Perioperative Medicine最新文献

{"title":"Influence of portal hypertension-associated upper gastrointestinal bleeding and acute kidney injury on liver transplantation prognosis.","authors":"Shifeng Feng, Ou Huiying, Guo Wei, Jingsheng Yuan, Tao Lv, Jian Yang, Yong Zhao, Lingxiang Kong, Jiayin Yang","doi":"10.1186/s13741-025-00545-5","DOIUrl":"10.1186/s13741-025-00545-5","url":null,"abstract":"<p><strong>Background: </strong>Given that prioritization for liver transplantation (LT) is based primarily on the model for end-stage liver disease (MELD) scores, patients with lower MELD scores, who experience chronic anemia and recurrent hypotension due to gastrointestinal bleeding (GIB), tend to be marginalized.</p><p><strong>Methods: </strong>A total of 581 patients with no evidence of acute kidney injury (AKI) or chronic kidney disease 2 months before LT constituted a retrospective cohort. Within this cohort, a nested case-control study was conducted that included 134 patients with preoperative GIB (GIB(+)) and 246 matched patients without preoperative GIB (GIB(-)). A subgroup analysis was conducted based on the occurrence of AKI (AKI(- /+)) within 2 months prior to LT.</p><p><strong>Results: </strong>The incidence of preoperative AKI was significantly higher in patients with GIB(+) compared with patients with GIB(-) (14.9% vs 8.1%, P=0.039), along with higher rates of postoperative complications and prolonged hospital stay; however, long-term survival rates were similar between the two groups. Subgroup analysis also revealed that the postoperative incidence of AKI and mortality rates at 60 days were elevated in patients with preoperative GIB(+) AKI(+) compared with patients with GIB(+) AKI(-). Furthermore, 5-year survival rates were significantly lower for patients with GIB(+) AKI(+) (65.0% vs 82.5%, P = 0.040). However, no significant difference was observed between the two subgroups of AKI(+) (GIB(+) versus GIB(-)) and the two subgroups of AKI(-) in relation to postoperative complications, short-term mortality, and long-term survival rates.</p><p><strong>Conclusions: </strong>Patients who experience preoperative GIB face an elevated risk of developing AKI, which is significantly correlated with a poorer prognosis for LT. A more proactive approach is needed to assess the transplant priority of patients with GIB on the waiting list.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"61"},"PeriodicalIF":2.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216521","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 warning model for predicting patient admissions to the intensive care unit (ICU) following surgery.","authors":"Li Li, Hongye He, Linjun Xiang, Yongxiang Wang","doi":"10.1186/s13741-025-00544-6","DOIUrl":"10.1186/s13741-025-00544-6","url":null,"abstract":"<p><strong>Background: </strong>Postoperative admission to the ICU for surgical patients is a significant burden in nursing care, and there is currently a lack of corresponding assessment tools.</p><p><strong>Methods: </strong>Clinical information of patients was extracted from the VitalDB database. LASSO regression and random forest algorithms were used to screen clinical variables related to postoperative ICU admission. Subsequently, the effectiveness of logistic regression, random forest, support vector machine, and multi-layer perceptron algorithms was compared using ROC curves. After selecting the best algorithm, postoperative ICU admission probability prediction nomogram was constructed.</p><p><strong>Results: </strong>This study identified 18 clinical factors that influence postoperative ICU admission. The factors influencing patient outcomes include three physiological characteristics: age, weight, and gender; five preoperative laboratory tests:platelet count, prothrombin time(%),activated partial thromboplastin time, albumin, and blood urea nitrogen; and seven intraoperative anesthesia details: anesthesia duration, propofol dosing during surgery, midazolam dosing during surgery, phenylephrine dosing during surgery, calcium chloride dosing during surgery, American Society of Anesthesiologists (ASA) classification, and anesthesia method. Additionally, three other factors are considered: whether the surgery is classified as an emergency, the department category, and the type of surgery. The logistic regression model developed using these 18 variables was identified as the most effective predictive model for postoperative ICU admission, achieving an ROC AUC of 0.925.