Perioperative Medicine最新文献

{"title":"Analgesic application of a novel non-steroidal anti-inflammatory drug imrecoxib after total knee arthroplasty: a prospective randomized controlled study.","authors":"Guoyang Bai, Xiangxiang Sun, Qunli Dou, Bowei Li, Kai Qin, Xiaobo Sun, Jianbing Ma, Chao Xu, Yuanchi Huang","doi":"10.1186/s13741-025-00559-z","DOIUrl":"https://doi.org/10.1186/s13741-025-00559-z","url":null,"abstract":"<p><strong>Background: </strong>Imrecoxib is a novel non-steroidal anti-inflammatory drug. As a moderately selective COX-2 inhibitor, it has achieved certain therapeutic effects in postoperative analgesia such as spinal, arthroscopic, and total hip arthroplasty. However, the efficacy of imrecoxib in postoperative analgesia after total knee arthroplasty (TKA) is still unknown. Therefore, this study aims to explore the clinical efficacy and safety of imrecoxib in postoperative analgesia after TKA.</p><p><strong>Methods: </strong>The 120 patients were randomly assigned to two groups. The experimental group was given one tablet of imrecoxib 4 h after surgery in addition to conventional treatment. Starting from the second day, the dose of imrecoxib was 0.1 g/time, twice a day. The control group only received conventional treatment. The observation indicators included visual analogue scale (VAS) score, joint range of motion (ROM), opioid consumption, erythrocyte sedimentation rate (ESR), C-reactive protein (PCR), interleukin-6 (IL-6), and incidence of adverse reactions.</p><p><strong>Results: </strong>At rest, the VAS pain scores of the experimental group at 24 and 48 h after surgery (3.033 ± 1.154, 2.700 ± 0.988) were lower than those of the control group (2.017 ± 0.128, 1.950 ± 0.589), with statistical differences (P = 0.000 < 0.05, P = 0.000 < 0.05). At movement state, the VAS scores of the experimental group at four postoperative time points (4.050 ± 0.805, 4.633 ± 1.048, 4.517 ± 1.057, 4.233 ± 0.844) were lower than those of the control group (4.433 ± 0.782, 5.067 ± 0.910, 5.800 ± 0.945, 5.167 ± 1.003), with statistical differences (P = 0.013 < 0.05, P = 0.027 < 0.05, P = 0.000, P = 0.000).The joint ROM of the experimental group at 24 h (84.783 ± 7.902) and 48 h (86.403 ± 10.367) was higher than that of the control group (76.725 ± 9.499, 79.802 ± 8.400), with statistical differences (P = 0.000 < 0.05, P = 0.000 < 0.05).The postoperative opioid consumption of the experimental group (0.567 ± 0.692) was significantly lower than that of the control group (2.783 ± 1.156), with a statistical difference (P = 0.000 < 0.05).</p><p><strong>Conclusion: </strong>Our prospective randomized controlled trial demonstrates that imrecoxib can effectively alleviate postoperative pain after TKA, reduce opioid dosage, and does not cause additional adverse reactions, providing a new option for analgesic treatment after TKA.</p><p><strong>Trial registration: </strong>The study was registered with the China Clinical Trial Registry (registration number: ChiCTR2300072839). Registered date: 20,230,616.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"73"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643065","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":"Sugammadex versus cholinesterase inhibitors to antagonize respiratory dysfunction after neuromuscular blockade in patients undergoing pulmonary surgery: a systematic review and meta-analysis.","authors":"Bo Liu, Keqin Song, Peilin Wang, Fangshuo Li, Qianfeng Guo","doi":"10.1186/s13741-025-00557-1","DOIUrl":"10.1186/s13741-025-00557-1","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of respiratory dysfunction associated with postoperative residual curarization (PORC) after thoracic surgery is high, even affecting the prognosis. There is no consensus on whether sugammadex is beneficial. This study aimed to elucidate the effect of sugammadex in the management of PORC-related respiratory dysfunction following thoracic surgery.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, and Web of Science were searched from database inception to January 2025 for studies on respiratory outcomes after thoracic surgery when sugammadex was used as an antagonist. The pooled risk ratio or weighted mean difference was used to evaluate the outcomes.</p><p><strong>Results: </strong>Among 1398 studies searched, 11 studies were finally included, involving 1445 subjects. The results showed that sugammadex could reduce the incidence of postoperative respiratory complications (RR = 0.77, 95% CI: 0.66-0.90), particularly atelectasis (RR = 0.61, 95% CI: 0.47-0.79) and pneumonia (RR = 0.64, 95% CI: 0.46-0.91). In addition, according to the subgroup analysis by age, surgery type, anesthesia duration, and body mass index, sugammadex was associated with a shortened extubation period (P ≤ 0.005).