Minerva anestesiologica最新文献

{"title":"Comparison of three different types of injection methods for supraclavicular block and their effects on diaphragm muscle function evaluated with diaphragm thickening fraction: a prospective, randomized, double-blind study.","authors":"Çağrı Yeşilnacar, Zeki T Tekgül, Hüseyin Özkarakaş, Aysun A Kar","doi":"10.23736/S0375-9393.25.19148-7","DOIUrl":"https://doi.org/10.23736/S0375-9393.25.19148-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to compare the effects of three different types of injection methods used in supraclavicular blocks on levels of phrenic nerve blocking with diaphragm thickening fraction (DTF).</p><p><strong>Methods: </strong>The study was designed as prospective, randomized, controlled, and double-blind. Patients presenting for elective upper extremity surgery were divided into three groups according to the injection method for the supraclavicular block (The multi-injected GM group (N.=28), the GD group given two equal injections intracluster and the corner pocket (N.=29), and the GC group (N.=28), who were given local anesthetic only to the corner pocket). The primary outcome was to demonstrate the DTF differences. The secondary outcomes included sensory block level, block success, and additional procedures during the operation.</p><p><strong>Results: </strong>In terms of the DTF difference before and after the block (ΔDTF), a statistically significant difference was observed (P=0.001). Median ΔDTF was found to be 62% (IQR: 47%) in the GM group, 38% (IQR: 61%) in the GD group, and 20% (IQR: 47%) in the GC group. A successful block was detected in 100% of the GM group, 97% in the GD group, and 82% in the GC group, with a statistically significant difference (P=0.022).</p><p><strong>Conclusions: </strong>The method with two equal injections intracluster and the corner pocket shows a more acceptable diaphragm involvement rate compared to the multi-injection method and a high block success rate close to the multi-injection method.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of intraoperative blood pressure fluctuations on postoperative delirium in elderly patients undergoing hip fracture surgery: a retrospective cohort study.","authors":"Ziyu Huang, Hong Zhao, Yi Feng","doi":"10.23736/S0375-9393.25.19135-9","DOIUrl":"https://doi.org/10.23736/S0375-9393.25.19135-9","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a frequent and serious complication in elderly patients undergoing hip fracture surgery, frequently resulting in adverse outcomes. Due to the scarcity of effective treatments, targeting modifiable intraoperative factors, such as blood pressure fluctuations, may mitigate risk. This study investigated the association between intraoperative blood pressure fluctuations and POD and evaluated whether vasopressor use contributes to this relationship.</p><p><strong>Methods: </strong>In this retrospective cohort study, 330 patients aged ≥65 years who underwent hip fracture surgery between June 2019 and May 2020 were included. Fluctuations were defined as the count of episodes in which the absolute fractional change in median systolic blood pressure over two-minute intervals exceeded 0.10 (|FCM| SBP>0.10). The primary outcome was in-hospital POD. Multivariable logistic regression assessed the association between blood pressure fluctuations and POD, and mediation analysis investigated the role of vasopressor administration.</p><p><strong>Results: </strong>The incidence of POD was significantly higher in the high fluctuation group (≥nine episodes: 11.0%) compared to the low fluctuation group (<nine episodes: 4.8%, P=0.037). Blood pressure fluctuations were independently associated with POD (adjusted OR=6.30, 95% CI 1.63-24.30, P=0.008), with uniform findings across subgroups. Mediation analysis showed intermittent bolus vasopressor use increased POD risk by intensifying blood pressure fluctuations (mediation effect=0.02, 95% BootCI 0.01-0.04, P=0.024).</p><p><strong>Conclusions: </strong>Intraoperative blood pressure fluctuations are an independent risk factor for POD in elderly patients. Minimizing fluctuation, potentially through continuous rather than intermittent vasopressor administration, may improve perioperative neurocognitive outcomes.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of neuropathic pain: a survey of the Italian Association for the Study of Pain.","authors":"Salvatore Sardo, Maria C Pace, Caterina Aurilio, Stefano Tamburin, Filomena Puntillo, Enrico Polati, Vittorio Schweiger, Mario Musu, Giustino Varrassi, Chiara Corno, Domenico Tiso, Diego M Fornasari, Gabriele Finco","doi":"10.23736/S0375-9393.25.19094-9","DOIUrl":"https://doi.org/10.23736/S0375-9393.25.19094-9","url":null,"abstract":"<p><strong>Background: </strong>Neuropathic pain significantly impacts the quality of life. This study explores neuropathic pain management practices among members of the Italian Association for the Study of Pain (AISD).