Revista espanola de anestesiologia y reanimacion最新文献

{"title":"Training in cardiopulmonary resuscitation among anesthesiology residents in Spain: results of a national survey","authors":"M. Bernardino Santos ,&nbsp;M. Aliaño Piña ,&nbsp;C. Ruiz-Villén ,&nbsp;A. Vidal Marcos ,&nbsp;D. Gutiérrez Martínez ,&nbsp;P. Monedero ,&nbsp;Surveyed co-authors","doi":"10.1016/j.redare.2026.502052","DOIUrl":"10.1016/j.redare.2026.502052","url":null,"abstract":"<div><h3>Background and objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 5","pages":"Article 502052"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","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":"The impact of sedation and analgesia on post-ICU syndrome: Experience from a post-critical care follow-up clinic","authors":"B. Zalba-Etayo ,&nbsp;L. Villén-Lapuente ,&nbsp;J.J. Araíz-Burdio ,&nbsp;J.L. Cabrerizo-García","doi":"10.1016/j.redare.2026.502107","DOIUrl":"10.1016/j.redare.2026.502107","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate physical, cognitive, and psychological complications in critically ill patients following ICU stay and analyse their relationship with sedation and analgesia.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt;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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 5","pages":"Article 502107"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","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":"Preoperative and postoperative anaemia in colorectal cancer surgery: Are we there yet?","authors":"M.A. Warner,&nbsp;T. Richards","doi":"10.1016/j.redare.2026.502041","DOIUrl":"10.1016/j.redare.2026.502041","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 5","pages":"Article 502041"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464609","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":"Use of extracorporeal membrane oxygenation with a cardiotomy reservoir for patient blood management in thoracoabdominal open surgery: A single centre experience","authors":"J.S. Ruano ,&nbsp;C. Aparicio ,&nbsp;A. Gonzalez ,&nbsp;L. Carballo ,&nbsp;L. Enrique Muñoz ,&nbsp;F. Manzano","doi":"10.1016/j.redare.2026.502108","DOIUrl":"10.1016/j.redare.2026.502108","url":null,"abstract":"<div><div>Open thoracoabdominal aortic aneurysm repair (TAAAR) is associated with mortality rates of between 8% and 25%. One of the characteristics of TAAAR is massive bleeding that requires multiple units of blood, plasma and platelets. Following the development of endovascular techniques, open surgery is now reserved for more complex cases, such as collagenopathy diseases or failure of previous endovascular repair. These surgeries carry an even higher risk of bleeding.</div><div>We present 4 cases in which veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and cardiotomy suction were used. In VA-ECMO, we used heparin 100 units/kg to achieve an activated clotting time of up to 250 s. At the end of the procedure, 1 mg of protamine was administered for every 100 units of heparin. This strategy has the advantage of preventing the loss of fibrinogen, coagulation factors and platelets in the blood processed from the cell saver.</div><div>The use of a cardiotomy reservoir with VA-ECMO may help optimise intraoperative patient blood management and reduce the incidence of coagulopathy during TAAAR.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 5","pages":"Article 502108"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583392","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}

{"title":"Perioperative cardiac arrest in obstetric patients","authors":"M. Astete ,&nbsp;H.J. Lacassie ,&nbsp;A. Gálvez","doi":"10.1016/j.redare.2026.502037","DOIUrl":"10.1016/j.redare.2026.502037","url":null,"abstract":"<div><div>Perioperative cardiopulmonary arrest (CPA) in the obstetric patient is a rare but devastating complication, representing a significant clinical challenge due to the speed with which it threatens the lives of the mother and fetus. Although, compared to the general population, obstetric patients have a lower risk due to their youth and fewer comorbidities, recent records show an increase in the incidence of CPA in this group. Anesthetic factors are key, especially when general anesthesia is used, and unexpected conversion from neuraxial blocks poses an additional risk. Success in the management of CPA critically depends on early recognition and a coordinated, structured approach, where understanding the causes and maternal physiology is essential. Emphasizing education specifically dedicated to obstetric CPA is a priority, as conventional approaches like basic and advanced cardiac life support have proven insufficient for the particularities of this setting. To optimize outcomes, it is recommended to train skilled multidisciplinary teams, implement adapted protocols, and carry out timely interventions such as <em>perimortem</em> cesarean section. Effective communication between teams and the application of advanced support measures, always considering maternal and fetal well-being, are decisive factors for prognosis. In summary, perioperative CPA in obstetrics requires specific protocols, ongoing knowledge updates and simulation, with the primary goal of reducing maternal mortality and improving neonatal outcomes in one of the most critical scenarios faced by healthcare teams.