Revista espanola de anestesiologia y reanimacion最新文献

{"title":"From uterine atony to aHUS: A case of postpartum thrombotic microangiopathy","authors":"J.M. Blanco Flores,&nbsp;A.M. Oubiña López,&nbsp;A. San Antonio Gil,&nbsp;M. Reina Molina,&nbsp;P. Ramos Curado,&nbsp;M. Echevarría Moreno","doi":"10.1016/j.redare.2026.501983","DOIUrl":"10.1016/j.redare.2026.501983","url":null,"abstract":"<div><div>We report the case of a 42-year-old primiparous woman who developed severe postpartum hemorrhage due to uterine atony after an instrumental delivery, requiring massive transfusion and Bakri balloon placement. Despite initial haemodynamic stabilization, she progressed to persistent anuria and acute kidney injury. Imaging revealed bilateral renal cortical necrosis. Atypical haemolytic uremic syndrome (aHUS) was suspected on the basis of tests showing anaemia, thrombocytopaenia, complement consumption, and ADAMTS13 activity &gt;10%. Treatment with eculizumab and renal replacement therapy was initiated, achieving good haematologic response.</div><div>This case highlights a rare postpartum complication in which early suspicion enables prompt targeted therapy. Ansesthesiologists play a key role in initial haemodynamic management and in identifying warning signs suggestive of thrombotic microangiopathies.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501983"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986096","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":"Ultrasound-guided peripheral nerve stimulation implantation in the spiral groove. A case report","authors":"J. Mateos-Granados ,&nbsp;L.E. Fernández-Rodríguez ,&nbsp;M.M. Hernández-García ,&nbsp;F. Martínez-Martínez ,&nbsp;V. Roqués-Escolar","doi":"10.1016/j.redare.2025.501982","DOIUrl":"10.1016/j.redare.2025.501982","url":null,"abstract":"<div><div>Neuropathic pain can be treated with peripheral nerve stimulation (PNS), a technique that has become more widespread following the introduction of ultrasound-guided placement. Superficial radial nerve neuropathy is a common disorder, and implanting a PNS device in the distal humeral has been shown to provide good pain control; however, the nerve block test is negative is some patients, and are therefore not candidates for neurostimulation. We report a case of ultrasound-guided implantation of a peripheral nerve stimulator in the spiral groove to treat superficial radial nerve neuropathy. The treatment provided good pain control for more than 1 year, at which time the electrode lead fractured and had to be surgically removed and reimplanted. This may be an effective alternative in certain patients, although further studies are required.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501982"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764831","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 effect of opioid-free anesthesia on postoperative pain in orthopedic surgery: A systematic review and meta-analysis of randomized controlled trial","authors":"A. Bachtiar Effendi ,&nbsp;F. Cahya Ramadhan ,&nbsp;G.D. Ica Manohara ,&nbsp;R.M. Laksono","doi":"10.1016/j.redare.2026.501989","DOIUrl":"10.1016/j.redare.2026.501989","url":null,"abstract":"<div><h3>Background</h3><div>Opioid-free anaesthesia (OFA) is increasingly recognized as a perioperative approach that may offer effective pain control with reduced risk of adverse effects. Considering that orthopaedic surgeries often lead to at least moderate postoperative pain, we assessed the effectiveness and safety of OFA in orthopaedic procedures.</div></div><div><h3>Methods</h3><div>We searched PubMed, ScienceDirect, ProQuest, and EuropePMC for relevant randomised controlled trials (RCT) and supplemented the data with citation tracking. Data were analysed using RevMan version 5.4. The risk of bias and the certainty of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and the GRADE approach. The study was registered on PROSPERO (CRD420251048348).