INTRODUCTIONPatients with valvular heart disease are at high risk of postoperative pulmonary complications, which contribute to morbidity and mortality. However, few studies have focused specifically on peri-operative rehabilitation in this patient population. We aimed to evaluate whether peri-operative rehabilitation benefits patients undergoing elective cardiac valve surgery by reducing the incidence of postoperative pulmonary complications, the duration of postoperative hospitalisation and mortality.METHODSThis single-centre, randomised controlled trial compared usual care (usual care group) with a peri-operative rehabilitation bundle (rehabilitation group) comprising four components: education; inspiratory muscle training; active cycle of breathing techniques; and early mobilisation. The primary outcome was a composite measure of the occurrence of postoperative pulmonary complications within the first 7 days; incidence of prolonged postoperative hospitalisation > 7 days; and in-hospital all-cause mortality. Secondary outcomes included each component of primary outcome measure; duration of stay in the ICU; total duration of postoperative hospitalisation; and 3-month all-cause mortality.RESULTSOn an intention-to-treat basis, data from 818 patients were analysed (419 allocated to the usual care group and 399 to the rehabilitation group). The primary composite outcome did not differ between groups, occurring in 224/419 (53.5%) patients allocated to the usual care group and 206/399 (51.6%) patients allocated to the rehabilitation group (odds ratio 0.88, 95%CI 0.66-1.17, p = 0.376). Postoperative pulmonary complications were present in 197 (47.1%) patients allocated to the usual care group and 161 (40.4%) patients allocated to the rehabilitation group (odds ratio 0.720, 95%CI 0.541-0.956, p = 0.023). There was no significant difference between the groups in terms of duration of postoperative hospital stay of > 7 days or in-hospital mortality.DISCUSSIONPeri-operative rehabilitation reduced the incidence of postoperative pulmonary complications in patients having surgery for valvular heart disease. We recommend incorporating comprehensive peri-operative rehabilitation into the clinical management of these patients.
瓣膜性心脏病患者术后发生肺部并发症的风险很高，这是导致发病率和死亡率的重要因素。然而，很少有研究专门关注这类患者的围手术期康复。我们的目的是评估围手术期康复是否通过减少术后肺部并发症的发生率、术后住院时间和死亡率而使择期心脏瓣膜手术患者受益。方法本单中心随机对照试验比较常规护理（常规护理组）与围手术期康复治疗（康复组），包括四个部分：教育；吸气肌训练；主动循环呼吸技巧；以及早期动员。主要终点是前7天内术后肺部并发症发生的综合指标；术后长时间住院率bbb7d；以及院内全因死亡率。次要结局包括主要结局指标的各个组成部分；ICU住院时间；术后住院总时间；3个月的全因死亡率。结果以意向治疗为基础，分析了818例患者的数据，其中419例分配到常规护理组，399例分配到康复组。主要综合结局在两组间无差异，224/419例（53.5%）患者被分配到常规护理组，206/399例（51.6%）患者被分配到康复组（优势比0.88,95%CI 0.66-1.17, p = 0.376）。常规护理组197例（47.1%）患者出现术后肺部并发症，康复组161例（40.4%）患者出现术后肺部并发症（优势比0.720,95%CI 0.541 ~ 0.956, p = 0.023）。两组患者术后住院时间为70 ~ 70天，住院死亡率差异无统计学意义。讨论：围手术期康复可降低瓣膜性心脏病患者术后肺部并发症的发生率。我们建议将全面的围手术期康复纳入这些患者的临床管理。
{"title":"Peri-operative rehabilitation in patients undergoing elective cardiac valve surgery: a randomised controlled trial.","authors":"Yuting Liu,Fengyao Liu,Mingyu Xu,Haofeng Zhou,Haochen Wang,Yuanhui Liu,Xuyu He,Huanlei Huang,Tucheng Sun,Xuhua Jian,Jimei Chen,Min Wu,Yijia Sun,Peihua Cao,Jiyan Chen,Lan Guo,Huan Ma","doi":"10.1111/anae.70025","DOIUrl":"https://doi.org/10.1111/anae.70025","url":null,"abstract":"INTRODUCTIONPatients with valvular heart disease are at high risk of postoperative pulmonary complications, which contribute to morbidity and mortality. However, few studies have focused specifically on peri-operative rehabilitation in this patient population. We aimed to evaluate whether peri-operative rehabilitation benefits patients undergoing elective cardiac valve surgery by reducing the incidence of