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Reply to: more on fasting hypoglycaemia in children. 回复:更多关于儿童空腹低血糖的内容。
IF 3.6 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1097/EJA.0000000000001990
Martin Ingi Sigurdsson, Steinunn Snaebjornsdottir, Theodor Skuli Sigurdsson
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引用次数: 0
Conflicting guidelines: a commentary on the recent European Society for Emergency Medicine and European Society of Anaesthesiology and Intensive Care guidelines on temperature control after cardiac arrest. 相互矛盾的指南:对欧洲急诊医学会和欧洲麻醉学与重症监护学会近期关于心脏骤停后体温控制指南的评论。
IF 3.6 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1097/EJA.0000000000002006
Lars W Andersen, Mathias J Holmberg, Jerry P Nolan, Jasmeet Soar, Asger Granfeldt
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引用次数: 0
Number of anaesthesia residents in Spain: correction to publication by Berger-Estilita J, et al. 西班牙麻醉住院医师人数:对 Berger-Estilita J 等人发表的文章的更正。
IF 3.6 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1097/EJA.0000000000001992
Pablo Monedero
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引用次数: 0
Effect of different lung recruitment strategies and airway device on oscillatory mechanics in children under general anaesthesia. 不同的肺募集策略和气道装置对全身麻醉下儿童振荡力学的影响。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-21 DOI: 10.1097/EJA.0000000000001999
Emanuela Zannin, Julie Nguyen, Sara Vigevani, Neil Hauser, David Sommerfield, Raffaele Dellacà, R Nazim Khan, Aine Sommerfield, Britta S von Ungern-Sternberg

Background: Atelectasis has been reported in 68 to 100% of children undergoing general anaesthesia, a phenomenon that persists into the recovery period. Children receiving recruitment manoeuvres have less atelectasis and fewer episodes of oxygen desaturation during emergence. The optimal type of recruitment manoeuvre is unclear and may be influenced by the airway device chosen.

Objective: We aimed to investigate the different effects on lung mechanics as assessed by the forced oscillation technique (FOT) utilising different recruitment strategies: repeated inflations vs. one sustained inflation and different airway devices, a supraglottic airway device vs. a cuffed tracheal tube.

Design: Pragmatic enrolment with randomisation to the recruitment strategy.

Setting: We conducted this single-centre trial between February 2020 and March 2022.

Participants: Seventy healthy patients (53 boys) aged between 2 and 16 years undergoing general anaesthesia were included.

Interventions: Forced oscillations (5 Hz) were superimposed on the ventilator waveform using a customised system connected to the anaesthesia machine. Pressure and flow were measured at the inlet of the airway device and used to compute respiratory system resistance and reactance. Measurements were taken before and after recruitment, and again at the end of surgery.

Main outcome measures: The primary endpoint measured is the change in respiratory reactance.

Results: Statistical analysis (linear model with recruitment strategy and airway device as factors) did not show any significant difference in resistance and reactance between before and after recruitment. Baseline reactance was the strongest predictor for a change in reactance after recruitment: prerecruitment Xrs decreased by mean (standard error) of 0.25 (0.068) cmH 2 O s l -1 per  1 cmH 2 O -1  s l -1 increase in baseline Xrs ( P  < 0.001). After correcting for baseline reactance, the change in reactance after recruitment was significantly lower for sustained inflation compared with repeated inflation by mean (standard error) 0.25 (0.101) cmH 2 O ( P  = 0.0166).

Conclusion: Although there was no significant difference between airway devices, this study demonstrated more effective recruitment via repeated inflations than sustained inflation in anaesthetised children.

Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12619001434189.

