Revista espanola de anestesiologia y reanimacion最新文献

英文中文

Beyond compliance: Patient risk, ERAS adherence, and postoperative outcomes through explainable machine learning 超越依从性：通过可解释的机器学习，患者风险、ERAS依从性和术后结果。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2026.501990

J. Ripollés-Melchor , Á.V. Espinosa , A. Abad-Motos , A. Abad-Gurumeta , P. Galán-Menéndez , A. Zorrilla-Vaca , R. Navarro-Pérez , A. Ruiz-Escobar , J. Fernanz-Antón , A. Suárez-de-la-Rica , C. Aldecoa , the EuroPOWER Study Investigators Group

Background

Enhanced Recovery After Surgery (ERAS) protocols improve outcomes after colorectal surgery, but adherence remains variable and may interact with patient risk. Traditional compliance scores lack granularity to explore these dynamics. We aimed to use interpretable machine learning to quantify the contribution of individual ERAS items and clinical features to postoperative complications, and to identify data-driven ERAS phenotypes.

Methods

This was a secondary analysis of the EuroPOWER cohort (NCT04889798), a prospective European study including 2841 adults undergoing elective colorectal surgery. Two Extreme Gradient Boosting models were trained to predict in-hospital complications: a complete model (clinical variables + 23 ERAS items) and an ERAS-only model. Both were interpreted using Shapley Additive Explanations (SHAP). In the complete model, SHAP matrices were clustered to derive phenotypes. Feature importance, adherence, and complication rates were compared descriptively.

Results

The complete model achieved an AUC of 0.627. SHAP analysis identified frailty, ASA class, BMI, and age as leading predictors, followed by early mobilisation, nutritional care, and thromboprophylaxis. Three phenotypes were identified, with complication rates of 17.7%, 27.1%, and 41.1%, corresponding to robust, intermediate, and frail profiles. The ERAS-only model showed similar discrimination (area under the curve 0.642), but reduced interpretability. SHAP redundancy analysis supported inclusion of all ERAS items.

Conclusions

The clinical effect of ERAS adherence appears to be modulated by baseline vulnerability and implementation patterns. SHAP-based models enable transparent risk attribution and phenotype identification, supporting more targeted ERAS strategies and future development of automated quality monitoring tools.

背景：增强术后恢复（ERAS）方案可改善结直肠手术后的预后，但依从性仍存在差异，并可能与患者风险相互作用。传统的遵从性评分缺乏探究这些动态的粒度。我们的目标是使用可解释的机器学习来量化单个ERAS项目和临床特征对术后并发症的贡献，并确定数据驱动的ERAS表型。方法：这是对EuroPOWER队列（NCT04889798）的二次分析，这是一项前瞻性欧洲研究，包括2,841名接受选择性结直肠手术的成年人。训练两个极端梯度增强模型来预测院内并发症：一个完整模型（临床变量+ 23个ERAS项目）和一个仅ERAS模型。两者均采用Shapley加性解释（SHAP）进行解释。在完整的模型中，SHAP矩阵被聚类以获得表型。描述性地比较了特征重要性、依从性和并发症发生率。结果：完整模型的AUC为0.627。SHAP分析确定虚弱、ASA等级、BMI和年龄是主要预测因素，其次是早期活动、营养护理和血栓预防。确定了三种表型，并发症发生率分别为17.7%，27.1%和41.1%，对应于健壮，中等和虚弱的表型。ERAS-only模型具有相似的判别性（曲线下面积0.642），但可解释性降低。SHAP冗余分析支持纳入所有ERAS项目。结论：ERAS依从性的临床效果似乎受到基线脆弱性和实施模式的调节。基于shap的模型能够实现透明的风险归因和表型识别，支持更有针对性的ERAS策略和未来自动化质量监控工具的发展。

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引用次数: 0

Towards universal implementation of videolaryngoscopy: A new milestone in airway management driven by SEDAR. 视频喉镜检查的普遍实施：SEDAR驱动下气道管理的新里程碑。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-20 DOI: 10.1016/j.redare.2025.501993

