Perioperative Medicine最新文献

{"title":"Reduced hypopharyngeal muscle strength in patients with dysphagia symptoms after anterior cervical discectomy and fusion.","authors":"Chih-Jun Lai, Fon-Yih Tsuang, Jing-Rong Jhuang, Ming-Yen Hsiao, Ya-Jung Cheng, Yeun-Chung Chang, Jo-Yu Chen","doi":"10.1186/s13741-026-00691-4","DOIUrl":"https://doi.org/10.1186/s13741-026-00691-4","url":null,"abstract":"<p><strong>Background: </strong>Dysphagia symptoms are a common complication following anterior cervical discectomy and fusion (ACDF). The Eating Assessment Tool-10 (EAT-10) is widely used to screen for dysphagia symptoms, particularly in patients with scores ≥ 3. However, the underlying pathophysiological mechanisms and specific swallowing muscle impairments associated with dysphagia symptoms after ACDF remain incompletely understood. Videofluoroscopy is considered the gold standard for evaluating swallowing function. High-resolution impedance manometry (HRIM) enables quantitative assessment of pressure dynamics during swallowing. Therefore, this study aimed to identify alterations in pharyngeal contractile function and pathophysiological changes associated with dysphagia symptoms following ACDF using HRIM and videofluoroscopy.</p><p><strong>Methods: </strong>Patients who underwent ACDF within one year postoperatively were enrolled in this cross-sectional study. Dysphagia symptoms were defined as an EAT-10 score ≥ 3. Swallowing function was evaluated using HRIM and videofluoroscopy. Swallowing tests were performed with two food textures, as defined by the International Dysphagia Diet Standardisation Initiative (IDDSI): level 0 (thin liquid) and level 4 (extremely thick liquid). HRIM parameters were compared between patients with and without dysphagia. Aspiration was defined as a Penetration-Aspiration Scale (PAS) score ≥ 6 on videofluoroscopic examination.</p><p><strong>Results: </strong>A total of 43 patients were included, comprising 29 with dysphagia symptoms and 14 without. During thin liquid swallowing (IDDSI level 0), patients with dysphagia symptoms had significantly lower hypopharyngeal mean peak pressure (hypoPeakP) and higher Swallow Risk Index (SRI) compared with those without dysphagia symptoms (median 55.79 vs. 104.85 mmHg and 18.60 vs. 4.30, respectively). During extremely thick liquid swallowing (IDDSI level 4), hypoPeakP remained significantly lower in the dysphagia symptoms group (median 86.96 vs. 161.19 mmHg), whereas SRI did not differ significantly between groups. No aspiration events were observed.</p><p><strong>Conclusions: </strong>Post-ACDF dysphagia symptoms were associated with reduced hypopharyngeal contractile pressure. These findings offer physiological insights into the association between dysphagia symptoms and swallowing biomechanics and may inform future research on swallowing assessment in this population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04591665; IRB Approval: 202008024RINC.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841056","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":"The impact of preoperative regular exercise on mental health in patients undergoing Type II incision surgery.","authors":"Xiwen Yang, Sibin Yi","doi":"10.1186/s13741-026-00694-1","DOIUrl":"https://doi.org/10.1186/s13741-026-00694-1","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the effect of preoperative regular exercise on postoperative mental health in patients undergoing Type II incision surgery. Explore the correlations between preoperative exercise and postoperative mental health in this patient group.</p><p><strong>Methods: </strong>A total of 480 patients who underwent Type II incision surgery at a tertiary Grade A hospital in Pingxiang from July 2024 to June 2025 were enrolled. Preoperative physical activity was assessed via the International Physical Activity Questionnaire (IPAQ) short form, and patients were divided into an exercise group (EH, n = 133) and a nonexercise group (NEH, n = 347) on the basis of the \"sports population\" criteria in China. Mental health was evaluated via the Hospital Anxiety and Depression Scale (HADS) and the 12-Item Short-Form Health Survey (SF-12) on the 14th postoperative day.</p><p><strong>Results: </strong>Compared with the NEH group, the EH group had significantly lower postoperative HADS-Anxiety (HADS-A) scores (5.3 ± 2.0 vs. 8.5 ± 3.3) and higher SF-12 Mental Component Summary (MCS, 49.1 ± 7.5 vs. 42.1 ± 8.3) and Physical Component Summary (PCS, 47.3 ± 7.1 vs. 42.8 ± 7.6). Correlation analysis revealed that preoperative regular exercise in the EH group was negatively associated with postoperative anxiety (r = -0.55) and positively associated with the SF-12 PCS (r = 0.72) and MCS (r = 0.60). No significant correlations were observed in the NEH group for anxiety or depression.