</div></div><div><h3>Results</h3><div>Seven RCTs involving 408 patients were included. The intensity of postoperative pain measured in the post-anaesthesia care unit (mean difference [MD]: −0.08), at 24 h (MD: −0.06), and at 48 h (MD: −0.26) was not statistically significant. OFA reduced the risk of postoperative nausea and vomiting (PONV) (RR: 0.37; <em>P</em> = .00001) and prolonged the time to first request for analgesia (MD: 25.60 min; <em>P</em> = .00001). Twenty-four-hour morphine consumption was comparable across groups (MD: −0.28; <em>P</em> = .76). OFA reduced the incidence of intraoperative hypotension (risk ratio [RR]: 0.56; <em>P</em> = .02) but increased the risk of intraoperative bradycardia (RR: 1.86; <em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>In orthopaedic surgery, OFA provides comparable pain control to opioid-based anaesthesia. It also reduced the incidence of postoperative nausea and vomiting and intraoperative hypotension, and prolonged the time to the first request for analgesia (statistically, but not clinically). However, the potential risk of bradycardia should be considered when using dexmedetomidine-based anaesthesia.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501989"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961097","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":"Predictive value of muscle tone loss and perfusion index in the success of supraclavicular brachial plexus block: A pilot study","authors":"M.A. Hernández-Govea ,&nbsp;G.F. Álvarez-Orenday ,&nbsp;M. Guerra-Hernández ,&nbsp;V.B. Kway ,&nbsp;A.M. Castro-Alemán","doi":"10.1016/j.redare.2026.501986","DOIUrl":"10.1016/j.redare.2026.501986","url":null,"abstract":"<div><h3>Background</h3><div>Currently, no standardized tool accurately predicts the success of supraclavicular brachial plexus block (SBPB) in the shortest time possible. This study aimed to evaluate the early predictive value of muscle tone loss and perfusion index in predicting SBPB success. This is the first study to report the use of this device for objective assessment of nerve block success.</div></div><div><h3>Methods</h3><div>A prospective observational pilot study was conducted at \"Dr. Ignacio Morones Prieto\" Central Hospital, Mexico, involving 33 patients (ASA 1, 2, 3) requiring surgery on the distal third of the upper limb with ultrasound-guided SBPB. Exclusion criteria included infections at the puncture site, local anaesthetic allergies, coagulopathies, restrictive pulmonary pathologies, oxygen dependency, brachial plexus radiculopathy, and uncontrolled diabetes. The motor block was assessed with a conductive ink flexion sensor (FS), and the sympathetic block was evaluated with perfusion index via pulse oximeter at 3, 5, 10, and 15 min. Block success was defined as a Numerical Rating Scale (NRS) for pain &lt;2 during surgical stimulation. Statistical comparisons were made between successful and unsuccessful blocks, with ROC curve analysis identifying optimal cutoff points for predictive variables.</div></div><div><h3>Results</h3><div>Of the 33 patients, 24 had a successful block, and 9 did not. At 5 min, a PI &gt; 196.07 showed 100% sensitivity, 87.5% specificity, and AUC 92% (<em>p</em> &lt; 0.001). A 27.38% loss in muscle strength showed 100% sensitivity, 87.5% specificity, and AUC 95% (<em>p</em> &lt; 0.001). Combined, these parameters had a 100% predictive value (<em>p</em> &lt; 0.005).</div></div><div><h3>Conclusion</h3><div>PI and muscle strength loss are reliable early predictors of SBPB success, offering a valuable tool for optimizing anaesthetic strategies.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501986"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986115","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":"GLP-1 agonists: A hidden challenge for airway management","authors":"M.A. Fernández-Vaquero ,&nbsp;C.A. Puga-Carrasco ,&nbsp;J.A. Sastre","doi":"10.1016/j.redare.2025.501991","DOIUrl":"10.1016/j.redare.2025.501991","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501991"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764893","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":"Lost in submission? Investigating publication bias in regional anaesthesia: A pilot case study of the erector spinae plane block","authors":"A. De Cassai ,&nbsp;B. Dost ,&nbsp;Y.E. Karapinar ,&nbsp;M.A. Yilmaz ,&nbsp;E.I. Turan ,&nbsp;E. Sarikaya Ozel","doi":"10.1016/j.redare.2026.501995","DOIUrl":"10.1016/j.redare.2026.501995","url":null,"abstract":"<div><h3>Background</h3><div>The Erector Spinae Plane (ESP) block is a regional anaesthesia technique with a growing range of clinical applications due to its short learning curve, low complication rate, and effectiveness. However, publication bias can distort the perceived efficacy of interventions, especially when studies with negative or inconclusive results remain unpublished. The real extent of publication bias in ESP-related clinical research currently remains unclear.