Best Practice & Research-Clinical Anaesthesiology最新文献

英文中文

An overview of procedural sedation guidelines and their differences 程序性镇静指南的概述及其差异

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.09.007

T. Verschakelen , G. Dewinter

Procedural sedation has become a widely used practice due to the growing need to manage anxiety, discomfort and pain during various diagnostic and therapeutic procedures. The responsibilities and necessary qualifications of anaesthesiologists and non-anaesthesiologists administering procedural sedation have been a topic of debate for years across various national and international guidelines. This narrative review compares national and international recommendations across six areas: pre-procedural assessment and fasting, monitoring standards, pharmacological management, provider training, and paediatric considerations. These areas were examined within clinical guidelines issued by professional organizations representing anaesthesiologists, emergency physicians, paediatricians, gastroenterologists, radiologists, and dentists. While key safety principles—such as continuous monitoring and preparedness for rescue—are broadly endorsed, there remain discrepancies regarding monitoring requirements, definitions of sedation depth, fasting guidelines, and the role of non-anaesthesiologist providers. Special populations, including paediatric and high-risk patients, often require tailored protocols, the level of specificity varies. By identifying areas of consensus and divergence, this review aims to support the development of harmonized best practice frameworks that prioritize safety while allowing for contextual flexibility.

由于在各种诊断和治疗过程中管理焦虑、不适和疼痛的需求日益增长，程序性镇静已成为广泛使用的实践。麻醉医师和非麻醉医师的责任和必要资格管理程序镇静多年来一直是各种国家和国际指南争论的话题。这篇叙述性综述比较了六个领域的国家和国际建议：手术前评估和禁食、监测标准、药理学管理、提供者培训和儿科考虑。这些领域是根据代表麻醉师、急诊医师、儿科医师、胃肠病学家、放射科医师和牙医的专业组织发布的临床指南进行检查的。虽然关键的安全原则——如持续监测和抢救准备——被广泛认可，但在监测要求、镇静深度的定义、禁食指南和非麻醉师提供者的角色方面仍然存在差异。特殊人群，包括儿科和高危患者，往往需要量身定制的方案，特异性水平各不相同。通过确定共识和分歧的领域，本审查旨在支持制定统一的最佳实践框架，优先考虑安全性，同时允许上下文灵活性。

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引用次数: 0

Expanding procedural sedation to satellite facilities: Current structures, provider models, and future directions 将程序镇静扩展到卫星设施：当前结构、提供者模型和未来方向

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpa.2025.08.001

Anthony Tanella, Howard Roselinsky, Ranjit Deshpande

As healthcare delivery becomes increasingly decentralized, the demand for procedural sedation beyond the operating room continues to grow. This review examines how sedation services are adapting to meet the demand across various procedural settings. We compare models led by anesthesiologists with those managed by non-anesthesia providers and outline practical considerations for expanding services to satellite facilities. Central themes include patient safety, governance and oversight, staffing models, technology integration, and provider education. We stress the importance of standardizing practices, promoting interprofessional collaboration, and utilizing telemonitoring to ensure consistent, high-quality care across diverse clinical settings.

随着医疗服务日益分散，手术室以外的镇静需求持续增长。这篇综述探讨了镇静服务如何适应不同程序设置的需求。我们比较了由麻醉师领导的模型和由非麻醉提供者管理的模型，并概述了将服务扩展到卫星设施的实际考虑因素。中心主题包括患者安全、治理和监督、人员配备模式、技术集成和提供者教育。我们强调标准化实践、促进跨专业合作和利用远程监控的重要性，以确保在不同的临床环境中一致、高质量的护理。

引用次数: 0

The role of biomarkers in the preoperative evaluation of cardiac surgical patients – A narrative review 生物标志物在心脏手术患者术前评估中的作用——综述

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.09.002

Giles Coverdale , Matthew Camilleri , Mathew Patteril

Background

Biomarkers play a crucial role in the preoperative assessment for cardiac surgery, aiding in risk stratification and evaluating comorbid diseases.

Objective

This narrative review summarizes current evidence on preoperative biomarkers in cardiac surgery and their role for risk stratification in international guidelines.

Methods

A review of relevant literature was conducted to assess the prognostic value of various biomarkers, including their integration into established risk scoring systems.

