Revista espanola de anestesiologia y reanimacion最新文献

{"title":"Awake orotracheal intubation using the C-MAC D-Blade in cancer patients with predicted difficult airway: A single-center experience","authors":"D. Abdellatif Elebedy,&nbsp;A. Medhat Mohasseb,&nbsp;E. Mohamed Mokbel,&nbsp;M. Mohammed Alseoudy","doi":"10.1016/j.redare.2026.502130","DOIUrl":"10.1016/j.redare.2026.502130","url":null,"abstract":"<div><h3>Background and aims</h3><div>Managing difficult airways in cancer patients remains a significant challenge for anesthetists worldwide due to the risk of serious complications. Therefore, this study aimed to evaluate the feasibility of awake orotracheal intubation using the C-MAC D-Blade in cancer patients with predicted difficult airways undergoing elective surgery under general anesthesia.</div></div><div><h3>Method</h3><div>We enrolled 180 cancer patients with difficult airways, as assessed by the El-Ganzouri Risk Index. Awake orotracheal intubation was performed using the C-MAC D-Blade, with topical local anesthesia and sedation. The primary outcome was the first-attempt intubation success rate. Secondary outcomes included the total intubation time, hemodynamic changes, patient responses, complications, and the ease of the procedure, assessed by both anesthesiologists and patients using a visual analog scale (VAS).</div></div><div><h3>Results</h3><div>First-attempt intubation was successful in 89.4% of patients (n = 161), 8.3% (n = 15) required a second attempt, and 2.2% (n = 4) required a third attempt. No failed intubations were recorded. The mean intubation time with its standard deviation was 40.8 ± 9.01 s. At one and two minutes after intubation, heart rate and mean arterial blood pressure increased significantly from baseline values (<em>P</em> &lt; .001). Tooth damage occurred in three patients, bleeding gums in seven patients, and tissue edema in four patients. The median VAS score for both anesthesiologists and patient satisfaction was 9, indicating high procedural feasibility. Additionally, a statistically significant positive correlation was observed between the number of intubation attempts and cough severity (<em>P</em> = .001).</div></div><div><h3>Conclusion</h3><div>Awake video-laryngoscopic intubation using the C-MAC D-Blade achieved a high first-attempt success rate (89.4%) with minimal complications in cancer patients with predicted difficult airways. These results suggest it is a safe and effective option when careful assessment, adequate topical anesthesia, and appropriate sedation are ensured, although comparative studies are needed to better define its role.</div></div><div><h3>Clinical Trial Registry</h3><div>Registered at clinicaltrial.gov registry system (clinical trial identifier: PACTR202408730457046).</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502130"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059325","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":"Perioperative management of antithrombotic drugs in the real world: Study of the impact of not following the consensus document","authors":"M. Echeverri ,&nbsp;D. Vivas ,&nbsp;J. Igualada ,&nbsp;M. Anguita-Gámez ,&nbsp;B. Nozal-Mateo ,&nbsp;S. Gadín-López ,&nbsp;N. Bouzó-Molina ,&nbsp;F. Marín ,&nbsp;M. Anguita ,&nbsp;I. Egocheaga ,&nbsp;M.A. Esteve-Pastor ,&nbsp;R. Ferrandis ,&nbsp;on behalf of the REQXAA study investigators","doi":"10.1016/j.redare.2026.502119","DOIUrl":"10.1016/j.redare.2026.502119","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>In order to standardise the periprocedural management of antithrombotic drugs, a national and multidisciplinary consensus document was drawn up in 2018. This study analyses the follow-up of this consensus and its outcome in the perioperative setting.</div></div><div><h3>Methods</h3><div>Sub-analysis of the REQXAA study (observational, prospective, multicentre with 30-day follow-up) in patients scheduled for surgery. Antithrombotic management was considered appropriate according to the consensus document. Logistic regression analysis was used to study the effect of appropriate management and other variables on the incidence of adverse thrombotic and/or haemorrhagic events (odds ratio (OR) and confidence interval (95% CI)).</div></div><div><h3>Results</h3><div>A total of 506 patients were included (57.5% antiplatelet therapy; 38.9% anticoagulant therapy; 3.6% dual therapy), with 50 adverse events recorded (overall incidence 9.9%), 46 of which were haemorrhagic. In 50.2% of patients, management was suboptimal, which was associated with a significant increase in adverse events (OR 2.3, 95% CI 1.2–4.2). The following factors independently increased the risk: inappropriate indication for bridging therapy (OR 3.9, 95% CI 1.9–7.9), chronic kidney disease (OR 2.0, 95% CI 1.1–3.9) and high thrombotic risk (OR 3.7, 95% CI 1.6–8.6). Patients with moderate-to-high bleeding risk and suboptimal management had a higher risk of bleeding (OR 4.4, 95% CI 1.6–11.9).