postoperative pulmonary complications, the duration of postoperative hospitalisation and mortality.METHODSThis single-centre, randomised controlled trial compared usual care (usual care group) with a peri-operative rehabilitation bundle (rehabilitation group) comprising four components: education; inspiratory muscle training; active cycle of breathing techniques; and early mobilisation. The primary outcome was a composite measure of the occurrence of postoperative pulmonary complications within the first 7 days; incidence of prolonged postoperative hospitalisation > 7 days; and in-hospital all-cause mortality. Secondary outcomes included each component of primary outcome measure; duration of stay in the ICU; total duration of postoperative hospitalisation; and 3-month all-cause mortality.RESULTSOn an intention-to-treat basis, data from 818 patients were analysed (419 allocated to the usual care group and 399 to the rehabilitation group). The primary composite outcome did not differ between groups, occurring in 224/419 (53.5%) patients allocated to the usual care group and 206/399 (51.6%) patients allocated to the rehabilitation group (odds ratio 0.88, 95%CI 0.66-1.17, p = 0.376). Postoperative pulmonary complications were present in 197 (47.1%) patients allocated to the usual care group and 161 (40.4%) patients allocated to the rehabilitation group (odds ratio 0.720, 95%CI 0.541-0.956, p = 0.023). There was no significant difference between the groups in terms of duration of postoperative hospital stay of > 7 days or in-hospital mortality.DISCUSSIONPeri-operative rehabilitation reduced the incidence of postoperative pulmonary complications in patients having surgery for valvular heart disease. We recommend incorporating comprehensive peri-operative rehabilitation into the clinical management of these patients.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"200 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Propofol and the promise of unconsciousness in end-of-life care: a warning about the use of low-dose propofol infusions.","authors":"Thomas M Donaldson","doi":"10.1111/anae.70047","DOIUrl":"https://doi.org/10.1111/anae.70047","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ASA physical status classification: a relic of a bygone time?","authors":"Shaun Evans, David Mayhew","doi":"10.1111/anae.70046","DOIUrl":"10.1111/anae.70046","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 2","pages":"167-170"},"PeriodicalIF":6.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clístenes C de Carvalho,Amit Pawa,Kariem El-Boghdadly
{"title":"Motor-sparing regional anaesthesia in lower-limb arthroplasty: balancing analgesia and function.","authors":"Clístenes C de Carvalho,Amit Pawa,Kariem El-Boghdadly","doi":"10.1111/anae.70044","DOIUrl":"https://doi.org/10.1111/anae.70044","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"53 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Conscious sedation vs. general anaesthesia for the peri‐operative management of patients undergoing transcatheter aortic valve implantation","authors":"Shingo Kawashima, Hiroyuki Kinoshita, Atsushi Kobayashi","doi":"10.1111/anae.70050","DOIUrl":"https://doi.org/10.1111/anae.70050","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"100 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We thank Jin et al. [<span>1</span>] and Yang [<span>2</span>] for their interest in our study of the analgesic efficacy of continuous erector spinae plane block vs. an opioid-based regimen for postoperative pain management following video-assisted thoracoscopic lung resection [<span>3</span>]. Regarding the comments from Jin et al. [<span>1</span>], the non-inferiority margin was set at 8% of the cumulative area under the curve in the control group, corresponding to a value of 11.86. This translates to an average difference of approximately 0.25 on the numerical rating scale for each hour of the 48-h study period. Thus, any difference ≤ 0.25 points, which is less than the minimal clinically important difference, remains clinically acceptable.