Results

Among cardiac biomarkers, brain natriuretic peptide (BNP) has been found to independently predict outcomes and may enhance prognostic accuracy when combined with scoring systems such as the Society of Thoracic Surgeons (STS) and Euroscore calculators. Additionally, several biomarkers related to comorbid diseases demonstrate independent associations with postoperative outcomes, some of which are already included in these scoring systems. Biomarkers such as glycosylated haemoglobin, C-reactive protein (CRP), and albumin levels are strongly linked to surgical outcomes and may aid perioperative optimization. Emerging evidence suggests that novel biomarkers, including inflammatory cytokines, may provide predictive value for specific complications.

Conclusion

Biomarkers are an essential component of preoperative assessment and risk stratification in cardiac surgery. Further research is needed to refine biomarker-based predictive models to enhance postoperative morbidity and mortality risk assessment.

生物标志物在心脏手术术前评估中起着至关重要的作用，有助于风险分层和评估合并症。目的本综述总结了心脏手术术前生物标志物的最新证据及其在国际指南中风险分层中的作用。方法回顾相关文献，评估各种生物标志物的预后价值，包括将其整合到已建立的风险评分系统中。在心脏生物标志物中，已发现脑钠肽（BNP）可独立预测预后，并可与评分系统（如胸外科学会（STS）和欧洲评分计算器）联合使用时提高预后准确性。此外，一些与合并症相关的生物标志物显示出与术后结果的独立关联，其中一些已被纳入这些评分系统。生物标志物如糖化血红蛋白、c反应蛋白（CRP）和白蛋白水平与手术结果密切相关，并可能有助于围手术期优化。新出现的证据表明，新的生物标志物，包括炎症细胞因子，可能为特定并发症提供预测价值。结论生物标志物是心脏手术术前评估和风险分层的重要组成部分。需要进一步的研究来完善基于生物标志物的预测模型，以提高术后发病率和死亡率的风险评估。

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引用次数: 0

Role of risk prediction scores in preoperative assessment of cardiac surgical patients 风险预测评分在心脏手术患者术前评估中的作用

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.006

Kathirvel Subramaniam , Sennaraj Balasubramanian , Elissa Castor , Pooja Tallapaneni , Gautham Raghuthaman , Ibrahim Sultan

Preoperative risk prediction scores help to identify high risk patients, guide decision making on cardiac surgical procedures and also optimization before definitive surgery. The Society of Thoracic Surgeons large database-derived scoring system is utilized for this purpose in the United States. The STS risk score is not only useful in predicting mortality but also individual organ dysfunction after cardiac surgical procedures. Similarly, Euro SCORE is utilized in European countries to predict mortality after cardiac surgery. Apart from these two scoring systems, multiple organ specific complication scoring systems are being used to predict morbidity (e.g., atrial fibrillation score). Several frailty scoring systems are available to evaluate the risk of poor outcomes due to age-related decline in overall physiological reserve after surgery. In this article, we describe some of the commonly used risk prediction scores in cardiac surgery with their accuracy and drawbacks.

术前风险预测评分有助于识别高危患者，指导心脏外科手术决策，并在最终手术前进行优化。在美国，胸外科学会的大型数据库衍生评分系统被用于此目的。STS风险评分不仅对预测死亡率有用，而且对心脏手术后个体器官功能障碍也有用。同样，欧洲国家也使用Euro SCORE来预测心脏手术后的死亡率。除了这两种评分系统外，多器官特异性并发症评分系统也被用于预测发病率（如房颤评分）。有几种虚弱评分系统可用于评估手术后由于年龄相关的总体生理储备下降而导致预后不良的风险。在这篇文章中，我们描述了一些在心脏手术中常用的风险预测评分，以及它们的准确性和缺点。

引用次数: 0

Preoperative investigations and imaging for cardiac surgical patients 心脏手术患者的术前检查和影像学

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.10.002

Sennaraj Balasubramanian , John Driggers , Alice Whyte , Kathirvel Subramaniam

Cardiac surgery poses several unique challenges for perioperative physicians and surgeons, and thorough preoperative assessment and investigation are imperative. Meticulous preoperative assessment and investigations allow selection of appropriate surgical procedures, identification of patients at high risk of perioperative complications, and crafting individualized perioperative care plans for these patients. Our review describes many facets of pre-operative investigations for patients undergoing cardiac surgery, highlighting their importance and limitations.

