https://journals.lww.com/ejanaesthesiology/toc/9900/00000 en-us Sat, 02 Aug 2025 20:33:42 -0500 Wolters Kluwer Health RSS Generator https://images.journals.lww.com/ejanaesthesiology/XLargeThumb.00003643-202509000-00000.CV.jpeg https://journals.lww.com/ejanaesthesiology/toc/9900/00000 https://journals.lww.com/ejanaesthesiology/fulltext/9900/incidence_of_transient_sinus_pause_in_cardiac.331.aspx BACKGROUND The hyperanglulated videolaryngoscope blade may exert different forces on the larynx compared to the standard angle blade, potentially leading to haemodynamic changes, particularly in cardiac rhythm. OBJECTIVE This study aimed to investigate the impact of the hyperangulated blade on haemodynamic changes during tracheal intubation. DESIGN A prospective randomised controlled trial. SETTING Tertiary, university hospital, single centre. PATIENTS A total of 134 patients scheduled for general anaesthesia were included in the final analysis INTERVENTION Tracheal intubation using either a standard angle videolaryngoscope blade (Standard group) or a hyperangulated blade (Hyperangulated group). MAIN OUTCOME MEASURES The occurrence of a transient decrease in heart rate or a transient sinus pause during tracheal intubation was recorded. RESULTS The incidence of transient sinus pause was significantly higher in the Hyperangulated group compared to the Standard group (19% vs. 4%, respectively, P = 0.009). The percentage of the glottic opening score was significantly higher, and the incidence of backward, upward, and rightward pressure was significantly lower in the Hyperangulated group. The incidences of direct epiglottis lifting was significantly higher in the Hyperangulated group, and the total length of time of the blade in the mouth was significantly longer in the Hyperangulated group. Multivariate logistic analysis identified the use of a hyperangulated blade as an independent predictor of transient sinus pause during tracheal intubation (odds ratio = 5.73, 95% confidence interval = 1.53 to 21.53; P = 0.010). CONCLUSION The hyperangulated videolaryngoscope blade is associated with a higher incidence of transient sinus pause than the standard angle blade during tracheal intubation. TRIAL REGISTRATION Clinical Research Information Service. Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare (Republic of Korea). (Identifier: KCT0006534). Online address: http://cris.nih.go.kr.]]> Thu, 24 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00331 https://journals.lww.com/ejanaesthesiology/fulltext/9900/inefficiency_of_silica_zeolite_based_scavenging_of.330.aspx No abstract available]]> Tue, 22 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00330 https://journals.lww.com/ejanaesthesiology/fulltext/9900/multimodal_prehabilitation_as_a_strategy_to_reduce.328.aspx BACKGROUND Prehabilitation has shown efficacy in improving postoperative outcomes in abdominal surgery. Data on cardiac surgery are controversial. OBJECTIVE To determine if a multimodal prehabilitation programme reduces the rate of postoperative complications after elective cardiac surgery. DESIGN Randomised controlled trial. SETTING Single-centre study in a tertiary hospital with inclusion period spanned from March 2018 to June 2021. PATIENTS One hundred and fifty-one patients, with an expected waiting time before surgery of 6 weeks or more, completed the study. Excluded were those with functional, anatomical or cognitive impairment; cardiac instability; dynamic left ventricle outflow tract obstruction or proven exercise-induced arrhythmias. INTERVENTION Four to six weeks of a multimodal prehabilitation programme, including exercise training, psychological and nutritional support. MAIN OUTCOME Incidence of postoperative complications. RESULTS No differences were found in the rate of postoperative complications (80% in both groups, P = 0.968), most of which were mild, with a Comprehensive Complication Index of 21 and more than 70% with Clavien–Dindo grade I or II. Prehabilitated patients showed a significant improvement in endurance time assessed by a constant-work rate cycling exercise test: preintervention vs. postintervention (301 ± 109 vs. 578 ± 257 s, P = 0.001), and in 6-min walk test (6MWT) (487 ± 77 vs. 504 ± 74 min, P = 0.001). No patients experienced adverse events attributable to the intervention. A sub-analysis restricted to prehabilitated patients who showed a meaningful response to exercise assessed by the 6MWT (increase ≥ 30 m) showed a reduction in the number and severity of postoperative complications, compared to nonresponders (1.1 ± 0.9 vs. 2 ± 2 complications per patient, P = 0.038); and the Comprehensive Complication Index (16 ± 15 vs. 25 ± 19, P = 0.044). CONCLUSION A multimodal prehabilitation programme before elective cardiac surgery did not reduce the incidence of postoperative complications. Nevertheless, when analysis was restricted to meaningful responders to intervention, a significant reduction in postoperative complications and their severity was observed. TRIAL REGISTRATION ClinicalTrials.gov (NCT03466606).]]