</p><p><strong>Conclusion: </strong>Preoperative regular exercise significantly alleviates postoperative anxiety and improves both physical and mental function in patients undergoing Type II incision surgery, with these effects remaining significant after adjusting for confounders. However, its effect on improving postoperative depression is not significant. Additionally, preoperative exercise is closely associated with better postoperative psychological status in the EH group, while the NEH group shows no significant correlations between preoperative activity and postoperative anxiety/depression, and weaker correlations with physical/mental function-suggesting that establishing preoperative exercise habits may be a key factor in promoting postoperative psychological recovery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841147","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":"Rethinking ejection fraction for anesthesiologists: a narrative review.","authors":"Marco Rabis, Patrick Moldzio","doi":"10.1186/s13741-026-00690-5","DOIUrl":"https://doi.org/10.1186/s13741-026-00690-5","url":null,"abstract":"<p><p>Left ventricular ejection fraction (EF) is one of the most frequently cited cardiac parameters in perioperative risk assessment and is often used as a surrogate marker of global cardiac stability. However, EF was validated primarily in chronic cardiovascular disease and long-term heart failure management, raising important questions about its suitability as a dominant marker of short-term perioperative risk. EF does not capture key determinants of perioperative vulnerability, including diastolic function, ventricular compliance, right ventricular function, venous congestion, or contractile reserve. Contemporary clinical data suggest that only severely reduced EF (< 30%) is consistently associated with markedly increased perioperative risk, whereas mildly to moderately reduced EF in clinically stable patients often carries less prognostic significance than preserved EF in the presence of heart failure with preserved ejection fraction (HFpEF), congestion, or right ventricular dysfunction. Common perioperative scenarios such as HFpEF, distributive shock, hypovolemia, venous congestion, and chronic compensated heart failure illustrate that EF may substantially underestimate or overestimate true hemodynamic vulnerability depending on the physiological context. In contrast, functional capacity, volume status, and clinical stability emerge as more robust determinants of short-term perioperative risk. Advanced echocardiographic parameters, including diastolic indices, global longitudinal strain (GLS), and focused assessment of right ventricular function, together with biomarkers provide a more physiologically coherent risk profile. The uncritical use of EF as a primary perioperative risk marker is not supported by current evidence. For anesthesiologists, EF should be interpreted as one component within a multidimensional, physiology-guided assessment that integrates focused perioperative ultrasound, clinical history, and targeted biomarkers to more accurately characterize perioperative cardiovascular risk.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841070","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":"Risk factors for postoperative pneumonia following intracranial aneurysm surgery: a propensity score matching analysis.","authors":"Yuting Zeng, Xi Chen, Ka Yan Ho, Weihong Huang, Jianting Tang, Jiao Xu, Li Li, Janelle Yorke","doi":"10.1186/s13741-026-00686-1","DOIUrl":"https://doi.org/10.1186/s13741-026-00686-1","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pneumonia (POP) after intracranial aneurysm surgery is common and can lead to prolonged hospitalization, respiratory failure, or death, significantly worsening patient outcomes.</p><p><strong>Aim: </strong>This study aimed to identify independent preoperative, intraoperative, and postoperative risk factors for POP in patients undergoing intracranial aneurysm surgery using propensity score matching to control for confounding.</p><p><strong>Methods: </strong>This retrospective cohort study included 1,115 patients aged ≥ 18 years who underwent intracranial aneurysm surgery at a hospital between January 2019 and July 2022. Patients were grouped by the presence or absence of POP. Logistic regression analysis with 1:1 propensity score matching (PSM) was performed to identify independent risk factors for POP in patients with intracranial aneurysms.</p><p><strong>Results: </strong>After 1:1 propensity score matching, 668 patients (334 per group) were analyzed. Multivariate logistic regression identified six independent risk factors for POP: preoperative antimicrobial prophylaxis, operative duration ≥ 4 h, indwelling gastric tube, intensive care unit (ICU) admission on the day of surgery, postoperative use of analgesics or sedatives, and white blood cell (WBC) count ≥ 10,000 cells/µL.</p><p><strong>Conclusions: </strong>Six risk factors for POP after intracranial aneurysm surgery were identified in this study, some of which are modifiable. Targeting these factors may reduce POP. These variables may inform risk stratification; some may represent potential targets for intervention; however, prospective validation is required before any changes to clinical pathways can be recommended.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841054","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":"Phase-specific dynamics of coagulation factors V, VIII, and XIII during liver transplantation: insights from a prospective study.","authors":"Sarah Thaler, Anna Zorn, Isabell Aster, Dionysios Koliogiannis, Markus Guba, Bernhard W Renz, Philipp Groene","doi":"10.1186/s13741-026-00695-0","DOIUrl":"https://doi.org/10.1186/s13741-026-00695-0","url":null,"abstract":"<p><strong>Background: </strong>Liver dysfunction is associated with a rebalanced but fragile hemostatic system, in which alterations in coagulation factor synthesis and activity contribute to both bleeding and thrombotic risks. During liver transplantation, this fragile equilibrium is further challenged by major physiological stress. This study aimed to characterize the phase-specific intraoperative dynamics of coagulation factors V, VIII, and XIII (FV, FVIII, and FXIII) to better understand hemostatic modulation and its clinical implications during liver transplantation.