心脏手术对围手术期医师和外科医生提出了几个独特的挑战，彻底的术前评估和调查是必要的。细致的术前评估和调查有助于选择合适的手术程序，识别围手术期并发症高风险患者，并为这些患者制定个性化的围手术期护理计划。我们的综述描述了心脏手术患者术前调查的许多方面，强调了它们的重要性和局限性。

引用次数: 0

Preoperative evaluation and prehabilitation for cardiac surgical patients: Managing medications pre-procedure to optimize patient outcomes 心脏手术患者的术前评估和康复：术前药物管理以优化患者预后

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.007

Marie Caruso , Alyssa Exarchakis , Anika Pruthi , Erin Pukenas

引用次数: 0

Preoperative pulmonary optimization and risk mitigation 术前肺优化和风险降低

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.009

Evan Derector , Jennifer Varallo , Wissam Abouzgheib , Talia K. Ben-Jacob

Optimization of pulmonary health and risk mitigation is a critical component of preoperative preparation for cardiac surgery, impacting both short- and long-term postoperative outcomes. A wide array of tests and interventions have been studied such as pulmonary function testing, pulmonary risk stratification, and prehabilitation therapies. While each intervention has its utility, there lacks consensus on pulmonary evaluation and optimization prior to cardiac surgery. Special consideration should be given to the preoperative management and treatment of underlying comorbid pulmonary conditions that frequently impact postoperative outcomes. Targeted approaches have demonstrated potential to mitigate the risks associated with these conditions and improve surgical outcomes. This review aims to summarize recommended preoperative pulmonary evaluation and prehabilitation protocols, and discuss targeted approaches for patient-specific comorbidities to optimize patients and reduce postoperative complications in cardiac surgery.

优化肺部健康和降低风险是心脏手术术前准备的关键组成部分，影响短期和长期的术后结果。广泛的测试和干预措施已被研究，如肺功能测试，肺危险分层和康复治疗。虽然每种干预措施都有其效用，但在心脏手术前的肺部评估和优化方面缺乏共识。应特别考虑术前管理和治疗的潜在合并症肺部疾病，经常影响术后结果。有针对性的方法已被证明有可能减轻与这些疾病相关的风险并改善手术结果。本综述旨在总结推荐的术前肺部评估和康复方案，并讨论针对患者特异性合并症的针对性方法，以优化患者并减少心脏手术术后并发症。

引用次数: 0

Brain health measures and prehabilitation in cardiac surgery 心脏手术中的脑健康措施和康复

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.09.001

Ludmil Mitrev , Adam S. Mangold , Stefano Benincasa

Prehabilitation is the optimization of patients prior to surgery to improve postoperative outcomes. Postoperative neurological complications, including stroke, delirium, and postoperative cognitive decline, are commonly reported in patients undergoing cardiac surgery. To risk-stratify and optimize patients prior to cardiac surgery with respect to these complications, various measures of preoperative brain health are utilized in prehabilitation regimens. In this narrative review, we summarize the markers and assessments of brain health that are used to evaluate preoperative brain function, as well as the prehabilitation measures that have shown favorable association with reduction of postoperative neurologic complications. This includes an overview of serum biomarkers, physical therapies, cognitive training, nutritional supplementation, and substance use cessation counseling that are available during cardiac prehabilitation. Neurocognitive outcomes of patients who underwent prehabilitation prior to cardiac surgery are reported. Substance use cessation prior to cardiac surgery is discussed.

预康复是在手术前对患者进行优化，以改善术后预后。术后神经系统并发症，包括中风、谵妄和术后认知能力下降，在心脏手术患者中经常被报道。为了在心脏手术前对这些并发症进行风险分层和优化患者，在康复方案中采用了各种术前脑健康措施。在这篇叙述性综述中，我们总结了用于评估术前脑功能的脑健康标记和评估，以及显示与减少术后神经系统并发症有利关联的康复措施。这包括血清生物标志物，物理治疗，认知训练，营养补充，以及在心脏康复期间可用的药物使用戒烟咨询的概述。报道了心脏手术前接受康复治疗的患者的神经认知结果。讨论心脏手术前停止药物使用。

引用次数: 0

Cardiac prehabilitation: Is there a role in cardiac surgery 心脏康复：在心脏外科手术中有作用吗

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.008

Chiara Di Giambattista, Katelijne Buyck, Stephen Shepherd

Background

Cardiac surgery presents significant perioperative risks, particularly for high-risk populations such as elderly and frail patients. Prehabilitation, a preoperative strategy focusing on patient optimization, has emerged as a promising intervention to enhance recovery and reduce complications.

Objectives

This review explores the evidence supporting prehabilitation programs, which integrate exercise, nutritional optimization, psychological support, and patient education to improve cardiac surgical outcomes.