> Thu, 17 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00328 https://journals.lww.com/ejanaesthesiology/fulltext/9900/the_effect_of_methylprednisolone_on_the_reversal.329.aspx BACKGROUND Sugammadex is an effective agent for reversing aminosteroid neuromuscular blocking agents, but its effectiveness can be influenced by interactions with steroid-based drugs. Previous studies suggest corticosteroids may affect sugammadex effectiveness, but data on methylprednisolone in paediatric patients is limited. OBJECTIVE This study aimed to determine whether methylprednisolone administration at induction affects the reversal time of rocuronium by sugammadex. DESIGN Single centre, double blinded, randomised controlled trial. SETTINGS Turkish tertiary care centre from September 2024 to January 2025. STUDY POPULATION Paediatric patients undergoing elective adenoidectomy and/or tonsillectomy. INTERVENTION(S) Patients were randomly assigned to receive either methylprednisolone 1 mg kg−1 (group M) or a placebo (group C) with anaesthesia induction. Neuromuscular block was induced with rocuronium, monitored using acceleromyography and reversed with sugammadex 2 mg kg−1 at the end of surgery. MAIN OUTCOME MEAURES The primary outcome was the reversal time of rocuronium by sugammadex: time from sugammadex administration at train of four (TOF) count = 2 to a TOF ratio of ≥0.9 of baseline. Secondary outcomes included extubation time (time from sugammadex administration at TOF count = 2 to extubation), postoperative pain, nausea and vomiting scores, and incidence of adverse events (stridor, hoarseness, severe cough and desaturation). RESULTS At 89 ± 20.3 s, the reversal time of rocuronium by sugammadex was statistically significantly longer in group M compared with the 54.6 ± 9.3 s of group C (P < 0.001). The mean with 95% confidence interval (CI) of the difference was 34.5 (27.3 to 41.6) s. The extubation time was also significantly prolonged in group M compared with group C: 426.8 ± 134.4 vs. 331.3 ± 129.0 s (P = 0.002) with a difference of 95.5 (95% CI, 36.8 to 154.2) s. No significant differences were observed in postoperative pain, nausea and vomiting scores, or frequency of adverse events. CONCLUSION Although methylprednisolone administration resulted in a significantly prolonged reversal of rocuronium-induced neuromuscular block by sugammadex and subsequent delayed extubation, the clinical importance of this interaction is minor. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06623370]]> Thu, 17 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00329 https://journals.lww.com/ejanaesthesiology/fulltext/9900/editorial_commitment_to_trust_and_integrity_in.327.aspx No abstract available]]> Wed, 16 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00327 https://journals.lww.com/ejanaesthesiology/fulltext/9900/post_discharge_digital_health_technology.326.aspx BACKGROUND Given the early discharge associated with ambulatory surgery, digital health interventions (DHIs) may be useful in out of hospital follow-up. However, there are no systematic reviews concerning the use of DHIs in this setting. OBJECTIVE To identify and evaluate the effects of DHIs on, patient safety, patient experience, and efficiency in post discharge ambulatory surgery. DESIGN Systematic review and meta-analysis. Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation were used. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus were systematically searched from inception to 9 October 2024. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs); ambulatory surgical patients ≥18 years; post discharge digital health interventions, including but not limited to computer tablets, mobile applications, and smart phones. Control group interventions included post discharge follow-up by a general practitioner, office-based follow-up, telephone follow-up, or no intervention. RESULTS Six RCTs, with a total of 1397 patients were included. The meta-analyses showed no significant effects of DHIs compared with control group interventions on average pain intensity during postoperative days one to three, standardised mean difference = −0.15 (95% CI, −0.66 to 0.35), P = 0.556, or on unplanned healthcare encounters up to six months postoperatively, relative risk = 0.98 (95% CI, 0.92 to 1.05), P = 0.580. A review of individual articles showed that patients in the DHI groups reported significantly less impaired sleep, mood swings, stress, dizziness, headaches, sore mouth, constipation, and wound-related problems. Additionally, costs were lower, and patients reported improved functional status and well being compared with the control group. The risk of bias varied from low to moderate and the quality of evidence was low. CONCLUSIONS Digital health interventions may reduce some symptoms and costs following discharge from ambulatory surgery, while improving quality of life. However, uncertainty remains due to the limited number of studies, some inconsistent results, and the low certainty of evidence.]]> Mon, 14 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00326 https://journals.lww.com/ejanaesthesiology/fulltext/9900/ultrasonographic_assessment_of_sugammadex_enhanced.324.aspx BACKGROUND In adults, sugammadex promotes faster neuromuscular recovery compared with neostigmine; however, its impact on diaphragmatic recovery and atelectasis in children remains unelucidated. OBJECTIVES We compared the effects of sugammadex and neostigmine on restoration of diaphragmatic function and postoperative atelectasis in paediatric patients. DESIGN A prospective randomised controlled study SETTING Seoul National University Children's Hospital, Seoul, Republic of Korea PATIENTS A total of 73 children aged 2 to 7 years were randomised to receive either sugammadex (2 mg kg-1, n = 36) or neostigmine (0.02 mg kg-1, n = 37) for neuromuscular blockade reversal when the train-of-four count reached 4 (train-of-four ratio < 0.9). MAIN OUTCOME MEASURES The diaphragmatic excursion (DE) and thickening fraction (TF) were measured by ultrasound at three timepoints: baseline (T0), before postanaesthesia care unit (PACU) admission (T1) and 30 min after PACU admission (T2). Atelectasis was assessed via lung ultrasonography at T1 and T2. The primary outcome was the diaphragmatic excursion ratio at T1 (DET1/DET0), and