</p><p><strong>Methods: </strong>A subset of 17 liver transplant recipients receiving transfusion support without administration of recombinant FVIII or FXIII was analyzed. Measurements were obtained at three defined intraoperative time points: T1 anesthesia induction, T2 end of anhepatic phase, T3 end of surgery. Activities of FV, FVIII, and FXIII were quantified and analyzed for temporal trends.</p><p><strong>Results: </strong>All three coagulation factors declined during surgery. FV was already markedly reduced at T1 (37% (22/55)) and further decreased to 26% at T3 ((19/34); p = 0.0309). FVIII showed supranormal levels at T1 (193% (160/254) and declined to near-normal levels at T3 (109% ((67/143); p < 0.0001). FXIII remained close to the lower limit of normal (T1: 68% (50/85)); T3: (63% (55/78)) without significant change.</p><p><strong>Conclusion: </strong>This prospective analysis reveals distinct, phase-specific trajectories of FV, FVIII, and FXIII during liver transplantation. Understanding these differential patterns may help identify critical periods of hemostatic vulnerability and guide individualized factor-specific therapeutic interventions to optimize perioperative coagulation management in liver transplant recipients.</p><p><strong>Trial registration: </strong>German Clinical Trials Register (DRKS00032827).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"15 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FXII decline during cardiopulmonary bypass and the limits of routine coagulation assays: a prospective observational analysis.","authors":"Sarah Thaler, Isabell Aster, Emmanuelle Patton, Charlotte Voigt, Sven Peterss, Matthias Feuerecker, Philipp Groene","doi":"10.1186/s13741-026-00687-0","DOIUrl":"10.1186/s13741-026-00687-0","url":null,"abstract":"<p><strong>Background: </strong>The contact activation system is triggered when blood comes into contact with artificial surfaces. Cardiopulmonary bypass (CPB) induces such activation, however the extent of factor XII (FXII) reduction and its reflection in routine coagulation assays remain unclear.</p><p><strong>Methods: </strong>In this prospective observational study, 20 adult patients undergoing elective cardiac surgery with CPB (10 coronary artery bypass grafting (CABG), 10 aortic aneurysm repair) were analyzed. Blood samples were collected immediately prior to anesthesia induction (T1) and three minutes after protamine administration (T2). Laboratory analyses included FXII, factor VIII (FVIII), and factor V (FV) activities, activated partial thromboplastin time (aPTT), prothrombin time (Quick/INR), fibrinogen, and viscoelastic testing (ROTEM).</p><p><strong>Results: </strong>FXII activity decreased significantly after CPB (whole cohort: 98% (79/122) vs. 62% (51/83); CABG: 108% (83/124) vs. 64% (47/85); aortic: 92% (75/119) vs. 61% (52/82), p < 0.001 each). FV declined, whereas FVIII tended to increase. aPTT prolongation was minimal and remained within the normal range. A strong correlation between FXII decline and aPTT change was observed only in CABG patients (ρ = - 0.835, p = 0.003). ROTEM clotting times were moderately prolonged after CPB but showed no correlation with FXII activity.</p><p><strong>Conclusions: </strong>CPB induced a significant reduction in FXII activity. Global coagulation assays such as aPTT or ROTEM have limited sensitivity for contact factor deficiencies. Isolated prolongation of these parameters after CPB should be interpreted cautiously and, in the absence of clinical bleeding, should not routinely prompt hemostatic interventions. Future studies should address subgroup differences (CABG vs. aortic surgery) in larger cohorts.</p><p><strong>Trial registration: </strong>The trial was registered in the German Clinical Trials Register (DRKS00034174).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Impact of mild hypo- and hyperventilation on cerebral oxygen supply during general anesthesia.","authors":"Philipp Groene, Miriam Rapp, Tobias Ninke, Peter Conzen, Klaus Hofmann-Kiefer","doi":"10.1186/s13741-026-00658-5","DOIUrl":"https://doi.org/10.1186/s13741-026-00658-5","url":null,"abstract":"","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"15 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a patient-controlled analgesia pump management model based on a wireless analgesic management system on postoperative pain management in orthopedic patients: a prospective randomized controlled trial protocol.","authors":"Daxue Zhang, Cong Yu, Jian Kang, Lijun Guo, Chushan Zheng, Junliang Wang, Xuchun Li","doi":"10.1186/s13741-026-00688-z","DOIUrl":"https://doi.org/10.1186/s13741-026-00688-z","url":null,"abstract":"","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777785","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":"Efficacy of postoperative tranexamic acid administration in patients undergoing proximal femoral tumor endoprosthesis reconstruction.","authors":"Muhammet Salih Ayas, Faruk Karaca, Fevzi Gürkan Aslan, Muhammed Burak Usta","doi":"10.1186/s13741-026-00682-5","DOIUrl":"https://doi.org/10.1186/s13741-026-00682-5","url":null,"abstract":"","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777875","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":"Prehabilitation before pancreatoduodenectomy: results of a retrospective single-center study.","authors":"Philipp R Scherber, Jana Bauer, Sebastian Holländer, Gereon Gäbelein, Evelyn Marth, Laura Brusokas, Samra Gafarli, Peter Jacob, Matthias Glanemann","doi":"10.1186/s13741-026-00685-2","DOIUrl":"https://doi.org/10.1186/s13741-026-00685-2","url":null,"abstract":"","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"15 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}