</p><p><strong>Methods: </strong>During the 46^th National Congress, 240 physicians affiliated with AISD were surveyed. The data included demographics, clinical settings, diagnostic procedures, treatment approaches, and preferences. The analysis utilized descriptive statistics, treatment rankings, and consensus evaluations.</p><p><strong>Results: </strong>Respondents practicing in pain medicine reported the numbers of cases managed monthly. Neuropathic pain diagnoses relied on clinical findings corroborated by diagnostic tools. Treatment typically commenced within one to two weeks, emphasizing pharmacological interventions, which were often combined with invasive procedures. The leading pharmacological choices included gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Varied rankings were noted for invasive procedures, with nerve and neuraxial blocks particularly favored. Nutraceuticals such as palmitoylethanolamide, alpha-lipoic acid, and vitamin B complex were commonly prescribed, reflecting differences based on the physician's age and specialty.</p><p><strong>Conclusions: </strong>Generally, practices aligned with guidelines, showing a strong consensus on specific pharmacological treatments. Discrepancies in the rankings of invasive procedures, particularly among specialists, have led to questions regarding their perceived efficacy. These inconsistencies may indicate varying levels of expertise in interventional management, differences in the availability of these techniques, or different views on the current evidence supporting these procedures. The use of nutraceuticals indicated potential gaps in the guidelines.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational setups and non-elective surgical delays - a single-center cohort study: institutional setups and surgical delays.","authors":"Maxime T Aparicio, Jean Pasqueron, Sylvain Diop, Cécile Boccara, Ariane Roujansky, Françoise Tomberli, Alexis Laurent, Christophe Quesnel, Fabrice Cook, Roman Mounier","doi":"10.23736/S0375-9393.25.19107-4","DOIUrl":"https://doi.org/10.23736/S0375-9393.25.19107-4","url":null,"abstract":"<p><strong>Background: </strong>Extended delays in non-elective surgeries have been associated with suboptimal outcomes. The SARS-CoV-2 pandemic forced healthcare systems to adapt their setups for unscheduled procedures, leading, in our institution, to a reorganization from a setup with two dedicated operating rooms (ORs) at a central facility without dedicated teams to a temporary one with both dedicated teams and ORs during lockdown phase. This study evaluates the impact of this transitions on the time to surgery considering unscheduled procedures.</p><p><strong>Methods: </strong>We considered three periods: a historical cohort from the year preceding the first French lockdown, the lockdown period, and a post-lockdown era covering the four weeks immediately afterward. The ideal time to surgery (iTTS) was retrospectively determined using the non-elective surgery triage classification. The primary outcome focused on the proportion of patients operated after their iTTS.</p><p><strong>Results: </strong>Over study periods, 435 patients underwent non-scheduled surgery: 137,198 and 100 in the historical cohort, the lockdown, and post-lockdown period respectively. The proportion of out-timed patients was significantly lower during lockdown period than in the historical cohort (36.5% vs. 55.3%, P<0.001), driven by the less urgent patients (i.e., NEST 5-6 patients, 25.6% during lockdown vs. 58.2% in historical cohort). There was no significant difference between the lockdown era and the post-lockdown phase.</p><p><strong>Conclusions: </strong>Our findings suggest that dedicated teams and surgical suite may reduce time to surgery for non-scheduled procedures, particularly for less urgent cases. However, the retrospective monocentric design and our limited statistical power limit the extend of our conclusions.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel mode of heart and lung machine for real-time identification of cerebral autoregulation impairments during cardiac surgery with cardiopulmonary bypass: prospective observational study.","authors":"Greta Kasputyte, Vilma Putnynaite, Edvinas Chaleckas, Laimonas Bartusis, Yasin Hamarat, Rolandas Zakelis, Milda Svagzdiene, Birute Kumpaitiene, Judita Andrejaitiene, Tadas Lenkutis, Arunas Gelmanas, Edmundas Sirvinskas, Vytautas Petkus, Arminas Ragauskas, Rimantas Benetis","doi":"10.23736/S0375-9393.25.18890-1","DOIUrl":"https://doi.org/10.23736/S0375-9393.25.18890-1","url":null,"abstract":"<p><strong>Background: </strong>Postoperative cognitive dysfunction (POCD) occurs in 20% to 80% of patients following cardiac surgical interventions. The incidence of delirium is from 20% to 50%. Impaired cerebral autoregulation (CA) during cardiopulmonary bypass (CPB) contributes to these issues. We investigated a novel method for real-time monitoring of CA during CPB. The study aimed to obtain real-time CA impairment data to demonstrate the timely arterial blood pressure (ABP) management for immediate restoration of intact CA and, potentially, to reduce the incidences of POCD and delirium.