secondary outcomes included the DET2/DET0, TFT1/TFT0, TFT2/TFT0 atelectasis score and incidence of significant atelectasis. RESULTS At T1, the DET1/DET0 was significantly higher in the sugammadex group (neostigmine vs. sugammadex group, 0.91 ± 0.19 vs. 1.02 ± 0.24; P = 0.034) as was the TFT1/TFT0 (0.93 ± 0.39 vs. 1.15 ± 0.49; P = 0.041). No significant intergroup differences were found in the DET2/DET0 and TFT2/TFT0. The atelectasis score and incidence of significant atelectasis were comparable between the groups. CONCLUSIONS Compared to neostigmine, sugammadex accelerates diaphragmatic recovery immediately after extubation; however, this early recovery does not significantly reduce the incidence of postoperative atelectasis. TRIAL REGISTRATION NUMBER NCT05724550]]> Tue, 08 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00324 https://journals.lww.com/ejanaesthesiology/fulltext/9900/mean_arterial_pressure_is_all_you_need_in_a.325.aspx BACKGROUND Anaesthesiology and intensive care use monitoring to identify patients in danger of deterioration. Traditionally, trends and early warning scores allow clinicians to predict deterioration with moderate reliability. Reduced mean arterial blood pressure has been associated with complications, and models have been sought to predict its value. Machine learning methods with complex inputs have been used for predictive monitoring in hospital care. OBJECTIVES This study evaluates whether machine learning can predict mean arterial pressure (MAP) from previous values. DESIGN This is a monocentre, retrospective, exploratory, observational cohort study using the MIMIC-III-WDB, VitalDB and an internal study centre dataset, training machine learning models on adult patients with invasively measured blood pressure (IBP) as input during an observation window up to 20 min before the prediction horizon (5 to 20 min). SETTING Kepler University Hospital, Linz, Austria. PARTICIPANTS Two thousand three hundred and forty-six patients from the internal dataset, 4741 patients from MIMIC-III-WDB and 3357 patients from VitalDB were analysed. MAIN OUTCOME MEASURES The primary endpoint was model performance in predicting whether MAP would fall below 65 mmHg in a given time frame. In a secondary analysis, we restricted the input set to stable patients with current MAP above 65 mmHg. RESULTS Models using the complete training data achieved receiver operating characteristic area under the curves (ROC AUCs) of 0.963, 0.946, 0.934 and 0.923 on the internal dataset for 5, 10, 15 and 20 min of prediction horizon, respectively, and 0.856, 0.837, 0.821 and 0.804 in the secondary analysis. The maximum difference of ROC AUC to baseline measurement (ROC AUC of last measured MAP as trivial estimator) was 0.006 for the complete training data and 0.051 for stable patients. The prediction of MAP may allow clinicians to intervene in time before MAP deterioration becomes clinically relevant. CONCLUSION Predicting MAP below 65 mmHg within 5, 10, 15 and 20 min for patients with and without a MAP above 65 mmHg is possible and requires only MAP as input for machine learning models. TRIAL REGISTRATION ClinicalTrials.gov (NCT05471193)]]> Tue, 08 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00325 https://journals.lww.com/ejanaesthesiology/fulltext/9900/_the_trachea_heals_but_the_hypoxia_does_not__an.323.aspx ‘Can’t Intubate Can’t Oxygenate’ (CICO) situation is a life-threatening emergency, and an uncommon event in the healthy paediatric population. In children without anatomical airway anomalies, this scenario is most often due to laryngospasm or airway obstruction and can in most cases, be reversed with appropriate medical treatment or removal of the foreign body. This case report describes an emergency front-of-neck surgical airway (eFONA) with a scalpel–bougie–tube method, during cardiopulmonary resuscitation in a 4-year-old child due to foreign body airway obstruction.]]> Mon, 07 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00323 https://journals.lww.com/ejanaesthesiology/fulltext/9900/new_onset_postoperative_hypotension_in_patients.322.aspx BACKGROUND It remains unknown whether postoperative mean arterial pressures less than 65 mmHg constitute clinically important hypotension for individual patients, or might be within their normal pressure range. OBJECTIVE We aimed to evaluate postoperative arterial pressure in patients recovering from noncardiac surgery and determine the proportion of patients in whom a mean arterial pressure less than 65 mmHg constitutes new-onset postoperative hypotension. DESIGN A prospective observational study. SETTING German university medical centre between October 2020 and September 2021. PATIENTS Patients with elevated cardiovascular risk recovering on general wards from noncardiac surgery under general anaesthesia. MAIN OUTCOME MEASURES Before and after surgery, we automatically measured arterial pressure at 30-min intervals for about 24 h. We considered patients to have new-onset postoperative hypotension when they had a postoperative mean arterial pressure less than 65 mmHg, and their lowest postoperative mean arterial pressure was at least 5 mmHg below their lowest pre-operative mean arterial pressure. RESULTS We enrolled 307 patients and included 248 in the final analysis. The median [IQR] duration of surgery was 62 [40 to 90] min. Postoperative mean arterial pressure was less than 65 mmHg at least once in 101 patients (41%). In 44 of these 101 patients (44%; 18% of all 248 patients), postoperative mean arterial pressures less than 65 mmHg constituted new-onset postoperative hypotension. In 57 of these 101 patients (56%; 23% of all 248 patients), postoperative mean arterial pressures less than 65 mmHg did not constitute new-onset postoperative hypotension. CONCLUSION About 40% of our patients recovering from noncardiac surgery on general wards had at least one postoperative mean arterial pressure less than 65 mmHg, and about half of these patients had new-onset postoperative hypotension.]]