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Chronic postsurgical pain ICD11 definition is important but not always usable. 慢性术后疼痛的ICD11定义很重要,但并不总是可用的。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-02 DOI: 10.1097/EJA.0000000000002104
Valeria Martinez, Thomas Lehman, Esther M Pogatzki Zahn, Marcus Komann, Winfried Meissner, Dominique Fletcher
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引用次数: 0
Goal-direct analgesia: can analgesia nociception index effectively reduce intra-operative opioids? 目的-直接镇痛:镇痛痛觉指数能否有效减少术中阿片类药物?
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-02 DOI: 10.1097/EJA.0000000000002096
Alireza Danesh, Hamid R Vahabzadeh-Monshie, Alberto J de Armendi, Amir L Butt
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引用次数: 0
Intra-operative norepinephrine via peripheral venous catheter is safe: A short scientific report. 外周静脉导管术中去甲肾上腺素是安全的:一篇简短的科学报道。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2024-10-11 DOI: 10.1097/EJA.0000000000002080
Renate Schmucki, Christoph A Rüst, Miodrag Filipovic
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引用次数: 0
A comparison between invasive and noninvasive measurement of the Hypotension Prediction Index: A post hoc analysis of a prospective cohort study. 有创和无创测量低血压预测指数的比较:一项前瞻性队列研究的事后分析。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2024-10-16 DOI: 10.1097/EJA.0000000000002082
Santino R Rellum, Eline Kho, Jimmy Schenk, Björn J P van der Ster, Alexander P J Vlaar, Denise P Veelo

Background: Clinical trials and validation studies demonstrate promising hypotension prediction capability by the Hypotension Prediction Index (HPI). Most studies that evaluate HPI derive it from invasive blood pressure readings, but a direct comparison with the noninvasive alternative remains undetermined. Such a comparison could provide valuable insights for clinicians in deciding between invasive and noninvasive monitoring strategies.

Objectives: Evaluating predictive differences between HPI when obtained through noninvasive versus invasive blood pressure monitoring.

Design: Post hoc analysis of a prospective observational study conducted between 2018 and 2020.

Setting: Single-centre study conducted in an academic hospital in the Netherlands.

Patients: Adult noncardiac surgery patients scheduled for over 2 h long elective procedures. After obtaining informed consent, 91 out of the 105 patients had sufficient data for analysis.

Main outcome measures: The primary outcome was the difference in area under the receiver-operating characteristics (ROC) curve (AUC) obtained for HPI predictions between the two datasets. Additionally, difference in time-to-event estimations were calculated.

Results: AUC (95% confidence interval (CI)) results revealed a nonsignificant difference between invasive and noninvasive HPI, with areas of 94.2% (90.5 to 96.8) and 95.3% (90.4 to 98.2), respectively with an estimated difference of 1.1 (-3.9 to 6.1)%; P  = 0.673. However, noninvasive HPI demonstrated significantly longer time-to-event estimations for higher HPI values.

Conclusion: Noninvasive HPI is reliably accessible to clinicians during noncardiac surgery, showing comparable accuracy in HPI probabilities and the potential for additional response time.

Trial registration: Clinicaltrials.gov (NCT03795831) https://clinicaltrials.gov/study/NCT03795831.

背景:临床试验和验证研究表明,低血压预测指数(HPI)具有良好的低血压预测能力。大多数评估 HPI 的研究都是根据有创血压读数得出的,但与无创血压读数的直接比较仍未确定。这种比较可为临床医生在有创和无创监测策略之间做出决定提供有价值的见解:评估通过无创和有创血压监测获得的 HPI 之间的预测性差异:对2018年至2020年间开展的一项前瞻性观察研究进行事后分析:在荷兰一家学术医院进行的单中心研究:成人非心脏手术患者,计划进行超过2小时的择期手术。在获得知情同意后,105 名患者中有 91 名患者的数据足以进行分析:主要结果是两个数据集之间HPI预测的接收者操作特征曲线(ROC)下面积(AUC)的差异。此外,还计算了事件发生时间估计值的差异:AUC(95% 置信区间 (CI))结果显示,有创 HPI 和无创 HPI 之间的差异不显著,分别为 94.2% (90.5 至 96.8) 和 95.3% (90.4 至 98.2),估计差异为 1.1 (-3.9 至 6.1)%;P = 0.673。然而,无创 HPI 对较高 HPI 值的估计时间明显更长:无创 HPI 可供临床医生在非心脏手术过程中可靠使用,显示了 HPI 概率的可比准确性和额外响应时间的潜力:试验注册:Clinicaltrials.gov(NCT03795831),2019 年 1 月 10 日。https://clinicaltrials.gov/study/NCT03795831。
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引用次数: 0
Glucagon-like peptide-1 receptor agonists in peri-operative care: Dispelling myths and unveiling insights with essential considerations for anaesthesiologists. 胰高血糖素样肽-1受体激动剂在围手术期护理:消除神话和揭示与麻醉学家的基本考虑的见解。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2024-11-29 DOI: 10.1097/EJA.0000000000002103
Larissa Paggers, Dieter Mesotten, Hendrik Stragier