M Á Gómez-Ríos, A Abad-Gurumeta

引用次数: 0

Delirium in the postoperative patient. 术后患者谵妄。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-20 DOI: 10.1016/j.redare.2025.501987

C Chamorro-Falero, J García-García, J J Morales-Domene

引用次数: 0

Use of saline solution to reverse interscalene block-induced phrenic nerve palsy: A case report 应用生理盐水逆转斜角肌间阻滞引起的膈神经麻痹1例。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redare.2025.501851

A.M. Castro-Alemán, J.A. Estupiñán-Tibaduiza, R.P. Altamirano-Muñoz, J.C. Altuve-Quiroz

Brachial plexus block at the interscalene level is a regional anaesthetic technique widely used to provide analgesia in shoulder and upper extremity surgery; However, it is associated with a high incidence of phrenic nerve block with diaphragmatic paralysis which has clinical implications in patients with underlying respiratory disease, showing respiratory difficulty symptoms. As consequence, it has been contraindicated in certain population groups. Once diaphragmatic paralysis and respiratory symptoms are established, management is supportive and expectant. In recent years, the administration or “washing” with normal saline solution has been described with the same approach, to reverse the phrenic nerve block and thus the respiratory symptoms. We present the first case of successful reversal of phrenic nerve block with saline in Latin America.

斜角肌间水平臂丛阻滞是一种广泛应用于肩部和上肢手术的区域麻醉技术；然而，膈神经阻滞伴膈肌麻痹的高发与膈神经阻滞相关，膈肌麻痹对有潜在呼吸系统疾病的患者有临床意义，表现为呼吸困难症状。因此，它在某些人群中是禁忌的。一旦确定膈肌麻痹和呼吸道症状，治疗是支持和期待的。近年来，用生理盐水给药或“冲洗”也采用了同样的方法，以逆转膈神经阻滞，从而缓解呼吸道症状。我们提出的第一例成功逆转膈神经阻滞与生理盐水在拉丁美洲。

引用次数: 0

Preoperative cognitive function assessment: Feasibility and outcomes 术前认知功能评估：可行性和结果。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redare.2025.501857

B. Tena, A. Fervienza, I. Gracia, N. Fábregas

引用次数: 0

Challenges in anesthesiology: Severe subglottic stenosis 麻醉学的挑战：严重的声门下狭窄。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redare.2025.501842

L. Gómez-López, R. Bergé Ramos, A. Vallejo Tarrat, J. Doménech de la Lastra

引用次数: 0

Platelet-rich plasma injections improve functional results over pulsed radiofrequency in ganglion impar treatments for coccydynia 富血小板血浆注射改善功能结果比脉冲射频神经节损伤治疗尾骨痛。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redare.2025.501929

J. Pilco Inga , A. Fervienza Sánchez , J.J. Velázquez Fragoso , M. Fa-Binefa , I. Moya Molinas

Introduction

Coccydynia is a painful condition commonly related to trauma or repetitive stress. While most cases respond to conservative management, a subset of patients requires minimally invasive interventions. Platelet-rich plasma (PRP) has recently emerged as a biological treatment alternative, promoting tissue repair. This study aimed to compare the clinical efficacy of PRP injections versus pulsed radiofrequency (PRF) at the ganglion impar in patients with coccydynia refractory to conservative treatment.

Methods

A retrospective cohort study was conducted on 40 consecutive patients treated for coccydynia. 20 received PRP injections and 20 underwent PRF at the ganglion impar. Functional disability was measured by the Oswestry Disability Index (ODI) and pain intensity was assessed using the Visual Analogue Scale (VAS) at baseline and at six months. Statistical analysis included t-tests and multivariable regression models adjusted for baseline characteristics.