> Thu, 03 Jul 2025 00:00:00 GMT-05:00 00003643-990000000-00322 https://journals.lww.com/ejanaesthesiology/fulltext/9900/comparison_of_analgesic_efficacy_and_safety_of.317.aspx BACKGROUND The established analgesic efficacy and safety of dexmedetomidine in children has demonstrated a rise in its use and various administration routes have been explored. However, clinical comparisons between caudal and intranasal dexmedetomidine are lacking. OBJECTIVES We aimed to compare the analgesic efficacy, postanaesthesia recovery characteristics and side effects associated with caudal versus intranasal dexmedetomidine as an adjunct to a single-shot caudal block in paediatric infraumbilical surgeries. DESIGN A noninferiority randomised controlled trial. SETTING A tertiary care hospital from November 2022 to May 2024. PATIENTS Sixty-four children aged 1 to 8 years undergoing infraumbilical surgeries under general anaesthesia supplemented with caudal analgesia. INTERVENTIONS Patients were randomised to receive either caudal dexmedetomidine (1 ml kg−1 caudal 0.2% ropivacaine + 1 μg kg−1 caudal dexmedetomidine) or intranasal dexmedetomidine (1 ml kg−1 caudal 0.2% ropivacaine + 1 μg kg−1 intranasal dexmedetomidine). MAIN OUTCOME MEASURES The primary outcome was the duration of postoperative analgesia. Other outcomes assessed included postoperative pain scores, peri-operative analgesic consumption, peri-operative haemodynamics, postoperative recovery profile and adverse events for 24 h postoperatively. RESULTS The duration of postoperative analgesia in caudal and intranasal group was 527 ± 83 and 545 ± 90 min, respectively (P  = 0.422). There was a comparable decrease in the intra-operative heart rate. The greater number of episodes of intra-operative hypotension in the caudal group (P  = 0.016) did not warrant vasopressors. Children in the caudal group were more sedated until 2 h postsurgery following which the sedation scores in both the groups were equivalent. Postoperative pain scores, peri-operative analgesic consumption and the incidence of emergence delirium was comparable. No adverse events were reported in either group. CONCLUSION Intranasal dexmedetomidine can be considered a feasible analgesic adjunct to a single-injection caudal block in children undergoing infraumbilical surgeries associated with a smooth recovery profile and no associated adverse effects. CLINICAL TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2022/09/045492; http://www.ctri.nic.in).]]> Fri, 27 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00317 https://journals.lww.com/ejanaesthesiology/fulltext/9900/remimazolam_tosylate_or_propofol_and_delirium_in.318.aspx BACKGROUND Remimazolam tosylate, a novel short-acting benzodiazepine, is increasingly being used in general anaesthesia, but its role in the incidence of postoperative delirium is uncertain, particularly in frail elderly patients. OBJECTIVE To compare the effects of remimazolam tosylate with propofol on the incidence of postoperative delirium in frail elderly patients undergoing hip surgery. DESIGN Randomised, single-centre, single-blind controlled trial. SETTING A tertiary teaching hospital in China, conducted from March to December 2023. PATIENTS Frail elderly patients (Reported Edmonton Frail Scale Score ≥ 6) undergoing hip surgery under general anaesthesia. INTERVENTIONS Patients were randomly assigned to either the propofol or remimazolam group. Both groups received total intravenous anaesthesia following a standardised protocol with either propofol or remimazolam tosylate for induction and maintenance. MAIN OUTCOME MEASURES The primary outcome was the incidence of postoperative delirium within three postoperative days, assessed twice daily using the 3D Confusion Assessment Method (3D-CAM). The secondary outcomes included the quality of postoperative recovery and adverse events. RESULT A total of 136 patients were enrolled. The incidence of postoperative delirium was significantly lower in the remimazolam group than in the propofol group [3 of 68 (4.4%) vs. 12 of 68 (17.6%), risk differece (RD) -13.2%, 95% CI -23.5% to -2.9%, relative risk (RR) 0.25, 95% CI 0.074 to 0.847, NNT 7.6, P = 0.0143]. The incidence of hypotension after induction was also lower in the remimazolam group [16 of 68 (23.5%) vs. 32 of 68 (47.1%), RD -23.5%, 95%CI -39.1% to -8.0%, RR 0.5, 95% CI 0.304 to 0.822, NNT 4.3, P = 0.004], with fewer patients requiring vasopressors [55 of 68 (80.9%) vs. 66 of 68 (97.1%), RD -16.2%, 95% CI -26.3 to -6.0, RR 0.8, 95% CI 0.737 to 0.942, NNT 6.2, P = 0.003]. Notably, the remimazolam group exhibited significantly less burst suppression compared with the propofol group, both in terms of burst suppression time (2.2 s [0 to 17.6] vs. 21.9 s [2.3 to 115.3] median difference = 11.98 s, 95% CI 2.44 to 27.90, P < 0.001) and its proportion relative to the total surgery time (0.3‰ [0 to 2.1] vs. 2.8‰ [0.2 to 14.7], median difference 1.30‰, 95% CI 0.27 to 3.34, P < 0.001). CONCLUSION In frail elderly patients, remimazolam tosylate was associated with a lower incidence of postoperative delirium compared with propofol. TRIAL REGISTRATION Chinese Clinical Trial Registry, Chictr.org.cn, identifier: ChiCTR2300068632.]]