</p><p>To mitigate the risk of expectation bias, ward nurses not involved in peri-operative care were trained and collected all data. We used real-time data monitoring and weekly audits to ensure protocol compliance. Segmentectomies in this study were unplanned and resulted in comparable surgical trauma. While segmentectomy preserves more lung parenchyma, its impact on chest wall structures and postoperative pain is anatomically similar to that of lobectomy. We argue the inclusion of these patients did not influence the outcomes materially and that the non-inferiority conclusion remains valid.</p><p>While a marked reduction in postoperative pulmonary complications was observed in the erector spinae group, this outcome was secondary and assessed without blinding. This finding should be interpreted as hypothesis-generating rather than conclusive. Although serum ropivacaine levels were not measured, all patients were monitored for clinical signs of local anaesthetic systemic toxicity. No such events were observed throughout the study period. We therefore consider our dosing regimen (approximately 775 mg over 48 h) to be clinically safe under monitored conditions.</p><p>Regarding the comments from Yang [<span>2</span>], we acknowledge that the limited number of postoperative pulmonary complications (n = 26) falls below the recommended threshold of at least 10 events per predictor variable, which may affect the stability and generalisability of the multivariable model. To mitigate the risk of overfitting and enhance model reliability, candidate variables were restricted to those with strong clinical justification and a univariable association of p < 0.05. No exploratory model-building practices were employed. Following backward elimination, only continuous erector spinae plane blockade and previous chemotherapy were significant predictors. Our unadjusted analysis showed a significant reduction in postoperative pulmonary complications with continuous erector spinae blockade. The multivariable result showed a substantial reduction, which we argue has biological plausibility. However, these results should be interpreted cautiously and viewed as exploratory. They are intended to generate hypotheses for future v
我们感谢Jin等人[1]和Yang b[2]对我们研究连续竖脊肌平面阻滞与阿片类药物方案对视频胸腔镜肺切除术[3]术后疼痛管理的镇痛效果的兴趣。对于Jin et al.[1]的评论，非劣效裕度设为对照组曲线下累计面积的8%，对应值为11.86。这意味着在48小时的研究期间，每小时在数值评定量表上的平均差异约为0.25。因此，任何小于0.25分的差异，小于最小临床重要差异，在临床上仍然是可接受的。为了减少预期偏差的风险，对未参与围手术期护理的病房护士进行培训并收集所有数据。我们使用实时数据监控和每周审计来确保协议的遵从性。本研究中的节段切除术是计划外的，导致了类似的手术创伤。虽然节段切除术保留了更多的肺实质，但其对胸壁结构和术后疼痛的影响在解剖学上与肺叶切除术相似。我们认为纳入这些患者对结果没有实质性影响，非劣效性结论仍然有效。虽然在竖脊组中观察到术后肺部并发症的显著减少，但这一结果是次要的，并且没有进行盲法评估。这一发现应该被解释为假设产生，而不是结论。虽然没有测量血清罗哌卡因水平，但所有患者都监测了局部麻醉全身毒性的临床体征。在整个研究期间没有观察到此类事件。因此，我们认为我们的给药方案（约775毫克/ 48小时）在监测条件下是临床安全的。关于Yang[2]的评论，我们承认有限数量的术后肺部并发症（n = 26）低于每个预测变量至少10个事件的推荐阈值，这可能会影响多变量模型的稳定性和通用性。为了降低过拟合的风险并提高模型的可靠性，候选变量被限制为具有强烈临床理由且p <； 0.05的单变量相关性的变量。未采用探索性模型构建实践。在反向排除后，只有连续竖肌脊柱平面阻滞和既往化疗是显著的预测因素。我们的未经调整的分析显示，持续的竖脊肌阻断术显著减少了术后肺部并发症。多变量结果显示了大量减少，我们认为这具有生物学上的合理性。然而，这些结果应该谨慎地解释，并被视为探索性的。它们的目的是产生假设，以便将来在更大的、适当的研究中得到验证。我们同意，观察到的1-1.5小时的早期活动和到口服摄入时间的差异并没有转化为住院时间的减少，并且在增强恢复的背景下，这些差异的含义应该谨慎解释。住院时间受到多种非临床因素的影响，包括机构出院协议；床上的可用性;还有社会环境。因此，住院时间没有差异并不一定反映康复质量没有差异。然而，功能恢复结果的持续加速支持了连续竖肌脊柱平面阻滞作为多模态镇痛策略的一部分的价值，值得在现实世界中进一步研究。我们的研究没有包括正式的经济分析。然而，一旦掌握了阻滞技术，它可以应用于各种外科手术，在其他地方产生潜在的好处。此外，通过潜在地减少术后并发症，连续竖脊肌平面阻滞也可能缩短住院时间并减少并发症相关费用，因此具有相当大的长期成本效益潜力。