With the growing use of glucagon-like-peptide-1 (GLP-1) receptor (GLP-1R) agonists as anti-obesity medication it is becoming increasingly important to examine its consequences in the peri-operative period. GLP-1R agonists are known for their effects of glucose-lowering and gastroparesis the latter causing some safety concerns regarding induction of anaesthesia, more specifically the risk of pulmonary aspiration. This article gathers the available evidence on this subject in addition to the already established guidelines. Current evidence makes us assume there is indeed an increased level of gastroparesis, but there are no studies to date with evidential confirmation of a presumed elevated risk of pulmonary aspiration. Future perspectives should focus on the actual risk of pulmonary aspiration and the possible implementation of ultrasound in the preoperative assessment.

随着胰高血糖素样肽-1 (GLP-1)受体(GLP-1R)激动剂作为抗肥胖药物的使用越来越多,检查其在围手术期的影响变得越来越重要。GLP-1R激动剂以其降糖和胃轻瘫作用而闻名,后者引起一些关于麻醉诱导的安全问题,更具体地说,是肺误吸的风险。本文收集了关于这一主题的现有证据,以及已经建立的指导方针。目前的证据使我们假设胃轻瘫的水平确实增加了,但迄今为止还没有研究表明肺误吸的风险增加。未来的观点应侧重于肺误吸的实际风险和可能实施超声在术前评估。
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引用次数: 0
Continuous peri-operative glucose monitoring in noncardiac surgery: A systematic review. 非心脏手术围术期连续葡萄糖监测:系统综述。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2024-11-07 DOI: 10.1097/EJA.0000000000002095
Alessandro Putzu, Elliot Grange, Raoul Schorer, Eduardo Schiffer, Karim Gariani

Background: Glucose management is an important component of peri-operative care. The usefulness of continuous glucose monitoring (CGM) in noncardiac surgery is uncertain.

Objective: To systematically assess the glycaemic profile and clinical outcome of patients equipped with a CGM device during the peri-operative period in noncardiac surgery.

Design: Systematic review.

Data sources: Electronic databases were systematically searched up to July 2024.

Eligibility criteria: Any studies performed in the peri-operative setting using a CGM device were included. Closed-loop systems also administering insulin were excluded. Analyses were stratified according to diabetes mellitus status and covered intra-operative and postoperative data. Outcomes included glycaemic profile (normal range 3.9 to 10.0 mmol l -1 ), complications, adverse events, and device dysfunction.

Results: Twenty-six studies (1016 patients) were included. Twenty-four studies were not randomised, and six used a control arm for comparison. In bariatric surgery, diabetes mellitus patients had a mean ± SD glucose of 5.6 ± 0.5 mmol l -1 , with 15.4 ± 8.6% time below range, 75.3 ± 5.5% in range and 9.6 ± 6.7% above range. During major surgery, diabetes mellitus patients showed a mean glucose of 9.6 ± 1.1 mmol l -1 , with 9.5 ± 9.1% of time below range, 56.3 ± 13.5% in range and 30.6 ± 13.9% above range. In comparison, nondiabetes mellitus patients had a mean glucose of 6.4 ± 0.6 mmol l -1 , with 6.7 ± 8.4% time below range, 84.6 ± 15.5% in range and 11.2 ± 4.9% above range. Peri-operative complications were reported in only one comparative study and were similar in CGM and control groups. Device-related adverse events were rare and underreported. In 9.21% of cases, the devices experienced dysfunctions such as accidental removal and issues with sensors or readers.

Conclusion: Due to the limited number of controlled studies, the impact of CGM on postoperative glycaemic control and complications compared with point-of-care testing remains unknown. Variability in postoperative glycaemic profiles and a device dysfunction rate of 1 in 10 suggest CGM should be investigated in a targeted surgical group.

