Revista espanola de anestesiologia y reanimacion最新文献

Background: Haemodynamic research advanced across perioperative and critical-care medicine, with major contributions in vascular physiology, microcirculation, fluid therapy, arterial pressure targets, organ protection and the clinical performance of monitoring and artificial intelligence (AI) supported systems. Given the breadth and heterogeneity of this evidence, a coherent physiological synthesis is required.

Methods: Between December 2024 and December 2025, we undertook a broad, intentionally inclusive review of high-impact perioperative and critical-care journals, complemented by targeted PubMed searches centred on perfusion, arterial pressure, microcirculation and haemodynamic monitoring in adult patients. Selection was curatorial rather than exhaustive, optimization studies that materially advanced physiological understanding or challenged prevailing assumptions. Relevant trials, mechanistic studies and conceptual papers were grouped into thematic blocks and interpreted through a unified physiological lens. No formal risk-of-bias scoring was applied.

Findings: Macrocirculatory correction alone did not ensure microvascular or metabolic recovery. Vasoplegia, endothelial dysfunction and venous congestion repeatedly defined the limits of resuscitation, while vasopressor efficacy proved phenotype-dependent. Timing of fluid administration outweighed cumulative volume, and early-perfusion markers outperformed traditional surrogates such as lactate. Intraoperative blood pressure prediction and automation consistently reduced hypotension exposure but did not improve organ injury or complications. Renal protection advanced through biomarker-enriched prevention rather than numerical thresholds. Updated guidelines emphasised physiological coherence over fixed targets, highlighting persisting uncertainty around personalised arterial pressure goals, optimal perfusion monitoring and the integration of emerging AI systems.

Conclusion: The 2025 haemodynamic literature reinforces a unifying principle: numerical optimization is insufficient; clinical benefit arises only when interventions respect vascular biology, microcirculatory capacity and metabolic tolerance.

Background: Maternal hypotension is common during spinal anesthesia for cesarean delivery and is influenced by patient position. Positioning also affects sensory block height, which determines visceral analgesia. This study compared immediate supine, sitting, and semi-sitting positions to identify the optimal balance between cardiovascular stability and surgical anesthesia.

Methods: In this randomized controlled trial, 216 ASA II term parturients scheduled for cesarean delivery under spinal anesthesia were assigned to three groups (n = 72). Group A received immediate supine positioning, Group B sat for three minutes, and Group C assumed semi-sitting for three minutes. All received 2.5 mL of 0.5% hyperbaric bupivacaine. The primary outcome was maternal hypotension; secondary outcomes included block height, intraoperative discomfort, vasopressor use, and neonatal Apgar scores.

Results: Hypotension occurred most in Group A (65.3%), followed by Group C (47.2%) and Group B (33.3%) (p < 0.001). The supine group had 3.79 times higher odds of hypotension compared with sitting. Ephedrine use was greatest in Group A (14.5 ± 3.2 mg) and least in Group B (8.1 ± 2.3 mg). Median block height was T3 in Group A, T5 in Group C, and T6 in Group B. Intraoperative discomfort was highest in Group B (22.2%) compared with Group C (12.5%) and Group A (5.6%) (p = 0.009). Hypotension correlated with nausea, most frequent in Group A (19.4%). Neonatal Apgar scores were ≥8 at 1 and 5 minutes in all groups.

Conclusion: Maternal position after spinal anesthesia significantly influences hemodynamics and block height. Sitting reduces hypotension but risks lower block and discomfort, while semi-sitting provides a favorable compromise.

Trial registration: [NCT06857162].

Introduction: Interscalene brachial plexus block (ISB) remains the gold standard nerve block in shoulder arthroscopic surgery. However, some anatomical variations exist in addition to several reported complications and technical challenges. Upper trunk block (UTB) may be a feasible alternative. The primary outcome was the success rate of UTB and ISB. Secondary outcomes included: duration of block performance, guidance interventions, visualization of anatomic structures, postoperative pain and opioid consumption, and diaphragmatic function.

Methods: One hundred and twenty patients were divided randomly into 2 groups; 60 patients received ISB before general anaesthesia (GA) and 60 patients received UTB before GA. All blocks were performed by anaesthesia trainees under supervision of an attending consultant.