</p><p><strong>Conclusion: </strong>Compared with traditional muscle relaxant antagonists, the use of sugammadex after thoracic surgery can help reverse the respiratory dysfunction related to residual muscle relaxants and reduce the risk of atelectasis, pneumonia, and reintubation. However, there is no difference in the risk of pleural effusion and pneumothorax. Except for post-anesthesia care unit duration, the differences in hospitalization and chest tube dwelling duration between the two groups remain to be clarified.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"72"},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601125","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":"Development and validation of a nomogram prediction model for surgical site infection after instrumentation for degenerative lumbar spinal diseases.","authors":"Yongjun Liu, Xiaodong Wei, Xiaoyan Chen, Yan Ding","doi":"10.1186/s13741-025-00556-2","DOIUrl":"10.1186/s13741-025-00556-2","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective study aimed to investigate the incidence and risk factors for surgical site infection (SSI) following instrumentation for degenerative lumbar spinal diseases, and to develop a predictive nomogram model.</p><p><strong>Method: </strong>Patients who underwent posterior instrumentation for degenerative lumbar spinal diseases between January 2020 and December 2022 with a minimum 12-month follow-up were included. Patients were classified as having an SSI or not, and differences in demographics, clinical data, and laboratory indicators were compared. Multivariate logistic regression was performed to identify independent risk factors, and a nomogram was constructed to visualize the results.</p><p><strong>Results: </strong>The study included 1,462 patients (687 men, 775 women) with a mean age of 52.9 ± 13.7 years and 53 patients (3.5%) developed an SSI. Multivariate analysis identified several risk factors for SSI: higher ASA class (III or IV vs I or II, OR = 2.362; 95%CI, 1.312 to 4.249), surgery involving sacral vertebrae (OR = 2.319; 95%CI, 1.242 to 4.330), open surgery compared to minimally invasive surgery (OR = 3.081; 95%CI, 1.701 to 5.581), prolonged surgical time (per hour increase, OR = 1.482; 95%CI, 1.017 to 2.160), and preoperative hemoglobin < 100 g/L (OR = 4.962; 95%CI, 1.728 to 6.943). The nomogram model demonstrated good discrimination, with a C-index of 0.743 (95% CI: 0.682-0.804), which remained robust at 0.722 after 1,000 bootstrap verifications. The calibration curve indicated the predicted SSI probability aligned well with the actual probability.</p><p><strong>Conclusions: </strong>This study found a moderate 3.5% SSI rate following instrumentation for degenerative lumbar spinal diseases and identified several risk factors. These findings can inform preoperative patient counseling, risk assessment, and the development of personalized strategies to mitigate SSI.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"71"},"PeriodicalIF":2.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584495","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":"Efficient statistical analysis of trial designs: win ratio and related approaches for composite outcomes.","authors":"Wilson Fandino, Matthew Dodd, Gudrun Kunst, Tim Clayton","doi":"10.1186/s13741-025-00550-8","DOIUrl":"10.1186/s13741-025-00550-8","url":null,"abstract":"<p><p>In randomized controlled clinical trials, composite outcomes are often used to study treatment effects. This approach is popular because it increases the number of observed events, enhancing statistical power while reducing the required patient sample size. However, composite outcomes do not provide insight into the effect of individual endpoints. This becomes particularly relevant when mortality is combined with less critical but clinically relevant endpoints or when the clinical importance of individual endpoints varies significantly. As a result, interpreting composite outcomes can be challenging.This narrative review introduces the win ratio (WR), a method for prioritizing individual endpoints within a composite outcome. The WR offers an alternative to composite outcomes by considering the clinical importance of each component and prioritizing the most critical endpoint, such as death, over less significant events.Despite the popularity of the WR among cardiovascular trialists, this approach has not been extensively used in other areas of clinical research. We contend, that perioperative and periprocedural researchers could consider the WR and related approaches when the outcomes of interest are not of similar clinical importance. To this end, understanding the benefits and limitations of the WR will be essential to exploit its benefits, while avoiding potential misuses of the technique.