Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery. These recommendations summarize evidence-based principles of measuring and screening for frailty, as well as basic interventions that can help improve patient outcomes.
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ESAIC focused guidelines for the management of the failing epidural during labour epidural analgesia.
Eur J Anaesthesiol
February 2025
From the Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Calle de O'Donnell, 48, 28009 Madrid, Madrid, Spain (NB), the Servicio de Anestesia, Hospital Universitario Sanitas La Zarzuela, Madrid, c/ Pleyades, 25, 28023 Madrid, Spain (NB), the Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, P° de la Castellana, 261, 28046 Madrid, Spain (IVG), the Department of Paediatric and Obstetric Anaesthesiology, Juliane Marie Centre, Rigshospitalet & Institute of Clinical Medicine, University Hospital of Copenhagen, Copenhagen, Denmark (AA, KL), the University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany (PK, SR), the Division of Anesthesia Critical Care and Pain, Tel Aviv Sourasky Medical Center affiliated with the Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv Israel (CFW), the London North West NHS University Trust, Watford Road, London, UK HA1 3UJ (NL), the Department of Anesthesia & Intensive Care Medicine, Liège University Hospital, Belgium (PYD), the Servicio de Anestesia y Reanimación. Hospital Universitario Fundación Jiménez Díaz. Av. de los Reyes Católicos, 2. 28040 Madrid. Spain (EGA), the Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University, Shmuel Beyth St 12, Jerusalem, 9103102 Israel (AI), the Department of Anesthesia and Intensive Care, Akademiska Sjukhuset, Sjukhusvägen, 75185, Uppsala, Sweden (AK), the Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel affiliated with Tel Aviv University Medical School (SOZ), the Department of Anaesthesiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands (OvdB), the Department of Cardiovascular Sciences, KU Leuven, and Department of Anaesthesiology, UZ Leuven, Belgium (MvdV), the Department of Anaesthesia, Intensive Care and Pain Medicine, University General Hospital of Valencia, Methodology Department, European University of Valencia, Valencia, Spain (CSR).
Background: Labour epidural analgesia reportedly fails in up to 10 to 25% of cases. A joint taskforce of European Society of Anaesthesiology and Intensive Care (ESAIC) experts was created to develop this focused guideline on the management of failing epidural analgesia in a previously well functioning epidural catheter.
Design: Six clinical questions were defined using a PICO (Population/Intervention/Comparison/Outcome) strategy to conduct a systematic literature search.
Potential influence of different peri-operative analgesic regimens on tumour biology and outcome after oncologic surgery: A narrative review.
Eur J Anaesthesiol
December 2024
From the Département d'Anesthésie, Chirurgie et Interventionnel (LB), U1138 Metabolism, Cancer and Immunity, Gustave Roussy, Villejuif, France (LB), Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, California, USA (LB), Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition (PF), Anaesthesia department, NHS Grampian, Aberdeen, UK (PF), IMAGINE UR UM 103, Montpellier University, Anesthesia Critical Care, Emergency and Pain Medicine Division, Nîmes University Hospital, Nîmes, France (PF), Pain and Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ID ESAIC_RG_PAND) Research Group, Brussels, Belgium (PF), Department of Anaesthesiology, Amsterdam UMC, Amsterdam, The Netherlands (MWH), School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, Woolloongabba Qld, Australia (M-OP), Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Center, Leipzig, Germany (TP), EuroPeriscope, ESAIC Onco-Anaesthesiology Research Group, Brussels, Belgium (TP, LB, PF, MWH).
The management of peri-operative pain is one of the pillars of anaesthesia and is of particular importance in patients undergoing surgery for solid malignant tumours. Amongst several options, the most commonly employed analgesic regimens involve opioids, NSAIDs and regional anaesthesia techniques with different local anaesthetics. In recent years, several research reports have tried to establish a connection between peri-operative anaesthesia care and outcome after cancer surgery.
View Article and Find Full Text PDFEpigenetic and Metabolic Landscape of Dementia with Lewy Bodies.
Mov Disord
December 2024
Department of Metabolomics, Corewell Health Research Institute, Royal Oak, Michigan, USA.
Background: Lewy body diseases, including dementia with Lewy bodies (DLB), are characterized by α-synuclein accumulation, leading to dementia. Previous studies suggest distinct epigenetic and metabolomic profiles in DLB.
Objective: This study aims to identify diagnostic biomarkers by analyzing the methylome and metabolome in the Brodmann area 7 of postmortem brain tissues from DLB patients and control subjects using multiomics approaches.
Sex Assignment in Cases of Ambiguous Genitalia.
Cureus
November 2024
Department of General Surgery, General Medicine Practice Program, Batterjee Medical College for Science and Technology, Jeddah, SAU.
Ambiguous genitalia is a rare disorder where it is unclear whether an infant's external genitals are male or female. This can be attributed to various internal and external etiologies, such as androgen receptor abnormalities, gonadal abnormalities (such as gonadal dysgenesis or Klinefelter syndrome where a male has an extra X chromosome), enzymatic defects, etc. Correction of such atypical genitalia requires a multidisciplinary approach, including but not limited to surgeons and therapists.
View Article and Find Full Text PDFBlood transfusions in craniotomy for tumor resection: Incidence, risk factors, and outcomes.
J Clin Neurosci
December 2024
Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, Pakistan. Electronic address:
Background: Blood transfusions (BT) are often needed in neurosurgical procedures, especially craniotomies for tumor resections, due to risks of anemia, ischemic brain injury, and hemorrhage. However, BT may increase the risk of perioperative complications. This study aimed to determine the incidence, associated factors, and outcomes of BT in patients undergoing craniotomy for intracranial tumor resection.
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