Best Practice & Research-Clinical Anaesthesiology最新文献

英文中文

Point of care ultrasound: lung and diaphragm 护理点超声：肺和膈

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-12-01 DOI: 10.1016/j.bpa.2025.11.002

Beyza Büyükgebiz Yeşil , Rosemary M.G. Hogg

Point-of-care ultrasound (PoCUS) of the lung and diaphragm has moved from an area of interest to a significant component of perioperative and critical care practice. Lung PoCUS can rapidly assist in the identification of numerous pathologies including pneumothorax, increased interstitial fluid, pleural effusion, and consolidation. Diaphragm PoCUS complements these findings using either qualitative or quantitative assessment to provide a bedside analysis of diaphragmatic function. PoCUS has been shown to improve patient-centred outcomes in many areas, but its widespread use varies by institution and speciality.

This review combines current concepts in lung and diaphragm PoCUS into a practical, anesthesiology-focused framework for image acquisition, interpretation, and bedside application. We aim to simplify practice by outlining nomenclature, scanning windows, key sonographic signs, and recognizing treatable conditions, while integrating the best available evidence to support perioperative decision-making.

While lung and diaphragm PoCUS may enable rapid, repeatable, and actionable bedside assessment; realizing their full impact requires the development of consistent training and integration into decision pathways.

肺和膈的即时超声（PoCUS）已经从一个感兴趣的领域转变为围手术期和危重症护理实践的重要组成部分。肺PoCUS可以快速帮助识别多种病理，包括气胸、间质液增加、胸腔积液和实变。横膈膜PoCUS通过定性或定量评估来补充这些发现，提供横膈膜功能的床边分析。PoCUS已被证明可以在许多领域改善以患者为中心的结果，但其广泛使用因机构和专业而异。本综述将肺和膈膜PoCUS的当前概念结合到一个实用的、以麻醉为重点的图像采集、解释和床边应用框架中。我们的目标是通过概述术语、扫描窗口、关键超声征象和识别可治疗的条件来简化实践，同时整合最佳可用证据来支持围手术期决策。虽然肺和膈肌PoCUS可以实现快速、可重复和可操作的床边评估；实现它们的全部影响需要发展一致的培训并将其纳入决策途径。

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引用次数: 0

Advances in procedural sedation: From traditional agents to novel pharmacologic approaches 程序性镇静的进展：从传统药物到新型药理学方法

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.09.006

Stijn Diels , Steffen Rex , Layth Al tmimi

Procedural sedation and analgesia (PSA) have undergone significant development over the years and are now considered an essential component of care for patients undergoing diagnostic or therapeutic interventions in various clinical settings. Many traditional and newer sedative agents are used daily, each with a distinct pharmacokinetic and pharmacodynamic profile.

While sedative agents are well known to anaesthesiologists, they remain less familiar to many non-anaesthesiology care providers who are increasingly involved in delivering PSA. Established agents such as midazolam, propofol, and ketamine remain commonly used because of their well-known pharmacokinetic and -dynamic profile. Nevertheless, these agents have several side effects, including respiratory depression, haemodynamic instability, and emergence reactions in a particular group of patients. In response to these shortcomings, novel agents such as remimazolam, dexmedetomidine, esketamine, and ciprofol have been introduced. These sedatives show promising improvements in safety and procedural predictability. In contrast, etomidate analogues like ABP-700 and ET-26 are still largely investigational. They aim to minimise organ-specific adverse effects, while keeping the favourable effects of the products from which they are derived.

Despite encouraging findings, direct comparisons across agents are limited. The latter is due to heterogeneity between study methods, population, and outcome measures. The current review aims to provide anaesthesiologists and other healthcare providers with a complete overview of established and novel agents used for PSA, focusing on their pharmacologic properties, clinical application, and safety considerations.