Results

Both groups showed improvement in pain and function. There were no significant differences in pre- or post-treatment VAS scores between the two groups. However, the mean change in ODI scores was significantly greater in the PRP group (−9.6 ± 4.2) compared to the PRF group (−5.4 ± 6.3), with a statistically significant difference in functional improvement (p = 0.018), and a clinically relevant improvement (≥30% reduction in ODI) was achieved in 85% of cases versus 45%, respectively (p = 0.02). The adjusted analysis confirmed the superiority of PRP after controlling for baseline differences.

Conclusion

PRP injections at the ganglion impar demonstrated superior improvement in functional outcomes compared to PRF in patients with refractory coccydynia. These findings support the use of PRP as a potentially more effective minimally invasive treatment, though prospective studies with longer follow-up are needed to confirm these results.

简介：尾骨痛是一种通常与创伤或重复性压力有关的疼痛状况。虽然大多数病例对保守治疗有反应，但一小部分患者需要微创干预。富血小板血浆（PRP）最近成为一种生物治疗替代方案，促进组织修复。本研究旨在比较PRP注射与脉冲射频（PRF）治疗难治性尾骨痛患者神经节损伤的临床疗效。方法：对40例连续治疗的尾骨痛患者进行回顾性队列研究。20例接受PRP注射，20例在神经节处接受PRF。在基线和6个月时，采用Oswestry残疾指数（ODI）测量功能残疾，使用视觉模拟量表（VAS）评估疼痛强度。统计分析包括t检验和多变量回归模型调整基线特征。结果：两组患者疼痛及功能均有改善。两组治疗前和治疗后的VAS评分无显著差异。然而，与PRF组（-5.4±6.3）相比，PRP组ODI评分的平均变化（-9.6±4.2）显著大于PRF组（-5.4±6.3），在功能改善方面存在统计学差异（p = 0.018）， 85%的病例实现了临床相关的改善（ODI降低≥30%），分别为45% （p = 0.02）。在控制基线差异后，校正分析证实了PRP的优越性。结论：与PRF相比，在神经节处注射PRP对难治性尾骨痛患者的功能结果有更好的改善。这些发现支持使用PRP作为一种潜在的更有效的微创治疗，尽管需要更长时间随访的前瞻性研究来证实这些结果。

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引用次数: 0

Reflections on: “Comparison of serratus plane and erector spinae plane blocks for postoperative analgesia in unilateral breast surgery” 思考：“单侧乳房手术后使用锯肌平面与竖脊平面阻滞镇痛的比较”。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redare.2025.501927

R. M. Sethuraman, R. Aravindan, Y. Mariam

引用次数: 0

Diagnosing paradoxical fat embolism syndrome after cemented hip arthroplasty 骨水泥髋关节置换术后悖论性脂肪栓塞综合征的诊断。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redare.2025.501841

S. Maia , A. Carneiro , M. Vargas , B. Xavier , S. Caramelo

The diagnosis of cerebral fat embolism syndrome (FES) is not linear. In this case report, a 79-year-old woman underwent urgent cemented hip arthroplasty 24 h after a femoral neck fracture. Immediately after the procedure she had a brief episode of altered state of consciousness. After 4 h, she presented with multiple neurological symptoms which led to activation of the stroke alert system. Various new neurological deficits appeared during the day. She had 2 brain CT scans, which were normal. Transthoracic echocardiogram showed a patent foramen ovale with an exuberant aneurysm. Electroencephalogram showed nonconvulsive status epilepticus, which was promptly treated. Brain MRI showed findings compatible with cerebral FES. After ruling out acute ischaemic stroke, conditions that lead to multiple embolic strokes in different vascular territories had to be considered due to the diverse neurological deficits. The embolization hypothesis was also supported by the sudden onset of the symptoms. Even though FES is an exclusion diagnosis, the patient’s brain MRI showed the distinct radiographic features of fat microembolism. Perioperative neurological deficits are not uncommon, particularly in elderly patients. Accurate diagnosis and appropriate management are crucial to ensure favourable outcomes and prevent long-term sequelae.

