Anaesthesia最新文献_第10页

Issue Information – Editorial Board 发行信息-编辑委员会

IF 6.9 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-14 DOI: 10.1111/anae.16348

引用次数: 0

A systematic review of brain health in adults with chronic pain 慢性疼痛成人脑健康的系统回顾。

IF 6.9 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-14 DOI: 10.1111/anae.70021

Angeline Lee, Sara Al-Dahwi, Thomas Angell, Abinaya Arulalagan, Ryan Bloxsom, Harry Clarkson, Rose Faure, Soutiam Goodarzi, Minshu Gupta, Adithya Kale, Kin Lam, Freyia Mahon-Daly, Chloe Parry, Vidushi Pradhan, Finlay Ryan-Phillips, Suraj Shah, Serina Sidhu, John Smiddy, Aparna Sridhar, Syed F. Tahmid, Robert Wight, Nia Roberts, Anya Topiwala

Introduction

Recent research has linked chronic pain with an increased risk of clinical dementia diagnosis. Yet structural and functional brain changes associated with chronic pain and their potential role in accelerating brain ageing have not been characterised comprehensively. Understanding these effects is crucial to developing targeted prevention and management strategies.

Methods

We conducted a systematic review of all English language articles in MEDLINE and Embase. Studies were eligible if they compared neuroimaging, clinical, biological, cognitive or mental health outcomes in adults with chronic pain to healthy controls. Following screening, data were extracted and the risk of bias was assessed.

Results

Of 5805 identified studies, 365 met the inclusion criteria. Most were cross-sectional studies with small sample sizes; conducted in middle-aged populations in China or the USA; had moderate to high risk of bias; and represented > 30 distinct pain phenotypes. Magnetic resonance imaging was the most common method for assessing brain health. Key findings in patients with chronic pain included: lower grey matter volumes and reduced fractional anisotropy; evidence of accelerated brain ageing including older brain age and higher white matter hyperintensities; mixed results in resting state functional connectivity; increased power densities and connectivity on electroencephalography; and higher levels of serum brain-derived neurotrophic factor. The most consistently affected brain regions across magnetic resonance imaging studies were the insula; anterior and posterior cingulate; thalamus; hippocampus; primary motor cortex; and cerebellum.

Discussion

Adults with chronic pain exhibit widespread alterations in brain health compared with healthy controls. Several observed features overlap with biomarkers of Alzheimer's disease and other forms of neurodegeneration. These findings highlight the need for larger, well-designed studies incorporating clearly defined pain phenotypes, multimodal imaging and causal inference methods to clarify the role of chronic pain in brain ageing and dementia risk.

最近的研究将慢性疼痛与临床痴呆诊断风险增加联系起来。然而，与慢性疼痛相关的大脑结构和功能变化及其在加速大脑衰老中的潜在作用尚未得到全面表征。了解这些影响对于制定有针对性的预防和管理战略至关重要。方法对MEDLINE和Embase中所有英文文章进行系统综述。如果研究将患有慢性疼痛的成年人的神经影像学、临床、生物学、认知或心理健康结果与健康对照进行比较，则该研究是合格的。筛选后，提取资料并评估偏倚风险。结果5805项纳入研究中，365项符合纳入标准。大多数是小样本量的横断面研究；在中国或美国的中年人群中进行的；有中高偏倚风险；并代表了30种不同的疼痛表型。磁共振成像是评估大脑健康最常用的方法。慢性疼痛患者的主要发现包括：灰质体积降低，分数各向异性降低；大脑加速老化的证据，包括大脑年龄变老和白质高强度增加；静息状态功能连通性好坏参半；脑电图上功率密度和连通性增加；血清中脑源性神经营养因子的含量也更高。在磁共振成像研究中，受影响最一致的大脑区域是脑岛；前扣带和后扣带；丘脑;海马状突起;初级运动皮层；和小脑。与健康对照相比，患有慢性疼痛的成年人在大脑健康方面表现出广泛的改变。一些观察到的特征与阿尔茨海默病和其他形式的神经变性的生物标志物重叠。这些发现强调需要更大规模、设计良好的研究，包括明确定义的疼痛表型、多模态成像和因果推理方法，以阐明慢性疼痛在脑老化和痴呆风险中的作用。