</div></div><div><h3>Methods</h3><div>We searched ClinicalTrials.gov on 2 February 2025 using the terms «Erector Spinae Plane Block» and «ESP block», and obtained 671 records. After excluding duplicates, irrelevant, and ongoing studies, 500 records were eventually included. Study characteristics and publication status were determined using a multi-step search strategy that included PubMed®, Scopus®, Embase®, and Central®. Data were analysed using appropriate statistical tests on R (v3.4.0).</div></div><div><h3>Results</h3><div>Of the 500 studies included, 361 (72.2%) were complete, 102 (20.4%) had unknown status, and 37 (7.4%) had been suspended, terminated, or withdrawn. Only 211 studies (42.2%) were published, and included data from 14,374 of 32,600 intended patients. Published studies were registered significantly earlier than unpublished ones (median year 2020 vs 2021; <em>P</em> = .004). No significant differences were found between published and unpublished studies in terms of main outcome, continent, surgical setting, study design, or sample size.</div></div><div><h3>Conclusions</h3><div>A substantial proportion of ESP block studies remain unpublished, indicating potential publication bias. Although earlier registration was associated with publication, other study characteristics were not. These findings highlight the need for increased transparency and for clinical trial results to be published regardless of outcome in order to ensure that the evidence base is unbiased.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501995"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992349","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":"GLP1 receptor analogues and perioperative management considerations: A narrative review","authors":"A. Vázquez Lima,&nbsp;M. Vidal Lopo","doi":"10.1016/j.redare.2026.501985","DOIUrl":"10.1016/j.redare.2026.501985","url":null,"abstract":"<div><div>Glucagon-like peptide type 1 analogues (aGLP1) are a group of drugs capable of stimulating the GLP1 receptor, a key peptide in glycaemic homeostasis through its actions at the pancreatic and gastric level.</div><div>This narrative review summarises the possible implications of the perioperative use of this group of drugs. The pancreatic and extrapancreatic effects of aGLP1s determine their anaesthetic implications and perioperative management. The repercussions of their long-term suspension and their effects on the immune system have not yet been sufficiently clarified. The perioperative use of GLP1 agonists is associated with better glycaemic control without a significant increase in complications. However, their use involves a delay in gastric emptying dependent on multiple factors, which may increase the risk of bronchoaspiration.</div><div>At present, we can conclude that the perioperative maintenance of GLP1 agonists optimises glycaemic control and avoids disruptions to the potential benefits of treatment without demonstrating an increase in postoperative complications. Delayed gastric emptying and possible bronchoaspiration require measures to minimise risk and ensure patient safety.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501985"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992219","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":"Inter-observer reliability of gastric ultrasound and level of agreement with clinical evaluation in adult patients requiring emergency surgery","authors":"J.C. Villalba ,&nbsp;J.M. Quintero ,&nbsp;C.E. Melo ,&nbsp;D.F. Reyes ,&nbsp;J.P. Tovar ,&nbsp;A. Perlas","doi":"10.1016/j.redare.2026.501994","DOIUrl":"10.1016/j.redare.2026.501994","url":null,"abstract":"<div><h3>Introduction</h3><div>Pulmonary aspiration of gastric contents is a major perioperative complication with a mortality rate of 75% and severe morbidity of 14%. The risk increases in emergency surgeries and gastric ultrasound may be useful to establish gastric content and inform aspiration risk assessment. In this study we describe the degree of agreement between pre-surgical clinical evaluation and gastric ultrasound, in the identification of full stomach in adult patients requiring emergency surgery.