多年来，程序性镇静和镇痛（PSA）经历了重大发展，现在被认为是在各种临床环境中进行诊断或治疗干预的患者护理的重要组成部分。每天使用许多传统和较新的镇静剂，每一种都有不同的药代动力学和药效学特征。虽然麻醉剂是众所周知的麻醉师，他们仍然不太熟悉的许多非麻醉护理提供者越来越多地参与提供PSA。由于其众所周知的药代动力学和动力学特征，咪达唑仑、异丙酚和氯胺酮等已建立的药物仍然普遍使用。然而，这些药物有一些副作用，包括呼吸抑制，血流动力学不稳定，以及在特定患者群体中的突发反应。针对这些缺点，一些新型药物如雷马唑仑、右美托咪定、艾氯胺酮和环丙酚已经被引入。这些镇静剂在安全性和程序可预测性方面显示出有希望的改善。相比之下，依托咪酯类似物如ABP-700和ET-26仍处于研究阶段。他们的目标是尽量减少器官特异性的不利影响，同时保持其衍生产品的有利影响。尽管有令人鼓舞的发现，但药物之间的直接比较是有限的。后者是由于研究方法、人群和结果测量之间的异质性。当前的综述旨在为麻醉师和其他医疗保健提供者提供用于PSA的现有和新型药物的完整概述，重点是它们的药理学特性、临床应用和安全性考虑。

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引用次数: 0

Procedural sedation in older adults: A narrative review of pharmacological challenges, cognitive risks, and patient-centred approaches 老年人的程序性镇静：药理学挑战、认知风险和以患者为中心的方法的叙述性回顾

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.08.011

Lina Puodziukaite , Marco Perikar Dimaano , Steve Coppens , Danny Feike Hoogma

Procedural sedation in older adults presents distinct clinical challenges due to age-related changes in physiology and pharmacology. As patients age, they experience reduced cardiopulmonary and functional reserve, altered drug distribution and clearance, increased sensitivity to anaesthetics, and a higher burden of comorbidities and polypharmacy. These factors contribute to a heightened risk of complications such as hypotension, hypoxemia, and cognitive dysfunction.

Commonly used sedatives and opioids require careful dose adjustment and monitoring due to their variable and potentially unpredictable haemodynamic and cognitive effects. Emerging evidence supports the safety and predictability of newer agents like remimazolam and dexmedetomidine, while regional anaesthesia combined with light sedation may offer additional protection against cognitive complications. Effective patient-centred care, including thorough preoperative assessment, informed consent, and enhanced intra- and post-procedural monitoring, is essential to improve outcomes.

This review highlights the need for tailored, evidence-based sedation strategies that address the unique pharmacologic and cognitive risks in the older population.

由于年龄相关的生理和药理学变化，老年人的程序性镇静呈现出明显的临床挑战。随着患者年龄的增长，他们的心肺和功能储备减少，药物分布和清除改变，对麻醉剂的敏感性增加，合并症和多重用药的负担更高。这些因素增加了低血压、低氧血症和认知功能障碍等并发症的风险。常用的镇静剂和阿片类药物由于其可变和潜在不可预测的血流动力学和认知作用，需要仔细调整剂量和监测。新出现的证据支持雷马唑仑和右美托咪定等新药物的安全性和可预测性，而局部麻醉联合轻度镇静可能提供额外的保护，防止认知并发症。有效的以患者为中心的护理，包括彻底的术前评估、知情同意以及加强术中和术后监测，对于改善结果至关重要。这篇综述强调需要量身定制的、基于证据的镇静策略，以解决老年人群中独特的药理学和认知风险。

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引用次数: 0

Non-pharmacological sedation techniques: The role of hypnosis, virtual reality, and other strategies 非药物镇静技术：催眠、虚拟现实和其他策略的作用

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.09.004

Kristof Nijs , Charlotte Jorissen , An Teunkens , Marc Van de Velde , Björn Stessel

Non-pharmacological sedation techniques are increasingly recognised as valuable adjuncts in modern perioperative care. This narrative review explores the clinical applications of hypnosis, virtual reality, music therapy, aromatherapy, and mindfulness-based interventions in various settings, including regional anaesthesia, paediatrics, obstetrics, and ambulatory surgery. These strategies aim to reduce perioperative anxiety, enhance patient comfort, and lower reliance on pharmacological sedatives. Hypnosis and virtual reality are supported by growing evidence from randomised trials, while simpler interventions such as music and aromatherapy are easily implementable with minimal training. Mindfulness and breathing exercises show promise but remain underexplored in anaesthesia-specific settings. Successful implementation requires selecting appropriate patients, developing effective protocols, and providing staff education. These techniques are most effective when used as part of a multimodal approach to sedation. Further research is needed to assess long-term outcomes, cost-effectiveness, and standardisation across institutions. Non-pharmacological sedation offers a patient-centred, low-risk contribution to safe and personalised anaesthesia care. Their use during procedural sedation, either as standalone strategies or in combination with pharmacological agents, is increasingly recognised across a range of interventional and diagnostic settings.