</div></div><div><h3>Conclusions</h3><div>Failure to follow the consensus document for the perioperative management of antithrombotic drugs is associated with an increase in adverse events. The implementation of multidisciplinary protocols in the perioperative period, following current recommendations, could improve these outcomes.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502119"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102407","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: “Comparison of single-shot neuraxial morphine and erector spinae plane block on quality of recovery after major open gastrointestinal surgeries”","authors":"R.M. Sethuraman,&nbsp;R. Aravindan","doi":"10.1016/j.redare.2026.502045","DOIUrl":"10.1016/j.redare.2026.502045","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502045"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273682","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":"Social determinants associated with unhealthy lifestyles in adults over 60 years of age with chronic musculoskeletal pain","authors":"A. Loyola-Pinchetti ,&nbsp;M. Jara-Manríquez ,&nbsp;T. Vera-Vera ,&nbsp;A. Venegas-Rodríguez ,&nbsp;C. Santander ,&nbsp;M. Moena-León ,&nbsp;Á. Besoain-Saldaña ,&nbsp;C. Cruz-Montecinos ,&nbsp;R. Núñez-Cortés","doi":"10.1016/j.redare.2026.502129","DOIUrl":"10.1016/j.redare.2026.502129","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic musculoskeletal pain in older adults is associated with unhealthy lifestyles, possibly influenced by social determinants of health (SDH).</div></div><div><h3>Objective</h3><div>To identify the association between SDH and unhealthy lifestyles in older adults with chronic musculoskeletal pain.</div></div><div><h3>Material and methods</h3><div>A cross-sectional study was conducted. A structured survey was administered to assess SDH (gender, educational level, income, availability of green spaces, rurality, multimorbidity, and cohabitation) and lifestyles (physical activity: IPAQ; sleep quality: abbreviated PSQI; perceived stress: PSS-4; adherence to the Mediterranean diet: MedDiet Score). Mann–Whitney U tests and multivariate logistic regression models were applied.</div></div><div><h3>Results</h3><div>One hundred people were included (mean age 69.0 ± 9.8; 83% women). Forty percent were physically inactive, 71% had poor sleep quality, 36% had high perceived stress, and 76% had low adherence to the Mediterranean diet. Female sex was associated with poorer sleep quality (p = 0.023), absence of green areas with less weekly walking time (p = 0.042), multimorbidity with higher perceived stress (p = 0.039), and low educational level with lower adherence to the Mediterranean diet (p = 0.022). These findings were maintained in logistic regression models adjusted for age, body mass index, and pain intensity.</div></div><div><h3>Conclusions</h3><div>Being female, having lower educational attainment, living without access to green areas, and presenting multimorbidity were associated with poorer sleep, decreased dietary adherence, lower physical activity, and higher stress, respectively. These findings correspond to associations observed in a cross-sectional design and do not allow causal relationships to be established.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502129"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152718","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":"Anaesthetic management for pulmonary bilobectomy in a patient with previous contralateral lobectomy and total laryngectomy with tracheostomy","authors":"R. Iraburu,&nbsp;J. Fernández,&nbsp;C. Francisco,&nbsp;M. Taboada","doi":"10.1016/j.redare.2026.502026","DOIUrl":"10.1016/j.redare.2026.502026","url":null,"abstract":"<div><div>Pulmonar lobectomy by video-assisted thoracoscopic surgery (VATS) usually requires collapse of the operative lung and ventilation of the contralateral lung only. The complexity of anaesthetic management in such procedures is further increased by patient comorbidities and previous pathologies. We report the case of a patient scheduled for right lower lobectomy by VATS with a history of previous left lower lobectomy and total laryngectomy with permanent tracheostomy after a glottic carcinoma. A left-sided double-lumen tube was used in combination with a bronchial blocker in order to allow selective ventilation of the right upper lobe should intraoperative hypoxaemia occur.