{"title":"Erector spinae plane block vs. opioid-based regimen: a reply","authors":"Wei Wei","doi":"10.1111/anae.70038","DOIUrl":"10.1111/anae.70038","url":null,"abstract":"<p>We thank Jin et al. [<span>1</span>] and Yang [<span>2</span>] for their interest in our study of the analgesic efficacy of continuous erector spinae plane block vs. an opioid-based regimen for postoperative pain management following video-assisted thoracoscopic lung resection [<span>3</span>]. Regarding the comments from Jin et al. [<span>1</span>], the non-inferiority margin was set at 8% of the cumulative area under the curve in the control group, corresponding to a value of 11.86. This translates to an average difference of approximately 0.25 on the numerical rating scale for each hour of the 48-h study period. Thus, any difference ≤ 0.25 points, which is less than the minimal clinically important difference, remains clinically acceptable.</p><p>To mitigate the risk of expectation bias, ward nurses not involved in peri-operative care were trained and collected all data. We used real-time data monitoring and weekly audits to ensure protocol compliance. Segmentectomies in this study were unplanned and resulted in comparable surgical trauma. While segmentectomy preserves more lung parenchyma, its impact on chest wall structures and postoperative pain is anatomically similar to that of lobectomy. We argue the inclusion of these patients did not influence the outcomes materially and that the non-inferiority conclusion remains valid.</p><p>While a marked reduction in postoperative pulmonary complications was observed in the erector spinae group, this outcome was secondary and assessed without blinding. This finding should be interpreted as hypothesis-generating rather than conclusive. Although serum ropivacaine levels were not measured, all patients were monitored for clinical signs of local anaesthetic systemic toxicity. No such events were observed throughout the study period. We therefore consider our dosing regimen (approximately 775 mg over 48 h) to be clinically safe under monitored conditions.</p><p>Regarding the comments from Yang [<span>2</span>], we acknowledge that the limited number of postoperative pulmonary complications (n = 26) falls below the recommended threshold of at least 10 events per predictor variable, which may affect the stability and generalisability of the multivariable model. To mitigate the risk of overfitting and enhance model reliability, candidate variables were restricted to those with strong clinical justification and a univariable association of p < 0.05. No exploratory model-building practices were employed. Following backward elimination, only continuous erector spinae plane blockade and previous chemotherapy were significant predictors. Our unadjusted analysis showed a significant reduction in postoperative pulmonary complications with continuous erector spinae blockade. The multivariable result showed a substantial reduction, which we argue has biological plausibility. However, these results should be interpreted cautiously and viewed as exploratory. They are intended to generate hypotheses for future v","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 1","pages":"144-145"},"PeriodicalIF":6.9,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pre‐oxygenation in patients living with obesity","authors":"Etienne Couture, Jean Bussières","doi":"10.1111/anae.70043","DOIUrl":"https://doi.org/10.1111/anae.70043","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"24 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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