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引用次数: 0

Carbon footprint of total intravenous anaesthesia vs. inhalational sevoflurane anaesthesia in adults: a modelling study 成人全静脉麻醉与吸入七氟醚麻醉的碳足迹：一项模拟研究

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-14 DOI: 10.1111/anae.70023

Becca Elson, Ingeborg Steinbach, Rosie Hillson

SummaryIntroductionThe carbon footprint of propofol is less than that of sevoflurane per minimum alveolar concentration hour equivalent of drug, but there are justifiable concerns about the amount of clinical waste generated during total intravenous anaesthesia (TIVA), especially in the context of shorter procedures. The aim of this study was to assess the carbon footprint of inhalational sevoflurane anaesthesia vs. TIVA with propofol and remifentanil, including all the consumables used, over the first 6 h of general anaesthesia in adult patients.MethodsA hybrid approach was used to model 10 scenarios: intravenous induction followed by inhalational sevoflurane maintenance with five levels of sevoflurane consumption; and five TIVA scenarios with different combinations of low, moderate and high doses of propofol and remifentanil.ResultsFor the first 22 min, the median consumption sevoflurane scenario had a lower estimated carbon footprint than all TIVA scenarios, beyond which all TIVA scenarios had a lower carbon footprint. Beyond 44 min, all sevoflurane scenarios had higher carbon footprints than all the TIVA scenarios. For every hour of general anaesthesia beyond 22 min, the carbon footprint of the moderate dose TIVA scenario increased by 0.04–0.60 kgCO2e.h‐1, compared with 4.01 kgCO2e.h‐1 for the median consumption sevoflurane scenario. Hotspot analysis of the moderate dose TIVA and median consumption sevoflurane scenarios showed that the consumables used in TIVA contributed most to the estimated overall carbon footprint of this technique (50.9–60.4%), followed by drugs (39.6–45.4%). In the sevoflurane scenario, sevoflurane was the greatest contributor to the carbon footprint, eventually being responsible for 99.5% of the total footprint at 360 min.ConclusionAdopting TIVA for appropriate cases lasting longer than 22 min will reduce the carbon footprint of general anaesthesia compared with median consumption of sevoflurane general anaesthesia. Using low fresh gas flows or end‐tidal control reduces the carbon footprint of inhalational general anaesthesia.

异丙酚每小时最低肺泡浓度当量的碳足迹低于七氟醚，但在全静脉麻醉（TIVA）期间产生的临床废物量方面存在合理的担忧，特别是在较短的手术过程中。本研究的目的是评估吸入性七氟醚麻醉与含异丙酚和瑞芬太尼的TIVA的碳足迹，包括所有使用的消耗品，在成人患者全身麻醉的前6小时。方法采用混合方法模拟10种情况：静脉诱导后吸入七氟烷维持，七氟烷用量为5个水平；以及低、中、高剂量异丙酚和瑞芬太尼不同组合的五种TIVA方案。结果在前22分钟，七氟醚消费中位数情景的碳足迹估计值低于所有TIVA情景，超过这一数值，所有TIVA情景的碳足迹都较低。超过44分钟，所有七氟醚情景的碳足迹都高于所有TIVA情景。超过22分钟的全身麻醉每一小时，中剂量TIVA方案的碳足迹增加0.04-0.60 kgco2 .h‐1，而中位数七氟醚方案的碳足迹为4.01 kgco2 .h‐1。对中剂量TIVA和中位数七氟醚情景的热点分析表明，TIVA中使用的耗材对该技术估计的总碳足迹贡献最大（50.9-60.4%），其次是药物（39.6-45.4%）。在七氟醚情景中，七氟醚是碳足迹的最大贡献者，最终在360分钟内占总足迹的99.5%。结论与七氟醚全麻的中位数消耗相比，适当的病例采用持续时间大于22 min的TIVA可减少全麻的碳足迹。使用低新鲜气体流量或潮汐末控制可减少吸入性全身麻醉的碳足迹。