</p><p><strong>Methods: </strong>An observational pilot clinical trial involved 108 elective on-pump surgery patients of whom 78 were included in the final analysis. All patients were evaluated for cognitive function on the 7^th to 10^th postoperative day. A rectangular blood flow modulation technique was proposed and applied to facilitate real-time detection of CA status impairment by using CA(t) transient response analysis.</p><p><strong>Results: </strong>A single CA impairment event lasting longer than 241 seconds was statistically significantly associated with POCD (P=0.0178), while impairments exceeding 262 seconds were related to delirium (P=0.0315). It was demonstrated that CA impairment events and patient-specific lower and upper limits of CA can be identified with sub-minute delays during cardiac surgery.</p><p><strong>Conclusions: </strong>The study demonstrated the feasibility of a novel heart and lung machine operation mode with rectangular blood flow modulation. Precise personal ABP(t) management can be performed during CPB to restore patient-specific optimal brain perfusion with sub-minute time resolution and, potentially, to reduce incidences of POCD and delirium.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritizing hemodynamic stability in elderly hip fracture surgery: a cornerstone for preventing postoperative delirium.","authors":"Alfredo Abad-Gurumeta, Manuel Á Gómez-Ríos","doi":"10.23736/S0375-9393.25.19391-7","DOIUrl":"https://doi.org/10.23736/S0375-9393.25.19391-7","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forecasting the fall: the role of machine learning in predicting intraoperative hypotension, a scoping review.","authors":"Angelina Koh, Dhanya Baby, Walston Martis, Daniel Capurro","doi":"10.23736/S0375-9393.25.19197-9","DOIUrl":"10.23736/S0375-9393.25.19197-9","url":null,"abstract":"<p><strong>Introduction: </strong>Intraoperative hypotension is associated with increased risk of postoperative mortality, myocardial injury, acute kidney injury and stroke. Early identification with machine learning models allows pre-emptive management to reduce incidence and duration of intraoperative hypotension. This study aims to assess the accuracy of machine learning models in predicting intraoperative hypotension and its impact on clinical outcomes.</p><p><strong>Evidence acquisition: </strong>This scoping review looked at databases Medline, Embase, PubMed and Cochrane from inception to 25 June 2024. Inclusion criteria were use of machine learning algorithms predicting intraoperative hypotension in adult surgical patients (≥18 years of age). Data extracted were the type and accuracy of machine learning models used, type of surgery, incidence and duration of hypotension, and patient relevant outcomes including length of stay, end organ dysfunction and mortality.</p><p><strong>Evidence synthesis: </strong>Twenty-six studies were included (N.=48,707 patients). About 92.3% of studies were done in non-cardiac surgeries; 65.4% of studies used a proprietary machine learning algorithm known as the Hypotension Prediction Index (HPI), followed by neural networks (19.2%) and logistic regression (19.2%). HPI was the most accurate in predicting intraoperative hypotension up to 15 minutes prior to the event with the median area under the receiving operator characteristic curve of 0.912 (0.896-0.930). Machine learning resulted in a statistically significant difference in dose and incidence of vasopressor use in three studies and a significant increase in volume of fluids in two studies. Two studies showed a significant reduction in length of stay, postoperative complications and quantity of blood transfusion products.</p><p><strong>Conclusions: </strong>Despite the ability of machine learning algorithms to predict intraoperative hypotension to a high degree of accuracy, practical implications are not yet fully elucidated. Studies on machine learning predicting intraoperative hypotension are in their early stages with a larger emphasis on algorithm accuracy rather than clinical outcomes.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"842-848"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior quadratus lumborum block, a novel approach to treat chronic hip pain: a cohort study.","authors":"María T Fernandez Martin, Ignacio Aguado-Maestro, Jose A Aguirre","doi":"10.23736/S0375-9393.25.18749-X","DOIUrl":"10.23736/S0375-9393.25.18749-X","url":null,"abstract":"<p><strong>Background: </strong>Hip osteoarthritis is a common disease, and the pain associated with it has a major impact on morbidity and quality of life. Therefore, the management of chronic hip pain requires a multimodal approach to improve joint function and quality of life. The aim of this study was to assess whether the posterior quadratus lumborum block (QLB) reduced pain and enhanced quality of life in patients suffering from chronic pain.