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502026"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147877048","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":"KETOMED Study Protocol: Ketonemia and emergence delirium in a multicenter study","authors":"R. Poves Álvarez ,&nbsp;E. López-Santín ,&nbsp;B. Martínez-Rafael ,&nbsp;R. Badenes ,&nbsp;M. Varela ,&nbsp;A. Abad-Gurumeta ,&nbsp;S. de Miguel-Manso ,&nbsp;M.A. Miñambres-Villar ,&nbsp;E. Carrasco Serrano ,&nbsp;A. Fernández-Urbón ,&nbsp;E. Tamayo ,&nbsp;E. Gómez Pesquera","doi":"10.1016/j.redare.2026.502131","DOIUrl":"10.1016/j.redare.2026.502131","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergence Delirium (ED) following general anaesthesia affects up to a third of paediatric patients. Its multifactorial aetiology suggests that the metabolic state derived from preoperative fasting plays a significant role. Ketonemia, a physiological state associated with fasting, has been minimally investigated as an independent risk factor for ED. The KETOMED study aims to determine whether preoperative ketonemia is independently associated with the development of emergence delirium in the paediatric population.</div></div><div><h3>Material and methods</h3><div>Multicentre observational study in paediatric patients under general anaesthesia. Participants will be grouped based on the presence or absence of ED, defined using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Inclusion and exclusion criteria have been based on age, surgical type, and anaesthesia protocol. Main outcome will be ED and its association with ketone levels. Secondary outcomes include other clinical and sociodemographic risk factors and parental satisfaction.</div></div><div><h3>Discussion</h3><div>Despite the number of studies showing the beneficial role of ketone bodies in cerebral development, little is known of their potential role in the induction of ED. KETOMED addresses this issue in a robust prospective study using validated tools, including the Spanish translation of the PAED scale.</div></div><div><h3>Conclusion</h3><div>KETOMED is expected to establish evidence supporting the implementation of low-cost preoperative ketonemia screening. The results have the potential to guide clinical practice regarding fasting management and clear fluid administration, ultimately aiming to reduce the incidence of ED and improve the quality and safety of paediatric anaesthetic recovery.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502131"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059295","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":"Lumbar plexus block with ultrasound-guided shamrock technique: In-plane versus novel out-of-plane approach","authors":"K. Ökmen,&nbsp;G. Güler,&nbsp;G.K. Ülker","doi":"10.1016/j.redare.2026.502128","DOIUrl":"10.1016/j.redare.2026.502128","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar plexus block (LPB) can be used with different techniques for anaesthesia and postoperative analgesia during femoral surgery. This study aimed to compare in-plane and out-of-plane methods using the Shamrock technique.</div></div><div><h3>Methods</h3><div>Forty-two patients scheduled for surgery due to femoral neck fractures were included in this randomized controlled study. The Shamrock technique was used to visualise the lumbar plexus. Patients were randomized to 2 groups: one group received LPB using the in-plane technique (IP group, <em>n</em> = 20), and the other received LPB using the out-of-plane technique (OOP group, <em>n</em> = 20). The primary outcome measure was block procedure time. Secondary outcomes included the number of needle insertions and redirections, needle depth (cm), minimal nerve stimulation (mA), sensory and motor block levels, and epidural spread.</div></div><div><h3>Results</h3><div>No statistically significant difference was found between the groups in block procedure times (<em>p</em> &gt; 0.05).The number of insertions and the number of needle redirections were significantly lower in the OOP group compared to the IP group (<em>p</em> = 0.005). The needle depth was significantly greater in the IP group compared to the OOP group (6.5 ± 1.1 cm vs 5.1 ± 0.8 cm, <em>p</em> = 0.001). No difference was found in sensory and motor block times (<em>p</em> &gt; 0.05). No differences were observed in the number of patients with epidural spread or in the incidence of complications (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>The OOP technique demonstrated similar efficacy to the IP method using the Shamrock technique. The OOP technique can be used as an alternative for elderly patients in whom the IP technique can be difficult.