> Fri, 27 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00318 https://journals.lww.com/ejanaesthesiology/fulltext/9900/anaesthesia_in_2050__how_emerging_technologies.319.aspx In the next 25 years, we will see unprecedented technological progress due to the artificial intelligence (AI) revolution. AI-driven advances will be made in five strongly interconnected domains: reenergised drug discovery, continuous real-time monitoring, personalised medicine, automation and decentralised care. Drug discovery will move from in vitro to in silico approaches. We will identify molecules that fit protein targets and protein targets that fit molecules, allowing us to better understand mechanisms of anaesthesia and pain. Improved monitoring of physiological and biological variables will lead to better assessment and prediction of haemodynamics, anaesthetic depth and nociception. Anaesthetic care will be personalised by AI-driven analysis of population, personal and biomarker data, as well as an understanding of the values and wishes of patients. Automation will streamline routine tasks in hospitals, especially in relation to documentation and service delivery. Remote monitoring and assistance systems will help patients receive more of their care at home. The introduction of AI may have unforeseen consequences, especially for equity, sustainability and the future of work. We must think deeply about the future role of anaesthesiologists and ensure that we are involved in redesigning our role. AI can simulate empathy, and will do so increasingly well, but most of us will not be deceived because it is not the human-to-human connection that we crave. Perhaps the greatest gift of AI in anaesthesia practice will be that we come to value what it means to be human.]]> Fri, 27 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00319 https://journals.lww.com/ejanaesthesiology/fulltext/9900/continuous_positive_airway_pressure_to_prevent.320.aspx BACKGROUND Pulmonary complications, including atelectasis and reintubation, are common after cardiac surgery and are associated with increased morbidity and mortality. Postoperative continuous positive airway pressure (CPAP) may reduce these risks, but its effectiveness remains uncertain. OBJECTIVES To assess whether CPAP reduces the need for reintubation in hypoxaemic patients after cardiac surgery, and to evaluate its effect on other postoperative pulmonary complications. DESIGN Multicentre, open-label, randomised clinical trial. The study was prematurely terminated due to funding constraints, leading to an underpowered sample. SETTING Ten university-affiliated hospitals across Italy. PATIENTS Adults undergoing cardiac surgery with cardiopulmonary bypass who developed a PaO2/FiO2 ratio 200 or less within 1 h of extubation. Exclusion criteria included severe COPD, previous mechanical ventilation and lack of consent. MAIN OUTCOME MEASURES The primary endpoint was reintubation within 28 days of surgery. Secondary endpoints included atelectasis, pneumonia, sepsis, mortality and oxygenation. RESULTS The incidence of reintubation was 10.8% (95% confidence interval [CI], 6.52 to 15.15) in the control group and 8.3% (95% CI, 4.51 to 12.16) in the treatment group (P = 0.3908). In contrast, the occurrence of atelectasis was significantly higher in the control group at 24.1% (95% CI, 18.20 to 30.07) compared with 14.2% (95% CI, 9.38 to 19.05) in the treatment group (P = 0.0110). At 48 h, the incidence of reintubation was significantly lower in the CPAP group 2.94% (95% CI, 0.60 to 5.28) compared with the control group, 7.39% (95% CI, 3.76 to 11.02), P = 0.0425. No significant differences in pneumonia, sepsis or mortality were observed. CPAP significantly improved oxygenation (P < 0.0001). CONCLUSION CPAP did not significantly reduce 28-day reintubation rates compared with oxygen therapy via Venturi mask. However, CPAP was associated with a significant reduction in atelectasis and early reintubation at 48 h. Further research is warranted to confirm these findings and compare CPAP with other noninvasive support strategies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01726140]]> Fri, 27 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00320 https://journals.lww.com/ejanaesthesiology/fulltext/9900/postmarketing_safety_analysis_of_remimazolam_.315.aspx BACKGROUND Remimazolam is a new ultra-short-acting benzodiazepine used in anaesthesia, valued for its rapid metabolism and reversibility. Despite its growing clinical use, a comprehensive assessment of its real-world safety profile remains essential. OBJECTIVE To evaluate the postmarketing safety of remimazolam using adverse event (AE) data from the US and Japanese pharmacovigilance databases. DESIGN Retrospective analysis of AEs associated with remimazolam using disproportionality analysis techniques. SETTING FDA Adverse Event Reporting System (FAERS) and Japanese Adverse Drug Event Report database (JADER) from January 2020 to December 2023. PARTICIPANTS Patients who experienced remimazolam-related AEs reported in the FAERS and JADER databases. MAIN OUTCOME MEASURES Identification of significant AEs using reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network and multiitem gamma Poisson shrinker. Categorisation of AEs using the ’Important Medical Event Terms List’ (IME) list (version 26.1). RESULTS We identified 199 remimazolam-related reports (69 from FAERS, 130 from JADER) revealing 20 significant AEs. Key findings include previously unlabelled serious AEs such as cardiac, cardio-respiratory, and respiratory arrests; nine events classified as Important Medical Events, including hypotension and anaphylaxis; four AEs not included in current Food and Drug Administration (FDA) labelling; and low-frequency but clinically significant off-label events including arrhythmias and postoperative delirium. CONCLUSIONS While remimazolam shows a generally acceptable safety profile, our pharmacovigilance analysis identified serious unlabelled reactions requiring clinical vigilance. Practice recommendations include judicious administration with balanced crystalloids and comprehensive cardiorespiratory monitoring. Future research should address prospective surveillance of rare serious events, optimal administration protocols to prevent vascular occlusions and investigation of anaphylactic reactions. TRIAL REGISTRATION Not applicable.]]