Results: Age, sex, BMI, and duration of surgery were not different statistically. The duration of block performance was significantly longer in the ISB group (P = 0.002). Guidance interventions in the ISB group were higher than the UTB group (P < 0.001). There were no significant differences regarding the worst postoperative pain score (P = 0.574), postoperative nalbuphine consumption (P = 0.813) or success rate (P = 0.31) between groups. Visualization of the anatomic structures in the 2 groups was not statistically significant (P = 0.183). Diaphragmatic function was significantly affected in the ISB group (45 % complete paralysis and 35 % paresis) versus (8.3 % complete paralysis and 30 % paresis) in the UTB group.

Conclusions: UTB may be considered a safer and a technically easier approach than ISB for providing equivalent intra and postoperative regional analgesia in arthroscopic shoulder surgery by anaesthesia trainees.

Objectives: The main objective of this study was to create and validate a metric for the correct performance of orotracheal intubation with an angled blade video laryngoscope (GlideScope®). The secondary objectives were to break down the technique into correct phases and steps (competency metrics), define errors and critical errors.

Method: Prospective observational study divided into two phases. In phase I, the metric was created: a group of experts deconstructed the procedure, identifying phases and defining the competence metrics and errors with the help of three previous recordings. The metrics were stress-tested for objectivity and consensus was sought in a meeting of 24 experts using the modified Delphi methodology. In phase II, the metric was validated by recording 9 experienced and 9 novice professionals performing the procedure on a mannequin. Subsequently, 2 external evaluators, previously trained in the use of the metric, evaluated the videos independently.

Results: A metric was created, defined by 4 phases, 22 competency metrics, and 31 errors, of which 16 were considered critical. Experienced professionals completed more competency metrics than novices (17.05 vs. 13.72 (p = 0.010), had fewer total errors (p = 0.0017) and fewer critical errors 0.55 vs. 2.61 (p < 0.001). Inter-rater agreement for the total score of all videos was >0.80.

Conclusions: The metric created is valid and reliably discriminates between operators who are competent and those who are not competent in performing the technique.

Objective: The objective of this study was to find the relationship between MAPSE and LVEF by modified Simpson's method using point of care cardiac ultrasound.

Design: Prospective observational study.

Setting: Intensive care unit.

Patients: Seventy-five patients admitted to the intensive care unit were recruited for determining the relationship between MAPSE and LVEF by modified Simpson's method. It was validated in the second part in another 75 patients by comparing the result obtained from modified Simpson's method and the previously derived equation.

Interventions: None.

Measurements: MAPSE, LVEF from modified Simpson's method in part I. An equation was derived from a linear relationship between the two. In part II, the derived equation for calculation of LVEF from MAPSE was validated with respect to a previously described equation and LVEF obtained by modified Simpson's method. Bias and precision were calculated. Time taken for both the procedures was also noted.

Results: MAPSE showed a strong correlation with LVEF calculated by modified Simpson's method. The linear equation obtained was LVEF = 3.27 × MAPSE (mm) + 18.79 (ρ = 0.761, R² = 0.520). Time taken for calculation of MAPSE was quicker (51.47 ± 11.18 s) as compared to that by modified Simpson's method (192.27 ± 31.93 s; P < .001). The equation was found to be 89.33% accurate. A MAPSE of 10.325 mm, predicts EF > 50% with a sensitivity of 90.7% and 90.6% specificity.

Conclusion: MAPSE correlates well with the EF measured by modified Simpson's method. It is faster and provides an accurate estimation of ejection fraction.

Background: Data comparing the effects of caudal epidural anaesthesia and perianal block during anal sphincter sparing procedures under general anaesthesia are limited. We aimed to compare the efficacy and safety of ultrasound-guided caudal block versus perianal block on anal sphincter muscle tone and in reducing postoperative pain among patients undergoing anal sphincter-sparing procedures.

Methods: This randomized double-blinded study enrolled 46 adult patients, American Society of Anesthesiologists physical status I or II, who underwent anal sphincter sparing procedures under general anaesthesia. Patients were randomly assigned to one of two groups (23 patients each). Group A received an ultrasound-guided caudal block, while Group B received a perianal block. The primary outcome was duration of postoperative analgesia. Secondary outcomes included total postoperative morphine consumption, postoperative pain intensity, time to postoperative ambulation, intraoperative external anal sphincter muscle tone by Digital rectal scoring system (DRESS), patient satisfaction, and incidence of complications.