脑脂肪栓塞综合征（FES）的诊断不是线性的。在这个病例报告中，一位79岁的女性在股骨颈骨折24小时后接受了紧急骨水泥髋关节置换术。手术后，她立即出现了短暂的意识状态改变。4小时后，她出现了多种神经系统症状，导致中风警报系统激活。白天出现了各种新的神经功能缺陷。她做了两次脑部CT扫描，都正常。经胸超声心动图显示卵圆孔未闭伴增生动脉瘤。脑电图显示非惊厥性癫痫持续状态，并及时治疗。脑MRI显示与脑FES相符。在排除急性缺血性中风后，由于不同的神经功能缺陷，必须考虑导致不同血管区域的多发性栓塞性中风的情况。栓塞假说也被症状的突然发作所支持。尽管FES是一种排除性诊断，但患者的脑部MRI显示出明显的脂肪微栓塞的影像学特征。围手术期神经功能缺损并不罕见，特别是在老年患者中。准确的诊断和适当的管理对于确保良好的结果和预防长期后遗症至关重要。

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引用次数: 0

New-onset chronic and neuropathic pain in survivors of severe COVID-19: A secondary analysis of the PAIN-COVID Trial 重症COVID-19幸存者的新发慢性和神经性疼痛：pain - covid试验的二次分析

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-01 DOI: 10.1016/j.redare.2025.501915

A. Ojeda , T. Cuñat , O. Comino-Trinidad, J. Aliaga, M. Arias, A. Calvo

Background

Survivors of critical illnesses, including COVID-19, are at risk of developing Chronic ICU-Related Pain (CIRP) and neuropathic pain (NP). This study evaluates the incidence of CIRP and NP 6 months after hospital discharge and their impact on pain intensity, functional status, and quality of life (QoL).

Methods

We performed an observational prospective cohort analysis based on a secondary analysis of data from the existing PAIN-COVID randomized controlled trial, which included adult survivors of severe COVID-19 admitted to the ICU. CIRP and NP were assessed at 6 months post-discharge using validated scales (Brief Pain Inventory [BPI] and DN4-interview). Propensity score matching was used to control for confounding factors when comparing pain intensity, functional impact, and QoL between groups.

Results

New-onset CIRP was reported by 47.7% of patients. In matched cohorts, patients with CIRP had significantly lower EQ-5D-5L index (0.705 [0.613–0.818]; p < 0.001) and VAS (72 [60–80]; p = 0.019) scores compared to those without pain. NP affected 36.5% of patients. Patients with NP showed higher BPI-intensity (5.3 [2.5–6], p=0.002) and BPI-interference scores (4.5 [1.5–6.9], p=0.025). The EQ-5D-5L index (0.68 [0.36–0.81]; p = 0.29) and VAS scores (60 [47.5–85]; p = 0.032) were lower compared to those without NP.

Conclusion

A substantial proportion of COVID-19 ICU survivors develop new-onset CIRP and NP within 6 months after discharge, resulting in significant impairment in QoL.

Trial registration

# NCT04394169, registered on 5/19/2020.

背景：包括COVID-19在内的危重疾病幸存者有发生慢性重症监护病房相关疼痛（CIRP）和神经性疼痛（NP）的风险。本研究评估出院后6个月CIRP和NP的发生率及其对疼痛强度、功能状态和生活质量的影响。方法：在对现有PAIN-COVID随机对照试验数据进行二次分析的基础上，我们进行了一项观察性前瞻性队列分析，该试验包括ICU收治的重症COVID-19成年幸存者。CIRP和NP在出院后6个月使用有效的量表（简短疼痛量表[BPI]和dn4访谈）进行评估。在比较组间疼痛强度、功能影响和生活质量时，采用倾向评分匹配来控制混杂因素。结果：新发CIRP占47.7%。在匹配的队列中，CIRP患者的eq - 5d - 5l指数显著降低(0.705 [0.613-0.818]；p结论：有相当比例的COVID-19 ICU幸存者在出院后6个月内出现新发CIRP和NP，导致生活质量明显下降。

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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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