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"70"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567719","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":"Platform trials-an emerging methodology for perioperative medicine: a narrative review.","authors":"Tom E F Abbott, Sarah-Louise Watson, Salma Begum, Priyanthi Dias, Joanne S Haviland, James Glasbey, Lawani Ismail, Sharon Love, Rupert M Pearse","doi":"10.1186/s13741-025-00543-7","DOIUrl":"10.1186/s13741-025-00543-7","url":null,"abstract":"<p><p>The traditional model for testing new treatments, before widespread usage in clinical practice, is the parallel group randomised trial. However, these are often inefficient, time-consuming and expensive, which can be barriers to the timely improvement of clinical care. This is a particular issue for anaesthesia and perioperative medicine where funding for large clinical trials is often scarce. Platform trials are an emerging methodology for testing new interventions, which offer benefits over the traditional parallel group paradigm. Platform trials have the ability to test multiple interventions at the same time, and to add or remove interventions during the course of the programme without undermining the validity or integrity of the trial findings. They are most often structured around a master protocol, which describes the core methods and research governance processes, with each intervention described in either a sub-section or appendix to the master protocol. The principal benefit to researchers and to research funders is that, unlike the sequential parallel group trial model, platform trials can use the same research infrastructure (e.g. database, standard operating procedures etc.) to answer multiple research questions, which is much more time and cost effective. The benefits of platform trials can be further enhanced with the use of adaptive designs or by sharing control patients, for example, by using a multi-arm multi-stage design. Perioperative medicine, anaesthesia and surgery are ideally placed to benefit from platform trials.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"67"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565074","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":"A case of perioperative euglycemic ketoacidosis in a patient without diabetes: are current guidelines enough?","authors":"Shushmita Hoque, Rebecca Longo, Paul Teague, Eugene Kim","doi":"10.1186/s13741-025-00548-2","DOIUrl":"10.1186/s13741-025-00548-2","url":null,"abstract":"<p><strong>Background: </strong>Euglycemic ketoacidosis (eKA) is a serious and potential life-threatening complication of SGLT2-inhibitor (SGLT2i) use. eKA associated with SGLT2i has been increasingly reported in patients without diabetes likely due to more widespread use. The perioperative setting is a particularly vulnerable time for patients due to decreased carbohydrate intake, volume depletion, medication changes, and increased counterregulatory hormone activity due to surgical stress. Current guidelines recommend that patients with type 2 diabetes hold SGLT2i for at least 24-72 h prior to elective surgery.</p><p><strong>Case presentation: </strong>We report a case of an 82-year-old woman without a history of diabetes who held empagliflozin for 72 h prior to planned bowel resection for management of colon cancer. The indication for empagliflozin was heart failure with reduced ejection fraction. Intraoperatively, she was found to have profound metabolic acidosis, high-normal anion gap, normal glucose, and elevated serum beta hydroxybutyrate. Given the high risk for decompensation intraoperatively, the patient was empirically given dextrose and insulin to treat eKA. The surgery was otherwise uncomplicated. Afterward, the patient was transferred to the intensive care unit for treatment of eKA with insulin and dextrose infusions. She recovered and was discharged home. Empagliflozin was not restarted.</p><p><strong>Conclusions: </strong>Our patient's case demonstrates that there is not a one-size-fits-all approach to withholding SGLT2i in patients in the perioperative setting. Despite holding the SGLT2i preoperatively, our patient without a history of diabetes nonetheless developed eKA. Upon further review, this patient had risk factors for developing eKA, including age, sex, chronic kidney disease, and preoperative nutrition status. Additional preoperative workup may have been warranted due to suspected preoperative hypovolemia associated with bowel preparation, perhaps allowing us to identify eKA prior to surgery. Future considerations include obtaining a basic metabolic panel on day of surgery for patients taking SGLT2i to evaluate for acute renal dysfunction and metabolic acidosis prior to surgical intervention. Point-of-care serum beta-hydroxybutyrate could also be incorporated into clinical decision-making though this may not be widely available. Future investigation should examine risk factors that predispose patients to developing eKA and drive development of protocols to guide which patients require more monitoring perioperatively.