European Journal of Anaesthesiology最新文献

Background: The left head rotation (LeHeR) manoeuvre has been proposed to improve the laryngoscopic view based on case reports of unexpectedly difficult intubation under emergency conditions.

Objectives: To evaluate the potential of the LeHeR manoeuvre to improve the direct laryngoscopic view under elective surgical conditions and to investigate the dependence on patient- and examiner-dependent factors.

Design: Single-centre prospective cohort study.

Setting: This study was conducted at the Department of Anesthesiology of Saarland University Hospital between November 2022 and March 2023. Laryngoscopy findings in the Jackson position and after the application of the LeHeR manoeuvre were recorded during the routine surgical program by the responsible anaesthetists in the presence of a study physician.

Patients: One hundred and two adult patients scheduled for elective surgery, general anaesthesia with endotracheal intubation, and without a particular risk of aspiration.

Main outcome measures: primary outcome was the laryngoscopic view graded according to the modified Cormack and Lehane classification score (CLS) and subsequently in the percentage of glottic opening (POGO) score before and after application of the LeHeR manoeuvre. The secondary outcomes were the differences in laryngoscopic views according to both scores (ΔCLS, ΔPOGO).

Results: With the improved Jackson-position, the median laryngoscopic view was CLS grade 2a [1 to 2a], with a POGO score of 80 [42.5 to 100]. With LeHeR, the median laryngoscopic view was CLS grade 2a [1 to 2b], with a POGO score of 70 [42.5 to 90], indicating a reduced laryngoscopic view (CLS, P < 0.001; POGO, P = 0.041). While patient characteristics had no influence on the difference in laryngoscopic views, longer professional experience correlated significantly with an improvement in the laryngoscopic view according to the POGO (r = 0.242, P = 0.018), but not the Cormack and Lehane scores (r = -0.29, P = 0.004).

Conclusions: The LeHeR manoeuvre failed to significantly improve the direct laryngoscopic view compared to the improved Jackson-position under standard conditions for elective surgery. However, experienced anaesthetists achieved better results with this manoeuvre than novice anaesthetists.

Trial registration: This study was prospectively registered in the German Clinical Trials Register (DRKS00029944).

Background: Acute kidney injury (AKI) is a common complication after surgery. Greater fluid administration has been related to an increased incidence in patients undergoing major surgery but there are no large series of patients in specific perioperative settings showing relationship between fluid balance and the occurrence of AKI.

Objective: This study tested the hypothesis that higher perioperative fluid balance was associated with an increased risk of postoperative AKI.

Design: Prospective observational study. Predefined secondary sub-study of the Postoperative Outcomes Within Enhanced Recovery After Surgery (POWER) study.

Setting: A pre-planned secondary analysis of a multicentre study in 80 hospitals in Spain during a single period of 2 months of recruitment between September and December 2017.

Patients: Patients undergoing elective primary colorectal surgery with a planned overnight stay were included if they had complete data regarding postoperative fluid balance. Patients who underwent urgent or emergency surgery or with estimated glomerular filtration rate less than 30 ml min-1 were excluded.

Main outcomes measures: The primary outcome was the occurrence of AKI (mild, moderate, or severe) at 30 days following surgery. AKI was defined according to KDIGO and EPCO guidelines, incorporating serum creatinine and urine output criteria.

Results: A total of 1139 patients were included in the study. Of these, 73 patients (6.4%) developed acute kidney injury in the postoperative period. The adjusted relative risks (RR) that compared the quartile with the lowest perioperative fluid balance (Q1) with other quartiles were 4.10 [95% confidence interval (CI), 1.60 to 10.51] for Q3 and 4.81 (95% CI, 1.91 to 12.11) for Q4. In the Poisson loglinear model after adjusting by sex, ASA grade, Enhanced Recovery After Surgery (ERAS) adherence and intraoperative bleeding, RR for AKI were higher with a higher positive perioperative fluid balance (quadratic nonlinear P < 0.01).

Conclusions: In this secondary analysis, we found that higher positive perioperative fluid balance during the first 24 h was associated with an increased risk of postoperative acute kidney injury in patients undergoing elective colorectal surgery.

Trial registration: Clinicaltrials.com identifier: NCT03012802.

Background: International guidelines recommend preoperative clear liquid fasting for 2 h before anaesthesia. However, excessive fasting times remain widespread, potentially contributing to patient discomfort and adverse clinical outcomes.

Objective: To evaluate current preoperative liquid fasting practices among adults undergoing elective procedures across multiple European centres.