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 4","pages":"Article 502037"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483218","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":"Post-spinal position and its impact on hemodynamic, block height, and comfort in caesarean delivery: A randomized assessor-blinded trial","authors":"A. Mohamady Eldemrdash,&nbsp;I. Elabd Hassan,&nbsp;A. Youssef Mohamed,&nbsp;H.M. Ahmed Raslan","doi":"10.1016/j.redare.2026.502089","DOIUrl":"10.1016/j.redare.2026.502089","url":null,"abstract":"<div><h3>Background</h3><div>Maternal hypotension is common during spinal anesthesia for cesarean delivery and is influenced by patient position. Positioning also affects sensory block height, which determines visceral analgesia. This study compared immediate supine, sitting, and semi-sitting positions to identify the optimal balance between cardiovascular stability and surgical anesthesia.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 216 ASA II term parturients scheduled for cesarean delivery under spinal anesthesia were assigned to three groups (n = 72). Group A received immediate supine positioning, Group B sat for three minutes, and Group C assumed semi-sitting for three minutes. All received 2.5 mL of 0.5% hyperbaric bupivacaine. The primary outcome was maternal hypotension; secondary outcomes included block height, intraoperative discomfort, vasopressor use, and neonatal Apgar scores.</div></div><div><h3>Results</h3><div>Hypotension occurred most in Group A (65.3%), followed by Group C (47.2%) and Group B (33.3%) (<em>P</em> &lt; .001). The supine group had 3.79 times higher odds of hypotension compared with sitting. Ephedrine use was greatest in Group A (14.5 ± 3.2 mg) and least in Group B (8.1 ± 2.3 mg). Median block height was T3 in Group A, T5 in Group C, and T6 in Group B. Intraoperative discomfort was highest in Group B (22.2%) compared with Group C (12.5%) and Group A (5.6%) (<em>P</em> = .009). Hypotension correlated with nausea, most frequent in Group A (19.4%). Neonatal Apgar scores were ≥8 at 1 and 5 min in all groups.</div></div><div><h3>Conclusion</h3><div>Maternal position after spinal anesthesia significantly influences hemodynamics and block height. Sitting reduces hypotension but risks lower block and discomfort, while semi-sitting provides a favorable compromise.</div></div><div><h3>Trial registration</h3><div>[NCT06857162].</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 4","pages":"Article 502089"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505959","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":"Relationship between mitral annular plane systolic excursion and left ventricular ejection fraction by modified Simpson’s method using point of care cardiac ultrasound: An observational analytical study","authors":"N. Kumar,&nbsp;K. Arya,&nbsp;M. Pandey","doi":"10.1016/j.redare.2026.502088","DOIUrl":"10.1016/j.redare.2026.502088","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to find the relationship between MAPSE and LVEF by modified Simpson’s method using point of care cardiac ultrasound.</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting</h3><div>Intensive care unit.</div></div><div><h3>Patients</h3><div>Seventy-five patients admitted to the intensive care unit were recruited for determining the relationship between MAPSE and LVEF by modified Simpson’s method. It was validated in the second part in another 75 patients by comparing the result obtained from modified Simpson’s method and the previously derived equation.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements</h3><div>MAPSE, LVEF from modified Simpson’s method in part I. An equation was derived from a linear relationship between the two. In part II, the derived equation for calculation of LVEF from MAPSE was validated with respect to a previously described equation and LVEF obtained by modified Simpson’s method. Bias and precision were calculated. Time taken for both the procedures was also noted.</div></div><div><h3>Results</h3><div>MAPSE showed a strong correlation with LVEF calculated by modified Simpson’s method. The linear equation obtained was LVEF = 3.27 × MAPSE (mm) + 18.79 (ρ = 0.761, R² = 0.520). Time taken for calculation of MAPSE was quicker (51.47 ± 11.18 s) as compared to that by modified Simpson’s method (192.27 ± 31.93 s; <em>P</em> &lt; .001). The equation was found to be 89.33% accurate. A MAPSE of 10.325 mm, predicts EF &gt; 50% with a sensitivity of 90.7% and 90.6% specificity.</div></div><div><h3>Conclusion</h3><div>MAPSE correlates well with the EF measured by modified Simpson’s method. It is faster and provides an accurate estimation of ejection fraction.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 4","pages":"Article 502088"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492448","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}