European Journal of Anaesthesiology最新文献

Background: The effect of anaesthesia induction on cerebral perfusion is complex due to the coinciding respiratory and haemodynamic changes that occur.

Objective: To examine how changes in blood pressure and oxygen administration are related to cerebral oxygenation and its progression over time during and after anaesthesia induction.

Design: Prospective observational study.

Setting: Dutch tertiary hospital from October 2019 to May 2022.

Patients: Two hundred and fifty-one elective cardiac surgery patients of which 188 were included in the analysis.

Main outcome measures: Continuous cerebral oxygenation, measured using near-infrared spectroscopy (NIRS)-based regional cerebral tissue oximetry, was assessed in relation to mean arterial pressure (MAP), partial pressure of end-tidal oxygen (PetO 2 ) and fraction of inspired oxygen (FiO 2 ) during and after anaesthesia induction. Cerebral oxygenation between subgroups with and without the occurrence of postinduction hypotension (PIH) (defined as a MAP <65 mmHg for >60 s) was compared. PetO 2 was used as a measure for the efficacy of oxygen administration to assess the effect of a high FiO 2 of 1.0 on cerebral oxygenation.

Results: Cerebral oxygenation and PetO 2 increased during anaesthesia induction with the use of a FiO 2 of 1.0, while blood pressure decreased. All parameters decreased after anaesthesia induction, but the timing of onset of decline in cerebral oxygenation coincided with the moment that the FiO 2 was adjusted from high to low, whereas it preceded the decline in MAP by 16.4 s (95% confidence interval (CI), 2.4 to 30.4; P  = 0.02). The occurrence of PIH, which comprised of 42% of our study population, did not affect cerebral oxygenation. During anaesthesia induction and the use of a FiO 2 of 1.0, cerebral oxygenation increased by 0.14% (95% CI, 0.12 to 0.16; P  < 0.001) per percentage point increase in PetO 2 .

Conclusion: Changes in regional cerebral tissue oximetry during and after anaesthesia induction are more related to changes in oxygen administration than blood pressure.

Trial registration: Overview of medical research in the Netherlands (reference: NL-OMON29121).

Malignant hyperthermia (MH) is a severe reaction occurring upon the use of certain pharmacological agents during anaesthesia. The reaction typically includes an uncontrolled increase of body temperature, muscle spasms, tachycardia and hypercapnia. Identifying a genetic aetiology in MH patient allows diagnostic confirmation and genetic screening of relatives at risk. MH susceptibility (MHS) has extensively been associated with heterozygous missense variants in the RYR1 gene of dominant inheritance, but new variants are still to be discovered. We report here a novel de novo RYR1 variant c.487C>G p.(Arg163Gly) identified in a young boy who experienced a peroperative MH crisis. To the best of our knowledge, this is the first case reporting this new RYR1 variant, paving the way for future diagnosis, but genetic counselling and presymptomatic screening may vary depending on the classification that is used.

Background: Invasive ventilation can be challenging in acute brain injury (ABI) patients as partial pressure of carbon dioxide and oxygen need to be kept in precise optimal ranges while simultaneously applying lung-protective ventilation. Fully automated ventilation may be effective in achieving protective ventilation targets for brain and lung.

Objectives: To compare automated ventilation to conventional ventilation for ABI patients.

Design: Single-centre, observational, cross-over trial.

Setting: Primary care hospital in Italy, recruiting in 2024.

Patients: Twenty ABI patients receiving invasive mechanical ventilation.

Methods: We performed 3 h of data collection during conventional ventilation followed by 3 h of data collection during automated ventilation.

Main outcome measure: The primary endpoint was the percentage of breaths in three predefined zones of ventilatory targets, defined as optimal, acceptable and critical. The zones were based on patient-specific ranges of four measures: end-tidal carbon dioxide (EtCO 2 ), peripheral oxygen saturation (SpO 2 ), tidal volume (V T ), and maximum airway pressures ( Pmax ).

Results: A total of 20 patients were included. With automated ventilation the proportion [range] of breaths within the optimal zone significantly increased from 2.7% [0.0 to 23.4] to 30.5% [0.9 to 66.3] ( P  < 0.001). Automated ventilation markedly decreased the proportion of breaths in the critical zone, from 16.6% [1.9 to 41.3] to 2.1% [0.5 to 7.4] ( P  < 0.001), while slightly reducing breaths in the acceptable zone from 58.1% [34.4 to 90.9] to 45.1% [25.4 to 90.8] ( P  < 0.001). Optimal breaths increased for EtCO 2 , SpO 2 , and V T , but declined for Pmax with automation. The percentage of time spent in each ventilation zone mirrored the percentage of breaths in each zone.

Conclusion: Automated ventilation outperformed conventional ventilation in maintaining protective ventilation targets for brain and lung in ABI patients.

Trial registration: Clinicaltrials.gov identifier: NCT06367816.

Background: Processed electroencephalography is widely used to assess depth of anaesthesia and to titrate anaesthetics, thereby increasing the quality of recovery. However, the processed electroencephalogram is influenced by technical, patient, and anaesthetic factors. Adding information from the frontal real-time raw electroencephalogram may help to overcome these limitations.

Objective: To assess the effect of a raw electroencephalogram tutorial and its intra-operative implementation versus standard care on postoperative quality of recovery and propofol consumption.

Design: Multicentre double-blind randomised controlled trial.

Setting: The trial was conducted at four tertiary centres in Switzerland.

Patients and anaesthesia practitioners: We screened 534 adult patients undergoing in-hospital laparoscopies and 346 anaesthesia practitioners with at least 2 years of anaesthesia experience. We matched and randomised 232 pairs and analysed 209. The patients were 78% female.

Intervention: The anaesthesia practitioners assigned to the patients were randomised to a validated tutorial for assessing depth of anaesthesia with the raw electroencephalogram or to a no tutorial group. Monitoring included raw and processed electroencephalogram for patients allocated to the tutorial and only processed electroencephalogram for the no tutorial group.

Main outcome measures: The primary outcome was quality of recovery on the first postoperative day measured with the QoR-15 score. The first secondary outcome was propofol consumption. Groups were compared with a two-sample t -test.

Results: We found no statistically significant difference between the tutorial and the no tutorial group with mean differences of -3.2 [95% confidence interval (CI), -8.8 to 2.5, P  = 0.273] for QoR-15 score and 0.36 mg kg -1  h -1 (95% CI, -0.01 to 0.73, P  = 0.055) for propofol consumption.

Conclusion: A short tutorial on the raw electroencephalogram and its addition intra-operatively was not able to improve quality of recovery or reduce propofol consumption in middle-aged, largely female patients. A more in-depth tutorial applied to more vulnerable patients might have shown different results.