European Journal of Anaesthesiology最新文献

Background: Liquid fasting durations often exceed current recommendations, resulting in patient discomfort.

Objective: To investigate the feasibility of three preoperative liquid fasting protocols in patients with low risk of aspiration in preparation for a future large-scale trial, with a particular focus on patient-centred benefits.

Design: Prospective, randomised, controlled, pilot trial.

Setting: Secondary care; single academic centre in Germany.

Patients: One hundred and seventy-four adult surgical patients with low risk of aspiration.

Intervention: Patients were randomised either to 'control group' (usual care, 2 h liquid fasting protocol), 'conservative intervention' (patients received assistance in adhering to a 2 h liquid fasting protocol) or 'liberal intervention' (patients could drink until they were called to the operating room).

Main outcome measures: Piloting process endpoints and performance endpoints were assessed. The primary outcome was patient-reported thirst before anaesthesia induction categorised as none, moderate, or severe.

Results: No patient dropped out or was lost to follow-up. Blinding was successful in 98.3%. The conservative and liberal interventions reduced the median [interquartile range or IQR] fluid fasting time from 5.38 h [3.67 to 9.53 h] in the control group to 3.00 h [2.23 to 4.25 h], P  < 0.001, and 1.97 h [1.20 to 3.02 h], P  < 0.001, respectively. Both conservative and liberal intervention significantly reduced the risk of preoperative thirst compared with the control group, presented as odds ratio (OR) and 95% confidence intervals (CI); conservative intervention OR 0.41 (CI, 0.20 to 0.82), P  = 0.013; liberal intervention: OR 0.21 (CI, 0.10 to 0.43), P  < 0.001. In the liberal intervention group, postoperative thirst, OR 0.32 (CI, 0.13 to 0.75), P  = 0.009, and preoperative headache, OR 0.24 (CI, 0.07 to 0.66), P  = 0.009, were significantly reduced compared with those in the control group. No adverse events were reported.

Conclusions: The trial design proved feasible. Liberal fluid intake reduced thirst and headache. The trial was not powered to provide definitive conclusions on safety.

Trial registration: The clinical investigation plan can be accessed at ClinicalTrials.gov identifier NCT06253052. Deidentified individual participant data, the data dictionary, and statistical code can be accessed upon reasonable request from the corresponding author.

Background: Prehospital tracheal intubation intends to provide respiratory support and protect the airway from possible pulmonary aspiration. Trauma guidelines recommend tracheal intubation in patients with a Glasgow Coma Scale (GCS) score of <9.

Objectives: We hypothesised that in clinical practice, GCS scores before prehospital tracheal intubation are lower in trauma and medical patients.

Design: Retrospective observational cohort study.

Setting: Swiss anaesthetist-staffed helicopter emergency medical system between 07 September 2020 and 11 December 2023.

Patients: Intubated trauma and nontrauma patients ≥18 years and nonintubated patients with GCS <9 admitted to three tertiary referral Swiss hospitals.

Interventions: Prehospital tracheal intubation.

Main outcome measures: GCS score before prehospital tracheal intubation. Association of GCS score before prehospital tracheal intubation with length of ventilator days, intensive care unit stay, hospitalisation, and 28-day survival.

Results: We screened 35 021 missions, of which 401 (335 intubated vs. 66 nonintubated) met inclusion criteria. The median GCS before prehospital tracheal intubation was 4 [IQR 3 to 6] for nontrauma and 6 [3 to 8] for trauma patients. Trauma patients with burns had a GCS score of 14 [13 to 15] before prehospital tracheal intubation. In the trauma cohort, women had a median GCS score of 5 [3 to 7] compared to men with 6 [3 to 8] ( P  = 0.043). The GCS before prehospital tracheal intubation was associated with length of intensive care unit stay ( P  = 0.042) and survival ( P  = 0.036) but not with length of ventilation and hospital stay.

Conclusions: Overall median GCS score before prehospital tracheal intubation was lower than 8. Our data suggests that the GCS score is not suitable as the sole indicator for prehospital tracheal intubation. Further randomised controlled trials should investigate more robust intubation criteria to be included in the guidelines for trauma and nontrauma patients. Finally, a patient-centred approach should be emphasised, especially in patients with burns.

Over the past decade, clinical guideline development has undergone significant advancements, with an increased focus on rigour, transparency and stakeholder engagement. In this study, the first in a series of four articles, the European Society of Anaesthesiology and Intensive Care (ESAIC) outlines key principles that guide the development of high-quality guidelines within ESAIC. Starting in 2025, ESAIC will progressively adopt the GRADE approach to enhance the quality and applicability of its guidelines. Core methodological principles include the use of systematic reviews, a multidisciplinary development process, conflict-of-interest management, a transparent link between evidence and recommendations, and ensuring that recommendations are specific and actionable. This study provides an overview of the roles and processes involved in guideline production and details the transition of ESAIC from its traditional grading systems to the updated GRADE standards. Strong recommendations indicate that one option offers a clear net benefit and should be implemented with all or nearly all patients. In contrast, conditional recommendations reflect uncertainty in the balance between benefits and harms, emphasising the need for careful consideration of clinical contexts and patient values. Although specific methodological decisions may vary, the principles outlined here provide a foundation for rigorous, evidence-based guideline development within ESAIC.

Although it is very rare, the syndrome of Congenital Insensitivity to Pain with Anhidrosis (CIPA) should be known to anaesthetic practitioners due to its perioperative implications. We report the first case of this in the British Isles, in a 5-year-old girl, whose osteomyelitis required surgical intervention. The genetics, the cellular basis and pathophysiology of the condition are outlined, and the relevance of analgesia in this challenging setting is considered in this report.