背景:据报道,在接受全身麻醉的儿童中,有68%到100%的儿童会出现气胸,这种现象会持续到恢复期。接受通气操作的儿童在苏醒过程中发生的气道闭塞和氧饱和度降低的情况较少。目前尚不清楚最佳的吸气动作类型,可能会受到所选气道装置的影响:我们的目的是研究强制振荡技术(FOT)采用不同的吸入策略:反复充气与一次持续充气,以及不同的气道装置(声门上气道装置与带袖带的气管导管)对肺力学的不同影响:设计:根据招募策略随机进行务实招募:我们在2020年2月至2022年3月期间开展了这项单中心试验:70名健康患者(53名男孩),年龄在2至16岁之间,接受全身麻醉:使用与麻醉机相连的定制系统在呼吸机波形上叠加强迫振荡(5 Hz)。在气道装置的入口处测量压力和流量,用于计算呼吸系统的阻力和反应。在招募前后进行测量,并在手术结束时再次进行测量:测量的主要终点是呼吸反应的变化:统计分析(以招募策略和气道装置为因素的线性模型)显示,招募前后的阻力和反应性没有明显差异。基线反应是预测征召后反应变化的最有力因素:征召前 Xrs 平均值(标准误差)为 0.25 (0.068) cmH2O s l-1 ,基线 Xrs 每增加 1 cmH2O-1 s l-1 就会减少 0.25 (0.068) cmH2O s l-1 (P 结论:虽然征召前和征召后的呼吸阻力和反应差异显著,但征召前和征召后的呼吸阻力和反应差异并不明显:尽管气道装置之间没有明显差异,但本研究表明,在麻醉儿童中,重复充气比持续充气更有效:试验注册:澳大利亚-新西兰临床试验注册中心:ACTRN12619001434189。
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引用次数: 0
Cardiopulmonary exercise testing, computed tomography-derived body composition, systemic inflammation and survival after elective abdominal aortic aneurysm repair: A retrospective cohort study. 心肺运动测试、计算机断层扫描得出的身体成分、全身炎症和择期腹主动脉瘤修补术后的存活率:一项回顾性队列研究。
IF 3.6 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI: 10.1097/EJA.0000000000002004
Nicholas A Bradley, Josh McGovern, Christina Beecroft, Campbell S D Roxburgh, Donald C McMillan, Graeme J K Guthrie

Background: Cardio-pulmonary exercise testing (CPEX) is selectively used before intervention for abdominal aortic aneurysm (AAA). Sarcopenia, a chronic condition defined by reduced skeletal muscle function and volume, can be assessed radiologically by computed tomography (CT)-derived body composition analysis (CT-BC), and is associated with systemic inflammation.

Objective: The aim was to describe the association between CT-BC, CPEX, inflammation and survival in patients undergoing elective intervention for AAA.

Setting: Patients were recruited retrospectively from a single, secondary-care centre-operative database. Cases undergoing elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR) between 31 March 2015 and 25 June 2020 were included.

Patients: There were 176 patients (130 EVAR, 46 OSR) available for analysis in the final study; median (interquartile range [IQR]) follow-up was 60.5 [27] months, and all completed a minimum of 2 years follow-up.

Main outcome measures: Preoperative CPEX tests were recorded. CT sarcopenia score [CT-SS, range 0 to 2, calculated based on normal/low SMI (0/1) and normal/low SMD (0/1)] assessed radiological sarcopenia. Preoperative modified Glasgow Prognostic score (mGPS) was used to assess systemic inflammation.

Results: Mean [95% confidence interval (CI) survival in the CT-SS 0 vs. CT-SS 1 vs. CT-SS 2 subgroups was 80.1 (73.6 to 86.6) months vs. 70.3 (63.5 to 77.1) months vs. 63.8 (53.4 to 74.2) months] ( P  = 0.01). CT-SS was not associated with CPEX results ( P  > 0.05). Elevated CT-SS [hazard ratio (HR) 1.83, 95% CI, 1.16 to 2.89, P  < 0.01] was independently associated with increased hazard of long-term mortality; however, CPEX results were not ( P  > 0.05).

Conclusion: CPEX test results were not consistently associated with body composition and did not have significant prognostic value in patients undergoing elective treatment for AAA.