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引用次数: 0

Feasibility of the Modified Telephone Interview for Cognitive Status (M-TICS) in the peri-operative environment 改良的认知状态电话访谈在围手术期环境中的可行性。

IF 6.9 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-14 DOI: 10.1111/anae.70022

Kelly J. Atkins, Lis Evered, Brendan Silbert, Joanne Robertson, Lucy Mackintosh, David Ames, David A. Scott

Introduction

Peri-operative neurocognitive disorders are common among older adults presenting for surgery and anaesthesia. Cognitive screening is recommended to identify patients at risk for adverse neurocognitive outcomes, though the most appropriate peri-operative tool remains debated. Remote assessment methods may be advantageous, but they need robust validation. We aimed to examine the feasibility and validity of the Modified Telephone Interview for Cognitive Status (TICS-M) among older adults and provide recommended TICS-M scores to identify those most at risk of poor postoperative cognitive outcomes.

Methods

As part of a prospective longitudinal study with 215 older adults living in the community or scheduled for elective surgery, we conducted the modified, 22-item, 50-point version of the TICS remotely, followed by in-person assessments using two common cognitive screening tools: the Mini-Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale Cognition Subscale (ADAS-Cog); and a comprehensive neuropsychological and functional assessment.

Results

The TICS-M was feasible and acceptable, with a completion rate of 86%. TICS-M scores correlated with scores on the MMSE (r = 0.61, p < 0.001) and ADAS-Cog (r = -0.55, p < 0.001) at baseline, and associations remained consistent at 12- and 24-month follow-up. After controlling for age, sex and education, baseline performance on the TICS-M was independently associated with subsequent cognitive impairment at 12 months (OR 0.84, 95% CI 0.77–0.92, p < 0.001) and 24 months (OR 0.84, 95% CI 0.76–0.94, p = 0.001). A TICS-M score of 32.5 was the optimal threshold to identify people with cognitive impairment (0.76, 95% CI 0.70–0.82, p < 0.001).

Discussion

The TICS-M is a feasible, valid and reliable remotely administered tool that shows utility in the peri-operative environment. We recommend its implementation into routine clinical practice for remote pre-operative assessment in patients aged ≥ 65 y scheduled for surgery and anaesthesia.

围手术期神经认知障碍在接受手术和麻醉的老年人中很常见。认知筛查被推荐用于识别有不良神经认知结果风险的患者，尽管最合适的围手术期工具仍存在争议。远程评估方法可能是有利的，但它们需要可靠的验证。我们的目的是在老年人中检验改进的认知状态电话访谈（tic - m）的可行性和有效性，并提供推荐的tic - m评分来识别那些最有可能出现术后不良认知结果的人。方法作为一项前瞻性纵向研究的一部分，我们对215名生活在社区或计划择期手术的老年人进行了远程修改，22项，50点版本的TICS，随后使用两种常见的认知筛查工具进行了现场评估：迷你精神状态检查（MMSE）；阿尔茨海默病评估量表认知量表（ADAS-Cog）；以及全面的神经心理和功能评估。结果tic - m是可行和可接受的，完成率为86%。tic -m评分与基线时MMSE评分（r = 0.61, p < 0.001）和ADAS-Cog评分（r = -0.55, p < 0.001）相关，并且在12个月和24个月的随访中保持一致。在控制了年龄、性别和受教育程度后，在12个月（OR 0.84, 95% CI 0.77-0.92, p < 0.001）和24个月（OR 0.84, 95% CI 0.76-0.94, p = 0.001）时，tic - m的基线表现与随后的认知障碍独立相关。tic - m评分为32.5是识别认知障碍患者的最佳阈值（0.76,95% CI 0.70-0.82, p < 0.001）。tic - m是一种可行、有效和可靠的远程管理工具，在围手术期环境中显示出实用性。我们建议将其纳入常规临床实践，用于≥65岁计划手术和麻醉的患者的远程术前评估。