</p><p><strong>Conclusion: </strong>The postoperative admission warning model constructed in this study can effectively predict the probability of patients being admitted to the ICU after surgery, providing a corresponding management tool for postoperative care in surgical patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"60"},"PeriodicalIF":2.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209109","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 butorphanol nasal spray administration on patient cooperativity during labor epidural placement: a single-center randomized controlled trial.","authors":"Jing Sun, Fan Wu, Mingguang Wu, Guanxiong Wu, Zhao Zheng, Gehui Li, Xiaoguang Wang, Xiaolei Huang, Yuantao Li","doi":"10.1186/s13741-025-00535-7","DOIUrl":"10.1186/s13741-025-00535-7","url":null,"abstract":"<p><strong>Background: </strong>Epidural block stands as the prevailing, secure, and efficient approach to labor analgesia. Inadequate maternal cooperation not only hampers anesthesia effectiveness but also may lead to severe consequences, including nerve damage due to positional changes.</p><p><strong>Methods: </strong>A randomized controlled clinical trial with 200 participants was conducted to compare painless delivery with epidural alone versus a combination of butorphanol nasal spray preceding epidural administration for painless delivery. The objective was to assess the combined approach's efficacy in diminishing maternal pain and enhancing maternal compliance.</p><p><strong>Results: </strong>Within 8-min post-anesthesia, the combined analgesic group (EXP group) exhibited significantly lower maternal pain intensity scores, improved maternal cooperation, reduced visual analogue scale (VAS) pain, and McGill scores compared to the epidural alone group (CTRL group). No statistically significant differences emerged in 24-h postpartum blood loss, labor duration, or lactation period. Neonatal indicators, including umbilical artery blood PCO2, base excess of extracellular fluid (BE-ecf), weight, and Apgar score, showed no significant differences between the EXP and CTRL groups. However, the EXP group demonstrated a higher umbilical artery blood pH than the CTRL group. The EXP group exhibited significantly higher probabilities of pain intensity scores ≤ 6, maternal cooperation scores ≤ 3, VAS scores ≤ 3 at 6-, 8-, and 10-min post-anesthesia, and McGill scores of 0 compared to the CTRL group.</p><p><strong>Conclusion: </strong>Butorphanol nasal spray emerges as an effective means to alleviate pain during epidural puncture in labor analgesia, markedly improving maternal anesthesia adherence. This combined analgesic method proves to be a safe and efficacious approach for maternal pain relief during labor.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"59"},"PeriodicalIF":2.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132589","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":"The effects of intrathecal fentanyl on postoperative opioid utilization rates in elderly patients undergoing lower extremity orthopedic surgery: a randomized controlled trial.","authors":"Yinghua Gu, Yan Li, Wenxun Liu, Xin Liu, Qingshan Ye","doi":"10.1186/s13741-025-00541-9","DOIUrl":"10.1186/s13741-025-00541-9","url":null,"abstract":"<p><strong>Background: </strong>Various types of lower extremity orthopedic surgeries can cause severe postoperative pain in elderly patients. Achieving adequate pain control while minimizing the use of opioids is advantageous, as it helps reduce postoperative complications and facilitates recovery. In this randomized trial, we compared the opioid utilization rates of elderly patients who received or not receive intrathecal fentanyl as an anesthesia adjuvant.