背景:心肺运动试验(CPEX)是腹主动脉瘤(AAA)介入治疗前选择性使用的方法。肌肉疏松症是一种慢性疾病,由骨骼肌功能和体积减少所定义,可通过计算机断层扫描(CT)得出的身体成分分析(CT-BC)进行放射学评估,并与全身炎症有关:目的:描述CT-BC、CPEX、炎症和AAA择期介入治疗患者生存率之间的关系:从一个二级医疗中心手术数据库中回顾性招募患者。纳入2015年3月31日至2020年6月25日期间接受择期血管内动脉瘤修补术(EVAR)和开放手术修补术(OSR)的病例:共有176例患者(130例EVAR,46例OSR)可用于最终研究分析;随访中位数(四分位数间距[IQR])为60.5[27]个月,所有患者均完成了至少2年的随访:术前 CPEX 测试记录。CT肌少症评分[CT-SS,范围0至2,根据正常/低SMI(0/1)和正常/低SMD(0/1)计算]评估放射学肌少症。术前改良格拉斯哥预后评分(mGPS)用于评估全身炎症:CT-SS 0 vs. CT-SS 1 vs. CT-SS 2亚组的平均[95%置信区间(CI)生存期为80.1(73.6至86.6)个月 vs. 70.3(63.5至77.1)个月 vs. 63.8(53.4至74.2)个月](P = 0.01)。CT-SS 与 CPEX 结果无关(P > 0.05)。CT-SS升高[危险比(HR)1.83,95% CI,1.16 至 2.89,P 0.05]:结论:CPEX检测结果与身体成分的关系并不一致,对接受AAA选择性治疗的患者没有显著的预后价值。
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引用次数: 0
More on fasting hypoglycaemia in children. 更多关于儿童空腹低血糖的信息。
IF 3.6 2区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1097/EJA.0000000000001961
Justine Mullie-Leger, Damien Lemaire, Francis Veyckemans
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引用次数: 0
Difficult airway management case studies. 困难气道管理案例研究。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 10.1097/EJA.0000000000001988
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引用次数: 0
Effect of phenylephrine rescue injection on hypotension after spinal anaesthesia for caesarean delivery when guided by both heart rate and SBP during an early warning window: A randomised controlled trial. 剖腹产脊髓麻醉后,在预警窗口期同时以心率和 SBP 为指导注射苯肾上腺素抢救针对低血压的影响:随机对照试验。
IF 3.6 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-02-28 DOI: 10.1097/EJA.0000000000001977
Wenxi Tang, Haiying Liu, Zheng Zhang, Wenyuan Lyu, Penghui Wei, Haipeng Zhou, Jinfeng Zhou, Jianjun Li

Background: Spinal anaesthesia is now the most common technique for caesarean delivery. However, because of the intermittent nature of noninvasive blood pressure (NIBP) measurements, maternal blood pressure may become hypotensive between the measurements. There is thus an inbuilt delay before the anaesthesiologist can intervene to counteract the hypotension. Based on the principle that changes in blood pressure can induce compensatory changes in the heart rate (HR), combining the NIBP with real-time HR, we designed two warning windows to predict hypotension and hypertension.

Objective: To evaluate whether phenylephrine administration guided by these warning windows would help maintain haemodynamic stability.

Setting: A teaching hospital.

Design: A randomised controlled trial.

Patients: One hundred and ten pregnant women scheduled for elective caesarean delivery were enrolled, from which, after exclusions, 86 were eligible for the study.

Interventions: All eligible patients received a continuous intravenous infusion of phenylephrine as soon as spinal anaesthesia was initiated. Thereafter, patients were randomly assigned to two groups. In the test group (Win-Group): rescue phenylephrine administration was triggered by an early warning window of HR above 100 beats per minute (bpm) and SBP 90 to 110 mmHg; pausing the infusion phenylephrine was triggered by a HR lower than 60 bpm and SBP greater than 90 mmHg. In the control group, phenylephrine was guided by BP only when it appeared on the monitor: SBP less than 90 mmHg was the trigger for administering rescue phenylephrine; SBP greater than 110 mmHg was the trigger for pausing the phenylephrine infusion.

Main outcome measures: The primary outcome was incidence of hypotension. Secondary outcomes were the incidence of hypertension and other adverse haemodynamic events.

Results: The incidence of hypotension was significantly lower in the Win-Group than in the BP-Group (27.8 vs. 66.7%, P  = 0.001). The minimum SBP was significantly higher in Win-Group than in BP-Group (93.9 ± 9.49 vs. 86.7 ± 11.16 mmHg, P   =  0.004). There was no significant difference in the incidence of hypertension between groups.