背景:葡萄糖管理是围手术期护理的重要组成部分。连续血糖监测(CGM)在非心脏手术中的作用尚不确定:系统评估非心脏手术围手术期配备 CGM 设备的患者的血糖状况和临床结果:系统回顾:数据来源:系统检索了截至 2024 年 7 月的电子数据库:纳入在围手术期使用 CGM 设备进行的任何研究。同时使用胰岛素的闭环系统除外。根据糖尿病状况进行分层分析,并涵盖术中和术后数据。结果包括血糖概况(正常范围为 3.9 至 10.0 mmol l-1)、并发症、不良事件和设备功能障碍:结果:共纳入 26 项研究(1016 名患者)。其中 24 项研究未进行随机分组,6 项研究使用对照组进行比较。在减肥手术中,糖尿病患者的平均(±SD)血糖为 5.6 ± 0.5 mmol l-1,其中 15.4 ± 8.6% 低于范围,75.3 ± 5.5% 在范围内,9.6 ± 6.7% 高于范围。在大手术期间,糖尿病患者的平均血糖为 9.6 ± 1.1 mmol l-1,9.5 ± 9.1%的时间低于范围,56.3 ± 13.5%的时间在范围内,30.6 ± 13.9%的时间高于范围。相比之下,非糖尿病患者的平均血糖为 6.4 ± 0.6 mmol l-1,6.7 ± 8.4% 的时间低于血糖范围,84.6 ± 15.5% 的时间在血糖范围内,11.2 ± 4.9% 的时间高于血糖范围。只有一项对比研究报告了围手术期并发症,CGM 组和对照组的并发症相似。与设备相关的不良事件很少发生,且报告不足。在 9.21% 的病例中,设备出现了功能障碍,如意外移除、传感器或读取器出现问题:结论:由于对照研究数量有限,与护理点检测相比,CGM 对术后血糖控制和并发症的影响仍然未知。术后血糖情况的不稳定性以及每 10 人中就有 1 人出现设备功能障碍,表明 CGM 应在目标手术组中进行研究。
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引用次数: 0
Metabolic acidosis in patients with diabetes 2 undergoing cardiac surgery: The impact of SGLT2 inhibitor use: a retrospective cohort study. 接受心脏手术的 2 型糖尿病患者的代谢性酸中毒:使用 SGLT2 抑制剂的影响:一项回顾性队列研究。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2024-10-24 DOI: 10.1097/EJA.0000000000002090
Hege K Brekke, Gunhild Holmaas, Marianne C Astor, Egil Steien, Rune Haaverstad, Fatemeh Z Ghavidel, Marit Farstad

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2-i) lower blood sugar and reduce cardiovascular events and kidney failure. However, there have been increasing reports of euglycaemic diabetic ketoacidosis (eDKA) linked to SGLT2-i medicines.

Objective: Investigating the association between SGLT2-i use and the incidence of metabolic acidosis in patients with type 2 diabetes undergoing cardiac surgery.

Design: A retrospective observational cohort study comprising 121 patients, with 38 in the SGLT2-i group and 83 in the control group.

Setting: A 2-year period at Haukeland University Hospital, a tertiary regional hospital in Western Norway.

Patients: Patients with type 2 diabetes undergoing cardiac surgery.

Interventions: Collection of clinical and laboratory data, including acid/base balance parameters, surgery details and SGLT2-i use.

Main outcome measures: Base excess and anion gap measurements as indicators of ketosis development. A subgroup analysis in patients without renal failure (glomerular filtration rate > 60 ml min -1  m -2 ) .

Results: Lower base excess levels and increased anion gaps were observed in the SGLT2-i group compared with controls at various time points postoperatively, with no significant differences in serum lactate levels.Twelve hours postoperatively, 41% of SGLT2-i patients without renal failure had a base excess -3 mmol l -1 or less after correction for serum lactate (indicating ketosis) compared with only 8% in the control group ( P  < 0.001). The anion gap was elevated in the SGLT2-i group compared to the control group at 12 h postoperatively ( P  = 0.018).Multivariable regression analysis identified SGLT2-i use as an independent factor associated with a lower base excess after correction for lactate levels ( P  < 0.001). Cessation of SGLT2-i medication did not correlate with the degree of acidosis.

Conclusion: While taking SGLT2 inhibitors, diabetic patients undergoing heart surgery are at an increased risk of ketosis and possibly metabolic acidosis. This emphasises the importance of careful observation and effective treatment strategies within this group.