</p><p><strong>Methods: </strong>A total of 180 elderly patients were enrolled in the study. They were randomly assigned to the BF1 group (bupivacaine plus 25 µg of fentanyl), the BF2 group (bupivacaine plus 50 µg of fentanyl), or the B group (bupivacaine), achieving a final between-group ratio of 2:2:1. Our primary outcome was the rate of opioid use, while secondary outcomes included the NRS score and the utilization rate of analgesic drugs on PODS1-3.</p><p><strong>Results: </strong>The usage rate of opioid analgesics within the POD3 was higher in B group compared to BF1 and BF2 groups (100% vs. 79.2% and 80.3%, respectively; P < 0.05). However, there was no significant difference in the usage rate of opioid analgesics among the groups within the PODS1-2 (P > 0.05). The incidence of patients with NRS scores ≥ 4 was significantly lower in BF1 and BF2 groups compared to B group on PODS2-3 (POD2, 62.2% and 68.9% vs. 93.8%, respectively; P < 0.05; POD3, 16.2% and 17.6% vs. 40.6%, respectively; P < 0.05). Additionally, BF1 group had a lower incidence of NRS scores ≥ 4 compared to B group on POD1 (P < 0.05). The rate of analgesic drug use was similar among the three groups on POD1-3 (P > 0.05).</p><p><strong>Conclusion: </strong>In elderly patients undergoing lower extremity surgery, intrathecal fentanyl as an anesthetic adjuvant may correlate with reduced pain scores on PODS1-3 and decreased opioid requirements on POD3.High-dose fentanyl does not provide significant therapeutic advantages.</p><p><strong>Trial registration: </strong>The study registered on the Chinese Clinical Trial Registry ( www.chictr.org.cn ), Clinical Trials identifier ChiCTR2200058362 (2022/04/07).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"58"},"PeriodicalIF":2.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102332","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":"Goal-directed therapy: what is the goal again?","authors":"Amy Yerdon, Ken Taylor, Katie Woodfin, Ryan Richey, Susan McMullan, Desirée Chappell","doi":"10.1186/s13741-025-00533-9","DOIUrl":"10.1186/s13741-025-00533-9","url":null,"abstract":"<p><p>Recent attention has focused on intraoperative hypotension (IOH) and hemodynamic instability. This enhanced awareness to limit IOH, combined with fluid restriction and increased vasopressor use, has been associated with an increase in postoperative acute kidney injury. Recent literature supports improved intraoperative monitoring of mean arterial pressure (MAP), fluid management, and appropriate use of vasopressors and inotropic support for hemodynamic management. Implementing an algorithm to manage the causes of IOH minimizes iatrogenic harm by guiding anesthesia clinicians to select the appropriate interventions at the optimal time. This ensures a comprehensive evaluation of contributing factors such as fluid deficits, myocardial depression, and vasodilation. Shifting attention from the MAP displayed on the physiologic monitor to more individualized care with a goal-directed therapy approach may improve patient outcomes.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"57"},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086379","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 pressure-controlled ventilation and volume-controlled ventilation for laparoscopic surgery in the Trendelenburg position: a systematic review and meta-analysis.","authors":"Cui Wen, Yi Qi, Yingying Xiang, Qianyun Pang, Jingyu Xiao, Ran An","doi":"10.1186/s13741-025-00540-w","DOIUrl":"10.1186/s13741-025-00540-w","url":null,"abstract":"<p><strong>Background: </strong>Volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) are commonly used in laparoscopic surgery in the Trendelenburg position, and pressure-controlled ventilation volume guaranteed (PCV-VG) has been increasingly used recently. However, there is still no consensus on the optimal ventilation mode. Therefore, a systematic review and meta-analysis were conducted to compare the effects of different ventilation modes for laparoscopic surgery in the Trendelenburg position.</p><p><strong>Methods: </strong>Multiple databases were searched for randomized controlled trials published before December 2024 to compare the effects of PCV, PCV-VG, and VCV in patients in the Trendelenburg position who underwent laparoscopic surgery. The primary outcomes included peak airway pressure (Ppeak), plateau airway pressure (Pplat), dynamic compliance (Cdyn), and blood gas analysis.