> Tue, 24 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00315 https://journals.lww.com/ejanaesthesiology/fulltext/9900/guidelines_on_strategies_for_the_universal.312.aspx OBJECTIVE The Airway Section of the Spanish Society of Anaesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), the Latin American Federation of Emergency Medicine (FLAME) and an international group of airway experts (IAG) aimed to establish multidisciplinary recommendations advocating for the universal use of videolaryngoscopy (VL) in both emergency and planned care settings. DESIGN A committee of experts from the two national scientific societies and an international group of airway experts was convened. Relevant research questions aligning with the document's objective were identified. A rapid systematic review of the evidence was performed, and the quality of evidence was assessed. Recommendations were formulated using the GRADE methodology (Grading of Recommendations Assessment, Development, and Evaluation) The entire process was conducted independently of industry funding. METHODS Six domains were defined pertaining to VL: Clinical Benefits; Infrastructure and Accessibility; Clinical Guidelines and Protocols; Teaching and Clinical Training; Dissemination and Promotion of Clinical Benefits; Innovation, Sustainability, and Research. For each domain, specific questions were developed using the PICO model (Population, Intervention, Comparison, and Outcomes). A literature search was conducted following PRISMA-R guidelines and analysed using the GRADE methodology. RESULTS The synthesis process resulted in 12 recommendations. Due to the low quality of available evidence, most recommendations were formulated based on expert opinion. CONCLUSION The experts achieved strong consensus, formulating 12 recommendations to support strategies aimed at universalising the use of videolaryngoscopy.]]> Thu, 19 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00312 https://journals.lww.com/ejanaesthesiology/fulltext/9900/continuous_noninvasive_blood_pressure_monitoring.311.aspx BACKGROUND The Biobeat wrist monitor (BB-613W; Biobeat Technologies, Petah-Tikva, Israel) and the Biobeat chest monitor (BB-613P; Biobeat Technologies) are wearable solutions for continuous noninvasive blood pressure monitoring. OBJECTIVE(S) We aimed to investigate the blood pressure measurement performance of the Biobeat wrist monitor and chest monitor after external calibration. DESIGN A prospective method comparison study. SETTING University Medical Center Hamburg-Eppendorf, Hamburg, Germany. PATIENTS Fifty high-risk patients recovering from noncardiac surgery in an advanced postanaesthesia care unit. MAIN OUTCOME MEASURES We compared blood pressure measurements from the Biobeat wrist monitor (BPWRIST-ART) and the Biobeat chest monitor (BPCHEST-ART) with intra-arterial blood pressure measurements (BPART). In addition, we aimed to compare blood pressure measurements from the Biobeat wrist monitor (BPWRIST-OSCI) with those from an oscillometric upper-arm cuff (BPOSCI). We used Bland–Altman analysis, four-quadrant plot and error grid analysis for statistical analysis. RESULTS The mean of the differences ± standard deviation (95%-limits of agreement) between BPWRIST-ART and BPART was 3 ± 11 mmHg (-19 to 25 mmHg) for mean blood pressure with a concordance rate to track 15-min blood pressure changes of 51%. The mean of the differences between BPCHEST-ART and BPART was 3 ± 11 mmHg (-17 to 24 mmHg) for mean blood pressure with a concordance rate to track 15-min blood pressure changes of 61%. The mean of the differences between BPWRIST-OSCI and BPOSCI was 6 ± 11 mmHg (-16 to 27 mmHg) for mean blood pressure with a concordance rate to track 15-min blood pressure changes of 49%. CONCLUSIONS Blood pressure measurements from the Biobeat wrist monitor and the Biobeat chest monitor did not show clinically acceptable agreement either with intra-arterial blood pressure measurements or with blood pressure measurements from an oscillometric upper-arm cuff in high-risk patients recovering from noncardiac surgery in an advanced postanaesthesia care unit.]]> Thu, 12 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00311 https://journals.lww.com/ejanaesthesiology/fulltext/9900/intraoperative_hypotension_during_robotic_assisted.310.aspx BACKGROUND Robot-assisted radical prostatectomy (RARP) represents the leading application of robotic surgery in the treatment for prostate cancer with faster recovery and reduced invasiveness. Maintaining stable blood pressure during RARP is crucial to avoid complications. The approach used is goal-directed therapy (GDT); however, the Hypotension Prediction Index (HPI), a machine learning algorithm that analyses arterial waveforms, may provide additional benefits. OBJECTIVE To evaluate the cumulative amount, frequency and duration of intraoperative hypotension episodes in patients undergoing RARP, comparing those managed with a GDT protocol guided by the HPI algorithm versus those managed without it. DESIGN Prospective randomised study. SETTING Single-centre university hospital. Recruitment from January 2022 to