Results: Patients in group A had a statistically significant longer time to first request for analgesia and lower morphine consumption than those in group B (2.50 ± 0.27 vs. 1.57 ± 0.53 h, and 3.30 ± 2.18 mg vs. 5.87 ± 2.05 mg, P < .001). Although these differences are modest in magnitude, they may contribute to improved recovery when combined with multimodal analgesia strategies. Moreover, caudal block resulted in shorter time to ambulation (2.17 ± 0.38 vs 3.48 ± 0.53 h), and low numeric pain scores (1.96 ± 0.56 vs. 3.48 ± 0.66, P < .001). The DRESS and Likert scores were significantly higher in patients in group A than in group B (2.83 ± 0.38 vs. 2.22 ± 0.42, and 3.78 ± 0.42 vs. 2.48 ± 0.66, P < .001).

Conclusion: In anal sphincter-sparing operations, ultrasound-guided caudal epidural blocks combined with general anaesthesia may improve pain management, reduce opioid requirements, and thereby reduce the incidence of postoperative nausea and vomiting, while maintaining anal sphincter tone compared to local perianal block.

Background and objectives: Opioid-free anesthesia (OFA) aims to achieve effective perioperative pain control while avoiding the adverse effects associated with opioid use. Its usefulness in breast surgery remains poorly studied. The primary objective of this study was to compare morphine consumption in the post-anesthesia care unit (PACU) between patients undergoing opioid-free anesthesia and those receiving conventional opioid-based anesthesia.

Materials and methods: A retrospective, observational, single-center study was conducted at the University Hospital of A Coruña. A total of 87 patients who underwent breast surgery between January and July 2022 were included. Two groups were compared: opioid-free anesthesia (OFA, n = 41) and conventional opioid-based anesthesia (non-OFA, n = 46). The need for morphine rescue at PACU discharge, at 24 hours, and at 48 hours postoperatively (if patients remained hospitalized) was recorded. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), oral tolerance, night rest, and length of stay in the PACU and hospital.

Results: The OFA group showed significantly lower morphine consumption in the recovery unit (9.8% vs. 47.8%; p < 0.001), with an absolute risk reduction of 38.1%. No PONV events were observed in the OFA group compared with 21.7% in the non-OFA group (p = 0.001). Delayed oral tolerance was more frequent in the non-OFA group (0% vs. 15.2%; p = 0.013), and night rest was also better in the OFA group (94.4% vs. 65.7%; p < 0.05). No differences were found in PACU or hospital length of stay.

Discussion: The OFA technique provided adequate analgesic control with a significant reduction in postoperative adverse effects.

Conclusions: Opioid-free anesthesia in breast surgery is a safe and effective technique that improves postoperative recovery.

Perioperative cardiopulmonary arrest (CPA) in the obstetric patient is a rare but devastating complication, representing a significant clinical challenge due to the speed with which it threatens the lives of the mother and fetus. Although, compared to the general population, obstetric patients have a lower risk due to their youth and fewer comorbidities, recent records show an increase in the incidence of CPA in this group. Anesthetic factors are key, especially when general anesthesia is used, and unexpected conversion from neuraxial blocks poses an additional risk. Success in the management of CPA critically depends on early recognition and a coordinated, structured approach, where understanding the causes and maternal physiology is essential. Emphasizing education specifically dedicated to obstetric CPA is a priority, as conventional approaches like basic and advanced cardiac life support have proven insufficient for the particularities of this setting. To optimize outcomes, it is recommended to train skilled multidisciplinary teams, implement adapted protocols, and carry out timely interventions such as perimortem cesarean section. Effective communication between teams and the application of advanced support measures, always considering maternal and fetal well-being, are decisive factors for prognosis. In summary, perioperative CPA in obstetrics requires specific protocols, ongoing knowledge updates and simulation, with the primary goal of reducing maternal mortality and improving neonatal outcomes in one of the most critical scenarios faced by healthcare teams.