</p><p><strong>Results: </strong>Sixteen studies were included in this meta-analysis. PCV [Ppeak, 15‒40-min post-pneumoperitoneum and Trendelenburg position (T2): mean difference (MD) - 4.28, 95% confidence interval (CI) - 5.91 to - 2.64, P < 0.01; 60-min post-pneumoperitoneum and Trendelenburg position (T3): MD - 4.51, 95% CI - 5.41 to - 3.6, P < 0.01; 120-min post-pneumoperitoneum and Trendelenburg position (T4): MD - 5.63, 95% CI - 7.35 to - 3.91, P < 0.01; Cydn, T2: MD 3.15, 1.53 to 4.77, P = 0.0001; T3: MD 2.78, 95% CI 1.43 to 4.14, P < 0.01] and PCV-VG (Ppeak, T2: MD - 3.99, 95% CI - 7.2 to - 0.78, P = 0.01; T3: MD - 3.46, 95% CI - 6.5 to - 0.42, P = 0.03; Cydn, T3: MD 4.44, 95% CI 2.23 to 6.66, P < 0.01; T4: MD 3.61, 95% CI 1.31 to 5.91, P = 0.002) significantly reduced Ppeak and improved Cydn compared with VCV after pneumoperitoneum and Trendelenburg position. PaO₂, pH, and PaO₂/FiO₂ did not differ between PCV and VCV or between PCV-VG and VCV during intraoperative surgery.</p><p><strong>Conclusions: </strong>Our meta-analysis suggests that in laparoscopic surgery in the Trendelenburg position, PCV or PCV-VG can provide a lower Ppeak and higher Cdyn throughout surgery but cannot offer better oxygenation than VCV. PCV or PCV-VG might be optimal for laparoscopic surgery in the Trendelenburg position.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"56"},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030811","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":"Anesthetic outcomes in pediatric tonsillectomy: insights from the Palestinian experience.","authors":"Ramzi Shawahna, Shahed Radwan, Dana Alyan, Rawand Obaid, Suha Sholi, Mohammad Jaber, Iyad Maqboul, Hatim Hijaz, Samer Bustame","doi":"10.1186/s13741-025-00537-5","DOIUrl":"https://doi.org/10.1186/s13741-025-00537-5","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in anesthesia, the anesthetic outcomes in pediatric tonsillectomy remain largely underexplored, notably in resource-limited healthcare systems. This study aimed to assess the anesthetic outcomes in pediatric tonsillectomy, including induction-to-incision time and predictors of duration of surgery.</p><p><strong>Methods: </strong>The study was conducted at one of the major surgical hospitals in the West Bank of Palestine, which is a tertiary referral center known for its comprehensive surgical and anesthetic services. The data were collected retrospectively from pediatric patients who underwent tonsillectomy with or without adenoidectomy in the period between 2021 and 2022. The data were collected using a standardized data collection form.</p><p><strong>Results: </strong>Of the 238 pediatric patients included in this study, 231 (97.1%) were operated for adenotonsillar hypertrophy, and 7 (2.9%) were operated for recurrent/chronic tonsillitis. The mean age of the patients was 5.6 ± 3.1 years. Of the patients, 151 (63.4%) were male, 13 (5.5%) had an allergy to foods or drugs 13 (5.5%) had other comorbidities, and 21 (8.8%) had a past surgical history. Of the patients, 230 (96.6%) received propofol and 183 (76.9%) received fentanyl as anesthesia induction agents. The mean induction to incision time was 5.2 ± 1.1 min, and the mean duration of surgery was 26.4 ± 5.4 min. Of the patients, 53 (22.3%) received antibiotics during surgery. The induction to incision time was significantly longer for male patients (5.4 ± 1.3 vs. 5.0 ± 0.7, p-value = 0.022). The duration of surgery was significantly longer for female patients, 5 years and older, who had allergies, had chronic tonsillitis, and received antibiotics during the surgery. Multiple linear regression showed that longer duration of surgery could be predicted by being operated for recurrent/chronic tonsillitis (β = 0.15) and receiving antibiotics during the surgery (β = 0.13).</p><p><strong>Conclusion: </strong>The findings of this study revealed that patient-specific factors influenced induction-to-incision time and duration of surgery. The findings of this study highlight the need for tailored preoperative assessment and individualized perioperative management to optimize resource utilization and improve surgical efficiency in resource-limited settings.