</p><p><strong>Methods: </strong>After Ethical committee's approval (no. PI 21-PI104 on June 26,2021) and registration (Trial registration number: NCT04438265) we started this prospective cohort study. The sample size calculated were 200 patients (100 per group) suffering from chronic hip pain with poor response to previous treatments. The intervention group received posterior quadratus lumborum block as an analgesic technique and control group did not. Pain (NRS) and quality of life (WOMAC questionnaire) were assessed at baseline, three weeks, three and six months in both groups.</p><p><strong>Results: </strong>Demographic data showed no differences between groups. The QLB group showed significant improvements in pain and quality of life at three months compared to baseline (NRS mean 7/4; and WOMAC mean 59/35) (P value=0.001), while the control group scores remained unchanged (NRS 7/8; and WOMAC (61/61). At three months, 50 patients in the QLB group showed an improvement more than 50% in NRS and WOMAC scores (ten of those patients had an improvement for more than one year). We observed that patients with avascular necrosis showed a minor improvement. Only two adverse events were registered.</p><p><strong>Conclusions: </strong>Our results suggest that posterior QLB could represent a minimally invasive option in chronic hip pain.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"800-807"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of different anesthesia methods on bleeding and prognosis in endoscopic sinus surgery: a meta-analysis and systematic review of randomized controlled trials.","authors":"Xiaoquan Wei, Mengsheng Yang, Dan Li, Zekun Lang, Haijun Zhang","doi":"10.23736/S0375-9393.25.18980-3","DOIUrl":"10.23736/S0375-9393.25.18980-3","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this paper was to assess whether intravenous anesthesia and inhalation anesthesia will affect intraoperative bleeding and prognosis in patients with endoscopic sinus surgery.</p><p><strong>Evidence acquisition: </strong>The Cochrane Library, PubMed, Embase, and the Web of Science were systematically searched to identify relevant randomized controlled trials investigating the impact of various anesthesia methods on patients undergoing endoscopic sinus surgery from January 1, 1990, to July 1, 2024. The primary outcome measures comprised intraoperative blood loss and scoring systems evaluating bleeding in the surgical field. Secondary outcome measures included common postoperative complications such as nausea, vomiting, and pain, among others. Data synthesis was conducted using risk ratios or standardized mean differences, along with 95% confidence intervals. The original study protocol was prospectively registered with PROSPERO (CRD42022359773).</p><p><strong>Evidence synthesis: </strong>A total of 26 randomized controlled trials involving 1472 patients were included in this meta-analysis. Lower blood loss is found during intravenous anesthesia compared to inhalation anesthesia (SMD, 0.69; 95% CI, 0.21 to 1.18; P=0.005; I²=90%). The results of several scoring systems for assessing surgical field bleeding have shown the superiority of intravenous anesthesia. In addition, the duration of operation under intravenous anesthesia is shorter (SMD=0.15; 95% CI: 0.03 to 0.26; P=0.01; I²=46%). However, the risk of postoperative nausea and vomiting in the inhalation anesthesia group was lower than that in the intravenous anesthesia group (RR=0.72; 95% CI: 0.55 to 0.93; P=0.01; I²=0). Univariate meta-regression analysis indicated that age may be one source of heterogeneity.</p><p><strong>Conclusions: </strong>Intraoperative blood loss and operation time are more advantageous in intravenous anesthesia. Anesthesiologists and surgeons should make individualized decisions based on the patient's condition and formulate a comprehensive plan during the perioperative period to bring greater benefits to the patient.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"828-841"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacral erector spinae plane block (S-ESP) combined with femoral nerve block: a promising surgical anesthesia approach for high-risk patients undergoing hip fracture surgery.","authors":"Matteo L Leoni, Tommaso Rossi, Marco Mercieri, Fiamma Creazzola, Ruggero M Corso","doi":"10.23736/S0375-9393.25.18875-5","DOIUrl":"https://doi.org/10.23736/S0375-9393.25.18875-5","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":"91 9","pages":"849-850"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}