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"68"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565071","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":"Ultrasound-guided iliopsoas plane block combined with lateral femoral cutaneous nerve block for postoperative analgesia in hip arthroplasty: a retrospective case series.","authors":"Jian Chen, Cong Liu, Meng-Lan Zhou, Hui-Wen Wang","doi":"10.1186/s13741-025-00542-8","DOIUrl":"10.1186/s13741-025-00542-8","url":null,"abstract":"<p><p>In recent years, iliopsoas plane block as a new type of regional nerve block technique has gradually gained attention; however, its actual effect on analgesia and motor function preservation in postoperative hip arthroplasty patients has not been fully verified. Because of this, we summarize the experience of 10 cases of successful application of iliopsoas plane block (IPB) combined with lateral femoral cutaneous nerve (LFCN) block for postoperative pain management after hip arthroplasty, to provide useful reference and inspiration for clinical practice.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"64"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565076","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":"Effect of multimodal home-based prehabilitation on objectively measured physical activity in patients undergoing elective cardiac or non-cardiac major surgery: secondary outcomes from a randomised controlled trial.","authors":"Thomas Vetsch, Simone Wen-Shi Dueblin, Prisca Eser, Christian M Beilstein, Patrick Y Wuethrich, Matthias Wilhelm, Dominque Engel","doi":"10.1186/s13741-025-00554-4","DOIUrl":"10.1186/s13741-025-00554-4","url":null,"abstract":"<p><strong>Objective: </strong>To assess physical activity (PA) measured in steps per day in the preoperative period in high-risk cardiac and non-cardiac surgical patients receiving home-based tele-supervised prehabilitation compared to standard of care and to compare steps per day with raw acceleration metrics.</p><p><strong>Study design: </strong>It is an analysis of secondary outcome data of a prospective, two-arm parallel group, randomised controlled trial.</p><p><strong>Setting: </strong>It is a single university hospital in Switzerland.</p><p><strong>Participants: </strong>These are patients ≥ 65 years awaiting elective cardiac or non-cardiac major surgery with a proven fitness deficit measured by a cardiopulmonary exercise test (CPET). Analysis of PA data after successfully enrolling 200 patients (167 with complete data) in the trial. Average age was 73.8 years (SD 5.3) in cardiac and 76.0 years (SD 6) in non-cardiac patients.</p><p><strong>Intervention: </strong>The intervention arm consists of a multimodal, home-based tele-supervised prehabilitation programme over 2-4 weeks addressing deficits in physical fitness, nutrition, and preoperative anaemia.</p><p><strong>Primary outcome: </strong>Steps per day are assessed by an open-source algorithm from wrist-worn accelerometer data.</p><p><strong>Secondary outcome: </strong>Raw acceleration as overall Euclidean Norm Minus One (ENMO) is expressed in milligravitational units (mg).</p><p><strong>Results: </strong>Non-cardiac (n = 107) patients had more steps per day in the intervention group versus standard of care (4662 [2817; 6807] vs 3378 [1919; 4831], p = 0.042). Overall, ENMO was higher in the intervention group but not statistically significant. No significant differences in PA measures were observed between randomisation groups in cardiac (n = 60) patients. Cardiac patients had overall higher PA levels and were younger than non-cardiac. The difference remained after adjusting for age. Steps per day correlated strongly with overall ENMO.</p><p><strong>Conclusion: </strong>Simple preoperative PA recommendations effectively improve steps per day in high-risk non-cardiac surgery patients. To detect changes in PA in the high-risk surgical patient, steps per day can be used as an intuitive measure. To compare with other populations, overall ENMO is preferable.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov Identifier: NCT04461301.