Conclusion: After spinal anaesthesia for caesarean delivery, when phenylephrine infusion is guided by HR along with BP from a warning window it effectively reduces the incidence of hypotension without any significant effect on incidence of hypertension.

Trial registration: Chictr.org.cn; Identifier: ChiCTR 2100041812.

背景:脊髓麻醉是目前最常见的剖腹产技术。然而,由于无创血压(NIBP)测量的间歇性,产妇血压可能会在两次测量之间出现低血压。因此,在麻醉师进行干预以消除低血压之前会有一个固有的延迟。根据血压变化可引起心率(HR)代偿性变化的原理,结合无创血压和实时心率,我们设计了两个预警窗口来预测低血压和高血压:评估在这些预警窗口指导下使用苯肾上腺素是否有助于维持血流动力学稳定:设计:随机对照试验设计:随机对照试验:110名计划进行择期剖腹产的孕妇被纳入研究,经排除后,其中86名符合研究条件:所有符合条件的患者在脊髓麻醉开始后立即接受持续的苯肾上腺素静脉注射。之后,患者被随机分配到两组。试验组(Win-Group):当心率超过每分钟 100 次(bpm)和 SBP 超过 90 至 110 mmHg 时,即进入苯肾上腺素抢救输注预警窗口;当心率低于每分钟 60 次(bpm)和 SBP 超过 90 mmHg 时,即暂停输注苯肾上腺素。在对照组中,只有当血压出现在监护仪上时,才会根据血压情况输注苯肾上腺素:SBP 低于 90 mmHg 时,启动苯肾上腺素抢救;SBP 高于 110 mmHg 时,暂停苯肾上腺素输注:主要结果:低血压发生率为主要结果。次要结果为高血压和其他不良血流动力学事件的发生率:结果:Win 组的低血压发生率明显低于 BP 组(27.8% 对 66.7%,P = 0.001)。Win 组的最低 SBP 明显高于 BP 组(93.9 ± 9.49 vs. 86.7 ± 11.16 mmHg,P = 0.004)。各组间高血压发生率无明显差异:结论:剖腹产脊髓麻醉后,根据警示窗的心率和血压输注苯肾上腺素可有效降低低血压的发生率,但对高血压的发生率无明显影响:Chictr.org.cn; Identifier:试验注册:Chictr.org.cn;标识符:ChiCTR 2100041812。
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引用次数: 0
Substantiating 'green' healthcare decisions: an explorative life cycle assessment study to identify differences in greenhouse gas emissions between general vs. regional anaesthesia for upper extremity surgery. 证实 "绿色 "医疗决策:一项探索性生命周期评估研究,以确定上肢手术全身麻醉与区域麻醉在温室气体排放方面的差异。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-26 DOI: 10.1097/EJA.0000000000001984
Wouter Droog, Veronica Grace, Lieke Droog, Ronald H Hendriks, Lauran F C M van Oers, Robert Jan Stolker, Eilish M Galvin
{"title":"Substantiating 'green' healthcare decisions: an explorative life cycle assessment study to identify differences in greenhouse gas emissions between general vs. regional anaesthesia for upper extremity surgery.","authors":"Wouter Droog, Veronica Grace, Lieke Droog, Ronald H Hendriks, Lauran F C M van Oers, Robert Jan Stolker, Eilish M Galvin","doi":"10.1097/EJA.0000000000001984","DOIUrl":"10.1097/EJA.0000000000001984","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293172","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
ICD-11: a major step forward towards the prediction and prevention of chronic postsurgical pain. ICD-11:向预测和预防慢性术后疼痛迈出的重要一步。
IF 4.2 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 10.1097/EJA.0000000000001996
Esther M Pogatzki-Zahn, Patrice Forget
{"title":"ICD-11: a major step forward towards the prediction and prevention of chronic postsurgical pain.","authors":"Esther M Pogatzki-Zahn, Patrice Forget","doi":"10.1097/EJA.0000000000001996","DOIUrl":"10.1097/EJA.0000000000001996","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853738","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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