April 2023. PARTICIPANTS Eighty-two patients. INTERVENTIONS Patients undergoing RARP were randomly assigned to either a GDT protocol alone (control) or a GDT protocol guided by the HPI (HPI group). All patients received both general anaesthesia and a single-shot spinal technique. MEAN OUTCOME MEASURES Cumulative amount of intraoperative hypotension [measured using the time-weighted average (TWA) of mean arterial pressure (MAP) below 65 mmHg]; frequency of hypotensive events; duration of hypotensive events; postoperative complications; length of stay. RESULTS No differences were observed in TWA-MAP, or in the frequency and duration of hypotensive events between the groups. Both groups maintained stable haemodynamics with minimal hypotension, and had similar fluid infusion and vasoconstrictor administration. Additionally, there were no differences in postoperative complications or length of stay. CONCLUSIONS In our study, HPI guidance did not reduce intraoperative hypotension during RARP. Interestingly, the control group experienced fewer hypotensive events than typically reported in the literature, likely because of the high standards of haemodynamic and anaesthesiologic management maintained across both groups. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT06535464.]]> Tue, 10 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00310 https://journals.lww.com/ejanaesthesiology/fulltext/9900/hypnotic_and_antinociceptive_contribution_of.308.aspx No abstract available]]> Fri, 06 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00308 https://journals.lww.com/ejanaesthesiology/fulltext/9900/regional_anaesthesia_related_complications_in.306.aspx BACKGROUND Regional anaesthesia is widely used in clinical practice, offering significant benefits but carrying risks such as nerve damage and other complications. Understanding medicolegal trends associated with regional anaesthesia is essential for improving patient safety and refining practices. OBJECTIVE(S) To analyse closed claims related to regional anaesthesia in Switzerland over the past 30 years, identify trends in complications and assess their medicolegal implications. DESIGN Retrospective analysis of the Swiss Anaesthesiology Closed Claims Analysis database, focusing on cases involving regional anaesthesia from 1992 to 2022. SETTING The study was conducted using data from Swiss medical malpractice insurers and the Swiss Society of Anaesthesiology and Perioperative Medicine together with their Foundation for Patient Safety in Anaesthesia. PATIENTS A total of 244 closed claims of patients were reviewed, of which 140 cases involved regional anaesthesia. INTERVENTION(S) None. MAIN OUTCOME MEASURES Key measures included patient demographics, type of anaesthesia, complications, adherence to best practices and legal outcomes such as liability acceptance and compensation amounts. RESULTS The number of claims involving regional anaesthesia decreased significantly over three decades, from 69 (49%) in the first decade to 30 (21%) in the last. Nerve damage was the most common complication (76%), with a notable reduction in permanent injuries from 57 to 28%. Advances in ultrasound-guided techniques and improved documentation may have contributed to these trends. Male patients tended to have higher rates of nerve injuries, while female patients reported more nonspecific pain syndromes and posttraumatic stress disorders because of the health impairment associated with the liability case. Liability was accepted in 43% of cases, with compensation often exceeding CHF 100 000. The highest compensations seemed to have been paid to male patients. CONCLUSIONS The decline in claims may reflect advancements in anaesthetic techniques and safety practices. This study underscores the importance of communication and training best practices in regional anaesthesia, including sufficient patient information and documentation to enhance patient safety and reduce medicolegal risks. Pain during performance, multiple attempts and re-injections should be avoided whenever possible. TRIAL REGISTRATION No registration]]> Thu, 05 Jun 2025 00:00:00 GMT-05:00 00003643-990000000-00306 https://journals.lww.com/ejanaesthesiology/fulltext/9900/differential_effects_of_propofol_anaesthesia.305.aspx BACKGROUND The developing neonatal brain displays different electroencephalographic (EEG) responses to GABAergic anaesthetics than adults. Evidence suggests the importance of isoelectric-like activity patterns. However, markers of hypnotic depth are currently lacking for this population. OBJECTIVE To explore potential EEG markers of propofol-induced hypnosis in sedated critically ill term neonates. DESIGN Observational exploratory cohort study. PATIENTS Twenty critically ill term neonates (postmenstrual age 37 to 44 weeks) undergoing intensive care and requiring anaesthesia for noncardiac surgery. Patients with perinatal asphyxia, neurological pathology, brain malformations and metabolic or haemodynamic instability were excluded. INTERVENTION(S) Frontal EEG (Sedline) was recorded before induction and during a 20-min continuous rate propofol infusion. MAIN OUTCOME MEASURES Depending on peak amplitude, segmented EEG signals (1 s epochs) were classified as either isoelectric (<10 μV), low-voltage 10 to 25 μV), or high-voltage (>25 μV). Propofol effects were evaluated in terms of time occupancy and spectral properties within these EEG states. Correlations between clinical variables and EEG states were explored. RESULTS The EEGs of 17 neonates were analysed. Most showed periods of low-voltage (16/17, 94%) and isoelectric states (2/17, 70.5%) before anaesthesia. The time spent in these EEG states increased