Methods

A review of current literature highlights the benefits, challenges, and emerging multidisciplinary approaches in cardiac prehabilitation, including inspiratory muscle training and tailored nutritional support.

Results

While prehabilitation is well-established in other surgical specialties, its implementation in cardiac surgery remains limited due to protocol heterogeneity, time constraints, and patient-specific factors. Early data suggest improved recovery, reduced hospital stays, and better perioperative outcomes.

Conclusions

Standardized prehabilitation protocols and additional research are necessary to improve patient selection, increase adherence, and assess long-term effects. With around one million cardiac surgeries conducted worldwide annually, incorporating structured prehabilitation programs may enhance patient outcomes and refine perioperative care.

背景：心脏手术存在明显的围手术期风险，特别是对老年人和体弱患者等高危人群。预康复是一种术前策略，侧重于患者优化，已成为一种有希望的干预措施，以提高恢复和减少并发症。目的本综述探讨了支持康复计划的证据，包括运动、营养优化、心理支持和患者教育，以改善心脏手术结果。方法回顾当前文献，强调心脏康复的益处、挑战和新兴的多学科方法，包括吸气肌训练和量身定制的营养支持。结果虽然康复治疗在其他外科专科已经很成熟，但由于治疗方案的异质性、时间限制和患者特异性因素，其在心脏外科的实施仍然有限。早期数据表明，恢复改善，住院时间缩短，围手术期预后更好。结论标准化的康复方案和进一步的研究对于改善患者选择、提高依从性和评估长期效果是必要的。全球每年约有100万例心脏手术，结合结构化的康复计划可以提高患者的预后并改善围手术期护理。

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引用次数: 0

Prehabilitation and enhanced recovery after cardiac surgery 心脏手术后的预适应和增强恢复

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Best Practice & Research-Clinical Anaesthesiology

Pub Date : 2025-06-01 DOI: 10.1016/j.bpa.2025.08.002

Benjamin Shuker, Kathryn Essak, Mathew Patteril

Cardiac surgery carries substantial risks, particularly for an aging population with increased frailty, morbidity, and malnutrition. Prehabilitation and Enhanced Recovery After Surgery (ERAS) protocols are emerging as essential strategies to optimize patients before surgery and accelerate postoperative recovery. In this review, we explore the role of prehabilitation and ERAS protocols in cardiac surgery, identify the challenges in implementing these strategies, and highlight areas for future research. Prehabilitation involves structured interventions such as physical conditioning, respiratory training, nutritional optimization, psychological support, and lifestyle modifications. While prehabilitation's role in non-cardiac surgery is well-established, its application in cardiac surgery remains less defined due to a lack of high-quality trial data and variability in studies. ERAS protocols, initially designed for colorectal surgery, have been adapted for cardiac surgery to include patient education, early mobilization, multimodal analgesia, and blood conservation techniques. Despite promising evidence regarding prehabilitation and ERAS protocols, the widespread adoption in cardiac surgery has been hindered by patient heterogeneity, limited access, and logistical constraints. The potential benefits include reduced complications, shorter hospital stays, improved recovery, and better patient outcomes. Future research should focus on standardizing prehabilitation protocols, assessing their impact on high-risk populations, and exploring telemedicine solutions to enhance accessibility.

心脏手术有很大的风险，特别是对老年人来说，他们越来越虚弱，发病率和营养不良。术前康复和术后增强恢复（ERAS）协议正在成为术前优化患者和加速术后恢复的基本策略。在这篇综述中，我们探讨了康复和ERAS协议在心脏手术中的作用，确定了实施这些策略的挑战，并强调了未来研究的领域。预康复包括有组织的干预措施，如身体调节、呼吸训练、营养优化、心理支持和生活方式改变。虽然预适应在非心脏手术中的作用已经确立，但由于缺乏高质量的试验数据和研究的可变性，其在心脏手术中的应用仍然不太明确。ERAS方案最初是为结直肠手术设计的，现已适用于心脏手术，包括患者教育、早期动员、多模式镇痛和血液保存技术。尽管在康复和ERAS方案方面有很好的证据，但由于患者的异质性、有限的访问和后勤限制，心脏手术的广泛采用受到阻碍。潜在的好处包括减少并发症、缩短住院时间、改善康复和改善患者预后。未来的研究应侧重于标准化康复方案，评估其对高危人群的影响，并探索远程医疗解决方案以提高可及性。

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