Jiménez-López ,&nbsp;J. García-Fernández ,&nbsp;J.V. Lorente","doi":"10.1016/j.redare.2026.502090","DOIUrl":"10.1016/j.redare.2026.502090","url":null,"abstract":"<div><h3>Background</h3><div>Haemodynamic research advanced across perioperative and critical-care medicine, with major contributions in vascular physiology, microcirculation, fluid therapy, arterial pressure targets, organ protection and the clinical performance of monitoring and artificial intelligence (AI) supported systems. Given the breadth and heterogeneity of this evidence, a coherent physiological synthesis is required.</div></div><div><h3>Methods</h3><div>Between December 2024 and December 2025, we undertook a broad, intentionally inclusive review of high-impact perioperative and critical-care journals, complemented by targeted PubMed searches centred on perfusion, arterial pressure, microcirculation and haemodynamic monitoring in adult patients. Selection was curatorial rather than exhaustive, optimization studies that materially advanced physiological understanding or challenged prevailing assumptions. Relevant trials, mechanistic studies and conceptual papers were grouped into thematic blocks and interpreted through a unified physiological lens. No formal risk-of-bias scoring was applied.</div></div><div><h3>Findings</h3><div>Macrocirculatory correction alone did not ensure microvascular or metabolic recovery. Vasoplegia, endothelial dysfunction and venous congestion repeatedly defined the limits of resuscitation, while vasopressor efficacy proved phenotype-dependent. Timing of fluid administration outweighed cumulative volume, and early-perfusion markers outperformed traditional surrogates such as lactate. Intraoperative blood pressure prediction and automation consistently reduced hypotension exposure but did not improve organ injury or complications. Renal protection advanced through biomarker-enriched prevention rather than numerical thresholds. Updated guidelines emphasised physiological coherence over fixed targets, highlighting persisting uncertainty around personalised arterial pressure goals, optimal perfusion monitoring and the integration of emerging AI systems.</div></div><div><h3>Conclusion</h3><div>The 2025 haemodynamic literature reinforces a unifying principle: numerical optimization is insufficient; clinical benefit arises only when interventions respect vascular biology, microcirculatory capacity and metabolic tolerance.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 4","pages":"Article 502090"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nitazenes: emerging challenges in acute care for synthetic opioid use","authors":"A. Alcántara Montero","doi":"10.1016/j.redare.2026.502000","DOIUrl":"10.1016/j.redare.2026.502000","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 4","pages":"Article 502000"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}