Design: Prospective, observational, multicentre study.

Setting: Forty-six centres in 12 European countries, conducted between November and December 2024.

Patients: A total of 5100 adults undergoing elective surgery or interventional procedures under general anaesthesia, regional anaesthesia or sedation.

Main outcome measures: Self-reported duration of preoperative liquid fasting; incidence of prolonged fasting duration (defined as liquid fasting times of more than 4 h). Median [IQR] fasting time was calculated, with subgroup analyses by country and procedure type.

Results: The median [IQR] preoperative liquid fasting time was 12 [10 to 14.6] h. Only 4% of patients consumed clear liquids within 2 to 4 h, and 0.8% within 2 h. Fasting durations were consistently prolonged across most countries and procedures, except for notably shorter times in Albania. Overall, 95% of patients fasted beyond 4 h.

Conclusions: Excessive preoperative liquid fasting remains highly prevalent across Europe, with poor implementation of established guidelines. These findings underscore the need for educational, institutional, and quality improvement interventions to align clinical practice with evidence-based recommendations and enhance patient-centred care.

Trial registration: ClinicalTrials.gov identifier: NCT06527703.

Background: Hallux valgus repair surgery is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and update previous PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations for optimal pain management after hallux valgus repair surgery.

Methods: A systematic review utilising PROSPECT methodology was performed. Randomised controlled trials and systematic reviews published in the English language from January 1, 2019 to November 19, 2024 that assessed postoperative pain using analgesic, anaesthetic and surgical interventions were identified from CENTRAL, CINAHL, EMBASE, MEDLINE and Web of Science.

Results: Of the 375 articles identified, 17 RCTs and 7 systematic reviews/meta-analyses met our inclusion criteria (total: 24 publications). Interventions that improved postoperative pain relief included: paracetamol and nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors; dexamethasone; ankle block and, as an alternative, local anaesthetic wound infiltration; and minimally invasive surgery or percutaneous osteotomy. Insufficient evidence was found for the use of perineural magnesium or liposomal bupivacaine. No evidence was found for continuous popliteal sciatic nerve block or for the use of the plantar compartment nerve block.

Discussion: This review provides an update to the previous guidelines written by the PROSPECT group: there is one important change, minimally invasive surgery or percutaneous osteotomy is recommended over open osteotomy. Contemporary publications confirm the analgesic effects of ankle block as a first-choice modality with wound infiltration as an alternative. In addition, the analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a nonsteroidal anti-inflammatory drug or cyclooxygenase-2 selective inhibitor administered preoperatively or intra-operatively and continued postoperatively, along with systemic dexamethasone, and postoperative opioids for rescue analgesia.

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.

Objectives: 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 (BP WRIST-ART ) and the Biobeat chest monitor (BP CHEST-ART ) with intra-arterial blood pressure measurements (BP ART ). In addition, we aimed to compare blood pressure measurements from the Biobeat wrist monitor (BP WRIST-OSCI ) with those from an oscillometric upper-arm cuff (BP OSCI ). 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 BP WRIST-ART and BP ART 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 BP CHEST-ART and BP ART 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 BP WRIST-OSCI and BP OSCI 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.

Neuraxial labour analgesia is considered the 'gold-standard' technique for the provision of analgesia during vaginal birth. Recently, there has been growing interest in the potential impacts of labour epidural analgesia beyond pain relief. One particular concern is its association with the development of maternal fever, so-called epidural-related maternal fever (ERMF). Hyperthermia during labour is a significant clinical concern, as it can impact both maternal and neonatal outcomes. This narrative review explores the association between epidural analgesia and maternal fever, outlines its suggested pathophysiological mechanisms, examines its potential implications and considers the management of neuraxial analgesia in the context of existing maternal fever. The two main theories explaining the development of ERMF are the sterile inflammation hypothesis, and the altered thermoregulation hypothesis. Patient characteristics, features of pregnancy and labour, midwifery and/or obstetric interventions and epidural-related factors can all contribute to an increased risk of developing ERMF. Although these factors may be manipulated to reduce ERMF incidence, there is no clear evidence that supports the recommendation of any intervention to prevent ERMF development. The associated detrimental effects of maternal fever on the woman, foetus, and newborn are highlighted, although many of these adverse outcomes have not been definitively established when ERMF has been the focus of study. There remains a significant need to further understand the pathophysiology, clinical significance, preventive strategies and treatment modalities of ERMF. It is crucial that future studies distinguish ERMF as a distinct category within maternal intrapartum fever.