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引用次数: 0

Association between pre‐operative sodium‐glucose cotransporter‐2 inhibitor use and postoperative outcomes: a propensity score‐matched analysis of the TriNetX database 术前钠-葡萄糖共转运蛋白2抑制剂的使用与术后结果的关系：TriNetX数据库的倾向评分匹配分析

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-14 DOI: 10.1111/anae.70024

Hsiang‐Ling Wu, Jui‐Tai Chen, Juan Pablo Cata, Chia‐Hsing Hsieh, Yih‐Giun Cherng, Ying‐Hsuan Tai

SummaryIntroductionWhile sodium‐glucose cotransporter‐2 inhibitors offer cardiovascular and renal benefits, their peri‐operative safety and effect profile remain unclear. This study aimed to evaluate the association between pre‐operative sodium‐glucose cotransporter‐2 inhibitor use and postoperative adverse events in patients with type 2 diabetes mellitus.MethodsThis nationwide propensity‐score matched cohort study utilised the TriNetX database to analyse data from patients with type 2 diabetes mellitus who underwent surgery in the USA. Patients were categorised based on whether they had received a prescription for sodium‐glucose cotransporter‐2 inhibitors 90 days before surgery. The primary outcome was 30‐day all‐cause mortality. Secondary outcomes included the incidence of major adverse cardiovascular events; acute kidney injury; and diabetic ketoacidosis.ResultsIn 98,118 matched pairs, 30‐day all‐cause mortality was significantly lower in patients in the sodium‐glucose cotransporter‐2 inhibitor group compared with those in the control group (RR 0.61, 95%CI 0.55–0.67, p < 0.001). Patients receiving sodium‐glucose cotransporter‐2 inhibitor treatment also showed lower risks of major adverse cardiovascular events (RR 0.89, 95%CI 0.86–0.91); acute kidney injury (RR 0.71, 95%CI 0.69–0.74); and diabetic ketoacidosis (RR 0.31, 95%CI 0.18–0.540) (p < 0.001 for all comparisons). Subgroup analyses revealed a more pronounced reduction in mortality among females, patients living with obesity or proteinuria, and those undergoing cardiovascular surgery.DiscussionOur study showed a significantly reduced risk of postoperative mortality and morbidity associated with pre‐operative sodium‐glucose cotransporter‐2 inhibitor use in patients with type 2 diabetes mellitus, including a notably lower rate of diabetic ketoacidosis, contrary to previous concerns. Randomised controlled trials are warranted to validate these findings.

摘要：虽然钠-葡萄糖共转运蛋白- 2抑制剂对心血管和肾脏有益，但其围手术期的安全性和效果尚不清楚。本研究旨在评估2型糖尿病患者术前使用钠-葡萄糖共转运蛋白- 2抑制剂与术后不良事件之间的关系。方法：这项全国性的倾向评分匹配队列研究利用TriNetX数据库分析在美国接受手术的2型糖尿病患者的数据。根据患者在手术前90天是否接受过钠-葡萄糖共转运蛋白- 2抑制剂的处方对患者进行分类。主要终点为30天全因死亡率。次要结局包括主要心血管不良事件的发生率；急性肾损伤；还有糖尿病酮症酸中毒。结果在98,118对配对患者中，钠-葡萄糖共转运蛋白2抑制剂组患者30天全因死亡率显著低于对照组（RR 0.61, 95%CI 0.55-0.67, p < 0.001）。接受钠-葡萄糖共转运蛋白- 2抑制剂治疗的患者也显示出较低的主要不良心血管事件风险（RR 0.89, 95%CI 0.86-0.91）；急性肾损伤（RR 0.71, 95%CI 0.69-0.74）；糖尿病酮症酸中毒（RR 0.31, 95%CI 0.18-0.540）（所有比较p <； 0.001）。亚组分析显示，在女性、肥胖或蛋白尿患者以及接受心血管手术的患者中，死亡率明显降低。我们的研究显示，术前使用钠-葡萄糖共转运蛋白- 2抑制剂可显著降低2型糖尿病患者的术后死亡率和发病率，包括显著降低糖尿病酮症酸中毒的发生率，这与之前的研究相反。有必要进行随机对照试验来验证这些发现。