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"69"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565073","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":"Association of perioperative intravenous lignocaine and intraoperative neuromonitoring in adolescent idiopathic scoliosis surgery: a retrospective study.","authors":"Siti Nadzrah Yunus, Huey Nee Chong, Zheng-Yii Lee, Rosmalinda Osman, Khean Jin Goh, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan, Mohd Shahnaz Hasan","doi":"10.1186/s13741-025-00552-6","DOIUrl":"10.1186/s13741-025-00552-6","url":null,"abstract":"<p><strong>Background: </strong>The use of intravenous (IV) lignocaine as an analgesic adjunct is increasing, but its impact on intraoperative neurophysiological monitoring (IONM) remains unclear. This study aimed to evaluate the association between IV lignocaine and somatosensory evoked potential (SSEP) and motor evoked potential (MEP) during adolescent idiopathic scoliosis (AIS) surgery.</p><p><strong>Methods: </strong>This retrospective study involved AIS patients who underwent single-stage posterior spinal fusion at a tertiary university hospital from 2020 to 2023. In addition to total intravenous anaesthesia (TIVA), patients who received IV lignocaine (1.5 mg/kg bolus at induction followed by 2 mg/kg/h infusion until wound closure) were included (lignocaine group) and matched with those who did not (standard group). Two neurophysiologists independently reviewed SSEP and MEP recordings at five-time points: T1 (10 min post-induction), T2 (during pedicle screw insertion), T3 (during rod insertion or deformity correction), T4 (start of wound closure, 30 min before surgery end), and T5 (post-skin closure). Neurophysiological changes were clinically significant if MEP or SSEP showed > 50% amplitude reduction or > 10% latency increase.</p><p><strong>Results: </strong>A total of 115 AIS patients receiving TIVA were analysed, 59 in the lignocaine group and 56 in the standard group. Demographics and vital signs were comparable. The mean intraoperative propofol dose was significantly lower in the lignocaine group (766.77 ± 315.86 mg vs 928.55 ± 242.93 mg; p = 0.003). MEP amplitudes over the right tibialis anterior and bilateral abductor hallucis were significantly reduced in the lignocaine group (p < 0.05). SSEP analysis revealed significant amplitude reduction and latency prolongation at the left cortical in the lignocaine group at all time points (p < 0.05). Longitudinal changes (T1-T4) in amplitude and latency for both MEP and SSEP were small and not clinically significant.</p><p><strong>Conclusion: </strong>Perioperative IV lignocaine infusion during TIVA for AIS surgery significantly reduced MEP and SSEP amplitudes and prolonged SSEP latency, though lacking clinical significance.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"65"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565072","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":"Proenkephalin A 119-159 as an early biomarker of acute kidney injury in complex endovascular aortic repair: an explorative single-center cross-sectional study with the utilization of two measurement methods.","authors":"Paulina Walczak-Wieteska, Konrad Zuzda, Jolanta Małyszko, Paweł Andruszkiewicz","doi":"10.1186/s13741-025-00553-5","DOIUrl":"10.1186/s13741-025-00553-5","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) remains a significant complication following endovascular aneurysm repair (EVAR). Current diagnostic methods often detect kidney damage too late for effective intervention. This study evaluated proenkephalin A 119-159 as an early AKI biomarker after EVAR procedures, comparing point-of-care testing with the ELISA method.</p><p><strong>Methods: </strong>Between April 2022 and June 2024, 68 patients undergoing elective EVAR were enrolled. Blood samples were collected preoperatively and for three consecutive postoperative days.</p><p><strong>Results: </strong>AKI was diagnosed according to the KDIGO criteria, with proenkephalin A 119-159 measured via point-of-care (penKid) testing and laboratory ELISA method. AKI occurred in 18 patients (26.5%). penKid showed a superior diagnostic performance to ELISA, demonstrating moderate agreement with KDIGO criteria (Gwet's AC1 = 0.52, p < .001). While penKid exhibited high sensitivity (80% day 1), specificity was moderate (51%). AKI patients had significantly higher median penKid levels (96.47 pmol/L vs 63.01 ng/mL, p = .001), longer hospital stays (12 vs 9 days, p = .028), and lower 6-month survival (50% vs 88.1%, p = .006).</p><p><strong>Conclusions: </strong>penKid testing shows promise as an early AKI biomarker following EVAR procedures, particularly for identifying low-risk AKI patients. However, its moderate specificity suggests it should complement existing clinical assessment tools rather than replace them. These findings support incorporating penKid monitoring into structured AKI care bundles for improved perioperative kidney outcomes.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"66"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565075","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}