非药物镇静技术越来越被认为是现代围手术期护理中有价值的辅助手段。这篇叙述性综述探讨了催眠、虚拟现实、音乐疗法、芳香疗法和基于正念的干预在各种环境中的临床应用，包括区域麻醉、儿科、产科和门诊手术。这些策略旨在减少围手术期焦虑，提高患者舒适度，降低对药物镇静的依赖。随机试验中越来越多的证据支持催眠和虚拟现实，而音乐和芳香疗法等更简单的干预措施，只需最少的培训就能轻松实现。正念和呼吸练习显示出希望，但在麻醉特定环境下仍未得到充分探索。成功的实施需要选择合适的患者，制定有效的方案，并提供员工教育。这些技术在作为多模式镇静方法的一部分使用时最为有效。需要进一步的研究来评估长期结果、成本效益和跨机构的标准化。非药物镇静提供了一个以病人为中心，低风险的安全和个性化麻醉护理贡献。它们在程序镇静中的使用，无论是作为单独的策略还是与药理学药物联合使用，越来越多地在一系列介入性和诊断环境中得到认可。

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引用次数: 0

Procedural sedation outside the operating room: Challenges, guidelines, and future directions 手术室外程序性镇静：挑战、指南和未来方向

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.08.003

Andres Brenes Bastos , Ronny Munoz-Acuna , Andrew P. Notarianni

Non-operating room procedures have become a fundamental component of modern clinical care. Minimally invasive, endovascular, and endoscopic procedures now constitute a large and growing proportion of interventions at hospitals and surgical centers, with projections indicating they will account for over 50 % of anesthetics delivered by 2030. Procedural sedation outside of the operating room presents a unique risk profile that may vary widely by care area. Anesthesiology has a responsibility to help advance sedation safety in these rapidly expanding care areas and to partner with various medical specialties in these efforts. Joint efforts to define standards of care, nomenclature, and professional competencies, as well as to delineate research needs, will help advance these goals and may also lead to the wider recognition of the additive value of anesthesiology in the modern healthcare environment.

非手术室程序已成为现代临床护理的基本组成部分。目前，微创、血管内和内窥镜手术在医院和外科中心的干预措施中所占的比例越来越大，预测表明，到2030年，它们将占麻醉药交付量的50%以上。手术室外的程序性镇静呈现出独特的风险概况，可能因护理区域而异。麻醉学有责任在这些迅速扩大的护理领域帮助提高镇静安全性，并在这些努力中与各种医学专业合作。共同努力定义护理标准、术语和专业能力，以及描述研究需求，将有助于推进这些目标，也可能导致更广泛地认识到麻醉学在现代医疗保健环境中的附加价值。

引用次数: 0

Procedural sedation and analgesia in clinical practice: From historical development to modern care 程序性镇静镇痛在临床中的应用：从历史发展到现代护理

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.09.008

Nikhil Chawla , Layth Al Tmimi

引用次数: 0

Procedural sedation in high-risk patients 高危患者的程序性镇静

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.10.005

Claudia R. Fernandez Robles, Adriana D. Oprea

Procedural sedation has seen a marked rise in recent years, driven by the development of less invasive diagnostic and therapeutic techniques and the rapid growth of Non-Operating Room Anesthesia (NORA). These advances have opened doors for patients who were once considered too high-risk for traditional surgery, making them appropriate candidates for procedures that can now be performed more safely and comfortably. While many of these interventions are low risk in nature, they can still be lengthy, painful, or distressing needing effective sedation to ensure success.

However, providing procedural sedation to high-risk patients requires more than just standard practice. It demands a thorough understanding of each patient's comorbidities, a clear definition of the sedation goals, deep familiarity with the pharmacology of sedative agents and the ability to rapidly intervene when adverse events arise.