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502128"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102387","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":"Teaching and training in ultrasound-guided regional anaesthesia","authors":"P. Diéguez García ,&nbsp;S. López Álvarez ,&nbsp;C. del Olmo","doi":"10.1016/j.redare.2026.502136","DOIUrl":"10.1016/j.redare.2026.502136","url":null,"abstract":"<div><div>The widespread adoption of ultrasound in regional anaesthesia has profoundly changed both clinical practice and the way this field should be taught. The current challenge is not merely the availability of more blocks or approaches, but preventing the growing number of variants and terms from leading to fragmented learning and inconsistent clinical decision-making. From this standpoint, competence should be viewed as the integration of clinical judgement, evidence-informed selection, pharmacological knowledge, safe technical performance, proper documentation, patient communication, and follow-up. Within such a framework, simulation should occupy a central place in training pathways not only during residency, but also in the continuing education of professionals involved in regional anaesthesia, because it supports competency-based progression and allows more objective assessment of learning outcomes. Accreditation processes promoted by scientific societies may help standardise practice, provided that adequate educational resources and teaching capacity are available for real implementation. In high-pressure clinical settings with frequent staff turnover, standardisation of training and care processes does not oppose clinical individualisation, but rather makes it safer, more reproducible, and better adapted to each patient’s characteristics.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502136"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944547","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":"Safety rounds as a tool to improve quality and safety in postoperative care units: A quasi-experimental study","authors":"J.J. López-Picazo Ferrer ,&nbsp;I. Vidal-Abarca Gutiérrez ,&nbsp;P. Doménech Asensi ,&nbsp;J. Padilla Rodríguez ,&nbsp;V. Valera Gómez ,&nbsp;J.M. Marín Martínez ,&nbsp;C. Garcia Palenciano","doi":"10.1016/j.redare.2026.502120","DOIUrl":"10.1016/j.redare.2026.502120","url":null,"abstract":"<div><h3>Introduction</h3><div>Safety rounds (SR) have become an effective strategy to enhance safety culture across various healthcare settings. Surgical critical care units (SCCUs) and postanesthesia care units (PACUs) are high-risk environments where active surveillance and early risk identification are essential to ensure safe care. This study aims to evaluate the applicability and effectiveness of SR in SCCUs and PACUs, providing evidence of their impact on quality and patient safety improvement.</div></div><div><h3>Methods</h3><div>A quasi-experimental study was conducted in a tertiary-level Spanish hospital with multidisciplinary participation. A structured four-phase procedure was designed for SR implementation in SCCUs and PACUs. Twelve key safety indicators were assessed through direct observation and document review using lot quality assurance sampling.</div></div><div><h3>Results</h3><div>Six SRs were conducted between 2022 and 2024. A progressive improvement in indicator compliance was observed, with non-compliance decreasing from 45% in the first round to 0% in the fourth. Indicators such as “Zero Pneumonia” and “Zero Resistance” showed recurrent difficulties, highlighting critical areas requiring targeted interventions.</div></div><div><h3>Conclusions</h3><div>SRs are an effective and adaptable tool to improve safety in SCCUs and PACUs. Their success relies on a structured approach, visible leadership, and active staff engagement, establishing them as a sustainable strategy for continuous improvement.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502120"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152697","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 metamorphosis of evidence: Predictions for the next decade","authors":"R. Poves-Álvarez ,&nbsp;E. Tamayo","doi":"10.1016/j.redare.2026.502050","DOIUrl":"10.1016/j.redare.2026.502050","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 6","pages":"Article 502050"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059333","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}