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"54"},"PeriodicalIF":2.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019575","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":"Postoperative arrhythmias in geriatric lung cancer patients undergoing thoracoscopic surgery: an exploration of prevalence and influencing factors.","authors":"Xiaoyu Chen, Yan Wu, Xiaofang Zheng","doi":"10.1186/s13741-025-00538-4","DOIUrl":"https://doi.org/10.1186/s13741-025-00538-4","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmias are a frequent complication in the postoperative period following surgical procedures. This study aims to investigate the incidence and contributing factors of arrhythmias in elderly patients with lung cancer who have undergone thoracoscopic surgery, thereby providing scientific evidence to support clinical treatment and nursing care.</p><p><strong>Methods: </strong>This retrospective cohort study included elderly patients diagnosed with lung cancer who underwent treatment at our hospital between June 1, 2022, and October 31, 2024. Patients were categorized into two groups based on the development of postoperative arrhythmias following thoracoscopic surgery: the arrhythmia group and the non-arrhythmia group. A comparative analysis of the clinical data was conducted between these two groups.</p><p><strong>Results: </strong>A total of 208 patients were enrolled, with an incidence of postoperative arrhythmias of 19.71% (41/208). Logistic regression analysis identified age ≥ 70 years (OR = 2.586, 95% CI: 1.805-3.221), hypertension (OR = 2.761, 95% CI: 2.103-3.588), history of smoking (OR = 2.070, 95% CI: 1.741-2.446), TNM stage II (OR = 3.181, 95% CI: 2.842-3.690), postoperative pulmonary infection (OR = 2.122, 95% CI: 1.836-2.690), and postoperative constipation (OR = 2.495, 95% CI: 1.988-3.072) as independent risk factors for postoperative arrhythmias (all p < 0.05).</p><p><strong>Conclusion: </strong>The incidence of postoperative arrhythmias in elderly patients with lung cancer following thoracoscopic surgery is relatively high. Targeted interventions addressing the identified risk factors are essential to mitigate the risk of postoperative arrhythmias.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"55"},"PeriodicalIF":2.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019595","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":"Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial.","authors":"Yang Wan-Jun, Geng Zhi-Long, Gao Yuan-Yuan, Cui Chao-Yuan, Chen Zheng-Ze, Tian Zi-Wei, Guo Xi-Lin, Zhang Ya-Nan, Wang Lu, Huo Rui, Ma Chen-Wei, Niu Jing","doi":"10.1186/s13741-025-00525-9","DOIUrl":"https://doi.org/10.1186/s13741-025-00525-9","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients are a vulnerable group with high perioperative risks. Thus, reducing the duration of anesthesia is important. Remimazolam is a benzodiazepine sedative commonly used for the induction and maintenance of general anesthesia given its rapid induction and rapid recovery. Most reports have focused on nonelderly patients.</p><p><strong>Aim: </strong>To compare the time to loss of consciousness, length of PACU stay and incidence of adverse events in patients older than 65 years who received remimazolam for general anesthesia with those of patients who received midazolam.</p><p><strong>Methods: </strong>This study was conducted at a university hospital between February 2022 and March 2023. We included 100 patients aged 65 years or older who were scheduled for surgery under general anesthesia. Patients were divided into 2 groups, namely, the midazolam group and the remimazolam group, with 50 patients in each group. The primary outcome was the time to loss of consciousness. The secondary outcomes included the time to extubation and length of PACU stay. We also recorded the percentage of flumazenil used and incidence of adverse events.