近年来，由于微创诊断和治疗技术的发展以及非手术室麻醉（NORA）的快速增长，程序性镇静的应用显著增加。这些进步为那些曾经被认为对传统手术风险太高的患者打开了大门，使他们成为现在可以更安全、更舒适地进行手术的合适人选。虽然许多这些干预措施本质上是低风险的，但它们仍然可能是漫长的，痛苦的，或者需要有效的镇静来确保成功。然而，为高危患者提供程序性镇静需要的不仅仅是标准做法。它要求对每个患者的合并症有透彻的了解，对镇静目标有明确的定义，对镇静药物的药理学有深入的了解，并有能力在出现不良事件时迅速进行干预。

引用次数: 0

PeRLS for procedural sedation: A specialized resuscitation framework enhanced by EASy-ALS ultrasound integration PeRLS用于程序性镇静：一个由EASy-ALS超声整合增强的专业复苏框架

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.11.003

Nibras F. Bughrara , Rosie Gaylor , William Hsu , Chelsey Santino , Mohamed Shembesh , Aliaksei Pustavoitau

引用次数: 0

"Point-of-care gastric ultrasound for assessing fasting status prior to procedural sedation: A narrative" 护理点胃超声评估手术镇静前的禁食状态：叙述

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.08.010

Jonathan Molina Cifuentes, Ronny Munoz-Acuna, Nikhil Chawla

Background

Procedural sedation carries a risk of aspiration, especially when fasting status is uncertain.

Objective

To evaluate the role of POCUS in assessing gastric contents and aspiration risk in patients presenting for procedural sedation.

Methods

Narrative review of literature examining gastric ultrasound techniques, accuracy, and clinical application in sedation contexts.

Findings

POCUS provides real-time risk stratification, especially in emergency or unplanned settings.

Conclusion

Incorporating gastric POCUS into sedation protocols may improve patient safety and clinical decision-making.

背景：程序性镇静存在误吸风险，特别是在空腹状态不确定的情况下。目的探讨POCUS在手术镇静患者胃内容物及误吸风险评估中的作用。方法对有关胃超声技术、准确性和在镇静情况下的临床应用的文献进行综述。spocus提供实时风险分层，特别是在紧急情况或计划外环境下。结论将胃POCUS纳入镇静方案可提高患者的安全性和临床决策。

引用次数: 0

Airway management during procedural sedation: Strategies for prevention and complication management 镇静过程中的气道管理：预防和并发症处理策略

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.09.005

Rebecca Jones , Antonogiannakis Anastasios , Roxaan Jappie , Omar Al-Rawi , Neil Coulson , Layth Al Tmimi

Airway obstruction and respiratory depression are common and serious risks during procedural sedation. Sedative drugs reduce pharyngeal tone and ventilatory drive, especially at deeper levels of sedation. A thorough pre-assessment to identify high-risk patients, including those with obesity, obstructive sleep apnoea, or a history of difficult airway management, is important, as well as careful patient selection. Key strategies include sedation titration to the minimal effective dosage, appropriate positioning, early use of airway adjuncts, and continuous monitoring with capnography. High-flow nasal oxygen and techniques like THRIVE can improve oxygenation and extend safe apnoea time. Emerging tools, such as artificial intelligence–assisted monitoring and capnography, may support earlier recognition of airway compromise and enhance safety. A well-prepared, preventative, and proactive approach is essential to improving safety in all sedation settings.

气道阻塞和呼吸抑制是手术镇静过程中常见且严重的风险。镇静药物降低咽张力和通气驱动，特别是在较深的镇静水平。进行彻底的预先评估以确定高风险患者，包括肥胖、阻塞性睡眠呼吸暂停或有气道管理困难史的患者，这一点很重要，同时也要仔细选择患者。关键策略包括镇静滴定至最小有效剂量，适当的体位，早期使用气道辅助工具，以及持续监测血管造影。高流量鼻吸氧和THRIVE等技术可以改善氧合并延长安全呼吸时间。新兴工具，如人工智能辅助监测和血管造影，可能有助于早期识别气道损害并提高安全性。充分准备、预防性和前瞻性的方法对于提高所有镇静设置的安全性至关重要。

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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Best Practice & Research-Clinical Anaesthesiology

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