背景:钠-葡萄糖共转运体2抑制剂(SGLT2-i)可降低血糖,减少心血管事件和肾衰竭。然而,越来越多的报告显示,优生糖尿病酮症酸中毒(eDKA)与 SGLT2-i 药物有关:调查接受心脏手术的 2 型糖尿病患者使用 SGLT2-i 与代谢性酸中毒发生率之间的关系:设计:一项回顾性观察队列研究,包括121名患者,其中SGLT2-i组38人,对照组83人:霍克兰大学医院是挪威西部的一家三级地区医院,为期两年:患者:接受心脏手术的 2 型糖尿病患者:干预措施:收集临床和实验室数据,包括酸碱平衡参数、手术细节和 SGLT2-i 的使用情况:主要结果测量:碱过量和阴离子间隙测量作为酮症发展的指标。对无肾功能衰竭(肾小球滤过率大于 60 ml min-1 m-2)的患者进行亚组分析:与对照组相比,SGLT2-i 组在术后不同时间点的碱过量水平较低,阴离子间隙增大,而血清乳酸盐水平无显著差异。术后 12 小时,41% 的 SGLT2-i 无肾衰竭患者在校正血清乳酸盐后的碱过量为 -3 mmol l-1 或更低(表明出现酮症),而对照组仅为 8%(P 结论:SGLT2-i 组与对照组相比,碱过量水平较低,阴离子间隙增大,而血清乳酸盐水平无显著差异:在服用 SGLT2 抑制剂期间,接受心脏手术的糖尿病患者发生酮症的风险增加,甚至可能出现代谢性酸中毒。这就强调了对这类患者进行仔细观察和采取有效治疗策略的重要性。
{"title":"Metabolic acidosis in patients with diabetes 2 undergoing cardiac surgery: The impact of SGLT2 inhibitor use: a retrospective cohort study.","authors":"Hege K Brekke, Gunhild Holmaas, Marianne C Astor, Egil Steien, Rune Haaverstad, Fatemeh Z Ghavidel, Marit Farstad","doi":"10.1097/EJA.0000000000002090","DOIUrl":"10.1097/EJA.0000000000002090","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2-i) lower blood sugar and reduce cardiovascular events and kidney failure. However, there have been increasing reports of euglycaemic diabetic ketoacidosis (eDKA) linked to SGLT2-i medicines.</p><p><strong>Objective: </strong>Investigating the association between SGLT2-i use and the incidence of metabolic acidosis in patients with type 2 diabetes undergoing cardiac surgery.</p><p><strong>Design: </strong>A retrospective observational cohort study comprising 121 patients, with 38 in the SGLT2-i group and 83 in the control group.</p><p><strong>Setting: </strong>A 2-year period at Haukeland University Hospital, a tertiary regional hospital in Western Norway.</p><p><strong>Patients: </strong>Patients with type 2 diabetes undergoing cardiac surgery.</p><p><strong>Interventions: </strong>Collection of clinical and laboratory data, including acid/base balance parameters, surgery details and SGLT2-i use.</p><p><strong>Main outcome measures: </strong>Base excess and anion gap measurements as indicators of ketosis development. A subgroup analysis in patients without renal failure (glomerular filtration rate > 60 ml min -1  m -2 ) .</p><p><strong>Results: </strong>Lower base excess levels and increased anion gaps were observed in the SGLT2-i group compared with controls at various time points postoperatively, with no significant differences in serum lactate levels.Twelve hours postoperatively, 41% of SGLT2-i patients without renal failure had a base excess -3 mmol l -1 or less after correction for serum lactate (indicating ketosis) compared with only 8% in the control group ( P  < 0.001). The anion gap was elevated in the SGLT2-i group compared to the control group at 12 h postoperatively ( P  = 0.018).Multivariable regression analysis identified SGLT2-i use as an independent factor associated with a lower base excess after correction for lactate levels ( P  < 0.001). Cessation of SGLT2-i medication did not correlate with the degree of acidosis.</p><p><strong>Conclusion: </strong>While taking SGLT2 inhibitors, diabetic patients undergoing heart surgery are at an increased risk of ketosis and possibly metabolic acidosis. This emphasises the importance of careful observation and effective treatment strategies within this group.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"152-161"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advancing the utility of bedside airway assessment: Awake-check videolaryngoscopy. 推进床边气道评估的应用:清醒检查视频喉镜检查。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-02 DOI: 10.1097/EJA.0000000000002084
Jane L Orrock, Patrick A Ward, Alistair F McNarry
{"title":"Advancing the utility of bedside airway assessment: Awake-check videolaryngoscopy.","authors":"Jane L Orrock, Patrick A Ward, Alistair F McNarry","doi":"10.1097/EJA.0000000000002084","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002084","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 2","pages":"186-187"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Emergency anesthesia procedures. 紧急麻醉程序。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-02 DOI: 10.1097/EJA.0000000000002093
{"title":"Emergency anesthesia procedures.","authors":"","doi":"10.1097/EJA.0000000000002093","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002093","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 2","pages":"188"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chronic pain after surgery = chronic postsurgical pain? 术后慢性疼痛=术后慢性疼痛?
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-02 DOI: 10.1097/EJA.0000000000002101
Ulrike M Stamer
{"title":"Chronic pain after surgery = chronic postsurgical pain?","authors":"Ulrike M Stamer","doi":"10.1097/EJA.0000000000002101","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002101","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 2","pages":"178-180"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
European Journal of Anaesthesiology
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