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引用次数: 0

Peri-operative haemoglobin trajectories in patients without pre-operative anaemia undergoing valvular heart surgery 无术前贫血的心脏瓣膜手术患者的围术期血红蛋白轨迹。

IF 6.9 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-13 DOI: 10.1111/anae.70036

Hee Won Choi, Hyun-Soo Zhang, Jae-Kwang Shim, Young Lan Kwak

<p>Anaemia is common in patients undergoing cardiac surgery and is associated with adverse clinical outcomes [<span>1, 2</span>]. While pre-operative anaemia is a well-established prognostic factor [<span>1, 2</span>], the clinical significance of postoperative anaemia and haemoglobin recovery are less well understood [<span>3</span>]. In our previous study [<span>4</span>], we showed that persistent postoperative anaemia, defined as haemoglobin < 100 g.l<sup>-1</sup> at 2 months, was associated independently with 1-year mortality, with particularly high risk in patients who developed postoperative anaemia despite normal pre-operative levels. To further explore the temporal dynamics of haemoglobin recovery, we analysed extended peri-operative haemoglobin trajectories in patients without pre-operative anaemia undergoing open valvular heart surgery.</p><p>Of 2486 patients who underwent surgery from 1 January 2016 to 31 July 2023, 1379 had no pre-operative anaemia, according to the World Health Organization (WHO) criteria [<span>5</span>]. Longitudinal haemoglobin profiles were constructed using daily measurements during hospitalisation and follow-up at 2 weeks and 2 months, 6 months and 12 months. Patients were stratified by postoperative anaemia status, and peri-operative haemoglobin trends were compared using the Mann–Whitney U-test. Individual time-point comparisons were interpreted with a Bonferroni correction applied. The interaction term from a linear mixed model was used to assess whether haemoglobin change differed between the groups over time. Patient characteristics and clinical outcomes, including previously identified risk factors for postoperative anaemia [<span>4</span>], were compared between the groups using the Mann–Whitney U-test for continuous variables and the χ<sup>2</sup> or Fisher's exact tests for categorical variables.</p><p>Among 1379 patients without pre-operative anaemia, 61 (4%) developed postoperative anaemia. The overall median (IQR [range]) pre-operative haemoglobin was 137 (130–145 [120–197]) g.l<sup>-1</sup>. The nadir occurred on postoperative day 4 at 88 (81–96 [50–154]) g.l<sup>-1</sup>, followed by gradual recovery to 127 (117–136 [51–170]) g.l<sup>-1</sup> at 2 months and 137 (127–148 [72–179]) g.l<sup>-1</sup> at 1 year. Patients who developed postoperative anaemia had significantly lower baseline haemoglobin (133 vs. 137 g.l<sup>-1</sup>, p = 0.002) and lower immediate (postoperative day 0–2) haemoglobin levels (all p < 0.004). Haemoglobin levels converged at postoperative days 3–5 with no significant differences, while from postoperative day 6 onwards, patients with postoperative anaemia consistently showed lower haemoglobin levels, with differences widening throughout the 1-year follow-up period (all p < 0.004). The interaction between time and anaemia was significant (p < 0.001), confirming divergent recovery trajectories (Fig. 1).</p><p>Patients with postoperative anaemia showed higher pre-op