</p><p><strong>Results: </strong>Clinical data from 96 patients who were scheduled for surgery under general anesthesia were included in the final analysis, with 46 patients in the remimazolam group and 50 patients in the midazolam group. The time to loss of consciousness was 304 (222, 330) s in the remimazolam group and 95 (67, 25) s in the midazolam group, and the difference was significant (p = 0.000). The time to extubation was 24.93 ± 11.617 min in the remimazolam group and 34.88 ± 19.740 min in the midazolam group, revealing a significant difference (p = 0.003). The length of PACU stay was 55 (48, 64) min in the remimazolam group and 65 (55, 85) min in the midazolam group, and the difference was significant (p = 0.001). The percentage of flumazenil used was 6% in the remimazolam group and 20% in the midazolam group, and the difference was significant (p = 0.003).</p><p><strong>Conclusion: </strong>General anesthesia with remimazolam has been shown to be effective and safe for surgery in elderly patients. The time to extubation was significantly shorter, length of PACU stay was shorter, and percentage of flumazenil used was lower in the remimazolam group than in the midazolam group.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"53"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024215","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":"Dosage of epidural morphine analgesia after lower abdominal cancer surgery: a randomized clinical trial among the older adults.","authors":"Muhammad Shawqi, Sahar Abdel-Baky Mohamed, Essam Sharkawy, Diab Hetta","doi":"10.1186/s13741-025-00521-z","DOIUrl":"https://doi.org/10.1186/s13741-025-00521-z","url":null,"abstract":"<p><strong>Background: </strong>Epidural morphine is considered one of the most potent drugs used for postoperative analgesia; however, its side effects are dose-related and exaggerated in elderly people. In this study, we aimed to determine which of three doses within that range (1.5 mg, 3 mg, or 4.5 mg) can provide adequate pain relief.</p><p><strong>Methods: </strong>A total of 102 patients were assessed for allocation into one of four groups to receive either placebo (group Morphine 0, N = 22), 1.5 mg of epidural morphine (Morphine 1.5, N = 22), 3 mg of epidural morphine (Morphine 3, N = 22), or 4.5 mg of epidural morphine (Morphine 4.5, N = 22) before skin incision, 24 h after surgery and 48 h after surgery. Cumulative intravenous IV-PCA morphine consumption, VAS pain scores, modified Ramsay Sedation Scores, nausea, vomiting, and pruritus were evaluated.</p><p><strong>Results: </strong>The VAS pain scores at activity of patients who received epidural morphine at doses of 3 mg and 4.5 mg were significantly lower than the placebo and 1.5 mg groups, VAS Score at 72 h was (2 ± 0.8) and (1.7 ± 1) vs (4.3 ± 1.1) and (4 ± 1) respectively, p value = 0.000. The mean total IV-PCA morphine consumption (mg) was significantly higher in patients who received received epidural 0.9% sodium chloride alone compared to 1.5 mg, 3 mg and 4.5 mg epidural morphine groups (38.1 ± 4.8 mg vs 27.2 ± 5.6 mg, 9.2 ± 3.5 mg, and 6.3 ± 3.3 mg respectively), p value = 0.000). However, the difference between the 3 mg and the 4.5 mg groups was not statistically significant in both of VAS scores and IV-PCA morphine consumption (P value > 0.05 for 3 mg vs. 4.5 mg). Patients who received 4.5 mg of epidural morphine experienced a significant increase in the level of sedation, measured by the Ramsay sedation scale, in comparison with 1.5 mg, 3 mg and placebo epidural morphine groups in the first 24 h, the Scale for this group was (2.5 ± 0.5) vs (2.1 ± 0.2, 2.1 ± 0.2, and 2.2 ± 0.5 respectively); p value = 0.000. No relationship between postoperative nausea and the dosage of epidural morphine was found.</p><p><strong>Conclusion: </strong>Epidural morphine 3 mg as a bolus every 24 h with add on IV patient control analgesia (PCA) morphine, set to deliver 1.5 mg boluses on demand without background infusion with a lockout period of 45 min, could achieve effective and adequate analgesia lasting up to 72 h postoperatively without increasing in the level of sedation or other side effects in older adults after a lower abdominal cancer surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"52"},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023028","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}