</div></div><div><h3>Materials and methods</h3><div>Descriptive observational cross-sectional study of diagnostic tests. The analysis included all adult patients with pathologies requiring emergency surgeries between August 2023 and May 2024 at Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia. The Kappa index was calculated between the two tests (Clinical evaluation vs. Gastric ultrasound), and the level of agreement between them was determined.</div></div><div><h3>Results</h3><div>A total of 57 patients were included in the study. Age, median (range): 51 (18–83), of whom 64.9% were male. The main types of surgeries were general surgery (80.7%), followed by trauma (19.3%). The majority of the population was classified as ASA 3. The most common comorbidities were Arterial Hypertension and type 2 Diabetes Mellitus. Fasting time ranged from 12 to 24 hours. There was a high level of agreement among the examiners for determining a full stomach using point-of-care (POCUS) gastric ultrasound, with a concordance level of 0.88 (p &lt; 0.001). In contrast, there was a low level of agreement between the clinical and sonographic evaluation for gastric content assessment, with a concordance level of -0.03 (p 0.768).</div></div><div><h3>Conclusion</h3><div>Our results suggest that gastric ultrasound has a high level of reproducibility in the emergency surgical setting and can provide information beyond the clinical assessment.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501994"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986117","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":"Beyond compliance: Patient risk, ERAS adherence, and postoperative outcomes through explainable machine learning","authors":"J. Ripollés-Melchor ,&nbsp;Á.V. Espinosa ,&nbsp;A. Abad-Motos ,&nbsp;A. Abad-Gurumeta ,&nbsp;P. Galán-Menéndez ,&nbsp;A. Zorrilla-Vaca ,&nbsp;R. Navarro-Pérez ,&nbsp;A. Ruiz-Escobar ,&nbsp;J. Fernanz-Antón ,&nbsp;A. Suárez-de-la-Rica ,&nbsp;C. Aldecoa ,&nbsp;the EuroPOWER Study Investigators Group","doi":"10.1016/j.redare.2026.501990","DOIUrl":"10.1016/j.redare.2026.501990","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) protocols improve outcomes after colorectal surgery, but adherence remains variable and may interact with patient risk. Traditional compliance scores lack granularity to explore these dynamics. We aimed to use interpretable machine learning to quantify the contribution of individual ERAS items and clinical features to postoperative complications, and to identify data-driven ERAS phenotypes.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the EuroPOWER cohort (NCT04889798), a prospective European study including 2841 adults undergoing elective colorectal surgery. Two Extreme Gradient Boosting models were trained to predict in-hospital complications: a complete model (clinical variables + 23 ERAS items) and an ERAS-only model. Both were interpreted using Shapley Additive Explanations (SHAP). In the complete model, SHAP matrices were clustered to derive phenotypes. Feature importance, adherence, and complication rates were compared descriptively.</div></div><div><h3>Results</h3><div>The complete model achieved an AUC of 0.627. SHAP analysis identified frailty, ASA class, BMI, and age as leading predictors, followed by early mobilisation, nutritional care, and thromboprophylaxis. Three phenotypes were identified, with complication rates of 17.7%, 27.1%, and 41.1%, corresponding to robust, intermediate, and frail profiles. The ERAS-only model showed similar discrimination (area under the curve 0.642), but reduced interpretability. SHAP redundancy analysis supported inclusion of all ERAS items.</div></div><div><h3>Conclusions</h3><div>The clinical effect of ERAS adherence appears to be modulated by baseline vulnerability and implementation patterns. SHAP-based models enable transparent risk attribution and phenotype identification, supporting more targeted ERAS strategies and future development of automated quality monitoring tools.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501990"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946955","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":"Reflections on: «New-onset chronic and neuropathic pain in survivors of severe COVID-19: A secondary analysis of the PAIN-COVID Trial»","authors":"A. Alcántara Montero ,&nbsp;P.J. Ibor Vidal","doi":"10.1016/j.redare.2025.501996","DOIUrl":"10.1016/j.redare.2025.501996","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501996"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759001","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}