贫血在心脏手术患者中很常见，并与不良临床结果相关[1,2]。虽然术前贫血是一个公认的预后因素[1,2]，但术后贫血和血红蛋白恢复的临床意义尚不清楚[10]。在我们之前的研究[4]中，我们发现持续的术后贫血，定义为血红蛋白100g。2个月时L-1与1年死亡率独立相关，尤其是术前水平正常但术后出现贫血的患者。为了进一步探讨血红蛋白恢复的时间动态，我们分析了无术前贫血的心脏直视手术患者的围手术期血红蛋白轨迹。根据世界卫生组织（世卫组织）标准[5]，在2016年1月1日至2023年7月31日接受手术的2486例患者中，1379例术前无贫血。通过住院期间的每日测量和2周、2个月、6个月和12个月的随访，构建纵向血红蛋白谱。根据术后贫血状况对患者进行分层，并使用Mann-Whitney u检验比较围手术期血红蛋白趋势。使用Bonferroni校正来解释个体时间点比较。线性混合模型的相互作用项被用来评估血红蛋白的变化是否随时间在各组之间有所不同。使用连续变量的Mann-Whitney u检验和分类变量的χ2或Fisher精确检验比较两组之间的患者特征和临床结果，包括先前确定的术后贫血的危险因素。在1379例术前无贫血的患者中，61例（4%）出现术后贫血。术前总中位血红蛋白（IQR[范围]）为137 (130-145 [120-197])g.l-1。最低点发生在术后第4天，为88 (81-96 [50-154])g。L-1，然后逐渐恢复到127 (117-136 [51-170])g。2个月时L-1, 137 (127-148 [72-179]) g。1年的L-1。术后出现贫血的患者血红蛋白基线明显降低（133 g vs 137 g）。L-1, p = 0.002)和较低的即时（术后0-2天）血红蛋白水平（均p &lt； 0.004）。血红蛋白水平在术后3-5天趋同，无显著差异，而从术后第6天起，术后贫血患者血红蛋白水平持续降低，在1年随访期间差异扩大（p < 0.004）。时间和贫血之间的相互作用是显著的（p < 0.001），证实了不同的恢复轨迹（图1）。术后贫血患者术前红细胞分布宽度较高；体外循环时间延长；术中输血增多；术后并发症较多（表1）。边缘性贫血妇女的比例（120-129克）。l-1)，被WHO标准归类为非贫血，在贫血组中显著更高（41%对24%，p = 0.004）。我们的扩展分析强调，心脏瓣膜手术后血红蛋白的恢复遵循不同的轨迹，根据术后持续贫血的新发展，这些血红蛋白差异保持分离长达1年。即使在手术前，根据世卫组织的标准，术后出现贫血的患者术前血红蛋白水平虽然仍然正常，但明显较低。这种微妙的差异表明存在潜在的易感性或血液储备减少，这可能无法被标准的贫血定义所捕获。具体来说，术后贫血组的女性在边缘性术前贫血患者中所占比例不成比例，这突出了性别特异性界限的局限性，并提示该亚组血液储备减少[6]。我们的研究结果表明，术后贫血不仅仅是手术失血或血液稀释的短暂影响，而是反映了红细胞生成恢复受损或持续的生理应激。从术后第6天开始，血红蛋白恢复的差异明显，标志着早期恢复期，此时临床上可区分出持续性贫血。术后贫血可能是心脏瓣膜手术后延长易损性的潜在标志和中介。是否积极干预纠正术后贫血可以改善临床结果仍不确定，值得进一步研究。术前无贫血但术后出现贫血的患者，定义为血红蛋白100g。2个月时的L-1表现为持续的血红蛋白恢复受损，从出院到1年，差异逐渐扩大。这一轨迹与1年死亡率的增加显著相关，突出表明术后贫血是长期风险的早期标志。

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引用次数: 0

Pericapsular nerve group block for intracapsular vs. extracapsular hip fracture 髋关节囊内与囊外骨折的囊周神经阻滞治疗。

IF 6.9 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-13 DOI: 10.1111/anae.70030

Santi Di Pietro, Riccardo Maffeis, Laura Girón-Arango, Eugenio Jannelli, Stefano Perlini