significantly during propofol infusion; 17/17 (100%), P < 0.001 and 16/17 (94.1%), P = 0.016, respectively. Propofol increased the mean [95% confidence interval (CI)] time spent in the isoelectric state per patient: 12.4 (3.3 to 21.5)% versus 28.6 (14.4 to 42.8)%, P < 0.002. A reduced spectral power was observed across all frequency bands during low-voltage states (all P < 0.026). Gestational age was negatively correlated with time in the isoelectric state; rho, 95% CI, −0.539 (−0.11 to −0.87), P = 0.031. CONCLUSION Our results show that isoelectric periods are common before anaesthesia in our studied population and more frequent in patients born at earlier gestational ages. The data suggest that propofol anaesthesia increases isoelectric EEG states while also reducing the spectral power, specifically during low-voltage EEG states. Potentially, both of these EEG changes could be biomarkers of neonatal hypnosis depth in this particular critically ill subpopulation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04904965.]]> Mon, 26 May 2025 00:00:00 GMT-05:00 00003643-990000000-00305 https://journals.lww.com/ejanaesthesiology/fulltext/9000/opioid_sparing_effect_of_modified_intercostal.98287.aspx BACKGROUND Peripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect. OBJECTIVE This prospective randomised trial was designed to evaluate the feasibility of a modified intercostal nerve block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy. DESIGN This was a randomised controlled study. SETTING The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020. PATIENTS Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled. INTERVENTION Patients were randomised to receive the intercostal nerve block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg−1 remifentanil, it was then infused at 0.2 to 0.5 μg kg−1 min−1 during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values. MAIN OUTCOME MEASURES The primary outcome was intra-operative remifentanil consumption. RESULTS Median [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03). CONCLUSION We have shown intra-operative opioid-sparing with a modified intercostal nerve block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects. TRIAL REGISTRATION http://www.chictr.org.cn, ChiCTR2000029337. Correspondence to Guang-hong Xu, Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China Tel: +86 0551 62922344; fax: +86 0551 62923704; e-mail: xuguanghong2004@163.com © 2022 European Society of Anaesthesiology]]> Thu, 09 Sep 2021 00:00:00 GMT-05:00 00003643-900000000-98287 https://journals.lww.com/ejanaesthesiology/fulltext/9000/acute_pain_after_serratus_anterior_plane_or.98374.aspx BACKGROUND Serratus anterior and paravertebral blocks can both be used for video-assisted thoracic surgery. However, serratus anterior blocks are easier to perform, and possibly safer. We therefore tested the primary hypothesis that serratus anterior plane blocks and thoracic paravertebral blocks provide comparable analgesia for video-assisted thoracic surgery. Secondarily, we tested the hypothesis that both blocks lengthen the time to onset of surgical pain and reduce the need for rescue tramadol. METHODS Patients having video-assisted thoracic lobectomy or segmentectomy were randomly allocated to ultrasound-guided thoracic paravertebral blocks, n = 30; ultrasound-guided serratus anterior plane blocks, n = 30; or, general anaesthesia alone, n = 30. Visual analogue pain scores analogue pain scores at rest, during coughing and Prince-Henry pain scores were used to assess postoperative analgesia. Our primary analysis was noninferiority of serratus anterior blocks compared with paravertebral blocks. RESULTS Baseline characteristics were comparable among the three groups. Two hours after surgery, the mean difference in visual analogue pain scores between the serratus anterior and paravertebral blocks was 0.0 (96.8% CI −0.4 to 0.3) cm at rest, −0.2 (−0.8 to 0.4) cm during coughing and -0.1(-0.5 to 0.3) for Prince-Henry pain scores. After 24 h, the mean difference was 0.0 (−0.7 to 0.8) cm at rest, 0.1 (−0.8 to 0.9) cm during coughing and 0.1(-0.4 to 0.6) for Prince-Henry pain scores. All differences were significantly noninferior. Time to onset of pain after surgery was 19 ± 5 (SD) hours with serratus anterior blocks, 16 ± 5 h with paravertebral blocks and 12 ± 5 h with general anaesthesia. Anaesthesia with either block was associated with significantly less intra-operative propofol and sufentanil, reduced postoperative rescue analgesia (tramadol) and less postoperative nausea and vomiting compared with general anaesthesia alone. Patients with serratus anterior block had a significantly lower incidence of intra-operative hypotension and requirement for intra-operative vasopressor (3.4%), compared with general anaesthesia alone. Serratus anterior block took less time to perform than paravertebral block (5.1 ± 1.1 min versus 10.1 ± 2.9 min). CONCLUSION Serratus anterior plane blocks, which are easier and quicker than paravertebral blocks, provide comparable analgesia in patients having video-assisted thoracic surgery. CLINICAL TRIAL NUMBER AND REGISTRY URL ChiCTR1800017671; http://www.chictr.org.cn/hvshowproject.aspx?id=13510. Correspondence to Jingxiang Wu, MD, Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West, Shanghai, China 200030 Tel: +86 18930857186; e-mail: wu_jingxiang@sjtu.edu.cn © 2022 European Society of Anaesthesiology]]> Fri, 15 May 2020 00:00:00 GMT-05:00 00003643-900000000-98374 https://journals.lww.com/ejanaesthesiology/fulltext/9000/effects_of_premedication_with_clonidine_on.99596.aspx No abstract available]]> Mon, 01 Nov 2010 00:00:00 GMT-05:00 00003643-900000000-99596