<p>The pericapsular nerve group (PENG) block is used increasingly for hip fracture analgesia in emergency departments [<span>1-4</span>]. Cadaveric and clinical studies suggest that, when performed with at least 20 ml of injectate, the PENG block provides analgesia for both intracapsular and extracapsular hip fractures, although greater volumes are associated with an increased risk of undesirable spread to the femoral nerve, resulting in quadriceps weakness [<span>2, 5, 6</span>].</p><p>No studies have yet compared the analgesic effect of the PENG block in intracapsular vs. extracapsular hip fracture. Koh et al. investigated the analgesic effect of PENG vs. supra-inguinal fascia iliaca block, which included a sub-analysis of intracapsular and extracapsular groups [<span>7</span>]. There was no statistically significant difference in pain scores between these groups, but the study was not powered for this outcome. However, a key limitation is the inclusion of subtrochanteric fractures, for which the PENG block is not indicated [<span>2</span>]. This likely underestimated the analgesic effect in the extracapsular group and amplified the between-group difference.</p><p>We conducted a similar exploratory secondary analysis of our recent trial, which investigated the analgesic effect of the PENG block vs. infra-inguinal fascia iliaca block in the emergency department [<span>8</span>]. Among the 30 patients who received a PENG block with an injectate volume of 20 ml, 13 had an intracapsular fracture (subcapital or transcervical) and 17 had an extracapsular fracture (basicervical, intertrochanteric, simple pertrochanteric or multifragmentary pertrochanteric).</p><p>We found that the interquartile range for visual analogue pain scale values was greater for extracapsular fractures, with nearly identical Q3 values between the two groups and a lower Q1 value in the extracapsular group (Fig. 1). We calculated pain intensity differences from visual analogue pain scale values at each time-point and the summed pain intensity differences. We then obtained the proportion of the summed pain intensity differences for the intracapsular and extracapsular groups as 68% (95%CI 53–83%) and 68% (95%CI 57–78%). These data suggest that the PENG block, performed with 20 ml injectate, may be as effective for extracapsular fractures as it is for intracapsular fractures. Nevertheless, the difference in the dispersion from median values may suggest a less consistent analgesic effect of the PENG block in extracapsular fractures, possibly due to higher variability in the injectate spread to the trochanteric area.</p><p>We present these data descriptively due to our small sample size and because our study was not powered for this secondary analysis. Future adequately powered studies should clarify if for a given injectate volume, the PENG block results in different analgesic effects in intracapsular and extracapsular fractures. It would also be worthwhile investigating whether the

在急诊科，越来越多地使用囊包神经阻滞（PENG）用于髋部骨折镇痛[1-4]。尸体和临床研究表明，当使用至少20ml的注射量时，PENG阻滞对髋关节囊内和囊外骨折均有镇痛作用，尽管更大的体积会增加不良扩散到股神经的风险，导致股四头肌无力[2,5,6]。目前还没有研究比较PENG阻滞在髋关节囊内骨折和囊外骨折中的镇痛效果。Koh等研究了PENG与腹股沟上筋膜髂阻滞的镇痛效果，其中包括对囊内组和囊外组[7]的亚分析。这些组之间的疼痛评分没有统计学上的显著差异，但该研究并没有为这一结果提供动力。然而，一个关键的限制是包括转子下骨折，彭阻滞不表明[2]。这可能低估了囊外组的镇痛作用，放大了组间差异。我们对我们最近的试验进行了类似的探索性二次分析，该试验研究了急诊科使用PENG阻滞与腹股沟下髂筋膜阻滞的镇痛效果[10]。在30例接受注射量为20ml的PENG阻滞的患者中，13例发生囊内骨折（资本下或经颈），17例发生囊外骨折（基础颈、粗隆间、单纯性粗隆或多碎片性粗隆）。我们发现视觉模拟疼痛评分值的四分位数范围在囊外骨折中更大，两组之间的Q3值几乎相同，而囊外组的Q1值更低（图1）。我们计算了每个时间点视觉模拟疼痛量表值的疼痛强度差异和疼痛强度差异的总和。然后我们得到囊内组和囊外组总疼痛强度差异的比例分别为68% （95%CI 53-83%）和68% （95%CI 57-78%）。这些数据表明，注射20ml的PENG阻滞对囊外骨折和囊内骨折可能同样有效。然而，分散度与中位值的差异可能表明，彭阻滞在囊外骨折中的镇痛效果不太一致，这可能是由于注射扩散到转子区域的变异性较大。由于我们的样本量小，并且我们的研究不能进行二次分析，因此我们描述性地呈现这些数据。未来充分有力的研究应该阐明，对于给定的注射量，彭阻滞是否对囊内和囊外骨折产生不同的镇痛效果。同样值得研究的是，这些裂缝模式是否需要不同的注入量才能使PENG区块有效。

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引用次数: 0

Beyond drug rankings in cardiac surgical delirium prevention 心脏手术谵妄预防的药物排名之外

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-10 DOI: 10.1111/anae.70034

Kai‐Chuan Hsieh, Mei‐Hsin Lin, Ming‐Hui Hung

引用次数: 0

Broadening the framework of medical futility 拓宽医疗无效的框架

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-10 DOI: 10.1111/anae.70033

Sarah E. Byrne‐Martelli, Alice Bottussi, Jacopo D'Andria Ursoleo

引用次数: 0

BMI-adjusted PEEP: a reply 经bmi调整的PEEP：回复。

IF 6.9 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-10-10 DOI: 10.1111/anae.70032

Tobias Becher, the authors

We thank Tang et al. [1] for their interest in our study and their comments on the BODYVENT trial investigating BMI-based peak end expiratory pressure (PEEP) adjustment during general anaesthesia [2]. We agree that the relatively short duration of procedures included in our trial constitutes a limitation, particularly regarding the detection of differences in postoperative pulmonary complications. The primary aim of our study was to investigate the feasibility and physiological effects of a BMI-guided ventilation strategy on intra-operative lung mechanics and postoperative lung aeration. We did not aim to show clinical outcome benefits regarding postoperative pulmonary complications with this comparatively small study. Evaluating effects on postoperative pulmonary complications would indeed require substantially larger trials with longer procedures and follow-up periods.

Not studying patients with BMI > 60 kg.m^-2 was a pragmatic decision to avoid PEEP levels > 20 cmH₂O, which are not supported by all anaesthesia ventilators and could raise safety concerns. Rather than a fixed target, we consider PEEP equating with BMI/3 as a physiologically grounded starting point for further individualisation [3]. Titrating PEEP within a range around BMI/3 (e.g. BMI/3 ± 5 cmH₂O) may be preferable to unguided approaches, including those based solely on electrical impedance tomography, which typically begin at arbitrarily chosen default PEEP levels.

Regarding patient selection, the relatively low ARISCAT scores observed in our cohort reflect the included patient characteristics in our study. Future investigations in higher risk populations will be essential to assess the clinical utility and outcome effects of BMI-guided PEEP adjustment strategies more broadly.

我们感谢Tang等人对我们的研究感兴趣，并对BODYVENT试验发表评论，该试验研究了全麻期间基于bmi的呼气末峰值压（PEEP）调节[2]。我们同意，在我们的试验中，相对较短的手术时间构成了一个限制，特别是在检测术后肺部并发症的差异方面。本研究的主要目的是探讨bmi引导通气策略对术中肺力学和术后肺通气的可行性和生理影响。我们的目的不是通过这项相对较小的研究来显示术后肺部并发症的临床结果获益。评估术后肺部并发症的效果确实需要更大规模的试验和更长的随访时间。没有研究体重指数为60公斤的患者。m-2是一个实用的决定，以避免PEEP水平>； 20cmh2o，这不是所有麻醉呼吸机都支持的，可能会引起安全问题。而不是一个固定的目标，我们认为PEEP等同于BMI/3作为进一步个体化的生理基础起点。在BMI/3左右的范围内滴定PEEP（例如BMI/3±5 cmH2O）可能比非引导方法更可取，包括仅基于电阻抗断层扫描的方法，后者通常从任意选择的默认PEEP水平开始。关于患者的选择，在我们的队列中观察到的相对较低的ARISCAT评分反映了我们研究中纳入的患者特征。未来对高危人群的调查对于更广泛地评估以bmi为指导的PEEP调整策略的临床应用和结果效果至关重要。

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引用次数: 0